Author: Daniel

User Scenario:

User Pain Point: Users for our service include both medical offices and the patients that utilize these medical offices for consultations, appointments, etc. The offices face trouble in the form of lost revenue when patients miss appointments due to lack of access to transportation. Further, patients who miss appointments due to lack of access to transportation miss out on crucial medical services necessary to their wellbeing.	Entice: Patients and offices are enticed to implement this service because there is currently a high demand for reliable transportation options for people living in low income situations. Patients specifically will be enticed to use this service in order to gain valuable insights to the resources available for transportation to and from doctor visits. These resources primarily focus on subsidized, scheduled, and reliable transportation.  Patients will also be enticed with the rewards system that is attached to our service. We are going to continue to  test which reward will have the maximum benefit but at this point we are thinking that when the patient uses the service they receive “uber points” to use for transportation at their own discretion.	Enter: Patients specifically enter this service the moment that they schedule an appointment. When scheduling appointments, patients are referred to this service so that they have the ability to examine potential transportation options and costs. Additionally, offices enter this service at the same point in time so that they can also be assured that patients are aware of all available transportation options and costs.
Engage: Patients are engaged with the service the moment they begin to commute from their starting location to the desired hospital location through the use of the app. How convenient the overall use and implementation of app, minimal waiting time, accuracy, and positive experience with other individuals during commute are all factors that will measure how engaged the user is.	Exit: When users arrive to their destination using the app to find the transportation method that most suits them.  Volunteers and other SJHS employees will readily welcome patients as they enter at their specific appointments.	Extend: Users extend the use of this service by using it repeatedly for the long-term or even as a primary means of transportation to get to their appointments. The rewards system is designed to incentivize users to continue using the service.

 

IDEA 1 ( Alex)

Idea 1 consists of a system utilizing both an app/website as well as a receptionist/ transportation coordinator. The system will begin when a patient first schedules an appointment. The receptionist will as if they have a Smartphone. If yes the receptionist will ask if they would prefer to get text message and use an app or to receive a phone call. If no it will automatically be a phone call. A few weeks before the appointment there will be a confirmation text or call. With the text, the patient will confirm the appointment and answer if they need transportation help. If yes it will direct them to a webpage or app in which they can enter all of the relevant information such as appointment time, pickup location, insurance information, budget,number of passengers etc. The app will put out all of the relevant transportation options including cost and duration of trip and the patient will select and schedule the method of their choice. If the patient does not have a smartphone or does not choose to use the app a phone call will be made and a receptionist or transportation coordinator will enter the information into the system and book the transportation for them. Patients will also receive a push notification or automated phone call the morning of their appointment reminding them of their pickup time and method of transportation.

 

Entice	Enter	Engage	Exit	Extend
Patients are enticed to the system when they first become a patient or try and book an appointment after the program is implemented. Receptionists,  Doctors, and transportation coordinators advertise this service and there are pamphlets in waiting rooms and information online.	Patients enter this service when they are first onboarded into the system. When they book an appointment they can choose to opt out, opt in, or have it on an appointment basis. When patients are asked to confirm an appointment, they enter when they click YES they need transportation help	Patients engage when they enter all of their relevant information and select and schedule a transportation option for their appointment.	Patients Exit the program after they successfully make it to their doctor’s appointment and make it back to their desired destination.	Extend occurs when patients tell their family and friends about the system and encourage them to take advantage of it.

 

Idea 2 – Partnership with Uber/Lyft ( Dan and Cole)

Idea 2 involves St. Joseph Health System developing a partnership with Uber.  While prices associated with Uber may be a concern, the flexibility and readiness that Uber provides will have enough of a positive impact that SJHS will overcome its current transportation problem.  Some barriers to developing such a partnership include billing; while Medicaid patients are covered for transportation in most situations, the amount organizations are reimbursed varies between states.  Another issue is the fact that SJHS patients and clients may not have the ability to readily access technology such as smartphones used to request Uber rides.  The benefits that having clients use Uber affords healthcare organizations outweighs these barriers, and there are even ways to overcome these barriers.  At the following URL, https://tinyurl.com/n4rthzp, a healthcare expert discusses the various ways organizations have undertaken partnerships with Uber and Lyft to overcome problems with transportation.  There is an opportunity for SJHS to give patients access to requesting Ubers on their website or through phone calls with receptionists.  Our team will conduct further research into the intricacies of billing regulations and any other liabilities or other issues associated with SJHS partnering with a transportation company such as Uber.

