Touchpoint Vol. 1 No. 2 - Health and Service Design

volume 1 | no. 2 | 12,80 euro

October 2009

Touchpoint the journal of service design

Health and Service Design •

A healthy relationship Lavrans Løvlie, Ben Reason, Mark Mugglestone and John-Arne Røttingen

•

Designing from within Julia Schaeper, Lynne Maher and Helen Baxter

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Revealing experiences Christine Janae-Leoniak

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Great expectations: The healthcare journey Gianna Marzilli Ericson

service design network

touc hpoint | the jour nal of se rvi ce desi gn

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Touchpoint Touchpoint

Proof Reading

Volume 1, No. 2

Lektorat Rotstift (Kirsten Skacel)

October 2009 The Journal of Service Design

Printing

ISSN 1868-6052

Heider Druck GmbH, Bergisch Gladbach

Publisher Service Design Network Editor Birgit Mager Editorial Board Maggie Breslin Shelley Evenson Mark Jones Coordination Judith Altenau

Fonts Mercury G3 Whitney Pro FF Justlefhand Service Design Network Prof. Birgit Mager Ubierring 40 50678 Cologne Germany www. service-design-network.org Contact Judith Altenau

Design

journal@service-design-

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network.org

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contents

October 2009

Health and Service Design

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04 From the editors 08 News 12 Introductory: Service Design and healthcare On how Service Design can improve the delivery of healthcare services

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A healthy relationship. A conversation between Service Designers and healthcare improvement professionals in the UK and Norway.

Lavrans Løvlie, Ben Reason, Mark Mugglestone and John-Arne Røttingen

22 Public health services On the importance of designled thinking within public healthcare services and the benefit of collaborations between patients, frontline staff and government authorities.

24 Designing from within: Embedding Service Design into the UK’s health system

Julia Schaeper, Lynne Maher and Helen Baxter

34 Designing for the social challenges of better health

Cale Thompson

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40 Design in practise. Enabling Change and flexibility with health providers An Interview with Daniela Sangiorgi and Valerie Carr

45 From quality surveys to new touchpoints – a challenge for Service Design

Fernando Secomandi, Erik Jan Hultink and Dirk Snelders

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contents

48 Hospitals and patient experience On the need of hospitals to communicate better, create memorable patient experiences and borrow from the hotel industry.

50 Shaping the hospital of the future Tine Park

55 We help our clients feel what their clients feel An Interview with Bob Cooper

58 Service Design from within a healthcare organisation

An Interview with Teresa Huber and Julian Hadschieff

66 Revealing experiences. Service Design within a

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healthcare institution Christine Janae-Leoniak

76 Brand positioning is the foundation for a memorable patient experience Hester van Thiel, Mike Janssen and Marc Fonteijn

78 Systems | people. Overlaying user-centered and

systems approaches for designing complex services Richard Hayami Z’Graggen

82 The care chain On the emotional aspects of healthcare journeys, the importance of self determination and the need for information and accessibility of services.

84 Great expectations: The healthcare journey Gianna Marzilli Ericson

92 The dilemma of the care recipient & The journey through the care system as mentally disabled Elin Kolterjahn, Ă…sa Adolfsso and Stefan Holmlid

100 Healthcare innovations under pressure: The Pressure Cooker Event

Peter van Waart, Ingrid Mulder, Carolien van den Akker and Justien Marseille

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104 In the service of health Services: Why co-creation matters

By Judith Altenau

110 Service Design Snapshots 112 Docstop – a medical service for european truck drivers

Julia Schirok

112 Design and sexual health (DASH) Lauren Tan, Benedict Singleton, Jenna Singleton and Mike Smart

113 360° health – an experience design approach for healthcare innovations

Lekshmy Parameswaran and László Herczegh

114 Designing healthy services: Exploring the role of conflict when implementing change John Curran

114 Why Service Designers are healthy for innovative projects – a client’s perspective Annika Hertz and Martin Beyerle

115 New channels for community health engagement

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David Hicks

117 Improving the visual communication of complex information in the health sector Sheila Pontis

118 Costumer Profile Anette Hiltunen and Reetta Kerola

122 Dos and Don’ts 127 Member Map

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from the editors

Letter from the Editor

Birgit Mager is Professor for Service Design at Köln International School of Design.

She is co-founder of the Service Design Network, founder of »sedes research« and »sedes social«.Current clients include Swisscom, Mobilcom Austria, Deutsche Bank, Haufe, Lexware and others.

Mark Jones As the lead for Service Innovation for IDEO Chicago, Mark works closely with service companies seeking to reinvent how they serve their customers. Recent projects include banking for Gen Y, mobile health management and bridging physical and digital retailing. Mark also teaches Service Design at the Institute of Design at IIT

The second issue of Touchpoint focuses on one of the most relevant topics of our time: Health Preserving and restoring health is of major concern for the life of all humans. The standards and the availability of medical services are among the strongest indicators for the maturity of a society. In addition, the health sector is relevant for all of our economies because it continues to grow in proportion to other areas and at the same time it is a very profitable industry that puts a lot of cost pressure on the state and individuals.

