Service Design and Service Thinking in Healthcare and Hospital Management

Increasingly, healthcare systems around the globe are looking to transition toward person-centered models of care. However, how to effectively support this complex transition is not clear. Here we forward service design as a key driver to aid in catalyzing this transformation. In this chapter, we integrate literature on service design (SD) and person-centered care (PCC) to better understand how a SD approach can aid in the transition toward PCC. Synthesized from existing literature, this chapter offers a framework for transitioning from the biomedical model toward PCC, highlighting key changes across four dimensions: contexts, roles, processes, and outcomes. We then show the alignment between PCC and SD across these dimensions and elucidate how SD can help to catalyze related changes with the support of specific methods. In doing so, this chapter offers a guide for healthcare practitioners looking to use SD to support the transformation toward PCC and builds a platform for future research at the intersection of SD and PCC.

Innovation in healthcare requires changing the institutional arrangements or what are often referred to as “the rules of the game.” Such a change demands that actors do institutional work—intentionally creating, disrupting, and maintaining the entrenched ways of operating within the system. This chapter explores how service design practices contribute to changing the rules of the game in healthcare by integrating research on service design and institutional work. Based on a literature review, five characteristics of service design practices—multidisciplinary, experiential, participatory, experimental, and reflective—are highlighted and linked to the antecedents of institutional work. Illustrative examples of service design projects from Experio Lab, an embedded service design group in the Swedish healthcare system, are used to contextualize the findings. In doing so, this chapter provides a clear rationale for how service design practices enable innovation in healthcare and offer insights for healthcare practitioners interested in working toward institutional change through service design.

Service design and service thinking in many industries concentrate on providing a competitive advantage. In healthcare, better service design focused on the patient and provider experience can also improve patient outcomes, for example, by ensuring healthcare regimens are followed. Improving patient care while concurrently minimizing costs requires both big leap and small step design thinking. Healthcare organizations that use service design and service thinking innovations are often touted for big leap, system-wide design innovations. While these types of big leap design change are important, small step design thinking can also help healthcare organizations make service changes with significant results. This chapter will present two case studies illustrating small step design thinking in healthcare. Small step service design focuses on processes that may seem routine or mundane but are integral to improving patient service experience and patient health outcomes. Examples include a patient appointment process that was designed to address research showing a patient is more likely to attend a clinical appointment if that appointment is set before the patient leaves the office of the current clinician visit and a design change at a city fire department that improved access and saved taxpayer dollars. These case studies will show how small step service design thinking can be used to achieve improved patient care and can be used by other healthcare organizations to guide their service thinking.

The chapter explains how to foster innovation and service excellence in hospitals by the design thinking/service design approach. The content is retrieved from a current best practice case from Austria and represents the findings from other projects as well. The children’s center of the University Hospital of Graz used the approach to redefine their operational and leadership processes within a construction project. The two clinics involved were the surgical and internistic units. They aimed to design a unique patient experience within the new outpatient clinic. The central elements included iterative design cycles focusing on the patient experience, an interdisciplinary design team to create holistic solutions and the prototyping zone to design and test the solutions in a tangible context with the users, patients, and planning stakeholders. The design thinking approach initiated a company-wide change toward Patient First as a guiding principle to deliver healthcare.

User centricity and user involvement is increasingly emphasized in Norwegian legislations related to service development in the health and public sectors. The service design discipline has emerged as a relevant and popular alternative to accommodate the requirements of user involvement. At the same time, the service design discipline has been criticized for lacking implementation competence. So far, there has been a focus on the earlier phases of service development both in service design practice and academia, while the later phases have received less attention. This chapter focuses upon the later development phases, in other words implementation and the transition from testing and piloting to an operationalized service. In this transition, the focus lies on the handover from service design consultants to the client. The topic of service design handovers is explored through an interview study with Norwegian service designers and civil servants. The interviews point toward a key challenge related to handovers, namely, how the clients can be supported in their further work, after the service design consultants have left, more specifically, how clients can make use of the service design material during implementation. This chapter presents a promising direction for service design handovers, by introducing the concept of roadmapping for service design. By combining findings from the interviews and technology roadmapping (TRM) research, the chapter introduces an approach I call service design roadmapping. Lastly, issues that are important to consider when further exploring service design roadmapping are discussed.

