The first part of the findings will present an illustration of the thematic network analysis from Slagelse Sygehus with an explanation of the, organizing themes, basic themes, herein examples, and lastly the global theme. Next the same will be done for the thematic network analysis from Roskilde Sygehus. Finally, the findings from the employee presentation will be described.
Thematic Network Analysis
Throughout the observations of the waiting areas of the pediatric outpatient clinic, different patterns and topics was found. These will be presented in an order appropriated to how the data was conducted. The observations from Slagelse Sygehus (appendix 1) will be presented first as it will later be used as a comparison to the observations from Roskilde Sygehus (appendix 2). Both observations notes have been thematically analyzed and each provided with their own web structure and global theme. The illustrations of the thematic networks are presented in figure 3 (appendix 3) and 4 (appendix 4).
Slagelse Sygehus
Figure 3: Thematic Network Analysis for Slagelse Sygehus (source: own creation based on Attride-Stirling, 2001)
Organizing theme 1: Having fun makes the waiting time go faster
The first organizing theme of Slagelse Sygehus “Having fun makes the waiting time go faster” is based on two basic themes, which will be explored individually. During the observations it was found that patients who were entertained and laughed did not have the same need to look at phones, nor were they sitting and tripping their legs or looking bored (appendix 1).
Basic theme A: Songs about good hygiene makes the waiting time more fun:
12.04.2021, 13:25 Waiting room 2
“Employee A tells me about the hygiene board, (…) with only hygiene advice on; how to wash your hands properly, why, and when to wash them, and a song to sing, when you wash your hands to make it more fun for patients.”
12.04.2021, 14:40 Waiting room 2
“The mother and son next to me look at the board with the hygiene advice on how to wash your hands. The boy reads out loud some of the advice. (…) The mother asks her son if they should take a picture of the hygiene advice, so they can practice it at home. They start to hum and sing the song on how to wash your hands, while laughing and smiling.
(…) the mother finds a similar song on her phone to play for her son. He starts dancing to the music.”
12.04.2021, 14:56 Waiting room 2
“The boy goes back to the hygiene board and starts singing the song again.”
The focus on hygiene is generally high at a hospital, but because of covid-19, this focus has been increased in the waiting areas. That is why Slagelse Sygehus had a board with hygiene advises (photo 1, appendix 5). It appears to be a great initiative from Slagelse Sygehus on how to inform the patients and their relatives on hygiene while at the same time inspire the patients to sing a song while waiting. The observed mother and son used it and took a photo of the song so that they could sing the song at home as well.
Basic theme B: Drawing and playing makes the waiting time more fun:
12.04.2021, 13:25 Waiting room 2
“At the bottom of the board, there are some drawings, that the patients can fill out with colors. They do not hand out that many drawings now due to covid-19 restrictions, but “if there is an uneasy child, it is better for them to have the possibility to sit down and draw, than having a bad experience, and then I just disinfect the pens afterwards.” – employee A (own translation)”
04.05.2021, 11:38 Waiting room 1
“A child and her father enter the waiting room. The child starts running around on the different level setup on the sides of the room. (…) She then crawls into a small room under the seats, like she is hiding. (…) She sits there and smiles at me; I then wave, and she waves back.”
The abovementioned quotes are picked out to best illustrate this basic theme, and the photos underpins the quotes (photo 2 and 3, appendix 5). There are many possibilities for the children at Slagelse Sygehus to draw, play and have fun while waiting. However, some of these possibilities are limited because of covid-19 restrictions. The observations showed that the interior of waiting room 1 invited the children to participate in playing activities.
Organizing theme 2: The interior and atmosphere has an influence on the experience
The second organizing theme of Slagelse Sygehus is about the interior and the atmosphere, as it was observed that these had influence on the patients’ experiences while waiting. This organizing theme is based on four basic themes, which will be explored individually (appendix 1).
Basic theme C: Covid-19 restrictions make the waiting rooms appear unapproachable:
12.04.2021, 10:10 Waiting room 1
“All over the waiting room there is red & white tape on the half of the seats, to illustrate where to sit and where not to sit because of covid-19 distance requirements of two meters.”
“(…) there is a table with two games glued on it, one for Kahlaha, and one for Tic-Tac-Toe. It is not possible to play them though, because the pieces for the games have been put away due to covid-19 restrictions.”
“All toys, magazines, and alike which is used by many during a day has been removed due to covid-19 restrictions.”
12.04.2021, 13:25 Waiting room 2
“Employee A tells me, that this waiting room is so boring now, due to covid-19. She finds some of the toys which is usually put forward and tells me how it is not responsible to have this out now (…)”
Because of covid-19 restrictions, all hospitals had to change their settings and procedures to provide a more hygienic, safe environment for their patients. At Slagelse Sygehus the restrictions were found to be very clear for the patients. However, it was also found that it changed the atmosphere of the waiting rooms to appear unapproachable for both the patients and the relatives, as there were no toys to play with (photo 4 and 5, appendix 5).
