By using the Design Thinking approach, we established a user-centered view, joining population and public servants on proposing solutions for common problems. This was possible by developing a deep understanding of the user experience and needs, creating a complex set of different points of view and enlarging the challenge first issued. The major stakeholders were involved and every step was approved by everyone, leading to better connected and more adherent solutions at the end.

The method Tellus used is based on the Double-diamond diagram, with four distinct phases:

1. Diagnosis: we investigate the context based on the facts and issues presented by our client.

2. Exploration: we develop a profound understanding of that context, identifying questions, expanding our research to other stakeholders that are also affected by that context and/or situation.

These two moments leads to define the major conceptual problems around that context, presenting the real challenges to be faced during the project. Those challenges will then be fundamental for the co-creation phase when we help stakeholders to build solutions for their own challenges through different kinds of workshops.

The last moment is prototyping, testing the solutions that may be implemented at the end of the project.

Although recognized as important, community participation and empowerment in public policies is not a common practice for governments in Brazil. There are several issues blocking this kind of procedure, many of them recurring to lack of knowledge and/or skills on how to involve people to discuss public policies. This project aims at this challenge, bringing people closer to the policy core and attaining their point of view to policy elaboration.

This resulted in a much more clear approach to the real citizens' problems and needs, developing an innovative Public Health policy, awarded by the Brazilian Central Government.

Rede Bem Cuidar (Well Caring Network) is a network of Local Health Units, each acting as a multi-generational social hub. Incorporating a community engagement process that involved local representatives, UBS staff, and community members. The changes are designed to improve healthcare facilities and services, support employee wellbeing, and create much-needed community space.

The project begun after Tellus was invited to run a complete assessment of the Public Health Sector in Pelotas. As a service design office, we used Design Thinking concepts and tools, applying our knowledge to boost the project. We did a lot of desk research, conducted in-depth interviews with stakeholders, including experts, and made several visits to the public health units to understand everyone’s experiences within the “Health Journey". The exploration gave us many useful insights on how people see and think “Public Health”.  Showing the poor quality of public health service delivered, with high complaints rates associated with the length of waiting for ques, and bad servicing from health workers. These and some other related questions built our core concept for the project: Continuous Care.

The next step was to run our solutions workshop, conceived as public open calls. Furthermore, experts and public servants were invited to participate in the workshop providing more technical discoveries and widening the common point of view. From our findings and their further validation, we implemented the complete journey, aligning all solutions within the major concept and structuring the implementation plan.

The first unit to implement the Project was UBS Bom Jesus. It went through a complete renovation of its services, freshly created in the last phase of the Project. There, we implemented most of our solutions and framed them within the Primary Services scope.

The approach we used relies on collaboration through all the process, regarding people's distinct needs and points of view in every outcome designed. So, by bringing their own experience to the discussion, we were able to create a deep understanding of the context, resulting in more adherent solutions.

We used several tools, such as workshops of many kinds (ideation, exploration, co-creation, prototyping), interviews, surveys. We also visited citizens houses and accompanied them through their days, understanding how that Health service impact their lives. Basic research on data and historic models of service deliverance in Pelotas were also used, especially when talking to experts on that field.

The project delivered distinct outcomes ranging from the building of new health facilities to the development of a public administration training focused on health management. Here are some of the deliverances and impact related to them:

- At first, people had to come by at 5:00 AM to receive treatment. Now, since the change in the reception procedure, people come at any time and can be treated, even if they do not have an appointment.

- The reception architecture has been significantly changed, with new seats, bathrooms, televisions showing Health tips, and all reception procedures being electronically made.

- The first attendance time has been reduced, from two months to 2-3 weeks.

- Every unit has its own pharmacy, delivering medicines to nearby neighborhoods.

- With the SuperAgentes program, the quality of household medical care has significantly improved. The public servers use tablets to quickly search for families’ information and to update information directly to physicians and nurses, making diagnosis easier to be defined.

- The free Physical Education program has become a major success since it has begun. The program combined with a dietitian’s work has improved the quality of health in the community. It started to be held twice-a-week with 8 people. Now, the program happens twice a day, 5 days a week and has over 240 participants.

- The neighborhoods around the renewed health facilities took advantage of the many modifications the project brought to them, with new sidewalks, improvements on streets lights and signage, and new urban equipment and furniture. The once dangerous place became home to many children playing outside their houses and too many adults looking for a good place to sit and drink chimarrão, a local herb drink.

- Health facilities that do not belong to the Rede Bem Cuidar group in Pelotas are adopting a few of the new features in order to improve the quality of service.

Developing such a project is not easy and many challenges must be overcome in order to keep functioning. It is said that projects that deal with a public policy are slower and harder to implement. However, the complexity of projects greatly improves the range and scale of solutions, and if we think that, despite all problems, their results are looking for a “greater good”, that is what keeps us going.

The major issues we faced were:

- Adopting innovation in a highly conservative environment

- Finding the correct stakeholders to develop a focus group towards maintaining the project going

- Little time to fulfill research on a complex system such as Public Health

- Public budget and the purchase of legal equipment

- Articulation between different stakeholders and Departments

- Poor internet infrastructure in the city

No matter how good the project is, if there is no formal leadership inside the government, nor resources available for maintaining the project after unfolding the pilot, it won't work. So it is of primary importance to create the political conditions for the project to establish within the government.

We already have replicated it within the same city (Pelotas has, today, 4 Well-Caring Network units, and 3 more are going to be implemented), since the project has been awarded by the central government, many other politicians from around Brazil are visiting Pelotas, looking forward to comprehending the unit's creation, using the network's ideas to implement inside their own units.

No matter how good the project is, if there is no formal leadership inside the government, nor resources available for maintaining the project after unfolding the pilot, it won't work. So it is of primary importance to create the political conditions for the project to establish within the government.

-To have managers and street-level workers aligned with the project creation, process, and outcomes.

-To have thought, from the beginning, on the project sustainability, having full leadership and available resources to maintaining it over time.

-To validate every step with local citizens and politicians, avoiding backtracks and assuring the adherence of the project to the distinct stakeholders.