Outpatient
Empathy
Refining the Waiting Experience
during Medical Daycare visits

Amen Salami
Supervisor: Eugenia Bertulis
Emily Carr University of Art + Design, 2020
Amen Salami © 2020

Outpatient Empathy
Refining the Waiting Experience
during Medical Daycare visits
by Amen Salami
Supervisor: Eugenia Bertulis
A Critical & Process Documentation Paper
Submitted in Partial Fulfillment of the
Requirement for the Degree of Master of Design
Emily Carr University of Art and Design, 2020
Amen Salami © 2020

Acknowledgements

Acknowledgements
I want to use this opportunity to express my sincere gratitude to
everyone who has helped me through this journey.
First, I thank God almighty, who gave me life and the ability to
accomplish this phase of my life. To my mum, dad, brother, and
sisters, I say thank you for the support.
To my supervisor, Eugenia Bertulis, thank you for your valuable
guidance and insights. Also, I want to thank my internal reviewer,
Katherine Benjamin for the numerous suggestions and support. To
the entire community, starting from my instructors; Helene Day
Fraser, Keith Doyle, Louise St. Pierre, Chris Jones, Katherine Gillieson,
Laura Kozak, Gillian Russell, Craig Badke, Celeste Martin, and Bonne
Zabolotney, and to all my design peers.
To Minetaro (Min) Naruki-van Velzen, and all staff of Jim Pattison
Outpatient Care and Surgery Center, and Fraser Health Authority,
I say thank you for allowing me to do my research at your site and
the support.
To the team at the Health Design Lab, Caylee Raber, Nadia Beyzaei,
Andrew Sui, and Lisa Boulton, I say thank you.
To Lois Klassen, thank you for reading through and providing
feedback on my ethics application.
Finally, to my sister, who lost her life going through this journey
called life, you are remembered now and always.

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Table of Contents

Table of Contents
Acknolwedgements
Table of Contents
Abstract
Glossary of Terms
Introduction
1.0 Beginnings
1.1

Understanding service design and the role of the designer in creating
change in a healthcare facility

1.2

Exploratory prototyping and mapping experiences using journey maps
and service blueprint

1.3

Insights from the mapping exercises

1.4

Use of design sprint for exploration, idea generation, and prototyping

1.5

Design outcomes from design sprints

1.6

Insights from design sprint I & II as an activity to further explore and
brainstorm possible design outcomes

2.0 Continuing design
2.1. Moving from exploratory to evaluative prototyping through interviews
and user testing
2.2. Desktop Walkthrough method and insights
2.3. Interviews, workshops and user testing
2.4. Insights and new understanding from interviews, workshops and user
testing
2.5. Designing for the user model (persona)
3.0 Designed touchpoints for improving the outpatient waiting experience
3.1

Prototyping design criteria and design language elements

3.2

Patient pathway prototype app and key features

3.3

Patient pathway armband

3.4

Patient pathway board

3.5

Storyboard of outpatient’s future state experience

4.0 Conclusion: challenges and opportunities when implementing service design
in healthcare
5.0 References
6.0 Appendices

Abstract

v

Abstract
Keywords

Extended wait time in healthcare affects the experience and overall percep-

Outpatient

tion of care for outpatients as well as the stress it puts on the clinical team

Medical Daycare

that is providing treatment services.

Service Design
Touchpoints

Through this research, some factors like the lack of information about

Patient Experience

treatment encounters, and insufficient interaction and understanding of

Exploratory Prototyping what goes on behind-the-scenes during waiting periods have been seen to
Evaluative Prototyping

contribute to extended wait times. Wait time affects more than just the
physical wellbeing, but also the aspects of the economic and psychological
aspects of the patient (Chu, Holly, et al., 8). Therefore, the goal of this
research was to use participatory methods to understand and identify
potential design opportunities that can help improve the outpatient experience by reducing the effect of the factors that contribute to the extended
wait periods. This research is carried out at Jim Pattison Outpatient Care
and Surgery Center, an outpatient facility in Surrey, British Columbia.
The research goes through phases of needs finding through exploratory
prototyping with stakeholders, which includes mapping the outpatient
journey during their visit to the facility. Afterward, based on the insights that
were gathered through these exploratory activities, the next was to conduct
participatory design workshops, including an interview with health professionals. The outcome of these activities was a potential design opportunity
that would give outpatients more information about their treatment
encounter, and what happens behind-the-scenes as a way of improving
their experience during extended wait periods.
The design opportunity that was prototyped and iterated on is called the
patient pathway. It includes an app prototype, an armband, and an information board.

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Glossary of Terms

Glossary of Terms
Outpatient – Healthcare insurance.org describes an outpatient as “An
individual (patient) who receives health care services (such as surgery) on an
outpatient basis, meaning they do not stay overnight in a hospital or inpatient facility” (Outpatient: What does outpatient mean?).
Medical Daycare – A type of outpatient clinic located at Jim Pattison Outpatient Care and Surgery Center, Surrey.
Service Design – Service design uses different methods to understand the
customer/user experience while using a service and the systems provided by
the service provider. “Service design aims at designing services that are
useful, usable and desirable from the user perspective, and efficient, effective and different from the provider perspective” (Mager and Sung, 1)
Touchpoints – Touchpoints make up the different places and points of
interaction between the customer/user and the service.
Patient Experience – The way a patient feels when interacting with one or
more aspects of a service over a period. The Beryl Institute defines the
patient experience as "the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of
care" (LaVela and Andrew, 26).
Design Sprint – “The sprint is GV’s (Google Venture) unique five-day process
for answering crucial questions through prototyping and testing ideas with
customers" (Knapp, et. al., 9).
Actors – Within the context of this research and in healthcare, the word
actors has been borrowed from Vink et. al.’s work. They include everyone
who are part of and contribute to value creation from an institutional
standpoint. “Innovation in healthcare requires changing the institutional
arrangements or what are often referred to as ''the rules of the game." Such
a change demands that actors do institutional work-intentionally creating,
disrupting, and maintaining the entrenched ways of operating within the
system” (Vink et. al., 19).

Introduction

1

Introduction
This research aims at improving the experience for outpatients by refining
touchpoints during their encounter at the Medical Daycare in Jim Pattison
Outpatient Care and Surgery Center using service design methods. The
patient population for this research predominantly resides within the Surrey
community in British Columbia, Canada. It is important to note that a key
aspect in outpatient care, specifically those on the first visit, can sometimes
be a challenge on the part of the healthcare system and the outpatient
during the process of onboarding and as such this research seeks to investigate what happens during the waiting period during their visits by answering the question;
How might we improve the outpatient experience through refinement of
existing touchpoints during extended wait period at the Medical Daycare at
Jim Pattison Outpatient Care and Surgery Centre?
To answer this question, I used a generative research approach through
participatory activities that become insights used to introduce touchpoints
that provide more information, transparency, and behind-the-scenes activities to improve the experience for outpatients during extended waiting
periods. One of the main insights through this research with healthcare
professionals is that the waiting period can last for as long as 3 hours to a
whole day. One key insight from methodology and process of making
reveals that prototyping roughly provides an opportunity for better engagement and discussion when working with health professionals and participants. In addition to this, mapping exercises are a good approach to exploring the problem space and identifying real opportunities, because it allows
stakeholders to visualize the interactions that happen between people and
their service.
Furthermore, the research revealed that outpatients do not have enough
information to understand why they have to wait for long, what happens
during their wait, and what to expect during their treatment encounter.
When wait time is inevitable, a way of improving the experience for outpatients, from a clinic environment perspective is to discern factors that are
responsible for wait times that are within their control that they can
manage (Chu, Holly, et al., 2).
The research specifically focuses on the experience of outpatients during
their treatment encounter at the Medical Daycare. However, it is important
to note that service design looks at the holistic experience, which also
includes pre and post-care experiences.

