Starting point
A counselor's Tuesday.
Picture a residential counselor. Yesterday, one floor had three serious medical and psychiatric emergencies, each involving the emergency room or the on-call clinicians. This morning all three patients are back. So is the counselor, alone for nine hours with several times the caseload the role was designed for. No one else is certified to hand out medication. The manager left last week, burned out, and the rest of the shift called in sick.
Days like that were not unusual. The facility cycled through hire, burn out, quit, repeat. Asked to help a manager see how care flowed, we traced where it came in, went out, and ran dry.
What we found
By mid-shift the counselor is running a deficit. The schedule builds it in.
We began with a manifesto and rewrote it as we learned. It held that where care is lost at the same point again and again, that point has been cut off from its supply. Then we drew three maps. One showed what a counselor gave to and received from the owner, doctors, therapists, and patients. One traced the hire-burnout-quit loop. One followed care in and out of the counselor by the clock, from the 7am shift start.
That last map showed care leaving the counselor all day and returning in trickles, never when she needed it. Breaks, supervision, and her own therapy were in the organization's values but missing from its timetable.
Where we went
A dashboard for the facility's health, audited to keep it about the system.
We weighed four kinds of interface and chose a large, always-on screen for the counselors' office. Its System Health score tracked whether each task the facility owed its people was late. Therapy was tracked in five stages, not a checkbox, and daily tasks sat beside long-term care goals. Counselors, managers, owners, and clinicians could each switch to their own view.
We audited our design three ways. A perception audit showed what the interface hid and who its real user was. A discrimination audit looked out for counselors: we cut every column that could count against one person, like arrival time, framed the screen as a report on the facility, and added a place to note why a task was missed. A maintenance audit asked who would keep it running on day two, so managers could edit the columns and maintainers were credited on screen. We also removed the flashing alerts, which rewarded speed over care.
For the people who would decide on adoption, we made two more pieces. A three-panel watercolor moved from the counselor stretched thin, to a redesigned flow of care, to the ecosystem that grows when care flows. A sectional drawing traced care through the real building.
What changed
A working prototype, and a way of seeing care that the facility can keep.
The dashboard is a working interactive prototype, built with AI from a written product requirements document. The map beneath it is the lasting intervention: a facility that can see its caregivers running dry can schedule care for them, as it schedules everything else.