Exploring Clinical Healthcare Challenges and Solutions Through a Design Thinking Education Program for Senior Health Professionals

Abstract

The purpose of this chapter is to reflect on the value of teaching clinicians a design thinking human-centred process through exploring the challenges/issues/problems from their own practice settings, developing their collaborative prototyping mindset, and generating and testing new solutions. This chapter focuses on an introductory program for health professionals to increase their awareness of the benefits of engaging in the design thinking process and new ways of thinking, doing, and working, to address health service quality improvement issues. Using insights from their patients’ experiences, clinicians worked with their colleagues and designers in a half-day workshop to co-design, prototype and test some potential solutions to their patients’ health-related problems. These workshops were supported by an online program of five modules introducing further useful tools for implementing design thinking in healthcare settings during the five phases of the design process, and a recorded discussion capturing reflections of members of the QUT HEAL Design Lab and their experiences working with clinicians. Team reflections as well as recommendations for future educational interventions and implications for designers working with medical professionals are discussed.

Matthews and Wright are joint first authors of this chapter, with authorship order alphabetical.

Despite seeming like an obvious fit, the formal intersection of design thinking and health is relatively recent. Design thinking or human-centred design is a powerful iterative and collaborative creative problem-solving process that delivers novel and high value solutions to complex challenges that meet the needs, desires, and constraints of end users. Grounded in empathy, design thinking is recognised as a key tool for navigating a multi-layered definition of health [1, 2]. Health professionals with high levels of empathy have been found to elicit therapeutic change more efficiently. Indeed, notions underpinning healthcare innovation include suggestions that physicians who increase empathy, a fundamental element of the therapeutic relationship between clinicians and their patients, make vital contributions to improving health outcomes. For these reasons, design thinking is increasingly included in health professional education [3, 4].

In the USA, Innovation Catalyst initiatives aim to grow a network of innovators trained in human-centred design, who can introduce and champion innovation strategies within their own organisations and help other safety net organisations discover new ways to apply design thinking to critical organisational challenges. Early signs indicate that these Catalysts, exposed to curriculum focused on empathy, exploration, experimentation, and entrepreneurship, are making inroads at their institutions, spurring cultural change across a continuum of activities including applied innovation, introducing new programs and technology and process improvement [5].

This chapter describes the processes and outcomes of a professional development initiative with similar intentions, developed and customised to introduce selected senior health professionals to the basic dimensions and benefits of design thinking (human-centred design), and provide an opportunity to develop a design mindset and creative confidence in exploring and experimenting with practical improvements and solutions. Through two facilitated half-day face-to-face workshops, designed to familiarise participants with the process and various design thinking tools, 30 Queensland Health Clinical Excellence (CEQ) Fellowship recipients and senior health executives were empowered to reframe and enact their own design-led quality improvement projects and future-focused scenario-based speculative designs, to value-add to the legacy of the 2020–2021 Health Excellence AcceLerator (HEAL) project. Additionally, a suite of five online modules and a recorded discussion between the two facilitators and Director of the QUT Design Lab captured reflections and insights on the value of applying a design thinking methodology in healthcare contexts, highlighting key learnings for both clinicians and designers.

Outputs and outcomes from the initial workshops highlight examples of how a design thinking process and mindset were used to reframe design challenges to deliver innovative practical solutions for cultural empathy, service design, and systems design projects. Some participants from the first workshop applied the design thinking processes in their own projects that have been reported elsewhere in this book.

Findings from the delivery of the initial two face-to-face workshops demonstrate the appetite of health professionals to actively engage in and collaboratively explore design thinking approaches for the generation, prototyping, and presentation of new creative solutions to healthcare challenges. The benefits of clinicians collaboratively experiencing and experimenting with design thinking processes, problem framing and problem solving are discussed, as well as reflections on future educational interventions needed to increase the productive collaboration of designers and clinicians/health professionals working within the health sector.