1.0 Beginnings
1.1 Understanding service design and the role
of the designer in creating change in a
healthcare facility
1.2 Exploratory prototyping and mapping
experiences using journey maps and service
blueprint
1.3 Insights from the mapping exercises
1.4 Use of design sprint for exploration,
idea generation, and prototyping
1.5 Design outcomes from design sprints
1.6 Insights from design sprint I & II as an
activity to further explore and brainstorm
possible design outcomes

Beginnings

3

1.0 Beginnings
Fig. 1 below highlights the activities that all contributed to the
research through insights that led to the design opportunity
through the space of 15 months.

Fig. 1 Timeline of design research (independent and participatory)
The process of progressing from primary research to independent work and the use of supporting literature to ground the
research on existing theories and knowledge in the field. Some of the main activities were exploratory prototyping through
mapping exercises and design sprint and evaluative prototyping through interviews and user testing with healthcare professionals
(illustration by the author).

4

1.1 Understanding service design and the
role of the designer in creating change
in a healthcare facility
Service design involves the front stage and back stage activities
that happen during a customer’s encounter of a service. The
front stage is the artifacts and things that the customer sees,
while back stage is the activities that propel and make the
interaction with the service possible. For example, when a
customer decides to go on vacation, the booking website and
attendants make up those that are front stage interactions,
while the technical system that allows the processing of the
request make up the back stage activities. Jim Kalbach, an
instructor, and author in user experience in his book mapping
experiences explains the front stage interactions as the individual experiences and backstage as the process necessary to
provide a service (229). This is to say that the practice of service
design is very much involved in the experiences that are visible
from an individual standpoint as well as the behind-the-scenes
activities that facilitate these experiences. Furthermore, service
design takes into account the journey that the customer goes
through and the interaction in the form of experiences over
time. Mager and Sung, professors in service design and industrial design respectively explain that service design focuses on
the experience throughout the customer journey, including the
experiences before and after the service encounters (1). In other
words, understanding how a customer flows through the entire
service experience is an integral part of service design. Service
design aims at designing services that are useful, usable, and
desirable from the user perspective and efficient, effective, and
different from the provider perspective (Mager and Sung 1). It
also involves the action that is required to execute high-quality
care service to carefully plan and promote coordinated action
(Shaw et al. 1). In the field of design, there are practical methods
and techniques which service design uses as methods towards
the improvement of services (Yu and Sangriorgi, 201). Previously, most of the writings on Service Design were around the
context of business but has since evolved to other areas. Shaw
et al. described service design to have been made famous
through the work of IDEO in the late 1990s (2).

Beginnings

Beginnings

5

In recent times, there has been advocating the need to create
change in the way care is delivered and the experiences for
patients during their treatment encounters and visits. MoreMore and more emphasis is being placed on empowering
patients. However, the system often does the opposite and as a
result, creates a hierarchy that often times entirely isolates the
patient in the process and leaves the power to clinicians.
Twentieth Century French philosopher, Pierre Bourdieu used
the concept of Doxa to describe how power is used in an
internalized way in healthcare. He observed that there is a
subconscious internalization of attitudes, knowledge, beliefs,
and values within the culture of healthcare as exhibited by
physicians (Nimmon, Laura, and Terese Stenfors-Hayes, 2). This
is to say that there is often a hierarchy that exists within the
healthcare system. This heirarchy negatively affect the time it
takes to make decisions, which can affect how quick patients
get attended to.

Fig 2. A visual representation of the designer's role in the patient - care provider interaction
Image A: Shows the current flow of outpatient through their treatment encounter where they go through a linear process starting
with interacting with touchpoints to finally meeting with the doctor at the end of their encounter. Policies and processes within
the healthcare system, which does not often deliver the best patient-centered outcome, directly influence the role of each actor.
Image B: Suggests a new system of a level playing field between the different touchpoints and the respective interactions that
happen with the patient. In this new model, the designer will work as the in-between to identify and create new opportunities that
start with the patient and blurs the lines of hierarchy across touchpoints. (illustration by the author).

6

Furthermore, considering that patients are reliant on their
interaction and care received from clinicians, the play of power
in the system creates an unequal relationship, which negates
the practice of communicative physician-patient relationship,
which improves patient outcomes as a result of physicians’
possession of health professionals (Nimmon, Laura, and Terese
Stenfors-Hayes, 2). The interest of the patients must be a priority
for the medical professionals ahead of the self-interest of
clinicians (Heidarnia and Heidarnia, 131).To this end, the role of
the designer becomes strategic in supporting a shift toward
patient-centric care within thisexisting complex system. The
best way to ensure a distinct outcome within this sort of complexity is to put the people who are going to use the service,
rather than the design object, at the heart of the design
process (Lovlie et al. 75). This approach is referred to as
human-centered design. Therefore, changing the pattern of
care delivery is a step in the right direction in improving healthcare systems to better meet the needs and expectations of
patients (DeVoe et al. 71).
Over time, in attempting to bring about change, designers have
had to come up with one or more proposals, such as introducing new service configurations or generating radically new
design opportunities from outside the system (Freire and
Sangriorgi, 3). Some of the tools often used in service design
will be discussed in the next section.

Beginnings

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7

1.2 Exploratory prototyping and mapping
experiences using journey maps and
service blueprint
“Exploratory prototyping is mostly done for yourself or the core
project team. Prototypes are created in parallel to quickly
compare different options and perspectives”
- Stickdorn et al., 2018, p. 213
Understanding the experience of patients and other beneficiaries of service requires the use of mapping methods.
Trischler et al. in their work mapping public services suggests
the use of three service design methods in identifying user
experience and designing better public services, which
includes personas (a fictitious user profile of a specific target
group), visualization and mapping techniques (used in transforming the systems and processes into visible dimensions) to
create clarity about what elements within the service system
have contributed to the experience and finally observational
techniques (enabling the designer to ‘walk in the customer’s
shoes) to provide a clear picture of how the user experiences
a service (724). These three methods have been used for this
research to guide the process of moving from a space of
broad understanding to specifically having to map the outpatient experience within the Medical Daycare and identifying
design opportunities.

