Changing the Rules of the Game in Healthcare Through Service Design

  • Josina VinkEmail author
  • Maíra Prestes Joly
  • Katarina Wetter-Edman
  • Bård Tronvoll
  • Bo Edvardsson


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.



This work has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No. 642116. Portions of this research have also been funded by Riksbankens Jubileumsfond project No. RMP16-1159.


  1. Adelman, T., Kitchener, M., Ng, T., & Harrington, C. (2012). Change and inertia in the New York state Medicaid personal care services program: An institutional case study. Journal of Aging and Social Policy, 24(3), 309–327.Google Scholar
  2. Akama, Y., & Prendiville, A. (2013). Embodying, enacting and entangling design: A phenomenological view to co-designing services. Swedish Design Journal, 1(13), 29–40.Google Scholar
  3. Athavankar, U., Khambete, P., Roy, D., Chaudhary, S., Kimbahune, S., Doke, P., et al. (2014). Multidisciplinary team dynamics in service design: The facilitating role of pattern language. In Proceedings of the India HCI 2014 Conference on Human Computer Interaction (New Delhi, India, December 07–09, 2014). India HCI ’14 (pp. 16–25). New York: AMC.Google Scholar
  4. Baek, J. S., Meroni, A., & Manzini, E. (2015). A socio-technical approach to design for community resilience: A framework for analysis and design goal forming. Design Studies, 40(September), 60–84.Google Scholar
  5. Battilana, J. (2006). Agency and institutions: The enabling role of individuals’ social position. Organization, 13(5), 653–676.Google Scholar
  6. Battilana, J., & D’aunno, T. (2009). Institutional work and the paradox of embedded agency. In T. Lawrence, R. Suddaby, & B. Leca (Eds.), Institutional work: Actors and agency in institutional studies of organizations (pp. 31–58). New York: Cambridge University Press.Google Scholar
  7. Battilana, J., Leca, B., & Boxenbaum, E. (2009). How actors change institutions: Towards a theory of institutional entrepreneurship. The Academy of Management Annals, 3(1), 65–107.Google Scholar
  8. Blomkvist, J., & Bode, A. (2012). Using service walkthroughs to co-create whole service experiences. In Paper presented at the Third International Service Innovation Design Conference (Vol. 3, pp. 1–6), October 22–24, 2012, No. 01, Tainan, Taiwan.Google Scholar
  9. Blomkvist, J., Holmlid, S., & Segelström, F. (2010). This is service design research: Yesterday, today and tomorrow. In M. Stickdorn & J. Schneider (Eds.), This is service design thinking (pp. 308–315). Amsterdam: BIS.Google Scholar
  10. Buchenau, M., & Suri, J. F. (2000). Experience prototyping. Paper presented at the Third Conference on Designing Interactive Systems: Processes, Practices, Methods, and Techniques, August 17–19, 2000, New York City, New York.Google Scholar
  11. Carlborg, P., Kindström, D., & Kowalkowski, C. (2014). The evolution of service innovation research: A critical review and synthesis. The Service Industries Journal, 34(5), 373–398.Google Scholar
  12. Clatworthy, S. (2011). Service innovation through touch-points: Development of an innovation toolkit for the first stages of new service development. International Journal of Design, 5(2), 15–28.Google Scholar
  13. Creed, W. D., Hudson, B. A., Okhuysen, G. A., & Smith-Crowe, K. (2014). Swimming in a sea of shame: Incorporating emotion into explanations of institutional reproduction and change. Academy of Management Review, 39(3), 275–301.Google Scholar
  14. Dorado, S. (2005). Institutional entrepreneurship, partaking, and convening. Organization Studies, 26(3), 383–413.Google Scholar
  15. Edvardsson, B., & Tronvoll, B. (2013). A new conceptualization of service innovation grounded in S-D logic and service systems. International Journal of Quality and Service Sciences, 5(1), 19–31.Google Scholar
