Digitalizing Access to Care: How Self-Check-In Kiosks Shape Access to Care and Efficiency of Hospital Services

Abstract

Responding to labor shortages and rising healthcare expenses, hospitals increasingly turn to self-check-in kiosks to streamline service delivery and improve patients' experiences. The purpose of this study was to reflect on the implementation of these self-check-in kiosks in a Dutch university hospital, particularly in relation to access to care for more vulnerable patients and intended efficiency goals. We followed a technology-in-practice approach to better understand how new technologies shape care practices in relation to in/exclusion and carried out an ethnographic action study involving desk research, participatory observations, semi-structured interviews, and reflection sessions with developers and hospital staff. Data were analyzed through ethnographic content analysis. Our results show that although self-check-in kiosks work well for some patients, many people experience practical and psychosocial difficulties, especially those who go through a complex care pathway, are low-literate, experience a distance the online world, or have sensory, motor, or cognitive impairments. Kiosks are not yet attuned to these patients and typically leave little flexibility and room for negotiation and personal support in what is, for many, a foreign environment. Therefore, patients frequently seek confirmation and assistance from already downsized or busy staff. In conclusion, we find that digitalization under the banner of efficiency within a healthcare system already under pressure carries risks, as it can unintentionally generate extra (invisible) work for patients and care professionals and threaten access to and quality of care for patients most in need. A more concentrated effort on refining the digitalization of healthcare processes using an inclusive-technology-in-practice approach has the potential to contribute to fairer and more efficient care for all patients.