8

Beginnings

Fig 3. Initial sketches from the mapping exercise with health professionals at JPOCS and
Outpatient Rehabilitation Center at Surrey Memorial Hospital
The process of mapping the outpatient experience began with sketching cards of the different stakeholders (outpatients – children,
adults, older adults, clerk, nurse, and doctor). The process of working in a very rough and low-fidelity state had a way of improving
the discussion and engagement with health professionals.This was an initial exploratory activity aimed at identifying opportunities
for the research used to identify deeper interactions as well as emotional phases during the outpatient medical daycare visit.
Image A: Outcome of journey mapping exercise with health professionals at JPOCSC.
Image B: Outcome of journey mapping exercise with health professionals at the Outpatient Rehabilitation Center. (illustration by
the author and health professionals at both sites)

Beginnings

There were two journey mapping activities; the first one was at
JPOCSC (primary research site) and the second was at the
Outpatient Rehabilitation Center at Surrey Memorial Hospital.
Both activities at the two outpatients’ facilities were conducted
in a similar pattern where health professionals were in control
of the process through participatory making.
One of the initial activities was to explore the problem space by
creating a journey map with a patient care coordinator at
JPOCSC. Journey maps in service design research is a valuable
method used to visualize the journey taken by a customer,
indicating how they interact with service from start to finish. It
is a tool used for understanding the service process, capturing
activities, emotion, and the location where these interactions
take place relative to time. Zomerdijk & Voss (qtd in McCarthy
et al.) in their research Service Design for Experience Centric
Services explains “journey maps go beyond the static view of
other service design methods by illustrating the relationship
between the customer and the service organization as dynamic and ubiquitous within the system” (357). In healthcare, journey maps have become even more popular as an approach
used in understanding the patient’s journey and how to
provide better healthcare outcomes. Considering this usefulness of journey maps, having a workshop with health professionals (care providers) at Jim Pattison Outpatient Care and
Surgery Center to map the process was both a generative and
an opportunity to identify the problem space. Doing the journey map exercise with health professionals showed that outpatients had little interaction while they waited for the treatment
encounter, which resulted in having little information of the
procedure besides the initial check-in that happens at the
reception with the clerk. Considering that the clinical process
involves a combination of different stakeholders and individuals, the mapping process helps bring everyone together who is
responsible for improving the process (Ben-Tovim, David I, et. al.
S15). The impact of this will be discussed later in this research
and how it affects the experience, with regards to the waiting
period, which is the focus of this research.

9

10

Beginnings

There were two journey mapping activities; the first one was at
JPOCSC (primary research site) and the second was at the
Outpatient Rehabilitation Center at Surrey Memorial Hospital.
Both activities at the two outpatients’ facilities were conducted
in a similar pattern where health professionals were in control
of the process through participatory making.
One of the initial activities was to explore the problem space by
creating a journey map with a patient care coordinator at
JPOCSC. Journey maps in service design research is a valuable
method used to visualize the journey taken by a customer,
indicating how they interact with service from start to finish. It
is a tool used for understanding the service process, capturing
activities, emotion, and the location where these interactions
take place relative to time. Zomerdijk & Voss (qtd in McCarthy
et al.) in their research Service Design for Experience Centric
Services explains “journey maps go beyond the static view of
other service design methods by illustrating the relationship
between the customer and the service organization as dynamic and ubiquitous within the system” (357). In healthcare, journey maps have become even more popular as an approach
used in understanding the patient’s journey and how to
provide better healthcare outcomes. Considering this usefulness of journey maps, having a workshop with health professionals (care providers) at Jim Pattison Outpatient Care and
Surgery Center to map the process was both a generative and
an opportunity to identify the problem space. Doing the journey map exercise with health professionals showed that outpatients had little interaction while they waited for the treatment
encounter, which resulted in having little information of the
procedure besides the initial check-in that happens at the
reception with the clerk. Considering that the clinical process
involves a combination of different stakeholders and individuals, the mapping process helps bring everyone together who is
responsible for improving the process (Ben-Tovim, David I, et. al.
S15). The impact of this will be discussed later in this research
and how it affects the experience, with regards to the waiting
period, which is the focus of this research.

Beginnings

11

Fig. 4 Iteration and detailed sketch of the outpatient journey map with JPOCSC
The redesigned journey map visualizes more details of the interaction that happens during an outpatient visit to the Medical
Daycare. The image shows the high points and low points as well as areas of opportunity for the research and insights that
contributed to the design opportunity (illustration by the author).

12

Beginnings

The next activity after the journey map was to create a service
blueprint to visualize the interaction that is visible to the outpatient and those behind-the-scenes. Service blueprints show the
activities that happen front stage and backstage in the process
through a collaborative process with members of the team
(Stickdorn and Schneider, 204). The service blueprint has five
main components; the physical evidence, actions (outpatient
actions), front-of-stage interactions, back-of-stage interactions,
and support process.

Fig. 5. Visual representation of the service blue print
For my design, the service blueprint served as both a process to help map out the interactions that happen, and also as a generative tool that would be iterated on later in the research. Creating a service blueprint is a valuable exercise in my process within
service design. It visualizes some design opportunities, specifically around wait time as can be seen at the topmost row (physical
evidence) (illustration by the author).

Beginnings

13

1.3 Insights from the mapping exercises
Journey maps are a useful tool that is used to explore potential design opportunities by way of understanding gaps in
customer experience (Stickdorn et al., 2018, p.44). For this
research, understanding the experiences through exploratory
activity is very key, because it helped provide an avenue to
compare and understand the journey of outpatients at two
types of outpatient facilities (JPOCSC and Outpatient Rehabilitation Center in Surrey Memorial Hospital). The experiences varied, most notably with regards to the wait time. One of
the reasons for this, which was identified through the mapping session, was that outpatients who visit the rehabilitation
center have a better idea of the process because their
encounters are usually repeated compared to that of
JPOCSC. In other words, two different purposes for facilities
mean two different types of experience for the outpatient.
Similar to those of other services, cancellation of appointment by outpatient also contributes to waiting time experienced at JPOCSC. Comparing these outcomes and visualizing
the entire journey reaffirmed that there was an opportunity
to redesign the experience e at JPOCSC, considering that
their facility had a problem of wait times caused by a variety
of factors. While journey mapping and service blueprint are
useful exercises, the potential weakness is that the information can become overwhelming, and stakeholders may
become too attached and may want to withdraw without
going further in needs finding. To prevent this from happening, it is important to clearly articulate the purpose of a
mapping exercise from the onset, however, it is less likely to
happen when creating a service blueprint because it is
usually designed in the later part of the mapping process
when there is a shared understanding amongst stakeholders.

14

1.4 Use of design sprint for exploration,
idea generation, and prototyping
A very important part of the research is the design sprint. The
design sprint process that was used for this research is inspired
by Google, which was developed by Author Jake Knapp while
he was working as a design partner at Google Ventures. It uses
a five-day period (Monday to Friday) to answer design and
business-related questions through ideating, prototyping, and
testing with customers, however, this five-day timeline can be
modified depending on the context and limitations. Some
reasons to shorten the duration are as a result of the intensity,
if unpaid or if there are no perceived direct benefits from the
participants’ point of view. I conducted two design sprint
workshops and chose to run it for three days; 4 hours on the
first day (understanding, divergent & convergent phases), 6
hours on the second day (prototyping), and 4 hours on the third
day (testing). The design sprint was conducted with peers, and
the aim of the workshops within the context of this research
was to generate ideas and explore the problem space further
through participatory activities.