Throughout the centuries we have gone through enormous scientific and technological breakthroughs in medical science, in research, and practise. The life expectancy has risen, new diagnoses and cures have been found for a large amount of diseases. The stakeholders within the health system – hospitals, doctors, nurses, pharma industries, insurance companies, public health service administrations, to mention only a few – have focused on medical technology and on economic aspects in order to fight and to administer diseases.

However, far too often, the people were not regarded a relevant factor within the system. But it is all about people. It is about taking them, their problems, their experiences, and their journey serious. Margaret A. Breslin from Mayo Clinic describes the change that is taking place: “Until recently, most problems facing healthcare were perceived to be ones of technical knowledge. We pursued greater knowledge using the traditional methods of science and medicine. But increasingly, the biggest issues facing healthcare are issues of delivery; questions not of what but of who, when, how, and where. Medicine’s traditional methods of discovery are less equipped to answer these questions.”

When we sent out the call for papers for the second Touchpoint issue we received more then fifty contributions. It was amazing to see how Service Design has become involved in so many aspects of the health service system. Hospitals employ full time Service Designers, the UK National Health Service has for the first time, employed a Service Designer – it seems that the value of Service Design is being discovered right in the heart of the system.

As Margaret puts it: “Service Design brings process and methods which engage with the issues within the context of care and illuminate new concepts from a deep understanding of the people at the core of healthcare delivery. It is worth noting that the clash of these two ways of thinking, scientific and creative, is by far one of the greatest challenges that faces multidisciplinary approaches to rethinking healthcare delivery.”

Healthcare providers need to rethink the way they work. The interfaces between the providers of health services and the user need to be radically innovated.

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Mark Jones from IDEO, Chicago, explains why: “There are two major reasons why healthcare service providers should invest in Service Design. The first is simply to drive customer (or patient) loyalty. Many people go to a provider for a procedure and never return. They may well have had a good outcome but they did not leave with a positive feeling about their experience. But there are many opportunities to have great care backed up by a great experience. Most interesting is the extension of the experience into peoples’ homes before and after the in-facility episode. The second and I think more important reason is that data-rich technology is soon going to become embedded in the entire care continuum. Continuous monitoring, evidence-based decision support tools and self-care will change the relationships among patients, healthcare providers, and institutions. So we will need to help these groups rethink the entire care journey.”

The opportunities and challenges for Service Design to bring innovation into healthcare services are numerous. And in order to face these challenges we also need to rethink design education and enable young designers to influence the quality of health service experiences. Shelley Evenson has done many health service projects with her students at Carnegie Mellon University. Her experience is: “At first students are challenged by Service Design for healthcare systems. They have to learn about the domain of healthcare, what it means to be sick, and to treat and be treated when the stakes are so high – particularly with chronic diseases. On one level, they need to learn about healthcare facilities.

At the same time, they have to learn the methods and tools that Service Designers bring to any service experience. They all need to learn to listen more carefully than they ever have before. Empathy plays a role in service, but student designers must learn to be even more sensitive to the expectations and fears people bring when it comes to their own health.”

Shelley Evenson is a principal, user experience designer at Microsoft. Shelley has been an Associate Professor at Carnegie Mellon School of Design, where she was also the director of graduate studies. She teaches in the area of interaction and Service Design.

Maggie Breslin is a designer/ researcher in the SPARC Design Lab, Center for Innovation at the Mayo Clinic. In her role, she has led research, design and development efforts around topics that include patient decisionmaking, integration and practise models, patient-centered hospital experiences and remote care.

This issue of Touchpoint gives exciting and inspiring insight into the innovative approaches that are taken in the health sector, into new methods that are being developed in order to match the needs of healthrelated Service Design and into the multitude of projects that are successfully being done.

In the name of this issue’s editorial board – Margaret A. Breslin from Mayo Clinic, Shelley Evenson, Microsoft Inc., and Mark Jones from IDEO – I would like to thank the authors for their contributions. We do hope you will enjoy reading through, reflecting on, and maybe even responding to Touchpoint #2!

Birgit Mager Editor in Chief touc hpoint | the jour nal of se rvi ce desi gn

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news

By Judith Altenau

New lecturer and researcher in Service Design at Lucerne University, Switzerland

Service Design at Macromedia University of Applied Sciences, Media and Communication in Munich, Germany

The University in Lucerne, Switzer-

specialisation, emphasis is placed on

Beginning winter term 2009/2010,

land, has recently appointed Andy

the development and design of usable

the Macromedia University of Applied

Polaine Lecturer and Researcher

and useful services. With a clear focus

Sciences will offer an accredited MA

in Service Design. He will promote

on the user, corporate structures are

course in Media and Design with one

research activities in the field of

rethought in order to make flexible and

of its major subjects being Service De-

Service Design and contribute to the

customer-oriented processes possible.

