nurturing u: innovating a university clinic's check-in and waiting experience

COMFORT

COMMUNICATION

PRIVACY

Supply individual space

Reduce patient contact with people other than doctor,nurse, and pharmacist

Security of information (why visiting)

Information about conditions, medicines, basic health improvements

Directive information: What to do (Wayfinding) and where do you go (Info finding)

Security of information (give the appropriate information)

Alert system (when is your turn)

Reduce Contact with Patients

Materials of Space

Keep Informed of Visits Progress (Where are you at in Line)

Allowing Individual Behavior/ Environment

INNOVATING AUNIVERSITYCLINIC'S CHECK-IN AND WAITING EXPERIENCE

Description:

*WATKINS MEMORIAL CENTERSTUDENT HEALTH SERVICE CENTERUNIVERSITY OF KANSASMISSION:Student Health Services supports the students learning experience through the delivery of high quality affordable healthcare services and innovative pro-grams that promote the health of the student, University and community.

Our objectives:

Give privacy to users

Improve communicationReduce stressGive information to users

Reduce germs in waiting roomImprove comfortReduce waiting timeGive users something to do while waiting

NURTURING U

OUR MAIN GOAL:IMPROVE the WAITING EXPERIENCE atWatkins MemorialCenter SHS*

SOLUTION STRUCTURE:

The Nurturing U project stems from a need to improve the check-in and waiting experi-ence for patients in the Watkins Memorial Health Center, located on the Lawrence campus of the University of Kansas. The main goal of this project is to improve the patient waiting experience inside of the main Watkins waiting area. A final product then emerged that reflected the teams Evidence-Based Design (EBD) ap-proach to solving the discovered problems.

By the 1960s, the university had outgrown Watkins Memorial Hospital, opened in January 1932. The hospital, the gift of Elizabeth Miller Watkins and named for her late husband, could not be expanded because of its hillside site, so a larger, more modern hospital was planned for the playing fields southeast of Robinson Center. George Hampton & Associates of Wichita and State Architect Kenneth R. McCain designed the dark brick building with medical director Raymond A. Schwegler. It cost $3.65 million, paid largely by student fees, and retained the original name.

Its 60,000 square feetincluded 34 inpatient beds;a clinic; a laboratory andX-ray facilities; apharmacy; allergy and immunization, physicaltherapy and psychiatrictreatment areas; andadministrative andbusiness offices.

The Ralph Canuteson Memorial Library is named for the first student healthdirector (1928-65). In 1988 the facilitys name was changed to Watkins Memorial Health Center.

A major expansion and renovation costing $5.6 million, designed by Lawrence R. Good & Associates of Lawrence and completed in 1997, created more physicians examining rooms, a gynecology clinic, a mens clinic, and an urgent care clinic. The health center offers treatment and educational programs in general medicine, sports medicine, nutrition, allergy management, physical therapy, immunizations and radiology.

A wellness re-source centeroffers education and support in nutrition, fitness, alcohol and drug use, sexual behavior, and stressmanagement.

Watkins Memorial Health Center

Student Health Centerand the Waiting experience

SHS is commited to support students learning experience that requieres a considerable amount of time. Waiting at the Healthcare facility for more time than expected can interfere with a students academic activities.

An experience analysis showed that a students typical waiting journey proceeds as such: check-in line, waiting room for nurse, exam room for doctor, for prescriptions at pharmacy, at the lab for testing.

