better outcomes by design- improving health and wellbeing through participation

8/17/2019 Better Outcomes by Design- Improving Health and Wellbeing Through Participation

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SDN Touchpoint Vol. 6 No. 2 –

Better Outcomes by Design

SDN Touchpoint Vol. 6 No. 2 –

Better Outcomes by DesignMain Takeaways


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CONTENT SUMMARY

Capture User Experiences As they happenUsing smartphones to gain user insights

Humanising Healthcare through hands, heads and hearts

Using Patient Insights to design future health solutionsCollaborating with patients through online communities.

Exciting Times to be in healthcareService Design work-out on innovation in healthcare

Health Matters: Reframing Design in Community Health Interventions

5% Design Action’: Cancer Screening Service Innovation in Taiwan

Interview: Geke van Dijk and Bas Raijmakers

Better outcomes by design


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Whilst mobile researchparticipants won't give long,drawn-out responses, it ispossible to keep 'checking in'and to capture feelings andbehavior over a period of time –

weeks, for example – as opposedto more traditional research,which relies on spending anhour or two with a respondent,or an evening at most.

75 %Smartphone and tablet penetration has risen toseventy-five percent indeveloped countries, paving theway for mobile research tobecome a serious alternative tosome more traditional methods.

Smartphones allow us to capturedata that is both real-time richerin content, bringing us closer tothe moments when and whereexperiences actually happen.

CAPTURE USER EXPERIENCES AS THEY HAPPENUsing smartphones to gain user insights

For more information please refer to pages 17-18 of this PDF.


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Humanising

Healthcare through

H

A N D SE A D S

EARTS

Patients aren’t just lines in a spreadsheet,records in a CRM system, or the list of ailments

in their medical records. They are people. Andwhile lots of healthcare companies are talkingabout “humanising the healthcare experience,”I get the feeling that they’re not always crystalclear on what that means.

Kerry Bodine

HEAD

HEART

HAND

For more information please refer to page 19 of this PDF.


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To develop meaningful relationships and improve medical outcomes,health service providers need to connect with their patients.

Specifically, they need to touch them at their hands, heads & hearts as follows:

HA N D SE A D SEARTS

Hands: by using wearable bodymonitors that track everything frommiles walked and calories burned to thequantity and quality of a person’s sleepand so on. To make health-relatedwearables a reality, companies havehad to overcome significant technical

challenges like shrinking sensors andextending battery life. But of course, thereal challenge now comes in developinguseful services that will allow us toimprove our health by taking fulladvantage of our quantified selves.

Hearts: Medical providers need tounderstand their customers’ underlyingemotional drivers — both on theaggregate and individual levels — andmake sure that the patient experienceis aligned appropriately.

Heads: Healthcare providers should aim tomake every single patient (and payer) interactionas easy as possible. Good case: Josh Kushner,founder of venture capital firm Thrive Capitalshared his frustration with the health insurancespace during a recent interview on CNBC’sSquawk Box, a U.S. cable news program.

“I opened my insurance bill one day and I realizedthat I had absolutely no idea what it meant. I’meducated, I run a growing business, and I didn’tknow what my benefits were with doctors orhospitals I had in my network, how to file a claim…”Being the young entrepreneur that he is, Joshdecided to create a new type of health insurancecompany — from scratch. His goal was to “make itsimple, transparent, understandable, and relatableprimarily through technology, data, and design.”



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USING PATIENT INSIGHTS TO DESIGN FUTURE HEALTH SOLUTIONS.Collaborating with patients through online communities.

People with a chronic conditionare increasingly taking activecontrol of their health, sharinginformation about treatmentsand finding great support intheir interaction with fellowpatients.

Patients risk becoming isolatedif they fail to be understood bytheir peers and loved ones.

Chronic patients participatingin online communities becomemore knowledgeable, feelbetter supported socially andmore empowered

Three potential routes for UCBto facilitatepatient communication:

Raise public awareness: Patients are not ‘armed’ toeducate their broader circle of friends andacquaintances about their condition and its impact.

Trigger communication planning: The ‘excuse’ fornot engaging in the conversation about theircondition is often the ‘lack of opportunity’ or that theynever ‘planned’ to talk about it.

Articulate their status and talk to others.



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EXCITING TIMES TO BE IN HEALTHCARE

Across the world, there is a realization andunderstanding that existing healthcare systems

will not deliver what the future requires.

The World Economic Forum estimated that,unless current trends reverse, chronic diseases

will cost the world $47 trillion in treatments andlost wages by 2030.

At a time when healthcare finances are so constrained whilstdemands are increasing, the need to design more effectivesolutions is self evident. Healthcare providers seem to face clearchoices: they can work towards containing healthcare spending by

restricting services, or request often-overworked staff to work evenharder. Alternatively, of course, they can seek to think differentlyabout the way they deliver their services using available resourcesand design fundamentally different service innovations. But notonly is this harder to do, it also brings more risk than working withexisting process parameters because whole-service innovations aremore complex and likely to question existing organizationalboundaries, or to challenge current healthcare management.



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Nudging behaviors:

New tools and incentives arebeing designed to improvedecision making about personal

healthcare and treatmentoptions by promoting moreproactive models of health andby helping people better trackand understand theirday-to-day behaviors.

Rather than viewing future predictions as overwhelming obstacles, healthcareleaders and entrepreneurs are starting to see a landscape full of opportunities by

focusing on some emerging healthcare themes:

Empowered patients:

Equipped with moreknowledge about theirconditions and lifestyles,citizens are starting to take a

key role in determining whenthey interact with thehealthcare system and howtheir care is delivered. Newservices are emerging to helpempower patients withtechnology and to provideaccess to social communitiesand peer-to-peer advice beforevisiting a professional.

More joined-up care:

Digital platforms have evolved tofacilitate communicationbetween doctors, patients andstaff, ensuring that patientrecords and treatment plans arereadily accessible and cuttingdown internal inefficiencies.

EXCITING TIMES TO BE IN HEALTHCAREFor more information please refer to page 22 of this PDF.


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An increasing number of people now

turn to the internet first to look uptheir symptoms and then decidewhether or not to consult aspecialist, or to question a givenexpert diagnosis.

SERVICE DESIGN WORK-OUT ON INNOVATION IN HEALTHCARE

Taking patients seriously entails

helping them to better understandthe complexity of their situation. Forinstance, by making the costs of caremore transparent, and givingpatients the opportunity to bettercompare different care providers,patients can decide for themselveswhat they find most important andwant to pay for.

Sharing personal experiencesbetween patients who havesimilar diseases would enable

the exchange of tips and tricksand help them to cope betterwith a disease.

Take patients seriously.



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Shifting the mindset of medical

staff from ‘patients’ to‘consumers’ is needed for thehigh quality care the medicalprofessional should aim for.

If hospitals differentiate their

service level to specific targetgroups, This would give thehealthcare consumer morefreedom of choice, while thehospital would be able tomanage their revenues andmargins more effectively.

Cutting costs does notnecessarily have to lead to alower level of service or adecline in the patientexperience. The bigchallenge for healthcare is to

become more efficient and, atthe same time, improve the

patient experience.

BILL

SERVICE DESIGN WORK-OUT ON INNOVATION IN HEALTHCAREFor more information please refer to page 23 of this PDF.


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One way of improving the service levelwithout extra costs would be to betteralign specialists, based on a moreintegrated patient approach. This couldlead to both an improved experience forthe patient and a smoother internal

process. Patients could also be givenbetter information and guidancebeforehand, so that they better knowwhat to expect. This would create abetter flow and experience during theirhealthcare process.

Hospitals could, for instance, involveprevious patients as volunteer‘experience experts’ to better preparethe new patients. The new patientswould get more attention than currently,which could lead to less stress, a

smoother care process, and an improvedexperience at the same time.

PATIENT PATIENT EXPERT


SERVICE DESIGN WORK-OUT ON INNOVATION IN HEALTHCARE


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Individuals withchronic healthproblems – obesity,diabetes, problems withmobility – would oftenrate their health as“very good” or even“excellent,” exposingthe insufficiency of ourown understanding ofwhat health means tothis group.

When designing healthinterventions, thepatient’s voice shouldbe part of the design

development.

ob e s i t y

d i ab e t e s

e x c el e n t !!