sign. The course has been accredited

refinement of the Product Design &

The course is structured to establish

by FIBAA. It offers an international

Management major in the University’s

a close relationship between students

outlook and a high level of self-direct-

Master’s programme. Since September

and researchers in order to generate

ed learning, including case studies

2009, Lucerne University has offered

new insights into Service Design.

and projects with industry partners.

comprehensive qualifications in Ser-

The Master of Arts in Design is a

Students can choose between a full-

vice Design as part of an MA in Prod-

consecutive full-time study programme.

time and a part-time programme. The

uct Design and Management. Product

It is three semesters long and is com-

deadline for applications is September

Design and Management major stu-

prised of 90 ECTS points. Graduates

1st, 2009. Studies start October 1st.

dents can choose between ‘Textiles’,

from this programme will be awarded a

Late applications in October are also

‘Products’ or ‘Services’ as their main

Master of Arts degree in Design.

accepted.

subject and develop their own projects in these disciplines. Within the latter

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www.macromedia-fachhochschule.de/ english.hslu.ch/

touc hp o in t | the jo u rn al of s ervice d es ign

en/master.html

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news

New degrees in Service Design at Savannah College of Art and Design, Georgia, USA

By Judith Altenau

established and emerging principles,

scoping projects in key areas of

theory, and practises in Service Design.

focus within the NHS. These include building capability and capacity for

www.scad.edu/servicedesign

improvement and innovation, using the customer experience to redesign healthcare services and the potential

SCAD is the first university in the United States to offer Bachelor of Fine

First in-house Service Designer at the NHS Institute for Innovation and Improvement, UK

Arts and Master of Fine Arts degrees

for an increased focus on prevention rather than cure in order to ensure the long-term sustainability of the NHS.

in Service Design. The first quarter of study begins September 2009. The

Service Design tools

programme explores the business practises, technologies and design

In March 2009, the NHS Institute for

paradigms that focus on user-centric

Innovation and Improvement appoint-

Within the framework of coopera-

encounters. New language, tools,

ed its first in-house Service Designer,

tion between DensityDesign research

techniques and methodologies are re-

Julia Schaeper, who had previously

group at INDACO Department (Po-

viewed and developed to form a range

worked for Engine Service Design in

litecnico di Milano) and DARC (Do-

of approaches and knowledge assets

London. Her new role within the NHS

mus Academy Research & Consulting),

that inform and shape the emerging

is to support the institute in using

Roberta Tassi has complied an open

discipline of Service Design.

Service Design skills within all of their

collection of tools used during design

The undergraduate programme

programmes. Core to this is the identi-

processes that deal with services or

provides an opportunity to explore the

fication of challenges through anthro-

other complex systems. The ‘Service

fundamental principles and practises

pological and observation techniques,

Design Tools’ were developed during

of Service Design. It explores the

idea generation, concept develop-

her graduation thesis in Industrial

concepts of service and touchpoints,

ment and service prototyping. Most

Design.

and their symbiotic relationship and

recently, Julia has been supporting

The online collection is an open and

ecologies. The graduate programme

five post-graduate MBA Associates

dynamic resource, which gives an

is aimed at high-potential design-

overview of the existing techniques

ers seeking to redefine a new type of

that can support the representation

design practise. Focusing on the im-

and communication during the design

proved customer experience, students

phases. It offers a compendium of

practise skills necessary in planning

what has been already done and high-

and organizing infrastructure, systems,

lights some opportunities that haven’t

communications, products, experienc-

been explored yet. In order to provide

es, and behaviours in order to improve

a clearly arranged overview, the tools

the quality and interaction between

are displayed according to different

providers and customers. The new

issues such as the design activities they

degree programme provides an op-

can be used for, the kind of representa-

portunity for students to explore both

tion they produce, the recipients they

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touc hp o in t | the jo u rn al of s ervice d es ign

in meaningful research relevant to

ger, who discuss how design thinking

the challenges design is dealing with

and innovative methods work as tools

today and in the future. Conceived

for co-creating services and desir-

as an online blog, the Service Design

able value propositions, how Service

research initiative hosts interviews

Design is an effective means to design

with key representatives of the Service

a more sustainable society, and how

Design research area, offering a valu-

Interaction Design offers us insights

able resource of shared knowledge,

into more user-oriented services.

experiences, opinions, and fundamental insights on Service Design.

Design practitioners such as Fran Samalionis (IDEO), Arne van Oosterom

www.servicedesignresearch.com

(DesignThinkers) and Paul Thurston

are addressed to and the contents of

(thinkpublic) share their Service

the project they can convey. www.servicedesigntools.org

Design thinking and the benefits of

Designing Services with Innovative Methods” by Satu Miettinen and Mikko Koivistoy

the Service Design case studies from different business areas. Different cultural contexts are presented and described in detail. “Design Services

Service Design research

The new publication “Designing Ser-

with Innovative Methods” opens the

vices with Innovative Methods”, edited

discussion on designers’ methods and

by Satu Miettinen (Kuopio University

approaches to developing services.

of Design) and Mikko Koivisto (Service Designer at the concept agency Yatta) Design researchers Daniela Sangiorgi

is a joint publication between Kuopio

(ImaginationLancaster, UK), Stefano

Academy of Design and the University

Maffei (SDI Agency Politecnico di

of Art and Design Helsinki. It features

Milano, Italy), Anna Meroni (DIS,

Service Design experts such as Ezio

Politecnico di Milano, Italy) and Nicola

Manzini, Stefan Homlid and Birgit Ma-

www.taik.fi

Morelli (Aalborg University, Denmark) have launched a new website focused on Service Design research. The website is aimed at collectively building an understanding of Service Design and initiate a dialogue on the development of Service Design as well as current Service Design research and practise.

