Keywords

Healthcare transformation and innovation brings changes to practices, challenges to uptake, and potential benefits to end-users. With these divergent complexities, the approaches that healthcare institutions use to embrace changes and the strategies employed to address those challenges are of critical importance. Design Thinking strategies are increasingly being employed in healthcare quality improvement approaches to facilitate innovation pathways and better health outcomes.

Healthcare innovation is part of a dynamic learning culture that characterises the healthcare sector. According to Persaud [1], such a learning culture is reflective of high-performance workplaces promoting continuous improvement, best practices, innovation, integrated data analytics, and evidence-based decisions. Innovation in healthcare can take many forms, from therapies and procedures, devices and tests, to professional training, management, and service delivery models [2]. It is in this broad context of healthcare innovation where quality improvement plays an important role. It provides performance measures upon which to benchmark innovations against to prove and secure benefits for end-users while outweighing the challenges of the changes that innovations might bring. Quality in healthcare is measured by seven characteristics: efficacy, effectiveness, efficiency, optimality, acceptability, legitimacy, and equity [3]. Achieving quality improvement across all characteristics requires a systematic approach. Combined and ongoing efforts of all involved (healthcare professionals, patients and their families, researchers, payers, planners, and educators) are required to make the changes for better patient outcomes (health), better system performance (care) and better professional development [4, p. 2].

With increasing demand for healthcare resources, individualised patient care and the higher cost of healthcare, quality improvement methods enable healthcare systems to make, measure and assess change and the effects of a change, while feeding the information back into the system and adjusting until results are satisfactory [5]. Increasingly, qualitative methods for quality improvement include participatory approaches and ethnography in healthcare contexts. For example, Vougioukalou et al. [6] explain that ethnography provides rich insights into the views and concerns of healthcare professionals and patients and captures their diverse and complex perceptions. Due to the nature of healthcare environments where long-term observations of the same participants are limited, Vougioukalou et al. [6] refer to focused and rapid ethnography formats and their limitations. They bring attention to a mixed-method ethnographic quality improvement method that includes observations of co-design processes in addition to interviews and questionnaires. Such ethnographic observations and co-design processes reveal practices of healthcare services delivery, often involving not only healthcare professionals and patients, but also infrastructure, spaces, and objects. Buse et al. [7, p. 2] explain that objects and spaces in healthcare settings provide a lens for examining care practices and make visible the tacit and non-verbal aspects of care practices.

In their book Materialities of Care, Buse et al. [7] discuss how the infrastructure and spaces in which healthcare services are provided are also part of the practice of providing care. The trending medical drama genre of television shows portraying emergency rooms and medical practices provide a glimpse of the multiple interactions taking place as part of the complexity of the healthcare system. While television fiction might be inaccurate in presenting medical procedures, it makes visible to the general public the myriad of devices, spaces, and equipment that health care professionals interact with as part of their daily medical practices.

In this article, we share our approach to Human Centered Design in Design Thinking sessions, through the use of an observation technique that was piloted with the CSDS team in February 2021 as part of the HEAL initiative. Our approach to implement a Design Thinking session combined two different worlds of knowledge and processes through a co-design approach. This project was conducted with QUT Ethics Approval number 107031.

1 Organisational Context of the Study

We conducted this study with the Clinical Skills Development Services (CSDS) team from the Metro North Hospital and Health Service (MNHHS) in Queensland. The core business of CSDS is to deliver specialised training for healthcare professionals; these are through simulation education programs or technical simulations of medical procedures and techniques. In the Queensland healthcare sector, they contribute to healthcare improvement through training, collaboration and innovation. CSDS is based at a 3000 m2 purpose-built facility on the Royal Brisbane and Women’s Hospital campus. The Service supports a network of satellite sites across Queensland and is considered one of the world’s largest providers of healthcare simulation. The CSDS team comprises a diverse group of professionals from different specialties (instructional & product designers, web and online learning developers, videographers, administrators, nurses, doctors, and clinicians). All members of the team contribute to the facilitation and delivery of the different programs and sessions. Its world-class service is one of a kind nationally and is globally recognised as excellent.