 

Entice	Enter	Engage	Exit	Extend
While scheduling appointments, patients will be made aware of SJHS’s partnership with Uber and the benefits associated with using Uber.	Patients will have easy access requesting Uber rides through their smartphones, through the SJHS website, or through phone calls with SJHS employees.	Uber drivers will be knowledgeable of the reimbursement policies so that rider and driver feel in control of the situation.	Uber allows SJHS clients to leave reviews, similar to regular Uber users.  SJHS should look to develop a survey or platform to assess patient satisfaction.	Assessing a decrease in missed appointments and word of mouth will validate the usefulness of a SJHS-Uber partnership.

 

IDEA 3 – Fleet of vans/ shuttles  (Helen and Joe)

Idea 3 involves St. Joseph Health System to provide shuttle services to their clients. The idea is that clients would request a ride from designated pick-up and drop-off locations either online or through the phone. Clients will enter location, date and time, and how many people are riding with them. SJHS would then use its own vehicles to supply rides for its demanding customers. The designated locations can imitate the transpo bus stops or SJHS can cater more towards its clients by using its database to find the ideal drop-off/ pick-up zones. Although resources are tight, it could be a worthwhile investment for SJHS to buy one or two vans as it will pay off more for their patients to get to their appointments than to lose money for every missed appointment. Similar to Notre Dame’s SafeBouND system, volunteers could be in constant contact with a dispatcher for safety, legal, and logistical reasons.  

 

Entice	Enter	Engage	Exit	Extend
Patients are enticed to examine this service at the time that they schedule an appointment.	Patients enter this service when they confirm that they are in need of transportation services in order to get to an appointment.	Patients engage this service when they schedule a pick up by a hospital van/ bus, and fill out all required information to be picked up. They are then picked up from a designated location and taken to their appointment.	Patients Exit the service after they successfully make it to and from their appointment.	Patients extend this service by spreading word of it to friends, family, and other people in the community. Through this, the service will become more popular and utilized, allowing all patients to make it to appointments.

 

1. I placed my phone against a stack of papers and folders so I was able to watch videos on my phone.

2. I use a cup so that my toothbrush stays straight up and the brush part does not touch the counter.

3. I use a small plastic bag as a liner because my trash can does not have one.

Our team met with Michelle Peters, the Community Benefit Ministry Officer and Director Community Health and Well-being for Saint Joseph Health System.  During gallery day we discussed the research we had conducted, future plans to conduct additional research and begin prototyping, and Michelle offered very insightful feedback for different parts of the project.  Her involvement with SJHS has proven a valuable resource as she is very knowledgable about past projects about the same issue.  She also is a great resource in terms of understanding the dynamics of funding, an issue we consider to be one of the main obstacles in securing transportation for SJHS’s clients living in poverty.  Below are listed a few takeaways from gallery day as well as future plans for our team which we discussed with Michelle.

Main Takeaways:

• In discussing our journey map which illustrates patients’ journey to their appointment, Michelle noted that the main obstacles are actually finding transportation and the timeliness of a patient who struggles to find transportation.  Miss appointments can potentially result in economic losses for SJHS.
• Our Users, Needs, and Insights board provided excellent insights from social and non-profit workers who deal with transportation issues with their clients.  Michelle noted we could certainly learn more from more encounters with actual patients.
• After we talked about our immersions which included a bus ride, an uber ride, and borrowing a friend’s car, Michelle noted that she believes if SJHS were to provide transportation it would likely be through a partnership.  She still believes outlets such as Uber should continue to be explored though.

 

Further Research/Plans

• Michelle provided us with the contact information of SJHS case managers so we may gain a better understanding into the struggles faced by SJHS clients who are living in poverty.
• We plan to spend more time analyzing the intricacies of funding for publicly funded, private, and other means of transportation.
• We plan to observe the current state of SJHS and see if there are any unused resources that could potentially be utilized in a transportation service.

*Pictures of our team’s gallery day will be provided by other team members.

Ethnographic Summary- St. Joseph Regional Medical Center

Dan Thompson interviewed Becky and John, a husband and wife at St. Joseph Regional Medical Center (SJRMC).  They were waiting for their grandson who was also accompanied by his family, but I only spoke with Becky and John.

 

Date: 3/6/17

Type: Interview

Location: St. Joseph Regional Medical Center

Team participants: Conducted interview alone

 

User characteristics:

• 60 years old (Becky), 65 years old (John)
• They have three daughters and 4 grandchildren
• Becky used a wheelchair

 

Memorable quotes/moments:

• Apprehensive of using public transportation.  When asked about how they felt about using bus, Becky mentioned she had not used one since high school.
• Were completely unaware of Uber or Lyft.
• There drive was about 12 miles which took them 20-30 minutes.

