In the introduction of this Living Case Study, Jeri Pack, CHAM, Director, Revenue Solutions, Baptist Health, described how her organization benefited from the use of self-service kiosks during patient check-in. She explained how her patient population, whose average age is 62.5 years old, quickly accepted the use of new self-service ATM-style kiosks during their registration and return check-in processes. She also illustrated how her staff not only overcame their initial reluctance to adapt the kiosks into their work routines, but they are now champions of the technology because of the increased efficiencies and patient satisfaction levels that they’ve witnessed firsthand. These benefits prompted me to consider the origins of this deceptively simple solution. What I found was not only forward thinking in terms of technical application, but also very evocative relative to the tremendous push in healthcare for greater patient satisfaction.
Hitting the sweet spot
During the 1970s, my grandfather owned a gas station. In addition to a four-gas-pump island, he had a three-car service bay where his customers could get pretty much any repair or light body work done. Attached to the service bay, there was a small auto parts and convenience store where customers could buy spark plugs, fan belts and Bubble Yum bubble gum. (My favorite flavor was grape.) Behind the main building was a large salvage yard with mountains of discarded vehicles of various types and ages.
Besides my grandfather, my favorite person at the station was Donny, a mechanic who lost most of his left hand fighting in the Vietnam War. His main job was to supervise the service bay whenever things got hectic, but, most days, he ended up on the pump island filling gas tanks and tires, checking oil, cleaning windshields and sometimes getting a tip from an appreciative patron.
He could name most customers’ cars on sight. Before they fully parked at one of the pumps, he knew what type of oil the driver preferred, if they had a slow leaking tire or if they were running late for work. He knew drivers by first name (men) and last (women). He knew everything about his customers and he had their complete trust.
Donny’s biggest hassle was dealing with payments. He had to take cash or a credit card from the driver’s window to his cashbox on the pump island where he made note of the amount of gas purchased, wrote a receipt and returned to the car. Sometimes he had to run into the main store to make change or to get a credit charge approved by my grandfather. Donny hated the whole process. “It keeps me away from my customers,” he said, “I’m here to help them with their cars, not to be their accountant.”
One day, I asked Donny if he would teach me all that he did at the station so that I could take over his job when he retired.
“That would be something,” he said with a slight smile. “But, I think there’s only a handful of years left for someone to make a living pumping gas. Soon robots and computers will have this job.”
I was confused by his answer. I couldn’t imagine a machine being able to deal with all the tasks Donny performed – even if he did only have one fully functional hand.
“A generation ago, this wasn’t a job at all, and a generation from now it won’t be a job again. Guess you could say I hit the sweet spot,” he said, “That’s fine by me. I’ll have more time to spend working in better ways.”
“I’d be scared if a robot washed my windshield,” I said.
Donny laughed. “Believe it or not, Jason,” he said, “There are a lot of people who are scared of me washing their windshields. It just takes people time before it becomes normal and natural.”
A new mindset is evolving
Many of the principles that Donny explained to me when I was seven years old are identical to those outlined in Pack’s introduction. Donny had the foresight to understand that emerging technology could perform certain tasks efficiently. He also understood that people, while expressing initial frustrations or reluctance to change, would eventually openly accept new technologies that prove to be helpful, reliable and convenient.
“Our Chief Operations Officer always uses the ‘paying at the pump’ analogy,” says Brian Stone, Chief Financial Officer, Clearwave, “and I have to agree with him. That level of acceptance took some time, but now the use of such unmanned technology is considered normal. Our company and our partners believe that the general public will soon look at our patient check-in kiosks the same way they view the technologies they use every day at their local gas station.”
While Stone’s assessment seems reasonable, many in the healthcare industry still have a mindset that kiosks are impersonal in nature in terms of service. “The disconnect they make is they think if a patient checks in at a kiosk, they are going to feel that they are not getting the attention that they need and be upset,” says Stone, “What tends to happen is just the opposite.”