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5% DESIGN ACTION:CANCER SCREENING SERVICE INNOVATION IN TAIWAN

8,2

13 The World HealthOrganization haspredicted that in the nexttwo decades, the numberof global cancer patientswill rise by as much asfifty-seven percent. Deathscaused by cancer will also

rise from 8.2 million to 13million per year.

In fact, more than fiftypercent of cancers could

be prevented or diagnosedearlier if people ledhealthy lifestyles andreceived regular cancerscreenings

To increase the cure rateand reduce the cost ofcancer treatment, Taiwanhas begun the provisionof free-of-chargescreenings for oralcancer, breast cancer,colorectal cancer and

cervical cancer.

5% Design Action wasable to determine

reasons behind people’sdecisions not to getcancer screenings,including the feeling thatthey were too healthy, toobusy, too embarrassed ortoo old to get one.



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,, When you aim to change howgovernments engage with citizensand other stakeholders in policydevelopment, or if you want todevelop a service in a traditionalproduct-oriented company,organizational change is neededand that won’t be achieved with asingle project. It needs longer

partnerships that result in changeon an organizational level.’’

Interview: Geke van Dijk and Bas RaijmakersFor more information please refer to page 30 of this PDF.


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BETTER OUTCOMES BY DESIGNBETTER OUTCOMES BY DESIGN

“The physician should not treatthe disease but the patient whois suffering from it”

Maimonides (12th centuryscholar and physician )

Translating the human-centered

nature of service design into apatient-centered focus forhealthcare and wellbeing ishappening worldwide.


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REFERENCESREFERENCES

time Whilst mobile researchpartici or installing a digital television set


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The advent of mobile research provides radical new opportunitiesin the field of user research. Smartphones allow us to capture datathat is both real-time richer in content, bringing us closer to themoments when and where experiences actually happen. Whilesome organisations have been active in the field of mobile research for several years, it is still not being implemented across themainstream. However, smartphone and tablet penetration hasrisen to seventy-five percent in developed countries, paving theway for mobile research to become a serious alternative to some

more traditional methods.

Mobile research offers severaladvantages:

• Whenever, wherever: users wakeup and go to bed with their smart-phones giving us constant accessto their daily lives, anywhere theygo, at any time.

• Rich data: smartphones allow usto collect all kinds of data likevideo, audio, photos, quotes andimages, reflecting the diversity ofthe user’s life.

• In-situ data collection: capturingthe defining (true) moments asthey happen, instead of hazymemories after the fact.

• Metadata: smartphones automati-callyprovide us with valuablemetadata such as time, durationand GPS locations. This combina-tion of users’ active and passivefeedback (data and metadata,respectively) blurs the traditionalline between qualitative and quan-titative data.

• Real-time monitoring: progress ismonitored in real-time, allowing aleaner and more dynamic process— the learning comes faster.

The nature of smartphones meansthat they are currently best suitedfor capturing bite-sized responses,instead of extensive, detailed feed-back: users are not likely to engagefor more than a few minutes at a

time. Whilst mobile researchpartici-pants won’t give long, drawn-outresponses, it is possible to keep‘checking in’and to capture feelingsand behaviour over a period of time— weeks, for example — as opposedto more traditional research, whichrelies on spending an hour or twowith a respondent, or an evening atmost.While mobile research is still

in its infancy, new functionalitieswill open up new opportunities andapplications in the future. The ques-tion is: where does its applicationharness the best results? To date,we have found that our mobileresearch platform, Contextmapptm,yields excellent results in thefollowing three types of userresearch.

• Mobile diary studies

Use it as a sensitiser, or as astand-alone explorative study tocapture behaviour over extendedperiods (e.g. the course of a week)and uncover the ebb and flow ofuser needs.

• Customer journey research

Let people map their experiences

and gain direct insight into theirneeds throughout the customerjourney; discover how they experi-ence a brand’stouchpoints.

• Explorative product and serviceresearch

Zoom in on people while they arepreparing a meal, consuming media

or installing a digital television set.Get a detailed impression of theirlives using photo and video, all thewhile saving time by not having toactually be with the respondent.

A practical look atContextmappTM

The work that we have done for

Philips Kitchen Appliances nicelybrings to life the benefits of usingmobile technology. The goal of theresearch was to find out whichkitchen appliances people wereusing: which ones they liked best;why they preferred these; how theywere using them; and the overallcontext in which they used them. Inpursuit of this, a group of peoplewere asked to participate in a

mobile diary study, over the courseof a week. With studies like this weusually invite between fifteen andthirty people. It is not a hard andfast rule, but we find that this‘sweet spot’ allows enough insightto bring some robustness, withoutbeginning to be overwhelmed bythe volume of data. However, in thisparticular case, we built a landingpage and asked, via Philips’ Twitteraccount, for people to join, which led

to forty-five completed diaries. Theresearch was prepared using theContextmapptm dashboard. Ourdashboard enables one to easilysetup research projects by creatingseveral assignments. These assign-ments consist of a set of questions:open, multiple choice, multipleimage (e.g. a set of emoticons) orratings/sliers and photo, audio orvideo tasks. Depending on the type

Capture User Experiences asThey HappenUsing smartphones to gain user insights

of assignment being created types be made in any format Questions 2 Fit around the user’s life behaviour it inspires during


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of assignment being created, typesof question can be chosen, as wellas the statement to be reviewed. Inthe case of Philips, we posed sug-gestions like: ‘Take a picture of theingredients of your meal’ and askedthem questionssuch as: ‘Whatkitchen appliances do you like bestand why?’ Automated push notifi-cations helped respondents

remember to complete assignmentsat the right moment.As soon as the project was live,users were asked to completeassignments on their smartphones.Participants could choose the orderof assignment in the way thatsuited them best. Results wereuploaded immediately, allowingboth us and the client to havereal-time monitoring of progress. Inother, more linear, projects, we couldset a particular order of assign-ments or it could be a set of repeat-able assignments, allowing forself-reporting.As soon as the first participantsfinished, the hunt for interestinginsights started! The online dash-board gives two options: ‘ExportData’, which results in a download-able Excel and folder with mediafiles, or ‘Visualise Data’, which

offers three choices:

• A chronological timeline, whereall results are plotted.It is a visual representation of thejourney of the participant, whichwe call ‘experience storyboards’,enabling a dive deep into one per-son’s story

• A selection of results, which can

be made in any format. Questionsare chosen and the results arevisualised for all participants,which makes it easy to comparedifferences between participants

• Search for results, enabling oneto find all results that contain acertain keyword, like ‘blender’ or‘irritating’

The research Philips conductedhelped them to create a segmenta-tion based on cooking behaviourand pinpointed particular needsand problems, per segment. Theteam from Philips was particularlyexcited about the richness of thedata. As the client said: “It was goodto not only get the answer, ‘I’m cook-ing pasta’, but to also be able to seewhat kind of pasta it was, whetheror not the person cut the vegetablesthemselves, the kitchen they werepreparing it in, and so on. We gotanswers to questions we didn’task!” Six mobile research princi-ples Along with Phillips, we haveconducted many similar projectsand, in doing so, learned a greatdeal. Based on our experiences,here are six research principles:simple guidelines that help you

set-up your project, should you beinterested in doing so.

1. Make it fun!

Using visuals, gamificationelements and a light tone of voicehelps to enhance the experienceand thus engagement of the partici-pants: creating a place where theycan be creative helps to get moreout of them.

2. Fit around the user s life

Try to anticipate and understandhow the research fits into the life ofthe user; smart usage of push notifi-cations and timely reminders canhelp people remember to partici-pate in a way that is also convenientfor them.

3. Improve and test

Always conduct the researchupfront yourself. You’ll find thatsome questions and assignmentsare best asked differently. Iterate,then iterate again.

4. Ask ambiguousquestions

Ambiguous questions allow yourparticipants to fill in the assignmentas they see fit. This way, you will getthe answers that really matter tothem, as opposed to steering theiranswers in a certain direction.

5. Monitor progress

See who is on track and help slowerrespondents if needed. This is far

better than a cultural-probe exer-cise being completed just before theactual interview takes place, as wehave sometimes experienced usingtraditional methods.