Innovative service design is crucial in the ever-changing healthcare environment in order for organizations to hold competitive advantage. The concept of service design thinking refers to the marketing and design of services that improve the customer experience and the interactions between customers and service providers. Innovative thinking in service design can help organizations gain competitive advantage. The challenges with service design thinking in healthcare and innovative ways of thinking about service design in healthcare are introduced, as well as ways to build and sustain competitive advantage in healthcare.

To meet the complex societal and economic challenges facing healthcare service provision, the public sector is dependent on new partnerships and networked collaboration in order to meet policy and program goals. The medical culture with its deeply institutionalized ways of working combined with siloed expertise makes such collaboration and organizational change especially difficult. A lack of a common goal, a misalignment of working cultures and professional languages, and a lack of a shared understanding can pose obstacles for collaborative activities needed for co-developing healthcare services. Service design and co-design practices are therefore increasingly being called upon to manage collaborative processes and drive service innovation in designing patient-centric care. Tangible co-design communication tools commonly used in service design have shown to effectively support co-design processes through facilitating multimodal communication on topics that are otherwise difficult to articulate. However, such tools have not been commonly adopted by the medical field as the contribution of design to service innovation, and the value of using our bodily senses in design methods has not yet been clearly identified. This chapter aims to contribute to the uptake of tangible tools in healthcare by presenting the design and use of tangible tools and exemplifying tools from practice, through an analytical framework drawing on the use of metaphors and affordances in physical objects.

In recent years, there has been a growing investment in service design to transform healthcare. While existing literature describes several trade-offs related to catalysing change in complex settings, there has been little understanding to date of how practising service designers in healthcare respond to these choices. There is a need to learn more about how these practitioners navigate their positioning, achieve change and influence healthcare organisations. Bringing forward the situated and contextual knowledge of practitioners about their approach is critical for advancing the emerging practice of healthcare service design. This chapter explores and weaves together the narratives of seven practitioners who employ service design within the healthcare context. What is revealed from this exploration is an “in-betweenness”—where practitioners cope with and make use of contradictions through three compound approaches in healthcare service design. We have labelled these approaches as (1) enacting the insider-outsider, (2) creating radical-incremental change, and (3) catalysing top-up dynamics. The dialogue that emerges through this chapter deepens the understanding of how service designers approach their work within the existing dynamics of social and organisational hierarchies while co-creating change with and within healthcare organisations. Through reflection on the composite nature of healthcare service design approaches, this research offers a grounded perspective on service design practice in healthcare and sheds light on possibilities for future research.

Service design provides the means to make sense of the complex interactions and processes experienced when delivering and receiving patient care. The tools of service design generate visual narratives that communicate experiences of and interactions between medical staff, hospital patients and carers, as well as mapping processes and systems and identifying the nature of relationships between the various stakeholders involved. Often service design tools are used to communicate what was observed and what might be done, but when used as analytical and diagnostic tools, they deliver a powerful means of sharing thinking and decision-making across a wider community beyond the designers themselves. The authors discuss the application of human-centric service design, not only as the means to design innovative service outcomes but to analyse and diagnose the complex processes involved in delivering patient care. The utilisation of this multifaceted design process resulted in richer service prognosis and propositions in concordance with the needs of patients, carers, hospital staff and clinicians than often provided by the more routine qualitative or quantitative analysis of service delivery. Using case studies of projects undertaken at University Hospital Crosshouse to illustrate our findings, this chapter explores the issues encountered during the application of service design and service thinking by clinical and non-clinical professionals, including the lessons learned in developing sustainable innovation practices that reduced reliance on the presence of designers. We highlight the dynamics of this approach, looking through the lens of person-centred service design and open innovation, how staff and service users engaged in exploring new insights and approaches.