1 Why Design Thinking in Health Care?

Design thinking is a human-centred approach to innovation that draws on the designer’s toolkit to integrate the needs of people, the possibilities of technology, and the requirements for business success [6]. In creating value for others, designers exercise an open and complex productive reasoning pattern, which builds upon induction, conventional problem solving, and analytical reasoning, and relies on creating a working principle (‘how’) and a product/service (‘what’) in parallel [7]. Design thinking can be described as a designer’s mindset—an attitude that demonstrates creative confidence [8], uses empathy in its interactions with stakeholders, embraces ambiguity, takes an optimistic perspective, values learning from failure, translates ideas into tangible artefacts, and is continuously iterating to test out new possibilities. The characteristics to look for in a design thinker are “empathy and a people-first approach, integrative thinking to combine multiple perspectives, optimism regarding potential solutions, experimentation to explore constraints, and collaboration with others from diverse disciplinary backgrounds” [6, p. 87].

Design thinking focuses on users and their explicit and latent needs. In any context, its purpose is delivering optimal outcomes for users, often by asking them to reflect on their actual needs. Research reveals that using a human-centred approach delivers better and more appropriate solutions in health, education, and management [4, 9].

As a problem-solving process, design thinking is increasing in popularity in the health care sector [4, 6, 10]. Specifically, design thinking and human-centred design have been shown to generate new, imaginative, and high-value solutions to long-standing challenges and issues [11, 12]. An indication of interest and investment in further application of design thinking is its direct inclusion in medical education [4, 13]. A recent review of 15 articles where design thinking frameworks were used in health professions education found a range of outcomes including self-efficacy, perceptions, and solutions for specific problems [4].

2 Design Thinking in Healthcare Education

The skillset required for healthcare professionals to optimise the healthcare experience is a combination of scientific knowledge, technical aptitude, and affective qualities such as compassion and empathy. Empathy is at the core of effective patient-centred care that is found in kindness, compassion, and dignity, recognises the role of the patient’s family and support system, understands the influence of the physical environment in healing, and responds to the patient’s psychological, emotional, spiritual, and social needs [14].

Developing a public health workforce that can understand problems from a user-centred perspective not only has utility in problem-defining and solution-finding for healthcare products and services [7], but also provides healthcare professionals with the critical skills for creativity, innovation, and empathy to engage meaningfully with community members and more effectively approach historically burdensome challenges [15].

Harvard Medical [16] recognises the importance of operationalising empathy into the health system by “directly incorporating the patient’s voice” when “redesigning care processes with empathy-centred design thinking”. ‘Clinical empathy’, defined as “the ability to observe emotions in others, the ability to feel those emotions, and finally the ability to respond to those emotions” [17, p. 55], constitutes an important skill for health and social care professionals, and brings benefits to patients, medical students, and health practitioners alike. Guidi and Traversa [18] reference multiple studies which highlight improved satisfaction and positive clinical outcomes for patients—therapeutic effectiveness, shorter hospitalisations, improved physiological responses, patient wellbeing, and economic advantage—as well as benefits for health practitioners including increased well-being and job satisfaction preventing burnout, and decreased malpractice claims. Further, they propose the notion of ‘empathic concern’ in healthcare, suggesting that clinicians embrace ‘engaged curiosity’, non-verbal attunement, and the effort to imagine the other’s experience to gain a deeper and more comprehensive understanding of the patient’s experience.

Despite efforts to promote the value and importance of a person-centred approach in healthcare, studies show a decline in empathy among medical students as they proceed through their training, and adoption of low levels of empathetic engagement in clinical settings [19, 20]. This is attributed to factors such as stress, understaffing and increased workload to meet operational targets, the lack of adequate time and long working hours, work culture, the focus on therapy within a siloed academic culture, and inadequate focus as an underlying objective in the teaching process of health and social care undergraduate students and continuous lifelong education of professionals [19,20,21].