There was a change in the covid-19 restrictions from the first day of observing (12.04.2021) to the second day of observing (04.05.2021). Toys was still not available, but the tape was gone, and the room was found to be more approachable.
Basic theme D: Pictures of animals and recognizable figures on the walls are good for conversation:
12.04.2021, 10:54 Waiting room 1
“Two persons come into the waiting room, a child and her mother. (…) They play a game, where the mother is guessing an animal, that the child is thinking about. The mother did not guess it. The child says it was a duck. Now it is the child’s turn to guess which animal, the mother is thinking of.”
12.04.2021, 14:30 Waiting room 2
“A boy and his mother go up the hallway towards waiting room 2. The boy shows his mother a green penguin painted on the wall in the
hallway, which they talk and laugh about. (…) The mother then points at the Mickey Mouse figure on the wall, asking her son if he can recognize who it is, he looks, smiles, and says yes.”
04.05.2021, 12:59 Waiting room 1
“The girl looks at the wall with all the different photos of street art.”
“The girl from before goes to the other side of the room and looks interested at the animal photos on the wall.”
It was found that the patients had interest in the different wall decorations, in particular the animals in waiting room 1 and the recognizable Mickey Mouse in waiting room 2 (photo 7, appendix 5).
Photo 6, 8, 9, and 10 also illustrates what the patients were experiencing in the waiting rooms (appendix 5). The different animal photos and wall decorations were also found to be conversation starters for patients and their relatives.
Basic theme E: Noises from patients, relatives, employees, and interior can be disturbing:
12.04.2021, 12:54 Waiting room 2
“I can hear loud noises from one of the consultation rooms, probably from one employee talking to another. The loud noises are a doctor complaining about work (…).
12.04.2021, 13:43 Waiting room 2
“(…) but I can now agree with the head nurse that the hallway and waiting room 2 is very noisy. She told me, “We hope to get some sounds out here in the hallway, it could just be meditation sounds, but something to take the noises from the consultation rooms” (own translation)”
12.04.2021, 15:00 Waiting room 2
“The clock says the cock-a-doodle-doo sound. Both the boy and his mother go over there laughing. (…) The boy is making the same sound as the clock, and his mother says that he needs to be quiet, because they are at a hospital.”
In addition to the sounds mentioned in the citations from the observations, the radiators in waiting room 2 was also found to be very noisy. The clock on the wall was found to be atypical for the regular hospital settings as it made a loud sound every hour (photo 11, appendix 5).
Basic theme F: Different levels of seating areas make a more dynamic place to play and sit on:
04.05.2021, 11:38 Waiting room 1
“The child starts running around in the different level setup (…) She then crawls into a small room under the seats, like she is hiding”
04.05.2021, 13:36 Waiting room 1
“Then the baby starts crying. The father says something to the mother, who then takes the baby and walks across the room to take a seat at a higher level, to breastfeed the baby.”
This is not the basic theme with most observations, as the different level seating areas was partly closed of the first day of observations (12.04.2021). Even though it was still allowed to sit on some of the seats that day, it was observed that most patients did not use it. The different level seating areas make waiting room 1 more dynamic to use in the sense that it is possible to have more different areas and themes in the waiting room. On one side there is the animals and lower seating levels and tables, and on the other side the tables and seats are normal height with street art wallpapers (photo 4, 6, and 10, appendix 5). This makes the atmosphere of waiting room 1 welcoming towards patients with different ages and interest.
Organizing theme 3: Youth patients have other needs for waiting areas than young patients
The third organizing theme of the observations from Slagelse Sygehus is based on two basic themes, which will be explored individually. Overall, there was a larger representation of young patients, but a few youth patients were also observed (appendix 1).
Basic theme G: The youth waiting room has been designed to facilitate the needs of youth patients.
12.04.2021, 10:00 Waiting room 3
“The head nurse showed me waiting room 3 as she showed me around.
The decision behind the making of this waiting room was based on a survey they did on order to gain knowledge about the youth patients’
preferences and what they thought was missing in the existing waiting rooms.” – “One wall is covered in graffiti, making the look more urban.
It has a huge couch and some chairs. The wall across from the couch is going to have a tv for music videos and alike to be played on (told by the head nurse).”
As waiting room 3 was not yet in use in any of the observation days, it was not possible to observe the youth patients in these facilities. But it was still observed, how Slagelse Sygehus prioritized the needs of their patients, youth patients in particular by making sure they are met in these new waiting facilities, e.g., by painting a wall with graffiti (photo 12, appendix 5). This basic theme is very closely connected to the next basic theme.