6. Visualise results

Use the rich data that you havegathered. It helps you during analy-sis to understand needs and

behaviour, it inspires duringideation and concept developmentand it convinces clients, becausethey can literally see what is goingon. Altogether, mobile research isan area in rapid development,where a lot of (technical) innovationis still to be expected. Think abouttext mining, smart algorithms, auto-matic face and image recognition,

integration of ‘iBeacons’, co-re-search and automatic data process-ing and visualisation. And we hav-en’t even mentioned wearables,such as Google Glass.

We’re entering an exciting newtime, where we don’t think ofpeople as simply consumers, but ascollaborators in the design process.We have built our mobile tool withthat philosophy at its centre. Andalthough we’re not fully there yet,we have learned a lot and keeplearning more every day. Andimproving. And learning. Andimproving. We’re interested ingetting in touch with other agen-cies that want to share or gainexperience with mobile research.

Robbert-Jan van Oeveren

It’s our heads that help us navigate ones. This is obvious when we’re look-


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HumanisingHealthcare

through HANDS

E A D S

EARTS

The following should not be news to you, but it’s sometimes easy to forget: Patients aren’t just lines ina spreadsheet, records in a CRMsystem, or the list ofailments in their medical records. They arepeople. Andwhile lots of healthcare companies are talking about‘humanising the healthcare experience,’ I get the feeling thatthey’re not always crystal clear on what that means.

To develop meaningful relationshipsand improve medical outcomes, health

service providers need to connect withtheir patients. Specifically, they need totouch them at three key body parts.(Don’t worry. This doesn’t require aphysical exam, and it won’t be awk-ward at all.)

Hands

With four long fingers and nifty oppos-able thumbs, our hands help us dothings. As healthcare consumers, we allhave things that we’re trying to dowhen we visit a particular provider —like fixing a chipped tooth, filling aprescription, or filing an insuranceclaim. Healthcare companies help usaccomplish these goals (or perhaps youprefer to call them ‘tasks’ or ‘jobs to bedone’) by developing useful servicesand getting them into our hands. Wear-able body monitors represent a majoradvancement in this area. Up untilrecently, we’ve had limited ability to

continuously monitor what’s happen-ing in our bodies. In 2004, I worked for

BodyMedia, the maker of one of thefirst wearable body monitors on themarket. Today, a host of companies likeJawbone (which acquired BodyMedialast year), Nike, and Fitbit marketwearable devices that track everythingfrom miles walked and calories burnedto the quantity and quality of a person’ssleep. To make health-related wear-ables a reality, companies have had toovercome significant technical chal-lenges like shrinking sensors andextending battery life. But of course,the real challenge now comes in devel-oping useful services that will allow usto improve our health by taking fulladvantage of our quantified selves.

Heads

The head is the seat of our cognitivefaculties and information processingfunctions like perception, recognition,and memory recall.

It s our heads that help us navigatehealth insurance websites and fill outintake forms at the doctor’s office.These experiences shouldn’t make ourheads hurt. Healthcare providersshould aim to make every single patient(and payer) interaction as easy as possi-ble. Josh Kushner, founder of venturecapital firm Thrive Capital shared hisfrustration with the health insurancespace during a recent interview on

CNBC’s Squawk Box, a U.S. cable newsprogram. “I opened my insurance billone day and I realised that I had abso-lutely no idea what it meant. I’m educat-ed, I run a growing business, and Ididn’t know what my benefits werewith doctors or hospitals I had in mynetwork, how to file a claim…” Being theyoung entrepreneur that he is, Joshdecided to create a new type of healthinsurance company — from scratch. Hisgoal was to “make it simple, transparent,

understandable, and relatable primarilythrough technology, data, and design.”

The result is Oscar, a New YorkCity-based startup with more than40,000 physicians in its network. TheOscar website includes a robust provid-er search that includes physician feesand patient reviews; an online quotingtool that enables prospective customersto fill in their marital status, number ofkids, income, and zip code in a quickand easy Mad Libs format; a Face-

book-like timeline of the subscriber’smedical history; and, of course, clearbilling information that’s aggregatedper visit.

Hearts

The heart is our metaphorical emotionalcore. And although we might try to denythis, it’s impossible to disconnect ourfunctional needs from our emotional

ones. This is obvious when we re looking at a patient who’s going throughchemotherapy or a woman who’sgiving birth to her first son — but it’sequally true when we’re just trying toeat a healthy take-out meal or join agym. And don’t forget that we bring ouremotions with us when we go to work,so businessto- business healthcarecompanies aren’t off the hook in thisarea! Medical providers need to under-

stand their customers’ underlyingemotional drivers — both on the aggre-gate and individual levels — and makesure that the patient experience isaligned appropriately. To helpchildren’s medical imaging go from‘terrifying to terrific,’ GE Healthcarecreated its Adventure Series, a set ofdecals that turns CT scanners, MRImachines, and entire imaging roomsinto a pirate ships, jungles, and coralreefs. Similarly, my own dentist in San

Francisco has placed flat screen moni-tors on the ceiling and plays comedyshows during exams to help patients ofall ages refocus their attention andreduce their anxiety about their dentalprocedures.

Kerry’s Take

At its essence, ‘humanising the health-care experience’ means rememberingthat patients are human — andconnecting with patients’ hands, heads,

and hearts is a critical step towardsthis goal. But the three H’s of customeranatomy are equally valuable for anyservice designer in any industry. Sokeep them with you as you’re workingtoday and ask: Will this decision oraction connect us with our customers’hands, heads, and hearts?

Kerry Bodine

opportunities for patient solu- problem for patients dealing


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The challenges of living with a chronic disease Today, patients have more information than ever before about theirdiseases and treatment options. Think about the wealth of data onthe online community PatientsLikeMe, where more than 220,000patients share their stories about over 2,000 conditions andPatient.co.uk, which has 16 million visits each month. Patientempowerment is one of the main trends in today’s digitalisedhealthcare landscape. People with a chronic condition areincreasingly taking active control of their health, sharing

information about treatments and finding great support in theirinteraction with fellow patients.

But while large numbers ofpatients connect with distantfellow sufferers via online com-munities, they often have aharder time communicatingabout their disease in theirimmediate environment: withfamily, friends, neighbours or

colleagues. Those close to themdo not always seem to under-stand them as well as fellowpatients do, leaving them attimes feeling powerless, ratherthan empowered. The problem isthat many symptoms — such asfatigue and depression — andtheir impact are hard to explain.Patients struggle to communi-

cate these less-tangible prob-lems to the people closest tothem, causing physical and emo-tional distress. Living with achronic illness, for examplerheuma toid arthritis (RA), cantake its toll on the patients’ well-being and personal relation-

ships. To overcome communica-tion challenges in relation tothese ‘significant others’ and toavoid social isolation, InSitesConsulting and UCB, a biophar-maceutical company focused onchronic diseases, created aresearch community for patientsdiagnosed with a chronic condi-tion. The goal was to identify

pp p ltions that help them improvetheir ability to communicateabout their illness to their lovedones and others who they social-ise with.

Empowering patients in anonline community

We invited fifty US participantswith chronic health conditions,more specifically RA (62%) andepilepsy (38%). A three-weekonline research community wasthe backbone of this patientresearch project. The objectivesof the community were to• connect participants from allover the country on an online

closed platform• enable participation in a flexi-ble asynchronous way to maxi-mally accommodate patients’abilities and• allow participants to sharetheir stories and exchange tipsand tricks in an inspiring learn-ing environmentThe community research projectstarted with ‘patient immersion’,a one-week online ethnographicmultimedia module wherepatients shared their personalstories with the moderator in aprivate forum. In the secondweek, the participants wereinvited to connect with peerswho were suffering from thesame research is merely thestarting point in tackling a big

p bl p l gwith a chronic disease, it caninspire the health industry totake patient-support servicesforward. Why is it relevant toservice design? This study illus-trates the huge potential ofpatient collaboration for thehealth industry to co-create rele-

vant patient chronic condition, todiscuss common grounds andshared needs in an online dis-cussion forum. In the last week,we invited all participantstogether (across therapy areas)for the patient brainstorm dis-cussions, to ideate about poten-tial patient communication sup-port services for the future. Thisgradual approach helped

patients to open up to the moder-ator and to each other, resultingin 2,552 posts and 367 photosand video testimonials. Further-more, the community approachhelped to bring new insight tothe table and bring down the‘silo thinking’ of the differentdepartments involved within theorganisation. Carl Vandeloo fromUCB explains:“It was very interesting to allowpatients with epilepsy and RAto communicate with each other,as patients struggle to expressthemselves in both diseaseareas. This was a great way togroup the UCB teams of differentareas to think about solutionsserving more than one patientgroup.”