Top learnings:

• Elderly people are more likely to resist using technologies such as Uber or Lyft.
• Public transportation is not for everyone for a variety of reasons.  One specific reason may be that some people associated a negative stimulus with public transportation

Key Insights: (1) Depending on the person’s experience, they acquire information in different ways.  (2) Much time should be given to how an organization advertises transportation services.

Ethnographic Summary- St. Joseph Regional Medical Center

Dan Thompson interviewed Linda, a woman whose husband was in the Emergency Room at St. Joseph Regional Medical Center (SJRMC).  She spoke about her experiences traveling to and from the medical center

 

Date: 3/6/17

Type: Interview

Location: St. Joseph Regional Medical Center

Team participants: Conducted interview alone

 

User characteristics (Linda):

• 68 years old
• 2 sisters and 1 brother who live in different cities other than South Bend
• Her brother runs a transportation service for the elderly in the city in which he lives
• Her reason for traveling to the hospital was for her husband

 

Memorable quotes/moments:

• She purchased a car yesterday in anticipation of her husband’s visit to SJRMC because she was unable to climb into his truck, the only car owned between the two previously.
• When asked if she was familiar with services such as Uber and Lyft, she spoke of the elderly saying, “don’t do this push button stuff” in reference to technology.
• When discussing what hospitals could do better in terms of providing transportation, she said, “Why can’t they pay taxes for it?”  She seemed upset at the fact that issues of funding even existed.

 

Top 3 learnings:

• Even those that own transportation struggle traveling to and from places.  In Linda’s case, she struggled accessing her husband’s car and had to purchase a new one so that they could get to the hospital.
• Some demographics, especially the elderly, are unfamiliar and sometimes even unwilling to use new technologies like Uber and Lyft.
• Although a lot of people, such as Linda, do not miss appointments, they still feel passionate that more resources should be utilized to help patients access the hospital.

Key Insight: (1)  The elderly and those with disabilities are specific populations that really need assistance traveling to and from the hospital.  (2)  Providing transportation is not only a practical and financial matter, rather the organization’s image can be impacted positively or negatively by the public’s perception of their transportation service or lack thereof.

Initially, we planned to contact South Bend Public Schools to gain insight into how they plan their bus routes.  After several missed calls, we located a school system online that provided adequate information for us to gain a better understanding of how a school system plans their bus routes.  We thought this experience would be informative in that it would give us guidance for how St. Joseph Health System could standardize a transportation service for a diverse population

The Rosemount-Apple Valley-Eagan Public Schools website is located here: http://www.district196.org/

 

Bus Article Summary:

• Routes are determined by measuring the shortest distance from residencies to the school’s front door.
• Parents receive a postcard each month with bus stop location, bus numbers, and the arrival/departure times for specific school.
• Bus stops are determined by safety, efficiency, and distance between stops.
• Buses are located at intersections for efficiency and safety.
• The school system provides parents guidelines to ensure their kids have a safe and efficient bus ride

Insights gained:

• Each parent and/or family has specific needs and preferences which makes it difficult to standardize a bus system.  I recognized this after reading through the Q/A section for parents.
• The school system consistently assesses bus routes and stops; they say they are willing to adjust routes if needed.  This sheds light on the importance of remaining flexible throughout the process.
• The school system’s guiding principles for planning and handling bus routes are safety and efficiency.

 

 

These are images of various aspects of a typical journey to and from medical services for someone living in poverty.  I will ask people how they feel about each image as part of my interactive ethnography.

Kari Tarman heads Marketing and Communications at Oaklawn.  Oaklawn is an organization that provides mental health and addiction services in South Bend, Mishawaka, Goshen, and Elkhart.  The organization provides transportation for many of their clients since they are unable to drive.  Learning about their transportation services provided insight into how we can help St. Joseph Health System with their issues transporting patients.  Below are the questions I asked with summaries of our discussion, as well as key insights gained.

 

Could you please tell me about Oaklawn’s mission and the specific population you serve?

• 80% of Oaklawn’s clients are Medicaid/Medicare recipients.  This is relevant since Oaklawn can bill these programs for transporting the clients.
• Oaklawn provides inpatient and outpatient services, including a residential program at one location.
• There are two main barriers for their clients securing transportation.  One being they are physically unable to drive and two being they felt stigmatized being in public.
• “With all of those barriers for people to come to services, we found that providing transportation increases engagement in services.  So we have better success treating clients, better medication management, better relationships with our clients.”  (Tarman)

 

How does Oaklawn bill for transportation?