Beginnings

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15

Fig. 6 Visual representation of Design Sprint I&II
The visual shows how each phase of the design sprint activities contributes to identifying the design opportunity. Very key in the
process is the iterations that happened during the time that initial design outcomes had been identified through the spring
activities (illustration by the author).

16

Beginnings

The process started with getting background knowledge of the
research space as participants had asked crucial questions to
know the problem is the purpose of the project, the benefits of
the project from the short-term to long-term, and what questions were needed to be answered. Cards were handed over to
participants that had a list of insights and knowledge-to-date
about the users (outpatients) and the opportunity space.
Participants used this opportunity to sort out each card into
themes (see Fig. 7 and 8). This process of sorting helps create a
hierarchy of information, which in the process helps narrow
insights from the bottom up in a way that is coherent and easy
to understand. For example, some of the ideas placed in categories included; problems of interactions with care providers,
the reduced amount of information that is available, and
unavailability of a system/device to use in times where they
needed more information, which was all gotten from the initial
mapping exercise.

Fig. 7 A participant interacting with the insight cards and sorting them into categories.
The process of sorting the cards helps in the process of narrowing down and placing initial ideas into categories.

Beginnings

17

Fig. 8 An image of the problem definition card.
The next activity was to inspire participants by introducing a visual of the outpatient journey (see fig. 9 and 10). The journey map
shows each stakeholder’s journey (fig. 9) and the combined patient and nurse (fig. 10) interaction. Visualizing things in this format
allowed participants to be able to get a sense of how the opportunity space could be brainstormed and ideated.

Fig. 9 Top Image: The outpatient journey map.
This image shows a top-level flow which the outpatient goes through from the time of arrival through treatment encounters.
(illustration by the author).
Bottom Image: The care provider journey map, similar to that of the outpatient shows how the service deliveries as well as
backstage actions that can help improve the patient experience.

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Beginnings

Fig. 10 The image shows an overlap of the patient and care provider journey.
The blue circles are the areas where the outpatient actions, while the purple indicates the care provider's actions. This visual
representation is overlapped to show the interactions and easy comprehension of the flow from a holistic viewpoint. (illustration by
the author).

Insights from the sessions were shared with health professionals, which revealed that wait time at the Medical Daycare goes
up to 3 hours to a whole day, which was a key insight that has
driven the research opportunity. This useful user data helped
create the right environment for the workshop to encourage
free discussions about how existing interactions occur as well
as some of the needs and behavior of the patient. It was also an
opportunity to develop a shared understanding amongst
participants of who the stakeholders (patient and care providers) are. The outcome of this activity was the design of user
personas visualizing their interactions using the journey map.
This activity was a way to explore the problem space through
divergent thinking further to understand the user, their aspirations, their pain points, and gaps in the quality of service that
they receive. The next phase of the sprint activity was sketching.
The use of the sketch was to further explore the opportunity
space. It is an approach of exploratory prototyping as ideas
were introduced as a way of encouraging divergent thinking.
Approaching it in this manner allowed for everyone to stay
within the goal and context of the research. At this phase, we
had started sketching our ideas as roughly as possible.

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19

At the end of this activity, participants had an opportunity to
discuss their sketches verbally with the team thereby giving
and receiving feedback across the board. At the end of this
activity, we had over ten ideas by the time we had finished,
which could serve as stand-alone design opportunities. We had
come to the end of the divergent phase. At this point, ideas are
passed around and developed individually. Each participant
sketched the next person’s idea as a way of encouraging team
working and collaboration, whereby an idea becomes a collection of every individual member’s effort within the group. It was
also an excellent way to have those who are not comfortable
talking to share their opinion and insights freely without feeling
overwhelmed.The last activity was scrutinizing and selecting
ideas through a process of heat mapping. We placed individual
sketches from each participant on a whiteboard and used
colored dots to form heat maps indicating ideas that should be
prototyped (see fig. 11, 12 and 13). The colors of the dots used
were red, yellow, and green. The red dot was placed on ideas
that could have possible restrictions and constraints, which
would make it challenging to implement. The yellow dots were
a mid-point to represent ideas that are somewhere in-between
and could do with a little more finessing. The green dots
described concepts that had little to no restrictions and were in
alignment with the design problem and was feasible, taking
into consideration possible constraints. The ideas that had
three green dots represent the idea of the patient priority cards
and patient priority.

Fig. 11 The image on the left shows the final sketch that had the highest number of
green dots - the patient priority card and patient priority infographics.

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Beginnings

We had come up with the names for the prototypes during the
session. At this phase, we had the belief that this was the final
design prototype, however, there was a shift which will be
discussed later in this research.

Fig. 12 An image showing how translucent dot sticky notes were used to select ideas to be prototyped.

Fig. 13 Image of sketches on a whiteboard showing three sticker colors; Green, Yellow, and Red.
The green stickers are ideas that are ready to be prototyped. The yellow dot stickers would require a few modifications, and the red
dot stickers do not sufficiently address some of the design needs

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21

1.5 Design outcomes from design sprints
A. Outpatient Priority Cards
The idea of the outpatient priority cards is a design opportunity
that communicated different directions for different outpatient
categories (see fig. 14 for sketches). It uses three colors (Green,
Orange, and Purple) with complementing shapes and duration
(Triangle, Circle, and Square). Considering that outpatients start
their interaction from the reception, the idea of the patient
priority card is a touchpoint that is handed over to outpatients
by the clerk as an initial representation of the duration of their
treatment encounter. The green card with the triangle shape is
for outpatients whose encounters are less intense and would
require just a few hours to complete. It could be anywhere from
30 minutes to 1 hour. The orange card with the circle shape is
for patients whose procedure may go up to 3 hours and may
require multiple encounters through their journey at the
Medical Daycare. The third card, which is the purple card with a
square shape are for visits that may last anywhere between 3
hours to a whole day and involves multiple encounters.

Fig. 14 Images of the sketch wall with all the ideas from participants

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Beginnings

B. Outpatient Priority Infographics
This idea of a priority infographic is to visualize the outpatient
journey as a support touchpoint that gives information to
patients about their journey while they wait. The idea is to
imagine the journey like a race where the number of encounters represents milestones (see fig. 15). Also, giving more
information about the care team, the priority cards, and the
different stages that they have to go through. It is intended
that they will be placed in the waiting area.

Fig. 15 Close-up shot of the process of iterating and prototype of the outpatient priority card
and infographic design. (illustration by the author).

Fig. 16 Image showing where the priority card design opportunities are situated
within the outpatient journey map (illustration by the author).

Beginnings

23

C. KYN (Know Your Needs) Interactive Boards
The KYN is an interactive board designed to provide a customized experience for patients, at which they can get information
about their treatment based on the filters that they provide to
the system (see fig. 17 for sketches). The board will help manage
the uncontrolled display of information through posters on the
wall of the facility, thereby giving outpatients more personalized information. The interface would have language translation
and voice activation as a way of also addressing the call for
universal design. This proposed design opportunity has a very
close similarity to the final design outcome in terms of the
medium and technology.

Fig. 17 Sketch of the KYN (Know Your Needs) interactive board.
The visual shows sketches of how it is intended to be used and where it is placed at the MDC.

24

Beginnings

Fig. 18 Image of the KYN (Know Your Needs) prototype.
The materials used for the prototype are corrugated cardboard, straw, paper, glue, and tape.