  16. Emirbayer, M., & Mische, A. (1998). What is agency? American Journal of Sociology, 103(4), 962–1023.Google Scholar
  17. Fan, G. H., & Zietsma, C. (2017). Constructing a shared governance logic: The role of emotions in enabling dually embedded agency. Academy of Management Journal, 60(6), 2321–2351.Google Scholar
  18. Freire, K. & Sangiorgi, D. (2010). Service design and healthcare innovation: From consumption to co-production to co-creation. In S. Clatworthy, J.-V. Nisula, & S. Holmlid (Eds.), ServDes Conference Proceedings (pp. 39–50), December 1–3, 2010, Linkoping, Sweden.Google Scholar
  19. Friedland, R., & Alford, R. R. (1991). Bringing society back in: Symbols, practices and institutional contradictions. In W. W. Powell & P. J. DiMaggio (Eds.), The new institutionalism in organizational analysis (pp. 232–263). Chicago: The University of Chicago Press.Google Scholar
  20. Frögård, M. (2016). Negotiating matters: Supporting agonistic pluralism in community planning. In N. Morelli, A. de Götzen, & F. Grani (Eds.), ServDes Conference Proceedings (pp. 495–499), May 24–26, 2016, Copenhagen, Denmark.Google Scholar
  21. Gallouj, F., & Savona, M. (2009). Innovation in services: A review of the debate and a research agenda. Journal of Evolutionary Economics, 19(2), 149.Google Scholar
  22. Greenwood, R., Raynard, M., Kodeih, F., Micelotta, E. R., & Lounsbury, M. (2011). Institutional complexity and organizational responses. The Academy of Management Annals, 5(1), 317–371.Google Scholar
  23. Grenha Teixeira, J., Patricio, L., Huang, K.-H., Fisk, R. P., Nobrega, L., & Constantine, L. (2017). The MINDS method: Integrating management and interaction design perspectives for service design. Journal of Service Research, 20(3), 240–258.Google Scholar
  24. Gustafsson, A., Högström, C., Radnor, Z., Friman, M., Heinonen, K., Jaakkola, E., et al. (2016). Developing service research: Paving the way to transdisciplinary research. Journal of Service Management, 27(1), 9–20.Google Scholar
  25. Halskov, K., & Hansen, N. B. (2015). The diversity of participatory design research practice at PDC 2002-2012. International Journal of Human-Computer Studies, 74(February), 81–92.Google Scholar
  26. Holm, P. (1995). The dynamics of institutionalization: Transformation processes in Norwegian fisheries. Administrative Science Quarterly, 40(3), 398–422.Google Scholar
  27. Holmlid, S., & Evenson, S. (2008). Bringing service design to service sciences, management and engineering. In H. Bill & M. Wendy (Eds.), Service science, management and engineering education for the 21st century (pp. 341–345). New York: Springer.Google Scholar
  28. Joly, M. P., Teixeira, J., Patrício, L., & Sangiorgi, D. (2018). Service designers, unite! Identifying shared concerns among multidisciplinary perspectives on service design. In ServDes 2018, June 18–20, 2018, Milan, Italy.Google Scholar
  29. Karpen, I. O., Gemser, G., & Calabretta, G. (2017). A multilevel consideration of service design conditions: Towards a portfolio of organisational capabilities, interactive practices and individual abilities. Journal of Service Theory and Practice, 27(2), 384–407.Google Scholar
  30. Kasali, A., & Nersessian, N. J. (2015). Architects in interdisciplinary contexts: Representational practices in healthcare design. Design Studies, 41(B), 205–223.Google Scholar
  31. Kodeih, F., & Greenwood, R. (2014). Responding to institutional complexity: The role of identity. Organization Studies, 35(1), 7–39.Google Scholar
  32. Koskela-Huotari, K., Edvardsson, B., Jonas, J. M., Sörhammar, D., & Witell, L. (2016). Innovation in service ecosystems: Breaking, making & maintaining institutionalized rules of resource integration. Journal of Business Research, 69(8), 2964–2971.Google Scholar
