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Door To Doctor

Improving Outpatient Transportation


Table of Contents Problem Statement Chapter 1 Field Research Chapter 2 Ideation Chapter 3 Solution Chapter 4 Conclusion & Next Steps

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Elderly, disabled, impoverished and immuno-compromised patients in the St. Louis area are often re-admitted to BJC hospitals after missing critical followup treatment. Transportation issues hinder them from reaching these appointments. Let’s improve their experience.


Chapter One

Field Research Listening is the first step; it puts us at eye level with the very people we are designing a solution for. Here we ingrain ourselves in that community, absorbing everything the people have to offer that might inform us of the best direction to take our project.

Learning About The Problem

Interviews

Experience Map

Top Three Insights

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Interviews ER Nurse “We give out too many rides. All these patients want free rides out of state - but these are all the same people with two packets of cigarettes in their pockets. I ask them why they can’t pay for a ride home but they can pay for that.”

We conducted a series of on-site interviews with the help of BJC and Barnes-Jewish and Christian hospitals. Talking with patients, caretakers, staff and social workers allowed us to see multiple points of view on outpatient transportation.

Derek Powers ER Social Worker Those who come up with a good story and don’t have a support system may be provided with transport. “If you’re 87, alone at 10pm, we’re not gonna sick you out in the cold.”

Certified Nursing Assistant, Waiting for employer in ER She’s been there four hours waiting. Has seen a lot of people come in by ambulance today–always by themselves. They come specifically to BJH because their local hospital in Illinois “treats him like baggage.” She has to frequently make this drive to BJH, which is full of traffic and 1.5 hours each way. In response to the question what would he do without her, she said, “I don’t know.”

Marquetta, ER Patient with daughter Ciara, age 5 She took the same 3 buses to get to BJH as she does to get to work every day. It takes 2 hours each way. “Everybody I know uses the bus.” She does not know own a car or know how to drive. The only time she’s driven was the one time she went to Six Flags in high school and drove a go-kart. “It was too scary for me,” she said, laughing. She knows she needs to get a car because she has 3 kids. She has no “dream car;” she just need “something to get me around.”

“It feels like 75% of my job is dealing with our patients’ transportation issues.”

-ER Social Worker

Regarding patients trying to get rides, he looks for “an obvious deficit,” such as age, MR, learning disabilities, clothing, lack of support system, etc. “If you’re young, you have an iphone, or your shoes are better than mine - good luck.” 8

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Present Experience Map

Research Methods After our initial BJC interviews, our eyes were opened. We realized we needed to delve deeper into the issue by conducting a series of phone interviews with non-profits as well as extensive online research surrounding public transport. To process and compile this information, we created two Post-it maps. One contained all the salient

insights about public transport, and the other mapped user experience. Combining our two maps allowed us to view the patient’s journey and emotional state over time–all in one place. We included all salient quotes gathered not only from patients, but from caretakers and social workers interviewed by both our group and the class.

This process allowed us to make connections, empathize with all user groups, and find existing successes. After digitizing the map, we were able to clearly identify our top three insights.

Our palette is bright and friendly, offering a balance of saturated and neutral colors. This allows our mark to jump out on the screen, separating from other apps. The colors carry with them suggestions of health, technology, and traffic signals.

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Our three most important insights from this process were: 1. Simplify the patient experience. 2. Take the load off the social workers. 3. Cars are the most reliable transport.

We also included a conclusions portion of our map to hold all of our potential solution ideas. They are also plotted along the patient journey timeline to show where these improvements would be implemented and have an impact.

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Chapter Two

Ideation It’s hard to approach an established issue with a clear mind, free of our assumptions. Essentially we are breaking stuff with the foresight that when we put it back together, it will be something special.

Learning About The Problem

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Interviews

Experience Map & Insights

Solutions and Ideation

Free Rice Model

Community Car Share

Future Experience Map

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Failing Fast – Free Rice

Free Rice Model Essentially our version of Free Rice would be a quiz game that would generate revenue for an existing method of patient transportation– such as the BJC cab vouchers. We mapped the gamer’s experience (below), expressing their thoughts, feelings and actions during the process. The most exciting part of the user’s experience would be watching

the points that they earn from the quizzes translate into actual concrete rides earned for patients. When we presented the idea, several problem areas were discovered, including vague quiz content, what the ride service being funded would actually be, and how the patient experience factored in.

Our top three salvageable insights from our Free Rice user experience map that we could carry over to our new concept were: 1 We needed a free van shuttle system to pick up patients. 2 Select local communities will already be incentivized to help out of moral conviction and the reward of positive social impact. 3 This transportation system will need

While this idea addressed the pain post of cost, it didn’t actually solve the problem for outpatients or staff. Salvaging our three best insights, we realized we needed to shift our focus. We reframed our process and began to develop a new van shuttle system operated by the local community and controlled by social workers via an app tracker.

