| FINISHING REMARKS - ___________________

The previous part discussed the findings and presented contributions to business and literature. The last part of this thesis aims to structurally summarize and clarify the main findings by answering the research question. Lastly, it will provide suggestions and perspectives for future research.

Conclusion

In the introduction of this thesis, it was stated that “the time spent in a waiting room is often referenced to as an uncomfortable situation where the patients and relatives are in a limbo between what they know and the unknown”. With the chosen literature on the customer experiences, touchpoints, and journeys, servicescapes, healthscapes, and patient journeys, and a research design including a micro-ethnographic study analyzed with thematic network analysis, the strive throughout this thesis was to answer the main research question: How can the pediatric outpatient clinic of Roskilde Sygehus improve their patient journey through the touchpoints in the waiting areas?

And at the same time, it became clear if there were a coherence with the assumption stated in the introduction.

Some of the main findings from Slagelse Sygehus and Roskilde Sygehus are found and summarized into organizing themes. From Slagelse Sygehus: (1) Having fun makes the waiting time go faster – (2) The interior and atmosphere has an influence on the experience – (3) Youth patients have other needs for waiting areas than small children – (4) Waiting time includes many different feelings, emotions, and behavior. From Roskilde Sygehus: (1) The employees have an influence on the experience – (2) The interior and atmosphere have an influence on the experience – (3) Waiting time includes many different feelings, emotions, and behavior.

It is clear to see that some of the organizing themes between Slagelse Sygehus and Roskilde Sygehus were the same, but the findings and discussion also shows where there were dissimilarities between the two, which gave two different global themes, Slagelse Sygehus: The waiting areas provide the patients with physical surroundings which encourage approach behavior, and Roskilde Sygehus: The touchpoints in the waiting areas could be improved for all patients, youth patients in particular. In

the discussion the two global themes were compared, and it was argued that their waiting areas were found to be different as they are arguably managed differently.

The management of the pediatric outpatient clinic of Roskilde Sygehus can improve their patient journey through the touchpoints in waiting areas by starting off with implementing the suggestions provided for them in employee presentation on the 1^st of October (appendix 7). However, the improvement of their patient journey through the waiting areas should take a stand in the eight propositions provided in the part Propositions for pediatric health care business. These eight propositions can be applied in other pediatric health care businesses; however, it was also discussed if and how they could be applicable for other businesses.

The question of why the management of Roskilde Sygehus should improve their patient journey through the touchpoints in the waiting areas was not asked directly but is arguable an underlying premise for understanding the research area, and in many ways answered through the chosen literature. Some of the main points are presented below.

For an organization to be successful it must be familiar with the critical points and built the service experience so that the customer gets as easy and successful through as possible (Vandermerwe, 1993; Meyer & Schwager, 2007). As all the touchpoints interfere with each other and create an overall judgment of the experience, the journey needs to be holistic with an appealing touchpoint architecture to get higher customer and employee satisfaction (Dhebar, 2012; Maechler, Neher, &

Park, 2016; Vorhees, et al., 2017).

It is important to remember that the physical surroundings particularly influence the behavior at hospitals of both the patients, relatives, and employees, which is why it is important to manage the touchpoints within (Bitner, 1992). The perception on the touchpoints in the waiting areas will also influence how the medical treatment (product) is perceived (Bitner, 1992). In addition, Hutton &

Richardson (1995) argues that the healthscape can have an impact the patient’s healing process, which is arguable one of the most important reasons of why it is necessary to proper manage the touchpoints in the physical surroundings.

Furthermore, having touchpoints like toys and other playing activities in the waiting areas can create possibilities for the young patients to feel less anxious and afraid (Corsano, Majorano, Vignola, Guidotti, & Izzi, 2015). Ultimately, the reason of why is that Roskilde Sygehus can improve the quality

of the service provided by improving the touchpoints in their waiting areas (Gualandi, Masella, Viglione, & Tartaglini, 2019).

It is argued that another answer to why is that the patients and relatives needs distractions in the waiting room as it was stated in the introduction: the children must be distracted from the situation and the relatives must have their distracting thoughts removed so they can overcome the situation.

It is the assumption that by working with the touchpoints in the waiting area of Roskilde Sygehus, distraction would be easier found for both patients and relatives.