Attempts to improve empathy in medical and nursing schools and clinical practice over the years have largely focused on communication/social skills and perspective taking [20]. The relationship between empathy and healthcare is particularly prominent in ‘Narrative Medicine’ [22], an approach focused on promoting the importance of storytelling and encouraging the empathic encounter between health practitioner and patient. Guidi and Traversa [18] stress the importance of further research in this field due to its efficacy in teaching and promoting empathic concern in healthcare.

Similarly, in the design realm, narrative inquiry and storytelling, giving insight into the nuanced thoughts, feelings, and experiences of others, has been proposed as a method which aligns design solutions with the multiple dimensions of physical, emotional, spiritual, and interpersonal needs of patients and caregivers, and offers a new way to effectively communicate design ideas [23]. Utilising the skills of passive ethnographic listening and observation, evidence suggests that students of design using this method experience heightened self-reflection, acknowledge diverse perspectives, and are encouraged to design for the whole person—essentially cultivating empathy. Additionally, narrative inquiry can encourage creativity and innovation, and reduce surface misconceptions and tensions with stakeholders, therefore being an effective instrument for problem definition [24].

3 The HEAL Design Thinking for Clinicians (DT4C) Education Program

With the intention to provide a foundational understanding of design thinking processes, skills and mindsets, incorporating some of the aforementioned methods, the HEAL Design Thinking for Clinicians (DT4C) Education Program for clinical professionals used a two-phase process. A summary of these phases is shown in Fig. 1.

Fig. 1

Phases of the design thinking for health education initiative

Phase 1: Design, development, and delivery of two face-to face half-day workshops with clinicians, exploring design thinking within the context of their workplace projects with CEQ participants from 2020 and 2021 Fellowship cohorts. Design thinking frameworks and hands-on methods were explored, generating useful insights and lessons, as well as generating potential new solutions to their workplace problems.

Phase 2: Design and development of an online ‘Introduction to Design Thinking’ course, which provides five modules expanding on information about each phase of the design process with specific healthcare examples tailored to clinical professionals through videos and textual resources.

This course was supplemented by production of a video capturing reflections and further discussion about of the application of design thinking frameworks in healthcare by the facilitators of the Phase 1 workshops and the Director of the QUT Design Lab.

4 Phase 1: Design Thinking for Health Face-to-Face Workshops

Seeking to achieve long-term and wide-reaching cultural change within Queensland Health through the Clinical Excellence Queensland (CEQ) program in 2020, it was suggested that the CEQ Fellows, a peak group of current and future leaders (including doctors and allied health professionals selected from clinical facilities state-wide) could be instrumental in embedding the principles and practices of design thinking for healthcare improvement across Queensland hospital and health services. Fellows from the Clinical Excellence Queensland (CEQ) Fellowship scheme in both 2020 and 2021 were invited to participate in a half-day face-to-face Introduction to Design Thinking workshops developed and facilitated by the design team from the QUT Design Lab.

Initially, the design team was tasked with designing and facilitating a customised 3-hour interactive workshop to provide 2020 health professionals with a general understanding of the mindset, principles and practices of design thinking. It was then repeated for the 2021 cohort. These workshops provided an opportunity for CEQ Fellows to apply this learning to projects of their own choosing, in order to provide a foundation for future design thinking, design doing (co-creating and enacting design-led change initiatives), and design visioning (future-focused scenario-based speculative design).

4.1 Face-to-Face Workshop Format

Each workshop began with a discussion about design and design thinking using Herb Simon’s stance which proposes that “everyone who devises courses of action aimed at changing existing situations into preferred ones is a designer” [25, p. 101]. The human-centred approach was then introduced utilising the Stanford d.school process [26], which is commonly used in educational settings. This process utilises the phases of Empathise, Define, Ideate, Prototype, and Test, as shown in Fig. 2.

