Client
MedStar Washington Hospital Center is the busiest and largest hospital in the Washington, D.C. area and part of MedStar Health, a not-for-profit healthcare organization which operates more than 120 entities, including ten hospitals in the Baltimore–Washington metropolitan area.

Brief
MedStar Washington Hospital Center has one of the longest average ER wait times in the country. They want to improve their patient satisfaction using an application that will allow patients to have a better wait experience in the ER.

Duration
2 weeks

Team
Lisa Hansan
Krissy Kimura
Chris Oliver

My Role
User survey, user interviews, persona creation, competitive analysis, paper prototype creation, usability testing

Tools
Pen, Marker, Paper, Typeform, Sketch, Marvel, Keynote
Discovery & Research
User Survey
To begin our research into the problem, my team and I drafted survey questions, which I revised to be less leading. We then ran the survey with individuals who had visited an ER in the past year. I analyzed the results and found that nearly 2/3 of participants were non-recurring patients in the ER, meaning that they were not repeatedly visiting the ER for a pre-existing condition.

We also asked participants whether they thought the hospital staff had appropriately handled their needs, and I discovered a very interesting difference between recurring and nonrecurring patients. While only 1/3 of recurring patients felt dissatisfied with the hospital staff, nearly 2/3 of non-recurring patients were dissatisfied. This suggested that having more accurate expectations for waiting in the ER could increase patient satisfaction.
Our survey results revealed that understanding the ER process might improve patient satisfaction.
User Interviews
We also conducted interviews with patients in MedStar Washington Hospital Center’s ER waiting room, individuals who have visited the ER in the past year, and hospital staff, and there were several patient frustrations that came up over and over again, all of which showed that there was a clear lack of adequate communication from hospital staff:

Non-recurring patients
 - Not understanding the process or what to expect

All Patients
 - Not knowing what is happening behind the scenes
 - Not knowing who is taking care of them
 - Feeling like staff is not giving them attention
"You don’t feel like you’re being taken care of because you can’t see it."
-Patient in ER waiting room
Affinity Diagram
We created an affinity diagram, grouping key information from our interviews into three groups that would be the basis for our personas: a nonrecurring patient, a recurring patient, and an ER doctor.
The team sorting user interview data on our affinity diagram to create personas
Personas
We then used those user groups to create our personas: Carl Washington, Sheryl Stropp, and Dr. Peter Gutierrez. Carl is a non-recurring patient and our primary persona, Sheryl is a recurring patient, and Peter is an ER Specialist.
Competitive Analysis
We researched several direct competitors including iTriage, Care Logistics, and INOVA. Additionally, because we realized that actually reducing ER wait times was outside of our control, I suggested researching competitors from other industries that manage waiting in different ways. These included the DMV, theme parks, and Domino’s. Intrigued by the Domino’s pizza tracker, we explored deeper into tracking technology and discovered a plethora of apps and services that allow people to track everything from pizza to exercise to packages.
Ideation
Our Solution
Inspired by the tracking services we researched, we decided to create a web app that reframed the ER ‘waiting’ experience into a ‘tracking’ experience and armed patients and loved ones with the knowledge and information they needed to feel in control. Patients would access the web app using a unique link sent to their phone via text message after check-in.

Rough Sketches
Very early in the design process, we thought we could improve patients’ waiting experience by providing them with entertainment options like TV, music, and games. However, during our research, we learned that the majority of users were already playing their own games and media on their phones while waiting in the ER, indicating that there wasn’t really a need for additional entertainment. We decided to remove the entertainment features completely, instead focusing our efforts on providing better communication to patients.
Patients already had their own games and media on their phones, so we removed the entertainment features.
Storyboard
We created a storyboard for Carl to plot his journey when using the ER tracker. This helped us better understand how the app would fit into his life and made feature prioritization easier.
Carl, our primary persona, uses the MedStar ER Patient Tracker to track his progress and update his wife during his visit to the ER (illustrations by Krissy Kimura).
Feature Prioritization
We listed out possible features that had been developed during ideation and then prioritized those features based on the goals and needs of our personas to create our MVP (Minimum Viable Product).
List of features considered for the MedStar Tracker
Prototyping and Testing
Prototypes
We created several rounds of sketches and paper prototypes, usability testing and iterating after each round, before creating an interactive prototype using Sketch and Marvel.
Many iterations of sketches and paper prototypes
Usability Testing & Results
There were two major changes we made to our design as a result of usability testing.

First, we initially used the last 4 digits of the patient’s social security number as a method of authentication without requiring the patient to create an account. However, test users were uncomfortable providing this information, even if it was for an app from the hospital, so we used date of birth instead.
Test users were uncomfortable providing the last 4 digits of their social security numbers, even if it was for an app from the hospital, so we used date of birth for authentication.
Second, we created a feature that allowed patients to share with their loved ones information about their status and the hospital they were in, and we labeled the button for this feature “Share.” However, during testing, we learned that users strongly associated the word “share” with social media, which led them to be very worried that they might be sharing private medical information with the world at large. To remedy this, we changed the label to “Notify emergency contact,” which test users were much more comfortable with.
Test users thought that the Share button would share their status on social media. We changed the label to “Notify Emergency Contact” to clarify its purpose.
Conclusion
Early during this project, solving the problem of long ER wait times seemed like an insurmountable task because there were too many factors outside of our control. However, our research showed that dissatisfaction among patients stemmed from a lack of communication from hospital staff about what is happening and what to expect. By researching a diverse set of competitors, including–of all things–the Domino’s Pizza Tracker, we were able to both improve communication with patients and reframe their experience in ER from waiting to tracking.
Final Interactive Prototype

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