The patient’s path in Emergency Departments
Using UX research and design thinking to get around a wicked problem
Context
As part of our journey to become full fleshed UX designers, our next Ironhack mission was to apprehend a bigger societal problem and apply what we had just learned about UX research to understand the main pain points for users. We were split in groups of four and the end goal was to come up with solutions to answer these problems, with a lo-fi prototype to present two weeks later.
My amazing teammates: F-Anaïs Sidibé, Juliette Gaboriau and Marion Guitton
Brief: How might we transform the end-to-end experience in public hospitals? From requesting an appointment with the doctor to engaging in community initiatives or volunteering.
The scope here is quite broad, so for the sake of this exercise we had to narrow it down to a specific department. We had recently heard stories of difficulties encountered during the path in the emergency department in our social circles, so this scope seemed to offer design opportunities for us.
A question of perspective
One of our first interrogation was to identify our target. The context of the Emergency Department is particularly sentitive, it is a place where people are in pain, are anxious about there diagnosis and might even be in shock after the incident that led them there. However, this context is not only stressful for patients, but also for the health care personal. As they are in constant contact in this environment, addressing one of these targets will obviously affect the other.
However, we took a step back and quickly realized that the time given for our reseach was not enough to thoroughly study the work conditions of the caregivers: we do not have a medical background and the pool of experts that would be accessible in a few days would not give us enough matter.
That is why we concentrated on the patient’s path. Nonetheless, we still took caregivers in consideration in our research, but more in an exploration approach: we needed to get a view on how emergency departments work from the inside. These interviews revealed that the tools and platforms used by caregivers to manage patients in the ED are a bit old but actually work well. The most stressful aspect of their job if managing people, not their files. Their contacts with patients are often difficult, exhausting, and even violent so times. Then, this kind of testimonial gave us another reason to target the patient’s path and see what we can do to make it less stressful and problematic.
Surveys
We approached that audience with a quantitative and a qualitative method.
The first one was realized through online surveys, shared around us. We just had one criteria: the respondent needs to have been to an ED in the last two years, as a patient or as an accompanying friend or relative. 65 people answered this survey.
The answers gave us a few insights on our target:
- Most people go to this department very occasionally and are not familiar with it (93 % in our survey)
- Most people go to the hospital accompanied (65 % in our survey)
- Many people don’t know where to go to get to the ED (52 % in our survey)
- The main difficulty identified during this path is declared to be the wait.
This approach gave us broad data but the insights were not the most accurate to comprehend the mental model of ED patients. We needed to go deeper in the attitudinal and behavioral study of patients, that is why we completed the research with qualitative studies.
Interviews
We lead 19 interviews with people who recently went to the hospital for emergencies. With this method, we could discuss in depth how the participants perceived the ED and focus and their recent experiences. Here again, we were interested in stories from people who were patients, but also the ones who accompanied friends or relatives. This method was crucial to identify other pain points than the wait, which is typically the first thing that comes to mind when you think about ED.
Mapping the feelings of the ED patients
The research was especially enlightening in terms of feelings and emotions associated to this kind of experience, for instance:
- The feeling of being lost in the hospital and the different steps of this path: lack of information, lack of consideration, shock after an incident.
- The lack of intimacy
- The feeling of loneliness for those who could not come with a friend or a relative, or who simply cannot be accompanied during a part of the path (exams, analysis, etc)
- More than just waiting, the conditions in which they had to wait: the pain, the uncomfortable waiting rooms, the stress of the results, the specific predicament (people bleeding, not dressed appropriately as they rushed to the ED, etc.)
- The anxiety of being in a hospital
The wait was still a major pain point and was described as particularly difficult to endure, even for people who were not in shock or in intense suffering : “After a certain number of hours, I could not think of anything else, I was just obsessed by the wait (…) At some point I even felt better, I think I was trying to convince myself that I was ok just so that I could leave and stop waiting”.
The perspective of people accompanying patients was particularly interesting as well, as it highlighted a feeling of frustration: the lack of consideration when you are not part of the family, the lack of information on the patient’s path, the unbearable wait and the stress that they have to endure as well.
To always keep in mind these behavioral and sentimental aspect, we identified four user personae:
Pain points
Lucas, our main persona, gathers the traits that we encountered the most during our surveys and intervews:
- not used to hospitals
- occasionally goes to ED
- is in pain but is not one of the most severe cases so he has to wait
During his patient path, he faces many difficulties :
The research on this topic was particularly rich and led us to identify many problems. When analyzing these problems and sorting them, they falled in the many clusters:
- the means of transport to go to the hospital
- the orientation (to go to the hospital and between the different services)
- the wait
- the physical environment (cold, uncomfortable, worrisome)
- the communication with caregivers (being listened to and receiving information)
- the pain of the patient
- the place and consideration of the people accompanying patients in this path
- the lack of bearings
Letting aside the things that we could hardly change like the infrastructures or the physical pain of the patients and crossing this data with the journey of our main patient, three design opportunities stood out:
- Orientation: how might we guide the patients to the right hospital, the right entrance and the right service? How might we give them some bearings in a big hospital that they don’t know?