One of the areas in which CSDS has specialized is in running Design Thinking workshops for diverse healthcare professional groups. These are delivered through their Innovation Hub for a broad variety of needs and to address complex problems in healthcare. For example, they are used to develop new ideas, such as VR applications, through to reviewing models of care or developing novel simulation training programs. Many of the CSDS team members are versed in Design Thinking methods and are expert facilitators of this type of sessions in the healthcare context. From a research perspective, and with the purpose of generating new knowledge to support capability building of their team, CSDS engaged with QUT Design Lab researchers to collaborate in exploring opportunities to input novel approaches to their Design Thinking workshop toolkit and strategy.

2 Design Thinking in Healthcare Innovation

Design Thinking in healthcare settings refer to co-design processes that are inherently visual [8,9,10], where physical design tools, including 3D representations of environments and tactile models, enable teams to discuss and collaborate, reflect and initiate enquiries [11,12,13,14]. It is this visual quality that makes Design Thinking effective for exploring the inherent complexities of healthcare settings, which involve not only clinicians and patients, but all that surrounds the provision of care, from the infrastructure and technology in place, to support teams and carers, procedures and data workflows, the emotions and experience of all involved [15].

Design Thinking workshops are well known across various sectors, from education to business and to healthcare. Design has a potential to envision alternative futures for health care through new forms of innovation [16]. A design approach based on a holistic understanding of problems constitutes a prerequisite for innovations in complex contexts where problems are open, complex, dynamic, networked, and have a wicked character [17]. Design Thinking workshops provide a human-centered framework for problem solving and foster exploring needs and ideas for a particular group of users [18]. The term Design Thinking (DT) is commonly used when discussing design from a process or innovation perspective and is increasingly being adopted as an approach to innovation. The UK Design Council refers to DT as a way to “get to the heart of the problem quickly and suggest radical, innovative solutions” [17].

3 The Opportunity: Observations in Design Thinking Processes

Co-design techniques employed in healthcare contexts adopt known IDEO or Stanford school Design Thinking strategies. There are no strategies that employ observations as input for those Design Thinking strategies in co-design workshops. The CSDS team wanted to explore whether observations would be a useful input in their Design Thinking strategy toolbox.

Amongst many other problems, the COVID-19 pandemic has disrupted the practices of healthcare, administration processes, regulations, and supply chains of medical products, equipment and instruments, requiring increasingly agile ways of working and innovation in the delivery of services. When looking at areas such as enhancements to service delivery, CSDS run a number of workshops to facilitate problem identification, problem solving, and training. The CSDS team at MNHHS is dedicated to healthcare improvement through training of procedures and simulation of new techniques, collaboration across departments of QLD Health, and supporting innovative solutions to emerging problems. The facilitation of Design Thinking workshops fulfils a key goal of creating an environment for key stakeholders to connect and approach problems differently. CSDS calls it the Ideate Collaborate Innovate approach.

Traditionally, CSDS has followed a co-design strategy similar to the ones run by IDEO U, a North American-based design consultancy that is delivering commercial Design Thinking courses online through their IDEO U brand. CSDS found this strategy inspiring but limited to a set type of problems they can address in healthcare innovation. One of the limitations they found is in the inability to include field observations as part of the components of their current ideation sessions. Elaborating on observed problems would broaden their opportunities to develop new strategies for their design workshops to enhance the shared learning experience of participants, and the Ideate Collaborate Innovate approach.

The collaboration between CSDS and QUT Design Lab aimed at broadening the horizons of CSDS’ innovation services and to uncover their next steps as facilitators of these workshops for QLD Health. Building on a shared understanding that healthcare practices are evolving at fast pace due to new technologies, affecting interactions and processes, the combined team agreed to develop a capacity-building session to include field observations as part of CSDS’ Design Thinking strategy. The underpinning theoretical approach comprised a socio-technical lens focus on people’s interactions with other people, infrastructure, services and objects, in addition to a Human Centred Design approach, all integrated within the steps of the Design Thinking workshop strategy. The goal of the proposed workshop strategy was to explore whether this approach could help participants understand how to identify people-activity-context aspects from an observed problem, and how to work with those insights to identify potential solution paths, for quality improvement and innovation.

4 The Project: Including Observations as an Activity in a Design Thinking Workshop

CSDS has been supporting clinical improvement for several years and incorporating Design Thinking into healthcare. Using techniques from simulation-based education debriefing [19, 20], Design Thinking [17] and improvement science [21, 22], the facilitators at CSDS deliver workshops to support Queensland Health. These techniques were already part of the CSDS innovation and improvement strategy.

In Design we employ Human Centred Design (HCD) to work with observations as data. In this approach, by breaking down an observation into people-activity-context [23, 24] components, designers and researchers gain insights about what triggers problem areas and what prompts solutions. The People-Activity-Context (PAC) approach provides a suitable strategy for a Design Thinking workshop in a healthcare setting, as it can factor in the range of complexities and their interactions among one another. This project was used to pilot the strategy at a session with the CSDS team as participants. It consisted of one 3-h Design Thinking workshop, where we delivered our method for working with observations. At completion of the workshop, the CSDS participants were invited to comment about the usefulness of this strategy by completing a five-question questionnaire. Their responses were analysed to gain insights as to the how this approach extended (or not) their Design Thinking toolkit for healthcare innovation.

5 Participants and Recruitment

Fourteen participants took part in the workshop, each selected from the CSDS staffing pool. They had a wide a wide range of professional backgrounds all within healthcare. Participant recruitment was organised by CSDS. Selected staff were emailed Participant Information and Participant Consent forms (QUT Ethics Approval 107031), prior to initiating any activity. Once signed consent forms were received by QUT researchers, the research commenced.

6 Workshop Procedure

The Design Thinking workshop procedure comprised three stages: Stage 1: Preparation of a video prior to the workshop, Stage 2: Conduct of the Design Thinking workshop, and Stage 3: Debrief session post-workshop. Each stage comprised additional steps, which are detailed in the following sections.

6.1 Stage 1: Preparation of a Video Prior to the Workshop

Two weeks prior to the workshop, participants from CSDS were provided instructions to record short videos that communicated a problem relevant to the healthcare setting. The videos would be used to apply the PAC based observation method during the workshop. The instructions explained that each video should consider the following topic suggestions:

  • A technical interaction (e.g., people using a CSDS technology)

  • A process issue (e.g., a workflow that needs improvement)

  • A space problem (e.g., use of multipurpose spaces)

  • A protocol issue (e.g., people’s comments of how they experience the said problem).

To identify issues for the videos, a problem identification session was delivered internally within CSDS. The session used the 5 whys tool [25] to identify and clarify potential problem topics. The group identified four problem statements. In discussion with the QUT Design Lab team, the four problems were further reduced to one that focused on the CSDS course development process. The agreed problem statement was chosen because it touched on several aspects of the service and lent itself to an observational activity.

Once the problem statement had been identified, each participant produced a 1-to-2-min video with their personal perspective of the problem. All videos were uploaded to Padlet (Fig. 1), an online collaboration platform, for them to share with the QUT group before and during the workshop.

Fig. 1
A screenshot of a window titled Design Thinking Workshop. The main screen displays videos of team 2 Lego video, team 1 Lego video, Prue video, Jodie and Tracey, Ben's interview missed opportunity, Ben H C D workshop Q U T, H C D video Jodie, H C D video Kate, H C D Tracey, and others.

Padlet board shared with CSDS team

Full size image

6.2 Stage 2: Conduct of the Design Thinking Workshop

The Design Thinking session was conducted at the Innovation Hub of the CSDS building, which is equipped with interactive screens and digital post it notes that allow people to work and annotate from their phones and send directly to the room’s screens. The duration of the workshop was 3 h and comprised two distinctive parts: Part 1 Problem Exploration, and Part 2 Future Focus.

6.2.1 Part 1: Problem Exploration

Participants were grouped into teams of four. An icebreaker activity was conducted, in which a short sample video with an example of a problem that might occur in a healthcare context was shown. The QUT group used this example to walk CSDS participants through the approach for analysing a video using PAC. In addition, the icebreaker activity ensured participants were able to engage with the session material and technology.

