Ethnography Report on BMC waiting room

By Lazlo Ring

Introduction

Geriatric health care is a quickly growing problem. As medical advances improve the lifespan of our generation, larger percentages of people are living past the age of 65, and start to require additional health care. A new problem emerges from this though, the problem of educating this population about healthcare. In this study, we observe the interactions of a geriatric waiting room at Boston Medical Center with a kiosk designed to teach geriatric patients about health safe tips, such as fall prevention, and vaccines. From these observations, we hope to better learn how to improve and design systems for the geriatric population.

Methods

One hour was spent observing and interviewing patients between the hours of ten and eleven on a Wednesday morning. This time was selected since the staff at the Boston Medical Center Geriatric Clinic said this is when most patients schedule their appointments. While there, we observed approximately 10 patients and their caretakers, and conducted two semi-structured interviews focused around what they thought of the kiosk currently in place, and what other things they though the waiting room could use.

Results

From the observational study, we found a few areas of improvement that the current kiosk setup could use and several suggestions on how to develop a system for a geriatric waiting room. The first factor we observed in this study was that the average waiting time for patients was about ten minutes. It should be noted that the waiting room was reported to usually be busier then it was at the time of the observation, but this means that any interactions designed for this space should optimally take 10minutes or less. Additionally, patients will be interrupted often while using the system so it needs to be able to return back to a welcome screen shortly after the patient stops using it.

One of the first observations we made upon arriving to the waiting room was the placement of the kiosk in relationship to the rest of the waiting room. According to the staff and patients, this was a new waiting room that they had just recently relocated to, but the kiosk was positioned in a corner out of sight from the rest of the waiting room. Previous studies have shown that geriatric patients have declined peripheral vision, so the placement of the kiosk in a corner may make it less apart to the most patients and could be related to why many patients reported to have never noticed it.

The next potential problem observed in the waiting room was that many of the patients there had walkers or canes to assist them in walking. A 70 year old woman stated in an interview we conducted that the kiosk was difficult to use because “standing for a long time is hard for a lot of us to do”. Although the stand the kiosk was built on had an adjustable height feature, this feature was not apparent to many users, and the fact that it was plugged into the wall make it seem like they should not try and move it. A simple solution would be to incorporate a chair or seating area into the system so that it is more appealing for people with mobility problems.

A few problems were noted about the visual design of the system, mostly dealing with the way the kiosk was presented. The system was not enclosed; with the computer running the system exposed to the patient, and free wires, including a fire wire cable sticking out towards the user. Because of this, it appeared as if the system may be currently under repair, causing a few people to be unsure if they should interact with it or not. In addition, many of the patients were not very experienced with computers, and could have been put off by the exposed computer. If the system was enclosed, more people would be inclined to use it. By remodeling it after a system people are already familiar with, such as an ATM machine, some of the fear of using the system might have gone away.

Another feature that many of the patients seem to want was the ability to return back to the trivia game, and to tell the system when they were leaving. Once a user agreed to talk with the virtual agent in the system, they had to complete the entire dialog with the agent before they were allowed to return to the trivia. The problem arose when one user would leave, and the other user would approach the system to find it in the middle of a dialog, which usually put them off, causing them to not interact with it. There are a few potential solutions to this problem, but the most effective might be to incorporate a motion detection device into the system to let it know when it is currently being used or not. If the system does not currently detect a user, it could return to the standard welcome screen. Also, letting the user exit out of the interactions with the virtual agent would allow the users to feel as if they were saying goodbye to the agent, and could make them feel more inclined to interact with it again.

The final, and potentially largest problem observed was a point many of the patients brought up, which was why should we use the system. A 65 year old retired professor explained to us that he had “no need to use the computer”. Since many of the patients had similar ideologies about computers and the system in the waiting room, it seems that the main problem that needs to be addressed is how to make the system attractive to patients with little to no computer experience. There was a sign posted behind the system explaining that the user should touch it to talk with Tanya, but the sign was in a obscure place in the waiting room, and did not seem to attract the people who noticed it.

As stated above, the main problem that we found from this observational study was that people did not find the system to be something they needed to use. Whether this is due to the fact that they never noticed it, or because they did not see the purpose of the system is up for debate, but either way it is an issue that must be addressed. This issue will be the focus of our team project, in which we hope to address this problem, along with the others found in this observational study, by try to find new and innovative ways of making a system that both attracts and educates users.