  33. Krippendorff, K. (2006). The semantic turn: A new foundation for design. Boca Raton: Taylor & Francis.Google Scholar
  34. Kurtmollaiev, S., Fjuk, A., Pedersen, P. E., Clatworthy, S., & Kvale, K. (2018). Organizational transformation through service design: The institutional logics perspective. Journal of Service Research, 21(1), 59–74.Google Scholar
  35. Lawrence, T. B., Hardy, C., & Phillips, N. (2002). Institutional effects of interorganizational collaboration: The emergence of proto-institutions. Academy of Management Journal, 45(1), 281–290.Google Scholar
  36. Lawrence, T. B., & Suddaby, R. (2006). Institutions and institutional work. In S. Glegg, C. Hardy, T. B. Lawrence, & W. R. Nord (Eds.), Handbook of organization studies (2nd ed., pp. 215–254). London: Sage.Google Scholar
  37. Lawrence, T. B., Suddaby, R., & Leca, B. (2009). Institutional work: Actors and agency in institutional studies or organizations. New York: Cambridge University Press.Google Scholar
  38. Lin, M. C., Hughes, B. L., Katica, M. K., Dining-Zuber, C., & Plsek, P. E. (2011). Service design and change of systems: Human-centered approaches to implementing and spreading service design. International Journal of Design, 5(2), 73–86.Google Scholar
  39. Lusch, R., & Nambisan, S. (2015). Service innovation: A service-dominant logic perspective. MIS Quarterly, 39(1), 155–175.Google Scholar
  40. Lusch, R. F., & Vargo, S. (2014). Service-dominant logic: Premises, perspectives, possibilities. Cambridge: Cambridge University Press.Google Scholar
  41. Mager, B. (2017). Service design impact report: Health sector. Service Design Network: Köln. Accessed February 22, 2018, from
  42. Maguire, S., Hardy, C., & Lawrence, T. B. (2004). Institutional entrepreneurship in emerging fields: HIV/AIDS treatment advocacy in Canada. Academy of Management Journal, 47(5), 657–679.Google Scholar
  43. Mattelmäki, T., Vaajakallio, K., & Koskinen, I. (2014). What happened to empathic design? Design Issues, 30(1), 67–77.Google Scholar
  44. Meroni, A., & Sangiorgi, D. (2011). Design for services. Aldershot: Gower.Google Scholar
  45. Meyer, R. E., & Höllerer, M. A. (2010). Meaning structures in a contested issue field: A topographic map of shareholder value in Austria. Academy of Management Journal, 53(6), 1241–1262.Google Scholar
  46. Morelli, N. (2015). Challenges in designing and scaling up community services. Design Journal, 18(2, SI), 269–290.Google Scholar
  47. Mutch, A. (2007). Reflexivity and the institutional entrepreneur: A historical exploration. Organization Studies, 28(7), 1123–1140.Google Scholar
  48. Nilsson, W. (2015). Positive institutional work: Exploring institutional work through the lens of positive organizational scholarship. Academy of Management Review, 40(3), 370–398.Google Scholar
  49. North, D. C. (1990). Institutions, institutional change and economic performance. Cambridge: Cambridge University Press.Google Scholar
  50. Oliveira, M. D., Magone, J. M., & Pereira, J. A. (2005). Nondecision making and inertia in Portuguese health policy. Journal of Health Politics, Policy and Law, 30(1–2), 211–230.Google Scholar
  51. Ostrom, A. L., Parasuraman, A., Bowen, D. E., Patrício, L., Voss, C. A., & Lemon, K. (2015). Service research priorities in a rapidly changing context. Journal of Service Research, 18(2), 127–159.Google Scholar
  52. Parker, C. J., May, A., Mitchell, V., & Burrows, A. (2013). Capturing volunteered information for inclusive service design: Potential benefits and challenges. Design Journal, 16(2, SI), 197–218.Google Scholar
  53. Patrício, L., Fisk, R. P., Cunha, J., & Constantine, L. (2011). Multilevel service design: From customer value constellation to service experience blueprinting. Journal of Service Research, 14(2), 180–200.Google Scholar