Basic theme H: Including patients in a youth panel gives them a say in their own waiting room:
12.04.2021, 10:00 Waiting room 3
“The results from the survey showed that the youth patients were missing a place only for them without the company and noises from young patients (told by the head nurse).”
04.05.2021, 13:58 Waiting room 2
“A girl and her mother enter, and right after an employee sees them, and asks the girl, if she would like to become part of the youth panel that they have here at the ward (…) The girl takes a seat, while listening to the employee explaining about it. The employee says that she will get some information for the girl and walks out. She comes back with a piece of paper, and the mother takes a seat next to the girl, and they read it together. They talk about it and the girl seems to be interested.”
It was found that Slagelse Sygehus is interested in a constant improvement for their youth panel by asking more youth patients to participate. It was also observed that a teenager and his mother was using their phones while waiting in waiting room 1, which could be due to the lack of facilities for youth patients in the existing waiting areas. A basic theme concerning phones while waiting will be explored in the next organizing theme.
Organizing theme 4: Waiting time includes many different feelings, emotions, and behaviors Lastly the fourth organizing theme at Slagelse Sygehus is based on four themes, which will be explored individually. The findings shows that even though a hospital visit can trigger a various of negative emotions like fear, sadness, and anxious, a lot of patients and relatives were also in a good mood, and showing feelings of happiness, and behaviors like showing interest in the environment (appendix 1).
Basic theme I: Phones are used by the patients and relatives while waiting:
12.04.2021, 11:19 Waiting room 1
“Two more enter into the waiting room, a teenager boy, and his mother (…) Now they both sit and look at their phones.”
12.04.2021, 14:01 Hallway
“Another mother and her young boy (…) take place in the hallway. They do not talk. The mother looks at her phone. Then they talk a bit with lowered voices.”
It was observed that some patients and relatives used their phones while waiting. Like mentioned above this could have something to do with the facilities for youth patients in the waiting areas. The absence of toys to play with due to covid-19 restrictions can also take part in the reason why phones are used during waiting time.
Basic theme J: Patients and relatives show emotions of joy.
12.04.2021, 13:07 Hallway
“A girl and her mother come down the hallway with an employee to go to a consultation room. Both smiling.”
12.04.2021, 13:20 Hallway
“Down the hallway I can see two children running out of two different consultation rooms with the employees, as they need to go to get examined. They both seem happy, like they are enjoying themselves.”
The findings shows that numerous patients and relatives showed emotions of joy and smiling during their hospital visit. The two above mentioned quotes are observations of patients right before their consultations and during. But as it illustrates from earlier mentioned quotes from the observations, many of the patients and relatives were also enjoying themselves while using the facilities of the waiting areas.
Basic theme K: Patients show emotions of sadness, anxiousness, and fear:
12.04.2021, 11:05 Waiting room 1
“One child and her mother enter, (…) The child does not say anything.
The mother asks the child if they should take of their jackets. The child does not answer, the mother takes of her jacket. (…) The mother whispers “I think it is our turn soon, honey” (own translation). The mother talks a bit more to the child, but she does not answer.”
12:04.2021, 13:38 Hallway
“Now there is a child screaming and crying from a consultation room. A father comes out, carrying the little child, who is very sad.”
04.05.2021, 11:38 Waiting room 1
“She (a little girl) then bits her father, and he says, “no you cannot bite me” (own translation). (…) The child says sorry for biting her father.”
Beside showing emotions of joy, the patients also showed emotions of sadness, anxiety, and fear.
The above quotes are selected from the observations to best underpin this basic theme. The findings shows that some patients were crying a lot, this can of course be of various reasons, but it is not unlikely that the anxiousness and fear of the unknown can be overwhelming in these situations.
Other ways for children to show discomfort can be like in the first quote: where the child simply does not say anything or the last quote: where the child bits her father. In addition to these findings, it was also observed that many of the relatives was trying to calm and showing emotional support to their children by giving them kisses and hugs.
Basic theme L: Waiting is boring and annoying for both children and relatives:
12.04.2021, 14:17 Hallway
14:25
“The mother and boy sitting in the hallway are still waiting. It seems like they are bored. The mother is tripping her feeds on the ground, and the boy is swinging his legs back and forth from the chair.”
“The boy and his mother, whose have been waiting 25 minutes in the hallway enter (…) The mother shortly complains about the waiting time, and employee A says sorry.”
12.04.2021, 14:30 Waiting room 2
14:40
“His mother says that they must see how much time they will spend here, but that they probably will have time to play a game, when they get home.”
“Employee A excuses to the boy and mother, for her running late on schedule.”