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1. Waited in Line for 5 Minutes to Check-in.2. Checked-in- Was asked to Scan ID, Reason for Visit, For Current Address and Insurance Information3. Directed to Sit in the First Waiting Area- Waited for 15 Minutes. Wanted to sit in the second waiting area because it is more se-cluded (away from all the sick peoples path-way). Watched two girls come in for Allergy Shots. 4. Directed by Nurse to Weight Station.5. In Exam Room- Nurse took Vitals, Asked Again the Reason For My Visit. She Entered the Data on the Computer. I told her I needed a form signed after the visit. She then said the doctor would be in shortly. I waited 10minutes for the

Doctor to come in. He asked if I was excited to be going to Russia. I said yes. He then said we would begin the exam. During the Exam he checked my chest, my spin, my ears, my eyes, he then asked a series of questions about where I would be staying in Russia. I said St. Petersburg. He informed me that I needed to get two shots and gave me a handout on Important facts about Russia. He signed my form and told me to get an ocial stamp after I stop by the shot room. 6. Directed by the Doctor to the Shot Room- Was told she was busy and that I need an appointment to meet with her.7. The Appointment Desk- I then went to make a follow up Shot appointment and

have my form signed. There the lady stamped the form and asked if I was free for an appointment now. I said yes.8. I was directed to sit in one of the rst two chairs in the waiting room. I waited 5 min-utes.9. I was told by the Shot Doctor to come into the Shot Room. In the Shot Room- I was asked what shots I needed and why. I told her and then she made me read two handouts and then nally administered the shots. She then made me sit there 10 min-utes for them to take eect. She then told me if I felt any of the side eects to come in immediately and tell the doctors what I was experience. She wished me luck.10. I left the building.

CUSTOMER JOURNEY MAP

No distinct signage differentiating the waiting areas (flu waiting area and other)

Lack of privacy and individual seating

Posters are not legible

Uncomfortable seating

Nothing to do

Unaware of how long the wait is

A line forming to check-in

Privacy invasive due to telling secretary out loud reason for visit as well as other personal information such as address, phone number, insurance provider

GATHERING DATA THROUGH ETHNOGRAPHIC AND LITERARY RESEARCH METHODSTHE DESIGN TEAM POINTED OUT THE MORE IMPORTANTSITUATIONS IN THE CURRENT WAITING EXPERIENCE

CURRENT WAITING EXPERIENCE

PERSONAS

Frank Bartels is a 19 year old, Sophomore Finance Major at the University of Kansas. He has Sever Allergies and requires weekly allergy shots.

Frank is instructed to arrive at the campus clinic 15 minutes early. When he arrives, he checks-in by scanning his KU card and verifying his information (address, phone number, insurance).

He then proceeds to one of two waiting areas. He doesnt know which area to sit in so he sits away from patients who are coughing and appear to be sick. He doesnt want to catch what they have.

While Frank waits to be seen he checks his Face-book and plays on his iPhone. After about 7 min-

Sarah Jones and her boyfriend Mike Brown are Psychology Majors at the University of Kansas. They both are feeling sick and decide see a doctor.

They arrive at the campus clinic without an appointment and hope to be seen fast. They give the secretary their information.

They then head to the waiting area and look for a place to sit that will allow them to sit together. They are unaware of how long the wait is so they have a seat and start talking. After about 5 min-utes of waiting, Mike starts complaining of being hungry.

Frank

Sarah & Mike

Dr. Kosary

utes on his phone, Frank becomes bored and wishes he knew how much longer the wait is.

10 minutes after his appointment was suppose to have begun; a nurse calls his name. He approaches the nurse and heads back to have his weight and vital check. The nurse then leaves and Frank waits for Dr. Kosary to come in to give him his shot.

Dr. Kosary arrives 7 minutes later and gives Frank his shot. She then reminds him to make his next appointment.

Frank leaves the exam room and decides to call the clinic later to make the appointment.

Another 30 minutes passes and a nurse finally calls the couples name. The couple gets up to follow the nurse to be weighed and have their vitals taken. As Sarah has her vitals checked she asks Mike for a little privacy.

The nurse then leaves and Dr. Kosary comes into the exam room. Dr. Kosary determines that the couple has the flu and places a prescription for them.

Mike and Sarah then leave the exam room to go to the Pharmacy. It then takes 20 minutes to fill the prescription.

Dr. Kosary is a Physician at Watkins, the University of Kansass campus clinic. She has been a Doctor for the past 15 years and sees on average 4 patients an hour.