  54. Pawlak, M. (2011). Unintended consequences of institutional work. In A. Mica, A. Peisert, & J. Winczorek (Eds.), Sociology and the unintended: Robert Merton revisited (pp. 355–370). Frankfurt: Peter Lang Internationaler Verlag der Wissenschaften.Google Scholar
  55. Phillips, N., Lawrence, T. B., & Hardy, C. (2000). Inter-organizational collaboration and the dynamics of institutional fields. Journal of Management Studies, 37(1), 23–43.Google Scholar
  56. Reay, T., & Hinings, C. R. (2009). Managing the rivalry of competing institutional logics. Organization Studies, 30(6), 629–652.Google Scholar
  57. Ruebottom, T., & Auster, E. R. (2017). Reflexive dis/embedding: Personal narratives, empowerment and the emotional dynamics of interstitial events. Organization Studies, 00(0), 1–24.Google Scholar
  58. Sampson, S. E. (2012). Visualizing service operations. Journal of Service Research, 15(2), 182–198.Google Scholar
  59. Sanders, E., & Stappers, P. J. (2008). Co-creation and the new landscapes of design. CoDesign, 4(1), 5–18.Google Scholar
  60. Sangiorgi, D., Patrício, L., & Fisk, R. P. (2017). Designing for interdependence, participation and emergence in complex service systems. In S. Sangiorgi & A. Prendiville (Eds.), Designing for service: Key issues and new directions (pp. 72–86). London: Bloomsbury.Google Scholar
  61. Sangiorgi, D., & Prendiville, A. (2017). Designing for service: Key issues and new directions. Bloomsbury: Kindle Edition.Google Scholar
  62. Schön, D. (1983). The reflective practitioner: How professionals think in action (Vol. 5126). New York: Basic Books.Google Scholar
  63. Scott, W. R. (1995). Institutions and organizations. Foundations for organizational science. London: A Sage Publication Series.Google Scholar
  64. Secomandi, F., & Snelders, D. (2011). The object of service design. Design Issues, 27(3), 20–34.Google Scholar
  65. Seo, M. G., & Creed, W. E. D. (2002). Institutional contradictions, praxis, and institutional change: A dialectical perspective. Academy of Management Review, 27(2), 222–247.Google Scholar
  66. Siltaloppi, J., Koskela-Huotari, K., & Vargo, S. L. (2016). Institutional complexity as a driver for innovation in service ecosystems. Service Science, 8(3), 333–343.Google Scholar
  67. Snyder, H., Witell, L., Gustafsson, A., Fombelle, P., & Kristensson, P. (2016). Identifying categories of service innovation: A review and synthesis of the literature. Journal of Business Research, 69(7), 2401–2408.Google Scholar
  68. Steen, M., Manschot, M., & De Koning, N. (2011). Benefits of co-design in service design projects. International Journal of Design, 5(2), 53–60.Google Scholar
  69. Suddaby, R., Viale, T., & Gendron, Y. (2016). Reflexivity: The role of embedded social position and entrepreneurial social skill in processes of field level change. Research in Organizational Behavior, 36, 225–245.Google Scholar
  70. Thornton, P. H., Ocasio, W., & Lounsbury, M. (2012). The institutional logics perspective: A new approach to culture, structure, and process. Oxford: Oxford University Press.Google Scholar
  71. Trischler, J., Pervan, S. J., Kelly, S. J., & Scott, D. R. (2017). The value of codesign: The effect of customer involvement in service design teams. Journal of Service Research, 21(1), 75–100.Google Scholar
  72. Tsekleves, E., & Cooper, R. (2017). Emerging trends and the way forward in design in healthcare: An expert’s perspective. The Design Journal, 20(Suppl. 1), S2258–S2272.Google Scholar
  73. Vargo, S., & Lusch, R. (2016). Institutions and axioms: An extension and update of service-dominant logic. Journal of the Academy of Marketing Research, 44(1), 5–23.Google Scholar