Using Patient Insights toDesign Future Health SolutionsCollaborating with patients through online communities

Three roads towards cannot read minds and that they “My husband said to me,Th t ti l t


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h ee oads to a dsimproved communication

The research confirmed thatpatients risk becoming isolatedif they fail to be understood bytheir peers and loved ones.Patients participating in theresearch brought up three

potential routes for UCB to facili-tate patient communication. Thefirst and most important routeaccording to patients is to raisepublic awareness. Patients arenot ‘armed’ to educate theirbroader circle of friends andacquaintances about their condi-tion and its impact. Examples ofhow to raise public awarenessinclude more general public

campaigns about their conditionor simple instruction sheetsexplaining to ‘outsiders’ whichcritical incidents may occur.Patients would benefit greatlyfrom the public having anincreased knowledge abouttheir condition. They wouldexperience it less as a stigmaand would not need to explainthings that are self evident. Thesecond route is to trigger com-munication planning about theircondition with their significantothers. The ‘excuse’ for notengaging in the conversationabout their condition is often the‘lack of opportunity’ or that theynever ‘planned’ to talk about it.Patients do not even realise thattheir significant others others

yneed to integrate routines fordiscussion into their lives. A sys-tematic self-reflection by thepatient can be of great help, suchas a diary to keep one’s finger onthe pulse of one’s status and cur-rent services. First of all, chronicpatients participating in online

communities become moreknowledgeable, feel better sup-ported socially and more em-powered. Second, the resultspresent new opportunities forhealth care providers such asUCB to improve the patientexperience, for caregivers andfor patients living with a chronicdisease.needs. It stimulatestalking about the condition,

avoiding frustration or evenisolation. The third route is tosupport patient expression.Patients who have a difficulttime expressing their thoughtsand feelings about their diseaseshould have tools that facilitatecommunication, particularlywhen they need practical sup-port or emotional relief. The com-munity members made us real-

ise that many patients are inneed of simple status expressionaids. For example, refrigeratormood magnets are a tool that canenable patients to express theirstatus, both in terms of how theyare feeling and for rating thephysical burden.

These 3 routes could helppatients better reflect on theirfeeling, articulate their statusand talk to others. While this ser-vices. First of all, chronic patientsparticipating in online communi-ties become more knowledge-able, feel better supported social-ly and more empowered. Second,the results present new opportu-nities for health care providerssuch as UCB to improve thepatient experience, for caregiv-ers and for patients living with achronic disease.

y b ,‘Honey, I love you, but if youdon’t tell me how you’re feeling how am I supposedto know how I can helpyou? I can’t read yourmind.’ He was so right. Ihad to trust him enough to

confide in him when I ex-pected him to be there tosupport me.” — RA patient

Raise awareness

Trigger planning

Support expresion

Three potential routesfor UCB to facilitatepatient communication:

Magali Geens

Anouk Willems

...

online service that lets you instantlyconnect with a clinician via the net and

technologies provide deeper insightsand individualised coaching to activate


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At a time when healthcare financesareso constrained whilst demands areincreasing, the need to design moreeffective solutions is self evident.Healthcare providers seem to face clearchoices: they can work towardscontaining healthcare spending byrestricting services, or request

often-overworked staff to work evenharder. Alternatively, of course, theycan seek to think differently about theway they deliver their services usingavailable resources and design funda-mentally different service innovations.But not only is this harder to do, it alsobrings more risk than working withexisting process parameters becausewhole-service innovations are morecomplex and likely to question existingorganisational boundaries, or to chal-lenge current healthcare management.This, let’s face it, is a scary prospect forsome. And yet, we know that simplyremoving unwanted variation and nonvalue-added activities from existinghealthcare processes won’t deliver themore significant quality and productiv-ity gains we need. While the economicrealities of current healthcare modelstell a different story, we are starting tosee compelling signs of change againstsome of the unsettling healthcare chal-lenges. The NHS responded by creat-

and mobilise staff, patients and thepublic to collaboratively improve healthand care.2 Despite slow governanceprocesses, a multitude of health,lifestyle, wellness and social tools arealso being developed for the healthcareindustry. As designers, in this contextwe are presented with a great chance

to help healthcare leaders create andembrace new service innovations anddevelop services that are poised toimprove health outcomes in the longrun. Rather than viewing futurepredictions as overwhelming obstacles,healthcare leaders and entrepreneursare starting to see a landscape full ofopportunities by focusing on someemerging healthcare themes:3

Empowered patientsEquipped with more knowledge abouttheir conditions and lifestyles, citizensare starting to take a key role in deter-mining when they interact with thehealthcare system and how their careis delivered. New services are emerg-ing to help empower patients withtechnology and to provide access tosocial communities and peer-to-peeradvice before visiting a professional.As a result, patients will be betterprepared to communicate with theirdoctors during consultations to ensure

connect with a clinician via the net andask personalised touchpoint 6-2 51better outcomes by design medicalquestions to help diagnose commonconditions professionally and quickly. Itis reported that more than 7 millionpeople visit the site each month, tradingquestions and answers with a pool ofabout 46,000 doctors.

More joined-up careHealthcare providers are starting to usenew technologies, social platforms anddata systems to streamline the wayinformation is spread across organisa-tions to deliver a more personal andconsistent model of care. Secure onlineplatforms are offering new ways fordoctors to share research and adviceabout conditions that fall outside oftheir expertise, while analytics toolsinterpret patient data to support diag-nosis. Digital platforms have evolved to

facilitate communication betweendoctors, patients and staff, ensuringthat patient records and treatmentplans are readily accessible and cuttingdown internal inefficiencies.The NHS Hack Day5 aims to under-stand some alternative models forprocurement within health technologyand brings together healthcare andtechnology professionals to improveNHS IT. Patients Know Best6 letspatients and clinicians easily access

medical records that would typically betrapped in siloed IT systems. It givespatients anytime access to their medicalrecords and to doctors who may belocated across the world, and can, forinstance, interpret blood tests remotely.

Nu dging behavioursNew tools and incentives are beingdesigned to improve decision makingabout personal healthcare and treat-ment options by promoting more proac-tive models of health and by helping

and individualised coaching to activateusers around wellness and exercise.New feedback loops often encourageusers to make small behaviouralchanges over time. Early outcomesshow healthier citizens less reliant onpublic resources. Sherpaa7 providespatients and businesses with 24/7access to doctors over the internet tostem rising healthcare costs and to

provide more personalised patient care.Online consultations are designed toresolve health concerns quickly andconveniently, whilst companies' health-care spending is analysed to suggestways to save money, boost benefits andto expand coverage to more employees.Across the globe, we can see earlyadopters acknowledging some of theemerging healthcare themes andcreating alternative services that havethe potential to make the wider systemmore resourceful. This presents an

exciting new paradigm and frameworkfor designers to work within too, wherehealthcare is seen as an ongoingconversation between people, ratherthan something that happens whensomeone falls ill

References

1 http://www.wef rum.org/news/non-communicablediseases-

cost-47-trilion-2030-new-study-relea sedtoday2 http://changeday.nahs.uk and https://changeday.nhs.uk/healthcarer adicals 3 http://www.psfk.com/publishing/future-of-health-2014 4 https://www.healthtap.com5 http://nhshackday.com6 http://www.patientsknowbest.com7 https://sherpaa.com

