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Inaccessibility in the Hospital: The Adventures of My Daughter’s Fourth Eye Surgery

May 20, 2016 • Darrell Shandrow Hilliker

My four-month-old daughter is sleeping, so, in belated celebration of Global Accessibility Awareness Day, I thought I would describe our experience with her fourth Glaucoma surgery from an accessibility point of view.

Before I get started, let me say that I think Phoenix Children’s Hospital always treats my daughter very well and provides her with excellent care. I also believe the staff at the hospital do the best they know how to make the experience as accessible and pleasant as possible.

Allison, Allyssa and I arrived at Phoenix Children’s Hospital one hour before Allyssa’s scheduled surgery start time of noon. As we have done with previous surgeries, we contacted the hospital’s Language Services department to request accessible, electronic copies of Allyssa’s discharge instructions and medical records. As has been the case for previous surgeries, we agreed to receive a secured email containing the discharge instructions prior to leaving the hospital, followed by the remaining records tomorrow.

In order to check our daughter in for surgery, I initialed and signed several pieces of paper, including consent, financial responsibility and health insurance documents, without fully reading their contents. The person at the front desk simply provided me a one- or two-sentence summary of each document. There wasn’t enough time to fully read each piece of paper.

A screen in the waiting room displayed the status of Allyssa’s surgery, without any alternative means of independently obtaining the same information.

When our daughter had recovered sufficiently to be discharged, an initial miscommunication almost resulted in our failure to receive the promised accessible instructions. It was difficult for the nurses to understand why we were insisting we could not simply wait until tomorrow to receive our discharge instructions from medical records. Advocacy and awkward conversations with supervisors were required in order to make sure we received the same instructions regularly afforded sighted patients without incident.

In this case, everything turned out fine. No service was denied, Allyssa recovered without incident and we went home with accessible, easy-to-read follow-up care information.

So, you may ask, why am I bothering to write about this incident if, in the scheme of all things inaccessible, this situation enjoyed a happy ending? I am doing so to point out the difference between accommodation and accessibility, and to suggest ways of implementing realistic solutions that value and serve the needs of everyone, including people with disabilities.

As things stand right now, when Phoenix Children’s Hospital receives an accessibility request like ours, it is handled through the Language Services department as an accommodation, similar to situations where a translator is needed in order to help someone who does not understand English. In that framework, my requests for universal accessibility are met with shrugs, because I appear to be asking for nothing less than a perpetual universal translator to automatically convert all printed materials into Braille on the fly. Obviously, I am not requesting such an unrealistic solution, but my inability to successfully communicate this fact to those who may be able to change things for the better means overall accessibility for all patients remains at a standstill.

So, now that we know what’s not wanted, what would represent a better solution that embraces true accessibility, rather than just slapping on another Band-Aid?

I am asking Phoenix Children’s Hospital to make the following changes in order to improve the accessibility of their services for everyone:

  • Insure all the hospital’s websites, including bill pay and patient portal, meet internationally-recognized accessibility standards such as WAI-ARIA and WCAG and undergo regular user-acceptance testing by a diverse group of stakeholders for ongoing accessibility.
  • Insure the secure email system is being operated by a vendor with a deliberate, publicly stated commitment to accessibility.
  • Implement techniques to create or generate all PDF documents in ways that meet Web Content Accessibility Guidelines (WCAG).
  • Provide accessible display screens and kiosks, or supply similarly proactive alternatives, such as smart phone apps and text messages, that work for everyone, including people with disabilities.
  • Enact clear policies and procedures for positively and proactively handling accessibility requests from employees, patients and the general public as appropriate.
  • Train staff to value accessibility and understand the difference between it and reasonably accommodating a request for a service such as language translation.

Asked to Make Your iOS App Accessible to Blind People? There’s a Plan for that!

May 14, 2016 • Darrell Shandrow Hilliker

Are you a developer who has been asked to make your iOS app accessible to blind people using Apple’s built-in VoiceOver screen reader? Are you uncertain how to respond, why you should care or where you can go to get started? I hope to demystify these questions and encourage you to create and improve your product in ways that empower and include all your customers, even those who can’t see the screens of their smart phones and tablets.

How should I respond to a request for VoiceOver accessibility in my app?

However you choose to respond, I would encourage you not to simply ignore the request. As a professional, you expect a timely response to communications you initiate, so please afford your blind customers that same courtesy when approached. Please consider the following ideas for communicating with users regarding accessibility requests:

  1. Respond to the request right away informing the customer you have received it and you will take steps to follow up promptly.
  2. If you have a bug-tracking or case management system, create a ticket and escalate it as needed in order to get an answer.
  3. If you do not possess the authority to make this strategic decision, please work with your company’s owner or executive leadership to urge them in the right direction. If you do have the necessary authority, please read on for information on how you can open your doors to your blind customers.
  4. If your business has decided to be inclusive to blind people, please respond affirmatively to your customer, utilize the resources provided here and elsewhere online and start working actively with the connected, online blind community.
  5. Regardless of the outcome, please remember to follow up with your customer by providing updates as you are able to release information to the public.

Why should I care?

There are at least four reasons why you should incorporate accessibility into your apps:

  • Accessibility is simply the right thing to do. Would you create an app designed to categorically exclude women, African-Americans, Chinese or any other group of people? If not, then why would you want to exclude blind people or anyone else with a disability? The answer to the accessibility question determines whether or not everyone, including people with disabilities, will be afforded the opportunity to learn, work, enjoy leisure activities or otherwise participate in the benefits your app offers.
  • There is a business case for accessibility.
  • Accessibility can be easy, fun and interesting. In 2015, the White House and several other U.S. government agencies sponsored a hackathon demonstrating and discussing techniques for improving the accessibility of several forms of technology.
  • Accessibility is the law of the land in many parts of the world. In the United States, the Americans with Disabilities Act, Individuals with Disabilities Education Act (IDEA), Sections 504 and 508 of the Rehabilitation Act, 21st Century Communications and Video Accessibility Act (CVAA), and numerous other lesser-known laws require accessibility and full inclusion of people with disabilities in activities, education, employment, products, programs and services offered to the public at large. Similar laws are on the books in many other nations. Failure to empower people with disabilities to use your app may result in complaints, lawsuits, loss of business, negative publicity and a poor reputation.

Where can I go to learn more about iOS accessibility and get started with developing my apps in an inclusive manner?

Apple provides an excellent overview of all the accessibility features available on its iOS platform. The Applevis online community hosts Information For Developers On How to Build Accessible iOS and Mac Apps. Finally, a comprehensive, systematic plan has been published to aid developers and others in beta testing and evaluating the accessibility of iOS apps with VoiceOver.