Fig. 2

The Five Steps in the Design Thinking Process Framework, popularised by the d.school. (Source: Authors)

The importance of developing design thinking mindsets and ‘creative confidence’ [8] with repetition of experimentation and practice on the journey to developing design thinking expertise, was emphasised.

Participants in each workshop worked in small groups of 4–5 for the workshop duration, experiencing the design thinking process, experimenting with various design thinking skills, and exploring and sharing possibilities for their work in teams. Various templates and examples were utilised throughout the workshop to demonstrate how design thinking can be integrated into health care projects.

The Empathise phase, highlighted as a defining differentiation in this thinking approach, involved focusing on the patients and staff in the participants’ work contexts, and developing a contextualised clinical workplace scenario to explore during the workshop. First, participants were asked to reflect on their patients and develop a Persona—a composite character who embodies the needs, interests, wants, and desires expressed by real users, preferably an ‘extreme’ user. This Persona became the human face of the design—the end-user that the whole team could imagine clearly.

Participants were then challenged to put themselves in the user’s shoes to develop an Empathy Map summarising the traits, feelings, behaviours, and needs of patients during their clinical experience. This part of the process particularly focused on behaviours, as those could be remembered by the participants from real-life situations in their workplace scenario. That empathy map was then used by each team to agree on their biggest problem that needed to be solved in the scenario space.

In the Define phase, participants were invited to frame the challenge as a “How might we…?” question—a not-too-broad, not-too-specific way of reframing insights in order to turn those challenges into a generous array of possible future desirable outcomes.

Fig. 3

Visual prototype of Arrivals and Departures Board concept (top), and the solution for improving communication for Indigenous obstetric clients (bottom)

The Ideate or idea generation phase then provoked participants to brainstorm ideas to solve the “How might we…?” question. They were encouraged to develop a ‘moonshot’—an audacious attempt to solve the problem with a radically different way of thinking, that values creativity over cleverness. At the end of this phase, each team discarded their practical solutions, and selected one idea that was either ‘delightful’ or ‘a longshot’ to progress.

During the Prototype phase, groups of participants used basic materials (pens, paper, string, glue, scissors, and the like) to create ways to communicate the selected solution idea for evaluation. Situational narratives which were developed included: (i) Improving patient communication in waiting areas—ensuring current information about progress as well as delays while waiting for diagnosis and treatment; (ii) Improving facility access and physical environment for patients with chronic respiratory disease; and (iii) Improving the obstetrics process and outcomes for remote Indigenous patients relocated from offshore islands to the mainland.

In the Test phase, each team showcased their solution to the larger group in a 3 min ‘elevator pitch’ using props created in the prototype phase. Each team then had the opportunity to evaluate and modify their prototype on the basis of the questions and feedback received, and to exchange detailed feedback with another team.

Finally, all participants were asked to Reflect on the process and what had been learned during the workshop.

4.2 Outputs and Outcomes of Face-to-Face Workshops

Participants were highly engaged throughout the face-to face workshops, enthusiastically participating in developing visual and action-oriented rapid prototyping skills, and reflecting on the needs of users and the current challenges in their particular health-related contexts. Examples of output from activities from Workshop 1 include: a visual prototype of a potential solution generated to provide information on an Arrivals and Departures Board for use in Waiting Rooms (Fig. 3—top); and an artefact for prototyping a solution for better communication and connection for remote Indigenous obstetric clients (Fig. 3—bottom).

Evaluation comments from participants included, “Where can I learn more? Loved it” and “I’m keen to continue in this space using some these tools and tasks within my workplace.” They also expressed disappointment that the 2020 CEQ Fellows collaboration with the QUT Design Lab had begun so late in their Fellowship, asking whether they could be involved in future sessions, as they saw value in repetition of both learning and doing the design thinking process for ongoing projects. As a result, the workshop was offered in May to the 2021 CEQ Fellows cohort, and CEQ alumni from 2019 and 2020 were also invited.

