The Transparent ER

This is the outcome of our user research at the ER. We called it the Transparent ER.

Main screen in the waiting room of the Transparent ER deparment

Map screen from the Emergency Room website

Here you find our documentation of the project, from the user research up to the concept development.

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We developed a national online service designed to alleviate and disperse patient pressure on the regional E.Rs. By providing a simple overview of the state of each ER in the region, we enable walk-in patients to make smart decisions from home as to where they will be treated fastest and where they will burden the system the least, freeing up resources for the ones who need it the most.

At the same time, we expanded this online service into the ER´s themselves – providing real-time visual information in the waiting room as to the state of the ER; how many patients are being treated and what is their status: is it life or death? or is it simply a fractured ankle? Allowing waiting patients increased transparency as to why they are waiting would generate respect and understanding for the extremely important work of the staff and cut down on frustration for both staff and patients alike.

The Context
Hillerød Emergency Room is an extremely hectic and busy environment. Patients arrive with little to no warning, life and death decisions have to be made in the blink of an eye and space and resources are limited. Experiencing the ER exposes people in their most vulnerable state – frightened and confused. It also demostrates highly professional medical staff who balance the systemic challenges of securing an efficient flow of patients with the very human and emotional task of caring in situations where people need it the most.

Realising quickly that many of the routines are too sensitive and crucial to handle without extensive medical knowledge, we quickly decided to concentrate on some of the more soft factors, that although less direct, could still make a major difference in the day-to-day running of the ER. Focusing on the patient experience, we quickly began to see a pattern emerging, revealing a deeper schism between delivering efficient medical care and ensuring the most pleasant patient experience possible under the circumstances. This moved us towards several different directions, focusing on the issues of: patient identity; security; and information vs. frustration and emotion.

Gathering User Insight
To gain an initial understanding of the dynamics of the ER, we employed several different approaches. We shadowed different nurses at work, observing their routines and day-to-day tasks. We spent hours in the waiting room emulating patients and we interviewed a number of different doctors, nurses and patients.

These interviews took place partly as co-creation sessions where we employed different design games and scenarios to prompt interviewees to break out of their usual routines and perspectives. We asked the nurses to put themselves into the patients shoes, and describe what they thought was going on from the patients perspective through each stage of the journey through the ER, using pictures and key emotions. We checked this against patient interviews, looking for discrepancies and differing understandings.

We employed a more phenomenological approach, asking patients to dress dolls in layers of emotions – represented by actual doll dresses – ranking emotions and needs such as security, attention and information from the most important to the least. Also we used category shifts, asking the doctors and nurses to imagine the ER as a restaurant, and hence trying to concentrate on the service aspects of the experience.

These games and interviews provided us with following key insights: The relationship between patients and nurses is instrumental to the patient experience, but can be difficult to maintain throughout; There is a built in schism between focusing on the individual needs of the patient and the collective needs of the patient body as a whole; Many patients arrive with maladies treatable by their own GP´s – often because of lack of knowledge about their own condition and the function of the ER; and a vicious circle arises from patients being frustrated when not being informed, resulting in patients aggravating staff who then again have less mental resources to inform and care for patients.

Design Challenges
Based on our insights we developed 3 design challenges that framed our solution. We asked:

How can we increase transparency and reveal the inner workings of the ER, promoting increased empathy patient-to-patient and patient-to-staff?

How can we increase the flow of relevant information between staff and patients, creating more profitable relationships between them?

How can we decrease pressure, by limiting the expenditure of resources on patients who could be treated outside the ER?

Exploring the User Experience
We tested our online service and display prototype with nurses and doctors during our last co-creation session, using mock-ups and scenarios. Most of them thought if could be a good solution, reducing tension and frustration for patients that wait a long time before being treated.

On the other side, some nurses voiced concerns about creating false expectations about the waiting time – pointing to cases where serious patients push back all others, creating long waits for less than life threatening maladies. Still others suggested incorporating more information on the routines and duties of the staff, hoping to create a more empathic attitude and deeper understanding of the hectic reality of the staff.

Finally, there are political concerns regarding the redistribution of patients to different ERs. There is talk of closing down some of the regional ER´s and creating a “super-hospital” in Hillerød. Something that would require completely new facilities for the ER.

Hence we decide to concentrate on creating non-specific and abstract visuals, with no concrete information (e.g. definite waiting times in minutes and hours), thus avoiding false expectations while still keeping the transparency aspects intact. Also we included more space for information of different kinds: “What to expect as a patient”, “what to remember as a patient”, “what happens behind the scenes” “ what is the triage system and how does it effect you” and also specific and topical information like treating flu epidemics and the like.

Finally it was presented to management, who clearly saw the value of our solution – even inviting us to continue to contribute with insights, especially if the reorganisation goes ahead.


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