The Human Body as the Object of Service: The Hospital Waiting Experience
Published: May 21, 2012
The focus of many services is some primary object: your car in for maintenance at a garage, your clothes at a dry cleaners, your home being cleaned by a maid service. But for some services, the object of focus is you: your hair being cut at a salon or barber shop, your back being adjusted by your chiropractor. Your whole body can even be the focus of a service—for example, transportation, restaurant, or hotel services.
The service design challenges when the human body is the object of service are significant. One particular challenge is the diversity of customers’ contexts and mindsets. The service goal for an airline is getting you to your destination. But as a designer, you cannot assume that the reason someone is traveling is for a vacation at Disney World, a boring business meeting, or a funeral for a close friend. In healthcare and, specifically, for hospitals, the body is the service focus. Although the service goal of a hospital visit is improved health, the reasons for needing healthcare are diverse—ranging from getting treatment for a case of flu to an operation to correct a heart defect to palliative cancer support—each with an infinite number of accompanying patient and caregiver contexts and mindsets.
Regardless of what medical situation takes us to a hospital, one absolute exists: no one wants to be there. People want the outcome of going to a hospital—improved health for themselves or their loved ones—but they really do not want to be there. One of the primary reasons people do not want to be in hospitals is the significant amount of wasted time that passes between service activities: waiting to be admitted, waiting for the doctor to make her rounds and see a patient, waiting for the discharge process to begin, waiting for meals.
Although it may be obvious, so much waiting occurs because—unlike many other services—people’s bodies are an essential part of every aspect of the service, both medically and administratively. In contrast, when dropping off your car for service at your mechanic’s, some waiting may occur while your car gets worked on, but you can leave the garage. You can arrange for someone to pick you up or decide to take a leisurely walk. You can go about your life as you normally do, with just the one minor inconvenience of not having your car. However, at a hospital, our physical presence is an integral part of every healthcare service that we receive, which makes people feel imprisoned by hospitals. Hospitals can alleviate this feeling if imprisonment by improving the waiting experience for patients and their visitors through the integration of technology and the creation of empathetic spaces and transparent human interactions. This is the topic that this column explores.
Using Technology to Eliminate Waiting
One approach to preventing patients and visitors from feeling imprisoned in a hospital is to decrease or even eliminate the need to wait altogether using technology. New applications such as MASH for the iPad, from NIT Healthcare Technologies, let patients check themselves into a hospital. Future versions will allow patients to communicate their symptoms to hospital staff in advance of their admittance, using 3D body-imaging technology. Couple such pre-admission innovations with existing technology that helps monitor people’s health, including their heart rate, blood pressure, and oxygen levels, and hospitals can streamline many administrative and medical monitoring processes, allowing patients to take a walk or get a coffee, so they won’t feel confined to hospital waiting rooms.  Yet, if anything unexpected should arise when monitoring a patient’s health remotely, the patient would still be on the hospital grounds and could be instructed to return to his room or go directly to the nearest nurse’s station. Unfortunately, until hospitals and patients more widely adopt mobile devices, such innovations will remain unused, and hospitals will need to rely on more rudimentary technology solutions to enhance the user experience.�
For example, hospitals are beginning to use monitors to show visitors who are waiting to see patients after their surgery when they arrive in recovery, so they’ll know when they can visit their loved ones. Although this technology solution is not as freeing as something like MASH, such displays prevent people from feeling confined to a particular waiting room, because they do not have to fear missing an update from a doctor or staff member. Also, many hospitals are now posting their emergency room waiting times online, via SMS, or on digital roadside billboards, giving people realistic expectations for how long they’ll have to wait and, in some cases, enabling them to choose a different hospital based on that information.  According to the Chicago Tribune, with these technologies, “patients may feel more in control, because they learn before they head to a hospital or clinic that doctors are delayed. They then can try a different place, or wait more comfortably at home until minutes—instead of hours—before they’ll be treated.” 
Creating Empathetic Spaces
When such technologies as I’ve described are not feasible solutions, creating empathetic spaces can be another design option. Here is an example: Recently, a colleague was in a general-surgery waiting room, waiting for her husband, who was undergoing some minor surgery. Although she obviously hoped that her husband’s surgery would have no complications and would be completed safely, she wasn’t particularly concerned. But, as she looked around the large, open space, she saw people who were likely waiting for loved ones whose surgeries were more serious. On their faces, she could see the anxiety, concern, and subsequent relief when the hospital staff notified them that the patient was in recovery. She had wanted to do some work on her iPad, but felt guilty doing so, because she thought it might trivialize the situations of the others around her. But then something happened that was incredibly bizarre: a harpist began playing in the waiting room.
Since a hospital must accommodate so many diverse medical and, often, emotional scenarios, it’s difficult for patients and their loved ones to wait in a single, large space with others. In such situations, it is better to divide the space and create private areas, even if it’s just with large planters, furniture, or room dividers. Doing so allows those people who don’t want to lose their connection with their lives outside the hospital to use their iPad, watch TV, or read without feeling guilty; and it lets those people who can’t pretend to mimic normal life until they know their loved ones are safe to have some privacy.
Some hospitals are doing more to increase the comfort of their physical spaces than just creating more privacy with room dividers. At Mount Sinai Hospital in New York, a geriatric patient arrived in the emergency room and noticed, “There were no beeping machines or blinking lights or scurrying medical residents. A volunteer circulated among the patients like a flight attendant, making soothing conversation and offering reading glasses, Sudoku puzzles, and hearing aids. Above them, an artificial sun shined through a skylight imprinted with a photographic rendering of a robin’s-egg-blue sky, puffy clouds, and leafy trees.” The skylight did more than just provide a calming effect; it helped to alleviate sundowning, which occurs when the elderly confuse day and night. The patient satisfaction ratings for Mount Sinai’s redesigned geriatric experience are “off the scoreboard.” 