A recent paradigm shift in healthcare merges the traditional domains of cure and care in healthcare services with prevention and provides all of us with more participation as well as more responsibility in our own healthcare. This shift creates not only a need for personalization of services but also a design challenge with respect to inclusion and acceptance. Healthcare moves into people’s homes and merges medical devices with services hereby enlarging the current contrast between medical device cleanliness and the often cozier and textile-rich home environment. These developments bring important design challenges that will be addressed in this chapter, thereby raising important questions for the implementation of a new design perspective on healthcare.

Increasing attention has been paid to healthcare design, as evident by emerging health programmes in design educations and collaborations between design agencies and public and/or private healthcare actors. Moreover, and especially in the health and care fields, service design as an approach to service innovation increases. Application of service design processes has promising potential for developing holistic and well-functioning solutions through a fundamental human-centred focus and extensive interdisciplinary and intersectoral collaboration and co-creation.

This chapter takes a design education perspective to health-related service design by presenting the characteristics of a new master course which aims to offer design students a dedicated space for addressing societal challenges, particularly connected to healthcare, and introducing service design methodology. First, the rationale behind the course is elucidated, and the course structure and theoretical pillars are described. Next, a student project is used as an exemplifying case to illustrate practical, methodological and theoretical applications. Finally, some reflections and lessons learned are presented.

Scrutinising the work of design students is valuable because, compared to business and consultancy projects, the academic environment often encourages and allows for a more idealistic approach that explores and critically reviews theories, methods and tools. As such, the chapter is expected to be relevant for practitioners and lecturers working with healthcare and health-related design.

Most healthcare managers and professionals ignore how to include and take advantage of design thinking methods to improve services and processes. Yet, initial evidence is emerging about the potential of service design, not only to solve service challenges but also to support organisational change. In the field of mental healthcare, the inclusion of service design approaches was lately fostered by the increasing attention on co-production and patient engagement, as well as by the growing interest towards recovery principles and approaches. This chapter presents an action research project conducted by the Departments of Design and Management Engineering of Politecnico di Milano in collaboration with the Department of Mental Health of Spedali Civili di Brescia (Italy). It focuses on how the introduction of an evaluative component into the service design process supported the set-up of co-design activities aimed at triggering an organisational change in the mental health department. The project is described in its main phases, illustrating how an initial evaluative research, consisting of a qualitative field research conducted both from the user and the organisation perspectives, informed the assessment of co-production promising practices and values. Then, it is discussed how this evaluation approach, when integrated within service design as a practice, can help sensitising and amplifying co-production values, therefore favouring the diffusion of co-production within organisations.

When introducing novel solutions in healthcare, such as eHealth services, organizations frequently struggle with their adoption. The failure to address the needs of many users (healthcare workers, patients, and informal caregivers) is commonly part of the problem. Strategic designers bridge the gap between people’s needs, new technologies, and business viability. This is of great value in healthcare innovation where this integrated approach is often missing. This chapter introduces a practical framework of four strategic design abilities to address such challenges: future visioning, modeling value exchange relations, orchestrating service co-creation, and transforming organizational networks. Alongside we describe a strategic design project for a multinational healthcare technology company in The Netherlands where these abilities were applied. This resulted in a product-service system concept that facilitated integrated care innovation in the company.

Investment in Health Technologies (HTs) is one of the crucial points for hospital managers. It affects the goals and strategic orientation of the whole Health Organization. Decision-making regarding the employment of new technologies involves, prevalently, the hospital level, which directly concerns the healthcare delivery process and its design.

Hospital-Based Health Technology Assessment (HB-HTA) is aimed at selecting the portfolio of new HTs that provides the best balance between competing targets, namely, cost containment and quality improvement. This objective is achievable by thinking about how to improve the service delivered, through the use of innovative cost-effective HT.

Accordingly, the HTA role deals with the operational modalities of hospital departments, and it is strictly related to outcomes desired and in respect to budgets.

This evaluative process should be coherent with specific health organization necessities given that each one is concerned with its own geographic area, its own specific patients’ epidemiology, the social environment, and financial resources’ availability. However, HTA is usually run by practitioners whose competences contemplate mainly clinical and technical aspects; hence, the absence of a focus on performance management (PM) represents the main weakness of this function.

