Author: Graciela Hasbun

While on spring break and cancun, my friend nick took his sunscreen out at the pool and had taped a red solo cup shot glass to the top of the spray sunscreen to prevent it from leaking and spraying in his bag when he traveled and checked them. He said he didn’t trust the twist top

One of my roommate’s televisions was not high enough for her to see when she was laying in bed so she propped it up on printer paper to make it taller so she could see.

A friends freezer kept popping open and their food would spoil as it would not remain sealed and cold. They now use a duct tape latch to keep it closed when not in use.

My other roommate didn’t have a place to dry her bathing suits after coming back from break and hand washing them. She decided to use her shower curtain rod as a drying rack and placed a bath towel on the floor to catch the dripping water

Date: 3/3/17

Type: Immersion

Location: From Notre dame to St Joseph Regional Medical Center Mishawka Campus and back

Team Participants: Alexandra Charron and Joe Krause

The following is a supplemental perspective to the ethnographic summary previously provided by Joe Krause detailing the interviews with uber drivers and the statistics and costs of our trip.

On Friday, Joe and Alex took an uber to the St Joseph Regional Medical Center from Notre Dame and back to provide a contrast to to Dan and Coles bus ride. We aimed to compare time, ease, and cost of using uber instead of the transpo bus. Once arriving at the medical center we tried to navigate the hospital using the map to find the various offices we needed to interview people at. We tried to use the map in order to measure the ease of navigating the facility, as if people get lost looking for their medical office they make arrive late to their appointments causing them to have to reschedule.

We found the uber trip to be a very effective method of transportation. The trip to the Medical center took 11 minutes and cost 13.51 and the rip home took 12 minutes and cost $7.28.

Joe and I did have to wait 8 minutes outside in the cold which might be hard if you are sick or elderly, but could always have the option of waiting inside.

Once inside the hospital, Joe and I walked around and easily located a facility map. While the map was fairly easy to understand, all of the hallways looked the same and Joe got quite lost coming back from the bathroom. He said he walked around for 6 minutes trying to find where I was as ” all of the hallways look the same and there are lots of corners”.W

We observed that while some signs has a Spanish translation below them, others didn’t. This could also be a cause of delay and late arrival to appointments if patients can’t read the signs to figure out where they are going.

While standing in the lobby, Joe and I overheard a couple sitting in the hallway ” this goddam bus takes so long”. They had been sitting there for a considerable amount of time as we kept walking past them while conducting interviews and research. They unfortunately declined to speak to use when approached.

Key Takeaways

• Uber is a time effective way of getting to appointments but $20+ round trip is expensive.
• It was easy and dropped us door to door and picked us up right when we were finished.
• It required the use of a smart phone and credit card/ bank account
• The hospital was slightly confusing to navigate, and some signs are not in Spanish .
• People waited a long time for the bus .

Geoff Zimpelman, Manager, Population Health &Multi-Cultural Access for St. Joseph’s Health  Systems provided us with the following data on Missed appointments and no shows for St. Joseph Health Care System’s.

• There are 2 types of productivity losses when it comes to patient appointments. The first is cancelled appointments, and the second is no-shows.
• Cancelled appointments are variable because those slots could be filled with another patient, so there is not always complete productivity loss when it comes to cancellations.
• No-shows are a true productivity loss.
• Within the Saint Joseph Physician Network we had approximately 42,500 no-shows in the past 12 months.
• This accounts for approximately 12.1% of all appointments being lost productivity and revenue due to no-show. These no-shows often turn into another scheduled appointment. We have no-show policies in place to remove patients from continuing to schedule appointments at a practice if they habitually no-show.

During our conversation with Geoff, he stated that while they have this data, it does not indicate what percentage of missed and no show appointments are due to transportation issues.  He does believe that transportation plays big role in missed and no show appointments.

Interactive Ethnography

Date: 3/3/17

Location:St Joseph Health Systems Mishawaka Medical Center.

Participants: Alexandra Charron and Joe Krause

For an  interactive ethnography, Joe and Alexandra visited the Mishawaka Medical Center and asked patients to mark a red X on the journey map of getting to a medical appointment the step where they face problems.

The question we posed was “ Do you ever face problems in the process of getting to a medical appointment?” and then we handed them a piece of paper and directed them to mark a red X on the step of the journey where they mostly face problems or to indicate that they do not face problems getting to appointments.

After the patient left, Joe and I tried to record the patient’s gender and approximate age and if there were any other notable observations.

