The Heartbeat of Emergency Care:

Co-creating a Redesigned Experience Through a Service Design Approach

  • Monitor displaying a service blueprint for a redesigned ED process

Please note, this case study is a student project and is not affiliated with Vancouver Coastal Health.

Project Overview

The Big Picture

The Context

Emergency departments (EDs) can be high stress, fast-paced environments that pose challenges for both the public and staff. With both my teammate and I having healthcare backgrounds and myself having worked in an ED, we were familiar with many of these challenges. Recognizing the limitations of the current healthcare system, we saw an opportunity to redesign the ED experience to benefit both the public and staff.

  • Service design | UX design | school project
  • Team project with Jancis Wong.
    We worked collaboratively, with my role including: conducting research, creating a storyboard and service blueprint, planning and co-facilitating a workshop, and wireframing and prototyping.
  • 12 weeks
  • Headshots of Jancis and Kathryn

The Problem

Based on our experiences in healthcare, we identified the ED as a key area where negative experiences of both the public and staff can lead to a loss of trust and feeling unsupported by the healthcare system. This is concerning as EDs are foundational to hospitals and often set the tone for a person’s overall experience, so we developed our initial research question:

  • How might we optimize the emergency department (ED) experience in Metro Vancouver for people requiring same-day care, to increase the public and staff satisfaction, while reducing the rate of complaints?

The Solution

We took a service design approach to this problem, including the public and ED staff in an in-person co-design workshop. This led to the development of a service blueprint for an improved ED process, which includes wait-time procedures designed to enhance communication and transparency for the public while streamlining workflows for staff. This included a digital check-in kiosk, which we designed and prototyped.

DESIGN PROCESS

The Story Behind the Solution

To provide structure for our design approach, we followed the Service Design Thinking process, as outlined by Marc Stickdorn and Jakob Schneider.

  • Service design thinking process with accompanying tasks at each stage of the process
Image Adapted from Stickdorn and Schneider
I. Exploration

The Anatomy of an ED: Understanding the Experience

To conduct our research, we carried out site observations at three emergency departments and one urgent and primary care centre located in Vancouver. We also conducted six qualitative interviews, including three with individuals who had visited an ED within the past year, and three with ED staff members. To supplement our findings, we conducted secondary research on ED trends and factors influencing the public and staff experience.

  • Jancis using an informational kiosk at BC Children's Hospital
  • Exterior of the BC Children's Emergency Department
  • Exterior of the UBC Hospital Emergency Department
  • People in the waiting room at the Vancouver General Hospital emergency department
  • Informational sign at one of the urgent and primary care centers
  • Kathryn conducting an in-person user interview

Empathizing with The Public’s Uncertainty & ED Staff’s Overwhelm

Through our research, we were able to empathize with the perspectives and concerns of both the public and staff. From the public’s standpoint, we found that they often experience frustration due to feeling uninformed, helpless, and anxious when seeking medical assistance. On the other hand, the ED staff reported feeling overwhelmed by their workload and low staffing levels, leading them to feel unable to provide optimal patient care.

  • Empathy maps for the general public and ED staff, showing what they say, think, do, and feel

Seeing the Whole Picture

Across our observations, interviews, and secondary research, we analyzed our data to look for patterns. Using affinity mapping and dot prioritization, we found three key insights that guided our approach to the project.

Effective Communication

  • “…in the end, after I had all these tests done, I still didn’t know what happened.”

Caring Environment for the Public

  • “…navigating the ER can be really intimidating and really scary.”

Compassion & Support for Staff

  • “If staff had more support…they would be able to give more of themselves to patients.”

Narrowing in on Communication

Based on our research data, we decided to narrow our scope to focus on effective communication as the highest priority. Indirectly, enhancing communication would also have a positive impact on the other two insights. That led us to a refined research question:

  • How might we enhance communication between the public and staff in Metro Vancouver, helping the public feel more informed in a way that is efficient and beneficial for staff?
II. CREATION

Telling a Story

Guided by the findings of our interviews, we used LEGO to create a storyboard that visually depicts the user journey of a person visiting an emergency department. By building the individual steps in the storyboard, we were able to gain a deeper understanding of the process and then pain and gain points.

  • LEGO storyboard showing the steps involved for someone visiting the ED

Uncovering the Complexities of the Current Process

To ensure we captured all aspects of the current ED process, we created a service blueprint that documents the steps involved for both the public and staff.

  • Service blueprint of the current ED process

Co-Designing Solutions for Change

After gaining a thorough understanding of the current process, we facilitated a co-design workshop with members of the public and ED staff to collaborate on mutually beneficial solutions for change. Through activities such as crazy 8’s, affinity mapping, and dot prioritization, participants generated and prioritized ideas for innovation.

  • Kathryn facilitating affinity mapping at the co-design workshop
  • Participants having fun building a desktop walkthrough with LEGO
  • Kathryn facilitating affinity mapping, reviewing categories with the group
  • Participants constructing the ED with LEGO and playdough
  • Affinity map on whiteboard, displaying the education category
  • Participants around the table, planning their desktop walkthrough build with LEGO
  • Participants sitting at tables, completing the crazy eights exercise
  • Participants working together to build the scene
  • Affinity map on whiteboard, displaying the category of support person

Walking Through an Updated Process

Equipped with new ideas, the participants brought them into action by creating a desktop walkthrough to quickly simulate an updated ED process. This represents an initial step towards an improved ED experience according to the participants’ perspectives.

III. Reflection

Integrating New Communication Ideas

After reviewing the workshop ideas, we assessed which were the highest priority to implement in an updated ED process. We then integrated the most critical opportunities (highlighted in pink) into the service blueprint. Most of these changes were incorporated at the check-in phase, including a new wait time ticketing system and check-in kiosk.

  • Service blueprint of a redesigned ED process

Designing an Optimized ED Check-In

We designed the check-in kiosk to streamline registration for those with non-urgent medical needs. The kiosk efficiently collects personal health information, issues a wait-time ticket, and provides a QR Code to access ED visit information such as tips and estimated wait times. To accommodate a diverse user group, there are accessibility features and language options to minimize language barriers.

IV. IMPLEMENTATION

Evaluating Effectiveness

Using IDEO’s Design Thinking framework, we find our proposed solutions to be desirable, feasible, and viable. They support communication, streamline processes, and ideas such as ticketing systems and check-in kiosks have been successfully implemented in other EDs in North America. Furthermore, these ideas are in alignment with B.C.’s Digital Health Strategy, as they would help to empower patients and improve the provider experience.

  • IDEO design thinking framework - design thinking is at the intersection of desirability, viability, and feasibility
Image Designed by IDEO

Looking Ahead to Implementation

To move into the implementation stage of this project, we would do further testing to iterate on our service blueprint and check-in kiosk. To take this project one step further, we would consider engaging Vancouver Coastal Health or another health authority.

In CONCLUSION

Reflecting on Lessons Learned

This project challenged me in many ways and helped me grow as a designer. Throughout the process, I gained valuable learnings and reflections.

  • Due to system constraints and the exclusion of certain stakeholder groups, including those in leadership positions, there were missed opportunities in some key areas.
  • Designing holistically necessitates careful consideration, balancing information and identifying patterns to capture the entire experience.
  • Embrace the ambiguity, trust in the process, and be comfortable with not knowing everything.