Short abstract:

Hospitals are adopting self-check-in kiosks to streamline services, but their implementation in a Dutch university hospital raises concerns. While effective for some, vulnerable patients face challenges. The kiosks lack flexibility and may affect the efficiency and the access to quality care.

Long abstract:

In response to labor shortages and rising health care costs, hospitals increasingly use self-check-in-kiosks to streamline service delivery, improve efficiency and enhance patients’ experience. This study reflect on the implementation of self-check-in-kiosks in a Dutch university hospital, particularly in relation to access to care for more vulnerable patients and intended efficiency goals. This ethnographic action research employs desk research, participatory observations and semi-structured interviews. We followed a ‘technology-in-practice’ approach to better understand how this new technology shape care practices in relation to in/exclusion. Our results show that although self-check-in-kiosks work well for some patients, large groups experience practical and psychosocial difficulties. Especially those with sensory, motor or cognitive impairments, go through a complex care pathway, are low-literate, or have limited digital skills. Kiosks are not yet attuned to these patients, and typically leave little flexibility and room for negotiation and personal comfort in what for many is a foreign environment. Patients and staff employ varied (unexpected) strategies to make the machine operational in practice, such as seeking assistance from relatives or already busy staff, or by placing written notes on the counter or on the machine to guide patients. In conclusion, this research show that innovating within a healthcare system already under pressure, due to staffing shortages and budget cuts, carries risks, as it may unintendedly threaten access to and quality of care for patients. Due to the extra work this generates for such patients and for care professionals, the workload reduction aspired seems also elusive, or is, at the very least, unequally distributed. This raises questions about which process to digitize in the healthcare sector.