D. Patient Friendly Packet
Patient Friendly Packet is one of the design opportunities
designed as cards enclosed in sleeves, which will be handed
over to patients just after they check-in (see fig.20).
Information that is specific to each service is in this material
provided at the medical daycare. Information includes;
name(s) of everyone on the care team through their treatment encounter, what outpatients should know about their
treatment encounter, images, infographics, and personal
stories. Once the patient begins their treatment, the cards
will be retrieved from them. This design opportunity was
modified and infused into the final design opportunities as a
result of new insights from health professionals during user
testing and interviews.

Beginnings

25

Fig. 19 Image of the heat mapping activity and a sketch of the patient friendly packet.

Fig. 20 A prototype of the patient friendly packet.
The sleeves are designed to hold cards that pass information to the patient during their visit to the MDC. Most of the features of this
prototype has been introduced into the final design opportunity prototypes at the end of the research.

26

Beginnings

Fig. 21 Image showing where the “KYN” design opportunities are situated within the journey map (illustration by the author).

On the 3rd day, I had to test the ideas with participants
through role-playing, similar to the experience in the waiting
area. I set up space and made participants sit facing each other
after checking-in like patients would typically do (See fig. 22). At
this point, the design solution was tested with participants
through role-playing and iterated on subsequently based on
feedback. The process involved looking at each member and
not as a group to avoid biases and clouded judgment based on
another participant’s response.

Beginnings

27

Fig. 22 An image showing the seating arrangement of a classroom was simulated to look like the waiting area
including the prototype positioning at the Medical Daycare area.
The waiting area is arranged to have outpatients facing each other while they wait.

Fig. 23 An image showing how the infographic prototype is placed within the waiting area.
This touchpoint is aimed at allowing outpatients to get more insight and information into their treatment encounters.

28

Beginnings

1.6 Insights from design sprint I & II
as an activity to further explore and
brainstorm possible design outcomes
Through these design sprint activities, it was evident that
there is a need to have more check-in and information from
the care team, during extended times at the Medical Daycare.
In realization of this opportunity and to address the design
opportunity, it will require top-level intervention by getting
more support from the policymakers, which often can require
a more incremental approach. This project has attempted to
solve this problem by interviewing administration-level
healthcare professionals, and suggests an opportunity for
future research to look into the area of policymaking and
intervention within this space. Also, another insight from the
sessions revealed that during these extended wait times,
providing information materials in the clinic that were more
educational and customized could potentially improve the
experience, as outpatients will have control of what they are
exposed to while they wait. The possibility of providing more
transparency regarding backend service activities was also
explored during the sprint session. Another insight that
remained consistent through the research is the problem of
information overload. Having asystem looking at opportunities for progressive disclosure that could condense and
simplify this process for outpatients would be a step in the
right. In other words, good design also entails delivering
information that is not too much. This insight developed into
the choice of design outcomes that provide outpatients with
details about their encounter and would prepare them for
the procedure through the use of a simplified system. Design
sprint II was an opportunity to iterate and narrow down on
some developed ideas. Finally, the test sessions on the third
day showed that going in for treatment, outpatients tend to
be bored and anxious (See appendix for notes on user
testing) and they would like to educate themselves while
waiting by getting more information about the room and
treatment encounter.

2.0 Continuing design
2.1. Moving from exploratory to evaluative
prototyping through interviews and user
testing
2.2. Desktop Walkthrough method and insights
2.3. Interviews, workshops and user testing
2.4. Insights and new understanding from inter
views, workshops and user testing
2.5. Designing for the user model (persona)

30

Continuing Design

2.0 Continuing design
The next phase of the research, it involved shifts and approaches that were generative and focused on the opportunity space
that had been identified through initial exploratory research.
The activities included prototyping with desktop walkthroughs, interviews, workshops, user testing and designing a
provisional persona.

2.1. Moving from exploratory to evaluative
prototyping through interviews and user testing
Whether formal or informal, evaluative prototyping helps you to
converge again, to start reducing the number of options you
have and decide on what to focus on”
– Stickdorn et al., 2018, p. 213

Continuing Design

31

2.2. Desktop Walkthrough method and insights
Desktop walkthroughs are a good way of interpreting insights
and design opportunities from the phase of exploratory prototyping to stakeholders. Desktop walkthroughs are a crucial tool
in service design because they allow for easy collaboration
within the design process.

Fig. 24 Image showing the making process of the desktop walkthrough. The final prototype shows different
locations within the Medical Daycare labeled for easy identification.

Evaluating the prototypes using different methods was a way
of converging ideas to what is feasible based on the research
context and site requirements by creating a focus on sketched
ideas. The prototypes that were later introduced to health
professionals to get feedback. One of the most significant
shifts in the design prototypes was going from the word
‘priority’ to ‘pathway’, which was a result of health professionals
suggesting that each outpatient is a priority, only that they all
have independent pathways. The outcomes are: the Patient
Pathway App, Patient Pathway Armband, and Patient Pathway
Board. The Patient Pathway App is the lead design outcome
with others introduced as support to the healthcare environment and added information with the pathway board and
armband, respectively

32

Continuing Design

2.3. Interviews, workshops and user testing
Resistance to change within healthcare can sometimes complicate the process. A way of causing a change in healthcare
will involve actors changing the institutional arrangement,
using the enduring rules, norms, roles, and beliefs (Walling &
Fuglsang, 2017 in Vink, Josina, et al. 2019).

Interview and testing with Health Professionals
Taking the priority prototypes to healthcare health professionals at JPOCSC is a part of the evaluative process whereby their
input. The arrangement for this workshop had been made with
the site manager much earlier in the project. They were two
clinical/patient care coordinators (PCC), one of whom currently
oversees activities within the Medical Daycare at JPOCSC. While
this process introduced very useful key insights, there were
some challenges in the process like getting ethics approval on
time and the process of using healthcare language to create
shared understanding.

Fig. 25 Image showing the process of information gathering from health professionals through interviews.
Each question is categorized with specific emphasis on the intersection of findings (illustration by the author).

Continuing Design

33

The interview was designed into three parts; background,
experience, and empathy (see fig. 25). The first questions were
about the background (primarily getting an understanding of
the care provider’s role within the facility). The second set were
experience (their observations and measure that have been put
in place to improve the patient experience). Lastly, empathy
(involves the opportunity from their lenses on how to enhance
the experience for outpatients) (See appendix for interview
questions). With this plan, it made the process more seamless
in getting rich information that would help in the redesign and
improvement of the prototypes and a starting point for what
the design opportunity could be (Green intersection with the
question mark “?” in fig 25).

Fig. 26 Image of the iterated outpatient journey map was part of the materials used for the workshop with health professionals.
The use of pink sticky notes helps to indicate where each prototype will be placed within the patient’s journey within the facility.

34

Continuing Design

Fig. 27 An image of the patient priority infographic. The prototype is designed to provide more information about patient priority,
priority cards, and the care team. This was also part of the materials that were used during the workshop.

Continuing Design

35

Workshop and testing with Faculty and Peers
The sessions were carried out with faculty and design peers. The first activity
with faculty had them role-play as outpatients. Role-playing is one of the
methods in service design used in exemplifying a real context or scenario.
The materials used were the desktop walkthrough, and prototypes. This
activity was planned to last up to 30 minutes, which gives enough time to
go through the questions and introduce the prototype, which participants.