- Information: How might we provide an overview of the journey in the ED and keep the patients informed during their path?
- Wait: How might we help patients live the wait better and, in the process, alleviate their stress and pain?
This led us to our problem statement:
Patients in ED need a way to be guided and informed through their entire pathway (from the accident and until they leave the hospital) because the lack of visibility makes their wait and overall experience even more difficult than it already is.
A virtual ED companion
Through the prism of this problem statement, we brainstormed to think about all the solutions that could help patients. This divergent thinking led us to draw a mind map of the possible solutions:
Among all these ideas, here are the solutions that we kept and gathered in our first iteration (illustrated in a lo-fi prototype):
A map to get to the ED
A geolocalized service guiding patients to ED departments around them. It lets you decide where you want to go, according to your specific criteria. The first thing that comes to mind would be that we would like to go to the nearest one. However, the study of our personas, and especially the most extreme one, taught us that in some cases the patient is not going to rush in the ED and will prefer to go further to get to a less crowded hospital and have a more comfortable path.
This way, this service allows the user to choose the type of hospital that they want and guide them with an integrated GPS system.
An online patient file
On the way to the hospital, the patient or his companion can already fill up the patient file. This part of the file is declarative, that is what is traditionally done with the nurse when you first get to the ED. Doing it in the app is a way to save time (for the patient and the nurse) and keep this file accessible for the patient during their entire path. Even if the patient does not fill their profile on their own, this part will be synchronized with the information filled by the nurse during the check-in of the patient.
The goal here is to keep it as simple as possible. People going to ED department are never in a particularly good state of mind and can even be in state of shock or weakened by their condition. They are helped by keywords to describe their problem and can locate their pain on an illustrated body.
“My follow-up”
A timeline is available for the patient and synchronized at every step of the patient’s path. Everytime a new step is added to the timeline, a notification is sent to the patient, so they don’t have to worry about missing their call. They have access to a short identity sheet presenting the caregiver they are in contact with. Indeed, many interviewees told us that the caregivers did not present themselves (mostly because they don’t have the time to do that) and it was difficult to know who to talk to. With this sheet, the patient can quickly identify the persons in charge of their file.
They also have the opportunity to check again the results of their previous meetings. Here again, it is a question of time, the caregivers don’t have much to spend with every patient and they have to explain quickly the diagnosis and the next steps. The patient might not get everything at first, so it can be helpful to have a sum-up available in the app.
Share the path with friends
The followup can be share via sms to as many friends and relatives as the patient wants. It provides them with an overview of the patient’s path and their current location. This way, they can be reassured, have real-time information and join the patient (if they are in an area of the hospital accessible for visitors).
A chatbot to answer the patient’s question
In the aim to have a complete follow-up and help people who might feel lost and alone, we added a virtual companion. A voice option is available for people that could have trouble typing, considering their predicament. Communication is one of the major pain point that we have identified. The caregivers in ED are very busy and cannot have a lot of time for everyone, so we imagined a virtual contact that would be able to provide information to patients.
Activities to help patients wait
It is difficult to really provide a solution for the pain of the patients through an app. However, if we can help them pass time and calm themselves, it can alleviate their overall predicament and make the wait less difficult.
This way, we imagined an activity section with four types of contents to:
- Reduce their stress
- Manage their pain
- Entertain themselves
- Get more information
A map of the hospital
Once the patient is notified of a new step of their path, they can activate the itinerary to get to the right service and the right room. It opens a map of the hospital, showing the patient’s location and their destination.
The map is actually accessible at any time, from the menu, and can also be consulted offline (without geolocation).
Complete lo-fi prototype:
What we learned
The first tests that we made already gave us insights and elements that we would have to consider for our next iterations. The exploration interviews led with caregivers helped us avoid shortcuts and features that could have poor consequences on their work and the patients’ experience.
For instance, we first imagined the follow-up as a complete timeline, presenting the entire path, up to the final diagnosis. However, it is impossible to have precise elements to share to the patient on the steps they have not reached yet, and it would be risky to rely on estimations. If we announced to our main persona, Lucas, that his radio appointment was set at 2 pm, but a more severe case arrives and delays this appointment, it creates even more frustration for Lucas.
The level of priority is also a sensitive subject. Caregivers have hierarchy systems to sort patients according to their priority. However, if we provide visibility on these systems to the patients, they won’t always understand the way their pain was assessed. They could consider that they deserve to be top priority, or even turn their frustration toward the patient that are planned to be treated before them. Even though a lot of the people we interrogated were very understanding about the reason they had to wait in their last experience, people in ED can be in very different states of mind and it is risky to give them that kind of information.
The study of the different personas also gave us different perspectives to ideate our solution. Even if the app we designed is not specifically done for Patrice, our extreme persona, there are features that can meet his needs: he already knows his diagnosis, he just wants to be treated quickly and as comfortably as possible.
To finish, the overall exercise helped us realize that with method, even a broad topic like “Public Hospitals” can be tackled. Of course, we narrowed it down to Emergency Departments, but even then, it can seem overwhelming at first. However, the research actually gave us many insights on the patients’ experience and led us to particularly interesting design opportunities.