Exciting Times to be inHealthcare

Across the world, there is a realisation and understanding that existing health-

care systems will not deliverwhat the future requires. The World EconomicForum estimated that, unless current trends reverse, chronic diseases will costthe world $ 47 trillion in treatments and lost wages by 2030. 1

while the hospital would be able toth i d i

in the project to illustrate how serviced i t ib t t l h A


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In April 2014, the Dutch chapter of the Service Design Networkorganised the 6th Service Design Work-out. Around thirtyparticipants from various backgrounds came together to discussthe added value service design can bring to the healthcare sector.The session kicked off with a presentation by Jiska de Wit,innovation manager at the UMC (Utrecht Medical Center). Shediscussed the trends and issues the care sector currently faces.After a brief Q&A, the participants worked in groups on tacklingthe three questions below. This article summarises some of the

outcomes of these discussions.How to better support increasinglydemanding care consumers? Whileadecade ago it was still obvious to firstturn to a specialist in case of medicalproblems, patient routines have gradu-ally changed. An increasing number ofpeople now turn to the internet first tolook up their symptoms and thendecide whether or not to consult aspecialist, or to question a givenexpert diagnosis. As a result, the inter-action with the medical professionalhas changed. How to deal with thistrend? And how can this be turned intoan advantage for better services?Taking the patient seriously is at thecore of answering this trend. Shiftingthe mindset of medical staff from‘patients’ to ‘consumers’ is needed forthe high quality care the medicalprofessional should aim for. A servicedesign approach can support this, forinstance by identifying different type of

on how to use this trend as an advan-tage. What type of information wouldbe most useful to provide to patients?Sharing personal experiences betweenpatients who have similar diseaseswould enable the exchange of tips andtricks and help them to cope betterwith a disease. Also, providing highquality information on what is good,and why, could be useful for preventionpurposes. Related to this is the idea ofthe ‘quantified self’: by developing abetter understanding of your own bodyand behaviour, behaviour change canbe triggered in a positive way. Inreturn, this data for research purposescan be very interesting for the medicalprofessionals.

Can a hospital improve itsservice level despite the need tocut costs?

manage their revenues and marginsmore effectively. The group questionedif this ‘airline-type of service segmenta-tion approach’ could be translated tohealthcare, while safeguarding sensi-tivity to ethical issues. Another way ofimproving the service level withoutextra costs would be to better alignspecialists, based on a more integratedpatient approach. This could lead to

both an improved experience for thepatient and a smoother internal process.Patients could also be given betterinformation and guidance beforehand,so that they better know what to expect.This would create a better flowandexperience during their healthcareprocess. Hospitals could, for instance,involve previous patients as volunteer‘experience experts’ to better preparethe new patients. The new patientswould get more attention than currently,which could lead to less stress, asmoother care process, and animproved experience at the same time.How can service design thrive in ahealth care sector that is dominated bya focus on eff iciency and measuringeffects? Instead of opposing theefficiency and evidence-focused man-agement approach, it seems more effec-tive to explain that service design isactually valuable in a complementaryway. In many sectors, efficiency controland experimentation are equally

important to safeguard continuity andinnovation. It would definitely helpservice designers to develop a usefulmetaphor to explain the value of servicedesign in terms that resonate with man-agement aspirations. For instance, howdoes a five-star restaurant innovate?Building up a portfolio of best practicesfrom projects in other organisations andsectors is also a useful way to convincestakeholders in management. Thesereferences show how service design

design contributes to real change. Asthe management team does not havethe direct experience on the ground,they rely on this type of evidence. Makesure the ambassadors can tell the story,it will have a stronger impact whenthey tell the story. Attention should alsobe given to actively creating opportuni-ties to measure the success of theservice design project from the start.

This issue should be addressed earlyto be able to integrate ways to measurethe value of the results. This could beincreased customer satisfaction, but itmight also be a new type of key perfor-mance indicator (KPI). In health care,and specially in academic hospitals, itseems that being the best in class orthe first to do something, is veryimportant. service designers shouldthus also look for aspects that will helphospitals be the best or first in some-thing.

Conclusion

In a plenary wrap-up to the session, weshared the results from the variousgroup discussion and reflected withJiska how this could contribute to herdaily work in the UMC. She mentionedthat the discussions really inspiredher: “…it was good to be amongstservice designers again.” She alsoseemed very fired up by the lastdiscussion and indicated that it wouldreally help if service designers wereable to find a way to the connect the‘efficiency and measuring’ culture ofhospitals, thereby lowering the thresh-old of experimenting with it. The objec-tive of the Service Design Work-outs isto offer an opportunity for people work-ing in service organisations to presentsome of the issues they face in theirwork and ask the service design com-munity to think along with them. The

Service Design Work-out onInnovation in Health Care

M. Fairbanks School of Public Healththe previous year to see if and how the

research process and protocols. Theywill also collaborate with the design


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Garden on the Go® is an obesity-prevention effort initiated byIndiana University Health. This year-round, mobile,producedelivery program provides fresh, affordable vegetablesand fruit to Indianapolis neighbourhoods in need. In 2013, designresearchers from the Herron School of Art and Design, Garden onthe Go® leadership from IU Health and scientists from theFairbanks School of Public Health (FSPH) at Indiana Universityinitiated the Health Matters study. Health Matters aims tounderstand how individuals in underserved urban communities

define health in order to make health interventions more relevant to community health perceptions. This paper, specifically focusingon an interdisciplinary academic research process, will discussthe challenges and roles of designers in integrating theirdisciplinary practice into health care interventions.

What does health mean to YOU?The objective of Health Matters is toidentify new, people-centred defini-tions of health. We know that healthperceptions affect self-care: in otherwords, if you think you’re healthy whenyou actually aren’t, you won’t pay atten-tion to your health. Biometric readingssuch as weight and blood pressure areclinical measurements that don’t reflectpeople’s perception of being healthyfrom individual perspectives. Howmight we make these measures mean-ingful to people to motivate them toimprove their health? What other mea-sures are relevant to health percep-tions and how might we learn what

they are? From a service design coursecame an interdisciplinary partnershipIn 2012, we developed a project in thecourse entitled ‘People Centred ServiceExperience Design” in which we part-nered with Garden on the Go® toconduct a customer survey to learnabout customers and their needs.Instead of pursuing a conventionalsurvey method, we applied servicedesign methods such as a customerjourney map1 and personas2 thatprovided Garden on the Go® leadershipwith a comprehensive description ofthe people who use their service.Garden on the Go® conducted a healthassessment survey with the Richard

the previous year to see if and how theprogram impacted health through vari-ous biometric measures (weight, bloodpressure, etc.) The study revealed thatthe traditional methods of collectingqualitative information in healthassessment were inadequate for com-prehensive health measurement inunderserved urban populations, andprovided limited information. The team

noted that individuals with chronichealth problems — obesity, diabetes,problems with mobility — would oftenrate their health as “very good” or even“excellent,” exposing the insufficiencyof our own understanding of whathealth means to this group. Having seenour participatory approach to customerresearch, Garden on the Go® and theresearchers from FSPH saw the poten-tial of service design methods to helpbetter understand their population andproposed to develop a collaborativeresearch project between the HerronSchool of Art and Design, FairbanksSchool of Public Health and IU Health.

Working together: design-ers, public health scholars,and service providers

Since the project launched in 2013,Herron has served as the primaryresearch conveners and has taken thelead in developing research methods,gathering data and data analysis. As ofJune 2014, the study is concluding itsdata collection phase. At the completionof the study, Herron will be responsiblefor disseminating study findings backto the communities involved. The FSPHpartners, based on their communitybased research practice in the publichealth context, have provided consulta-tion and assistance in aligning servicedesign practice with academic

will also collaborate with the designresearchers in preparing the reports,abstracts and manuscripts to dissemi-nate findings to the academic commu-nity. IU Health has provided logisticalsupport and access to Garden on theGo® customers. Additionally, IU Healthwill assist in sharing the research finings with the community when theproject is completed.

Three different, but shared,aims

Often, health promotion interventionprograms are developed and imple-mented for target populations by publichealth professionals who possessvalidated, yet incomplete, understand-ings of the people they are trying toserve. When designing health inter-ventions, the patient’s voice should be

part of the design development.3 Whenthis inclusion does not happen, theprograms are not as effective as theycould be or, worse yet, may be rejectedout of hand. The findings of our studyaim to improve understanding of theculture of our target population —Garden on the Go® customers — withregard to their perceptions of healthand what they perceive to be a healthydiet. Under this overall study objective,each project partner has defined aspecific goal. The IU Health Garden on

the Go® aims to gain a better under-standing of what fruits and vegetableswould be attractive to their customersas well as how to assist them in theselection, preparation, and presentationof fresh fruit and vegetables as part ofa healthy diet for their families andthemselves. They are also interested toknow how they might improve theirservice overall, and expand theirOn-the-Go model to other programs that

Health Matters: ServiceDesign in Community HealthInterventions

would be relevant to their customers.The Richard M Fairbanks School of

Pre-research: An articula-tion of ethical practice in

who wish to use interdisciplinarycollaboration as a venue and means for

types was necessary, particularlybecause of the mix of disciplines


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The Richard M. Fairbanks School ofPublic Health aims to develop new,relevant and patient-centred measuresfor health, in alignment with curren-tresearch agendas seeking patientcentred outcomes. The service designresearchers at the Herron School of Artand Design aim to establish a collabora-tive research model by providing rele-vant design methodology for rich data

collection and deep analysis, connect-ing patients and healthcare providers/researchers by co-designing forhealthcare outcomes. measures forhealth, in alignment with currentresearch agendas seeking patientcentred outcomes. The service designresearchers at the Herron School of Artand Design aim to establish a collabora-tive research model by providing rele-vant design methodology for rich datacollection and deep analysis, connect-ing patients and healthcare providers/researchers by co-designing forhealthcare outcomes.