Fig. 28 Image of the first role - playing exercises with faculty

Fig. 29 Image of the second role - playing exercises with faculty

36

Continuing Design

The next activity was with design peers where the prototypes
used for the testing session were the patient pathway armband, pathway infographic board, and pathway app prototype.
Also, there was a task scenario for participants to go through as
a protocol towards the objective of user testing.

Fig. 30 The patient pathway app prototype with the task scenario. The task scenario serves as a guide for
the participant to go through the different stages of the task. Participants had to go through
a similar experience as an outpatient. The first activity is to check-in, get seated and wait to be attended by a clinician.

Fig. 31 An image of the first user testing with a participant.

Continuing Design

37

Fig. 32 An image of the second user testing with a participant.

Fig. 33 An image of the third user testing with a participant.

38

Continuing Design

Fig. 34 An image of the fourth user testing with a participant.

2.4. Insights and new understanding from interviews,
workshops and user testing
These sessions with health professionals, faculty and peers provided new
insights and considerations when going forward with the research. As I had
anticipated, the process helped in narrowing down and suggesting what
design opportunities will best fit the current requirements within the facility
and how well it was in sync with other existing design opportunities.
One of the early suggestions to health professionals, which were an initial
idea that I had during the early exploratory phase, was the possibility of
nurses potentially moving up on the stage of interaction to feature much
earlier in the outpatient’s journey. However, health professionals at JPOCSC
felt that this modification was a disruption of the current process and will
better of happen incrementally if at all. This was very vital feedback, which
could potentially open up more space for future research. Another insight
was that the word priority connoted a different meaning, which they
believed could be misleading simply because every patient is regarded as a
priority in healthcare and based on this the materials were renamed going
forward from after the activities with health professionals. This was one key
insight that has stayed throughout the research and brought about the
change of name from “priority” to “pathways”.

Continuing Design

39

Lastly, health professionals were of the opinion that instead of
making a promise on the amount of time it will take for patients
to get treated, it will be more realistic on the part of the care
providers to prepare patients for what to expect during their
visit. This insight is very vital to the decision on the information
and structure of the pathway design prototypes.
Some of the lessons learned from conducting activities with
internal participants through role-playing are that there are
tendencies of possible biases. For instance, the activity with
faculty in the university saw them switch from role-playing as an
outpatient to a more classroom instructor role and back again.
However, this switch was an opportunity to get useful insight
into the process.

40

Continuing Design

2.5. Designing for the user model (provisional persona)
Personas are useful in keeping a focus on the design target by eliminating
some of the potential pitfalls of designing for a wide range of user audiences. Importantly, in service design, to move from the clinic experience to
designing for a target often requires the use of personas. Personas provide
information from research data to inform design decisions. Personas are
powerful tools that prevent designers from designing for themselves but
rather to become more extrospective (Chris Noessel). American software
engineer and author, Alan Cooper suggest that in creating a persona the
information is often gotten from humans who are the users observed or
interviewed during the research that captures their human motivations in
the form of goals, whereby some are more obvious than others (Cooper, 68)
through the use of qualitative methods, behaviors, attitudes, and aptitudes
of potential and existing users are uncovered as well as technical, business,
and environmental contexts of the product to be designed (Cooper, 32).
When creating a persona, it is important to consider what is referred to as
the focus of the design. Design consultant Kim Goodwin describes this as
the primary focus of the design for each product and other times, the tools
used within the product (Goodwin). Often, there is a difficulty in distinguishing between the type of data that should be collected and the similarities with those of other disciplines. Cooper describes this distinction, by
suggesting that “while there are some process similarities between market
segments and design of personas, personas are based on behavior and
goals as exhibited and shown through research and observation and
market segments are based on demographics, distributing channels and
purchasing behavior of the user” (Cooper, 71).
Alan Cooper in the fourth edition of his book, About Faces, also describes
the users into three categories; the elastic user, self-referential design, and
edge cases (64). While the elastic user and self-referential design have been
described to affect the usefulness of personas, Cooper, however, suggests
that for the edge cases, they should be designed for but not the primary
focus (65). For this research, the data that has been used was gotten from
subject matter health professionals who are well conversant of the outpatient's interaction within the Medical Daycare and supported by secondary
data (see fig. 35 below for link and resource credit).

Continuing Design

41

Fig. 35 Visual of the design persona (illustration by the author).
The data used in writing this persona were derived from health professions interviews, demographic data from https://myhealthmycommunity.org/community-profile/surrey/, and field observation of outpatients at the Medical Daycare waiting area.

When designing provisional personas, the designer makes
guesses about behaviors, motivations, and goals based on
subject matter experts' knowledge of user and stakeholder
while adding to data that has been gotten through market
research (Cooper, 97). This is because often there may not be
enough resources, time, or budget to conduct primary research
as in depth through interviews and observation to get detailed
qualitative data, the use of provisional personas can be a useful
tool in determining who the important users are (Cooper, 97).
However, there are some potential pitfalls to using provisional
personas, which Cooper describes to include designing for the
wrong target, missing key behaviors, difficulty in getting buy-in
and discredit of the entire value of personas (97). This research
takes into consideration and identifies these potential pitfalls as
mentioned by Cooper and avoids them.

3.0 Designed touchpoints
for improving the outpatient
waiting experience
3.1 Prototyping design criteria and design
language elements
3.2 Patient pathway prototype app and key
features
3.3 Patient pathway armband
3.4 Patient pathway board
3.5 Storyboard of outpatient’s future state
experience

Designed Touchpoints

43

Designing better outpatient experience during extended wait
time is essential in the overall outcome of care and touchpoints
have a crucial role, and this research aims at introducing
touchpoints that improve the outpatient's experience.

Fig. 36 An iteration of the previous visual in fig. 25 showing how the intersection brought about the design opportunity
(pathway prototypes – app, armband, and board) (illustration by the author).

For this research and those similar in the field, actors include
health professionals who are key in the experiences of the
outpatient as service providers and their role in the design of
the pathway touchpoints. Service providers have different ways
of creating touchpoints for customers through online platforms, physical environments or catalogs and these are a way in
which they facilitate encounter and create interactions (Voorhees, 270); they (touchpoints) are the points of contact
between a service provider and customers (Clatworthy, 15). The
physical experience makes up the touchpoints that are available within the environment, and the relational elements to
the outpatient. In designing the touchpoints, working with
health professionals helps provides a deliberate constraint
which takes into consideration the physical and relational
experience as Zomerdijk, G, and Voss, C., (2009) suggest. One
insightful precedent revealed during the participatory activities

44

Designed Touchpoints

with health professionals was the failed virtual translator. This
virtual assistant had been developed to solve issues with
language barriers, but it had technical and operational problems such as lack of accuracy and personalization. This research
uses the app design to help address this problem by designing
a simpler and user-friendly interface.
Furthermore, health professionals believe that an ideal scenario
of an outpatient’s interaction with the care team involves
patients being able to check-in and get informed with updates
via their phone, thereby reducing wait time and anxiety. The
medical daycare has been described as a clean and friendly
environment that contributes positively to the patient experience, especially because of the nature of treatment that is
being carried out there, for example, antibiotic treatment.
However, there are times when the place gets noisy and
congested. Patients tend to lose their spot because they
wander away. The team believe that they could use a form of
notification during this time to call patients when it is their
turn. Parking is also a problem for patients. Most of the interaction that happens with outpatients is verbal. Sometimes treatment needs are triaged to give a patient a sense of wait time.
During this time, it is not uncommon for the triage nurse to tell
patients to go and return without telling them the reason why.
Out of all the units at the clinic, the MDC is described as having
the least interaction with outpatients. This discovery could be a
result of the treatment needs.
Finally, when asked about ways to improve the current system,
health professionals felt that it would be essential to inform
patients about the following;
1.

