Providers are navigating a convergence of pressures that have no easy resolution: rising care costs, workforce shortages, increasing regulatory complexity, and residents and families expecting a fundamentally different experience than the institutional models of the past.
What most organisations reach for first is operational efficiency. Tighter rosters. Consolidated services. Restructured reporting lines.
What they find is that efficiency alone does not solve the problem. And in some cases it makes it worse.
When Bethanie, one of Western Australia's leading aged care providers, engaged LeanCX, the question was not simply how to reduce cost or improve processes. The question was more fundamental: how do you redesign a care model around the experience of residents while keeping the organisation financially and operationally sustainable?
That is a strategic design question. And the answer required going much deeper than service improvement.
The first thing we did was map what residents actually experienced across a typical day.
Not what the organisation believed they experienced. Not what the governance framework said they should experience. What the day actually looked and felt like from the perspective of the person living in the facility.
Using Human-Centred Design principles, we worked alongside frontline teams, care staff, leaders, and residents to develop a genuine picture of the resident journey. We mapped day flows, developed personas, observed how different roles interacted across the hours of the day, and listened carefully to what staff described as the friction points in their work.
One insight became clear early and shaped everything that followed.
Residents were not experiencing care as separate departments or functions. They were experiencing it as one continuous day. A conversation with a care worker in the morning, a meal, a therapy session, a quiet hour, another conversation. From their perspective, these moments were not distinct service interactions. They were the texture of their life.
The implication was significant. Designing care around departmental efficiency was solving the wrong problem. The organisation needed to organise capability around the resident experience, not the other way around.
This is worth being direct about, because the two are often confused.
Service design asks: how do we improve the experience at key touchpoints? It is valuable work. But it operates at the surface of a much larger question.
Strategic design asks: what operating model, workforce structure, governance system, and capability framework do we need to consistently deliver that experience at scale, sustainably, over time?
The Bethanie engagement required both. The Human-Centred Design work surfaced what residents needed and what staff found difficult. But translating those insights into a model the organisation could actually operate required answering harder questions.
What work should sit closest to residents? What should remain specialist? How do you build more capability into frontline roles without compromising clinical standards? How do you maintain quality while managing rising care costs? How do you design a roster that reflects how care is actually delivered, not just how it is reported?
These are not design questions in the conventional sense. They are strategic operating model questions that happen to begin with the human experience.
The outcome of the design work was a Living Unit model built around smaller resident cohorts, stronger continuity of care, and a workforce structured around proximity to residents rather than hierarchical function.
At the centre of the model sat the resident. Around them, we redesigned capability across two interconnected layers.
The first layer focused on the people closest to residents every single day. Frontline roles including the Universal Care Worker and the Home-Lead were redesigned to support a more integrated, relationship-based model of care. Rather than fragmenting care across multiple specialist touchpoints, the design built multiskilled capability so staff could support residents more holistically throughout the day. Fewer handoffs. Greater continuity. More meaningful relationships between residents and the people caring for them.
The second layer focused on specialist and enabling functions that support frontline teams. Allied Health, clinical expertise, governance, and broader support services were repositioned as enablers of resident outcomes rather than as standalone service providers. Allied Health capability, in particular, shifted from isolated service delivery toward coaching, guidance, and workforce enablement. The goal was to ensure specialist expertise strengthened frontline capability without disrupting the resident experience.
Together, the two layers created a more integrated ecosystem where support functions stayed connected to resident needs while frontline teams operated with greater confidence and capability.
Residents do not experience org charts. They experience relationships, continuity, dignity, and the quality of everyday life.
By the end of the design phase, Bethanie had a robust and evidence-based blueprint for a future Living Unit model.
But the engagement also surfaced a reality that is easy to underestimate.
Designing the model was only the first step. The larger challenge was whether the organisation had the capability, leadership maturity, governance, and workforce systems to sustain the model at scale.
This is where many transformation efforts in aged care stall. The design work produces a compelling future state.
The implementation reveals how much the operating system underneath needs to change to support it. Rostering logic. Leadership capability. Governance structures. The behaviours that shape how care is delivered moment to moment across an entire facility.
Real transformation in aged care does not fail because organisations lack ambition or good ideas. It fails when organisations attempt to implement new models without aligning the capability, structure, and leadership behaviours needed to sustain them.
Recognising that gap, and naming it clearly, is part of what strategic design is for.
The Bethanie engagement reinforced something I have come to believe firmly across many years of working inside complex organisations.
Residents do not experience org charts. They experience relationships, continuity, dignity, and the quality of everyday life.
Designing a care model that delivers those things consistently requires more than a new service blueprint or a workforce restructure. It requires the courage to ask whether the operating model itself, the way work flows, decisions are made, capability is built, and accountability is structured, is actually designed around the people it is meant to serve.
When that question is asked honestly, and the design work follows the answer, something changes. Not just in how the organisation operates. In how it thinks about what it is there to do.
That is what strategic design makes possible.
Sudharsan Raghunathan is the founder of LeanCX, a transformation consultancy helping enterprises evolve intelligently by aligning people, process, and technology.
leancx.com.au