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Community Car Share

Getting the local community involved From our experience map, we learned that cars were the most reliable forms of transportation. But given that many patients don’t have reliable support networks, we would have to introduce a third group party to the patient and social worker future state. We chose to focus on college students as drivers for our shuttle service, since they are motivated by community service and are not limited by full-time work schedules.

Our service would involve the creation of an app that would allow students to input their availability on a shared calendar with social workers so they could schedule patient rides. This app would connect to Google Maps to provide GPS services for students during rides, as well as a simple ride progress tracking system that could keep social workers up-to-date on the trip’s progress.

We initially decided that students could be incentivized by a class setup where they earned credit for driving patients through a service-based learning course. Subsequent interviews revealed this to be impractical, so we stuck with our project as a community

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Our future experience map reflected the full journey of the college student driver from finding out about our program to sharing her experience with others and increasing awareness for this issue. Afterwards, we made similar maps for patient and social worker personas. These maps were much smaller, given that the beauty of our service is that it simplifies the experience for both of these users.

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Chapter Three

Iteration Now that we have distilled our concept, it is time to bring clarity, to reconstruct these ideas and to redesign the future of our human-centered experience.

Interviews

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Present Experience Map

Free Rice Model

Community Car Share

Future Experience Map

Door To Doctor

Branding

Personas & Storyboards

App

Synthesizing

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Our service is a community-operated shuttle that serves disadvantaged outpatients of BJC hospitals. The accompanying app allows drivers and social workers to coordinate this process together. 24

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Branding

Name & Mark When naming our transportation service, we wanted to emphasize the accessibility of the process for the patient. Using approachable, friendly language, the name Door to Doctor expresses that our service is both personable and easy to use.

Our palette is bright and friendly, offering a balance of saturated and neutral colors. This allows our mark to jump out on the screen, separating from other apps. The colors carry with them suggestions of health, technology, and traffic signals.

Our mark is a modified letter D that suggests not only the alliteration in our name, but some of our brand attributes as well. The use of the arrow suggests the ideas of a journey, road signage, and the completion of a cycle. In addition, our mark also resembles the refresh browser icon, referencing the tech component to our service.

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Personas

Linda Patient

Elyse Student

Becca Social Worker Based off of our earlier interviews we realized the patient demographic has limited online and smartphone access. We wanted to take this into consideration and create an app that would benefit the patient without giving them the burden of technology.

Linda is 72 years old.

Elyse is 21 years old.

Becca is 35 years old.

She has type one diabetes.

She is starting her senior year at Washington University in St. Louis.

She doesn’t get to use her real professional expertise because she is stuck being a travel agent for her patients.

Her Type 1 diabetes has worsened, causing her kidneys to fail. She now needs frequent dialysis. She is afraid of using public transportation because she had a bad experience witnessing a robbery on the metro She has used Call-A-Ride, but it is too unreliable for her.

She is a Psych major and is also pre-med. Her interest in Door to Doctor stemmed from her desire to improve the health care system.

She is frustrated with cab companies that will keep her on hold during her busy day. She is apprehensive when her patients don’t show up to their appointments and is looking for a reliable travel system that they feel comfortable with.

She has decided to opt in to Door to Doctor.

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Draft Storyboard

1. Elyse is checking out extra in the library and encounters Door to Doctor

2. After reading about outpatient transportation is she decides participate in the service.

3. She is very excited about her decisions and is looking forward to her first training session.

4. It is the first day of class and Elyse is meeting different students across the university.

5. The professor teaches them how to approach patients and learn how to drive an ADA van.

6. Her professor also tells them to download the Door to Doctor app so that they can put in their schedule.

7. The professor brings them to the parking lot of the university, where the vans are parked and gives them driving instructions.

8. The students learn how to drive the van.

9. Meet Linda, she is 72 years old and has Type 1 Diabetes and needs to get regular dialysis. Here she is talking to her doctor about her next appointment.

10. She then meets up with her social worker, Becca who will schedule the appointment for her. Becca suggests that Linda opts in Door to Doctor, a new free reliable car share run by students in the community.

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11. It is October 11 and Linda’s appointment is today.

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12. She gets a call from Becca that she will be getting picked up by a girl named Elyse in fifteen minutes.

13. Linda walks outside of her house to wait for her van service.

14. Elyse punctually arrives, once Linda has walked to the curb.

15. Elyse pulls in with a friendly smile.

16. She sets up the ramp so that Linda will have an easier time getting into the van.

17. During their drive, Linda and Elyse engage in friendly conversation.

18. The GPS on her app is tracking how far away she is from the hospital.

20. Becca is watching the GPS from the hospital.

21. She sees that Elyse will be dropping Linda off in fifteen minutes.

22. Elyse arrives at the hospital in time for Linda’s appointment.

23. Becca greets Elyse and Linda outside the hospital.

We realized that this would be too long for our presentation so we decided to cut it down to the most important details that would best show the experience of Door to Doctor. 24. Elyse still has half an hour, so she is more than happy to pick up these patients .