The challenges identified and explored by groups in the second workshop include: Induction procedures; individual pregnancy records, obesity issues; issues in suicide prevention, mobile dental health and KPI’s for the future. Experiencing the design process and designing ideas and prototyping potential solutions with this diverse range of challenges and solutions created a community of ideas, with individual participants and their groups collaboratively learning from each other, as shown in Fig. 4. An example of a Prototype from Workshop 2 providing some solutions for an obesity challenge, is shown in Fig. 5.

Fig. 4

Visual Capture of Scenarios from six groups of Clinicians in Face-to-face Workshop 2. (Source/credit: Simon Kneebone (permission granted))

Fig. 5

Multiple factors exploring obesity challenge- defining the challenge, and components (top), and Visual of Potential Obesity Solution—‘Wellness Lifestyle Centre’ (bottom)

Major insights from these initial workshops demonstrated that there is a strong appetite in Queensland Health for new ways of thinking about problems, as most students from both cohorts viewed the content as relevant to improving their responses to public health challenges and generating novel solutions. Participant comments from the initial workshop, including “Please continue collaboration (between CEQ and QUT HEAL Bridge Lab)”, and “How can we maintain a relationship with QUT Design Lab and HEAL post Fellowship?” speak to the strength of value that participants saw in learning this new way of thinking and doing, their excitement about generating new ideas and translating them into actionable solutions, and the desire to keep experimenting with designers.

Specifically, the importance of the Clinical Excellence Queensland (CEQ) portfolio and their projects was mentioned. As one participant commented in response to a question about how design thinking can add value to their work, “Thinking more bigger picture and what are impossible ideas that maybe CEQ can help push forward”.

Learning outcomes were clearly best achieved when learners focused on applying tools to challenges they had either personally experienced or were familiar with. When participants began to put themselves in the position of the patients, staff, and family members, they were able to connect to the wider problems on a deeper level, truly understanding what they thought, felt, and recalled. CEQ Fellows, selected to participate in the program to work on challenges for healthcare in their own workplace, were given additional tools to buttress their research with affective narratives of compelling human experience. This involved exploring end-users’ experiences through three modes of storytelling (verbal, written, and visual), to inspire new approaches. Use of the first person narrative in some cases motivated the teams to heighten empathy in ways that led to sensitively-designed, patient-centred outcomes.

Furthermore, clinician evaluations of the workshop reported a valuing of the design thinking process as a structured collaborative methodology that enables new perceptions of challenges, increased feelings of self-efficacy in engaging with problems, and a new solution-based approach to address specific problems.

The highly experienced Clinicians in the face-to-face workshops were highly motivated and focused on their workplace projects. They had deep knowledge and empathy with their patients from their immersion in the challenges they were addressing. The solutions that they designed, developed prototyped, and tested for their projects involved both service and system design elements.

Participants in the face-to-face workshops were deeply aware of the physical, social, and well-being challenges of their patients, demon- strating empathy with their situations. As clinicians are largely engaged in providing services to clients, the workshop groups demonstrated a strong focus on service design, finding new ways to develop solutions that met the social and functional needs of their patients, and proposing new approaches to designing systems that were more patient-centred, or that simplified or unified existing services.

5 Phase 2: Design Thinking for Health Online Program

Following the success of the introductory program of face-to-face CEQ workshops, a five module ‘Introduction to Design Thinking’ course for online, asynchronous delivery was developed to extend the QUT Design Lab CEQ DT4C education initiative. Each individual online module is less than 30 min and includes PowerPoints, customised resources and templates (eg. for Personas, Empathy Maps, Storyboards), reflection questions, and provocations and challenges. A video toolkit guides participants through the five phases of the design thinking process in more detail, providing extra tools relevant for the healthcare setting.

As shown in Fig 1, a video-recorded discussion and reflections of members of the QUT HEAL Design Lab captured the design team’s insights about the education and training initiative and the collaborations and outcomes for the greater HEAL project.