Designing Transparent Human Interactions
Designing the human interactions that occur within a hospital service can also improve the waiting experience. One of the most frustrating parts of the experience is a lack of any insight into when you can expect the next service interaction to occur or what that interaction might be.
When I gave birth seven months ago, my recovery days were filled with the following service activities: taking my blood pressure and temperature, asking me for my meal choices, completing various medical and administrative paperwork, measuring the baby’s weight, conducting the baby’s physical examinations. However, the timing of these activities, their order, and who would be doing them was never clear. I truly felt like I had given up my body to the hospital machine. In fact, when a few women came by and mentioned something about “nurse education,” “would take 20 minutes” I just numbly nodded, “Okay.” An hour later, I found myself lying down while six nursing students and one nursing educator used me as a test subject in teaching a class. I had become so accustomed to not understanding the service interactions of my own medical care and not having a choice that I had unknowingly agreed to be their guinea pig.
Because people’s bodies are the objects of focus within hospitals and, essentially, become an integral part of their operations, expectations regarding human interactions should be transparent to people. All staff, whether medical or administrative, should be accountable for ensuring that each interaction with patients and their loved ones addresses the what, how, why, who, and when of the hospital service. The following dialogue illustrates this concept, using my personal labor recovery as an example:
“Ms. Keller, I’m Sharon, your day nurse for today. You’re now in recovery and will remain here until Thursday morning, when we’ll discharge you. I want to explain, at a high level, what will happen each day. You can expect to see five different people on any given day: First, the nursing staff will take your blood pressure and temperature and check on the baby’s vitals—usually three times a day. Second, the hospital pediatrician will stop by to check on the baby one or two times before you go home. Third, your own doctor will visit you closer to Thursday to explain your medical care once you’re at home. Four, every day, hospital staff will come by to take your meal order for the next day and make sure you have clean linens and towels. Finally, administrative staff will ask you to complete various discharge paperwork. I’ve covered a lot, but do you have any questions? Okay, I’ll be back in a few hours to check on you. In the meantime, if you need anything, just press that button and one of us will come.”
If each staff member took just a few seconds to explain who they are, what they’re doing, where a patient is in the overall experience, and who they may see next and why, people would feel less like prisoners while waiting for their release from the hospital and more as though they have a role in the process.
Why Should Hospitals Care?
Hospitals have an unenviable and unique service challenge: How can they function effectively as a service provider when patients prefer not to be there? And even more important, what motivates hospitals to care when their success metrics are healthy discharged patients—regardless of whether those patients think the experience is optimal?
In actuality, there’s a connection between patients’ experience of and satisfaction with a hospital service and their health outcomes. When you couple feelings of imprisonment and a less-than-stellar overall hospital experience with any anxieties relating to the medical issue for which a patient is hospitalized, stress inevitably ensues—likely inhibiting strong health outcomes.
In the United States, recent Medicare legislature under the Affordable Care Act creates financial implications for hospitals based on patient satisfaction: “Love it or hate it, more hospitals are taking note of patient satisfaction with reimbursements on the line. Starting next year, Medicare will examine patient satisfaction scores when reimbursing hospitals, and better performing hospitals will win out on the incentive.”  Medicare understands that there really is a connection between patients’ healthcare experiences and positive health outcomes. As Jean Moody-Williams, from the Centers for Medicare and Medicaid Services, explains, “Asking whether a patient received proper discharge instructions points to quality-of-care issues, not simply patient experience.” 
This legislation is a great first step in driving change within the healthcare industry. But companies, unfortunately, often do the bare minimum to satisfy the requirements. Instead, hospitals should embrace the idea that a positive patient experience is connected to positive health outcomes and find opportunities to capitalize on it.
Rather than merely designing the waiting experience to prevent patients from feeling imprisoned, hospitals should consider ways of making this time meaningful from a health-outcomes perspective. Why should patients and their loved ones receive educational materials about their health situation only during a rushed discharge process? Why not distribute this information much earlier in the process, allowing patients to digest the information and ask questions of the staff? Taking this a step further, why not encourage patients to start following any new healthcare regimen while they are still in the hospital. For example, if someone with diabetes needs to change their lifestyle and lose weight, why not encourage them to walk around the hospital or read some diabetes cookbooks?
Filling hospital waiting times with such healthcare-related activities would let patients and their loved ones reflect, while still in the hospital, on how their lives might change after leaving the hospital and also provide hospitals the opportunity to make tangible progress toward positive health outcomes for its patients.
 Knibbs, Kate. “Why iPads Will Kill Off Hospital Waiting Rooms.” Mobiledia, April 17, 2012. Retrieved April 24, 2012.
 Story, Sara. “Hospitals’ ER Wait Times Online, on Billboards.” NBCDFW, May 2, 2011. Retrieved April 24, 2012.
 Manning, Kay. “Hospitals Use Technology to Cut ER Wait Times.” Chicago Tribune, April 10, 2012. Retrieved April 24, 2012.
 Hartocollis, Anemona. “For the Elderly, Emergency Rooms of Their Own.” NY Times, April 9, 2012. Retrieved April 24, 2012.
 Cheung, Karen. “Hospitals with Best Patient Satisfaction to Draw in Reimbursements.” FierceHealthcare, November 8, 2011. Retrieved April 24, 2012.