Fear and loathing in medical intake.

empathySimple ways empathy and anticipatory design can be used to ease fears.

A few years ago my family went through a very trying medical emergency, which required a trip to a local hospital. This trip was set up hours before our estimated arrival time so that we knew we could be seen and adequate personnel and procedures would be streamlined. However it was not the case. Without getting into too much personal detail, I will outline the shortcomings of this intake experience and how it could have easily been made better, and less traumatic. My skills are as a user experience professional, but I am a budding customer experience/service design enthusiast. But first and foremost I am a father, husband, and human. Any medical intake process can be alarming to a first timer regardless of the condition or situation. Fear overrules rationality, and when no information is flowing, that fear can take a firm grasp of your psyche.

The hospital knew we were coming, but had nothing showing in anticipation of our arrival. It was a cold, wet December evening with slush and snow still on the ground. And it was after visiting hours. This was our first experience with this facility, a fact that was shared with our intake team during the preceding few hours that led to the availability of their services. Upon arrival we noticed that there was no parking at the entrance to the facility, not even temporary. There was parking along side of the building, closest to the door, but every one of those spots were taken. Due to the time, well after visiting hours, my only assumption was that this was staff parking, the fact that many of the wipers were altered for the treat of ice cemented my thought that these folks intended on being here through the majority of the snow and ice. We parked at the rear of the facility, but were not allowed entrances through the rear. We had to walk around the facility parking lot, which was still full of slush and snow. Please keep in mind that this was somewhat of an emergency situation, not life or death, but something that needed an immediate visit. The first solution is to reserve the parking spaces closest to the front for intake only. Employees have access to the rear of the facility; nervous patients and their families do not.

When we arrived we noticed the intake/reception area was empty. We were the only ones there with the exception of the receptionist who sat in silence after we explained who we were and why we were there. She acknowledged that she was expecting us and asked us to take a seat. After a few more minutes in silence, the receptionist finally explained the process only after we asked her how long this would take. We were handed paperwork that was redundant to the information we provided on the phone prior to being cleared to arrive. We were scared nervous and needed support. But we are left in silence. There were water and snack machines, but the receptionist will not give change, says a note on the machine. A TV is playing news. There are flyers about various conditions scattered about on various end tables. No one is talking to us. This is all unknown and new to us, and it could be done so much better. The receptionist still has my driver’s license and health ID card, 30 minutes after I gave it to her. A quick reminder that she is working on things would have been helpful. An administrator did finally come to speak to us with a question about our paperwork. The administrator person further explained the process, but only after we pried for information.  She is being patient as well as the IT department is working on her computer and she is waiting for issues to be resolved of her own. She gave us book, pamphlets, and reminded the intake person we were waiting. The books and explanations provided gave us insight to what to expect. This was calming, however should have been done much earlier. She stated that if her computer wasn’t offline, these delays would not have happened; however there should be a plan for this situation.

How to easily make this better? Have information ready for us when we arrive. Start thinking in anticipation of arrival, not reactionary. There was no reason for this intake to take as long as it did. We were with our two children who were a little scared. Healthy snacks and something for them to do, like a coloring book, or something of that nature would have done wonders for them, and for us as parents. It is easy to come up with some healthy, non-allergenic snacks to have on stand-by for such a situation. Instead of a news program, perhaps the receptionist could have switched to an appropriate movie or something the kids could have enjoyed to ease any fears or confusion. If there is a snack machine in your lobby, be prepared to offer change.

The paperwork we went through on the phone could have been ready for us to sign when we arrived with follow-up validation steps. A complete repeat of the exact same process we worked for hours on the phone with the intake specialist felt soul crushing, and it seemed like a waste of time. The situation we were in was unique to us as it was our first time, but this facility deals with these scenarios often. Did complacency taint the experience? Is there a lack of empathy due to the repetitive nature to the work?

The suggestions I propose are low cost, and in my opinion, basic common sense. But I do not work in the facility or in that field of medicine to know a difference on what is procedural and what is apathy. But I am human and I understand empathy. Each of those people in the intake station should try to walk in the shoes of their patients every now and then to understand life on the other, scarier side of the desk.