5.1 Designers Working with Medical Professionals

Designers delight in collaboratively working with others to improve the health and wellbeing experiences of individuals, families/carers, and communities using design thinking. Designers are facilitators, clarifying design processes, stimulating and disrupting status quo, and capturing the overt and latent needs and interests of users. Teaching design thinking to health professionals often includes mapping the patient journey [27,28,29] and customising the design sprint to create solutions for diverse situations. While some transformative ideas were generated during the sprints, future iterative sessions would be required to further prototype and test these ideas with stakeholders, with input from designers or researchers to prevent the premature curtailing of ideation by focusing on contextual healthcare system constraints, and encourage maturation of initial concepts to delivery.

Medical professionals are closely engaged in developing solutions for the medical, health, and wellbeing challenges that often extend beyond the presenting medical conditions. Design and design thinking have been used extensively in health contexts regarding new products [30, 31], new and better services [32], patient friendly spaces [6], and patient-centred health and hospital systems [33,34,35].

Participants in the workshops discussed in this chapter were highly experienced health professionals, selected from a competitive application process and fully engaged with projects in their workplace contexts, targeting their issues of concern. They were curious and committed to exploring an alternative process for defining and solving problems and displayed the essential characteristics of empathising with their patients, an openness to ideas and risk taking, and a willingness to collaborate with other likeminded professionals in idea generation, prototyping, visualising, and experimenting.

In alignment with the literature, the relevance of design thinking to developing empathetic public healthcare systems and the intention to embed these professionals as design ‘catalysts’ in various areas of the healthcare system, calls for more in-depth and experiential learning, led by experienced designers [36].

While participants indicated their satisfaction with the learning outcomes and a greater understanding of key design thinking concepts, the strengths of the design thinking approach stem from its emphasis on the processes which must be practised repetitively to build ‘creative confidence’ and a design mindset [37, 38]. In the half day design immersion sprints described here, it was unlikely non-designers will move beyond a ‘Novice’ level of design expertise, but this seeded the opportunities to promote self-regulated learning which move them towards an ‘Advanced Beginner’ or situation-based level, suitable for facilitating learning with others in their workplaces [39, 40], dependent on the complexity of the problems being tackled [41].

The design processes of immersion in the patient’s context, empathising with the patient and their carers, engaging in ethnographic conversations, defining the challenges, generating ideas, and prototyping new possibilities increases the self-efficacy of health professionals [4] and their patients [42]. For this reason, literature suggests a focus on facilitating empathy and problem-finding learning processes for public health students through case-based learning, interviews, role-playing, group work, and community engagement. This recognises that creativity—essential for dispelling assumptions and finding new ways to explore challenges, involving significant cognitive flexibility, divergent, and convergent thinking and associative and analogical thinking—is not currently adequately developed in formal curriculum [36].

We recognise that designers who work with less experienced practitioners than those in our workshops may have different starting points for exploring a design thinking and doing process. Such work may require closer analysis of their patients and their patients’ journeys [43], with longer time for immersion in the challenge/opportunity space, and a longer focus on empathy and latent needs of their patients in preparation for design thinking workshops. Identifying the range and needs of diverse stakeholders and their involvement may also require extra time. However, as research has indicated [11, 12, 44], the engagement and involvement of designers at the front end of problem framing and defining as well as in working with stakeholders in an iterative fashion, provides new effective and productive solutions for patients and professionals. Service design thinking and doing [32] is indeed the focus of future work of designers with health professionals.

The CEQ DT4C education program fostered relationships among the Fellows and with the design facilitators that catalysed future project discussions and action towards quality improvement initiatives across the state. This engagement emphasised the importance of providing both physical and virtual environments for interprofessional learning in design thinking that cultivate socialisation, networking, collaboration, and sharing. While this program’s intention was to provide a foundational understanding of how design thinking for healthcare professions, alongside learnings developed from other HEAL projects as case studies, priorities for future curriculum development could include:

• Incorporating a design thinking approach to future interprofessional curricular development to ensure that the program directly targets the needs of all stakeholders including health care consumers, practicing clinicians, senior health professionals, and administrators, providing insights into the expectations, gaps, and goals of learning and practice in the current healthcare environment.