Lastly this thesis came to be a study of how a waiting room changes during a health care crisis pandemic with retractions and how it influences the patient experience. This was not the intention at the beginning of the research, however as covid-19 is an extreme health care crisis it was inevitably that it would not have influence on the research and patient experience, as the research area was within the health care business (Lemon & Verhoef, 2016).

To sum up, this thesis is an ethnographic study of the waiting areas as part of the patients journey through the pediatric outpatient clinic of Roskilde Sygehus, which have provided an insight into considerations and suggestions for various initiatives for the health care business in general, but also for the management of the pediatric outpatient clinic at Roskilde Sygehus to take into considerations.

Future Research & Perspectives

The research design in this thesis opens for several opportunities in which the direction for future research could go, both within the theoretically fields already used, however, other theoretically fields could be interesting as well.

Based on the conclusion it should be considered for future research to study the pediatric patient experience for a specific age group. As mentioned earlier the lack of appealing touchpoints for the youth patients at Roskilde Sygehus was severe, however it was difficult to go in-depth with the needs of youth patients, as it was mostly young patients being observed. Future research on this area could include a collection of some of the youth patients who visits the pediatric outpatient clinic frequent in a youth panel, which could also function as a focus group, and explore how to make the make

appealing touchpoints for them in the waiting area. It could be assumed that for this age group in particular the investigation could take a direction into the research areas of technology and how it can influence the patient experience. A thought could be that the waiting rooms should contain possibilities for digital games with physical interactions. These could be used by multiple players, making the patients and/or relatives interact with each other, and could also be used during the consultations between the patients and employees to check the physics of the patients.

Another interesting area for future research could also be found in the research areas of organizational implementation theory as it was found that a few employees at Roskilde Sygehus was not interested in the research of this thesis. It could be interesting to investigate how to proper implement new suggestions for improving the patient experience with the employees being onboard, as the improvement eventually will influence the employee experience too.

It could be considered to go into the research areas of philosophy and investigate waiting time and boredom as a concept, and why it seems like everything should be so efficient that waiting and boredom is such a “bad thing”. It is considered that boredom can lead to creativity (Thorp, 2020), which could be an argument for why waiting areas in fact should contain more possibilities for being creative for the patients and relatives. It was already seen with drawing tables at both Slagelse Sygehus and Roskilde Sygehus, but could there be more touchpoint with the possibilities for the patients and relatives to be creative, and could it in fact distract in such a way that it would influence the patient experience?

Lastly, it is noticeable that even though the research has moved a lot in the areas of consumer-, costumer-, and patient experiences, it seems like expectations are changing simultaneously. So does the culture. What could have been a great experience years ago will probably not be today, as what could be a great experience today, might not be in a few years. It is therefore questionable what the outcome of a research like in this thesis should be. If people, expectations, experiences, cultures, and everything in general always are in a constant change, how will this research even be relevant in the future? And if people (patients) are so different, is it then even possible to improve the patient journey, as some will always experience gaps between their perceptions of quality and the actual outcomes thus quality dissatisfaction.

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Appendices

Appendix 1, Observations: Slagelse Sygehus

Pediatric outpatient clinic, observations made by Sif Larsen.

Date: 12.04.21 Location: Entrance area

Interior: An information desk is centered in the front of the entrance. A small stool for kids to stand on, so they can see the employee sitting on the other side.

Orange floor. White walls, beside one which has a big decoration of a sand mountain in orange and brown colors.

In front there is a big giraffe statue standing on the floor with its head going into the ceiling and green plants around the head.

There are two child chairs, and four adult chairs to wait on. One green plant on the floor.

A banner is placed next to the small chairs but is not fully pulled up.

When arriving at the entrance area, the patient and/or the relative must use the patients’

sundhedskort in a machine, that then gives you information on your time of appointment, and where to sit and wait. Then they go to the giving waiting area, and a nurse or doctor come to get them, when it is their time.

Atmosphere: Hectic, patients and relatives coming in and out, and employees walking past from one ward to another. At the same time quiet as the people walking in, out, and past is either talking in a quiet voice or not talking at all.

Observations:

09:38

One child comes in from outside with her mother.

Two employees walk past.

Two more comes in, a child and her mother.