The online platform is meant to be a new means of consolidating existing knowledge and supporting the growth of a research community that engages touc hpoint | the jour nal of se rvi ce desi gn

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By Lavrans Løvlie, Ben Reason, Mark Mugglestone and John-Arne Røttingen

A healthy relationship A conversation between Service Designers and healthcare improvement professionals in the UK and Norway Most healthcare systems are attempting to deliver services that are efficient, effective, and value for money. To this end, there is a continual emphasis on how the delivery of services can be changed or improved. Many different improvement techniques and methodologies have been tried within healthcare settings and there is currently a growing interest in how design and specifically Service Design could be beneficial. Because healthcare delivery is complex, any attempt to improve or innovate in the delivery of services requires the balancing of multiple different perspectives. In this article, healthcare specialists Mark Mugglestone from the UK NHS (National Health Service) Institute for Innovation and Improvement and John-Arne Røttingen, Director of the Norwegian Knowledge Centre for Health Services, discuss with Service Designers Ben Reason and Lavrans Løvlie from live|work how these different perspectives interact.

John-Arne Røttingen A founding director, Norwegian Knowledge Centre for the Health Services

Introduction This discussion began during a seminar on design for healthcare at the Norwegian Design Council. The discussion identified the opportunity for Service Design to play a part in meeting healthcare challenges. There was agreement that Service Design can help to improve services by

providing a patient-led and ‘whole system’ approach. However, we recognized that health services have unique characteristics and challenges. It is essential for Service Designers to better understand the context and priorities of healthcare organisations if they are to have a significant impact.

Ben Reason Director and Co-founder, live|work, London

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a healthy relationship

By Lavrans Løvlie, Ben Reason, Mark Mugglestone and John-Arne Røttingen

What is the challenge for Service Design in healthcare?

Lavrans Løvlie Director and Co-founder, live|work, Oslo

Mark Mugglestone Associate, NHS Institute for Innovation and Improvement

John-Arne Røttingen: As a physician mainly with a research background, I have come to the field of service innovation and improvement gradually and very much with my medical background and culture as baggage. I think we need to consider how medical doctors, nurses, and other health professionals are trained and ‘cultivated’ to understand the healthcare environment. A medical doctors’ education is very much about establishing individual knowledge and skills and about individual patient interventions including technologies like drugs, i.e. how to diagnose and treat a patient. There is very little emphasis on how to work in a multidisciplinary team, on communication skills (even though patient communication skills have now a much larger emphasis), on logistics and service delivery, or on organisational issues – skills that are central to Service Design. This mismatch between training and needed skills suggests why it has been difficult to engage health professionals in service innovation.

There is broader interest in research and innovation for new diagnostics or therapeutics, i.e. product innovation and development, and it seems that there is a belief that as long as we have the technologies the rest will come by itself. We need to change this misconception, and demonstrate that true radical innovations will to a larger extent be about new service processes and delivery arrangements.

Ben Reason: I feel that Service Design

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and design in general has a challenge in relation to more established approaches in healthcare because of its focus on “efficient, effective, and value for money”.

Design is seen, and often is, a quality thing rather than an efficiency thing.

Design as the value-add is an established argument. That may be OK if you are a commercial company looking to differentiate or add value in a competitive market but in an almost monopoly health service I imagine that it can feel like an indulgence. In healthcare improvement this can look like designing ideal world scenarios where unavoidably traumatic experiences with accidents or illness are smoothed and made more bearable and comfortable. This chimes with the ‘customer’ culture that is popular in policy in the UK. The question is, can Service Design contribute to the more pressing quality of care, safety, and efficiency agenda? To be effective, Service Design has to ensure that patient experience work is not just about a ‘nice’ experience but about spotting the health issues that, if fixed, would improve both the experience and the well-being and safety of a patient.Service Design offers the ability to prototype and improve designs before larger scale investments are made, such as with health IT projects. The methods also work on a small scale when used to empower healthcare teams to be more innovative and develop local solutions to issues they face.

How might Service Design need to adapt for health services?