Design research in academ-ic partnerships: new terri-tory for designers

The main purpose of this article is toshare our experiences and challengesas designers in interdisciplinaryacademic research settings, and toaddress how we can integrate ourdisciplinary practice into health careinterventions as equal collaboratorswith research partners. Our researchprocess consists of six stages: pre-re-search, research design, recruitment,data collection, analysis and dissemintion. The project is currently conclud-ing the data collection stage and weexpect to reach the disseminationstage in the fall of 2014.

tion of ethical practice inresearch

Academic research goes through apre-research phase in order to ensurethat studies are ethically sound. Theinstitutional review board (IRB) — alsoknown as an independent ethics com-mittee or ethical review board —receives research proposals involvinghuman subjects and reviews and moni-tors biomedical and behavioural stud-ies to protect the safety and rights ofparticipants. IRB approval is requiredfor all such research undertaken at theUniversity. Current IRB review isdesigned for specific disciplines suchas medical or social science researchand is not optimally designed fordesign research practice. The vocabu-lary and overall framework of the IRBapproval process emphasises ethical

codes of medical research, includingthose relating to invasive procedures(such as drawing blood) and full disclo-sure of research methods. It alsoaddresses coercion, inequities inpower and social status and otherpotential psychological impacts. Theshift into an academically rigorousresearch practice entails a steep learn-ing curve for design researchers inorder to navigate the review systemfrom submission to approval. The IRBprocess is valuable for designresearchers for considering the ethicalaspects of research in design work.Questions of recruitment bias (manipu-lated selection of research partici-pants), misrepresentation of studyprocesses and potential forcoercion atany point in the study are among theissues that can cross the boundaries ofrespect and trust and ultimately under-mine the validity of the findings.What we learned: design researchers

collaboration as a venue and means forvalidation, and those who wish todisseminate the impacts of design tothe public need to become familiar withthe IRB in order to engage at a level onpar with specialists in other fields.Those who do not receive certification(typically, via an onlineeducationalmodule) are not permitted to interactwith study participants or potential

study participants. As design researchbecomes more integrated into interdis-ciplinary research, it is time for designto define its code of ethics from a disci-plinary perspective, to integrate it intoinstitutional mechanisms for researchsuch as IRB and to educate designersabout established research standardsoutside of commercial practice.Research design: what is beyond meth-ods and tools? In developing interdisci-plinary research projects — specificallywhen establishing a new project —there are a few things that requiremutual understanding from projectpartners: what are the common goals ofthe research endeavour, what is thedisciplinary language related toresearch processes and what are themethods to achieve the goal?Although this study was developedbased on a shared view of the noveltyand value of design research in datacollection, we design researchers hadonly a vague notion about what data

analysis entailed in public health. In thisstudy, we used photo, voice and groupdiscussion as methods for data collec-tion. Participants take photos of theirdaily lives relating to health, food andlifestyle and participate in informal, butstructured, follow-up discussions withthe research team.These combined methods generatethree types of data: photographs, jour-nal entries and discussions. A cohesiveapproach to data analysis across data

because of the mix of disciplineswithin our team. Our partners’ open-ness to learn alternative approaches indata analysis enabled usto lead theprocess of analysis. This stage provid-ed opportunities for us to reflect on thedifferences between public health andservice design in data analysis and tofurther articulate the methodologicalaspects of design research. While data

analysis in public health is executed byindividual researchers (generallspeaking) using a theoretical frame-work that feeds new knowledge backto the discipline, service designersexternalise the analytical phase andfacilitate collective analysis includingall stakeholders who share an under-standing of the defined population. Forinstance, we invited the Garden on theGo® counter staff and a communityliaison for data analysis. While they arenot certified academic researchers,they possess an intimate knowledgeand the most profound understandingof the audience through their frequentinteractions. What we learned: currentliterature in design research tends tofocus on methodology and tool making.Designers who wish to work in part-nership with academics will increas-ingly find it necessary to develop adisciplinary understanding of designresearch that encompasses the processof inquiry beyond the collection of data.

We need to define our own disciplinaryposition.

Recruitment: building theteam

Recruiting participants for researchprojects is frequently difficult, timeconsuming and inefficient. Additional-ly, once participants are secured, thereis often a problem with adhering to the

research process: participants drop outor fail to comply to research protocols

ples for ethical treatment of humansubjects as regulated by the IRB

of the following people: Lisa Cole andKaliah Ligon Indiana University Health;


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or fail to comply to research protocols.Health Matters was at an advantage inrelation to study recruitment: weconsulted with our partners at the IUHealth outreach team and selected fourof the active Garden on the Go® stops asour research sites and began workingwith community leaders at each stop tocoordinate days for recruitment,camera pick-up and discussion. Our

communication with the leadership ateach of the sites was key: we wereintroduced at community and residentmeetings, used community meetingtime for discussion groups and wewere able to leave boxes for camerapick-up on site in office spaces. Inter-actions outside of labs enabled us tobuild relationships with the partici-pants, to have a better understandingof the organisational cultures and toadjust our research plan accordingly.

Data Collection: Designingan experience of engage-ment

Framing the participant’s experiencefrom a service design point of view, weaimed at optimisation by identifyingand connecting the touchpointsinvolved in the research process. Fromrecruitment to data collection atdiscussion sessions, every touchpointin engaging with research participantswas carefully designed in order tooptimise their experience. Ourapproach in designing the participants’experience was complementary to ourpartners’ expertise in the area ofhealth research. The attention that wepaid to the participant experience inthe data collection process prioritisedthe person rather than the data and, ineffect, put us, as designers, in a moreprotective role aligned with the princi-

subjects as regulated by the IRB.

Conclusions

Our work with IU Health/Garden on theGo® and the Fairbanks School of PublicHealth demonstrated the potential forsimultaneous interdisciplinary collabo-ration in both the public realm and theacademy. Design research methods

yield rich, contextualised data forservice design (applicable to Garden onthe Go® as they expand their menu ofservices) and, for improved under-standing of underserved populations, itis a key learning outcome for publichealth. In the process of our research,our partnership has raised the profileof all three groups in community healthcircles through community presenta-tions. On the academic end, the work isa cutting-edge example of communi-ty-engaged research in health,currently a broadly supported area ofhealth research in the United States.Our process was made efficient by theclear definition of each of our roles: ourassociation with Garden on the Go®provided institutional support thathelped with recruitment, the School ofPublic Health provided a theoreticaland discursive home for the study,contextualising our data as new find-ings in a field unfamiliar with designresearch and design provided

patient-centred methods. Our nextsteps include codifying our methodolo-gy within public health research, andwith an ultimate aim of institutionalis-ing design research as a legitimatecomplement to existing data collectionmethods for patient-centred research.

Acknowledgments

This paper would not have been possi-ble without the generous contributions

Kaliah Ligon, Indiana University Health;Terrell Zollinger and Cindy Lewis, Rich-ard M. Fairbanks School of PublicHealth; Ashley Bailey, Brian Crain, Brid-get Hawryluk, Andrea Haydon, andNick Walters, Herron School of Art andDesign; Niki Girls and Lynn Rodg-ers,Concord Neighbourhood Centre;Tysha Sellers, Edna Martin ChristianCentre; Valerie Moore, Indianapolis

Housing Agency.Health Matters was funded in part withsupport from the Indiana Clinical andTranslational Sciences Institute funded,Grant Grant # UL1TR001108 from theNational Institutes of Health, NationalCentre for Advancing TranslationalSciences, Clinical and TranslationalSciences Award.