Thus, starting from the current body of literature in the fields of PM and HT management, this work theoretically identifies how to design an HB-HTA function and which the main relevant evaluation perspectives are. By explaining the implementation stages, it will be shown how HTA at the hospital level should be able to combine the different perspectives of business performance (financial and nonfinancial) with clinical needs.

The design of service delivery models for mental healthcare and mental illness prevention through the deliberate integration of healthcare and public health organizations and providers with community-level service providers, who may not be generally thought of as healthcare providers, holds promise of sustainable improvement to mental healthcare access issues, to improvements in care quality, to needed modifications of policy, and to reduction in care costs. This chapter addresses the use of tools and strategies to support learning from globalized information, knowledge, and resources to lead to effective community-level solutions designed to improve the social, economic, environmental, and cultural determinants of health and to create the level and type of pan-community collaboration necessary to make these improvements. Attention to these improvements is critical for advancing healthcare equity, especially in disadvantaged communities or in situations where the economic or political situation leads to inequities in health status. This chapter demonstrates that strongly integrated, community-centric, models of mental healthcare delivery are possible, affordable, and preferable to the models in current use through discussion of the approaches that can be re-tailored by specific communities to meet their unique set of circumstances. This chapter illustrates the tools and strategies through pertinent examples from around the globe. The objective of this chapter is to describe how communities can cost-effectively employ specific tools and reinforcing strategies, including those needed for evaluation, to transform the delivery of mental services and improve the health of their population in ways that ensure parity through innovation and accountability.

In this chapter we will suggest an articulated definition for touchpoints. We first review the relevant research, which shows discrepancies in the definition within the field of service design research. Next, we present a case which illustrates the use of touchpoints in the design of a new healthcare centre and points towards practices useful in the implementation of service concepts. Based on the case, we will present a redefinition of touchpoints and its relation with other concepts used in service design. The chapter finishes with a discussion on the use of the new definition in improving the practice of service design.

In this chapter we detail a spatial method to map cross-channel ecosystems based on systems thinking and the framing of cross-channel ecosystems as defined in information architecture. The spatial mapping tool is applied on a specific case in the ambient assisted living domain with the goal of exploring how such an approach might further the current understanding of service journeys and their connection to environmental, organizational, and actor-related aspects represented through information flows. Specifically, we discuss how organizations and care institutions could use such an approach to better understand the larger ecosystems in which they are to act in the future. Findings include the strategic role that seams present in the ecosystem map where a thorough design of seams allows to capture possible logical fallacies plaguing the ecosystem. Additionally, seams allow an organization to understand what part of the ecosystem they have influence over and when actors make the organization’s touchpoints an integral part of the activities they intend to perform. Specifically for the services mapped in this chapter, the ecosystem map shows the interplay between tablet and the oven and hob and to which users adhered to the most during service processes.

Digital tools should elevate, not hinder, the patient experience. In many clinical and nonclinical situations, doctors and caregivers end up spending more time in front of the screen than with the patient. Opportunities to leverage digital tools to make the patient experience better are frequently missed. Design has traditionally succeeded at creating great screen experiences. It has created effective environments in which patient care takes place. However, very rarely are those elements considered in a holistic, integrated manner. A tool to allow service design experts to design specifically for the integration of on- and off-screen experiences is completely missing. The 4D Wireframe tool steps into that void and offers a workflow that considers interaction steps and movement through space alike. The tool is a direct product of the author’s experience in traditional product development, service design, and digital user experience design. In this chapter, Vollmer introduces the tool, demonstrates the steps, and shares insights on how to best activate it in healthcare innovation projects.