Mark Mugglestone: It is interesting, one

of the things that we find in our work at the NHS Institute is that quality and efficiency go hand in hand. Whenever you do work to look at quality, you usually make the service more efficient. A simple example would be that, from a patient’s perspective, multiple attendances at a hospital can be frustrating. Redesigning services to mean fewer attendances will improve the experience of that service from the patients’ perspective. Having fewer attendances should also make the service as a whole more efficient, so everyone wins.I think Service Design in healthcare may feel like an indulgence because we are so used to evolved services, where no explicit design has taken place – so we do not understand or consider how the design component is a valid investment. I think that some responsibility also has to go to designers, Service Designers and the design culture overall. My experience of design within healthcare is that it is easy to do nice demonstrations that using a design perspective could make things better for patients, but they remain as demonstrations. Although some of this may be down to it being a new domain that is just really getting established, but I think it is also due in part to the design focusing too much on ‘experience’ and not also the other components of healthcare delivery.

One of the definitions of good design that we use a lot is: Good design = Performance + Engineering + Aesthetics of experience We often argue that the experience component is the missing link, but it needs integrating with the other two elements, rather than being a standalone – and I think that because of where designers

come from, they usually focus on this area. Maybe less designers, more engineers and accountants is what we need to develop the discipline of Service Design?

Is Service Design responding to these challenges?

» Good design = Performance + Engineering + Aesthetics of experience. «

Ben Reason: Responding can be challenging because there is a medical culture that discounts the importance of non-medical aspects of services that can be extremely significant. For example, we know that experience and environment have a significant impact on outcomes in maternity care in the UK but there are still mothers experiencing a totally medi-

»To be effective, Service Design has to ensure that patient experience work is not just about a ‘nice’ experience but about spotting the health issues that, if fixed, would improve both the experience and the well-being and safety of a patient. Service Design offers the ability to prototype and improve designs before larger scale investments are made.« touc hpoint | the jour nal of se rvi ce desi gn

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a healthy relationship

By Lavrans Løvlie, Ben Reason, Mark Mugglestone and John-Arne Røttingen

cal model of care. The cost of the caesarean is significant and the numbers for emergency caesareans is still rising. This suggests there should be Service Designers creating new maternity services all over the country but that isn’t the case.

In response to the suggestion that Service Designers may need to work closer with accountants live|work is rising to the challenge. We can see that this is a barrier for us and that we need to work with people who can help us make the business case for Service Design. We recently led some innovation work with a local government group and then engaged experts to create a cost benefit model so we can show how much of a financial impact a new service or redesign would need to make the upfront investment worthwhile. This leads to the third point

»I think Service Design in healthcare may feel like an indulgence because we are so used to evolved services, where no explicit design has taken place – so we do not understand or consider how the design component is a valid investment.« 16

touc hp o in t | the jo u rn al of s ervice d es ign

– engineers. We have learned that the most successful projects for us are when we work with the right ‘geeks’ (and geek is akin to expert in my world). They may be a transport economist, an insurance actuary or a nurse.

What is interesting is that private clients get this and hire us to complement their geek team. In our NHS work we have been much more stand alone on the patient experience side of Service Design and not found it more challenging to find the scientists of whatever hue we need to collaborate and really succeed. I’m not sure if this is the NHS or us but we now work hard to make sure we have the engineers we need.

Where does Service Design have the largest potential to create value?

John-Arne Røttingen: Service Design has, in my impression, most to offer for patients with a long standing and repeated contact with the health service, i.e. chronic conditions, care for the elderly etc. However, that does not mean that Service Design cannot be utilized for other user groups as well. One example of the latter may be to create a first line of care that rely on self-assessment and the use of pre-decided advice for simple acute conditions. Service Design may be a good approach to developing such selfcare systems. Regarding types of organisations, it would be easy to point towards institutions like hospitals and nursing homes where more complex services are given. Again, several examples of Service Design are related to community care and home care indicating that the type of

organisational setting does not seem to be a good discriminator.

Lavrans Løvlie: John-Arne mentioned that the greatest potential for radical improvement is in innovations in processes and systems rather than in medical technology. At the same time, I believe there is great potential in developing ‘service technologies’ such as telemedicine, journals that can be managed by patients themselves as well as phone- and webbased access to services.

John-Arne Røttingen: One example may be how for instance the combined health plan and delivery organisation Kaiser Permanente in California, US has invested heavily in empowering patients by giving them access to parts of their patient records, different lab results and the opportunity to interact with their physicians via a personalized web interface.

Lavrans Løvlie: Both in preventative care and with chronic diseases, patients have direct influence of the results of their own treatment, and services can be designed that allow them to be more active and engaged in the improvement of their own health. Development of more and better self-service offerings will give patients more power in the relation to the healthcare system, but may also be requisite in order to keep costs down as medical technology becomes more expensive.

In which ways can Service Design drive innovation in the health sector?

Ben Reason: I agree that the user-

»Development of more and better self-service offerings will give patients more power in the relation to the healthcare system, but may also be requisite in order to keep costs down as medical technology becomes more expensive.« centeredness that is central to Service Design has a lot of potential in health services. It would be wrong to say that nurses, doctors and administrators don’t focus on the patients, but as John-Arne explains, these are highly complex systems where one professional’s view of the patient may differ from another with a different point of view.

