Matching Excellence in Care: Evaluating a Hospital’s Service Experience

Interaction and experience designers are often only afforded a very focused, tactical design problem to solve, but the real impact comes when you can widen that lens and solve larger design issues. But how can a designer gain this increased breadth of perspective and scope? In this article, I’ll explain how we turned a tactical hospital signage study into an exploration of the broader service experience for its visitors.

To a great mentor, this article in memorium to Sylvia Harris.

It’s not always instinctual to consider a hospital as a business, making decisions every day to manage against a financial bottom line. Perhaps we want to forget that hospitals have other interests they are balancing beyond our own care. Regardless, the business implications for a poor service experience are no different at a hospital than with any other client; in fact, they are elevated given what’s at stake: people’s health. I had the opportunity to work with a large hospital in the Northeast US on a pro bono visitor experience study. The hospital was ranked in the top 10 of US hospitals for their clinical care, but the patient services group felt that the experience of navigating the hospital – or wayfinding – didn’t match the excellence in care. The poor visitor experience was leading to late or missed appointments, which has a tremendous effect on scheduling and budget, not to mention leading to frustrated visitors, and the team wanted to address these issues through an improved wayfinding system.

Expanding Our Lens @ the Onset

We collaborated with Sylvia Harris Research & Design and Two Twelve Associates, who were in the process of redesigning the hospital branding, on the study. The focus of our work was intended to be on the tangible wayfinding system and signage. However, while working with the patient services stakeholders to solidify the project objectives, we asked them questions beyond just the wayfinding system:

  • What resources do visitors use to prepare for their visit before they even arrive on campus (e.g. web site, campus maps, calling ahead)? What can improve the pre-visit preparation?
  • What is the process for appointment scheduling? Who’s involved?
  • Who are all of the constituents involved in the hospital service: patients, loved ones, volunteers, nurse staff, physicians, etc.? What is their role and influence in the service?
  • Beyond the physical structure of the building and the signage, what else do visitors rely on to navigate the hospital?
  • What are the diversity of reasons and scenarios for why someone comes to the hospital?

The exploration enlightened the stakeholders to the many facets required to create a successful visitor experience beyond solely the wayfinding system itself. We then co-created the long-term goal of the project, which you’ll notice doesn’t mention signs or wayfinding: to reduce patient & visitor stress and lateness, to ensure positive first and last impressions between the hospital and patients & visitors, and ultimately to match the excellence in care with excellence in experience.

Garnering Holistic Insights

Key sign indicating 'waiting room' is located to left of door, but not where most visitors approach (from right). Visitors walked straight past the room and asked clinical staff for directions.

Once we established the broader service lens through which we’d be evaluating the visitor experience, we needed to create a study that was equally holistic but manageable because it was a pro bono project.

To understand the interactions between the various hospital service elements, we observed for several hours the information exchange between patients & visitors and the information desk, which frequently represented the start of the on-site hospital experience. We noted the following: materials that the visitor had prepared (e.g., appointment slips were common), the request for help, clarity of directions given, comprehension by the visitor, and their general mental state. We then shadowed a sub-set of them, approximately 20, en route to their destination, noting how well they followed instructions, how they used the space and signage, and if they relied on any other resources along the way.

Doing so provided insights and recommendations beyond just the wayfinding system. For example, visitors consider all humans who work in the hospital – from security guards to surgeons – to represent the service provider, equally responsible to help them find their way. Therefore, hospital training for communicating with visitors should extend beyond just the info desk personnel. Also, the emotional aspects of being in a hospital cannot be underestimated. We frequently witnessed visitors enter a spiral of confusion about where they were, which led to them being overwhelmed and frantic, which in turn led to more confusion about the experience; the design solution – from the signage to the people – needs to not only empathize with this mindset, but help alleviate it.

visitors consider all humans who work in the hospital – from security guards to surgeons – to represent the service provider

The uninviting industrial door and fire exit (at the end of the hall) intuitively make visitors question whether they are going the right way. Signage earlier in the experience (front door) went unnoticed because of its location.

Surveys and interviews in a few waiting rooms helped us triangulate what we were observing through the shadowing exercise with the visitors’ own reflection on the experience without adding unnecessary stress or distraction to their already complex experience. While conducting these 50 interviews, we observed hundreds of interactions between the office staff and visitors. We observed confusing conversations over the phone about where they needed to go for an appointment or people showing up for their appointment, only to be told they needed to go somewhere else. No matter how intuitive the wayfinding system is, if the broader service experience and interactions among the clinical staff, the support staff, the information desk and the visitors is not orchestrated effectively, the system will continue to falter.

No matter how intuitive the wayfinding system is, if the broader service experience and interactions among the clinical staff, the support staff, the information desk and the visitors is not orchestrated effectively, the system will continue to falter.

Our last method was conducting scenario walk-throughs with six stakeholders and volunteers, giving them “tasks” (e.g., “find the Labor and Delivery room”) while we shadowed them. We asked them to articulate their behaviors and thoughts and probed with questions along the journey, which is not dissimilar from conducting a usability test. Involving stakeholders directly in the process illustrated to them first-hand what it feels like to be in a visitors’ shoes, interacting with the space, the signage, the people, and other various service elements of the hospital. Doing so also helped ensure that the stakeholders would continue to support the broader service lens we were applying to the project vs. suggesting we simply “evaluate the signage.”

Lessons for Designers

The hospital project originally intended to focus on the tangible aspects of the wayfinding system, but we very quickly acknowledged the need to explore the broader service experience of the hospital. Doing so requires a different perspective than we are accustomed to, one which does not have visitors as the ‘center’ of that experience and one which doesn’t focus on tangible design elements. Rather, it’s a decentralized, orchestrated system of elements with no single entity as the focus and one where intangible aspects – the communications between staff-visitors, the emotional considerations of the hospital context, the time it takes to find one’s way – are as important as the tangible ones.

A debate currently exists regarding service design and just how different it is from experience design. In short, if experience design is the proactive and strategic creation of a structure across interactions, channels, people, technologies, processes, objects, etc. within which you hope people have a certain type of experience, then I agree that service design has significant overlap with experience design. However, I fear that XD has become just another evolutionary definition of “usability” and “user experience” and question whether we’ve been able to successfully put the definition into practice.

A service by definition is a co-created value exchange among constituents, and the experience of that service succeeds or fails based on how well-orchestrated all of the service elements are. The burden and responsibility to design it right is deep. For experience design and interaction design professionals looking to have more impact in the design world, service design naturally affords us that opportunity because of its implicit broad and holistic perspective. Considering design problems previously thought of as tangible, focused, product-oriented experiences instead as decentralized, multi-faceted, service experiences may actually allow us the impact we aspire to have.

Laura Keller

For over 10 years, Laura has focused on representing the human element in any interaction with a brand, through actionable, business-impacting gathering of insights. At MISI Company, she has led multiple cross-channel experience design strategy and business transformation engagements for clients, including AstraZeneca, Hachette Book Group, Prostate Cancer Foundation, the NBA, Pfizer, and Glaceau. Laura’s passion lies at intersections between experience design and the physical, wayfinding, and service design spaces. She is a member of the Citizen Designer group, in New York, and has a column Service Design: Orchestrating Experiences in Context on UXMatters. You can follow her on Twitter @servicedesignLK.

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