Following the icebreaker, Problem Exploration using the participant-recorded videos began. The first stage was a 40-min User Centred observation and Team Brainstorming of the problem by watching other participants’ videos. The intention was to broaden the participants’ perspectives of the problem by understanding it from different points of view. In their teams, participants discussed each of the videos and annotated their ideas and comments on digital post it notes. Annotations focused on both positive (gains) and negative (pains) events and situations observed (Fig. 2).

Fig. 2
2 parts. Top. A photo of a woman exploring various options on the digital screen of the C S D S innovation hub. Two more individuals are standing behind her and staring towards her. Bottom. The closeup of the digital screen has various options under context, people, and two more.

Problem exploration at the digital screens of the CSDS Innovation Hub (top image), and Visual clustering with digital post-it-notes (bottom image)

Full size image

The second stage was a 10-min PAC Analysis and Visual Clustering. PAC stands for People-Activity-Context, and it is an analysis strategy employed in Design. The application of this strategy to the video-recorded observations allowed us to break down the observations recorded as annotations into workable categories for discussion and analysis. Each team discussed their annotations and categorised them as either People related, Activity related, or Context related. Where an annotation belonged to multiple categories, the annotation was duplicated and moved to each respective category (Fig. 2).

The final stage of Part 1 was a 15-min team discussion and idea generation of what aspect of the problem to work with, and what possible solutions there might be. The intention of this discussion was to develop some initial thinking about potential avenues to explore in Part 2 of the workshop. At the end of Part 1, participants had either annotated in digital post-it notes on the room screens or had employed paper and markers and pinned this up on the room walls. Each team’s work was visible for all participants to view. A 30-min tea break followed.

6.2.2 Part 2: Future Focus

Part 2 was dedicated to resolve in more detail the solutions that each team had proposed in Part 1. We employed the LEGO® Serious Play® methodology and ™LEGO bricks as a resource for participants to ‘make’ a solution. LEGO® Serious Play® is a methodology that engages non-designers in design related activities with a strong co-design focus [26]. Since 2010 it has been available as a community-based model, where Lego bricks are employed as a tool to generate innovative ideas and solutions to a predefined problem. A key component of the methodology is the open-ended play context that enables fast and adaptable activities [27]. The physical nature of Lego pieces makes it suitable for the collaborative and creative ideation stages of co-design [27, 28]. In the Future Focus session participants used Lego bricks for Design Thinking in four key stages.

The first stage was a warm-up in which participants performed a quick prototyping activity, requiring them to make a boat with 10 Lego pieces. The goal was to engage participants and familiarise them with the Lego process. The second stage was a 20-min individual prototyping task. Following on from the PAC analysis, the identified problem was discussed in teams, and each participant created an individual prototype as a metaphor to represent the challenge and/or solution, taking turns to share their interpretations and findings (Fig. 3). The third stage required the co-creation of an ecosystem of how their individual solutions could work together. This involved the groups physically combining the individual Lego prototypes, utilising storytelling strategies to reflect on key themes that emerged from the final combined model. They could make changes to their Lego prototypes in order for all solutions to be part of the one eco-system. This prototyping process was used as training to aid communication with diverse stakeholders, to create a shared story, and identify key insights to guide future actions and decision making.

Fig. 3
A photograph captures a group of individuals sitting around chairs making prototype models using blocks.

Interpreting ideas with LEGO blocks

Full size image

In the final stage of Part 2, each group consolidated and pitched their solution ecosystem. This involved creation of a video reflecting on the key discoveries and insights that had emerged from the co-design process, consolidating the workshop activities and outcomes, using role playing and/or storytelling methods to synthesise the identified problems, insights and take-aways for future development. Each team pitched their idea to the room.

