Category: St. Joseph Health Systems

I interviewed Julie at REAL Services, INC (Below is Julie, Front of REAL Services Building, REAL Services Logo):

Name: Julie

Age: 29

Occupation: Director of Client Services at REAL Services, Inc.

Summary: REAL Services, Inc. is an umbrella social services agency that has over 20 programs including elderly care, energy assistance, nutrition and transportation, and community action. Real Services has a partnership with Saint Joseph Health and Memorial while serving patients across 5 counties in Northern Indiana. Patients can privately pay for transportation assistance or, if applicable, use Medicaid coverage to get transportation to and from health appointments. Real Services assigns Case Managers to certain patients that need help, particularly with transportation. Volunteers and paid employees help with patient transport, but there is a limited amount of these volunteers and workers which limits the dates and times that can be offered to patients for transportation.

Key Insights and Quotes:

Real Services has a diverse, interdisciplinary team composed of various professionals including physicians, nurses, bus drivers, workers at REAL Services, community workers, and social workers. This advisory team has been working to create a more efficient way to transport patient to and from their appointments. Real Services has a moderately sized fleet of cars and vans to help patients transport. They have tried to implement taxis in the past but had a negative experience with them as the taxis were dirty and unkempt (not ideal for patient transport).  Finally, with the aging population (Baby Boomers), it is important to expect and respond to an increasing amount of elderly patients needing services.

“One patient said that the taxi driver was smoking in the car while driving the patient to the hospital.”

“We are looking into working with Uber, but we need more financial support to move froward with that.”

“While REAL Services does transport patients, but our transportation services operate within a very specific time frame which leaves some patients without transportation help.”

I interviewed a volunteer receptionist/clinical aid named Erik at the Sister Maura Brannick Health Center of the Saint Joseph Health System:

Name: Erik

Age: 24

Occupation: Volunteer/ Dooley Intern (Works as a receptionist and clinical aid) at the Sister Maura Brannick Health Center of the Saint Joseph Health System

Summary of Interview:

The Sister Maura Brannick Health Center provides services to those who are uninsured. Most patients are undocumented and Hispanic. While the center does occasionally give out bus passes, most of the center’s patients walk as they live close to the center. A lot of patients come to their appointments with family and friends.

Key Insights and Quotes:

The Sister Maura Brannick Health Center has recognized the issue of patient transportation within the Saint Joseph Health System and has worked with the University of Notre Dame to assign students to conduct a research investigation in order gain metrics on patient transportation need and supply. Because most of the center’s patients walk to their appointments, patient transportation is hugely dependent on the weather conditions with much lower attendance during the winter season.

The center is open late on Tuesday evenings to accommodate those patients who work during the day. The volume of patients is extremely high during this time.

Due to the center’s Hispanic population, the health center and transportation services in the area could benefit from having workers who know how to speak Spanish.

“Some inefficiencies arise when there is a language barrier between the patients and the center’s workers.”

“Attendance for appointments is much higher during the summer when the weather is nicer.”

“If a patient misses an appointment, there rarely is a follow up call to assess the reason(s) why the appointment was missed. We are looking into implementing follow-up calls in the coming months.”

I interviewed a patient in the lobby of the Our Lady of the Rosary Health Center of the Saint Joseph Health System (the patient requested to not be photographed):

Name of Patient: Rose (accompanied by her son Shawn)

Age: 72

Occupation: Retired (spends time reading, sewing, watching television, seeing her children)

Familial/Marital Status: Widowed. Rose does have four children. Her son typically helps her get to her appointments using his car on Monday afternoons when he is off from work.

Summary of Interview: Rose is an elderly, immobile patient in a wheelchair who typically goes to the health center once a month. Her son is a huge help to her as he has been taking her to all of her appointments over the past five years. Rose has chronic pain so it is important that she sees a doctor monthly in order to manage her pain and make any adjustments as needed.

Key Insights and Quotes:

While Rose has multiple children, she relies heavily on her son who supports her greatly. Without her son, she would have a much harder time getting to their appointments, especially because she is immobile. She works with the receptionist to schedule appointments almost exclusively on Monday afternoons if possible as that is the time of the week when her son if off work. Overall, while Rose is limited by her lack of mobility and time of the week when she can make it to the health center, Rose is able to keep up with her health. Rose is fortunate to have her son. Without her son, she would have a much harder time getting to her appointments.

“I come to Our Lady of the Rosary to feel better and reduce pain.”

“Buses are hard and cold. I wish that the bus was more comfortable.”

“I feel warm and safe in my son’s car. I really appreciate his help.”

