Designing a stress-free ambulatory care

Kaiser Permanente is an consortium that provides integrated care, i.e. they manage health plan, hospital, physicians and medical group to work together in a coordinated fashion. They were planning to expand their facilities by introducing more preventive & wellness care. This project was aimed at re-designing their ambulatory care experience(medical services that can be done in a day and does not require patients to be admitted). They needed a design solution to create a smooth and stress free environment for the members using these facilities.

As it is the case for all service design projects, this one involved planning and managing people, infrastructure, communication and materials used in providing that service.

Field Testing

Field Testing is putting the service model to life, alongside the existing staff. It includes working with the current work practices to catch issues before deployment. Including the existing staff helps design better solutions and have higher acceptance rate.

Project Journey

Guiding Questions

In this project, the biggest challenge was to make exploring huge facilities for multiple appointments stress free and enjoyable. This was along with all the other complications that come with healthcare sector and people of different age and abilities. We broke this problem into the three parts:

1. How to handle high volume check in: How technology and space can help service reps to check in high volume of members.

2. Call to Back: With all these different activities keeping members busy, how can we get them to their appointments on time?

3. New ways of working: How to make the staff feel comfortable with the new approaches that gives more control to members?

Learning from existing solutions

The project started off with getting some initial understanding of the ecosystem and revisiting some old learnings. It was followed by a series of brainstorming sessions to figure out the most important questions and their possible solutions.

I was specifically responsible for figuring out a solution/set of solutions to the Call to back problem, i.e. how to get members to their appointment on time. With the new Kaiser model, clinics were being pushed further away from their check-in stations which meant that the following situations were going to be an issue:

1. Nurses needed members available at the clinic when its their appointment time, or providers will fall behind.

2. Members are asked to move from Check-in to the Public Square, to the Perch and then into the Exam Room. This journey was disruptive and unnerving for members if timing was not done well.

To tackle this design problem, I started researching on solutions used to notifying members. I looked for inspirations in other places that handled similar tasks. For this I visited restaurants, shopping malls, stores like IKEA, Verizon and Ross and other hospital facilities. I mapped out their a user journey & user touch points. I started thinking about user needs to make this journey stress-free. This helped me come up with various solutions.

The solutions I found ranged from hardware systems like buzzing wristbands to software solutions like a mobile App. Some of the options that we test were:

1. Large public displays

2. Buzzer systems

3. Electronic Wristbands

4. Mobile messages

Testing out the solutions

Next we went to Kaiser facilities( Meridian, California; Brea, California; Rancho Cucamonga; Carmel Hill, Signal Valley) to test different our solutions. We used a technique called the Wizard of Oz for these experiments.

In Wizard of Oz, the responses from people, devices, apps, or the context/environment are manually created by invisible operators (“wizards”) behind the scenes. The users are working under the assumption that they are dealing with an actual working prototype. The Wizard of Oz approach can help to efficiently test user reactions before investing time and effort into more complex working prototypes.(https://www.thisisservicedesigndoing.com/methods/wizard-of-oz-approaches)

We spent time setting up facilities to look and work as if the solution was being realistically employed at that site. We would work with the staff members and train them with scripts and set up workstations. The experiments was testing the solutions for easy its adoption by the staff as well. An important aspect of this project was figuring out ways to make Kaiser a good place to work for its employees. While executing these experiments, we noted people’s reaction to it. We also conducted interviews during and after each field test.

Experiments & their learnings

Public displays: To test if public displays can work as a medium of notification for Kaiser members we installed several televisions in the facility. The position of these monitors were determined based on known user touch points. The monitors showed member information, appointment time, destinations and wait time. It would regularly get updated to provide latest updates to members .

Learning: From this experiment, we learnt that public displays were not a reliable solution to provide notifications to members. They failed to get members’ attention especially when members were engaged in other activities. The notifications were missed and there were problems displaying a large amount of content on these screens.

Buzzers: For testing handheld buzzers as a mode of communication, we bought 100 physical buzzers with led displays. They were issued to members during check-in and would vibrate to notify them for their appointment. The LED displays would show member’s arrival gate information at the time of their appointment. Members were told to enjoy the common space until they were called.

Learnings: Buzzers proved to be a good option for introducing something familiar to members and grabbing their attention when they are occupied. However, there were some sanitary concerns and logistics of handling these buzzers that had to be figured out.

Text Messages: Members were asked for their phone number on check-in and they were sent text messages with their appointment details. These messages would keep members updated on their appointment status. Member who did not want to opt for text messages due to security reason were given the option of using electronic handheld buzzers for notification.

Learnings: Text messages faired pretty well in all our tests. They were advantageous because Kaiser facilities could send detailed information to its members and members were more comfortable handling their own devices. Two-way communication was another benefit of this medium.

Mobile App: We implemented a mid-fidelity prototype of our mobile phone app. As prototypes could not be installed into member’s personal phones, we bought some Iphones and installed our prototypes on them. These Iphones were handed to the members during check-in and the app had features like interactive facility map, patient forms, appointment details and member medical records. The most popular features of the app were in-app notifications and tracking appointment wait times. We observed this app being used in practice and conducted surveys to gather more feedback.

Learnings: We tested only the notifications part of this app through our prototype and this solution got very good response from the users. It was ideal for delivering personalized & contextual information about the appointments and provide other features like wait time, facility map and online check-in forms.

Project take-away

Service design is the activity of planning and organizing a business’s resources (people, props, and processes) in order to directly improve the employee’s experience, and indirectly, the customer’s experience. 

For me, this project was an introduction to service design. It helped me see the appropriation of UX design, i.e. UX is more than designing interface. It is designing an experience for a user irrespective of the medium and application.

The best part of this project was being able to run contextual simulations. These facilities were fully functional while we tested our solutions. It helped us get some real time feedback and we improvised and iterated on the fly. It was a great learning experience for me and I got to work with some really knowledgable & kind people.