7 From Observations to Prototyping and Storytelling

The adapted LEGO® Serious Play® method was enhanced by the participants’ qualitative discoveries through the use of observation and the PAC analysis of the videos. These preceding activities were critical to setting up the problem definition and pathways for solutions, as it enabled the participants to have a shared experience of the identified problem and collectively uncover insights that would be difficult to obtain without the use of observation. Observing the pre-recorded videos and PAC analysis as a co-design exercise enabled a more tangible and immersive context to be explored and allowed for new insights by participants as they observed scenarios first-hand that would have been potentially difficult for them to witness and/or experience otherwise. As suggested by Allen, “observational research can highlight patterns of behaviour or idiosyncrasies that would normally be overlooked” [29, p. 24]. A key consideration is the content and quality of the pre-recorded videos to avoid generalisations or oversimplification. The participants’ feedback reflected this, in identifying the importance of selecting a suitable problem or theme for the exercise, and what constitutes a useful scenario to record.

Encouraging a creative mindset for the purpose of a Design Thinking session was possible through the introduction of a range of methods typically employed by designers (observation, PAC analysis, prototyping, storytelling) that enabled participants exploring a complex health scenario to brainstorm and ideate in diverse ways. As discussed by Ku & Lupton this ‘Health Design Thinking’ approach can aid the generation of novel ideas and solutions to complex health problems, where observation and research informs “active making and discovery” [30, p. 34]. This experience correlates with the literature. In developing the LEGO® Serious Play® methodology, Kristiansen and Rasmussen found there was value in enabling groups “to see the entire system that they were part of. This helped them envision scenarios and be better prepared for the future. By having a complete picture of their current system—a perspective that involved team roles, relationships, and culture—and testing the system with specific scenarios, team members gained more confidence, insight, and commitment in dealing with future events” [31, p. 3] through the prototyping and co-design process.

Co-design was a critical component of the workshop design and embedded into both the Problem Exploration and Future Focus sessions. As suggested by Ku & Lupton, co-design enables the synthesis of team members’ diverse and overlapping areas of knowledge within the design process [30, p. 24]. It is widely recognised that healthcare is an area undergoing rapid transformation, with shifts to more collaborative partnerships across health sectors [32, p. 186]. Employing co-design workshops with diverse stakeholders, like these run by CSDS, enables a collaborative evaluation and redesign of complex health systems that can be more representative of the diverse knowledge and skills of key stakeholders. It not only facilitates a collective understanding of the problem, but ideally an inclusive and shared vision of future solutions and pathways to action in the design and delivery of health services.

8 Lessons from the Pilot Workshop

Feedback sheets were provided to the CSDS team following the workshop to provide comments about the strategy of the overall workshop. Feedback was then later clustered into themes relative to each stage of the workshop. Overall, the CSDS team considered it a unique method and saw the benefit of it for some types of process examination. Observations are now under consideration for use in the CSDS Design Thinking facilitation kit. Despite the generally positive reception to the approach, there were several issues and limitations identified. The clustered feedback for each stage of the workshop is summarised in the following sections.

9 Pre-activity Feedback

The following positive feedback was identified in relation to the pre-activity:

  • Feedback was useful

    The feedback provided by the QUT team on unsuitable videos was found to be useful. It enabled the CSDS team to rethink their approach and ensure the video content was suitable for observation.

  • Useful for developing a shared understanding

    The video creation process led to a greater and shared understanding of many of the problems experienced by participants. It was noted that the videos helped to prompt thinking about problems from others’ perspectives and understanding their own conceptualisation of the problem.

Feedback for improvement of the pre-activity, which included the preparation of videos for use in the workshop, included the following:

  • Video requirements and purpose were not clear

    The CSDS team had not used videos for the purpose of observations before, which presented a challenge for them to understand the objectives of the videos. Many of the initial videos created by CSDS were interviews with staff involved with various processes. The QUT team evaluated these to be unsuitable, as they did not include observable information. With further clarity of the purpose, the CSDS team were able to create suitable videos. It was suggested by CSDS staff that the instructions needed to have clearer requirements and explanation of purpose.

  • Facilitator in problem identification

    It was suggested that it would be useful for a facilitator to be present during problem identification and initial planning of the videos. This would have helped clarify requirements and led to the selection of suitable problems to be filmed.

  • Focus on one video

    In the interest of covering a range of potential problems, each participant was required to create an individual video. The feedback received was that it may have been beneficial to narrow down the problem and focus on one video only, potentially created in groups.