References

1 Stickdorn, M., & Schneider, J.(2010).This is service design thinking :basics-tools--cases. Amsterdam: BISPublishers.2 Lidwell W, Martin B. (2012) UniversalMethods of Design, 100 Ways toResearch Complex Problems, DevelopInnovative Ideas, and Design Effective Solutions. Gloucester, Mass: RockportPublishers3 PCORI Methodology Committee, (2013),The Patient Centred Outcomes

Research Institute MethodologyReport. http://www.pcori.org/re-search-wesupport/ research-method-ology-standards/

Helen Sanematsu

Youngbok Hong

Helth talks

What you’re eating?

...

Designers have consistentlyencountered obstacles when trying

sionalism and authoritativenessthat have been established in the‘5% Design Action’


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Public health service is a complex and highly specialiseddiscipline, which has made it a tough nut to crack in terms ofeffective service design. Making use of an open and innovativestructure, this article aims to share a public health serviceinnovation in Taiwan — an innovative and sustainable design for acancer screening service — through which we hope to discoverhow organisations engage in learning and co-creation with theirstakeholders.

The World Health Organisation1 haspredicted that in the next twodecades, the number of globalcancer patients will rise by as muchas fifty-seven percent. Deathscaused by cancer will also rise from8.2 million to 13 million per year.Cancer has been at the lead of thetop ten causes of death in Taiwan-for thirty years running. On aver-age, one Taiwanese person is diag-

nosed with cancer every five min-utes and forty seconds. An evenmore astonishing fact is that theTaiwanese government spends U S$1.83 billion on cancer-relatedtreatment a year, which accountsfor twenty-seven percent of thetotal budget of the National HealthInsurance system. In fact, more thanfifty percent of cancers could be

prevented or diagnosed earlier ifpeople led healthy lifestyles andreceived regular cancer screen-ings. To increase the cure rate andreduce the cost of cancer treatment,Taiwan has begun the provision offree-of-charge screenings for oralcancer, breast cancer, colorectalcancer and cervical cancer, but thenumber of people who have takenup this opportunity has been low

thus far, resulting in unnecessaryincreases in social and medicalcosts and, despite the good inten-tions behind the program, placing agreat burden on the shoulders ofhealth and welfare policies.

Service innovation: a weakspot in cancer screening

encountered obstacles when tryingto introduce innovative ideas intopublic health services, and thecancer screening service serves asa good example of this in threeways:

Process and concepts of 5%Design Action

First, innovative ideas simply basedon user orientation seem to beincompatible with the inherent spe-cialisation and authoritativeness ofcancer screening services and,therefore, medical and public healthpersonnel may not be able to imple-ment such ideas. On top of users’needs and feelings, the validity and

legitimacy of the service providerare essential parts of servicedesign. In addition, Taiwan’s cancerscreening service involves a widerange of stakeholders, includinggovernment departments, medicalinstitutions, and relevant non-profitorganisations. Because of this, holis-tic innovative experience cannot beimplemented unless these stake-holders are effectively incorporated

therein. Second, public healthservices are resistant to innovation.Unlike general privately ownedbusiness, public services do not facefrequent external competition andthe pressure to continuously inno-vate and make breakthroughs. Mostpublic health service personneloffer only one standard option, justlike the Ford Model T. The profes-

that have been established in thehealth discipline result in people’sfirm adherence to specific services.Such adherence is a major obstaclestanding in the way of innovation:for example, demanding that physi-cians with authority to take intoaccount the needs of their patientsand their families or persuadinghospitals with enormous profits tointroduce service design is a task oftremendous difficulty. Third, acertain level of social cost may beinherent in public health service.The National Health Insuranceprogram is a compulsory service inTaiwan, and everyone has the‘right’ to get cancer screenings, butmost people do not realise that such

screenings are also somewhat of an‘obligation’. The additional medicalcosts caused by late diagnosis areshared by society as a whole,including those who get regularcancer screenings. This strangeform of social inequality needs to bechanged by incorporating an inno-vative model into cancer screeningservices.

5% Design Action: innova-tion in cancer screeningservices

‘Social innovation relies not somuch on ideas of design as practi-cal design action’. Such is the prin-ciple behind 5% Design Action, anon-profit design platform initiatedby Taiwanese designers in the

‘5% Design Action’:Cancer Screening ServiceInnovation in Taiwan

spring of 2013. However, in the past,there are few opportunities for

research team started to collect andanalyse secondary data, invite rele-

City Hospital and twelve healthservice centres in Taipei City); and

Transfer


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there are few opportunities formany designers to participate inthe service development process,even though they are passionateabout social issues. As a result, 5%Design Action plays a critical role asbeing a platform that invitesdesigners and other professionalsfrom a range of fields to pitch in five

percent of their free time. There-fore, they can join 5% Design Actionwith the main service providersand stakeholders to provide theirknowledge and professional skillsin designing new solutions to socie-tal issues or challenges. Centredaround service design, the objec-tive of 5% Design Action is to uncov-er potential innovation opportuni-

ties and solutions, and the plat-form’s first project was titled ‘Inno-vating in Screening Services andCancer Prevention’. The projectconsisted of five stages:

1. Target2. Recruit3. Co-Create4. Transfer

5. ShareTarget

From the very beginning of thisproject, 5% Design Action wantedthe participation of designers withan ambition for social innovation. Tocut straight to the core of the prob-lems involved, the platform’s

analyse secondary data, invite relevant stakeholders to take part inin-depth interviews and to con-struct a network of cooperation. Atthis stage, the primary goal was toidentify problems and focus onproducing practicable results thatsatisfied the needs and conditionsof service providers. This goal was

achieved through discussionbetween organisations and expertswho had been working in this field.Through these initial results, 5%Design Action was able to deter-mine reasons behind people’s deci-sions not to get cancer screenings,including the feeling that they weretoo healthy, too busy, too embar-rassed or too old to get one. At the

end of this stage, the objective ofthis project was agreed upon: toimprove the overall cancerscreen-ing experience and increase peo-ple’s screening acceptance andparticipation rates.

Recruit

After discussing with the stake-holders, clarifying the problems,

and agreeing upon the objective, 5%Design Action made the next stepforming a cooperative connectionwith various organisations, includ-ing:1. Government institutions (HealthPromotion Administration andDepartment of Health of the TaipeiCity Government);2. Executive departments (Taipei

service centres in Taipei City); and3. Non-profit organisations (fourcancer prevention foundations).

At this stage, 5% Design Actionrecruited volunteer designers withan interest in this theme: a total ofeighty volunteer designers werewilling to participate in this project,with areas of expertise spanning

graphic design, product design,interactive design, service designand fields related to public health.

Co-create

In the third stage, 5% Design Actiondivided the eighty volunteerdesigners that they had recruitedinto twelve groups. Each groupworked individually in exploringn-

service gaps and innovation oppor-tunities pertainingnto oral cancer,breast cancer, colorectal cancer and-ncervical cancer. The explorationresults were discussednby the con-nected organisations as 5% DesignAction sent representatives to thescreening sites to observe andinterview the people there. Servicedesign inspired 5% Design Action to

visualise the needs of ordinarypeople and service personnel toguide co-learning. It also helped inidentifying the core problems in thecomplicated context of a servicesystem. Moreover, a series of discus-sions were conducted in the form ofworkshops and online platforms todevelop innovative design conceptsand service models.

Near the end of this project, 5%Design Action developed ten con-crete-innovative concept designs,such as visualising the cancerscreening process to reduce peo-ple’s fear of it, establishing brandimages that related to the citizens’lifestyle and promoting cancer

screening service throughnetworks of friends, family andneighbours. While the guestdesigners have returned to theirwork, the research team continuesto exploit the result. Many detailsand minor modifications stillremain to be worked out throughdiscussions with executive depart-ments. After six months of discus-

sion, 5% Design Action is preparingto launch four new services in thethird quarter of 2014, and is aimingto continuously innovate in variousservice procedures.

