A voice-first survey in the clinic: what the facilitators saw

RESEARCH LEAD & WORKSHOP FACILITATOR | LOTIC | FEBRUARY 2024

Arkansas cut Medicaid reimbursement by half. Arisa Health's RDS program, a day program for adults with disabilities, needed evidence of what it does for clients and what their lives would look like without it. That evidence would inform changes to the program and support advocacy for better rates.

Lotic ran the survey that gathered it. Delta, Lotic's experience, asks people to answer by speaking, and their recorded responses are analyzed to produce insights. Arisa's program coordinators and peer support specialists delivered it to clients in clinic across January and early February 2024.

My job was to find out how that went. The clients included people with speech difficulties and other disabilities, so I designed the research to reach their experience through the people who sat beside them while they took it.

Approach

A feedback workshop with the people who ran it

One hour, remote, with the head of Arisa Health and clinic leadership. Nine Arisa stakeholders and four Lotic facilitators on Zoom and Miro.

A board built as a journey, not a discussion

Four phases, from setting up the technology through concluding the experience, with rows for steps, key actions, gains, needs and pains, call-outs, and opportunities. Facilitators reporting on an experience they delivered will tend to describe their own performance, so the board asked what they did and what they saw clients do, and kept interpretation for synthesis.

Provocations kept separate from findings

Each phase closed with how-might-we prompts, so the group could name a problem without having to solve it in the hour.

Interviews after the insights landed

One-on-one sessions at the end of February, once Arisa had received the findings, to learn whether the insights changed the program or fed the advocacy effort.

What the facilitators saw

The clinics were not set up for speaking

Not all computers had microphones. Many clients had older phones with limited or no data. Day programs run loud and busy, which left nowhere quiet to record. Coordinators solved it locally, pre-testing devices and claiming space, with the Southeast clinic using the manager's office. Where a private space was found, coordinators saw it improve the experience directly.

Support made the difference

At Central and Russellville, six coordinators and peer support specialists guided clients through it, inside the clinic and outside. The peer support specialists were former clients of the program themselves. Coordinators consistently reported that having someone beside a client through a new experience added reassurance.

Coordinators built the trust the product needed

They introduced the survey in morning meetings, worked from a Lotic flyer, explained the partnership, and answered questions about privacy and confidentiality before clients ever opened it. Enthusiasm rose with positive affirmation, and clients responded to being asked for their opinion.

The recording deterred some of the people the survey needed to hear from

Discomfort with being recorded, difficulty speaking aloud, and in some cases paranoia triggered specifically by the mention of AI. Where a client could not manage a spoken answer, a coordinator sometimes entered the response by hand, which captured the content and removed the client's own voice from it.

The product itself held up

Few usability issues, clients at ease, questions coordinators judged meaningful. Length was not a real problem either, with only a handful of clients finding it too long. The friction sat around the experience rather than inside it.

The people who delivered it were left waiting

Coordinators closed the workshop asking what would come of it. Is this going to help. When will we find out if this helps. Where does this leave us.

From finding to recommendation

• Enable typed responses where the survey asks people to speak, for clients who find speaking aloud difficult or who are deterred by the recording itself.

• Write the privacy policy, confidentiality standards, and AI explanation in plain language below a fourth-grade reading level, since that material is what clients weigh before deciding to trust the tool.

• Put a direct URL on flyers alongside the QR code, for participants whose phones cannot read one.

• Assess a partner's available technology before designing the experience, so the setup burden does not land on coordinators on the day.

• Have coordinators demonstrate the survey in morning meetings, since clients who had seen the process knew what to expect from it.

• Give each clinic its own report, with its data, visual summaries, and progress on completion.

• Send aggregated summaries to executives, because the program needed evidence in front of the people making funding decisions.

Where it landed

The typed-response option was built. Clients who could not manage a spoken answer, or who did not want to be recorded, got another way in.

Arisa's clinical team was compiling and analyzing the responses to share back with the organization when I left Lotic. I do not know what the program did with them, or how the advocacy went.

Reflection

The mechanic that made the product distinctive was the same mechanic that excluded part of its audience. Voice is what let Delta hear people properly, and voice is what some clients could not give. Most of what came out of the workshop was about building a second way in.

The other thing that stayed with me is what the workshop revealed about the coordinators. They had absorbed the setup problems, built the trust, sat with clients through the hard parts, and then had no idea whether any of it would help. Asking them to describe the experience surfaced their own stake in it, which was not what I went in looking for and was the thing I would act on first.