Thankfully, our issues have been controlled and we have not needed to return to that facility. However I wonder if anything ever got better. I do not wish to point blame, which is why the facility is not mentioned. The care we received served our needs, but it could have been a simpler, less scary experience with simple, more human, adjustments.




Guaxamole: Awesome food as metaphor for UX.

A few years back, Patrick Neeman shared Ed Lea‘s brilliant info graphic  on User Interface vs. User Experience utilizing cereal as the metaphor. It works on many levels, but mostly, in my opinion, because everyone understands cereal.

Since I am always hungry, I was wondering if I could do something similar, but expand it and using guacamole as the metaphor. I also wanted to see if I can push the conversation a little further to create a level of understanding that can explain the voodoo that we do, and be fun in the process.

mojcajete.jpgIf you have taken the time to read this, please follow through and see if I have missed something, or could expand on things more. I am planning a presentation to my UX team to go through these concepts while making a batch of my exquisite guacamole. I hope to capture some images from that event and post them here. In the meantime, here are my thoughts with various images from the web.

Initial considerations

  • What is the definition of done? We need to agree what is guacamole, is it just avocado and peppers? Tomato? Do we add lime? Defining our agreement on the recipe sets expectations and goals.
  • If guacamole is just smashed avocado and little else, are there pre-made products may be combined for quick satisfaction of need? This would increase your “time to market” but what about quality and differentiation?


  • Mise en place, the cooking term for your initial set up (knife, cutting board, ingredients, bowls), are the tools you need for development, development environment, server, content, information architecture, etc.
  • The cutting board and molcajete is your development environment. The latter is possibly your server or production environment as well.
  • The act of making guacamole is your development sprints.
  • If not serving from the same bowl you made the guacamole in, then plates used are your browser.
  • Tasting while you make guacamole is your unit tests. Having guests taste test are your constant user feedback. Other people tasting while in process is user interaction with prototyping.

ia-persUser Feedback/Ethnography

  • Chips are your User Interface.
  • Having multiple chips available, blue corn ships, cantina chips, etc. is a form of user feedback with A/B testing. Watching some chips break is usability testing of the UI.
  • Asking users about spiciness, cilantro tolerance, or preferences is ethnography.
  • Ethnography and user feedback lead to personalization factors. This can be in the form of extra jalapeño and salt allotted for personal tastes, or perhaps a new ingredient like a tomatillo can be offered.

service-designService Design/Customer Experience

  • Giving chips and salsa prior to making guacamole is service design, customer experience, and hints of anticipatory design. In a restaurant it primes the visitor for ordering guacamole, or a tasty beverage. This is part of your UX/Customer Experience strategy.
  • Table side guacamole in front of guests is the customer experience, more than just taste, creates memories. Entices others to order their own table-side guacamole.

Guacamole-00-ingredientsContent Strategy/Information Architecture

  • The categorization of ingredients is your content inventory. Fruits, vegetables, herbs, spices, heat, aromatics. These are also the elements of your information architecture.
  • Using fresh ingredients is an example of content strategy. You can opt for cheaper ingredients that are not as fresh, but will affect the outcome.
  • Chopping up ingredients is also part of content strategy. Do you want to create chunky or smooth guacamole? User feedback is key to finding this out. This is also part of your content strategy as it will define how you offer your product and how will it be prepared.

guaconthegoMobile Strategy

  • Responsive design, the use of small soufflé cups full of guacamole can represent a mobile solution for guacamole. The previously mentioned ready-made guacamole (like Wholly Guacamole) can also be considered part of a mobile first strategy as it is already packaged for travel.

visualVisual Design

  • Using best looking ingredients, different colors, purple chips, is visual design. This is your presentation layer. Do you have artistic platters or bowls. This is where colors and textures differentiate your guac from others.

Follow this post and comment and I will post my recipe and techniques on making the world’s best guacamole. Please comment so I can refine this.