09:46

There is no one behind the information desk, I try to ring the bell, but no responses.

Two more comes in, a child and his mother, they don’t have their sundhedskort, so they wait at the information desk, but there is no one to help them. The mother looks around, but without any luck.

Two comes out from the hallway in the pediatric outpatient clinic, a child, and his mother.

One adult comes out.

Two more comes in, a child and his mother.

Two employees are going into the information desk, ready to help the two standing in front.

Afterwards I go and ask them to inform the head nurse of the pediatric outpatient clinic, that I have arrived.

Location: Hallway

Interior: Has white walls and beige floor, with two stripes going from the information desk, one white to waiting room 1 and one blue all the way down to waiting room 2.

Many green plants alongside the walls.

Some painted animals on the walls.

By the entrance to every consultation room, you can see the number of the room, going from 1 to 18.

Atmosphere: Hospital quiet. There are noises from the consultation rooms, as it is not soundproofed prober (information told by the head nurse).

Observations:

09:50

The head nurse showed me around.

There are three waiting rooms. Do to covid-19 the hallway is being used as waiting area as well.

Location: Waiting room 3

Interior: One wall is covered with graffiti, making the look more urban.

It has a huge couch and some chairs.

The wall across the couch is going to have a tv for music videos and alike to be played on. This waiting room is smaller than the two others.

Atmosphere: Closed atmosphere, dark.

Observations:

10:00

The head nurse showed this waiting room as she showed me around. The decision of making this waiting room was based on a survey they did to gain knowledge about the youth patients’

preferences and what they thought was missing in the existing waiting rooms. The results from the survey showed that the youth patients were missing a place only for them without the company and noises from young children (told by the head nurse).

This waiting room is not in use yet.

Location: Waiting room 1

Interior: This is the biggest waiting room.

There are seats in different levels in both sides of the room. One side decorated with different photos of street art from different places. Giving a more youthlike look.

The other side is decorated with photographs of different animals and some flowers, some small plastic toy animals is also glued to the walls, as if they walk on the wall. Also, small lamps (not turned on) are placed around near by the tables.

One big green figure of a tree is placed in the middle of the room, I can just imagine how it would be perfect for hanging on Christmas stuff in Christmas time or eggs at easter. Behind this tree is a table in the same green color, with only one table leg going to the floor, which makes it wobbly.

This is where I sit with my computer.

On the front of the big green tree, there is a note saying why I am sitting here. Which means, that the patients and relative has a change to know, why someone is sitting and writing on her

computer all the time, also making it possible for them to ask me questions if they like.

Behind the green table, the end wall begins. It has windows and a door going outside to a courtyard. Next to each stair-sitting area on the sides, there is a small area, on the right side (looking form the entrance), there is sensory wall, with fake grass look alike carpet glued to the wall, some fur, and a sponge glued to the wall as well. Over this, some shelves; these where probably used to storage some toys, before covid-19.

There is also a chair for toddlers, and two chairs stabled on top of each other, with tape on. These are clearly not to be used.

Next to this, there is a small table with two chairs stabled upside down, maybe just from the cleaning earlier, but because of covid-19 and so much else being “closed” in the waiting room, it is hard to tell, if it is also because, the hospital doesn’t want the patients to use them. All over the waiting room, there is red & white tape on the half of the seats, to illustrate where to sit and where to not sit because of covid-19 distance requirements of two meters.

On the other side, there is a table with two games glued on it, one for Kahlaha, and Tic-Tac-Toe. It is not possible to play them though, the pieces for the games have been put away because of covid-19.

One of the walls is covered with wood like wallpaper, which gives the room some warmth.

All toys, magazines, and alike which is used by many during a day has been removed, due to covid-19.

Due to covid-19, around half of the seats in the waiting rooms cannot be used, because patients and relatives must sit with a distance of two meters to other patients. This mean that some patients and their relatives must sit and wait in the hallways.

Atmosphere: Quiet in the waiting room, but a lot of noises coming from the hallway. This waiting room is placed in the beginning of the ward, so every patient coming in walks past here. Seems like a nice place to wait during normal conditions but due to covid-19 the atmosphere in the waiting room is closed and boring. Welcoming of patients with different ages and interest.

Observations: