Keywords

Across the globe, healthcare systems are under pressure: escalating costs, the increasing burden of chronic disease and more complex health conditions, ageing populations, systemic inequities in healthcare access and outcomes, workforce shortages, system fragmentation and the under-utilisation of primary care means that providing timely, efficient, and effective healthcare is increasingly challenging—especially during ‘Covid times’. There is an urgent need for a fresh approach, for different thinking that improves health outcomes and ensures the sustainability of our health system.

This book argues for a design-led approach to transforming healthcare. Design is a method and mindset for creativity and innovation, simply defined by Herbert Simon as the “transformation of existing conditions into preferred ones” [1, p. 11]. As healthcare systems need continuous innovation, health is particularly suitable for the iterative, human-centred and interdisciplinary methods of design—where (1) challenges are reframed as opportunities for discovery and innovation, with (2) a focus on ongoing engagement, co-creating, testing, and refining implementable solutions, through (3) empathy, visual thinking, and rapid prototyping. Inherently optimistic, user-centred, and experiential, a design-led approach is a constructive new approach to healthcare innovation, and for creating transformative solutions with and for end-users: consumers and clinicians.

While a growing and diverse range of governments, industries, and organisations have engaged and applied the creative process and methods of design to identify opportunities, co-design problem-solve and foster innovation, surprisingly, to date, there are only a handful of documented examples of design-led innovation (specifically partnerships with professional designers) in healthcare [2,3,4]. This edited book addresses this knowledge gap, contributing to the emergent literature by outlining the origins, processes, and impact of a novel Australian initiative which connected healthcare professionals with designers to positively transform healthcare—the Healthcare Excellence AcceLerator (HEAL).Footnote 1

A collaboration hub, HEAL was designed to connect healthcare professionals with designers, who worked together using design approaches to transform thinking, spaces, places, processes, and products, thus positively transforming healthcare and accelerating healthcare improvement efforts. As the diverse chapters in this book will reveal, these cross-disciplinary design-led industry-academic collaborations—from innovative approaches to telehealth, co-designing prototypes of child-friendly personal protective equipment to playful wayfinding murals on the walls and floors of a large children’s hospital—have fostered true innovation, unlocking new ways of thinking, doing, innovating, improvising, and creating at the ‘sharp end’ of healthcare.

Before reflecting on these projects, their processes, and impacts, it is important to reflect on terminology and approaches. For several decades now, design thinking and human-centered co-design processes have been identified as critical to fostering creativity and innovation; the positive of this has been the amplification of user voices, especially in a healthcare context [5,6,7]. Figure 1 outlines the six key steps of the design thinking process, which are frequently deployed—by both professional designers and others—to create creative solutions to challenges. The unexpected negative of this raised awareness and acceptance of design methods, as Bason and Skibsted [8] explain below, is that the unique skillsets and mindset offered by professional designers is at times missed:

However, the concept has increasingly been reduced to a simple set of methods and processes that anyone and principal can apply as a way to empathize with users, cocreate new ideas with others, and build prototypes of potential solutions. Design thinking has served to democratise the field of design in many ways professional designers had never imagined (and many are uncomfortable with). On a positive note, this has propelled an understanding of basic design concepts into C-Suites around the world. On a negative note, it risks projecting a limited and reductive image of what design not only is, but can be [8, p. 24].

What distinguishes our design-led approach in HEAL, therefore, is the active collaboration between designers, clinicians, and consumers; it is this unique collaboration—with its emphasis on co-design, design thinking, design doing, prototyping, and implementation—that is facilitating the innovative and transformative change needed in healthcare.

Fig. 1
A chart details the six iterative stages of the design-thinking process. The stages include empathize, define, ideate, prototype, test, and implement, each accompanied by its respective definition.

The six iterative stages of the design-thinking process, adapted from d.school (creative commons 4.0)

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1 Why a Design-Led Approach Is Needed in Healthcare

Before describing the rationale, processes, and impact of HEAL’s design-led approach, we must first acknowledge two key facts. Firstly, there is an urgent need for our healthcare system to change—to become more agile, responsive, and innovative. Healthcare systems across the globe are under immense pressure: costs are rising, health budgets are diminishing, and populations are ageing, with more chronic and complex health problems (diabetes, heart disease, obesity, drug use, mental illness), and growing care disparities for vulnerable and marginalized populations: Indigenous, culturally and linguistically diverse, LGBTQ+ communities, younger, older and low-income people, as well as those residing in regional, rural, and remote locations [9, 10]. At the same time, there is an under-utilisation of primary care combined with high levels of system fragmentation—and technology (specifically the possibility of virtual and integrated care) is still not being used to its full potential.

2 The Promise and Perils of Technology

We are currently living through the fourth industrial revolution: an extraordinary time of change and challenge, with the fusion and blurring of boundaries between the physical, digital, and biological worlds. Advances in artificial intelligence, robotics, the Internet of Things, 3D-printing and more are radically transforming the design, delivery, and experience of healthcare [11]. Healthcare technology trends often support patient engagement and empowerment (for example, wearable biometric devices and apps enable patients to track and monitor their own health), and the increasing uptake of such technologies will and is transforming healthcare. Douglas Adams, author of the science-fiction series The Hitchhiker’s Guide to the Galaxy, has outlined an interesting set of rules which describe our relationship to technology:

  1. 1.

    Anything that is in the world when you’re born is normal and ordinary and is just a natural part of the way the world works.

  2. 2.

    Anything that’s invented between when you’re fifteen and thirty-five is new and exciting and revolutionary and you can probably get a career in it.

  3. 3.

    Anything invented after you’re thirty-five is against the natural order of things [12, p. 95].

Adams’ rules, while humorous, outline the human-technology interface challenge facing healthcare: we are on the precipice of massive, disruptive change, and educating and engaging clinicians, administrators, and consumers with such rapid technological advances will not be straightforward for, as Shaw and Chisholm [13] astutely have noted, complex health systems struggle to adapt to such disruptive innovations.

3 The Challenge of Changing Healthcare

Changing healthcare—which requires “spending money, diverting staff from their daily work, shifting deeply held cultural or professional norms, and taking risks” [14, p. 1]—is notoriously difficult. Critically, however, over the past two decades, healthcare improvement and knowledge translation efforts have moved away from simple linear ‘cause and effect’ narratives to the more nuanced complex adaptive systems approach, which recognises complexity, patterns, and interrelationships as the system develops, adapts, and changes in a constant, dynamic cycle of change. This complexity-informed systems thinking approach explicitly acknowledges that—for change to work—the people in the system need to be engaged and inspired to rethink existing practices; after all, as Kramer et al. [15] tellingly explained, there is no “systems change without organizational change and no organizational change without individual change” (p. 16.).

Thus, whilst healthcare has traditionally improved itself through (medical) evidence-based practice paradigms, in recent years, there has been the widespread adoption of improvement science [16], process engineering methodologies [17], knowledge translation frameworks [18], implementation science [19], and consumer-oriented clinical service innovation, actively engaging with consumers through design-thinking and experience-based co-design approaches [5]. A contemporary view, drawn from complexity science, is that previous improvement efforts have mistakenly attempted to address complex, interlinked, dynamic, and systemic issues with tools, thinking, and approaches that are best suited to mechanical or procedural problems. As Chari [20] explains:

Healthcare's preoccupation with statistical, process-driven and behavioural (incentive and punitive) strategies has failed to move the needle on safety or quality. Why? Because clinicians aren't 20th century factory workers, patients aren't motor cars and hospitals aren't assembly lines. Fundamentally, healthcare is a human sector—enmeshed within layers of social, technical and structural complexity. Performance, safety and risk are connected in such dynamic ways that simple improvement methods and conventional compliance measures have little chance of success (np).

Further, in situations where evidence is either limited or high-level and generalised, established approaches have failed to advance the capacity of large-scale systems to create novel, local solutions [21]. Traditional notions of reach and scale in health services research have tended to generalise approaches, and obscure the importance of creative, context-specific, adaptive solutions, which are vital to resolving evidence-based problems in practice [22, 23]. While there is no sole “magic bullet” to create a more adaptive, integrated, agile and innovative healthcare system, the chapters in this book argue that designers—with their creative design mindset and skills—could be the transformative change agents needed to accelerate health service innovation.

4 Designers as Agents of Change

Design is a diverse field, which encompasses a broad range of distinct disciplines including architecture, landscape architecture, interior design, industrial (product) design, interaction and digital design, visual communication, fashion design, and service design, as well as design management, strategy, and education. What unifies these diverse disciplines is how they think: regardless of their specialist disciplinary training, designers share an iterative design process and a unique approach to problem-solving that privileges visualisation and the processes of making.

Critically, as Herbert Simon [24] explains below, designers are agents of change: design is the practice of conceiving, creating, and planning what does not yet exist by creating and transforming environments, products, interfaces, services, processes, and systems.

Our task is not to predict the future; our task is to design a future for a sustainable and acceptable world, and then devote our efforts to bringing that future about. We are not observers of the future; we are actors who, whether we wish to or not, by our actions and our very existence, will determine the future’s shape [24, p. 1].

Design offers powerful human-centered tools for innovation, as it focuses on making places, products, and services (and our interactions with them) more effective, efficient, and accessible. As Brown [25] explains, human-centered design involves an empathetic understanding of users (service providers and clients) and drives innovation in three stages:

  • Inspiration—considering challenges or issues through design thinking processes

  • Ideation—the process of idea generation and testing

  • Implementation—setting out the path to market or sustainable change in the organisation.

Healthcare has been early to recognise the potential of design methods as a tool for collaboration and innovation, with elements of design now commonplace in health. The human-centered design approaches of design thinking and experience-based co-design (EBCD) have been used to engage diverse stakeholders in empathising, ideating, problem-solving, co-creating, innovating, prototyping, envisioning, and iterating. While these are the foundational principles and processes of design practice, often these processes are led by enthusiastic non-designers, who tend to focus more on the first part of the design process (inspiration and ideation) than fully applying the power of design in tangible outcomes and implementation.

This means that, to date, design has not yet shown its full impact in healthcare. As Jones [26] notes in his book Designing for Care, designers have not yet been “given the latitude to practice creatively and meaningfully in healthcare institutions … as valuable contributing members of the care team” (p. xviii). This is a missed opportunity that HEAL was developed to address—with the following chapters outlining the processes, strategies, tools, and outcomes. Critically, while there are a handful of books on using design-led thinking to improve healthcare [see 4, 27], this book is unique in presenting 19 case studies of people- (rather than technology) led design projects in healthcare, integrating the description of the design process with the actual situation it was used for, with reflections on practice from both the designers and the clinicians, all within the overall umbrella of a single guiding initiative.

As each chapter demonstrates, a design-led approach offers a fresh lens to the wicked challenges facing healthcare. Our lens is always human-centered; that said, we agree with the recent proposition from Bason and Skibsted [8] which calls for a more expansive outlook on problem-solving and more disruptive leaps of imagination to create the future we desire. Arguing that we need to go beyond human-centeredness, Bason and Skibsted [8] call for more ‘expansive thinking’ across six ‘expansion domains’ of time, proximity, value, life, dimensions, and sectors. Expansive thinking emphasises the importance of:

imagining alternative futures and going beyond the safe, stale, and culturally determined mindsets that typically take root in existing systems, sectors, and organisations. It means innovating on a more systematic level, figuring out what people, communities, and ecosystems need as a whole, and testing, improving, and scaling new approaches. Expansive thinking means challenging assumptions and preventing intellectual inertia [8, p. 24].

We concur. While not explicitly drawing on Bason and Skibsted’s recent expansion thinking framework, a defining feature of HEAL projects is working creatively and collaboratively to reimagine current practice, explore and test potential possibilities, leverage the potential of technology, and challenge assumptions. Additionally, alongside a strong awareness of co-design, design thinking and systems thinking, HEAL projects frequently encompass a futures-thinking perspective, with our co-design and design-thinking approaches often stepping beyond the typical five or six step design thinking structure (empathize, define, ideate, prototype, test, implement) to include an explicit futures lens.

Futures thinking and foresight methods emphasize processes of forecasting, imagining, planning, and building probable, preferable, and possible futures; the goal is to take action to create the futures we prefer while avoiding the undesired futures. Futurist Joseph Voros [28] developed a ‘futures cone’ which defines 7 types of alternative futures:

  • potential (as future is undetermined, not inevitable, everything is a potential future)

  • probable (based on current trends/quantitative data, likely to happen)

  • preferable (based on our values, should and want it to happen)

  • projected (the default, current business as usual)

  • plausible (could happen, based on current understanding of how world works)

  • possible (not currently, but might happen)

  • preposterous (improbable, impossible, will never happen).

In imagining all these different potential futures, Voros [28] also suggests adding ‘wildcards’ which are sometime also termed black swan events: an unpredictable event that has severe consequences. As Taleb [29] defined them, black swan events must (1) be an outlier; (2) must have a major impact; and (3) must be declared predictable in hindsight). The value of engaging with the futures cone, ‘wildcards’ and ‘black swan’ events is that it provides a framework, process, and place for thinking explicitly about ‘the future’.

A futures perspective is grounded in the belief that the future (purposely plural until one becomes the present) can be influenced, with long-term thinking encouraged as alternative futures and pathways or solutions for changes are collaboratively explored. As the UK’s innovation agency NESTA explains, this participatory futures approach is designed to “draw out knowledge and ideas about how the future could be” and “help people diagnose change and develop collective images of the futures they want” [30, p. 7]. Dunne and Raby [31], for example, have intentionally integrated a futures thinking lens into design practice with their concepts of speculative and critical design, which deploys futuristic and alternative scenarios (design fiction) to challenge assumptions and ask ‘how the world could be’. That was the aim of many of the projects described in this book, which as well as developing finalised design outcomes and prototypes, also provided the space, time and structure for clinicians and consumers to reflect on current and future healthcare experience, and how it should and could be creatively redesigned.

5 How to Read this Book

There is no one right way to read this book, which is divided into six unequally sized categories covering four distinct design approaches of design thinking, design doing, prototyping, and implementing. Projects have been grouped into six diverse categories—Placemakers, Makers, Advocates, Strategists, Instigators, Practitioners—which best describes their primary focus. While you can read the book from start to end, you may also choose to focus on a specific topic and read chapters in that section as a set of stand-alone narratives. Each chapter covers an important issue, with the relevance varying depending on your interests. In the overview that follows, we describe the purpose of each section and briefly summarise the main contributions of each chapter.

The book is purposely written in a conversational, informal and practical style, so regardless of your own disciplinary background, the information is accessible. However, we recognise that even within the common language of change and transformation there are disciplinary differences between designers’ and clinicians’ use and meaning of words, so we have tried to ensure that any technical terms have a simple explanation, making this book readable for both designers who are thinking of working within healthcare and clinicians and allied health workers who are thinking that they might need the help of a designer to unpick a wicked problem in their healthcare practice.

At the outset, it is important to note that the projects described here largely occurred during 2020 and 2021, at the height of the Covid-19 global pandemic. As you can imagine, hospitals were often closed to visitors, focused on pandemic preparation and response. Australia was fortunate to not have a large rate of infection, in part because of its physical location as an island a long way from most of the rest of the world, and in part because many of its states took swift action to close their borders and impose lockdowns on the populace. This meant that, although for many it moved to home, business continued largely as usual for the state of Queensland—so long as we followed public health protocols, such as physical distancing, mask wearing, and good hand hygiene. Thus, the collaborations described in this book proceeded in a unique time and place, and as a mix of remote and in-person work. In addition, almost all of the projects described here came directly from HEAL, with the exception of two unique contexts: the explanation of how prisoners access healthcare in Chapter “Agency and Access: Redesigning the Prison Health Care Request Process”, and clinicians’ experiences of palliative care in Chapter “Co-designing the Palliative Care Hospital Experience with Clinicians, Patients, and Families: Reflections from a Co-design Workshop with Clinicians”, where design academics from the HEAL team deployed design tools in these different settings.

The book is written to make it easy for you to take these design-led principles and find ways to apply them in your own workplace, whether that is a hospital or clinic, an office, a university, or somewhere else. We, of course, recommend collaborating with design professionals, with this book primarily written for two key audiences: (1) the healthcare clinician or administrator who wishes to experiment with a design-led approach in their workplace, and (2) designers who are, or wish to be, working in healthcare. Brown has observed that design thinking often involves “a great deal of perspiration” [25, p. 2], and we will see that in each of these reflective, practice-based chapters which deployed a wide range of design methods in healthcare—during the global Covid-19 pandemic. The chapters are frequently co-authored by designers and clinicians, sharing the origins and intentions of each project, with a focus on what was planned and intended, what actually happened, and reflections on how it could have worked better.

6 Part 1: Placemakers

All HEAL projects were guided by a participatory human-centred co-design approach, which acknowledges that health service users (consumers and staff) are experts of their own lived experience, and harnessing this expertise, knowledge and ideas is critical to design-led innovation. Engagement and participation, and related concepts of co- production, co-creation, co-design, and co-innovation is the “new Zeitgeist—the spirit of our times in quality improvement” [6, p. 247], for, as Don Berwick [32] wisely suggested nearly two decades ago, healthcare “workers and leaders can often best find the gaps that matter by listening very carefully to the people they serve: patients and families”.

Participatory human-centered co-design methods emphasize first- hand investigation, understanding who you are designing for—and designing in partnership with them—alongside an iterative, experimental approach of collecting data, making discoveries, and organizing ideas. Critically, the process emphasizes discovering the right problem to solve, by investing in both problem-finding and problem-solving to understand—at both a human and systems-level—where and how we might have the most leverage. In this first section, we start with four thought-provoking chapters on architectural and visual design responses to place-based challenges in healthcare.

In Chapter “Parrot Murals and Feather Floors: Co-designing playful wayfinding in the Queensland Children’s Hospital”, Seevinck and colleagues describe their experience designing and implementing playful placemaking and wayfinding, where previously monochromatic floors and walls were replaced by charismatic illustrations of parrots and natural landscapes around Queensland to provide a uniquely playful wayfinding design strategy, as depicted in Fig. 2. This chapter discusses the collaborative and research-led creative processes, focusing the significant turning points, the engagement process (between the academic design and research team, creative health and visual design staff at the hospital, and the wider hospital community and stakeholders), design outcomes, and the hospital staff and client reactions to the design.

Fig. 2
A photo captures two persons standing before a wall adorned with painted parrots perched on trees. One person points towards a parrot on the wall.

Playful parrots on the walls of Queensland Children’s Hospital. Photo credit: Sarah Osborn

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Chapter “‘It Takes a Village’: The Power of Conceptual Framing in the Participatory Redesign of Family-Centred Care in a Paediatric Intensive Care Unit” is the first of three chapters giving different perspectives on the Paediatric Intensive Care Unit’s (PICU) Partnership Project at the Queensland Children’s Hospital (QCH). In it, interior designer Wright and colleagues describe how current spatial layout, visuals and wayfinding did not support easy navigation for parents to rooms, nor any understanding about the spaces available for parents to use for self-care. The location and lack of storage (leading to clutter) in rooms and corridors makes it more difficult for parents to find anything, including each other. There was a need for storage solutions for parents’ personal belongings, and to better locate equipment and supplies in corridors and rooms. The chapter describes the innovative engagement and storytelling strategies, which provided insight into how the design of the space supports (or not) social and emotional needs, as well as an interior design and wayfinding concept proposal.

With the aim of creating a more therapeutic (comfortable, effective, meaningful, and supportive) physical, social, and digital environment for parents and families (and the staff caring for them) at a time of crisis, the PICU Partnership projects focused on how the spatial environment and visual communication could improve the delivery of family-centred care.

Chapter “Designing Hospital Emergency Departments for a Post Pandemic World: The Value of a BaSE Mindset—Biophilia (Natural), Salutogenesis (Healthy), and Eudaimonia (Contentment) in Architectural Design”, by Burton and colleagues, focuses on how the Emergency Room Exits and Entrances might be redesigned to develop better flow for vulnerable patients (elderly, mentally ill, children, neurotypically diverse, indigenous people) and support staff in delivering quality healthcare. Clinicians described how the design and layout of the waiting room impacted the patient experience—a well-placed triage desk, a children’s play area, screen for ‘health propaganda’, a taxi phone, a phone charger and multiple port adaptors and the addition of a waiting room nurse to improve communication with the waiting public were all initiatives they felt improved the ED experience. Wayfinding and placemaking was often a challenge, so Chapter “Designing Hospital Emergency Departments for a Post Pandemic World: The Value of a BaSE Mindset—Biophilia (Natural), Salutogenesis (Healthy), and Eudaimonia (Contentment) in Architectural Design” shares some solutions in terms of schematics of architectural design solutions that create flexibility and one-way flows.

Finally, Chapter “Transforming the NICU Environment for Parent and Staff Wellbeing: A Holistic & Transdisciplinary Supportive Design Approach” by Johnstone and colleagues, rounds out the Placemaking section of the book by describing spatial and other critical space-related issues related to the Neonatal Intensive Care Unit (NICU) at the Royal Brisbane and Women’s Hospital (RBWH). The chapter describes the transdisciplinary and holistic design approach taken to develop solutions with benefits for both staff and parents in the neonatal environment.

7 Part 2: Makers

This section turns to design prototyping projects, where the goal is to develop a real-world model or prototype to use for iterating improvements to a design concept. Prototyping is making a preliminary model of something, from which other forms or products are developed. It is a representation of a design idea, used to generate learnings for the final development or build. Prototyping is action oriented, with the intention of creating a tangible product. It moves people beyond talking into active creating and design doing. Typically, prototypes are built in iterative processes, where the lessons learned from one iteration informs the build of the next version. Prototypes are usually cheap (with a minimal investment of money or resources), quick (with a minimal investment of time), and generative (with the focus on learning). The design question for prototyping is always: what can be learned from this model?

In Chapter “Prototyping for Healthcare Innovation”, Chamorro-Koc describes her prototyping process, through the particular lens of the importance of prototyping as a step in the design research process. Particularly, she reflects on two projects: one on the creation of fun and playful facial PPE (Personal Protective Equipment) for paediatric wards to use, and the other on the development of a prototype interactive device for assessing children’s pain through physical readings of bodily functions, also for use in the context of a paediatric ward. Figure 3 shows one of the PPE prototypes—Sunny.

Fig. 3
A photograph illustrates a person wearing a P P E helmet with a shield. The text sunshine coast is written on the helmet. The face of the person is blurred.

The “sunny” child-friendly PPE prototype

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Chapters “Graphics and Icons for Healthcare with a Focus on Cultural Appropriateness, Diversity, and Inclusion” and “Agency and Access: Redesigning the Prison Health Care Request Process” document two innovative visual design in healthcare projects. In Chapter “Graphics and Icons for Healthcare with a Focus on Cultural Appropriateness, Diversity, and Inclusion”, Scharoun and colleagues share the process of re-designing a graphic poster that shows people how to correctly collect urine—thus reducing contamination rates. Feedback on an existing poster—designed for the Emergency Department—was that it was overly graphic, especially for use with children and in different cultural contexts, and so the design team redesigned and simplifying the poster, using a gestural drawing approach, as well as reduced the number of steps and combining what had been separate posters for men and women into the one poster.

In Chapter “Agency and Access: Redesigning the Prison Health Care Request Process”, Scharoun and colleagues describe how visual design might improve prisoners’ access to healthcare. Globally, 10.74 million people are currently in prison (either as pre-trial detainees/remand prisoners or convicted and sentenced), with rehabilitation a critical component of the criminal justice system. In Queensland, prisoners currently access non-emergency health access via a paper-based form, writing in their health concern. Prisoners generally have limited literacy, yet this process is reliant on prisoners being able to convey key information about their health, in writing, which health staff then use to determine when they should be seen (a triaging process). Confidentiality issues also arise if prisoners request assistance to complete the form. Chapter “Agency and Access: Redesigning the Prison Health Care Request Process” describes co-design activities with prisoners and staff, to reimagine the entire heath access process, as well as how the form was redesigned with icons and pictograms, to provide access to those with low literacy levels and be more suitable for future digital applications as part of a screen-based icon-system.

8 Part 3: Advocates

The third section showcases four hands-on projects we have grouped as Advocates—the co-creation and enactment of design-led change initiatives through working with people who are advocating on behalf of others. The first three chapters focus on projects that delivered outcomes that altered the cultural features of the hospital space in some way—whether through use of services or underlying principles about workflow. Two of those chapters take a broader view of the purpose of design and align it to issues of equity by using animated videos. The final chapter in this section moves us into the territory of end-of-life and the advocacy and decisions that can be supported by good design for our final healthcare experience.

In Chapter “In a Heartbeat: Animation as a Tool for Improving Cultural Safety in Hospitals”, Taboada and colleagues reflect on the process of developing an animated video that could be used in Cultural Safety training with clinicians. In Australian, First Nations persons, as well as patients from cultures outside the dominant one, often feel culturally unsafe in addition to the usual anxieties about going to hospital. The animated video is designed to increase clinicians’ awareness of the need for Cultural Awareness and Cultural Sensitivity, in order to enable consumers to feel Culturally Safe in hospital.

Chapter “Co-creating Virtual Care for Chronic Disease” describes the application of human-centered design methods in the development of the Virtual Outpatient Integration for Chronic Disease (VOICeD) project. VOICeD is a telehealth service designed to meet the needs of people with diabetes, by allowing them to see multiple healthcare practitioners in one virtual appointment. Through a series of experience-design journey mapping sessions, a participatory design workshop, and user testing, design methods were used to foreground the patient experience, streamlining, and humanising the transition to a digital platform.

In Chapter “Improving Interpreter Service Uptake and Access to Just Healthcare for CALD consumers: Reflections from Clinicians and Designers on Animation and Experience-Based Co-design (EBCD)”, Rieger and colleagues address the under-utilisation of interpreter services by customers. After data reviews and mapping clinical incidents, the team were able to use the lived experience of clinicians in combination with the first-hand insights gained from their data collection and the design skills within the team to develop an innovative, animated video response to address the issue, and enable greater access to healthcare for all.