She begins her day by seeing her first patient, Frank Bartels. His visit takes 5 minutes and then she stays behind to finish processing his informa-tion for his file.

She then sees 11 more patients before her lunch break, including Sarah and Mikes visit, which takes 20 minutes to complete.

At noon Dr. Kosary takes her lunch break and realizes she forgot her lunch at home. She only

has an hour for lunch and the closest place to eat is a 20 minute away. She wants to be able to order something healthy quickly and also satisfy her frequent chocolate cravings.

After lunch, she sees 12 more patients before her afternoon board meeting with the clinics adminis-tration.

Todays meeting was about a survey which showed that students were not satisfied with the amount of time being spent waiting for a doctor in the exam room. This meeting informs Dr. Kosary that she needs to update patients if a delay occurs during their visit. Once finished, she leaves to go home.

To know how long the wait isTo not get sick when visiting the doctorTo have options of things to do as he waitsTo make appointments quicklyTo not repeat the same information more than once during an appointment

GOALS

To be seen in a timely mannerTo have privacy even when visit is joinedTo know the waiting timeTo sit together To not be hungry

GOALS

To See Patients in a Timely MannerTo Have Access to FoodTo Satisfy Chocolate Cravings To Update Students of the Delay in Their Visit

GOALS

Total Appointment Time: 85 MinutesTime Spent Waiting: 55 Minutes

Total Appointment Time: 47 MinutesTime Spent Waiting: 32 Minutes

Personas use storytelling to engage social and emotional aspects of our brains, which helps each team member [of the design team] either visu-alize the best product behavior or see why the recommended design is good(Goodwin, 2009:229).

PROTOTYPING APPLICATION

Paper Prototype

PDF Prototype

Signage to match the waiting areaAlerts are goodConfirm/dismiss bar is confusing on 1 minute arrivalI dont need an alert every five minutesTell me when the halfway point is

INSIGHTS

It is pretty straight forwardWhat is QR Code?Needs sound with alertsCan I use my phone to check-in?

INSIGHTS

Students were given a prototype of

a smart phone application to use

throughout their visit at Watkins.

The students role-played a hypo-

thetical situation of checking-in

and waiting at Watkins. They were

handed a smart phone prototype

and asked to check-in using the

kiosk and then proceed to the wait-

ing area.

Students used gestures to show

how they would use the application

as well as think aloud protocol. This

enabled them to ask for help and

give feed back on areas of the in-

terface that confused them.

This testing allowed the design

team to see which areas of the in-

terface needed improvement.

PROTOTYPING KIOSK

Paper Prototype

PDF Prototype

Needs a change tab to fix informationNeeds to Work Without A SmartphoneCan I recieve text messages?Needs buttons on home page to mark activityReminds me of a self checkout at the super market

INSIGHTS

The kiosk could avoid linesCouldnt it be online and done from home?Confused tries to immediately scan QR code I avoid talking to people so this is a good thing

INSIGHTS

Students were given a prototype of

a kiosk to use as a check-in possibil-

ity instead of the traditional check-

in line. The students role-played a

hypothetical situation of checking-

in at Watkins. They were handed a

smart phone prototype and asked

to check-in using the kiosk.


how they would use the kiosk as

well as think aloud protocol. This

enabled them to ask for help and

give feed back on areas of the in-

terface that confused them.


team to see which areas of the in-

terface needed improvement.

PROTOTYPING SPACE

Post-It Prototype

Sketchup Prototype

Good to have individual spacesI am not interested in interacting with other peopleA small couch for two people if you come with someoneChairs surrounding a coffee tableWants chairs with cushioned armsSide tables for your stuffNice to have vending machines

INSIGHTS

Split waiting areas: that is goodAquariums: could be nice to look at and entertainingCaf: healthy food would be good. I would like tea or fruit drinks. Maybe a hot drink and a sandwich. People may be sleepy and like to eat while they wait here. Would use it after fasting if I knew there was food there to eat.

