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Lamé G, Komashie A, Sinnott C, Bashford T. Design as a quality improvement strategy: The case for design expertise. Future Healthc J 2024; 11:100008. [PMID: 38646045 PMCID: PMC11025066 DOI: 10.1016/j.fhj.2024.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Bad design in safety-critical environments like healthcare can lead to users being frustrated, excluded or injured. In contrast, good design can make it easier to use a service correctly, with impacts on both the safety and efficiency of healthcare delivery, as well as the experience of patients and staff. The participative dimension of design as an improvement strategy has recently gained traction in the healthcare quality improvement literature. However, the role of design expertise and professional design has been much less explored. Good design does not happen by accident: it takes expertise and the specific reasoning that expert designers develop through practical experience and training. Here, we define design, show why poor design can be disastrous and illustrate the benefits of good design. We argue for the recognition of distinctive design expertise and describe some of its characteristics. Finally, we discuss how design could be better promoted in healthcare improvement.
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Affiliation(s)
- Guillaume Lamé
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Alexander Komashie
- Health Systems Design Group, Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Tom Bashford
- Health Systems Design Group, Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK
- Department Anaesthetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, UK
- Technology and Systems Theme, Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, UK
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Romm KL, Gardsjord ES, Gjermundsen K, Aguirre Ulloa M, Berentzen LC, Melle I. Designing easy access to care for first-episode psychosis in complex organizations. Early Interv Psychiatry 2019; 13:1276-1282. [PMID: 30919597 DOI: 10.1111/eip.12802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/03/2019] [Accepted: 02/17/2019] [Indexed: 11/28/2022]
Abstract
AIMS Developing early intervention services (EIS) in healthcare organizations (HCOs) is difficult because it is necessary to integrate service approaches across units. To accommodate the needs of patients and relatives, Oslo University Hospital (OUH) chose to use service design (SD) to redesign their first-episode services with an emphasis on easy access to care. This paper discusses the results and how SD can help to overcome known barriers to change in complex organizations. METHOD SD is a method that relies on principles of participation, innovation and visualization to develop coherent services. The method emphasizes the exploration of a problem area from the perspective of multiple stakeholders to create a shared understanding of the complexity. Idea generation, visualization and early modelling of possible solutions are employed to test alternatives involving stakeholders. RESULTS A low threshold EIS was developed. A helpline with a specialist managing the phone was established. High-quality assessment regarding possible psychosis development was thus made available to patients, relatives and professionals, eliminating the need for paper referral. This approach was supported by a communication strategy that includes web-based information. A dedicated cross-specialist team was established to increase collaboration in complex cases. Finally, outreach services were improved. CONCLUSION SD is a suitable method to incorporate the views of different stakeholders (patients, relatives and professionals) to develop EIS services in complex organizations and can help overcome known barriers to change in HCOs.
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Affiliation(s)
- Kristin L Romm
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research and Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erlend S Gardsjord
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Manuela Aguirre Ulloa
- The Institute of Design, The Oslo School of Architecture and Design, Oslo, Norway.,Designit, Oslo, Norway
| | | | - Ingrid Melle
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research and Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Jun GT, Canham A, Altuna-Palacios A, Ward JR, Bhamra R, Rogers S, Dutt A, Shah P. A participatory systems approach to design for safer integrated medicine management. ERGONOMICS 2018; 61:48-68. [PMID: 28506152 DOI: 10.1080/00140139.2017.1329939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
It is recognised that whole systems approaches are required in the design and development of complex health care services. Application of a systems approach benefits from the involvement of key stakeholders. However, participation in the context of community based health care is particularly challenging due to busy and geographically distributed stakeholders. This study used action research to investigate what processes and methods were needed to successfully employ a participatory systems approach. Three participatory workshops planned and facilitated by method experts were held with 30 representative stakeholders. Various methods were used with them and evaluated through an audit of workshop outputs and a qualitative questionnaire. Findings on the method application and participation are presented and methodological challenges are discussed with reference to further research. Practitioner Summary: This study provides practical insights on how to apply a participatory systems approach to complex health care service design. Various template-based methods for systems thinking and risk-based thinking were efficiently and effectively applied with stakeholders.
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Affiliation(s)
- Gyuchan Thomas Jun
- a Loughborough Design School, Loughborough University , Loughborough , UK
| | - Aneurin Canham
- a Loughborough Design School, Loughborough University , Loughborough , UK
| | | | - James R Ward
- b Engineering Design Centre, University of Cambridge , Cambridge , UK
| | - Ran Bhamra
- c Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University , Loughborough , UK
| | | | - Amalin Dutt
- e Islington Clinical Commissioning Group , NHS Islington , London , UK
| | - Priyal Shah
- e Islington Clinical Commissioning Group , NHS Islington , London , UK
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Bazzano AN, Martin J, Hicks E, Faughnan M, Murphy L. Human-centred design in global health: A scoping review of applications and contexts. PLoS One 2017; 12:e0186744. [PMID: 29091935 PMCID: PMC5665524 DOI: 10.1371/journal.pone.0186744] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/08/2017] [Indexed: 12/01/2022] Open
Abstract
Health and wellbeing are determined by a number of complex, interrelated factors. The application of design thinking to questions around health may prove valuable and complement existing approaches. A number of public health projects utilizing human centered design (HCD), or design thinking, have recently emerged, but no synthesis of the literature around these exists. The results of a scoping review of current research on human centered design for health outcomes are presented. The review aimed to understand why and how HCD can be valuable in the contexts of health related research. Results identified pertinent literature as well as gaps in information on the use of HCD for public health research, design, implementation and evaluation. A variety of contexts were identified in which design has been used for health. Global health and design thinking have different underlying conceptual models and terminology, creating some inherent tensions, which could be overcome through clear communication and documentation in collaborative projects. The review concludes with lessons learned from the review on how future projects can better integrate design thinking with global health research.