  74. Vargo, S., Wieland, H., & Akaka, M. A. (2015). Innovation through institutionalization: A service ecosystems perspective. Industrial Marketing Management, 44(1), 63–72.Google Scholar
  75. Vink, J., Tronvoll, B., Edvardsson, B., Wetter-Edman, K., & Aguirre, M. (2017). Service ecosystem design: Doing institutional work through service design. In E. Gummesson, C. Mele, F. Polese (Eds.), Proceedings of the Naples Forum on service (pp. 1–15), June 6–9, 2017, Sorrento, Italy.Google Scholar
  76. Voronov, M., & Vince, R. (2012). Integrating emotions into the analysis of institutional work. Academy of Management Review, 37(1), 58–81.Google Scholar
  77. Voronov, M., & Yorks, L. (2015). “Did you notice that?”: Theorizing differences in the capacity to apprehend institutional contradictions. Academy of Management Review, 40(4), 563–586.Google Scholar
  78. Wallin, A. J., & Fuglsang, L. (2017). Service innovations breaking institutionalized rules of health care. Journal of Service Management, 28(5), 972–997.Google Scholar
  79. Wang, V., Lee, S. Y. D., & Maciejewski, M. L. (2015). Inertia in healthcare organizations: A case study of peritoneal dialysis services. Healthcare Management Review, 40(3), 203–213.Google Scholar
  80. Wetter-Edman, K., Sangiorgi, D., Edvardsson, B., Holmlid, S., Grönroos, C., & Mattelmäki, T. (2014). Design for value co-creation: Exploring synergies between design for service and service logic. Service Science, 6(2), 106–121.Google Scholar
  81. Wetter-Edman, K., Vink, J., & Blomkvist, J. (2018, March). Staging aesthetic disruption through design methods for service innovation. Design Studies, 55, 5–26.Google Scholar
  82. Wieland, H., Vargo, S. L., & Akaka, M. A. (2016). Zooming out and zooming in: Service ecosystems as venues for collaborative innovation. In M. Toivonen (Ed.), Service innovation: Novel ways of creating value in actor systems (pp. 35–50). Tokyo: Springer.Google Scholar
  83. Witell, L., Snyder, H., Gustafsson, A., Fombelle, P., & Kristensson, P. (2016). Defining service innovation: A review and synthesis. Journal of Business Research, 69(8), 2863–2872.Google Scholar
  84. Yu, E., & Sangiorgi, D. (2017). Service design as an approach to implement the value cocreation perspective in new service development. Journal of Service Research, 21(1), 40–58.Google Scholar
  85. Zeitz, G., Mittal, V., & McAulay, B. (1999). Distinguishing adoption and entrenchment of management practices: A framework for analysis. Organization Studies, 20(5), 741–776.Google Scholar
  86. Zietsma, C., & Lawrence, T. B. (2010). Institutional work in the transformation of an organizational field: The interplay of boundary work and practice work. Administrative Science Quarterly, 55(2), 189–221.Google Scholar
  87. Zietsma, C., & McKnight, B. (2009). Building the iron cage: Institutional creation work in the context of competing proto-institutions. In T. Lawrence, S. Roy, & B. Leca (Eds.), Institutional work: Actors and agency in institutional studies of organizations (p. 143). New York: Cambridge University Press.Google Scholar

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Authors and Affiliations

  • Josina Vink
    • 1
    • 5
    Email author
  • Maíra Prestes Joly
    • 2
    • 3
  • Katarina Wetter-Edman
    • 4
    • 6
  • Bård Tronvoll
    • 1
    • 7
  • Bo Edvardsson
    • 1
  1. 1.Service Research Center (CTF)Karlstad UniversityKarlstadSweden
  2. 2.Faculty of EngineeringUniversity of PortoPortoPortugal
  3. 3.Dipartimento di DesignPolitecnico di MilanoMilanItaly
  4. 4.School of BusinessÖrebro UniversityÖrebroSweden
  5. 5.Experio LabCounty Council of VärmlandKarlstadSweden
  6. 6.FoU i SörmlandEskilstunaSweden
  7. 7.Inland Norway University of Applied SciencesLillehammerNorway

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