Hospital Feedback System Design: NYU Langone

Service Design

Clients
NYU Langone Health

Duration
Nov. - Dec. 2021

Role
UX Researcher
UX Designer

Team
Vasu
Mingjing
Ker
Sarah
Yen-Yi Huang

Project Overview
In this project, our team worked with clients from NYU Langone Health to conduct a service design to improve gender-expansive patients' experience. Our design is selected by NYU Langone Health to feature in their Innovation Lab and will be used to shape future infrastructure and make Langone more gender-expansive friendly!

After researching related topics, we found that the pain point is the lack of trust between the patients and healthcare providers and the unequal power dynamic. Thus, we devised a feedback system to involve the patients and service providers.

This project has been selected to feature in the NYU Langone innovation space.

Research

Design Method

Literature Review

A Harmful Cycle for Gender-Expansive People Accessing Healthcare

According to our research, sexual and gender minorities encounter numerous barriers to accessing care. The main issue is:

Lack of providers who are sufficiently knowledgeable and cultural competence on the topic.

Other barriers include:

  1. Discrimination

  2. Financial barriers (lack of insurance, lack of income)

  3. health systems barriers (inappropriate electronic records, forms, lab references, clinic facilities)

  4. Socioeconomic barriers (transportation, housing, mental health)

As a consequence, certain LGBT patients may not feel comfortable revealing their sexual or gender identity during medical treatment, which can cause them to experience stress. Unfortunately, this can lead some individuals to avoid seeking healthcare altogether and turn to harmful alternatives like drugs and alcohol. This reinforces the negative societal attitudes towards the LGBT community, creating a harmful cycle.

Reference
Barriers to Health Care for Transgender Individuals
Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia
Sexual and Gender Minority Health: What We Know and What Needs to Be Done
Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data
Continued Barriers to Top Surgery among Transgender Men

Survey

The Surveys of Gender-Expansive people.

The survey shows above 80% of gender-expansive people have uncomfortable healthcare experiences. All of them mentioned being misgendered, and 20% said that healthcare providers are not acknowledge gender identity issues.

In the following interviews, they said:

“the doctor(s) do not accept nor acknowledge my gender identity….”

“I am always uncertain as to whether disclosing my pronouns with healthcare professionals will impact the quality of care I receive….”

“(I have) fear of being misgendered or having to explain myself to someone”

If they have unsatisfying healthcare experience

Based on their saying, we summarized 3 main concerns of gender-expansive people:

  1. Bias & Discrimination: (50%)
    Gender-expansive people are worried that the bias and non-acknowledgment from Healthcare providers may impact the quality of care they received

  2. Stigma:(16.7%)
    They are also afraid of harmful reactions from others by disclosing themselves.

  3. Gender Affirmation: (33.3%)
    The pre-assumption of pronouns and gender identity also makes them feel uncomfortable.

We found LGBT patients may have concerns about disclosing their sexual or gender identity during medical treatment. This discomfort may stem from a lack of trust in healthcare providers.

Also, 80% of them got information on healthcare through the internet platform, which matches the therapists' view in the interview in the following section.

The concerns they have while receiving healthcare

Interview

We interviewed 5 people including the therapists, clinicians, NYU Langone staff, and transgender patients about their experience in healthcare.

  1. Unreliable information mal-use of medical treatment

  2. Strong reliance on online community

Therapist

  1. No feedback system to speak up

  2. The inconspicuous layout of the information

Clinicians

  1. Be behind on gender training

  2. Misdiagnosis: confusion between gender and sex at birth

NYU Langone staff

  1. Need information compiled

  2. Rely heavily on community / community-focused

  3. No feedback system to know the patients’ need

Transgender patients

Some intersections exist based on the interview results:

  1. Reliance on online community

  2. Feedback system

  3. Information compiled in a clear and inconspicuous layout

Current Infastructure

The existing way to contact Patient Relations Team is only available via phone/ email.

NYU Langone has a Patient Relations Team to assist all patients with questions and concerns. However.

There’s also a Transgender Health page, which features healthcare providers caring for transgender patients and offering hormone therapy and affirmation surgery services.

Potential issues of the feedback system:

  • Patients may not be comfortable complaining over the phone or face-to-face with a staff member

  • Long wait times may deter a patient from submitting feedback/complaints

Research Conclusion

Our research findings indicate that several systemic issues prevent gender-expansive individuals from accessing healthcare, as outlined in our literature review. While addressing these issues may not be possible, we can concentrate on enhancing the relationship between patients and healthcare providers to break this cycle. Our survey results revealed that the primary concern for patients is a lack of trust in healthcare providers, which is often due to the unequal power dynamic between the two parties. Our interview results also pointed to the online community and feedback system as opportunities for building trust between healthcare providers and patients while also enhancing healthcare providers' training to create a more inclusive environment.

Personas

We organized 4 different types of users involved in the system: the current NYU Langone patients, potential patients, healthcare providers, and administrative staff responsible for the LGBTQ+ related service in NYU Langone.

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Problem Statement

How might we...

create a neutral meeting point between patient and provider, while building a sense of community within the hospital network?

Design Solution

Our solution utilizes patient feedback in a redesigned internal review system, allowing Langone’s Patient Relations Team to track and respond to concerns. Provider ratings are also collated into a database to monitor positive and negative feedback. Outstanding providers are highlighted on a website that serves as a community resource for patients.

Ideation & Sketch Prototype

Step 1 - Patient survey

Step 2 - Advisory Counsel ticket review

Step 3 - Administration employee audit

Step 4 - Public facing Langone dashboard

Interface Design

Structure & User Flow

The patient sees a QR code on a poster in the hospital. They can scan to access a survey. The user can complete the survey on their mobile phone/ online webpage/ physical form.

Patient Relations Team Internal View

Patient Survey

Internal Ticket View

Administration View

Public-Facing View

View all the feedback collected sorted by type and status. Click the icon to view ticket details

See details of the ticket, List by the time created. And the patient Relations Team can respond to the patient

Ticket View

Patient Relations Team Internal View

See the healthcare provider's ratings, metrics, and feedback received

Mobile Phone Survey

Webpage Survey

Physical Form

Alternatively, a patient can access the survey in a followup email at home.

The patients could also complete a physical form from a drop-off box located in the hospital.

To ensure the privacy of all physicians at Langone, we have chosen to feature only highly-rated providers on our platform. This allows the gender-expansive community to select the best-suited provider for their unique needs while maintaining the confidentiality of our physicians.

Our website will display a comprehensive list of the highest-rated healthcare providers based on feedback collected from patient surveys. By presenting this information to the community, we are bringing the data back to where it matters the most. Patients searching for providers at Langone will have access to a wide range of details about each physician, including patient ratings, testimonials, and Highly Inclusive badges, which will aid in their decision-making process.

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