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Affiliation(s)
- Alessandra N. Bazzano
- Taylor Canter for Social Innovation and Design Thinking, Tulane University, New Orleans, United States of America
- * E-mail:
| | - Jane Martin
- Creative Social Change, London, United Kingdom
| | - Elaine Hicks
- Tulane University School of Public Health and Tropical Medicine, New Orleans, United States of America
| | - Maille Faughnan
- Taylor Canter for Social Innovation and Design Thinking, Tulane University, New Orleans, United States of America
- Tulane University School of Public Health and Tropical Medicine, New Orleans, United States of America
| | - Laura Murphy
- Taylor Canter for Social Innovation and Design Thinking, Tulane University, New Orleans, United States of America
- Tulane University School of Public Health and Tropical Medicine, New Orleans, United States of America
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Speake H, Copeland RJ, Till SH, Breckon JD, Haake S, Hart O. Embedding Physical Activity in the Heart of the NHS: The Need for a Whole-System Approach. Sports Med 2017; 46:939-46. [PMID: 26942468 PMCID: PMC4920841 DOI: 10.1007/s40279-016-0488-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Solutions to the global challenge of physical inactivity have tended to focus on interventions at an individual level, when evidence shows that wider factors, including the social and physical environment, play a major part in influencing health-related behaviour. A multidisciplinary perspective is needed to rewrite the research agenda on physical activity if population-level public health benefits are to be demonstrated. This article explores the questions that this raises regarding the particular role that the UK National Health Service (NHS) plays in the system. The National Centre for Sport and Exercise Medicine in Sheffield is put forward as a case study to discuss some of the ways in which health systems can work in collaboration with other partners to develop environments and systems that promote active lives for patients and
staff.
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Affiliation(s)
- Helen Speake
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Hall, Collegiate Campus, Sheffield, S10 2BP, UK.,National Centre for Sport and Exercise Medicine, Sheffield, UK
| | - Robert J Copeland
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Hall, Collegiate Campus, Sheffield, S10 2BP, UK. .,National Centre for Sport and Exercise Medicine, Sheffield, UK.
| | - Simon H Till
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Hall, Collegiate Campus, Sheffield, S10 2BP, UK.,Sheffield Teaching Hospital NHS Trust, Royal Hallamshire Hospital, Sheffield, UK.,National Centre for Sport and Exercise Medicine, Sheffield, UK
| | - Jeff D Breckon
- Centre for Health and Social Care Research, Sheffield, UK
| | - Steve Haake
- Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, UK.,National Centre for Sport and Exercise Medicine, Sheffield, UK
| | - Oliver Hart
- Sloan Medical Centre, Sheffield, UK.,National Centre for Sport and Exercise Medicine, Sheffield, UK
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Franco-Trigo L, Hossain L, Durks D, Fam D, Inglis S, Benrimoj S, Sabater-Hernández D. Stakeholder analysis for the development of a community pharmacy service aimed at preventing cardiovascular disease. Res Social Adm Pharm 2017; 13:539-552. [DOI: 10.1016/j.sapharm.2016.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/16/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
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The feasibility of a train-the-trainer approach to end of life care training in care homes: an evaluation. BMC Palliat Care 2016; 15:11. [PMID: 26801232 PMCID: PMC4724146 DOI: 10.1186/s12904-016-0081-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/12/2016] [Indexed: 11/12/2022] Open
Abstract
Background The ABC End of Life Education Programme trained approximately 3000 care home staff in End of Life (EoL) care. An evaluation that compared this programme with the Gold Standards Framework found that it achieved equivalent outcomes at a lower cost with higher levels of staff satisfaction. To consolidate this learning, a facilitated peer education model that used the ABC materials was piloted. The goal was to create a critical mass of trained staff, mitigate the impact of staff turnover and embed EoL care training within the organisations. The aim of the study was to evaluate the feasibility of using a train the trainer (TTT) model to support EoL care in care homes. Methods A mixed method design involved 18 care homes with and without on-site nursing across the East of England. Data collection included a review of care home residents’ characteristics and service use (n = 274), decedents’ notes n = 150), staff interviews (n = 49), focus groups (n = 3), audio diaries (n = 28) and observations of workshops (n = 3). Results Seventeen care homes participated. At the end of the TTT programme 28 trainers and 114 learners (56 % of the targeted number of learners) had been trained (median per home 6, range 0–13). Three care homes achieved or exceeded the set target of training 12 learners. Trainers ranged from senior care staff to support workers and administrative staff. Results showed a positive association between care home stability, in terms of leadership and staff turnover, and uptake of the programme. Care home ownership, type of care home, size of care home, previous training in EoL care and resident characteristics were not associated with programme completion. Working with facilitators was important to trainers, but insufficient to compensate for organisational turbulence. Variability of uptake was also linked to management support, programme fit with the trainers’ roles and responsibilities and their opportunities to work with staff on a daily basis. Conclusion When there is organisational stability, peer to peer approaches to skills training in end of life care can, with expert facilitation, cascade and sustain learning in care homes.
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