Years ago when the first heart-rate and blood-pressure monitoring kiosks appeared in pharmacies and malls, many in healthcare felt that they would find little interest from the general public. Even though similar technology flourished within other industries such as retail and banking, many believed the intimate nature of personal health issues required staff-assisted technologies in order to provide consumers credible and satisfying information. However, it quickly became clear that even senior citizens could develop a high level of comfort using technology without the supervision of a medical professional. “Because our feelings about technology in our daily lives have changed over the past decade or so, items like our self-service check-in kiosks are not considered odd or intimidating by the public,” says Stone. “We are the latest example of a technology developing in a sweet spot of trending consumer tastes.”
Sweet spot. Those are the same words Donny used to describe the changes he saw coming to his profession. As a young child, I saw the potential of my grandfather’s customers being nervous, or even angry, when dealing with a “robot” rather than a person, but time has shown that sort of thinking as misguided and more than a bit naive. Stone also recognizes the realities in healthcare today relative to the resistance to adopting new technologies and processes. “Again, it’s a change for many, and I am not going to say some staff or patients aren’t going to complain initially,” he says. “Anytime you make a change to a process such as patient check-in, there are going to be complaints. But once the staff gets the process down, we have seen that patients prefer the check-in process at our kiosk to the more traditional methods, and they don’t want to go back.”
When I spoke with Jeri Pack about her patients’ feelings toward the traditional check-in process at Baptist Health, she echoed Stone’s point. “Today, our patients are saying that they hated our old check-in process,” she said. “Some felt that they had to spend too much time, writing and re-writing information during check-in. They wanted an easier and faster process. Now, using our self-service kiosk technology, they are realizing how much time they wasted and how less stressful check-in can be. They are also much more trusting that their personal information is safe and protected in our kiosks and not on pieces of paper.”
At Baptist Health, instead of completing a seemingly endless series of forms on clipboards before their appointments or annual visits, patients walk to a kiosk terminal and, if none of their personal information has changed, they simply hit the “next” button on the opening check-in screens. “Patients don’t have to sit there and write their names, their spouse’s name and their address all over again,” says Pack. “Most just scan their ID, make sure the kiosk displays their correct address, insurance and payment information, tap the screen a couple of times and they’re done. They can think about why they are at the hospital and not worry about clerical errors causing them problems in the future.”
If a patient has any other questions or issues after inputting their information into the kiosk, Baptist Health’s registration staff members can devote one-on-one time with them because they are no longer bound by the traditionally laborious registration task of data input. “Our staff really began to change the way they saw their jobs once the kiosks started to gain more and more acceptance from our patients,” said Pack. “They no longer see themselves as lower-level staff. They see themselves as real healthcare providers, and that has made a huge difference in the morale of our staff and our patients.”
A glimpse of the future
The theme of this Living Case Study update centers upon timing, specifically the timing of the public’s level of comfort with new technologies. It’s becoming clearer that self-service kiosks are experiencing a great deal of success today in the healthcare community due to their timeliness relative to the needs and expectations of both the industry and its patients. However, to say that its technology is limited to today’s needs is not a fair statement.
For more than a decade, the healthcare industry has tried to create systems that share clinical information from point A to point B, and self-service kiosks are poised to be a critical component of any future health information exchange (HIE).
“We believe our next step,” says Stone, “is going to be enabling patients to bring their information from Baptist Health to outside entities. We also want to give patients a mobile app where their information is stored centrally and allows for edits on the fly so that their information is automatically updated.” Very similar in nature to how cell phones are used currently in the airline industry, patients will be able to take their smartphones to a hospital’s self-service kiosk and have it scanned so that all of their information is automatically called up on the screen for verification.
“Patients want that kind of portability,” says Stone. “Looking at our future, we are uniquely positioned within the marketplace to provide this important service.”
In addition to mobile patient information storage and exchange, the self-service kiosks at Baptist Health are poised to take on other tasks such as payment counseling and survey distribution. Forty years ago it was almost unthinkable that consumers would feel comfortable with technology stepping into these very personal areas, just as it was unthinkable to me that Donny would be replaced. But when the credit card scanners arrived at my grandfather’s gas station and the gas pumps became self-service, Donny did not lose his job. He got busier, just like he said he would, helping his customers with even more personal attention.
Today, if someone drives up to a gas station and they see that they have to go inside to make a payment, most drive off to another station with self-service pumps. How long will it be before patients have the same mindset when entering a hospital? Don’t scoff at the idea. Only time will tell.