INSIGHTS

Students were first given a Post-It

prototype of the furniture and

asked how would they like their

space to be arranged. This infor-

mation was then used to generate

a Sketchup prototype of the space

to see what Watkins would poten-

tially look like. In the Sketchup pro-

totype students where asked if they

would use a caf, how they felt

about aquariums, sky tiles, and a

digital waiting cue display.


how they would use like the space

to appear as well as think aloud

protocol. This enabled them to ask

for questions and give feed back on

areas of the space that confused

them or that they liked.


team to see which areas of the

space needed improvement.

AQUARIUMS

Provide patients with a view

Distract patients while waiting

A natural stress reliever

CAFE

Offers alternative waiting area

Provides patients and staff with healthy food and drinks

Also provides the south end of campus with dining options

CHECK-IN KIOSK

Allows patients to check-in without speaking to a person

Allows patients to keep their information private

Prevents long check-in lines

Students can use their phone or id card

HELP DESK

Directs all incoming traffic

Could be a triage nurse for patients without ap-pointments

Allows patients to speak with a person instead of a machine

PHARMACY WAITING AREA

Distinguished those waiting for medi-cation from those who are seeing a doctor

Prevents the spread of germs

BLUE WAITING ZONE (HEALTHY PATIENTS)

Reduces the spread of germs

Single and small group seating available

Comfortable seating

REDESIGNING THE WAITING EXPERIENCE

WEIGHT STATION

Gives patients privacy when being weighed

Offers a smooth transition be-tween the waiting room and the

exam room

RED WAITING ZONE (SICK PATIENTS)

Reduces the spread of germs

Comfortable seating

Single and small groups seating available

PROPOSEDPATIENT JOURNEY

Log into appAnd check intoClinic remotely

App produces Qr code

Goes straight to watkins

and checks in via the

self-serve kiosk

Kiosk produces QR code for use by medical staff

throughout rest of visit.

Visit number produced tohelp students track wait times

via message screens.

QR code can be sent to phoneor printed onto a card.

Patient makesAppointment

OR

OROR

Have qr code

Scan student ID

Red zone For sever illness

Blue zone For moderate ailments

Cafe

Dont have qr code

Pre-check-in Arrive at watkins

Check-in Using kiosk

Proceed to Waiting area

Message screens showCurrent wait times

Turn alert sent to Phone via text

Nurse seeks out Patient in waiting area

Visit alerts produced

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OR

AND

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With smartphone

Without smartphone

Calls clinic

Via website

Ask for helpSHS services

CHECK-IN Schedule AnAppointment

GO TO KIOSK AND SCAN QR CODE

GO TO KIOSK AND

CHECK-IN

HELP DESK AND CHECK-IN

Ask for help SHS services

CHECK-IN Schedule AnAppointment

GO TO KIOSK AND SCAN QR CODE

CHECK-IN

ALLOW NURSE TO SCAN QR CODE

CHECK-IN

YOUR CHECK-IN IS COMPLETE

Please go to the red zone. You will be seen in 15 min

MAP

ALERT5 MIN REMAINING

MYSHS

ALERT1 MIN REMAINING

MYSHS

MOBILE TECHNOLOGY

MOBILE TECHNOLOGY

CHECK-IN KIOSK

SMARTPHONE APP

CHECK-IN SCAN QR CODE SWIP KU CARD

Hi FrankWould you please confirm your information

Ask for help SHS servicesCHECK-IN Schedule AnAppointment


START SCAN


NAME: Frank Bartels

ADRESS: 4101 w24th Pl. Apt. 512

MOBILE: 862 220 8760

INSURANCE PROVIDER: Seven Corners

ADRESS: 4101 w24th Pl. Apt.CHECK-IN SCAN QR CODE SWIP KU CARD

DONE


Hi FrankWould you please confirm your information

NAME: Frank Bartels

ADRESS: 905 Avalon Rd.