Why there is a wait time

2.

Give an estimated time

3.

Fix the Meditech parking

4.

Show proper time estimates through each process

5.

Get more clerks and volunteers

6.

Decongest the waiting area

7.

Create better check-in and access to the reception.

One other aspect that health professionals left out was if there
was an existing way of providing information to the patient
about the restaurant and other convenient spaces within the
facility. This may have been omitted because these are visible

Designed Touchpoints

structures within the facility.These insights, feedback, and
findings informed the design decision and the choice of key
features and considerations to be introduced that could help
reduce these factors that contribute to outpatients experiencing extended waiting periods.
The initial prototypes, as discussed earlier at this stage, were
narrowed down and refined after multiple iterations and user
testing. The outcomes at this point were the patient Pathway
App, Patient Pathway Armband, and the Patient Pathway
Board. Selected design opportunities have been combined to
improve the outpatient experience during their visit by giving
more information during different stages of their journey (see
fig. 37). The patient pathway design opportunities follow an
arrowhead pattern, with the app being the primary touchpoint
and others supplementing it.

Fig. 37. Revised service blueprint showing the touchpoints that have been introduced.
The redesigned service blueprint shows where each of the pathway prototypes prominently features
in the outpatient’s journey (illustration by the author).

45

46

Designed Touchpoints

Within the healthcare context and similar to designing for
other public-facing services, it is important to take into consideration the spectrum of users as this will help in achieving
better design outcomes that are easy and friendly to use by
everyone. According to the Ontario Digital Government on
designing for a full range of abilities, the government suggests
that “It is important you understand the full range of abilities
you are designing for, to make sure you don’t create barriers”.
This means making sure that there is a proper understanding
of how users perceive and can use the product or service. The
Ontario Digital Government as part of its accessibility guideline
says users' easy access to a service or digital product, depends
on how it is built in an accessible way that is easy for them to
use (Ontario Digital Government). At the Medical Daycare, there
are different types of patients with different accessibility needs
who will be interacting with the prototypes. Therefore designing these touchpoints, led by the pathway app, required taking
into consideration how the user will perceive texts, colors, and
images. The design had to be deliberate and obvious to all,
including those with visual impairment. This led to the design
of visual guidelines as a guide to how text and colors are used
in this design based on the recommendation on web accessibility provided by the Web Content Accessibility Guidelines
(WCAG) 2.1. Level AA.

Designed Touchpoints

3.1 Prototyping design criteria and
design language elements
The design criteria (see fig. 39) serve as the brief in achieving
the goals of the design opportunities, by drawing insights from
the research as well as identifying parts of the system that
would not be accommodated in the prototypes.

Fig. 38 A sketch of the ideation process towards creating visual guidelines.
This includes all the things to consider when moving from low-fidelity prototypes to
medium fidelity ones (illustration by the author).

47

48

Designed Touchpoints

Fig. 39 An image of the design criteria showing things to consider when designing
the medium-fidelity prototype (illustration by the author).

Designed Touchpoints

49

Fig. 40 Image of UI colors for the patient pathway design opportunities. The colors chosen for the UI elements
have been drawn from the brand and image Pantone from the criteria, which makes up the primary colors.
In addition, the three colors that represent the patient pathways have been included in the UI (illustration by the author).

50

Designed Touchpoints

Fig. 41 Image of the UI graphical element for the patient pathway app design opportunity. The choice of buttons, navigation,
and icon elements help users to achieve their goals easily and contribute to the experience when using the app prototype.
The UI element is a combination of universal elements (like the hamburger button, search, and home icon) and
ones that are customized (like the pathway icon) to the patient pathway app. (illustration by the author).

Designed Touchpoints

Fig. 42 Image showing the use of typography and paragraphs. The choice of font is Roboto which has a bold
presence and the font family is free from Google (illustration by the author).

51

52

Designed Touchpoints

Fig. 43. Vector character illustrations for the patient pathway app. The characters illustrated represents all genders and have been
created using the UI colors. The choice and style of the illustrations represent everyday activities and lifestyles of people that users
can relate to and connect with easily (illustration by the author).

Designed Touchpoints

53

3.2 Patient pathway prototype app
and key features
However, future versions could also include a responsive
website while ensuring that ethical standards are met and
information on user preference is kept private. The patient
pathway app prototype has been designed based on insights
and opportunities identified through the research. These
insights have been designed as features that allow outpatient
to achieve their goals when using the app.
In addition to the need of having customized experience for
outpatients, an app was chosen because it provides a better
and more personalized experience for users and a more
seamless onboarding. Also, considering that outpatients
could walk away from the waiting area during their treatment
visit and need to be informed of any update, an app makes
this feature easy by way of alerting and notifying patients,
which designing a similar feature on a website may be more
difficult and can cause a drop in the users to experience. The
word pathway has been used as a metaphor borrowed in its
literal sense used to describe a path towards the course of
action where outpatients can choose between three colors
(Green, Orange, and Purple), based on the number of
encounters and the severity of their treatment. This information is made known to them by their referring doctor or when
they visit the Medical Daycare. The process that the outpatient goes through using the app is visualized with the user
flow (see fig. 44), which starts by them choosing a pathway
that matches the color on their armband. The app also
provides transparency to backstage activities and the opportunity for outpatients to call the attention of a care provider if
they need more information.

54

Designed Touchpoints

Fig. 44 An image of the information architecture showing the user flow for the Pathway App (illustration by the author).

Designed Touchpoints

Key features of the app prototype

55

56

Designed Touchpoints

Fig. 45 An image of the information architecture showing the user flow for the Pathway App (illustration by the author).

Designed Touchpoints

57

Pathway app prototype screens

58

Designed Touchpoints

Designed Touchpoints

Fig. 46 Images of hi-fidelity app prototype interfaces design (illustration by the author).

59

60

Designed Touchpoints

3.3 Patient pathway armband
The patient pathway armband is a unique touchpoint in that it
mimics the system currently in place wherein. Patients are
given something similar at the time of check-in that contains
their necessary information. The prototype was one of the three
designed to follow an existing process that is common to the
Medical Daycare and many other healthcare facilities. As a
future possibility, this armband can replace the existing ones at
the facility that gives more information that is useful to the
outpatient at the time of their visits. The patient pathway
armband also uses similar colors to denote the encounter that
a patient goes through. Of the three design outcomes, the
armband has the least amount of information, which was a
deliberate design action because of its size.

