Abstract
Increasing demands on emergency departments (EDs) are due to rising patient volumes and operational inefficiencies. To support these needs, innovative redesigns that prioritize both patient experience and system throughput are necessary. At UVA Health, ED visits rose by 12% between 2022 and 2023 and by 25% since 2021, leading to widespread crowding and delays. In response to this growing issue, my capstone team conducted a simulated redesign of the UVA Emergency Department’s waiting room using Flexsim HC software. The current layout often forces patients to return repeatedly to the main lobby, disrupting flow and creating the perception of stagnant care. Our new proposed layout introduces “progression areas”: transitional spaces post-triage where patients can be monitored and moved efficiently without congesting the waiting area. Despite a 2% increase in average triage time due to longer walking distances, our model showed significant improvements in operational consistency: variance in key time metrics dropped by over 50% and the time to transfer trauma patients from registration to trauma bays decreased by 30%. These findings from our simulation indicate that improving the spatial design of the emergency department waiting room can enhance patient satisfaction by providing a more predictable and streamlined experience. While the redesign promises gains in performance, it also raises questions about how technology and design interact with the different flows and stakeholders at hand.
In parallel, my STS research explores the rise of patient-facing healthcare platforms such as MyChart and how well-intentioned technological innovation can both empower and exclude key stakeholders. MyChart and similar platforms promised transparent communication, democratization of healthcare information, and the promotion of patient autonomy between providers and patients. This moment marks a shift from provider-centered record keeping to patient-centered access, driven by laws, society, and growing emphasis on value based care. However, the introduction and shift in implementing this technology has revealed systemic barriers in practice. Through scholarly literature and interviews with healthcare stakeholders, I found that MyChart adoption remains uneven, particularly among non English speaking patients, elderly patients, and those in low-income communities. These groups often face linguistic, technological and cognitive barriers that inhibit their ability to use the platform. While MyChart aims to close gaps in care, it has widened them by creating parallel systems of healthcare access. In my paper, I examine and argue how current patient centered platforms overlook key socio-technical factors. In addition, I provide recommendations aimed at enhancing platform inclusivity through simplified interfaces, language support, and proactive digital literacy outreach.
These two projects are deeply connected through UVA Health’s dual focus on operational efficiency and digital transformation. As UVA pushes patients to adopt MyChart for tasks ranging from appointment scheduling to communicating with providers, this platform is becoming embedded in core workflows, especially within the ED and UVA Physicians Clinic. For example, MyChart is central to the clinic’s efforts to streamline Medicare Annual Wellness Visits, a process that has proven difficult through traditional cold call phone outreach. However, as my team observed during ED visits, even well-designed systems face implementation challenges. Staff are burdened with paperwork, and there is a strong desire for customizable electronic forms that integrate seamlessly with existing records. This intersection emphasizes the broader socio-technical challenge: how can we create healthcare environments that are not only more efficient, but also more equitable? While the capstone redesign improves patient flow, it does not take into consideration the technologies that structure communication, documentation, and care coordination. Both projects point to a need for holistic system thinking that accounts for how space, people, and technology interact. Ultimately, my technical and STS work reinforce one another by highlighting that innovation in healthcare must be both functionally effective and socially responsible, particularly as we move toward a more digitized and data-driven model of care.
