1. Implementation Plan Overview: Four Key Phases in Six Months
1.1. First Phase: Planning & Stakeholder Alignment (Month 1)
1.1.1. Supervise needs assessment with administrative and clinical staff
1.1.2. Complete budget and obtain buy in from leadership
1.1.3. Decide on kiosk vendor and software development group
1.1.4. Create an implementation team
1.2. Second Phase: Customization & Development (Months 2 & 3)
1.2.1. Program accessibility features and language
1.2.2. Build and customize softward for self triage and patient education
1.2.3. Configure analytics
1.2.4. Run test simulations with mock patients and obtain feedback from staff
1.3. Third Phase: Launch Pilot in 1 to 2 Locations (Month 4)
1.3.1. Install kiosks in high acuity urgent care locations
1.3.2. Train the receptionists and nursing staff
1.3.3. Observe usuage, pinpoint issues and request patient feedback
1.3.4. Establish IT support plan to include help desk
1.4. Fourth Phase: Evaluation & Roll Out (Month 5 & 6)
1.4.1. Access results of the pilot via metrics of patient throughput, patient satisfaction and diversion to the emergency room
1.4.2. Adapt interface and education materials based on data
1.4.3. Roll out to other clinic sites
1.4.4. Begin dicussion of next phases like a mobile application
2. Organizational Forces Influencing Success
2.1. The success of this innovation will be considerably impacted by several internal forces within the organization.
2.1.1. Support from leadership is vital, as executive endorsement will drive resource allocation, prioritize implementation, and promote a culture
2.1.2. Full engagmenet from clinical staff is equally essential - frontline staff must viewthe kiosk as a support tool rather than a threat to their roles, which requires active involvement and adequate training.
2.1.3. Integration into the exisiting workflow is another key factor. If the kiosk does not align seamlessly with existing patient intake processes or EHR systems, resistance, clinical throughput and patient safety is a threat.
3. Evaluation Strategies
3.1. Pre/Post Implementation Data Collection
3.1.1. Obtain baseline data from wait times, gaps in patient education and emergency room diversion
3.1.2. Compare with post implementation metrics at chosen intervals
3.2. Survey
3.2.1. Employ patient satisfaction surveys at the completion of their use of the kiosk
3.2.2. Staff feedback sessions to determine issues and impact on workflow
3.3. Outcome Tracking
3.3.1. Track patient compliance for patients who accessed health education material from kiosk
3.3.2. Mointor changes in non emergency visits in the emergency room
3.4. Cost/Benefit Analysis
3.4.1. Determine the savings from improved patient throughput and time saved by the staff
3.5. Outcome Indicators
3.5.1. Kiosk usage
3.5.2. Reduction in wait times
3.5.3. Emergency room diverson rates
3.5.4. Staff satisfaction
3.5.5. Patient comprehension
4. Making the Case: Why this Innovation is Timely & Necessary
4.1. Across the United States healthcare system, we see both urgent care centers and emergency departments becoming overwhelmed by the amount of patients coming into receive care. Staff burn out, loner patient wait times and lack in health literacy of patients in knowing where to turn for care. Many non emergent emergency department visits could be avoided if patients had the education to understand their symptoms.
4.2. In making the case through observing real world clinics and emergency rooms, this innovation can address the following concerns
4.2.1. Operational Efficiency: simplifies patient intake with collection data from their presenting symptoms prior to seeing clinical staff which decreases congestion
4.2.1.1. Redesigning the workflow, improved efficiency and reducing staff burn out fits into evidence based trend. (Sinsky et al.)
4.2.2. Empowering patients: providing educational materials to patients at the point of care, it helps them to understand their conditions and what the next steps would be
4.2.3. Health equity: aids language and culturally appropriate content which provides greater access for underserved populations
4.2.4. Contains costs of care: reducing unnecessary emergency room visits, decreases cost of care, decreases staff burnout and elevates preventive medicine
4.3. Goals of Innovation
4.3.1. Increase health literacy
4.3.2. Reduce staff burnout
4.3.3. Improve clinic throughput
4.3.4. Provide equitable healthcare
5. Resources
5.1. Fonseca, J. (2002). Complexity and innovation in organizations. Routledge. Institute of Medicine (US) Committee on Health Literacy. (2004). Health literacy: A prescription to end confusion (L. Nielsen-Bohlman, A. M. Panzer, & D. A. Kindig, Eds.). National Academies Press (US). http://www.ncbi.nlm.nih.gov/books/NBK216032/ Kotter, J. P. (2012). Leading change: An action plan. Must Read Summaries. Lee, S. (n.d.). Applying diffusion of innovations theory. Retrieved June 17, 2025, from https://www.numberanalytics.com/blog/applying-diffusion-of-innovations-theory Ortega, G., Rodriguez, J. A., Maurer, L. R., Witt, E. E., Perez, N., Reich, A., & Bates, D. W. (2020). Telemedicine, COVID-19, and disparities: Policy implications. Health Policy and Technology, 9(3), 368–371. https://doi.org/10.1016/j.hlpt.2020.08.001 Raff, D., Stewart, K., Yang, M. C., Shang, J., Cressman, S., Tam, R., Wong, J., Tammemägi, M. C., & Ho, K. (2024). Improving triage accuracy in prehospital emergency telemedicine: Scoping review of machine learning–enhanced approaches. Interactive Journal of Medical Research, 13(1), e56729. https://doi.org/10.2196/56729 Sinsky, C. A., Willard-Grace, R., Schutzbank, A. M., Sinsky, T. A., Margolius, D., & Bodenheimer, T. (2013). In search of joy in practice: A report of 23 high-functioning primary care practices. The Annals of Family Medicine, 11(3), 272–278. https://doi.org/10.1370/afm.1531