MOBILE: 862 220 8760

INSURANCE PROVIDER: Seven Corners

DONE

Your check-in is complete

Appointment Information:Wednesday May 9, 2012 / 10:30 a.m. / Dr. Kosary

Please go to the red zone. You will be seen in 15 min

MAP

The design team thought this would be an area that the could incorporate mobile technology. The phone and texting could be used as a paging system for patients. A time breakdown could show patients how long their wait is and updates of 5 minutes and 1 minute could tell the patients when to head back to the waiting room and when to get ready to meet a nurse

To reduce the waiting in lines and allow the students to not share their information with other people , the design team proposed a Check-in iosk. This system could use a QR Code that would be a part of the application and allow them to check-in by scanning the screen of their phone. If students do not have smart phones then they can also use the current method of scanning their student id.

Choosing the service(Check-in, Schedule appointment,Help, or more services)

Scan QR Code Putting the smartphone with the QR code over the screen to scan it

Confirming informationsuch adress, phone numberand insurance provider

Editing the adress information

Confirming theinformation is correct

Check-in completeSynchronizing informationwith the smartphone Guiding the patient to thenext step: Going to a waiting zone

Interactions with the Check-in Kiosk Screen

Interactions with the Mobile App

Initializing the App Choosing Check-inService

Receive directions Choosing Map Alert 5 min Alert 1 min Showing QR codefor the Nurse

RED ZONE

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Designed for those pa-tients who are more sick this zone will help to re-duces the spread of germs, offes a comfort-able seating and also has spaces fo small groups.

BLUE ZONE51080UP

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Designed for those patients who are more healthy, this zone will help to reduces the spread of germs, offers a comfortable seating and also has spaces fo small groups.Patients can choose staying in this zone or going to the cafe area.

CAFE/LOUNGE

The design team decided to add the addition of a caf to the existing structure of Watkins Health Center because it provides patients with an alternative area to wait in, it reduces stress, prevents boredom, and puts patients in control of the time they spend waiting.

Research shows that people will experience the waiting as shorter when: 1. they have something to do while waiting (Faessen, 2008). The design team thought this could be accomplished by adding a caf; a

common college hangout spot, to the health center. A caf could give patients control with respect to their physical surroundings (Faessen, 2008) when visiting the doctor. It would also provide a positive dis-traction (Faessen, 2008) by offering students a drink while they wait or a healthy snack. K. Wilson says in The Ecology of Waiting, giving visitors a choice of how to pass the time, by providing a variety of amenities and distractions, helps reduce stress, boredom, and anxiety associated with the waiting process (Wilson). A

caf would offer patients an alterna-tive choice to a waiting room set-ting. Patients can grab coffee and come back to the waiting area to wait or they can remain in the caf and keep track of their waiting time via the application on their phone or a display board that keeps track of the patients que.

These ideas were then generated into a low fidelity prototype sketch up model and students were inter-viewed to see if they liked the idea of a caf being attached to the health

centers space. Nurses and staff were also interviewed to see if they would like a caf as well.

After interviewing students and staff and seeing that this would be a viable solution to the waiting experi-ence, the design team was let in on the insight that a caf could not only provide nourishment to the health center but to the south end of campus as well. A nurse informed us that the closest restaurant was about a 15 minute walk or drive. Students interviewed said they

would like to have healthy choices to reinforce the healthcare aspect. That coffee would be good as they were leaving the facility but tea or a smoothie would be a better choice while waiting to see a doctor. An-other insight was that some test doctors run require fasting and after these tests it would be nice to have something to eat. The nurses of the facility requested, Some unhealthy option as well such as chocolate be-cause sometimes you just need a fix for a craving.

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Offers an alternative area to wait in

Provides patients with food and drink

Provides doctors and staff with food, drink, and snacks

Prevents boredom

Reduces stress

Puts patients in control of time spent waiting

Provides south end of campus with dining options

Health options: Coffee, tea, smoothiesSweet treats, Hot meals

PHARMACY

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Designed to distin-guish those waiting for medication from those who are seeing a doctor

WAITING AREA