  • Difficult to create and inflexibility

    Some participants found the process of creating a video difficult due to the specific format and challenges for articulating the chosen message. It was noted that video is a suitable medium for representing some issues but not all issues. A suggestion was to allow for greater format flexibility by allowing participants to select alternative formats to communicate their message, depending on what is most suitable.

10 Workshop Feedback (Part 1: Problem Exploration)

The following positive feedback was identified in association with the first stage of the workshop:

  • Understanding others’ perspectives

    Making sense of observations from different people’s perspectives was identified to be a helpful and enjoyable approach.

  • Usefulness of PAC tool

    Although there were comments identifying the difficulty of understanding the PAC tool, other participants noted that the PAC tool was a useful approach and could be easily understood. It was helpful to participants to further understand the problem from different contexts. It also encouraged ideation of solutions of aspects not considered before.

  • Facilitators helped understanding

    During the workshop, each group was accompanied by a facilitator. This was found to be highly valuable when discussing the problem, and to keep the team with the scope of the workshop timing.

In the first stage of the workshop delivery, the following themes were identified in the feedback for improvement:

  • Broader group discussion on videos

    Participants were organised into small groups to work through workshop activities. Participant feedback indicated that it would have been good to discuss directly with the broader group to clarify any questions about the observations.

  • PAC framework needs more understanding

    The PAC framework was introduced at the start of workshop session. However, participants identified that they did not fully understand the framework and would need to spend further time to understand it.

11 Workshop Feedback (Part 2: Future Focus)

The following positive comments were received in the second stage of the workshop delivery:

  • Shared understanding

    The eco-system activity was powerful to demonstrate the value of all ideas and how different perspectives could be integrated into a single workflow. The making of a model with Lego was considered as an unexpected and successful strategy that allowed for more comprehensive discussion between individuals and across teams, effectively adding conversations and the sharing of ideas.

  • Useful for ideation

    The use of Lego to represent ideas demonstrated that even abstract processes can be distilled into diverse parts or problem solving and then combined to form a larger system. Participants identified that the Lego took them out of their comfort zone, pushed their creative thinking and assisted in articulating their thought process.

In the second stage of the workshop delivery, the following comments for improvement were received:

  • More discussion time needed

    Participants commented on the need for more discussion on the implementation of solutions and ecosystems they created. This included suggestion of identifying components that could be practically implemented over the short and long term.

  • Better clarity on purpose

    It was identified that the purpose of the Lego activity was not clear and that participants were unsure of where it was leading. More clarity around the outcome was needed, to scaffold the Lego prototyping process as a creative problem-solving activity.

12 Post-activity: Action and Implementation

In addition to comments on the pre-activity and workshop delivery, feedback was provided on next steps and any additional items. A common area of feedback was regarding the translation of workshop outcomes into actions and implementations. It was identified by QUT and CSDS that this would give participants an opportunity to reflect on outcomes as potential tangible actions that could then be explored further in follow-up sessions.

13 A Co-design Process: Rethinking the Use of Observations in Design Workshops for Healthcare Innovation

We compiled the process and issues identified in the feedback questionnaire and presented it into a MIRO board (Fig. 4), for a co-design review session with CSDS.

Fig. 4
An illustration depicts multiple attributes under general, pre-activity, and problem exploration. The sticky notes on the right read as follows. Pre-activity with some guidance. Video example as part of the pre-activity. Short intro of the P A C in the pre-activity. Make the videos in teams.

Miro board employed for co-design session with CSDS team (top image), and Improvements identified throughout the co-design session (bottom image)

Full size image

We organised a 1-h session to discuss the three areas identified in Fig. 1: general issues, pre-activities, and problem exploration, to also include discussion on future focus. We contextualised the discussion from the perspective of CSDS clientele, identifying who might be future participants of these type of sessions if they were to deliver it as part of their Design Thinking for Innovation services.

CSDS’ clientele is defined as: anybody within healthcare; that includes people working in a Hospital, the Royal Brisbane Hospital (RBH) administration team—supervisors and management (not clinical background), teams coordinating outpatient administration, food service, admin, and executives coordinating teams—allied health, social workers, pharmacists, pathology staff, physio, occupational therapists, speech pathologists, podiatry, midwifery.

