Hospital Communications in the Age of Pandemic

Health Systems need to build trust through clear and concise communications with their patients.

Being Safe vs. Feeling Safe

As our country slowly reopens, signs of the pandemic are everywhere.  Noticeable everywhere are the masks we wear, and the hodge-podge of procedures and signage found at every grocery store, restaurant, and pharmacy.  Small businesses, like our local bagel shop, post handwritten signs on their front doors instructing patrons to wear masks and limit the number of people in the store at one time.  They also have a sign on the self-service cooler instructing customers to ask for assistance, but some either see the sign and ignore it or don’t notice the sign at all.  Interestingly, the inconsistent rule-following among cream cheese seeking patrons has turned into a humorous conversation piece. How a virus exposure point became a source of lighthearted humor is most likely because the perception of real danger doesn’t exist in the bagel shop or at the self-service cooler.

Of course, we’re most eager to re-engage with in-person pursuits related to things we desire, rituals we miss and crave, and routines we desperately need to feel human again.  The same doesn’t necessarily apply to those activities we generally prefer to avoid, even in normal times.  Who can’t wait to get back to the dentist?

To be sure, we take more seriously, are more scrutinizing, and hold to a higher standard the structure and clarity of virus-related safety procedures associated with those activities more likely to put us in harm’s way.  The slack we give our local bagel shop doesn’t apply to our physical therapist, dentist, or physician. And, of course, this makes sense.  Frontline healthcare workers have emerged as the new heroes of our pandemic age and are closest to the source of the danger.  And unfortunately, hospitals carry the stigma as a primary source for infectious disease and one of the riskiest places we can be.  Coupled with the fact we rarely visit the hospital under positive circumstances, we’ve rightfully adopted a mindset in which we’re unwilling to accept anything short of completely professional, direct, and clear communications regarding what to do and how to do it when entering an acute care environment amid the COVID-19 pandemic.  

Fostering Perspectives

This isn’t to suggest that hospitals are any less safe or any riskier than they’ve ever been, even before COVID-19.  Health systems’ top priority has always been and will always be patient safety above all else.  But, how do they convince their patients and visitors this is the case?  How do health systems address the business challenge of instilling confidence in a safe patient experience for those seeking elective procedures?  How do they prove it to their patients?  After all, this is more of a perception and communications problem than it is an infectious disease concern.  Many health systems we’ve spoken with suggest the physical distancing and access policies they’ve recently put in place may not materially improve safety but are there to give patients and visitors the perception that they’re doing everything possible to create a safe environment.

To this end, all health systems have revamped their websites to incorporate messaging related to COVID-19 considerations.  Most health systems have posted some variant of the phrase, “we are committed to keeping our patients, their families, and our staff safe. We are taking many steps to make sure that we protect everyone.”  Other, more direct calls to action implore, “Do not avoid treatment out of fear,” and “Don’t Delay Care!”  Is this messaging having an impact?  Is the 70-year-old knee replacement candidate ready to pull the trigger on her surgery, or has she convinced herself she should wait until next year?  Has the hypertensive diabetic rationalized that it’s more dangerous for him to go to the hospital than just to stay home and deal with some new unexplained symptoms?

Risk assessment in these uncertain times is a personal endeavor and not prescriptive.  From a financial perspective, health systems need to get back to business as usual, but what can they do to encourage more elective procedures and convince those with chronic conditions not to delay important care episodes?  

For starters, posting encouraging messaging on corporate websites is not enough.  Nor are homemade signs hanging from the information desk and one-way directional arrows fashioned from masking tape on the floor.  These approaches reflect a lack of seriousness and will only serve to heighten patient anxiety.  Amateurish responses to COVID-19 will make patients wonder what other ineptitudes lurk within hospital procedures and policies.  Hypervigilance for keeping patients safe is here to stay and not a temporary quick fix.  What works for the bagel shop will not suffice at the hospital.  Patients and visitors need to experience a permanent, comprehensive, structured and professional approach to addressing safety that pervades any and all contact they have with healthcare providers and the facilities in which they operate.  And the content of the new safety protocols needs to align with the guidance shared routinely by healthcare professionals.  That is, protocols need to show patients you have a handle on how they will be able to keep their hands to themselves, maintain safe distance, navigate the facility to minimize contact with the most contagious and find opportunities to wash their hands.

Call center employees need crisp talk tracks to reassure potential patients of the safety protocols in place. All hospital personnel, especially point of care staff, need to encourage patients to access digital tools to help them navigate their journey safely.  Those tools need to be reviewable in advance of the trip to the hospital and need to be made available on-demand instantly as the patients enter the hospital.  The patient should not be expected to download an app, but instead should be able to scan a QR code or receive a link through email or text to start the process. 

