Turning ComForCare San Fernando Valley’s paper flowsheet system fully digital to reduce errors and time spent on payroll by 50%.
Lead UX Designer
Mobile app design, native iOS
Real Time Board, Sketch, InVision, Abstract
ComForCare San Fernando Valley is a franchise of ComForCare, Inc., a leading in-home care services provider aimed at providing quality service, personalized care plans, and compassionate caregivers to help seniors live independently in their own home.
The franchise’s current billing and payroll processes are incredibly time-consuming, taking out around 20 hours of work every two weeks per employee. Why? Caregivers have trouble turning in flowsheets correctly and/or on time. ComForCare employees struggle to catch these errors and spend around hours manually fixing them for payroll. If mistakes are missed, clients can be billed incorrectly and caregivers can be paid incorrectly.
They currently have a caregiver app but don’t use it because it doesn’t appropriately meet business and insurance needs. My team’s primary goal is to deliver a redesign of this app that:
Better prevents common flow sheet errors that come from their current paper process
Is user-friendly and saves the company up to 10 hours biweekly
Better trains caregivers in the flowsheet process
We’re confident this redesign will omit their paper flowsheet process to become fully digital, significantly reducing the chance of billing errors.
Research & Discovery
We first met with the owners to understand their business goals, identify pain points, and narrow our scope. The owners walked us through their entire company from on-boarding clients to finding caregivers to their flowsheet and payroll process.
The big question I had: Why can’t they use their current app for flowsheets?
It turns out it doesn’t have sections to fill in required parts of the flowsheet, doesn’t accommodate all possible schedule-change scenarios, and doesn’t actually provide GPS-activated alerts and push notifications. Therefore, they stick with paper flowsheets.
The owners told us the most frustrating and time-consuming aspects of their business come from their payroll process. We collectively created a service map to identify what parts of that process are taking the most time, where the errors are actually happening and why there are so many opportunities for errors in the first place.
Note: Before payroll, each detail in Health Manager regarding schedules must be 100% accurate. All employees spend hours checking and double checking each paper flowsheet with Health Manager to ensure everything matches.
flowsheet PAIN POINTS
Employees spend 25% of their hours each week manually checking for errors by:
Pulling from current mental knowledge of the case
Calling caregiver to confirm the error
Fix on flowsheet itself
Not all caregivers submit flowsheets on time or do so incorrectly.
Employees have to individually contact caregivers via phone or email to confirm
COMMON FLOWSHEET ERRORS
Clock in/Clock out times don’t match Health Manager.
Caregiver writing incorrect hours
Client changes caregiver schedule last minute and employees might not be aware or remember
Missing information (tasks, narrative, signature, etc.)
Not turned in at all
How might we alleviate errors and save the company (and caregiver’s) time during the flowsheet and payroll processes?
We believe that redesigning the current caregiver app will better address payroll needs by decreasing the possibility for errors and significantly lowering the chance of incorrect billing. It will also save the company 5-7 hours of labor every other week.
Design & Ideation
We collectively sketched each screen to ensure universal agreement on the basic flow. Once we moved to digital, I created a pattern library to ensure consistency.
We struggled at first to nail down a flowsheet flow that worked for both the caregiver and the business, was insurance-compliant, and really did simplify this part of the process. I preferred a weekly system to keep a structure that they were used to, but other teammates felt a daily system would better simplify the process.
I was proven wrong. In testing, we learned the owners actually prefer a daily system because it 1) Trains caregivers to be better about the following process and 2) Allows employees to be more aware of what’s happening on a daily, vs. weekly, basis. We ultimately landed on a daily flow sheet system where caregivers review and submit flowsheets with signatures before clocking out of each shift.
Before we get to the final app redesign, take a look at the various iterations we tested throughout the process to identify the best solution.
Some versions of this page missed chunks of the flowsheet and some removed buttons that employees preferred, like the care plan button, and replaced them with buttons that felt out of place, like the signatures. We realized that this page was just getting increasingly cluttered and confusing.
Pressed and Inactive Buttons
We also tried several options to show completion on the app. Pressed state buttons didn’t really provide an option to go back or give caregivers one last check before they make decisions, which helps prevent errors. Inactive buttons showed something can’t be clicked until requirements are met, yet in tests with the owners, we realized detailed error messages would be more effective in teaching caregivers the process.
Review Weekly Flowsheet
We started with keeping to weekly flowsheets, with two versions: 1) By section and 2) By day. Breaking up by section turned out to be more work as it is easier for caregivers to see a daily overview of all tasks together. By day breakdown ultimately still focused on a weekly vs. daily flowsheet.
Before, if a caregiver clicked “check-in", the app would clock them in, no matter what time they clicked the button. This could severely impact the schedule if the caregiver clocked in too early, causing the client to overpay.
We updated the UI to better match the company’s logo and website. We also made the address clickable and provided map options (vs. a separate map button.)
We also added a pop up to confirm the clock in time. To accomodate users clocking in early, we designed an alert that trains caregivers to clock in on time:
Before, these screens were incredibly cluttered with information. The primary issue, however, was that they were missing the section for caregivers to check off the Daily ADLs (or Activities for Daily Living). When a PDF of the flowsheet was generated, it was blank for that entire section.
This means the PDF can’t be sent to insurance, and clients can’t be billed properly.
We first separated the daily flowsheet from teh shift details information to keep the screens organized and easy to follow.
Secondly, we added the ADL fields to this page to ensure caregivers can fill out every required section of their flowsheet in one easily scannable screen.
If caregivers try to submit without filling out a required section, they will be pushed to the section they didn’t fill out with an error message explaining what they need to do in order to submit.
When they push “clock out,” all caregivers will be prompted to make sure that is the time they want to clock out.
It is a common occurrence for clients to ask caregivers to stay later, so we wanted to ensure caregivers could adjust there time. If caregivers select “no,” they will be promoted to both adjust the clock out time as well as provide a reason, something that was incredibly important to the owners.
If caregivers leave the client house before the shift is over, they will receive a push notification like so:
We assessed all use cases and concluded there would be only two general reasons a caregiver can leave the house early. They are either transporting the client somewhere (errands, appointments, etc.) or they were asked to end their shift early. Any other use cases would need to be addressed directly with the company itself.
This is to better train caregivers to keep ComForCare employees better updated to changes in schedule and where they are during their shift.