Fig. 47 An image of the pathway armband (illustration by the author).

Designed Touchpoints

Fig. 48 An image simulation of the pathway armband placed on the wrist. (illustration by the author).

61

62

Designed Touchpoints

3.4 Patient pathway board
The patient pathway board is designed to be a life-size digital
board that scrolls through information about the different
pathways. It will be positioned in the waiting area at the MDC,
where it serves outpatients collectively. It is a design opportunity that follows convention with the way it operates, yet
mostly different from its specific purpose from other types of
boards.

Fig. 49 An image of the patient pathway board

Designed Touchpoints

63

Fig. 50 An image of the patient pathway board mocked-up.

64

Designed Touchpoints

3.5 Storyboard of outpatient’s future state experience
The patient pathway armband is a unique touchpoint in that it
mimics the system currently in place wherein. Patients are
given something similar at the time of check-in that contains
their necessary information. The prototype was one of the three
designed to follow an existing process that is common to the
Medical Daycare and many other healthcare facilities. As a
future possibility, this armband can replace the existing ones at
the facility that gives more information that is useful to the
outpatient at the time of their visits. The patient pathway
armband also uses similar colors to denote the encounter that
a patient goes through. Of the three design outcomes, the
armband has the least amount of information, which was a
deliberate design action because of its size.

Fig. 51 An image of the storyboard of the outpatient interaction with the touchpoints.

4.0 Conclusion: challenges
and opportunities when
implementing service design
in healthcare

66

Designed Touchpoints

4.0 Conclusion: challenges and opportunities
when implementing service design
in healthcare
There have been discussions regarding the role of actors in
healthcare and the need for them to embrace change.
Service design has a role to play in creating a new narrative
within the healthcare sector, which Vink et al., describes as a
perspective in service innovation called service-dominant
logic (S-D logic), which integrates new ways in value-co-creation among actors. The role of participatory practices and
social position means that service design is useful when
diverse stakeholders can collaborate and share ideas during
the service innovation process through a process of co-design.
During the exploratory phase, when health professionals at
the MDC were asked of an opportunity to intervene in the
current wait time, they advised that reducing the wait time
could not be promised, but rather it was more realistic for
patients to be more prepared for their treatment as a way of
significantly reducing a factor that contributes to the long
wait time. This insight greatly influenced the result of the
design outcome at the facility. Also, this research identifies
some factors that can be attributed to existing policies and
culture within healthcare. Vink et al., (2019), describes these to
be predicated within the subject of institutional arrangements that currently exist, and its effect on “the rules of the
game” as cited in Walling & Fuglsang, 2017. For example, from
a cultural perspective, health professionals suggested a move
from the name of the prototype to be changed from “priority”
to “pathway”.
Furthermore, exploratory and evaluative prototyping was
used to collaborate and share ideas respectively. This process
through the use of service design methods was key in understanding, ideating and prototyping design opportunities.
Testing design outcomes with internal participants through
role-playing and with health professionals (care providers)
revealed that there are gaps in the process that can affect the
outcome and quality of care for outpatients, especially as it
relates to waiting time. One other sticking part of the
research was the use of the journey map to go through the
entire process of their interaction through the service reveal-

Designed Touchpoints

ing that outpatients are not equipped with enough information and preparation about their treatment encounter, which
contributes to delays. This gap in service is evident on the
journey map with the few times they appear to interact with
the care providers – which only happens initially on the floor
of the check-in at the reception and subsequently when
called in for treatment. Initially, during the research phase of
observing the MDC waiting area, it was easy to identify and
suggest ways to reduce the wait time, however using a generative approach (service design methods), it allowed insights
and findings through the process lead to design outcomes
(patient pathway prototypes). This generative process also
revealed that policy and other institutional work within
healthcare contributes to longer waits, which is caused by
having too few care providers providing service for patients
[comment from one of the health professionals interviewed].
This resulted in discovering and prototyping design opportunities that reduce the effect of some of the factors that
contribute to extended wait time at the Medical Daycare.
Finally, working with participants and health professionals
provided new insights and considerations when going
forward with the research. For example, in narrowing down
and suggesting what design opportunities will best fit the
current requirements within the facility and how well it was
in sync with other existing touchpoints at the Medical
Daycare. As part of future considerations, this research is
believed to have opened up new opportunity space not
accommodated in this research. For example, design policies
that make the institutional framework in healthcare more
open to change. Other opportunities for future work are
researching new ways of encouraging non-verbal/gestural
ways of interacting with outpatients that are beyond the
current system in place to increase empathy and understanding of the needs of outpatient during treatment visits.

67

5.0 References

References

Chu, Holly, et al. “The Psychology of the Wait Time Experience –
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6.0 Appendices

Appendices

73

Early prototypes of the patient friendly packet

Early prototypes of the patient pathway app

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Appendices

Different screens and notes taken during user testing of the patient pathway app prototype

Different screens and notes taken during user testing of the patient pathway app prototype

Appendices

75

Different screens during user testing of KYN (Know Your Needs) prototype

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Appendices

Different screens during user testing of KYN (Know Your Needs) prototype

Appendices

77

Observation notes from Sprint I prototype testing session

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Appendices

Observation notes from Sprint II prototype testing session

Appendices

79

Observation notes from prototype testing session with Faculty

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Appendices

Observation notes from first prototype testing session with experts

Appendices

81

Observation notes from first prototype testing session with experts

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Appendices

Observation notes from first prototype testing session with design peers - 1-on-1

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Observation notes from second prototype testing session with experts

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Appendices

Jane’s visit to the Medical Daycare
for an Iron Infusion procedure
You have an appointment to undergo an Iron Infusion procedure (the procedure involves iron being
delivered to your body intravenously). At the check-in desk, you were given some information about
patient pathways. Now, you have to wait for before being attended to.
While waiting, perform the following tasks on the app to get more out of your visit today;
Task 1.
Task 2.
Task 3.
Task 4.

While you’re waiting, learn more about the pathway for the iron infusion procedure.
Navigate the steps to completing the iron infusion procedure.
Get more information about the behind the scenes activities.
It’s taking longer than you expected, using the app, call the attention of a member of the care
to know how much longer you have to wait.

Task Scenario

Task scenario used during usability testing

Welcome to this session, I want to go through some activities using these prototypes in front of you.
Please note that you are not being tested, but rather you are helping out to evaluate what is in front
of you so be as comfortable as possible. Also be aware that some of the protototypes may not be as
functional as you would expect or the size may be reduced from what the actual size would be.
The session will last up to 20minutes in total with the task coming first and a discussion afterwards.
Now go ahead and perform the following task in front of you.

Thank you for your time. Now let’s go into a discussion about your experience using the prototypes.
Post Task Evaluation
• How easy was it to use the prototype?
• Did you find it easy to keep track of your location on the app?
• How quickly could you find information on the app?
• Are the content intuitive enough and make you want to explore the app further?
Do you have any other feedback?

Post Evaluation Questions

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85

TCPS2: Core certificate of ethical conduct of research involving humans

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Appendices

Letter of authorisation to conduct research within Fraser Health Authority

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87

Certificate of Approval - Fraser Health Authority (FHREB)

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Appendices

ECU-REB Certificate of research ethics approval