Healthcare services are increasingly being digitized for greater flexibility and efficient sharing of information. There is also increased awareness among healthcare providers that they must consider their services from the perspective of the patient. To offer a coherent patient journey and efficient treatment, healthcare providers need a structured overview of their service processes and how these affect the patient journey. This chapter introduces customer journey modeling language (CJML) to support the design, management, and analysis of complex patient journeys. Through two case studies, we describe how CJML has been utilized for a shared overview of patient journeys, improvement work, internal training, and knowledge sharing. The first case study was carried out with DIPS, a supplier of eHealth systems to Norwegian hospitals. Here, CJML was used to support the documentation and rollout of a new generation of tools for surgery planning, a complex and resource-intensive process during which critical information is exchanged over time among a range of actors. The second case study was conducted at Oslo University Hospital. Cross-functional teams used CJML to document the patient journey associated with cervical cancer as the basis for improvement work. The two case studies demonstrate how CJML supports healthcare service design through a common understanding of the patient journeys among stakeholders and by visualizing the workflows and actors involved. Although several weaknesses in CJML remain to be resolved, the case studies suggest the benefit of a model-based approach in two regards: first, as an effective communication tool to unite medical, technical, and administrative expertise and second to enhance the patient focus throughout the improvement and digitization of health services.

This study explores the territory of designing for service and design for social innovation. More specifically, it discusses service as a platform of action that enables social change. The theme of aging exemplifies a social issue that is increasingly emerging in Brazil. This study is based on a literature review of key definitions in design for social innovation related to designing for service and on the concept of active aging, which is considered as a key qualitative guideline in designing for service for older people. The analysis relies on a case study divided in two parts: a design exploration developed under the proposed approach with undergraduate students in 2011 and a description of an actual service, started in 2015, that validates it. Results exemplify how social change is promoted through designing for service. This study was developed in the framework of the DESIS Network (Design for Social Innovation and Sustainability) approach and demonstrates how didactic activities developed in DESIS Labs can generate pioneering service concepts, projects, and visions to nurture processes of social change.

Western countries are faced with a number of intractable problems with people having increased longevity and the concomitant demand this places on health-care services, changing lifestyles that are contributing to greater numbers of people living with chronic conditions such as Type 2 diabetes and contracting government expenditure. Faced with these challenges, health-care providers are now looking at new ways of innovating their services through design methods and processes that are highly collaborative, interdisciplinary and human centred. This chapter will provide an introduction to the background of service design within health and social care settings, synthesising literature on design ethnography, service design tools, co-design and prototyping to explore the roles they can play in innovating these highly complex services. In addition the chapter will also reflect on the difficulties faced by service designers in overcoming the siloed nature of health-care services and the organisational changes needed to support service innovation, so that more transformative outcomes in health and social care can be achieved.

Healthcare is in need of change because of an ongoing growing and ageing population. Meanwhile, increasing attention has been paid to the potential value of service design tools within healthcare. Service design is the activity of planning and implementing change to improve the quality of a service. To manage change, it is important to identify challenges for change in the service that needs improving. A large number of change initiatives fail due to unfocused and insecure management, and there is a need for a new way of implementing change. Service design is a user-centric approach that includes service providers, end-users and stakeholders in the design process. This chapter gives an overview of pressures for change and identifies key barriers hospitals face when managing change. An overview of relevant methods and strategies from service design is given before they are exemplified through a case study of a service design project at an Emergency Department. The chapter then discusses how service design methods can be used in overcoming challenges in hospitals and effectively implement change. The chapter concludes that co-creation and multidisciplinary teams are essential in the context of hospital change management. Further, the chapter concludes that hospitals would benefit from using a user-centred, holistic approach that considers patient experience in their delivery of care.

Our goal has always been to awaken a playful mood in a rigorous, complex hospital environment. A key decision concerning the neonatal care unit project was to divide it into three circular areas that share the same entrance space, integrating them but also creating small groups with emphasis on personal attention. This strategy has allowed us to have an efficient flow of people, avoiding corners and reducing the stress level in an emergency. It also helps parents in their transition into a daily life routine by providing ambiences that help them move away from a sense of institutional design. In the hospital we work with a complete immersion methodology, which gives us the opportunity to perceive the atmosphere that surrounds the place.

