Service designing my hospital visit
I’m intrigued about the design of services, like a hospital visit, so felt inspired to blog about what I noticed.
My boyfriend and I spent the weekend in sunny Devon, staying with my parents for a family gathering in Exmouth on Saturday. Unfortunately, clumsy Nathan hurt his ankle while playing football with a child and limped around in pain for the rest of the day.
On the Sunday, we decided to drive over to the local Minor Injuries Unit to get it checked out. I’m intrigued about the design of services, like a hospital visit, so felt inspired to blog about what I noticed.
Deciding to visit the hospital
As with many medical visits, we were faced with the ‘do we, don’t we’ dilemma of whether this was a serious enough injury to seek professional treatment. I checked the NHS website to help make the decision.
In general I was pretty impressed with the information available. I easily found the opening times, phone number and the type of injuries they treat. An added surprise was the real time waiting times and the number of patients waiting to be seen. For most services I expect most things to be digital and feel peeved when (often) this is not the case. However, for the health service I don’t usually expect digital services, so I was pleasantly surprised by this.
The first sentence on the page (after the table with the key information about the facilities) was the following:
Please ring before you visit your local Minor Injuries Unit (MIU) to check that it is the most appropriate place to be treated for your ailment or injury.
Thanks to the laws of content design this caught my attention, so I gave the unit a call. The lady on the other end of the phone, informed me it was a walk-in unit and there was no need for me to call. I explained I was told to call first by the NHS website. She seemed surprised and miffed by this and hurried me off the phone. This step seemed like a waste of everyones time. She was clearly busy, likely dealing with other patients in the reception. I felt a bit stupid for calling up.
Parking at the hospital
I took a pocket full of change with us, as I expected the hospital had a pay and display car park. As I stood in front of the out of order payment machine, scanning the car park for another, a kind stranger on her way out offered me her ticket with 2 hours left on it.
I’m not sure why we have to pay to park at hospitals. It may be a way to make money, to deter local people using it as a free place to park or something else. Whatever the reason, the upfront payment does not work well for A&E or other walk-in hospital services. How are you supposed to know how long you are going to be? It must be fairly common that patients overpay their parking and have a ticket they could pass onto someone else. This might be frowned upon by those running the car park, however they have received payment for a parking space for a certain amount of time, so why should it matter which car is parked in it.
It would be cool if there were a way to donate your parking ticket on your way out (a box by the parking meter or in the hospital reception?), so that it could be passed onto someone in need.
Entering the hospital
As we entered the hospital, we followed signs for the Minor Injury Unit. Once Nathan had hobbled down the corridor, we arrived at an unmanned reception desk with the following sign above it:
To me this felt unclear. It didn’t explicitly say that the desk in front of us was not the main reception. Neither did it say where to find the main reception. We asked a couple in the waiting area, who pointed us back the way we had come.
In usual circumstances, for the fit and healthy, this wouldn’t have been a big deal. However, when attending an injury clinic, it’s likely you may have mobility issues. Better signposting once entering the building is a small thing that could save a lot of pain.
Once at the main reception, Nathan had to receit lots of information to the receptionist to register as a patient. This included names, contact details and four addresses:
- our home in Cardiff
- my parents
- his parents
- his GP
This was a very slow and painful process. It got me thinking there has got to be a better way to enter this information. Having a self-service option where you can enter those details yourself might be more efficient. This could be in the form of a piece of hardware, like an iPad or terminal like they have to check in at the GP, or a website you can access from your own device (of course there would still need to be an alternate option for those who would struggle to self-serve).
Seeing the clinicians (part 1)
Upon re-entering the Minor Injuries Unit, Nathan was immediately called to answer some initial questions with a healthcare assistant. Some of the information she asked for he had given seconds before at the main reception desk.
Obviously she had been alerted by her computer system that Nathan had checked-in at the unit, as she knew to call him over to her desk. It stands to reason then that she could have accessed his previous answers and therefore did not need to re-interview him about the injury.
This got me questioning — was this asking of duplicate information a deliberate design decision. It could be that despite seeing her colleagues account of Nathan’s story, she purposefully asks the same questions to:
- gain richer detail
- validate her colleagues conclusions
- see not just what he says but how he answers the question
…Or it could just be due to the IT systems not passing over all the information.
Next Nathan took a seat in the waiting area with the other patients. I left the building to quickly send a text. In the two minutes I had been gone, he had been called into the nurses office. I was really surprised that he had been seen almost immediately.
When Nathan returned, ten minutes later, he had taken some pain killers and been instructed to wait to be assessed again in half an hour.
The waiting room
There were a few oddities in the waiting room that caught my attention.
The first were these posters explaining that patients will be seen in order of priority.
This tickled me because I have imagined that they wrote the first sign to stop patients complaining that others, who arrived after they did, were being seen first. However, due to first sign not being effective at stopping the complaints, they refined it to the shorter version. If this is actually what happened (and not just a figment of my imagination), it’s an excellent example of iterative content design. It’s just a shame they didn’t take the first poster down (more is more…).
The next questionable piece of design was the entrance to the X Ray waiting room.
Now this could just be someone being funny. However, I daydreamed that they did this because patients were having trouble finding the right room. If this were the case, I would guess it was because the ‘official’ sign attached the the ceiling is titled ‘Imaging Department’. This might not be a phrase that patients automatically associate with their X Ray and therefore they overlooked it (despite the fact it does say X Ray in smaller writing underneath).
The third thing I would like to share from the waiting room is the water dispenser.
Looking at this machine and drawing on my 25 years of drinking water, I would presume one of these buttons would dispense cold water and the other even colder water. What baffles me is how I am supposed to know which button to select.
Blue is a colour that has familiarity with water. I do not feel uncomfortable selecting option blue to get my water. Green, however, is not a colour that I wish to associate with a drink. Why green was chosen for this machine and what the function of this button is, I will never know (unless someone reading this can enlighten me!).
Seeing the clinicians (part 2)
I found the half an hour wait a bit strange. Usually when waiting in a walk-in facility, you’re somewhere in a queue of other patients and you don’t really know how long it will be until you are seen. Having certainty around how long we were waiting and why, made anxious, impatient me feel much more chill.
If this experience is shared by others, then giving live waiting times is a technique that could be used to improve people’s experiences. However, if the wait ends up being significantly longer than you were told, how would you feel then? Would waiting much longer than you were told make your experience significantly worse than knowing the original wait time made it good? In that case there may be some sense to keeping people in the dark. I presume knowing why your wait is long may also be important.
Nathan’s pain had not improved with the pain killers so he was sent for an XRay. Afterwards, the nurse and Nathan sat at the computer screen together to review the image. I thought this seemed like a really good way to build trust as Nathan could understand how the nurse was making his decisions.
Nathan was told that it was likely a sprain, however, there’s a chance it could be something else, like a fracture. He took Nathan’s mobile number and said if it comes to light that it’s not a sprain, he will call.
This is a design pattern for getting medical test results that I’ve experienced before. If there’s a problem — we’ll call. If we don’t call you — it’s fine. I appreciate that it’s a time saver to only call those patients that need to be followed up about something. However, my worry in these situations is ‘what if I gave my number wrong by mistake and they need to get hold of me but can’t?!’.
Final reflections
I enjoyed pondering these things as I spent my sunny Sunday morning sitting in a hospital waiting room. I appreciate that it is full of my biases and assumptions and no evidence from people who are not me.
I hope that I did not come across as critical in my thoughts. I love the NHS and think our healthcare professionals do a marvellous job. I also think that everyone involved could benefit from employing a service designer, but that’s true of every public, private or charity service!
