No Wrong Door: Connecting the Dots in Health and Human Services

Mouhanad Hammami, MD, MHSA, Director & County Health Officer, Department of Health, Veterans and Community Wellness, Wayne County, Michigan

Local governments provide a wide array of direct services to residents through several departments. And although services provided by these departments sometimes overlap, similar programs are not connected—creating redundancies and inefficiencies. These silo operations housed in different departments often do not communicate despite sharing “the human factor” of providing services that impinge on the social and physical wellness of its residents.

There is no doubt that most of the people frequenting local governments offices prefer to receive all services in one location and preferably in their homes and communities. However, many are not aware of such services and even if they know these opportunities exist, they do not know where to start, how to access services through multiple departments and eventually they become frustrated along the way.

In 2015 Wayne County, Michigan went through recognizing its departments. The restructuring team was charged with identifying opportunities to improve efficiencies, eliminate redundancies and most importantly increase quality and access to services provided by the County. The result was a consolidation of two major departments and two divisions into one big department. The new department became responsible for more than 70 programs and the provider of 230 services that range from primary healthcare to veterans financial assistance.

Although this new structure was ideal for removing the silos and connecting all programs together, it posed a challenge for both County residents and staff alike to navigate through all programs and services, and identify requirements and processes. Staff working in what were separate departments did not know what services are provided under the consolidated model or how to navigate through it.

Creating high levels of visibility for the new department and bringing public awareness to all the services provided by it is technically the front porch of the No Wrong Door system

The key for service accessibility is to connect individuals, family members and caregivers, with the appropriate service or services in a manner that is efficient, effective, and seamless from the constituent’s perspective. Any point of entry into the system should allow County residents to access any and every service offered within the department. To the restructuring team at Wayne County it simply meant there is “no wrong door” regardless what the needs are or where the service being offered at.

The “No Wrong Door” framework includes four major components: visibility and awareness that provides public outreach, meeting the primary need that brought the constituent through the front door, personal centered counseling that includes screening for secondary needs and streamlined access to services through real time referrals. In order to maximize the potential for the “No Wrong Door” to meet the needs of County residents, technology has to play an integral part in each of these four components.

Creating high levels of visibility for the new department and bringing public awareness to all the services provided by it is technically the front porch of the No Wrong Door system. This requires a comprehensive communications strategy that creates proactive engagement with residents to familiarize them with services offered and how to utilize these resources. An interactive media interface where residents can navigate through all services provided and receive feedback on questions, they might have is a first step in raising awareness and increasing accessibility to County residents. A website with the ability to request information, fill applications or schedule an appointment opens the front door to meeting a need.

Once a primary need is identified and subsequently met, a person centered counseling takes place. This serves as screening to identify what other needs constituents have and whether or not they qualify for other services. This is challenging due to the variety of people that come through the door at any given moment. It is also burdensome for staff that have to be trained and keen on providing case management to constituents they serve. For an example, a public health nurse that is providing vaccines to a baby (the primary need that brought the family thorough the door) now should be able to identify whether the family has a veteran in household that can benefit from financial assistance or if a senior member qualifies for the senior nutrition program (secondary needs through other doors).

This requires staff to be knowledgeable about all County programs and services and to be able to provide information to many types of customers. In addition, service delivery must be prompt and efficient.

A robust customer management system will streamline this process and help both staff and constituents to better meet their needs. It allows staff to utilize a screening application within the system to provide enhanced screening capabilities, increase process efficiency, and capture customer data. It also enhances wrap-around service capabilities by staff and external providers that use the system as well. Such application can be integrated into a customer portal interface that County residents can access. Self service portals can be accesses by constituents at home, libraries, churches or any other public service location that has cyber connectivity. The constituent uses a guided questionnaire application within the self-service portal to explore County programs and services. The application filters the answers and identifies all services they can benefit from. A constituent can schedule an appointment on the spot, fill an application or download documents though the application. Self-service data feeds into customer management system and is accessible by staff and providers to ensure follow up.

A No Wrong Door model provides a “warm hand off” approach to information and referrals and translates into good customer service. It is going the extra mile to ensure all residents are connected to services and program they need and can benefit from. It will tremendously improve the customer’s experiences and allow access to services.

Providing a seamless interaction between residents and county government that allows residents to define the parameters of this interaction is better service delivery and outcome.