We were able to perform the interactive ethnography with 9 patients. Of the 9 patients

• 4 responded that they do not face transporation issues
• 2 people, an older man and a younger woman with a young child  responded that they have  issues making it to his appointment on time
• 1 woman responded that she forgets to attend appointments
• 2 people, a younger man and an elderly woman  responded that they have issues arranging transportation

Ethnographic Summary

Analogous Immersion

Chick Fil A Catering Process

Date: 3/3/17

Type: Analogous Immersion

Location; Mishawaka Chick Fil A

Participants: Lead by Alexandra Charron accompanied by Joe Krause

For our analogous immersion, Joe and Alexandra visited a local Chick Fil A to inquire about their catering service and the process for booking and scheduling drop off and pick up times. We spoke to Ron Taylor the assistant operations manager as well as examined the online catering scheduling and ordering form.

Interviewee: Ron Taylor, Chick Fil A Mishawaka Store Assistant Operations Manager.

Insights:

• Patrons can schedule catering delivery online or by calling the store.
• Once scheduled, CFA drops off the food at the specified location at the specified time
• They have an on staff driver, but if there is excess orders they will have  other staff act as drivers.
• They encourage patrons to drop off the hot plates and supplies when they are done as it is difficult to schedule and organize pickups due to the variability of end time and inability to schedule in advance.
• They have difficulty coordinating pickup times with football games.
• They would like a heads up and some notice before big orders in order to adequately plan.

We then examined the online form/ system that CFA uses to schedule catering drop offs.

1. You are first prompted to select Delivery or Pickup. We clicked Delivery

2.  You are then prompted to enter your delivery address

3. After Submitting the Address you are prompted to select the store you want to use. 

4. After selecting a restaurant you enter the desired delivery date and time 

5. You then select desired food you want delivered and then pay and schedule delivery 

Key Takeaways

• CFA also struggles with scheduling pickup times after the product was delivered due to variable end times and inability to schedule in advance.
• Their online scheduling platform is simple and self explanatory.
• They have a system in place to deal with a large influx of deliveries at peak times incase their on staff driver is overloaded.

Ethnographic Summary

Obi Madukoma

Care Coordinator Population Health – Mishawaka Medical Center

Alexandra Charron interviewed Obi Madukoma, Care Coordinator Population Health, from the Family Medicine Center at the Mishawaka Medical Center. She was able to provide insights on the transportation issues and voiced that she believed part of the issue was due to lack of marketing and awareness of the resources available.

Date: 3/3/17

Type: In Person Interview

Location: Family Medicine Center  St Joseph Health Mishawaka Medical Center

Team Participants: Led by Alexandra Charron accompanied by Joe Krause

User Characteristics:

• Care Coordinator
• Patient facing employee of SJHC
• Jack of all trades position
• Helps patients when they have identified issues
• Works in the Family Medicine Center with primarily low income patients
• Helps patients when they can’t afford appointments, medication or if they have health care and or financial issues
• Patients are referred to her

Memorable Quotes

• “ People and staff in house don’t know about the resources. There is a communication gap”

• “ The nurses and secretaries are good at transportation assistance so I don’t usually have to deal with that a lot”

• “ The patient has to make the calls to medicaid most of the time as when i call medicaid says “just ask the patient to call us instead” as it usually involves proprietary information”

• “ I am like a coach/ navigator for the patients”

Key Insights:

• Unawareness is a big issue. Patients and often staff do not know about the resources that are available.
• Part of the problem is that there is not enough marketing for the resources available and when people find they have a problem they often don’t know where to look for a solution.
• If patient have insurance and Obi knows what kind she is able to help them and direct them to the specific resources for their insurance type.

• Nothing is centralized. Each clinic and office does different things and they don’t work together with things such as transportation.
• Big problem is that patients are often late to appointments and office has a policy that if you are more  than 15 minutes late to an appointment you will have to reschedule. (see image below taken in office)

• The outreach department does provide resources for seniors and low income people but the outreach department is not involved with everyone in the system
• Lots of issues with using approved transportation as medicaid only supports certain transportation services.

Other Findings:

• A lot of the burden to schedule transportation sits on the patient who might be unable to do so or not know how to do it.
• This is partially due to medicaid wanting to speak to the patient directly
• There is a lack of information on the resources available.

Environment:

• In the front office/ reception area of the Family Medicine Center
• Family Medicine Center St. Joseph Hospital Main Campus