Article
5 minute read 16 September 2021

Designing for trust in HHS and labor programs

Using human-centered design to rebuild trust and improve mission impact

5 minute read 16 September 2021
Tiffany Fishman

Tiffany Fishman

United States

Kenneth J Smith

Kenneth J Smith

United States

RJ Krawiec

RJ Krawiec

United States

Rebuilding public trust is imperative if HHS and labor programs are to deliver on their respective safety net missions. To do so, they will have to operate with a focus on humanity, transparency, capability, and reliability.

Trust is what brings us, as humans, together. It’s the essential bond that underpins not only the relationships we have with one another, but also the relationships we have with government agencies and programs.

For health and human services (HHS) and labor programs, trust affects how program participants behave, in ways that help to determine how effective and efficient the program will be. Trust impacts everything from how well enrollees comply with policies and due dates, to how willing they are to participate in programs, to how likely they are to use digital self-service tools.

Take child support, for example. To encourage the custodial parent (CP) and noncustodial parent (NCP) to cooperate, communicate, and comply with their responsibilities, the caseworker needs to earn the trust of both. CPs won’t ask for child support services unless they feel a sense of trust in the process and that there will be a positive outcome. Without trust, CPs required to cooperate with the child support program will be reluctant to divulge all the necessary information, such as how the child was conceived and how to find the NCP. Neither CPs nor NCPs may be willing to divulge personal details unless they trust that the caseworker will not judge them, and that the agency will not misuse their personal or financial data. Failure to provide such information can lead to delays or failure in establishing paternity, a child support order, and payment on time and in full.

A crisis of trust

Trust in the federal government has declined steadily over the last six decades, from a high of 77% in the mid-1960s to a near-historic low of 20% last year.1 Even trust in state and local governments, which have traditionally enjoyed a higher level of public confidence, significantly declined during the pandemic.2

At the outset of the pandemic, many human services programs, already strapped for funding, buckled under an unprecedented surge in demand. At the same time, human services programs were required to quickly implement new federal programs and mandates and change benefit program policies. State HHS and labor organizations did what was necessary to respond quickly. Too often that meant making changes based on the immediate needs of the government agency administering the program rather than designing technology, processes, and communications based on the needs of the people they served.

Rebuilding public trust is imperative if HHS and labor programs are to deliver on their respective safety net missions.

The four trust signals

Our research suggests that trust can be built and sustained by demonstrating two foundational attributes—delivering on the promise, all the time, with competence, and doing so with good intent. Competence refers to the ability to execute. Intent refers to the meaning behind a leader’s actions.

The two foundational attributes of competence manifest themselves in four unique trust signals: humanity and transparency—which demonstrate intent, and capability and reliability—which demonstrate competence (figure 1).

HHS and labor agencies can instill confidence and improve public trust by focusing on four areas:

  • Humanity addresses the perception that an agency genuinely cares for its constituents’ experience and well-being by demonstrating empathy, kindness, and fairness.
  • Transparency indicates that an agency openly shares information, motives, and choices related to policy, budget, and program decisions in straightforward language.
  • Capability reflects the belief that an agency can create high-quality programs and services and has the ability to meet expectations effectively.
  • Reliability shows that an agency can consistently and dependably deliver high-quality programs, services, and experiences to constituents across platforms and geographies.

Designing for trust

Using a human-centered design (HCD) approach that embraces the need for trust can provide a foundation for improving mission impact. Trust-building is not a one-off activity. It should be continuous and action-oriented. Building trust often requires changing the status quo and being laser-focused on quickly incorporating changes based on constituent experience and perception.

So what can HHS and labor leaders do to start building greater trust? Here’s what they can consider:

1. Establish their agency’s trust baseline. Conduct research to establish an agency’s trust baseline. The goal is to understand how users prefer to engage, what their biggest pain points in “doing business” are, and how they perceive programs and services across each of the four trust signals. Start by looking at your agency’s current feedback, reach out to community partners, stand up a survey. There are lots of ways to engage. The most important thing is to get that unvarnished voice of the customer and key stakeholders.

Take unemployment insurance (UI), for example. Our research shows that humanity and transparency are the lowest-rated trust signals. Often one of the most challenging experiences UI claimants have is with overpayments, which occur when claimants are paid more than they are entitled to collect. While overpayments can result from fraud, they can also happen when people make honest mistakes due to confusion and a lack of clarity in the process or in the data that is sought. Often UI claimants don’t realize that they need to stop filing for UI when they go back to work, not when they collect their first paycheck. Fact-finding documents present another common source of confusion. As part of the verification process, UI claimants may receive 2–3-page documents containing legal and policy jargon that don’t always make clear that the claimant needs to take action and supply verification materials. Similarly, employers may receive the same type of documents to verify worker claims, which include policy jargon and a fast turnaround time, along with charging statements.

To identify areas for improvement, UI agencies should consider probing on feelings around the accuracy of communications, word choices, and understanding of policies and program rules.

2. Collaborate, evaluate, and iterate on solutions to strengthen key trust signals. Engaging end users does not end with the initial research. A design-led approach brings end users into the room with public servants and other stakeholders to engage in rapid prototyping, testing, and iteration of solutions with the people for whom they are created. The focus should be on activities, actions, policies, and behaviors that bolster an agency’s most relevant trust signals.

In child support cases, there is often an erosion of trust between the CP and the NCP, and the child support process or agency is wielded as a weapon against the NCP. When the intent of the program is in question, it can be difficult to get to cooperation, communication, and compliance. The CP and NCP both need to trust that the CS agency is neutral, working to promote the financial security and well-being of the child by establishing a child support order based on an unbiased assessment of ability to pay, using enforcement tools tailored to the NCP’s situation, and referring the NCP to other agencies that can help them meet their responsibilities. Using tools such as collaborative design, end-user evaluative testing, and rapid prototype iterations can lead to a balanced solution that takes into account the humanity of the solution for all parties.

3. Monitor trust, prioritize impact. As you develop a nuanced understanding of trust along the four signals, you can identify relationships between trust perceptions and corresponding human behaviors. Our research shows that long-term care (LTC) services, for example, score relatively high on humanity, while they fare lower on reliability. This perception of low reliability may translate into increased call volume and churn in service participation, which can lead to lower participant satisfaction, higher cost to serve, and ultimately, reduced individual well-being.HHS and labor agencies should consider investing in building methods and feedback mechanisms to measure progress on key trust signals and use this feedback to adjust strategies and make meaningful changes in communication, processes, and culture.

Looking ahead

Government institutions today, across all levels, often struggle to build public trust. Because trust is perceptive, government institutions should demonstrate competence and intent to rebuild trust. The four trust signals of humanity, transparency, capability, and reliability can help HHS and labor leaders in building greater trust. These signals can be measured, tracked, and improved—helping to make trust central to the functioning of HHS and labor agencies.

Cover artwork: Alex Nabaum

Health and Human Services practice

​For more than 45 years, Deloitte state health and human services professionals have worked side by side with state agencies. Our mission is to help you achieve your mission—protecting and improving the health, safety, and well-being of our fellow citizens. We are focused on helping you improve the efficiency, effectiveness, and accountability of state services and benefits. Our breadth of offerings includes: eligibility and service integration, state health care, child welfare, childcare and early learning, and many others.

RJ Krawiec

RJ Krawiec

Principal | Deloitte US

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