Ophthalmology Patient Portal and Online Communication Editorial

Lesson from the BART: First Use is Critical in Technology Adoption

On my recent trip to the American Academy of Ophthalmology meeting this fall in San Francisco, I realized an important pearl applying to the adoption of technology. My epiphany came in an unlikely setting at the hands of a most unlikely teacher.

Challenged by the BART:

If you have ever traveled on the Bay Area Regional Transit (BART), you will be aware of two very significant differences vis-à-vis subways in Boston, New York or Atlanta. The first is that fares are charged on a point to point basis rather than a fixed, ride anywhere, basis. Instead of paying a single fare to enter the system, the fare is determined by the destination. The second is that there are no attendants selling tokens. BART replaced the position with self service ticketing kiosks. There are no BART

 Artwork by Paul C. Seel, MD, MBA
 Vice President & Medical
 Director
 
 Sophrona Solutions
 Minneapolis, MN

officials available. This left me befuddled on my maiden subway trip from Oakland to downtown San Francisco.

The Setting:

I had arrived at the Oakland airport late for a lunch meeting in San Francisco. I hit the Oakland Coliseum BART station in a rush set to quickly purchase a token and hop on the next train. I saw none of the familiar token booths. There were no attendants making change, answering questions or selling tokens. A fellow traveler pointed to several self-service kiosks against the wall with patrons queued three to four deep. No problem I thought, at least until I got close enough to be confused by the lack of directions. It didn’t help seeing others struggling through the process. I just wanted to know where to insert the money and where to collect the ticket or better yet, the location of the booth for the tech challenged ticket buyers. No way out, no apparent help, I’d have to figure it out myself. In retrospect, I can say that it’s a screwy system that requires the addition or subtraction in five cent increments to arrive at the correct fare. But in looking for the fare, I couldn’t see any indication of what was needed. I’d be overly dramatic to say I was panicky, but I certainly was uncomfortable. All I wanted was to know the fare, how to exchange the money for a ticket and to be on my way. As I and many of my fellow travelers, specifically those BART novices fumbled through the process, I saw an out. A self described homeless man, a subway concierge of sorts, was efficiently assisting one after another buy their tickets. As I reached the kiosk, he asked me a series of questions: ‘where are you going?’, ‘one way or round trip?’, ‘cash or credit card?’ He quickly entered the correct fare from a chart I had missed and returned my credit card with my ticket. As confusing as the process had seemed before, it now seemed simpler.

And Now the Pearls:

As I thought about what had happened, I realized several general principles were at play. First was that I was uncomfortable trying to figure this out and not alone in how I felt. This feeling was shared in common with the others in the BART queue. Second was the realization that my unease stemmed from several factors. I was in an unfamiliar setting and I was under a time deadline to quickly complete the process. I had never experienced self service technology in a subway before. Third was the understanding how these factors acted as an inertial barrier or hurdle to my first time use of this technology. In my case, the barrier was significant enough that I spent more time looking for an alternative, rather than just figuring it out. Lastly I saw how a coach could help the first time user. For me, it was just like medical training: see one, do one, teach one. That was all it took and before I left the Bay area, I was helping others get their BART tickets when they struggled a head of me in line. Now as far as I’m concerned, this is a poorly designed system, creating a poor user experience, at least on the first use. But despite the design shortcomings of the BART ticketing kiosks, the key to success is getting someone through it that first time. After that first time through, it’s much easier.

Driving Adoption:

Keeping this first use principle in mind is critical in driving adoption of self service technologies. In some scenarios getting that first use can be done by eliminating the alternatives. It’s sink or swim as with the BART. (My homeless friend did provide a life vest, however, I’m sure I would have figured it out eventually.) In other self service settings, such as health care, organized assistance and encouragement may be the most successful approach. Often it’s just a matter of hand holding to help reluctant users get over that hurdle. Subsequently, I’ve thought through my own adoption of self service in other settings such as financial services, travel and on-line retailing. My path is pretty stereotypical; I’m initially anxious and resistant to change. Eventually, I’m helped over the first use barrier with some combination of encouragement, demonstration or outright assistance. In most cases all it takes is a couple of times to realize that self service is more efficient. It was no accident that my homeless friend had staked out this particular station. His entrepreneurial epiphany had been that there were a lot of first time BART users arriving from the Oakland Airport in need of help. Accordingly, he requested a “blessing” aka service charge for his help. I gladly rendered a tip for the service. Only after the fact did I realize just how he helpful he had been.