Today’s intensive care units (ICUs) pose a design dilemma considering the use of technology and its psychological effects on the inhabitants of the ICU. While the ICUs are designed to be technologically advanced in order to ensure patient safe recovery, the very technology that ICUs rely on threatens patients’ as well as clinicians’ wellbeing. Especially the system behind patient monitoring and the consequent alarm management needs to be reconsidered from the human perspective to prevent any occurrences of clinician alarm fatigue and post-traumatic stress syndrome observed in patients as well as their visitors. Moreover, advancements in patient monitoring technology, medical informatics, and societal developments offer new possibilities to give patient data a central role specifically in alarm management and clinician workflow in the ICUs in general. In this chapter, we envision a data-driven product-service system for patient monitoring in the future critical care context. Our design ideas and future vision are based on a critical review of the literature in patient monitoring, trend analysis, and technological developments in medical care, followed by a stakeholder analysis, the design of a future vision concept and scenario that we validated with expert interviews.

Technology-based service transactions, in the form of self-service kiosks in hospital and healthcare settings, are not the full extent of the self-service paradigms. This chapter examines self-service aspects of service design and service thinking to investigate the wider-ranging “systemic” effects of patient self-service. It focuses on harnessing self-service for patient experience beyond organizational productivity and efficiency gains. It offers a framing for this, by drawing in recent research from a variety of sources, including work on self-services, service design, and service research in healthcare, but also in the wider sociopolitical sphere, as well as advances in technology such as robotics and artificial intelligence.

Promising diagnostic and therapeutic technologies as well as disruptive information and communications technologies (ICTs) are transforming the healthcare sector significantly. In this chapter, I bring to light an innovative solution developed by the Swiss multisite hospital EOC, which has introduced the use of drones to transport blood and pathology samples between two of its hospitals in collaboration with Swiss Post and Matternet, a Silicon Valley company. Furthermore, I point up the main key success factors of this project in order to provide the readers with useful generalizable prompts. Finally, I develop a tool (the BIOSF model) that could be useful for the organizations that need to evaluate either the development or the adoption of new technologies, and I briefly go through other advances in technology that are currently shaping this sector.

This chapter focuses on a service design development project carried out in the Lapland Hospital District. Research was conducted on how to foster more agile, human-centred services using the service design approach. The hospital design process thus had to consider localised challenges and offer specialised healthcare and state-of-the-art management processes that are human-centred and that motivate the hospital staff. This chapter examines two different case studies of development projects related to the Lapland Central Hospital. The first one involved developing management processes for the new hospital using a benchmarking process. The second case study examined the children’s rehabilitation programme in Lapland and used service design tools to visualise the existing healthcare ecosystem surrounding municipalities’ rehabilitation facilities and to tackle local challenges in this programme.

Medical services are designed for the prevention, cure or stabilization of the patient in the perspective of improving the health of population which they serve and their quality of life. The improvement, efficiency and quality of these services are often sought through innovation in hospital management, whether in its strategic, key support, auxiliary or enabling processes. Hospitals have become providers of a complex nucleus of services in the health system that reach beyond their institutional borders, thus making it possible to incorporate different forms and actors in the innovation process. This approach serves to refer to and evaluate the main innovations that have been made over the past 5 years in two hospitals, one in Mexico City and another in the State of Mexico and provides answers to questions about: the kind of processes they were oriented towards; what role the owners or managers played; who operated them; their users, the technology or, knowledge, national policies or programs; and the context in which the interventions occur. As past studies show that hospitals in Mexico innovate due to external institutional initiatives, the relative importance of the innovations presented in this paper is classified into management, medical and medical products and services.

High rates of migration in the UK, Germany, and Austria present huge challenges for service design and delivery in these countries. How can we ensure effectiveness, efficiency, and access to healthcare system for immigrants? What kind of product-service design is needed to overcome the barrier of language and culture in universal healthcare system? In a digital age, what kinds of tools are needed that are culturally sensitive and user-friendly? What technologies in industry 4.0 can help to bridge the gap between provider and user and between practitioner and patient? This chapter would discuss these aspects based on two case studies on product-service design developed and tested in Austria and in the UK.