6. Designing an Innovation: Knowlege Mapping & Feasibility
6.1. Easy to Accomplish (Low Complexity)
6.1.1. Identifying high traffic clinic areas to place the kiosk.
6.1.1.1. Why its easy: I know the clinic's flow and the volume patterns. High Knowlege Level
6.1.2. Forming triage questions
6.1.2.1. Why its easy: Based on clinical experience and high acuity urgent care workflows. High Knowledge Level
6.1.3. Engaging with front and clinical staff
6.1.3.1. Why its easy: Creating strong relationships across scopes and job descriptions, firsthand experience in understanding their roles and routines. High Knowledge Level
6.2. Moderate Difficulty
6.2.1. Creating culturally relevant patient educational materials
6.2.1.1. Challenges: Needing to collaborate with health educators. Medium Knowledge Level
6.2.2. Frontline staff training to help patient use of kiosk
6.2.2.1. Challenges: Resistance to technology, training needs to be well designed to change patient management. Medium Knowledge Level
6.2.3. Creating evaluation metrics
6.2.3.1. Challenges: Familiar with department metrics and audits, but need more training on digital tracking. Medium to Low Knowledge Level
6.3. Difficult & Needs Support
6.3.1. Procurement of hardware/software
6.3.1.1. Why its difficult: Requires IT contracts, vendor management and budgeting. Low Knowledge Level
6.3.2. EMR integration
6.3.2.1. Why its difficult: Very complex systems and needs IT team. Low Knowledge Level
6.3.3. Creating multilingual digital interfaces
6.3.3.1. Why its difficult: Demands UX and language specialists as well as consultants on culture and linguistics. Low Knowledge Level
6.3.4. Funding
6.3.4.1. Why its difficult: Very limited experience in financial proposals. Low Knowledge Level
6.4. Knowledge Gaps & Support Needs
6.4.1. Multilingual Content Development
6.4.1.1. Partnering with community health educators and DEI consultants
6.4.2. Human Centered Kiosk Design
6.4.2.1. Consulting with specialists in human centered design and usability testing with clinical staff and patients
6.4.3. Project Funding
6.4.3.1. Working with administration for budgeting and funding proposals
6.4.4. Health IT Support
6.4.4.1. Consulting with IT and EMR teams as well as external vendors (kiosk vendor)
7. During my time as a certified medical assistant in a high acuity adult urgent care, I have observed frequent confusion in patients on when to seek emergency care versus being seen at urgent care. Digital Triage and Patient Education Kiosk System would assist patients upon arrival in making informed decisions based on their symptoms, while streamlining clinic operations and supporting staff by managing non-emergent flow more effectively
7.1. Innovation emerges from dynamic interactions and localized responses to organizational challenges. (Fonseca)The Digital Triage and Patient Education Kiosk System's adaptive role in real time enviroments.
8. Stakeholders
8.1. Patients
8.1.1. Role: End users
8.1.2. Rationale: Satisifaction, health literacy, and proper triaging affect the success of the system
8.2. Clinical Staff
8.2.1. Role: Support patient use of the kiosk and respond to the triage outputs
8.2.2. Rationale: Staff is on the frontlines of workflow and interaction with patients. The feedback provided from them helps system to integrate with the clinic operations
8.3. Clinicians
8.3.1. Role: Clinical oversight for triage criteria and symptom algorithms
8.3.2. Rationale: Accuracy is vital for patient safety. Input provided is based on evidence
8.4. Clinic Administrators
8.4.1. Role: Oversee approval, budgeting and implementation.
8.4.2. Rationale: They are the authority on decision making and can allocate resources
8.5. Health Educators
8.5.1. Role: Create and develop educational content for the kiosk
8.5.2. Rationale: Ensure that the materials are accessible, aligned with health literacy guidelines and are culturally appropriate
8.6. IT/EHR
8.6.1. Role: Hard/software installation, data integration and maintenance
8.6.2. Rationale: By successfully integrating the exisiting EHR system will improve documentation and clinic throughput
8.7. Quality Improvement/Compliance
8.7.1. Role: Mointor patient safety, patient outcomes and regulatory compliance
8.7.2. Rationale: Continuous evaluation of the effectiveness of the kiosk
8.8. Finance
8.8.1. Role: Budgets, purchased required technology and evaluates the return on investment
8.8.2. Rationale: Involvement of this team is vital for funding, long term scalability and cost benefit analysis
9. Two Key Objectives
9.1. Improve patient self triage and their health literacy at the point of care by 30% in the first six months of kiosk implementation
9.1.1. The goal is to empower patients to make imformed decisions about their care and their overall health. This reduces inappropriate visits to either the emergency department or urgent care.