Chapter “Co-designing the Palliative Care Hospital Experience with Clinicians, Patients, and Families: Reflections from a Co-design Workshop with Clinicians”, by Miller and colleagues, shifts our attention to a healthcare experience that most are unprepared for until it arrives—the palliative care experience at the end-of-life. Focusing on activities and staff perspectives from a co-design workshop on redesigning the palliative care experience, the chapter describes the collection of exceptional moments, the use of personas and empathy mapping, brainstorming of wild ideas to disrupt the hospital system, and then unpacking more pragmatic barriers to their implementation, before brainstorming new solutions and prototyping a preferred idea.

9 Part 4: Strategists

In this chapter, we outline how designers can be strategists, enabling clinicians and consumers to reimagine the future, and co-design how the experience and delivery of healthcare could be positively transformed. The approaches outlined in these projects are designed to “simulate our imaginations and expand the range of decision-making options available to us” [8, p. 41], and often use personas and future-focussed scenario-based speculative design activities in this process. By nature, designers are futurists: creating ideas that do not yet exist. Design visioning activities provides teams with the time and space to have focussed, reflective, and meaningful discussions around the future—to see new possibilities and think bigger about the impact of changing technologies, processes, and cultures, through optimistic future-focussed dialogue and storytelling about “what might be”.

While many of the projects described in this book required months of extended engagement, Chapter “Empathy in Action: A Rapid Design Thinking Sprint for Paediatric Pain—Perspective-Storming, Pain Points, and the Power of Personas” describes a different approach. Miller outlines the process, tools, and value for a rapid co-design sprint, held during the Queensland’s Children’s Hospital 2020 Ideas Festival. While design “sprints” are normally 3–5 days in length, enabling a deep dive, with creative and strategic thinking about issues, priorities, and responses, this event was much shorter. The aim of this rapid one-hour co-design sprint was to help clinical stakeholders understand, brainstorm, and design better ways to achieve optimal procedural care, reducing procedural pain (short-lived acute pain associated with medical investigations and treatments, e.g., blood tests, immunisations, IVs/Port access, dressing removals/changes, nasogastric tube insertions) for children and youth. A critique of design thinking is that it simply takes too long: this chapter approach shows the value of a condensed version, to introduce multiple stakeholders to the design-led innovation process.

Chapter “Asking the Right Questions: Cancer Wellness and Stroke Care”, by student designer Jessica Cheers, focuses on the importance of asking the right questions when designing new service delivery models, using examples from two projects. In the cancer wellness project, designing an authoritative evidence-based virtual home for wellness information, programs, and services for one large Brisbane hospital involved four key phases: Mapping, Visualising, Co-Designing and Evaluating, with a focus on understanding how current and emerging needs of end-users (people with cancer and patients at the hospital) would be met through an online offering.

The second case, on stroke care, reflects on how, after four virtual and in-person human-centered co-design workshops with clinicians across Queensland, Cheers created communication tools highlighting the complexity of stroke care and identifying areas where variation exists. Three different infographics (using the persona of Jenny who had suffered an ischemic stroke and required an endovascular clot retrieval) and seven patient journey maps were developed, showing the difference in care and the timeline of delivery depending upon where our persona—Jenny—had her stroke and which hospital she was transferred to. Across the state, more than a seven-hour difference in initial treatment time for the endovascular clot removal was described in the patient journey maps, depending upon the referring and receiving sites for treatment.

Chapter “The Art of Transformation: Enabling Organisational Change in Healthcare Through Design Thinking, Appreciative Inquiry, and Creative Arts-Based Visual Storytelling”, by Miller, Johnstone, and Winter, continues the focus on tools for engagement—but this time, with a purposeful focus on the value of a positive psychology-inspired appreciative inquiry approach for communicating change. The authors illustrate the value of innovative visual methods, with participants drawing and sharing a moment of “exceptional practice” (when they were engaged, excited, and proud of their work) and then creating a storyboard of healthcare through the medium of a comic. Clinicians, consumers, and their families were also asked to photograph their rehab experience and share their stories of learning to walk, eat and speak again, with this chapter highlighting the value of arts-based methods and design storytelling in triggering meaningful dialogue between clinicians and consumers.

Chapter “Thinking Differently: Six Principles for Crafting Rapid Co-design and Design Thinking Sprints as ‘Transformative Learning Experiences in Healthcare’”, by Miller, rounds out this section and provides six principles for creating transformative experiences using co-design and design thinking sprints. Using reflective learning from the more-than-30 rapid co-design and design thinking workshops that she has run as part of the broader HEAL project over the past 4 years, Miller explains what transformative learning experiences in healthcare can look like, and provides detailed guidance through six key principles for those wishing to develop a healthcare design sprint of their own.