• Clients must meet certain criteria on a sliding scale to be considered a “billable account”.  This includes type of patient condition, type of appointment, and several other parameters.
• It appears that smaller organizations are less willing to bill for transportation because they do not have the administrative resources.
• Oaklawn has a system that keeps track of patient records, cancellations and missed rides, and many other factors to continually assess the efficiency of their transportation service.
• Richard, a driver who spent part of the interview with us, thought the base rate for a one-way ride was 50 cents.

 

What are the efficiencies and inefficiencies of Oaklawn’s transportation service?

• There are 4 drivers, sometimes 5, and each drives an Oaklawn registered van that holds 7 passengers.  Sometimes they use a sixth car if one of the vans is not working or they are too busy.
• The drivers are local area residents and are very familiar with the area.
• Kari mentioned employing your own drivers is beneficial in that you can train them specifically to work with your clients.
• Another pro of providing your own transportation is that it “gives you a credibility source as an organization to say we offer this service to the community and we’re working to serve this population.” (Tarman)
• It is crucial to be able to communicate with clients or their support network to assess whether they want to continue to use the services.
• Richard mentioned often times they are overwhelmed and drivers must be able to be flexible and pick up other clients that may have been on another driver’s route.
• The vehicles do require periodic maintenance.  Each van has a gas card and car wash voucher provided by Oaklawn.
• The biggest challenges are clients living in different locations and that fact that many appointments vary in length so it is sometimes difficult to schedule.

 

What are the pros and cons of South Bend Transpo, private companies like Uber and Lyft, and services provided by the specific corporation?

• Public transportation
  • It is not used in South Bend as frequently as other places.  There may be a stigma attached to using such services.
  • If people do use it though, it is cheaper for the city in the long term
  • It typically takes a longer time to get from point A to point B on a bus than by other means.
• Uber/Lyft, etc
  • Difficult for corporations to expense
  • May not be trained to work with specific clients
• In house transportation
  • Hiring drivers allows for more personalized training and results in more accountability.
  • The corporation looks good in the eyes of the public.
  • Resources must be allocated to implement and maintain the services.

 

Do you mind providing some insight into the typical day as a driver?

• Drivers are told to honk upon arrival at a client’s residence.  If they do not respond in two minutes the driver calls the supervisor to make a decision.
• If a client has two no shows or cancellations, they are placed on will call and must make an extra phone call each morning they are scheduled for a ride until the supervisor deems they are in good standing.
• Drivers use radios and now smart phones to keep in constant communication with other drivers and the supervisor.
• Other than driving, drivers keep track of mileage and whether clients showed up or not.

 

Key Insights:

• A transportation service must be structured so that the service is flexible and able to deal with issues as they arise.

• Ideally, the clients view the service as a privilege so that they follow through on their commitments to use the transportation service.  Increasing cancellations and no shows hurts Oaklawn financially and in other ways.

• Although funding is required for a transportation service, the service likely enhances the quality of interactions between the organization and their clients.

• It is a huge benefit to be able to communicate with clients whether or not they want to continue to use the service is they have missed several rides.  An inability to communicate with patients who do not show up to their rides may provide a huge issue.

• A corporation must have the resources in place to bill for transportation.

 Cole and I rode the South Bend Transpo as part of our immersion experience for our project.  We wanted to take a bus from any South Bend location to St. Joseph Regional Medical Center.  We got on the bus near the intersection of Ironwood and Route 23.  Fortunately, the ride was free since we had our Notre Dame IDs; but a bus ride typically costs $1 for a resident.  If someone is handicap, they can request a ride from a van for $2.

 The first bus route did not include St. Joseph Medical Center though.  We had to stop at University Park Mall where we had to wait 30 minutes.  Fortunately, Cole and I were able to walk around the mall to pass the time; but many people cannot spend any leisure time away from the bus stop because they are sick or absolutely cannot risk missing the bus.

 

 After we boarded the bus at the mall, it made a few stops then finally reached St. Joseph’s.  The bus dropped us off at the door and our simulated immersion was over.

 

 Looking back on our trip on the bus to the hospital, we gained valuable insight into the challenges that many people face while trying to get to medical appointments.  Although the bus drivers were very friendly and buses were on time, our trip from bus stop to hospital took 57 and a half minutes.  This is especially concerning because many of St. Joseph’s patients come from work and cannot afford the time it takes to go on an hour bus ride, spend an indefinite time at their appointment, and go on another hour long return ride.  This immersion will be very helpful as we frame and conduct the rest of our research.