Last week I was working with a group of young women who are experimenting with walking tours to assess the health literacy environment of a hospital. We are using tools developed by Dr Rima Rudd at Harvard university. The young women are in years 10 and 11, so anywhere between 15 and 17 and we had lots of discussion about how to use the tools and what we might learn about the hospital environment. The idea is that they will ask a friend, who has never been to the hospital, to come on the walking tour and to find their way from point A to point B. All the friend will comment on the decisions they make, why they choose one way over another and how easy or hard the signage is to use. The young women found the idea a little difficult, and as earnest young women, were concerned also about getting it right. So we decided to do a dry run - I would be the observer and the tourist/patient would be one of the young women, who just happened to be a relatively newly-arrived Muslim, African woman, quietly spoken with a reasonably strong accent and a little shy (though scarily astute and confident in her discussion afterwards). So we asked her to find her way from the emergency lobby to the pregnancy clinics. She found her way first to the front information desk - choosing people over signage to find her way around and to elicit information. She asked the lovely woman at the front desk "where do I go to for a pregnancy clinic?". Unsure what she had said the woman asked "you want to go to Women's Clinics?" To which our 'patient' answered "yes". So off we all went, to Women's clinics - which is where women go for appointments for everything but pregnancy.
When we arrive, we hang back while our 'patient' goes into the waiting and check in area. She comes back out again within seconds because she is not sure if she is supposed to just sit and wait, or if she is supposed to go to the counter. I go in and I can see her problem - and I can see she is not the first to have had it because the desk staff have tried to rectify the confusion by creating their own signage on bits of paper stuck with tape to the barrier that keeps everyone from naturally approaching the desk.
Our patient approaches the desk and we watch from a distance. Our patient asks "is this where I come for a pregnancy clinic" and the woman behind the desk stands and says in a tone that can only be described as grumpy, rude and ever so impatient "No, pregnancy clinic is over there!" I'm a little shocked. To be honest, I have never seen our desk staff behave like that - indeed I'm always quite impressed by their patience and courtesy. I'm not sure I could maintain it over such a long day. It's possible too that it was a bad moment, a bad day and I think we're all entitled to them - but the interesting thing is what happened next. When our "patient" came back I asked her how that made her feel. Expecting of course that she would say how awful it was, or how the person behind the desk made her feel small, bad, stupid etc etc. What she said was "that was OK, she was just a bit busy." Our patient was completely unaffected by that interaction and I suspect the reason she was unaffected by it was because that's what she is accustomed to.
So, if our patient was asked to complete a patient satisfaction survey - what would she write in answer to the question "were the staff courteous?" She would answer "yes", and we would never know or be driven to work with our desk staff about how to address young African women who don't necessarily have the right information about where they should be going!