10 Part 5: Instigators

This section takes a future-view of the change that needs to happen in healthcare, turning to future-focussed scenario-based speculative design activities that engage consumers, clinicians, and policymakers. By nature, designers are futurists: creating ideas that do not yet exist. Design visioning activities provides teams with the time and space to have focussed, reflective, and meaningful discussions around the future—to see new possibilities and think bigger about the impact of changing technologies, processes, and cultures, through optimistic future-focussed dialogue and storytelling about “what might be”.

The three chapters in this section describe projects that helped clinicians and consumers conceptualise healthcare possibilities in new ways, using a hand-on user-centred design thinking framework as a problem-solving tool to spark creative innovation. Best conceptualized as three processes—(1) understand, (2) explore, and (3) materialize, the popular Hasso-Plattner Institute of Design at Stanford (d.school) model of design thinking breaks the process down into six iterative stages, as depicted earlier in Fig. 1 [33].

In Chapter “Bringing the University to the Hospital: QUT Design Internships at the Queensland Children’s’ Hospital Paediatric Intensive Care Unit (PICU)”, the second of the three PICU Partnership Project chapters, Tyurina and colleagues share how she set up a WIL (Work-Integrated Learning) unit project to assist with the development of visual communication and interactive design collateral to support the co-design of a more healing environment for PICU families and staff scaffolded by the six-step design thinking model. This specifically related to parent/staff engagement and storytelling activities to inform and activate and re-imagine key areas of shared spaces, as well as concepts for more long- term strategies for communication to parents and families in PICU and post-discharge, for example materials, posters, flyers, data visualisations and infographics.

Chapters “Exploring Clinical Healthcare Challenges and Solutions Through a Design Thinking Education Program for Senior Health Professionals” and “Co-designing Design Thinking Workshops: From Observations to Quality Improvement Insights for Healthcare Innovation” juxtapose this student-led approach by describing the process of introducing design thinking to two different cohorts of healthcare stakeholders. In Chapter “Exploring Clinical Healthcare Challenges and Solutions Through a Design Thinking Education Program for Senior Health Professionals”, Matthews and Wright provide a perspective on training a larger and more diverse group of clinicians, and describe two iterations of a design thinking workshop developed to introduce senior health professionals and program administrators to the ways that they could use co-design principles in their everyday work. In contrast, in Chapter “Co-designing Design Thinking Workshops: From Observations to Quality Improvement Insights for Healthcare Innovation”, Chamorro-Koc and colleagues describe the way that she and her team upskilled the Clinical Services Development Service within Queensland Health’s Metro North Hospital and Health Service, giving them hands-on experience with a unique observation strategy and a co-design workshop protocol that they could then use for their future staff development offerings.

11 Part 6: Practitioners

This final section concludes the book by taking a moment to reflect on the HEAL project’s processes thus far, before looking to the future and taking a future-view of the change that needs to happen in healthcare. Chapter “NICU Mum to PICU Researcher: A Reflection on Place, People, and the Power of Shared Experience” is the final of the three chapters based on the PICU Partnership Project, and is a personal reflection from a team member whose own infant daughter spent time in a PICU. Ness Wilson, who paused her Master’s degree to engage as the HDR (Higher Degree Research Intern) on this project, reflects on her experience, and how this deep empathy impacted the design process and her development of the framing for the final project delivery, as PICU Care, PICU Connect, and PICU Comfort.

The final chapter in this volume, by Chari, focuses on the macroscopic effects of the HEAL initiative and specifically how, through the medium of tangible design innovation, the HEAL initiative has shifted mindsets, broken down silos, sparked creativity, and seeded collaborations in ways that are enhancing the conditions for future ‘designability’ within our health system. In essence, HEAL is catalysing a fundamental transformation in healthcare so that it is less resistant to redesign and more conducive to innovation. Chari reflects on the importance of these virtuous cycles in creating and scaling generative change within complex systems like healthcare and how working with designers will be even more critical in coming decades.

Healthcare is an enormously complex system, which is very resistant to change. However, as the chapters in this edited collection show, engaging with design and designers is a novel and promising strategy for tackling the ill-defined, complex, and wicked problems facing healthcare, providing a novel, action-oriented way of facing complexity while systematically conceiving, developing, and driving forward new practices for undertaking large-scale transformation. Over a decade ago now, sociologist Norman K. Denzin challenged researchers to “trigger a discourse that troubles and positively changes the world” [34, p. 10]. That is the aim of the chapters in this edited collection, which collectively offer new thinking and techniques to transform healthcare—by design, in partnership with designers.