Category: St. Joseph Health Systems

*This post is supplemental info from the Interactive Ethnographic Research done by Alex and Joe. (Joe’s perspective)

Interactive Ethnography

Date: 3/3/17

Location: St Joseph Health Systems Mishawaka Medical Center.

Participants: Alexandra Charron and Joe Krause

As described in a recent post, the team went to Saint Joseph’s Regional Medical Center and conducted interactive research by having people identify their transportation issues on a journey map. The team asked a total of 9 people, “Do you ever face problems in the process of getting to a medical appointment?” They then handed them a journey map and had them mark an X where they faced problems.

This was a great way to gain anonymous information from people, especially since lack of access to transportation can be a touchy subject. The team made sure to ask people of different demographics in order to understand various perspectives.

Key insights:

1. This was an effective method because people were able to easily ID what problems they have through their basic instincts. They were often caught off guard, which allowed them to ID their problems without much thinking.
2. 4 of the interviewees did not have any transportation problems getting to appointments.
3. 2 of the interviewees sometimes had a difficult time arranging transportation.
4. 2 of the interviewees were often late to their appointments.
5. 1 of the interviewees missed appointments on occasion due to forgetfulness.

A more detailed summary of the interactive is displayed below in a blog post by Alex Charron, along with various pictures of the research.

The teams originally journey map is also attached below this blog post.

Interactive ethnography- Journey Map

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

Ethnographic Summary

Kaley Kubiak

Transportation Coordinator for Riverbend Cancer Services

Alexandra Charron interviewed Kaley Kubiak, the transportation coordinator for Riverbend Cancer Services, a South Bend nonprofit that provides assistance, services, and support to low income cancer patients and their families. Kaley was able to share the successful transportation scheduling system that Riverbend uses and how she is able to schedule 300 patients transportation to and from their appointments. She also provided insight on the various transportation optional available to low income patients.

 

Date: 3/2/17
Type: In person interview
Location: Notre Dame Bookstore as she is a student

Team Participants: Alexandra Charron

 

User Characteristics:

• Female, age 21
• Part time employee (15- 20 hrs/ week) at Riverbend Cancer Services, formerly worked full time over the summer
• Job is to schedule transportation to appointments for low income cancer patients
• Senior at St Mary’s college
• Majoring in Communicative Science with a Minor in Social Work
• Employed since May 2016, took over transportation system from predecessor Mollie

Memorable Quotes

• “ If we were not providing transportation they would not be coming to appointments”

• “Scheduling one single ride might take 7 separate phone calls and conversations”

• “ Most of my clients do not even have cell phones and if they do they are flip phones”

• “ We only have 300 dollars to spend on each patient each year and somehow we make it work. We get them to all of their appointments which can mean weeks of radiation and chemo. I have only had two people run of the money”

• “ We have to make every dollar count and stretch the 300 dollars and we do that by having lots of transportation options”
• “ Someone will call me at 930 am and tell me they need to get to an appointment at 130pm. .They could have called me 2 weeks ago but they didn’t”.

Key Insights

• Kaley spend 15- 20 hours a week solely focused on scheduling transportation for 300 patients and says the phone is constantly ringing off the hook and it takes her working efficiently and swiftly for the full time in order to make sure everything is scheduled.

• Riverbend conducted stress screening on clients in relation to transportation and found a significant decrease in stress when transportation was provided to them.

• Kaley said that her personal relationships with healthcare providers and the social workers at the hospitals and healthcare facilities is essential to her success in order to make it efficient and successful.

• Patients inform Kaley of their need for transportation and appointments times in all forms. She receives these requests in person, over the phone, through email and from a social worker or health care provider.

• Riverbend uses a verification process to confirm appointments and make sure gas cards and transportation is being used for intended purpose. This is where the relationships with the health care providers comes into play

• Patients miss scheduled pickups all the time but there is nothing Kaley can do. She just tells them they risk not being able to use that service again. Some services charge a no show fee and that is deducted from their 300$ budget

• Pickup is usually an hour before scheduled appointment . Pickup from the appointment is dependent on service. In some cases the patient will call when done with appointment and be picked up 20 minutes later and in other cases Kaley will have to ask physician how long appointment is supposed to last and inform transportation service.