The observations showed that some of the patients expressed signs of boredom while waiting in the waiting areas, but at the same time it was also found that most patients and relatives were accepting that waiting is part of the hospital visit. As illustrated by the quotes the employee apologized for the delays.
Global theme: The waiting areas provide the patients with physical surroundings which encourage approach behavior
It was found that the patients and relatives at Slagelse Sygehus in general were in a good mood and interacting with the physical surroundings. It was found that the pediatric outpatient clinic’s management wants to continue to improve the waiting areas so it can facilitate as many different needs from their patients as possible. However, it was also found that some patients were feeling sad or bored, but it is arguable there is a limit for how much a child can be distracted from negative experiences: if the medical treatment requires a blood test taken by a needle it will hurt, however it is possible to be distracted from the pain afterwards in the physical surroundings at the pediatric outpatient clinic at Slagelse Sygehus (appendix 1).
Roskilde Sygehus
The waiting areas at Roskilde Sygehus (appendix 2) are different from the ones at Slagelse Sygehus (appendix 1) in several ways. But at the same time, it was found that of the same basic and organizing themes were the same due to both being pediatric outpatient clinics and because the patients are in for the same purpose; to get a consultation from a health care employee. The following illustrates the thematic network for Roskilde Sygehus (appendix 4).
Figure 4: Thematic Network Analysis for Roskilde Sygehus (source: own creation based on Attride-Stirling, 2001)
Organizing theme 1: The employees have an influence on the experience
The first organizing theme of Roskilde Sygehus is based on three basic themes. The intention of the observations was not directly to observe the employees, but it was found that the presence and behavior of the employees had an influence on the atmosphere and thereby the overall experience.
Each basic theme will be explored individually in the following (appendix 2).
Basic theme O: The employees are happy and helpful:
02.06.2021, 09:47 11:11
Waiting room
“Employees walk around in the hallway; I can hear them laughing.”
“I can hear laughter from the employees in the office,”
07.07.2021, 09:55 Hallway
“An employee jumps the hopscotch while another employee walks past.
The employee says, “I could not resist” (own translation) and laughs.
The above-mentioned quotes help illustrates how the employees of the pediatric outpatient clinic at Roskilde Sygehus were in general happy and helpful. It was found that the laughter and interaction with the interior from the employees gave a positive vibe to the atmosphere. However, it can also be argued that some of the employees indicated resistance to the observations and why it took place. One of these situations was found after an observation in a consultation room were the employee seemed unwilling for another observation to take place in the same consultation room. This had no impact on the patients or relatives, and therefore no influence on the overall patient experience though.
Basic theme P: Hospital clowns gives a positive input to the experience:
21.04.2021, 11:24 Waiting room
The two hospital clowns enter the waiting room: “they say that they are the element of surprise in the waiting time. (…) They use the room as a tool for their entertainment (…) They observe the patients and their needs, and respect this. “Now like the girl in the hallway, she is being a bit reserved, so we only walked around her, played some music, and talk silly to each other” (own translation) But then the girl still gets an experience of seeing the clowns.”
07.07.2021, 09:55 Hallway
10:40
“I can hear children in the waiting hall talking about the different fish on the wall. Then the hospital clowns arrive and talks with them. The children are very interested in the clowns, and they talk about last time they saw each other in Tivoli. The clowns follow the children and their mother to the consultation room.”
“The two hospital clowns, children and their mother come out from their consultation. One of the clowns play some music on his guitar on their way out. The children are smiling.
The hospital clowns3 are not directly employees of the hospital, but this basic theme is still connected to the organizing theme regarding the employees because the hospital clowns still represent the experience at the hospital. It was observed that the patients had a thrill with the hospital clowns and that the hospital clowns at the same time managed to interact with the different patients based on their needs and moods.
Basic theme Q: The employees can make fun with the medical instruments during the consultation:
02.06.2021, 13:40 Consultation room 6
“The doctor asks the boy if he can listen to his lungs, he then takes small stuff out of his pocket, asking the boy if can use that for his lungs. The boy says no, and they laugh, and the doctor takes out the stethoscope and the boy say the name of it. The boy then asks if the doctor has more silly stuff in his pockets.”
07.07.2021, 13:14 Consultation room 2
“The boy then starts asking the doctor about the medical instruments lying on the desk.”
At two of the observed consultations, it was found that the patients had interest in the medical instruments. As the first quote underpin, the employee used the situation with the patient to engage him in what was happening and make fun out of the situation. The latter quote shows how another patient also had interest in the medical instruments.
3 The Danish Hospital Clowns are an organization of people trained as clowns, who visit Danish hospitals and entertain the patients, mostly at pediatric wards. They have a close teamwork with the hospital employees, and help the patients feel safer in the hospital situation with fun, games, theater, play, and music. The organization is sponsored (Danske