9.2. Reduction in the front staff and triage staff workload as it relates to screening symptoms and non emergent case routing by 20% within the first quarter of kiosk implementation
9.2.1. This will allow for enhanced workflows, allowing the staff to prioritize the higher acuity cases and improve patient throughput
10. Constraints
10.1. People Constraints
10.1.1. Resistance to change from the staff. They may be wary to adopt new technologies or workflows. More so if they see it as a threat to their job security.
10.1.2. Training will be required for both clinical and administrative staffs. This requires time as well as resources to learn to use the technology
10.1.3. Patients who are elderly or have lowered digital literacy will need assistance using the kiosk
10.2. Budget Constraints
10.2.1. Initial cost of the kiosks and the development of the software will be costly. It will need to be secure, comply with HIPAA requirements
10.2.2. EHR integration costs, the system will require custom development to work with the exisiting EHR system
10.2.3. Ongoing licensing and maintenance. Keeping those aspects in mind the budget must allow for software updates, hardware repairs and training materials
10.3. Assest Constraints
10.3.1. Physical space for the kisok, the clinic may have limited floor space in waiting areas without disrupting patient privacy or the flow of clinic traffic
10.3.2. Content development, limited access to health educators to provide and create accessible patient educational materials
10.3.3. IT infrastructure, limited WIFI or older network systems may be a barrier to real time data exchange and secure system operation
11. Scope of Innovation: What is Included and What is Excluded
11.1. Included
11.1.1. Installation of kiosks, placing them in the waiting room of the urgent care for patient use prior to check in
11.1.2. Self triage, allows patients to respond to symptom based questions to help determine if their visit requires the urgent care or the emergency room
11.1.2.1. Technology like triage tools have been shown to reduce delay in care and redirect low acuity patients from seeking care in the emergency room and to recieve care at a urgent care center. (Raff et al.)
11.1.3. Language and accessibility features to include different languages, visual aids and voice support
11.1.3.1. The need for inclusive, accessible digital health tools that reach underserved populations is critical. The kiosk can support equity by offering multilingual and simplified educational content. (Ortega et al., 2020)
11.1.4. Patient education modules that provide short videos and infographics about when to go to urgent care or to the emergency room, common conditions and preventive health measures
11.1.4.1. Limited health literacy contributes to poor health outcomes and the increased costs related to lack of health education. (Institute of Medicine (US) Committee on Health Literacy)
11.1.5. Data collection for continual quality improvement, data is anonymized and is used to improve services and recognize trends
11.1.6. Streamling triage information with the administrative staff to better route patient visits as well as documentation
11.2. Excluded
11.2.1. The current scope is limited to be used in the clinic; home or mobile application access may be deployed in the future
11.2.2. The kiosk will not replace the role of a licensed clinician and will not provide a diagnosis or treat conditions
11.2.3. The kiosk will not dispense medication nor provide medication recommendations/advice. It will not integrate with pharmacies
12. Managing Barriers & Resistance
12.1. Identify & Acknowledge Resistance Early
12.1.1. Barrier: Staff resistance, fear of job security and increased staff workload
12.1.1.1. Strategy: Engage in early stakeholder engagement to obtain staff input and actively listen to concerns. Acknowledge that resistance is to be expected and natural part of change. Communicate openly about the purpose and the impact of the innovative change. (Kotter, 2012)
12.2. Create a Coalition
12.2.1. Barrier: Lack of buy in from administration, leadership and clinical staff
12.2.1.1. Strategy: Recruit change agents in all levels (administration, leadership and clinical staff. They become supporters throughout the roll out process (Fonseca, 2002)
12.3. Adequate Training & Support
12.3.1. Barrier: Lack of confidence or technical skills with new upcoming technologies
12.3.1.1. Strategy: Provide in person demonstrations, help desks and strongly emphasize that that there will not be any punishments imposted for mistakes during the initial roll out (Lee, n.d.)
12.4. Highlight Value of Innovation with Early Wins
12.4.1. Barrier: The perception that the innovation brings little value or slows the clinic workflow/throughput
12.4.1.1. Strategy: Implement pilot program to obtain early metrics as found in patient satisfaction and wait time reduction. Provide real time dashboards and before and after innovation comparisons to help show progress (Sinsky et al., 2013)
12.5. Align Innovation with the Organization's Priorities
12.5.1. Barrier: Limited bandwith and competing with other initiatives
12.5.1.1. Strategy: Structure innovation as its aligns with goals of patient safety and access and healthcare equity. Show that its complementary and not threatening to staff or clinic workflow
12.6. Continual Feedback
12.6.1. Barrier: Failure of adapting to user feedback
12.6.1.1. Strategy: Develop a feedback system as in suggestion boxes and surveys. Deploy Agile principles to help update interfaces and clinic workflow (Fonseca, 2002)