CMS HCD Guidebook- A Research Driven Redesign
Through generative and evaluative research, our team reimagined this central resource and increased usage by 85%
The Challenge
Our team aimed to support designers and researchers within the Center for Medicare & Medicaid Services (CMS) with a Human Centered Design Guidebook that served as both an onboarding resource and a collection of best practices.
Upon learning that this guidebook was underutilized and inefficient, we set out to retool and redesign the guidebook into a more effective and relevant resource for the designers and researchers we served.
The Human Centered Design Unification Team
The Human-Centered Design Unification Team (HCDU) was a team within the Center for Medicare & Medicaid Services (CMS) created to serve and support 11 other independent teams within the CMS ecosystem. Collectively, this unit of teams was referred to as "MACBIS" (Medicaid and CHIP Business Information Solution products).
We supported these teams through:
- Facilitating a digital centralized repository for design and research operations
- Providing ad-hoc Human-centered design support for teams, projects and individuals who needed it, and
- Building and maintaining a community of practice to promote knowledge sharing, remove silos, and empower the 11 other teams within MACBIS
Team Goals and Ecosystem
I joined this team in September 2023, shortly after they had begun to support these initiatives. During my time with this team, we took great strides in tailoring and improving the way we supported teams within MACBIS.
We established success Check-ins with 8 of the 11 teams, which we provided personalized support for team members, which allowed us to assist over-capacity teams and combat team member burnout. We heard about internal and external blockers teams were facing, which allowed us to communicate the persistent problems affecting multiple teams to product owners at CMS, and advocate for more thorough support.
We established a Community of Practice, creating a place for connection that broke down a siloed environment as teams discussed solutions and challenges out in the open with other HCD professionals. Over the course of one year, Community of Practice attendance grew by 73%, and on average, 71% of attendees rated the Community of Practice as "Very Helpful"
We created and maintained a Human-Centered Design (HCD) guidebook, a comprehensive internal knowledge bank for HCD practitioners within MACBIS. This guidebook contained guides for the complicated processes and bureaucracies of MACBIS, a step by step onboarding guide for new team members, and tools and templates for design, research, content strategy, and accessibility.
What is the HCD Guidebook?
The HCD Guidebook is a central resource for HCD Practitioners within MACBIS, and a cornerstone of the work our HCDU team delivered. While it served many needs, the two most prevalent were:
An onboarding resource for newcomers to the MACBIS ecosystem. The wealth of information about CMS Programs, relationship between teams in MACBIS, and our ways of working were broken down into bite-sized "modules" to help newcomers get up to speed gradually.
A tool to help MACBIS HCD teams follow best practices. It provided access to shared resources like templates and asset libraries, guides on the best ways to work with stakeholders most effectively, and examples to refer to in their work.
As our HCDU team gathered feedback from other teams in MACBIS and reflected on our service offerings, we agreed that the HCD guidebook could be more relevant, more accessible, and feature more tailored content for its audience.
In September 2023, my colleagues and I on the HCDU team began the process of transforming the HCD Guidebook.
Research & Iteration Process
Transforming the HCD Guidebook needed to begin by gaining a clear understanding of the needs, expectations, and reality of our users. To better understand these needs and expectations, we conducted a round of generative research, starting with user interviews.
We organized our research goals into five sections that encompassed relevant factors to the Guidebook: Awareness, Access, Onboarding, Content, and Engagement.
Next, we conducted hour long interviews with eight practitioners and two product managers, where we sought to understand if and how the guidebook played a role in their onboarding experience, daily project work, and their team's relationship with the HCDU team.
From these interviews, we synthesized what we heard into 5 main insights, which we which we reviewed among our team and shared out with both CMS leadership and the community of MACBIS practitioners.
Gaps in communication when the Guidebook is first introduced can leave users without direction and purpose, and disincentives them from fully exploring its contents.
“I didn't feel like there was a directive when I got access to the HCD Guidebook”
There is an opportunity to better support visual learners by restructuring some content in the Guidebook.
“I need to see how things relate to each other. Seeing it in dense word blocks or getting a list of documents is not helpful to me”
Practitioners would have appreciated a more active role from the HCDU team during their time onboarding onto MACBIS.
"I think it would have been nice to have an intro chat with someone from the HCDU project to know the resources that are available to me in conjunction with the onboarding of what was given to me by the prime."