• Fostering a community of practice to allow for individuals from both healthcare and design to continue working together.

• Incorporating more effective and longitudinal evaluation strategies, ascertaining needs for future learning and supporting individual project development.

• Integrating training opportunities which respond to specific clinical environments and involve community-based participation, where clinicians can offer new perspectives and demonstrate leadership in process improvement outside their own workplaces.

• Providing learning opportunities in which clinicians and senior health professionals can work together more regularly and longitudinally with designers in simulated environments using patient care scenarios, to develop and deliver better solutions to complex issues.

• Providing more targeted professional development with designers and healthcare professionals collaborating on building actionable empathy skills, problem-finding and creative learning processes in the healthcare sector, capitalising on opportunities to mutually bridge the gap between ‘good design’ and patient-centred care.

Designers working in healthcare, despite the best of intentions to create impactful change, also face logistical challenges in ensuring products, environment, and service design outcomes and co-design processes are relevant and appropriate for users whose needs, expectations, and desires can be very dynamic. Additionally, while dedicated clinicians and health professionals are eager to embrace alternative thinking, sometimes healthcare administration can restrict collaborative processes and ideas for change. Increased operationalisation of care provision and focus on targets and protocols, understaffing, isolation of medical from social care, and systemic structures and practices have been identified as factors which impede continuity of care, from including empathic design considerations for products, services and environments [19]. Often it is also difficult to develop productive relationships, or even find the time for informal conversations to build trust with users and healthcare professionals within their workplaces for mutual learning, due to their stressful and time-constrained roles in busy, unpredictable environments.

The HEAL Project, including this Education program, provided a rare opportunity, unconstrained by these external pressures, for the design team to gain detailed insight into the challenging interactions of a cohort of extraordinarily dedicated clinicians with their patients, staff and administrators in the healthcare system, along with the time to mutually reflect on productive future collaborations for quality improvement in healthcare.

Staying true to the user-centred nature of design thinking, to develop the capabilities and mindsets of design thinkers, and provide ongoing opportunities for a shared language to emerge between health professionals and designers, requires significant time, energy, and empathy from stakeholders and healthcare administrators. Multi-tiered conditions and systems must be created in institutions to broaden the definition of empathetic healthcare to include ongoing interactions between healthcare professionals, patients, and designers. This involves promoting policy decisions regarding targeted and ongoing training for healthcare professionals, ensuring the workplace conditions for cultivating empathy amongst healthcare professionals, and developing implementation and evaluation of empathy-promoting policies across all phases of healthcare access and provision [19]. The development of empathetic skills must be supported through continuous and personal development education programs and supervised sessions, as well as habituation through lifelong reflection, action and relationship building [19, 21].

While the HEAL DT4C education program and associated case studies have demonstrated a promising approach towards disseminating design thinking capability throughout a state healthcare system, more coordinated educational interventions need to be developed and evaluated longitudinally. Evidence-based research is required to measure the impact of similar educational interventions on healthcare students and professionals in developing skills and mindsets for effective problem definition and co-design of healthcare products and services in conjunction with designers. Equally, recent experiences during the Covid-19 pandemic have highlighted the need to provide ongoing professional development for healthcare professionals to cultivate and maintain the critical skills of creativity, innovation, and empathy. There is value in developing programs in conjunction with health and medical schools and institutions building on existing concepts of ‘narrative medicine’ through design thinking.

With a clearer understanding of how design thinking education implemented during training or in healthcare settings could enhance and encourage empathic concern, educational collaborations between designers and health professionals such as this one will become ubiquitous and continue to improve the holistic quality of clinical care.