The CSDS team felt that this type of approach that includes video recording observations is more suitable for anyone who is involved in a physical process of healthcare services (Fig. 4). They identified the need to use observations in:

  • scenarios with more physical attributes—patient journey, system testing in a particular department.

  • patient flow—a systems view of how patients interact with the healthcare system.

  • Emergency Departments which are looking at this, but all the way through the process is useful

  • hospital avoidance process.

  • exploring how we interact with patients—empathy and building disclosure.

  • investigating patient-centric patient experience.

The redesign proposed a three-session workshop approach:

  • Pre-activity workshop (1–1.5 h)

    The pre-activity workshop would facilitate the problem identification and a shared understanding of the scenario to be explored. The workshop would be run approximately 2 weeks before the second workshop. Goals and activities would be:

    • Problem identification.

    • Pain and Gains to enable an open forum for discussion.

    • Play exemplar video and observations introduction.

    • Scaffold how to approach the video and form teams to create the nominated number of videos.

  • Main workshop (2 h)

    The main workshop is largely unchanged, with Part 1 and Part 2 remaining.

    PART 1

    • The exemplar video and observation’s introduction are removed (to run in the Pre-activity workshop).

    • The Pains and Gains method is removed (to run in the Pre-activity workshop, this allows more time to focus on the PAC analysis).

    PART 2

    • Part 2 remains unchanged. The takeaways from Part 2 are further expanded on in the new post-activity workshop session

  • Post-activity workshop (1–1.5 h)

    The post-activity workshop has been added to unpack the ecosystem findings further and identify implementable solutions. The workshop should be run approximately 2 weeks after the main workshop.

    • The findings are unpacked with tools used by CSDS currently, such as the Desirability, Feasibility, Viability method.

    • Actionable tasks are able to be consolidated and allocated.

    • Other stakeholders are also able be included to aid discussion and future pathways.

    Key to this workshop is providing an ongoing transparency on how the workshop findings are being actioned.

14 Discussion

This project provided the opportunity to contribute with new knowledge in Design Thinking strategies for healthcare innovation. The project delivered: (i) a HCD Design Thinking strategy suitable to use in the context of healthcare practices and; (ii) a workshop protocol that was tested and experienced first-hand by the CSDS team tested. Our HCD Design Strategy consists of four parts: problem exploration, future focus, prototyping and storytelling. Our workshop protocol proposes three stages of implementation: Stage 1 pre-workshop, Stage 2 main workshop, Stage 3 post-workshop.

Heiss and Kolshagina [13] discuss the use of Tactile Tools for Design Thinking in healthcare contexts through five case studies. They found that such tools enable participants to map meanings onto forms or objects (e.g., diagrams) they had created as part of the Design Thinking process. In Heiss and Kolshagina’s [13] study the use of shapes allowed participants to create processes, patterns, and represent roadblocks, and in doing that, the tool provided a medium to discuss complex healthcare challenges as well as interdisciplinary collaboration across clinical teams and designers.

The Co-Design session enabled us to reflect on the workshop delivery and redesign the workshop strategy to align with CSDS’s training structure and client expectations. The session critically evaluated the participants’ experiences of the workshop alongside the CSDS perspective. Key was the ability for CSDS to be immersed in the training, viewing it from the participants and also the trainer’s role.

The project is not yet complete. CSDS believes in a train-the-trainer style ‘do one, teach one’ approach. Therefore, validation of this process before they introduce this approach within their practices requires another session where they deliver it to us. This learning mode would help them build confidence in the process.

Three key reflections for designers or educators working in healthcare are:

  • The choice of scenario is critical to using the tools effectively. The patient journey was identified as a valuable case study and suitable for use. Look for a scenario that has a systems view of how patients interact with the health system.

  • Reflect the current emphasis in Queensland Health on the Patient, and Empathy in the healthcare context.

  • Be aware of your language. Rather than the term ‘problem,’ a better term could be ‘scenario’ to encapsulate and look at processes that are also working well.