The digital tools need to help patients find their way to the hospital and lead them through the hospital, intuitively and without stress, via one-way pathways to minimize encounters with other patients and maintain safe physical distance.  The tools need to inform patients of opportunities for handwashing/sanitizing along the way and contextually alert patients when nearing contagious areas where more vigilance and/or personal protective equipment is required.

Wayfinding is a Communications Platform

The communications approach related to COVID-19 needs to do more than warn.  It needs to proactively instruct patients and visitors on precisely what to do, what markers to heed, and what procedures to follow.  The communications need to reach everyone, not just those that have taken the initiative to seek out the provider’s website in advance.  Instructions cannot only exist within the health system’s native app. The bottom line is, we need to make it easy on the patients and visitors and meet them where they are, not demand that they come to where we want them to be.  We may want them to adopt our app, but forcing them to do so for them to follow new COVID-19 procedures may backfire.  The hospital needs to meet the consumer where they are with respect to how they are willing to engage.  For over a decade we’ve seen health system app adoption rarely exceed low single-digit percentages. That trend is likely to continue until and unless something dramatically shifts hospital visits away from being mostly episodic in nature.  

While these digital tools can take the form of extensions to patient access applications, most of the features needed to clearly and professionally communicate providers’ COVID-19 safety protocols are found in a wayfinding application.  The goal of wayfinding is to communicate how to best navigate a facility in order to lower the stress and anxiety the patient naturally feels when coming to the hospital.  Most wayfinding applications have the ability to configure one-way pathways and generate location-specific messaging.  But, the difference in a COVID-19 world is the importance of adoption.  Few wayfinding vendors include adoption and strategic communications as part of their offering.  Successful communication strategies require patients to be able to review clearly articulated procedures and pathways in advance of their visit, and communications must be made available to all, not just those willing to download your native app. 

Our bagel shop can cut corners when it comes to communicating safety protocols because we really miss our bagels.  Hospitals don’t have that luxury.  Getting back to the routine business of healthcare requires trust-building that comes from a crisp, professional COVID-19 communications strategy.  That can emerge from engaging in smart wayfinding with the right vendor that can guide the supporting communications and adoption strategy.

COVID-19 Pushes Us to Communicate Broadly with our Community

We can leverage these techniques to bring awareness to patient engagement initiatives.

Healthcare remains a community-based endeavor.

In response to COVID-19 provider organizations are pressed to find ways to communicate broadly to members of their community regarding important mitigation strategies such as procedures for hospital entry for those with fever or respiratory symptoms.  For lack of a better method, health systems typically post these notifications on their corporate websites.  Within the last couple of days even we’ve seen some vendors pushing branded iPhone/Android apps to communicate such information. 

The catch-22 here is easy to spot.  What’s the likelihood patients and visitors will come across this important information before heading out to the hospital?  Providers haven’t even been successful driving branded app adoption under normal circumstances and with the support of carefully executed marketing campaigns.  Is it reasonable to think patients facing a potentially life-threatening illness are going to take the time to download an app or proactively seek out information on the provider’s website to learn of hospital-specific policies and procedures that have been put in place within the last few days?

Health is a product of choice, but care is a product of circumstance.

For most of us, our local hospital serves as the site of seldom encountered life-changing events.  Like the Fire Department, we expect our hospitals to be there for us when we need them, but between visits they’re “out of sight, out of mind.”  That’s because the “care” part of healthcare is still very much encounter-based and typically not something with which we willingly choose to engage.  Everyday hobbies like travel or reading result in us establishing close relationships with vendors like Expedia and Amazon.  We choose to download their apps, opt into their communications and give them a fair amount of our highly sought after time and attention.  In contrast, those actively seeking to engage with acute care are only those that must.  The hospital only commands an active relationship with us during the care episode, after which, we just want to move on with our lives and typically forget what just happened.   

Given this, we can easily see why it’s been challenging for providers to bring patient engagement initiatives fully to fruition.  Because of healthcare’s episodic nature, community members do not listen to “hospital radio” so health systems have no way to simply and routinely bring awareness to and drive adoption for their patient engagement initiatives.  

There has been some progress in delivering tools of convenience such as patient portals offering test results, patient access applications offering online appointment scheduling, and telehealth as a means of serving more patients faster without person-to-person contact.  But these are pull, not push, channels.  Consumers call upon these tools when needed, but they do not command a persistence in our lives the way social media, news feeds, and selective retail channels do.  While push channels may exist for the tiny percentage of patients selectively invited to use technology to help manage chronic conditions, no patient engagement feature or innovation has emerged with broad appeal to attract the masses to “subscribe.” 