25. She drives over to them and greets them.

26. They ride off in the sunset.

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Final Storyboards

1. Elyse is looking online to find some community service opportunities. She discovers Door to Doctor on her university homepage and becomes interested in joining.

4. Elyse pulls up by Linda’s house and sets up the ramp for her to easily access the van.

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2. During her first session, her counselor teaches the group about patient protocol, as well as learning how to drive a ADA certified van.

5. On the road they bond over their favorite lasagna recipe and butterscotch candies.

3. Elyse downloads the Door to Doctor App so that she can notify the social worker what he schedule is this week and when she is free in general to drive patients.

4. Linda gets a call from her social worker and is told that Elyse will be picking her up in fifteen minutes.

6. Becca who has been tracking the van, see that they are 15 minutes away from the hospital.

7. This gives her the opportunity to pick Linda up from the hospital and walk her to her appointment. Elyse walks back to the van, happy to have gotten a new lasagna recipe and a new friend.

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App Development

Door to Doctor unites community drivers and social workers for the first time. It allows them to coordinate, communicate and monitor a ride’s progress in real time – eliminating the communication limbo for social workers and allowing them to better budget their time and use their professional expertise.

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AT&T LTE

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December 2013 > RULES

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12.5.13 Linda Bloom 4:15–5:45pm

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12.13.13 Dan Staple 10:00–11:10am

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12.13.13 Marjorie Louis 3:50–5:15pm

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12.17.13 Noreen James 9:00–9:55am

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The circles on the calendar view indicate the number of scheduled rides on that day. Users can tap any individual day to see the full day’s ride iternerary. Red circles and dates indicate that there is a scheduling problem and the student should contact the social worker. This red alert also shows up in the Upcoming Rides view so it is not overlooked.

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Students can schedule times they are generally free, view assigned appointments, be alerted to possible scheduling conflicts, and connect to GPS via a Google Maps plug-in. 39


Social workers can match patients who need rides with students available during the calculated necessary drive time to transport patients from their door to the hospital. While on the journey, the student will tap each of the progress points of the ride. The social worker can also see this screen in real-time, keeping them in the loop for the first time. This allows them to budget their time more effectively and even greet the patient at the door when they arrive.

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Ride Progress Thursday, December 5, 2013

PATIENT

STUDENT

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Josh

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Got Van 4:20pm

Elyse

Got Patient 5:11pm

Kunal

At Hospital

12.5.13 4:15–5:45pm

6 minutes late

12.6.13 2:30–4pm 4

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5:13 PM

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Chapter Four

Conclusion & Next Steps

Learning About The Problem

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Interviews

Present Experience Map

Insights & Ideation

Free Rice Model

Community Car Share

Future Experience Map

Door To Doctor

Branding

Personas & Storyboards

App

Synthesizing & Future Research

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The value and innovation of our service is found in its core potential.

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Further Research

Next Steps

What are the existing community groups we can reach out to?

Scaling Our Service When naming our transportation service, we wanted to emphasize the accessibility of the process for the patient. Using approachable, friendly language, the name Door to Doctor expresses that our service is both personable and easy to use.

How do you develop comprehensive training for them?

When naming our transportation service, we wanted to emphasize the accessibility of the process for the patient. Using approachable, friendly language, the name Door to Doctor expresses that our service is both personable and easy to use. Our brainstorm for possible funding sources included BJC, grants, university community service funds, and students reaching out to their social networks for personal pledges (Ă la Relay for Life or Dance Marathon).

What are the liability risks and HEPA law restrictions? Is it feasible to fund this service, especially in relation to insurance? Is the development of our app within this budget? What type of shuttle is most efficient in terms of capacity, cost, and room for patients medical equipment? How many patients and/or accompanying caretakers will be driven at a time? Will there be a sharing platform for riders to develop a community based around this experience?

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We have never had a collaborative platform to merge outpatients with their communities. Until now.

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Door to Doctor was created by Elizabeth Korb, Chloe Kramer, and Zev Powell for Interaction Workshops at Washington University in St. Louis in Fall 2013. Fieldwork and interviews were in collaboration with Barnes Jewish Christian. This book was written and designed by Elizabeth Korb and Chloe Kramer. It was printed using Vista Slab, Helvetica Neue, Archer, and Avenir font families. Printed on 28 pound Hammermill paper. Cover photo by Rick Davis Photography. Inside front cover image shows our final presentation with Doug Powell to BJC, taken by Alexis Turim. Process photography by Elizabeth Korb.

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Door to doctor final process book (1)