Someone in the private sector recently told me: “Our organisation is so complex, that the only one who can see the big picture is the customer.” I think bringing the ‘big picture’ to the table goes for the health sector as well. What Service Designers can bring to the table is a shared view of the patient and their needs that complex teams with mixed expertise can unite around. If everyone has the same picture of who the patient is and what is important to them, it is easier to align touc hpoint | the jour nal of se rvi ce desi gn

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a healthy relationship

By Lavrans Løvlie, Ben Reason, Mark Mugglestone and John-Arne Røttingen

»We have learned that the most successful projects for us are when we work with the right ‘geeks’« Ben Reason is the director and co-founder of live|work, a Service Design agency based in London, UK. He has provided strategic guidance and project delivery management on a range of public sector projects for organisations such as One NorthEast, Dott 07, the NHS, Sunderland City Council, Digital Inclusion, Skills Development Scorland and the Home Office.

Lavrans Løvlie is a founding partner of live|work and director of their Nordic office in Oslo, Norway.

Before setting up live|work he worked as an Interaction Designer in Norway and Denmark. Lavrans is a board member of the Norwegian Design Council and has served on the committee responsible for the new British Standard for Service Design. During the last years, he has lectured and run seminars at Design institutes and universities Europe-wide.

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conflicting interests and processes.

The tools are simple: Show examples of how users experience the services, visualize opportunities, make ideas tangible, and make it clear how it creates value.

As Mark says, quality and efficiency often go hand in hand. When the patient experience becomes a primary driver for innovation, we are also likely to find solutions that are economically and medically viable.

How can one combine an evidencebased approach with innovation?

John-Arne Røttingen: An evidencebased approach to healthcare means to rely on evaluations of effectiveness and safety when considering what kind of treatments and interventions to offer patients. This can easily be integrated with innovation and Service Design since the evidence base for the effectiveness of care very much indicates what kind of services should be delivered. With Service Design taking a strong user approach, this also lends an opportunity to inform patients in a good way about the existing treatment options and their different benefits and harms based on evaluations. An evidence-based approach is thereby very much about empowering patients given them a tool to explicitly ask for information about their care.

One can take the evidence-based approach one step further, like we do at the Norwegian Knowledge Centre, and say that not only clinical interventions should be evidence-based, but also the way we organize, finance, and deliver care. From this perspective, service in-

novation should be followed by a robust evaluation on the effectiveness of the new or improved process, asking wether it is more effective and efficient that the existing delivery of care. I think that both these approaches to combining evidencebased practise and innovation are crucial, and links back to demonstrating both value and cost-benefit as Ben said.

ing and piloting services with real users is becoming embedded in the field of Service Design. The key to success is to start light and do many, evolving prototypes, involving more and more people.

I believe such a practise can bring detail and trustworthiness to service innovations at a quick pace, and spread good ideas much faster than we see today.

Lavrans Løvlie: The evidence-based approach is an interesting challenge for designers, who often have been trained to value great ideas as a goal in itself. I find it obvious that a solid evidence base should be fundamental to Service Design, and few designers would disagree. It is more challenging to create systematic ways to test and measure concepts in a rigorous way. At the moment we are seeing that the practise of rapidly prototyp-

What about the value-based approach?

John-Arne Røttingen: There is an increasing focus on value-based healthcare, and this approach is particularly related to a move from the focus on processes of care, what kind of services and interventions are offered, to the outcomes of care and that patients actually improve and are treated with dignity. Still, much of the value-based approach is related to the

The strong emphasis on evaluation and evidence in medicine may inspire Service Designers to not only promote and sell ideas and processes, but also demonstrate and document that they achieve the impact.

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a healthy relationship

By Lavrans Løvlie, Ben Reason, Mark Mugglestone and John-Arne Røttingen

»This possible change of mind set may make healthcare ripe for approaches that utilize the experience and knowledge of their users when designing the services.« providers’ and professionals’ perspectives. The potential strategic impact of Service Design would be to strengthen the user/consumer perspective. It is how users consider the results, outcomes, and long-term impact of care that is important. Bringing users in both, on the design of services, and on how services should be assessed and monitored should go hand in hand. The introduction of the so-called PROMs (patient-reported outcome measures) in NHS may create many opportunities for Service Designers.

The NHS is asking patients about their health, functional status, and quality of life before they have an operation, and about their status and the effectiveness of the operation after it.

This may have dramatic effects upon the focus of providers and professionals since the experience of the patients will become a key performance measure.

This possible change of mind set may make healthcare ripe for approaches that 20

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utilize the experience and knowledge of their users when designing the services.

Conclusion Together we believe that Service Design can add something new to existing healthcare improvement strategies and practises, rather than looking to replace what already exists. First, there is an increasing prominence of prevention and self-care in healthcare. For instance, the Norwegian Health Minister has just released a reform on integrated care where stronger primary care and better preventive measures are central. The success of such approaches relies heavily on buy in and adoption by patients and on new ways of interacting with (and also between) patients. Second, as a public service healthcare needs strong support from the public. Even though most surveys indicate that patients assess the health services more positively than the general public, the ‘aesthetics of experi-

ence’ of healthcare needs to be improved to levels comparable to other – and often private – services. This must not, however, be carried out as a stand-alone approach. It must be integrated with the professional and business perspectives of healthcare. Thirdly, there is a need for a paradigmatic shift in healthcare from almost always attempting finding solutions in new single medical products to disentangling the real challenges through innovative delivery approaches and the dissemination and effective implementation of best practise. Service Design is an enabling tool for this cultural change.