Case-in-point, a client of ours is rightfully quite proud of their achievement to drive adoption for their branded app to north of 38,000 downloads.  This sounds impressive and relatively speaking is significant.  Considering, however, there are over 1 million people in the health system’s catchment area, a maximum of only 3% of community members would be reachable via push notifications through the app (assuming they all opted into such notifications).  While the lack of a simple, repeatable, and affordable channel for promoting adoption is stunting patient engagement, it’s downright dangerous when one considers the need to disseminate important information in times of public health crises.  This is becoming painfully evident in light of the COVID-19 crisis where the stakes for community awareness are much higher. 

So, what’s the answer?  Short of running PSAs on local TV, radio, or billboards, is there a way for provider organizations to reach their community with important messaging as they need it — especially in times of crisis, but also to bring greater awareness and adoption for patient engagement initiatives?

Awareness and Adoption is a deliverable.

There’s no silver bullet for disseminating information to all community members in their homes, places of work or their cars.  Again, care is generally not something that interests us until we need it.  But, health systems do control the messaging that occurs at the entry points at every one of their facilities.  They control the staff and signage at those entry points and, most importantly, they drive the culture that influences how registrars, volunteers, security personnel and even clinicians interact with patients and visitors.    

The COVID-19 crisis is a stark reminder to providers that if they really need to communicate information to every hospital visitor they have a means to do so assuming they have the necessary resolve to train staff, change culture and instill the important mission in the mind of every employee.  Staff needs to be held accountable for the communications initiative as one of their core responsibilities.  Strategies for awareness to drive adoption of patient engagement initiatives have not been taken this seriously, but certainly should be.  Vendors need to include user adoption of their engagement solutions as a deliverable. To do this, they must commit to working closely with their health system customers to implement ways to bring broad awareness of their solutions to community members. Technology is meaningless unless it creates measurable value for the consumer. That’s impossible if the consumer isn’t aware the feature or innovation is available.

To be sure, there are low tech but high impact techniques for communicating important information while maintaining social distance and preventing the spread of germs.  Prominent signage can impact visitors without the need for them to come within 10 feet of hospital personnel.  QR codes have seen a resurgence as a means to communicate information quickly and at distance. Users can now scan QR codes by simply pointing their smartphone camera and tapping the notification that appears. This obviates the need for germ-friendly kiosks and complicated talk tracks employees must memorize.  Responsive web applications can be easily launched from a QR code without the intrusive interim step of requiring the user to download an app from the app store.

As provider organizations mobilize to inform visitors and patients about the official particulars related to COVID-19, I hope they see the opportunities to bring awareness and drive adoption for broadly applicable patient engagement initiatives such as wayfinding, telehealth, price transparency, and patient portal access.  These features can be powerful for driving affinity to the brand, but only if members in the community are aware they exist.

Differences in Indoor Navigation Systems

Maps versus Photos

Many of us remember the days when we’d study our Rand-McNally road atlas or our AAA TripTik in advance of our Clark Griswold-esque family vacation.  Learning how to read a map was a rite of passage, much like learning to drive a stick or changing your own flat tire.

It’s truly remarkable that an entire generation of adult drivers has never been concerned with “map prep” prior to setting course to an unfamiliar driving destination.  In-dash navigation systems, Google Maps, and Waze have revolutionized the way we get around.  We don’t think much about how it works, we’re just grateful for the huge improvement over printing out maps, following road signs, tracking mile markers, or, heaven forbid, pulling over and asking a human for directions.  The technology behind GPS-based navigation systems really is a feat of great human ingenuity.  Mathematical graphing algorithms consider all the possible routes, optimize based on shortest distance, lack of tolls or traffic, then hand-off to micro-receivers to process location, velocity, and time from special satellite signals.  Add a dash of calculus and voila, instant navigation.  We’re not so much following a map as we are playing a video game.

As we consider the application of this new navigation paradigm to solve a different challenge – finding our way as we walk inside large complex buildings – we are quickly reminded that the real feat of Google Maps isn’t so much the gee whiz tech that makes it all possible but the simplicity and clarity with which Google communicates directions in cadence with the movement of the “blue-dot” on our navigation screen.  However, when we try to apply this blue-dot concept to pedestrian indoor navigation, we realize the cool tech that works wonderfully for navigating in open space while moving at 60 miles per hour may not serve us as well in confined spaces at low speed where our view of the navigation landscape is obstructed by walls and ceilings.

