Category: St. Joseph Health Systems

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.

Excellent work team!  You have two expert interviews complete.  For other interviews, please conduct the interview in context if possible.  It would be helpful to have the expert show you how they find information they need or complete certain tasks.  Or to show you how they believe patients/users complete certain tasks.  When in context the AEIOU framework you started to use to capture your Starbucks interview will make a lot more sense.  This also would give you meaningful photos.  I like that your team provided a Google link to the more-depth interview.

The immersion was spot on!  Actually waiting for the bus and feeling those struggles really helps you to connect with a user.  And nice job with the empathy around the length of time the trip took, the price of the ride, and the fact that the user may be not feeling well or have physical challenges complicating their process.  Was the return trip home similar?  Were the trip times consistent and convenient?

Dan Thompson, Helen Sung, Alexandra Charron, Cole Gillan, Joe Krause

Interview- 2/24/17

Joe and Alex sat down with Geoff Zimpelman to discuss the current transportation problems and solutions that exist for the Saint Joseph Health Systems group. As manager of population health and multi-cultural access at Saint Joseph Health Systems, Geoff has unique knowledge regarding the standing problem. Over the past few years, Geoff has worked with many community centered organizations to find sustainable solutions that would allow all people to have access to transportation, especially when it comes to making doctor appointments and other medical visits. The current transportation problem has various layers including lack of knowledge, low funding, and overall inefficient services. It seems that people working in this space have a few ideas that could work, but they are “waiting” for something big to happen that will allow their ideas (solutions) to come into fruition. Attached is the Ethnographic Summary that will go into more detail regarding our interview with Geoff.

 

Geoff Zimpelman- Ethnography Summary – Google Docs

 

 

Expert Interview 2/13/16

Phone Interview led by Alexandra Charron with whole team present

The team started off our expert interviews by interviewing project contact Michelle Peters to get her perspective on the project and define a scope. Michelle is the Director of Community Health and Well- Being for Saint Joseph Health System. Through speaking with her, our team discovered the following issues and insights.

1. The current systems in place are ineffective, underfunded, and often not utilized.
2. The system needs to be flexible to appointment times and durations and often patients need to go to other locations after the appointment besides home. ( ex. Pharmacy, Physical Therapy, Medical Supply Shop or Grocery Store)
3. There were several programs and systems tried before such as Angel Wings which were unsuccessful.
4. The Transpo system is limited by funding and doesn’t have weekend routes, late night hours, or routes that cover all medical facilities.

Michelle also provided us with contact information of other experts within the St Joseph Health Care system as well as contacts at other organizations in the area to speak with who might provide context, experience, or advice.

 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.

You are off to a great start.  What’s your team name?  And please include your team photo – at the top if possible.

Journey Map

 

Design Brief- St. Joseph Health Systems

 

 

• Project Description
• The purpose of this project is to find a method to help individuals living in poverty in South Bend get access to the vital health services they need within St. Joseph’s Health System by making transportation services more accessible and affordable.

 

• Intent/Scope

• Help people in poverty get consistent and reliable transportation to crucial medical services in the city of South Bend.
• Opportunities: health insurance coverage, transpo bus routes, hospital shuttles, hired taxis  

 

• Exploration Questions

• What are the reasons that those living in poverty cannot reach SJHS? 
• How much can health insurance (ex. Medicaid) cover rides for individuals?
• How will this project be funded and who will it be funded by?
• What have other cities done with similar situations?
• What are the typical days of our target users?

 

• Target Users
• Low income residents without access to transportation for medical services

 

• Research Plan

• Interview medical professionals
• Interview patients in low income areas
• Observe and analyze what similar medical/ health institutions do to provide transportation services
• Research federal and local legal aspects

 

• Expected Outcomes

• Expect to discover opportunities to cater to most impoverished residents
• Identify specific impoverished neighborhoods or geographic areas in South Bend that seriously lack transportation for medical services
• Improved transportation will result in a healthier population
• Improved transportation will lower emergency room costs and visits

 

• Success Metrics

• Population health, less emergency room visits, long term savings from healthier population, community’s approval
• Decrease in the number of missed appointments
• Usage and exposure of the program

 

• Project Planning

• Our team will conduct research in an attempt to solve our exploration questions over the course of the current semester. We will do so by following our research plan and evaluating the set success metrics frequently.  Interviews will be conducted with SJHS employees and target users in South Bend communities.