However, we believe that not only can Service Design benefit healthcare, Service Design can also get something back.

The strong emphasis on evaluation and evidence in medicine may inspire Service Designers to not only promote and sell ideas and processes, but also demonstrate and document that they achieve the impact. In healthcare “the customer is always right (as long as he pays)” does not always apply. One important challenge is overuse and misuse of services. Too many lab tests and radiology scans are carried out and too many drugs are prescribed without added value for the patients, even though they may feel well cared for and have a positive experience with the service provided. The user-led approach has its limits. Information and knowledge is the central currency in healthcare.

Data and evidence is needed for informing decisions (ex ante evaluations) and improving practise (ex post evaluations).

Service Design may facilitate patients using and learning from their own data (e.g. web-based patient records), the experi-

ences of others (e.g. through networks) and general best evidence (e.g. electronic libraries and web-based resources). Service Design may also assist the providers in collecting and utilizing data to improve the services (e.g. by identifying and measuring critical elements). As one of us has argued elsewhere, data is the ‘New Oil’ – especially in healthcare. Designers, users, and medical doctors and other professionals should work together to exploit it to create new patient, provider, and social benefits.

John-Arne Røttingen is the Chief Executive and founding director of the Norwegian Knowledge Centre for the Health Services, Norway.

He has previously worked as an associate professor at the Faculty of Medicine, University of Oslo. JohnArne has been Norway Oxford Scholar at Wadham College, Oxford University and has been working at the Wellcome Trust Centre for the Epidemiology of Infectious Disease, Oxford and at the Department of Infectious Disease Epidemiology, Imperial College School of Medicine, London. He holds an MD and a PhD from the University of Oslo and an MSc from Oxford University.

Mark Mugglestone is a lead associate with the Innovation Practise team at the NHS Institute for Innovation and Improvement, UK. He has responsibility for the continued development and implementation of the organisations improvement and innovation process.

Mark has held a variety of national roles focussed on healthcare improvement and has worked in the area of academic and applied research.

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chapter preview

Public health services On the importance of designled thinking within public healthcare services and the benefit of collaborations between patients, frontline staff and government authorities.

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Designing from within: Embedding Service Design into the UK’s health system Julia Schaeper, Lynne Maher, and Helen Baxter

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Designing for the social challenges of better health Cale Thompson

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Design in practise. Enabling change and flexibility with health providers An Interview with Daniela Sangiorgi and Valerie Carr

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From quality surveys to new touchpoints – a challenge for Service Design Fernando Secomandi, Erik Jan Hultink and Dirk Snelders

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By Julia Schaeper, Lynne Maher and Helen Baxter

Designing from within: Embedding Service Design into the UK’s health system The National Health Service (NHS) is the national healthcare provider in the UK. It is the fourth largest organisation in the world employing 1.3 million people through a wide range of organisations including hospitals, General Practise surgeries, and ambulance services. The NHS is used by millions of people everyday who value its expertise, its staff, and its ability to make them feel better. It is often referred to as a ‘national treasure’ yet at times it does not provide the best service that it could to all of the people who need to use it.

This results in inefficiencies, safety issues, a lack of personal care, and dissatisfaction. To make things worse, in the current economic climate it is suggested that the NHS will face its greatest financial challenge of its entire history – a £15 billion funding gap over the next decade 1. This means the need for strong leadership and increased productivity has never been greater. Time is short and experience of previous spending crises tells us that failing to rise to this challenge now will have serious consequences for the NHS, its patients, and staff. Work to deal with this unprecedented challenge is needed now, with the support of NHS staff, policy makers, and the public.

One ambition over the next years is to radically innovate within the health system, changing it so that it consistently

provides more choice, more personalised care and more meaningful involvement of the recipients of the service. Without doubt, this is a bold ambition and one that needs innovative tools, techniques and methods to help it succeed. It is an ambition that in our opinion can benefit from some of the tools, techniques, and methodologies found within the emerging discipline of Service Design.