 

River Bend Transportation Method Selection Process

 

• Ask Patient if they have access to a car
  • YES
    • Provide them with gas card
    • Calculate amount with algorithm
      • 15 miles per gallon
      • Round trip mileage
      • Number of appointments
  • NO
    • What kind of Insurance do you have
      • Medicaid ( Can also use no insurance options if below doesn’t work)
        • Patriot

 

 

• Medicaid Approved transportation
• 16$ minimum
• Serves surrounding area and will also go farther away
• LCP

 

 

• Accepts medicaid patients patriot wont
• Only accepts medicaid
• No insurance
  • American Cancer Society Volunteers

 

 

• Free volunteer service
• Not always available
• Transpo access

 

 

• Have to apply
• Have physician sign off
• 4$ rides round trip
• Pick up from home
• Have to schedule 2 weeks in advance
• Patriot

 

 

• More expensive without Medicaid
• Perfect Time
  • Last resort
  • Wheelchair accessible and will provide assistance
  • 75$ round trip

 

 

Environment

• Notre Dame Bookstore
• Was unable to coordinate time to meet at Riverbend as she is part time and class schedules did not coordinate

 

 

 

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.

 

 

Ethnography Summary- Uber Immersion

Joe Krause and Alex Charron took an Uber to and from the Saint Joseph Regional Medical center in order to estimate ride costs and duration, as well as talk to the drivers to gain their perspective on current transportation problems. The team spoke with 2 different drivers who asked to remain anonymous. The team combined the information from both drivers into 1 summary because both drivers had similar responses to our questions.

Date: 3/3/17

Type: Immersion

Location: From Notre Dame to Saint Joseph Regional Medical Center and back

Team participants:  Joe Krause and Alex Charron

 

User Characteristics: “Uber Driver”

• Drives clients to a specific location using an App-driven service
• Deals with people who have the App regardless of their demographics or background

 

Memorable Quotes:

• “Older people who cannot drive are starting to use Uber more, which I think is great because they are less dependent on public transportation or family and friends.”
• “It does not always make sense for me to drive during the day since I get way more money when I drive at night.”
• “I usually just drive whenever I have free time and I think that is the case for most drivers.”

 

Top 3 Learnings:

• Older people who cannot drive are beginning to use Uber as a main form of transportation to get anywhere ranging from doctors appointments to grocery stores.
• Before 8pm, most people use Uber to get somewhere that they need to go such as the dry cleaner or grocery store. After 8pm, most people use Uber to go to dinner or a bar.
• Surge charges drastically increase the price of an Uber.

 

Key insights:

• There are a lot more Uber drivers working at night because they make a lot more money working at night compared to working during the day. This is simply because more people use Uber at night.
• Elderly people are sometimes skeptical of using Uber, but after a few times they usually become comfortable with the service and then they will tell their friends and family about it.
• People that use Uber during the day usually do not have a car or access to a car.
• It is very common during the day for drivers to take customers to a medical appointment or urgent care.

 

Our Data:

• The trip from campus to the medical center took 11 minutes and it costed $13.51.
• The trip from the medical center to campus took 12 minutes and it costed $7.28.
  • The difference in price was due to a surge charge from Uber.
  • Surge charges can be so high at times that it does not make sense financially to use Uber instead of another option such as a cab.

Other Findings:

• The first car we were in was a mid-size svu and it was very comfortable/ spacious. 
  • The driver has picked up people in wheelchairs and people with oxygen tanks, although it is very rare for this to occur.
• The second car was a small sedan and it was not spacious. The driver had both front seats far back, which gave us very little leg room.
  • The driver has never picked up anyone with a wheelchair or oxygen tank. He was unsure if he would be able to since his car is so small.

***Attached below are photos from our Uber Immersion.

Uber Immersion Photos

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