 

My team tried contacting the South Bend Public School Bus System to learn about how they manage the transportation of students to and from school. We were not able to contact people who worked in the busing system and turned to other resources to learn about how public schools approach the organization of busing routes.  A public school system organizing the transportation of students across various regions and districts is similar to how a hospital may organize their transportation fleet to transport patients to and from their health appointments. Here is the information and online link to the public school system that we used to gather our information: The Rosemount-Apple Valley-Eagan Public Schools website is located here: http://www.district196.org/

School Bus Organization:

• Parents receive a postcard before school starts each fall showing bus stop locations, bus numbers, and times to take children to school
• School bus drivers do not have the authority to change bus routes or student pick-up/drop-off locations
• Bus stops are typically located at least three blocks apart
• Up to 25 students may be assigned to a bus stop
• Routes are established so no student rides the bus for more than 75 minutes one way (preschool students may not ride the bus more than 45 minutes one way)
• All decisions regarding school bus system organization center around providing safe and efficient transportation for students

Important Insights:

• Proper and even spacing of bus stop locations and times improves efficiency and uniformity among the school district’s busing fleet
• Establishing a maximum time that a student may ride the bus helps prevent long and burdensome bus rides for children (adapted for preschoolers to have an even shorter ride) – this can be applied to patients, having a shorter maximum time for elderly patients that other patients
• The overall goal of the school bus system is to ensure safe and timely rides for students (providing safe and timely transportation is something that all transportation service should strive for)
• The school bus system consistently assesses bus routes and stops and are flexible in making changes to make the system more efficient

I asked an elderly, immobile patient at Our Lady of the Rosary Health Center of the Saint Joseph Health System to view several images on a iPad. Once the patient viewed the images, I asked her to express her thoughts, feelings, and experiences with me. Below are the images I showed the patient, along with the patient’s responses:

   – Patient felt comfortable seeing this image. The patient associated this image with the final destination and a place where the patient can go for help and relief from suffering. Patient was happy to see this image and felt a sense of satisfaction.

 – Patient did not like this image primarily due to the fact that the patient felt that buses were uncomfortable and even dangerous. Patient has tried to take buses to places in the past but has not had good experiences with them. The patient expressed that, due to the patient’s immobility (wheelchair), buses present a huge challenge and sometimes cannot accommodate the patient in an immobile condition.

 

   – The patient was elderly and did not have a smart phone. The patient was entirely unfamiliar with this image and was not interested in learning more about it.

 

 – The patient found this image to be fairly neutral. The patient has used taxis in the past, but for transportation to a health center. The patient also cited the cost of taking a taxi as a reason for avoiding this method of transportation.

 – The patient felt best upon viewing this image. The patient expressed that this is her favorite method of transportation. While the patient cannot drive, the patient consistently has the help of family members who help the patient get to places, including health centers.

 

The patient was accompanied by a younger family member who facilitated the patient’s response to the above images. It was interesting to see how favorably the patient felt upon seeing the health center building, associating the picture of the building with help and healing.

Daniel Thompson and I participated in an immersion using the Transpo Bus Services in South Bend to see how a patient living near Notre Dame’s campus could get to the Saint Joseph Regional Medical Center if he/she has an appointment there. We initially got on the bus at bus stop “5” (see below) near the Martin’s Supermarket behind Notre Dame’s campus.

Once we arrived to the University Park Mall, we had to transfer buses in order to proceed to the Hospital.

Including the time it took to wait for a transfer bus at the mall, it took Daniel and I a total of around 57 minutes to get from the Martin’s Supermarket to the Saint Joe Regional Medical Center.

The trip felt long and a bit tiresome, which is valuable information to know considering the condition of a traveling ill patient. The cost for us was free as Notre Dame students. If we were not students the cost would be $2.00 to get to the hospital. The buses were punctual;however, we did not perform a return trip from the hospital back to Martin’s. While the bus drivers were kind and the seating was fairly comfortable, Dan and I talked about how taking the bus, as an ill and/or elderly patient, could be physically and mentally challenging and, in some time-sensitive situations, unpractical.

 

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.

*This is a supplement post of the Analogous Immersion done by Alex Charron and Joe Krause in the perspective of Joe.

Date: 3/3/17

Type: Analogous Immersion

Location; Mishawaka Chick Fil A

Participants:  Alexandra Charron and Joe Krause

The team visited the Mishawaka Chick Fil A (CFA) in order to gain knowledge regarding Chick Fil A’s catering and delivery process. The team spoke with Ron Taylor, the assistant manager of the Mishawaka branch.

Additionally, Alex researched the online ordering process, while Joe called the store to research the call in ordering process. It was a similar booking process accept an employee enters in the order information instead of the customer online.

Top Learnings:

• CFA will drop off food at a specific time and place and pick up the catering materials after the event.
• CFA prefers customers to return the catering materials after their event, but they will pick them up if necessary.
• CFA has a specific driver on staff, but will utilize other staff members if there are many orders on a given day.
• Logistically, CFA has a difficult time managing customer orders when big events, such as football tailgates, take place.
• CFA prefers customers to order at least 2 days in advance, but can still take orders 24 hours in advance.

Key Insights:

1. Logistically, the Chick Fil A catering service could be compared to the transportation problems that patients face getting to appointments, especially during times of mass catering orders.
2. Not limiting the number of potential drivers gives CFA excess capacity if there are a lot of orders that take place on a given day.
3. CFA is able to manage transportation for customers, which proves that there is potential to solve transportation problems for patients getting to appointments.

*Photos of the team’s analogous immersion, along with additional data and Alex’s perspective, are displayed below on a blog post from Alex.

 

 

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.

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 .