Share

In the last stage, ‘Share’, 5% DesignAction yielded results that were notspecifically targeted at the design

of the cancer screening service, butrather for the co-learning andco-creating ‘process, as a coopera-tion between designers from a vari-ety of fields and related participat-ing institutions. The course of thisproject has also been made into adocumentary2, in an effort to sys-tematically accumulate and transferknowledge or to create new values

in the future built on the existingfoundation. In 2013, 5% Design

Co-seeing, co-learning andco-creating

ipation rates. In response, thedesigners of 5% Design Action

vative ideas in a systematic way.With the experience and knowl-


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, gAction also organised a premiereand a conference built around theproject documentary, invitingpeople from important organisa-tions related to cancer. The pre-miere was a huge success, attract-ing social and media attention, aswell as constructing a channel for

communication between cancerscreening service providers. Fur-thermore, 5% Design Action devel-oped a design thinking toolkit fortraining healthcare personnel. Withthe toolkit and the results of thisproject, more people will be abletake part in service innovation incancer screening. In addition, thisproject was invited to share its

results and findings at the 2013National Cancer Prevention Confer-ence, in which more resourceswere expected to be provided for5% Design Action in the future, andthe phrase ‘innovation in cancerscreening services and cancer pre-vention’ was adopted to convey tohealthcare experts the value ofservice design.

Discussion and conclusions5% Design Action has been develop-ing service innovations for cancerscreening and other healthcareissues. Given the results and find-ings of this project, we have come tothe following conclusions, providedas a reference for others workingon the practical side of servicedesign:

co-creating

Empathising with users may beimportant for good service design,but designers and service provid-ers must respect each other’sprofessions and attempt to commu-nicate from each other’s perspec-

tive. A superior service designinvolves a long dialectical process,by which attractive, practicablesolutions can be co-created. Thisfaintly echoes the “collectiveimpact” proposed by Kania andKramer (2011). Complex social inno-vation should not be confined to aclosed system of thoughts involvingonly one area or unit. Interdisciplin-ary observation (of demands and

problems), learning and action arethe only solution for applying com-prehensive thought and innovationto a service system.

The crucial role played bynonstakeholders

Innovation is far from a new thing toboth the organisations and the per-

sonnel involved in cancer screen-ing: the problem is that competitionand dependent relationshipswithin the ecosystem have led to alack of communication and coopera-tion. Organisations would rather bedescribed as being ‘responsible’than invest effort in finding ways toimprove the service experienceand increase screening test-partic-

g gengaged this problem from theangle of the non-stakeholder: theyprovided assistance to theseresponsible organisations in imple-menting feasible innovations. Thisapproach, surprisingly, increasedthese organisations’ willingness tocooperate. This is similar to the con-

cept of the “free agent”, as developedby Kanter and Fine (2010). Theybelieved that, in the social network-ing era, free agents will be regardedas necessary promoters of socialinnovation and design throughcrowdsourcing.

Recording, accumulatingand re-creating knowledge

The average tenure of a publichealth nurse in Taiwan who per-forms cancer screenings is 2.7years. This high turnover hasobstructed the passing on of experi-ence. To accumulate results forlong-lasting participation, a docu-mentary was made about this proj-ect, and thepremiere and eventsestablished an interdisciplinary

platform of dialogue.Moreover, 5% Design Action hassummarised its research findings,as well as the demands and per-spectives of users and of executivedepartments, for the purpose ofeducational training. It evenproduced ‘innovative ideas cards’ toaccumulate knowledge and contin-ue encouraging the output of inno-

pedge acquired from this project, 5%Design Action expects executivedepartments to get acquaintedwith the ideas behind the methodsand values of service design and togain innovative energy from insidetheir organisations. In addition,design can be introduced to more

healthcare areas, thereby co-creat-ing more innovative solutions andopening up more valuable opportu-nities.

References

1 Kania, J., & Kramer, M. (2011). ‘Col-lective impact’. Stanford Social

Innovation Review, 9(1), 36-41.2 Kanter, B., & Fine, A. (2010). Thenetworked nonprofit: Connectingwith social media to drive change.San Francisco, CA: Jossey-Bass

Chen-Fu Yang

Chih-Shiang Wu

Shu-Shiuan Ho

Tung-Jung Sung

service design. The initial meet up wasactually triggered by clients who told usth t it th t did t k

offer a different perspective. Thesedifferent perspectives come naturally

ith th t l ti k i b t


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In this issue, editor Jesse Grimes interviews Geke van Dijk and BasRaijmakers and learns about their involvement in service designnetworks, their Anglo-dutch company STBY, and design research.

Back in 2008, you both took part inthe the first of the SDN’s Global-Conferences, in Amsterdam. Thatputs you in a good position to lookback on the growth of servicedesign in Holland in the years

since then. What are the develop-ments you’ve seen, and what chal-lenges remain for Dutch servicedesign practitioners?

In 2008 only a relatively small group ofpeople in The Netherlands were awareof service design. There has been ahuge growth in the involvement ofpractitioners in this field since then.There has been an strong uptake inindustry (among both agencies and

client organisations) as well as in edu-cation and government. By now servicedesign has firmly spread across manydifferent sectors, such as health care,utilities, transport, telecom, and hospi-tality. It has also been integrated inpioneering innovation programsbetween industry and academia, suchas the CRISP programme (2011-2015)where 60 organisations from academiaand industry collaborate to createknowledge about designing Product

Service Systems. The main challenge atthe moment in all these settings is tomove from projects to partnerships.Projects simply don’t achieve enoughlasting or systemic change and theissues that are addressed are often too

big or ‘wicked’ to be solved in a singleproject. When you aim to change howgovernments engage with citizens andother stakeholders in policy develop-ment, or if you want to develop aservice in a traditional product-orient-ed company, organisational change isneeded and that won’t be achievedwith a single project. It needs longerpartnerships that result in change onan organisational level.

There has been the (independent)‘Service Design Netwerk Neder-land’ established for many years.Who makes up that group, andwhat activities have you carriedout?

In the summer of 2008 we initiated theDutch service design network as aresult of an inspiring meet up betweenthe four agencies who were at thattime pionering under the banner of

that it was crazy that we did not knoweach other yet. So we had a drink anddecided to organise shared activitiesfor a wider community. One of our firstactivities was to support SDN withorganising the international servicedesign conference in Amsterdam. Sincethen we have organised more than 50local events, such as talks, discussions,

workshops, drinks, etc. After a fewyears of happily co-existing next to theinternational SDN, we discussed thisyear to maybe to transform the Dutchnetwork into a chapter within the inter-national network. It makes more sensenow the field is growing so much andalso consolidating internationally. Wehave now extended the core group oforganisers with extra people for indus-try and academia. It is a nice mix ofenthusiast professionals.

STBY operates both in the UK andHolland, two countries whereservice design is at its most estab-lished. How do you handle this wayof working, and what prompted thisexpansion? When we founded STBY 10 years ago,we immediately started in both Londonand Amsterdam. So there was never anexpansion from one country to the other,STBY is a truly Anglo-dutch company.

We saw equal opportunities in in bothcountries, and were already spendingmuch of our time in London, so for us asdirectors it really made sense to estab-lish ourselves in both countries. Thetwo studios virtually operate as one,with projects sometimes happeningacross the two locations. As the direc-tors, we spend about 50% of our time ineach studio, and the rest of the teamalso has a lot of contact with each other,to share knowledge and sometimes

with the two locations we work in, butalso the multinational and multiculturalteam we have, with currently fivenationalities. Our perspectives andlocal knowledge are even much morediverse with Reach, STBY’s partnernetwork for global design researchcurrently comprising 11 companiesaround the globe. For global companies

we do design research in several coun-tries simultaneously, always with local-ly based teams.

Design research is your area ofexpertise, and it’s an area that Ibelieve is sometimes overlooked byservice design practitioners. Whatrecommendations would you maketo Touchpoint readers on how toincorporate research into their proj-ects, especially if they face time orbudget limitations?

The most important advice is to not seedesign research as separate fromservice design. It is an integral part andcannot be separated from the rest. Itdoes not make sense to do one withoutthe other. To do proper service designyou need to do proper design research.This way of thinking and doing alsoremoves the time and budget limita-tions: if you have little time and budgetfor a service design project, you have to

be modest with your ambitions for theservice you are creating, and not justmodest with your research ambitions.

Interview: Geke van Dijk andBas Raijmakers

Geke van Dijk

Bas Raijmakers


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THANK YOU!

better outcomes by design- improving health and wellbeing through participation

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