Uncovering ‘Weak signals’ through patient journey mapping to inform the future redesign of the medical consultation room

BACKGROUND: Designing hospital environments requires balancing functional efficiency with patient-centered care. Subtle environmental and procedural frictions, often overlooked in traditional evaluations, can significantly affect patient experiences. This study explored how Patient Journey Mapping (PJM), and Mobile Ethnography (ME) can identify weak signals (recurring yet understated signs of discomfort, confusion, or disempowerment) and translate them into actionable design improvements in healthcare settings. METHODS: A case study was conducted in a private hospital in Portugal. Patients documented their care experiences in real time using a structured mobile ethnography platform. Data included photos, text entries, and emotional self-assessments rated on a five-point categorical scale (from very negative to very positive), which were later converted into a numerical format for analysis. Weak signals were identified through an inductive thematic analysis of the ethnographic data, whereby themes and sub-themes emerged directly from the patient´s narratives. RESULTS: Nine patient journeys (6 female and 3 male), with an average of 29 years old, were analysed using inductive thematic analysis. Thematic coding revealed four major domains: Physical and Emotional Discomfort, Process-Related Frustration, Digital Usability Challenges, and Lack of Experience Control. Emotional tracking across six journey phases (Appointment Scheduling, Pre-Visit Anticipation, Arrival and Check-In, Waiting, Consultation, and Post-Visit Follow-Up) showed a consistent pattern of distress during waiting and arrival stages, often linked to environmental overstimulation, fragmented navigation, and unclear digital processes. In contrast, emotional peaks occurred during empathetic and communicative clinical encounters. Weak signals were identified within each theme, including symptoms of sensory overload, lack of privacy, abrupt rescheduling, interface confusion, and affective detachment. These signals were later translated into specific design recommendations that informed targeted improvements to the consultation room. CONCLUSIONS: Weak signals provide valuable early insights into patient perception that may otherwise remain hidden. When captured through PJM and ME, and interpreted through a design thinking framework, they support targeted, cost-effective interventions that enhance both emotional safety and functional efficiency. These findings demonstrate the value of integrating ethnographic methods into healthcare service design to proactively address patient needs and inform systemic innovation.