Category: Projects Spring 2017

Joe, accompanied by Alex, visited the office of Volunteer Services at Saint Joseph Regional Medical Center (Hospital) in order to determine what roles the volunteers play in terms of transportation for patients. The team members spoke with Cari Wilson, Director of Volunteer Services, as well as Robert, one of the daily volunteers. In talking with Cari, the team discovered that there are multiple resources for patients to use in order to get to the center, but some of the time they simply are not aware of those services. For instance, a patient may not be aware that the Transpo bus runs every hour to and from the hospital. Rob, who works at the front of the building welcoming people, informed the team that it is very rare for a patient to come to the hospital and then face a transportation problem leaving the hospital. This is because, in most cases, patients will not come to the center without planning their travels beforehand. The ethnographic summary of the interviews is attached below, along with a few pictures pertaining to the interviews.

Ethnography-Volunteer Services

Ethnography Summary- Ranae: Receptionist at Family Medical Center inside Saint Joseph’s Hospital

Team members Joe Krause and Alex Charron interviewed receptionist Ranae in order to determine how often appointments are missed and cancelled with the Family Medical Center of SJHS .

Date: 3/4/17

Type: Interview

Location: Family Medical Center within Saint Joseph’s Hospital in Mishawaka, IN.

Team participants:  Led by Joe Krause and accompanied by Alex Charron

User Characteristics: “Veteran Receptionist for the Family Medical Center”

• 10+ years handling patient appointments, cancellations, and no-shows
• Helps register patients who have appointments
• Makes reminder calls to ensure that people are aware of their appointment

Memorable Quote- “The transportation services provided through Medicaid are inefficient and often result in a patient being so late that they completely miss their appointment.”

Top 3 Learnings:

1. Access to transportation in order to get to a medical appointment is a much bigger problem than people think.
2. Medicaid will pay for transportation to appointments, but they require a 72 hour notice and the patient must use specific approved cab companies. These cab companies often show up late, causing a patient to be late to an appointment.
3. There are a lot more cancellations than no-shows because a patient may lose complete access to the office if they miss a few appointments with no advanced notice. However, no-shows are unproportionally due to lack of transportation.

Key insight- Medicaid will cover the costs to get to and from an appointment, but most of the time cab services are late which cause patients to also be late. The family medical center has a policy that if a patient comes more than 15 minutes late, then their appointment will be cancelled automatically. Furthermore, not all patients are aware that medicaid will cover transportation expenses, so they look for alternative ways of getting to appointments that do not always work.

Activities:

• Met Alex on campus and took uber to the hospital.
• Spoke with various employees and patients
• Took referrals in order to gain the perspective of multiple stakeholders
• Left the hospital

Environment:

• Saint Joseph’s Hospital
• Family Medical Office

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.