Confluence exists as a space for “team-specific” resources in user’s minds, is inaccessible during critical onboarding periods for new practitioners, and is often difficult to navigate
“I need to see how things relate to each other. Seeing it in dense word blocks or getting a list of documents is not helpful to me”
New practitioners experience a minimum of 2 weeks without access to EUA systems, and the gap in access typically lasts around 4 weeks.
"The slowest part of the process was getting CMS access and access to those resources."
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After sharing these insights, we began prioritizing and implementing changes based on these insights, focusing first on creating clearer communication and methods of accessing the guidebook. Soon after, we began working on the biggest and most impactful update; restructuring and redesigning the guidebook's content and information architecture (IA)
Taking Stock with a Content Audit
I worked closely with a UX designer and service designer from the HCDU team to tackle the next step of restructuring and redesigning the guidebook's content and information architecture (IA). In order to ensure our work was comprehensive, we decided our first step would be to audit the existing content in the guidebook, noting whether content was meeting expectations for both our HCDU team and our users, when it needed to be revised, and when sections should be removed entirely.
Auditing the content of the HCD Guidebook was no small feat. We inventoried, reviewed, and revised over 60 pages, tracking and recording how each page should be edited or transferred in our redesign in a shared spreadsheet.
Our team also incorporated page analytics into our redesign strategy, factoring in the built-in Notion page analytics to review page views and overall popularity of different pages in the guidebook. This data shaped how we decided to consolidate and simplify content in our redesign, and in the building of an updated navigation.
As we progressed through the content audit, we synthesized the feedback received in user interviews, website analytics from previous year of Guidebook use, and our HCDU team’s goals for the guidebook to draft a new guidebook information architecture and navigation. Based on this synthesis, we hoped this new IA and navigation would do the following:
- Create more structure and clearly defined purpose for every stage of onboarding resources
- Emphasize templates and practitioner guides, and make those sections more accessible
- Consolidate resources that are only available after receiving a security clearance, in order to remove unexpected blockers in the user journey
Iterating and Validating with a Tree Test
Once we had drafted an updated IA and navigation for the guidebook, we sought to validate it with MACBIS Practitioners.
We had 11 practitioners participate in a short, 8 question tree test. In this tree test, participants answered questions about how they would look for a specific type of content or take a specific action, using a bare-bones version of our updated IA with the formatting stripped.
In this test, we saw how many participants were able to reach the answer right away, how many were in the right ballpark, and how many were nowhere close to the “correct” destination.
We knew from our discovery research that MACBIS Practitioners were naturally more tech-savvy than the average user, and often had direct bookmarks and links to the pages they used most often. This tree test served as a much needed gut check to how our target users would search for typical guidebook content with an unfamiliar navigation system, without any bookmarks or a searchbar as a crutch.
Overall, the tree test results were mixed. We were pleased to see that the most common and highest value tools and resources were easy to find for our participants. However, our labels and organization for practitioner tools did not test well, and the tasks asking users to navigate to those sections had low success rates.
Following the test, we iterated on our information architecture to address areas of concern, and added in new content, cross-linked resources, and other visual indicators to improve ease of navigation.
Rollout and Results
After countless collaboration sessions, team reviews, and content revisions, the redesigned HCD guidebook launched in the spring of 2024 to the excitement of our HCDU team, CMS leadership, and practitioners across MACBIS. The redesign featured navigation patterns that matched user needs, over 30 relevant guides and templates for research and design, and updated onboarding flows to support newcomers to MACBIS.
As our team continued to support teams across MACBIS, we were relieved to see the excitement around the HCD guidebook was not a flash in the pan. We saw the overall number of page visits to the guidebook increase by 85% over the next 5 months, with particular concentration around our research and design guides. The inclusion of HCD community and HCDU consulting links on the front page increased submissions to our team's intake form by 22% over the next month, which made orchestrating support for teams in MACBIS more efficient and organized. We were often reminded that the value of this project was worth the effort from the frequent praise and appreciation we received from the researchers and designers in MACBIS, and in the ease and efficiency it brought to our team's own design and research work.
Increase in HCD Guidebook page visits
Increase in Research Guide page visits
Increase in HCDU Intake Form Requests
Our HCDU team ended support of this resource in July of 2025, but it is still available to access here: https://hcdguidebook.notion.site
Shoutout to my teammates on this project:
Chris Oliver, Paul Weiss, Rebecca Bruno, Felix Gilbert, Sara Camnasio, Kit Miklik, Kevin Shaw, Laura Blumenthal, Bronwyn Clarke, Charnell McQueen