The Problems with Blue-dot Indoors

Replicating blue-dot driving navigation to solve for challenges encountered with pedestrian indoor wayfinding amounts to fitting the proverbial square peg of continuous, fast, and fluid movement into the round hole of slow walking with lots of stopping and starting.  Recall the time in your car when you were stopped or barely moving and Google Maps had no idea which direction you were pointed?  Depending on your sense of direction you may have started left only to quickly realize you should have turned right.  While this type of interaction is the exception with driving navigation, it is unfortunately the rule with pedestrian indoor blue-dot navigation.

While blue-dot map-based navigation may be the most well-known type of indoor mobile wayfinding, it is most certainly not the most effective.  It works by representing the user as a moving blue-dot on the “plan view” of a blueprint-like image of the facility (as if looking down from the ceiling).  Movement is achieved through the smartphone’s Bluetooth connection with hundreds of battery-powered low-energy Bluetooth beacons installed throughout the building.  Beacons serve an analogous function to GPS satellites for driving navigation insomuch as they determine user position.  Unfortunately, it seems as though beacons have become a solution looking for a problem.  Beacon manufacturers and their app-building partners push the promise of mobile wayfinding based on indoor positioning as a way to expand the market for such devices.  We should all be wary of circumstances where the widget or invention drives the user experience.  If all you have is a hammer, every problem looks like a nail.

Not surprisingly, the usability of blue-dot beacon-based apps is questionable due to the dreadful infinite loop of beacon latency, indecisive user movement, irregular location accuracy, and confounded by the user’s overtaxed cognition as they attempt to interpret the map in the midst of an increasingly stressful situation.  Users often start out walking only to realize they’ve taken many steps in the wrong direction by the time the beacon finally catches up with their current location.  Indoor maps, typically resembling blueprints (i.e. an imperfect abstraction of the physical space), require more brain power to follow and the low speed with which the user moves can make the system feel choppy and discrete rather than continuous and smooth as it seems when driving.  In his academic research, spatial cognitive scientist Dr. Christoph Holscher remarked, “many people have difficulties interpreting maps and other abstract visualizations of space. Research acknowledges that indoor maps are a compromised interface for people finding their way in complex environments.”

While map-based techniques for communicating directions don’t necessarily translate from driving outdoors to walking indoors, we mustn’t throw the baby out with the bathwater.  The hallways and points of interest in complex buildings like hospitals can still be modeled with graph theory.  Optimal pathways can certainly be dynamically generated based on important criteria such shortest distance, the need for elevators, etc.  What we need is a better and clearer method for communicating the algorithm’s optimal pathway to the user.  We need a method that converges with users’ natural way of thinking and effectively accommodates indoor nuance such as split-levels and mezzanines without confusing or frustrating the user.

A New Paradigm for Indoor Navigation — Photos

Thankfully, the scientific community has produced a stable of research regarding how humans think when it comes to matters of spatial awareness.  Their key takeaway is our need for visual landmarks.  Academics unanimously conclude that visual landmarks are the most efficient way to communicate wayfinding instructions, especially in circumstances such as hospital navigation where anxiety is high and cognitive capacity compromised.  Landmarks allow for fast reasoning because they align with humans’ natural cognitive navigation process.  So, how do we incorporate visual landmarks into a mobile wayfinding application?  Simple…we use pictures!

Photo Landmark Navigation is a more effective technique for indoor mobile wayfinding.  Like GPS or blue-dot navigation, it leverages graphing algorithms to generate optimized pathways from one point of interest to the next (e.g. main entrance to fourth floor surgery unit).  But instead of representing the user as a moving blue-dot on a map, the user is presented a narrative sequence of photographs of building hallways rich with visual landmarks and augmented with textual instructions, distances, and universally accepted wayfinding icons that represent arrows, elevators, stairs, escalators, etc.  As users reach each new visual landmark, they simply swipe to the next picture, revealing the next set of landmarks to walk toward.

The elegance of photo landmark navigation isn’t limited to superior usability.  Photos obviate the need for indoor positioning, thereby removing the need for beacons which are expensive to install and maintain.  And, while photo landmark navigation can be deployed in a native smartphone app, it doesn’t have to be.  Unlike blue-dot solutions which must be deployed in a native app because of their dependency on Bluetooth, photo landmark navigation can be deployed in a browser and initiated by QR codes or URLs delivered in email, text messages or via kiosks.  The opportunities afforded by offering an app-less mobile wayfinding solution dramatically increase the likelihood of usage and adoption.  Instead of only appealing to those users who have taken the time to download your app (likely a tiny percentage of all visitors), you can now offer mobile wayfinding to any visitor with a smartphone!

Be on the lookout for our next post in this series where we’ll address the relationship between indoor positioning systems and mobile wayfinding and explore the most critical success factors for implementing mobile wayfinding.