Julia Schaeper Service Designer, NHS Institute for Innovation and Improvement

Better by design

Lynne Maher

Of course, it has sometimes been a challenge to explain how design methodologies can improve the delivery of public services. As the Design Council noted not so long ago: “… design is a problemsolving process but it is difficult to think of what problems it can help you solve when all you really know about designers

Head of Innovation Practise, NHS Institute for Innovation and Improvement

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designing from within

By Julia Schaeper, Lynne Maher and Helen Baxter

Helen Baxter Associate, NHS Institute for Innovation and Improvement

is that they make nice gadgets like iPods or will have created the graphics for that attractive label on your tin of baked beans.” 2 Although still fairly unknown as a discrete discipline or specialist profession, Service Design reflects the understanding that techniques, which evolved from the production lines of the 20th century, can be applied not only to products, but also to fields from communications to business strategy, from sustainability to services . 3 In the wider public sector, several recent initiatives – for example, Dott 07 4 and the Design Council’s programme “Public services by design” 5 – have helped make clear that Service Design can make a valuable contribution to tackling some of the social and economic challenges we are facing today. And in healthcare we are also beginning to see change, as increas-

ing numbers of health experts have come to recognise the value of Service Design in terms of offering a methodology for turning ideas into high quality results that are cost-effective and productive whilst delivering the right experience for the patient. 6 Within health policy development, we are seeing a tangible focus on personalisation of care and a higher level of patient and carer involvement in designing health services. The Operating Framework for the NHS in England for instance, set out that everything we do must be geared towards improving the patient experience of NHS services and clinical outcomes of care. 7 This has led health organisations like ours to seek out new ways of working closely with patients to better understand their experiences and redesign services to better meet their needs. To do this, we are util-

The ebd approach (experience-based design) The ebd approach has been developed based on the work that the NHS Institute has done with Service Designers to focus on improving patient, carer, and staff experience of health services. The approach provides a framework to capture and understand health experiences and then work together with staff and patients to design better services.

A critical aspect is to really understand the challenges from the perspective of those who use the service in order to gather insights and themes, from which we can gain ideas as to how you might identify the appropriate solutions for the challenges. Experiencebased design is helping transform services at all levels, from management to front line staff. The methodology is transferable to diverse areas, for example; commissioners who might want to understand a whole patient pathway to GP practises.

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ising Service Design as an improvement methodology and are embedding the approach alongside existing processes.

Embedding Service Design as a fundamental principle of how we work At the NHS Institute we started this journey by working with a number of Service Designers who like NHS staff strive to ‘make things better for people’. We began to understand that design might be useful to healthcare improvement work and that we could gain considerable benefit from involving patients, as well as healthcare practitioners, in the design process – shaping services that meet the needs of those using or delivering them. Most importantly, we also began to understand the public’s expectations of healthcare as a ‘service’ – an interaction with a person or organisation from which you expect to gain value. Clearly the NHS is such a service – but it is one whose value has traditionally been defined in terms of clinical outcomes. And while healthcare organisations have demonstrated that they can improve the performance and reliability of services – producing tangible changes in how patients access care and how safe that care is –, these same organisations have not always placed equal focus on how it feels to use or be part of the service. So we started to understand that seeing health provision as a ‘service’ means considering the experience of care for all users – patients, carers, and staff – and that we now have the opportunity to focus on that.

We first started to apply Service Design when we developed our very own way of

»One ambition over the next years is to radically innovate within the health system, changing it so that it consistently provides more choice, more personalised care and more meaningful involvement of the recipients of the service.« doing things. Inspired by Service Design and looking at how other innovative organisations work, we developed our own ‘Work Process’ – a systematic but flexible process we use to convert concepts and ideas into new solutions that can make a real difference. It allows us to take appropriate risks – something at the heart of all innovation – while ensuring our end solutions are relevant, fit for purpose, and actually wanted by staff and patients.

A core component of this new approach involved using tools from the design sphere to bring new insight to the organisation. For example, observation forms a core part of our own innovation process.

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designing from within

By Julia Schaeper, Lynne Maher and Helen Baxter

a more anthropological approach to bear, learning about patients’ experiences and the context in which healthcare staff go about their work. Another important principle drawn from Service Design is that of ‘co-design’ – the understanding that in order to improve healthcare, we need to bring patients and staff much closer together than we had previously done in order to see the problems from their perspectives and to actively share the role of re-designing health services.

We also found evidence for the need of ‘co-design’ outside of the design world.

The National Audit Office for instance promotes the role of customer insight in particular in healthcare situations. They suggest that to be successful, innova-

»…design is a problem-solving process but it is difficult to think of what problems it can help you solve when all you really know about designers is that they make nice gadgets like iPods or will have created the graphics for that attractive label on your tin of baked beans.”«

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tive projects could only be delivered by meaningfully involving service users and citizens.

Supporting NHS improvements through Service Design In one instance, the application of these techniques resulted in patients, NHS staff, and designers making over 40 changes to one clinical pathway alone.

While the pathway in question had previously scored 98% in a patient satisfaction survey, our work revealed that people’s actual experience of the service fell short of the high level implied by the survey result. This helped us understand that there is a fundamental difference between an overall service satisfaction and a great experience and that working with satisfaction surveys alone is simply not good enough.

In order to encourage widespread uptake of Service Design approaches, we have learnt from designers and ‘translated’ some of the tools and techniques internally. Having first designed our internal work process, we then created some programmes to support the NHS in developing capability, capacity, and confidence – for example the ebd approach (experience-based design), the Observation Tool and the Innovation Practitioner Programme. These products are designed to challenge current NHS practise of starting improvement projects simply by jumping straight to a solution. Instead we advocate spending time up-front to identify and delineate problems more systematically so as to be able to then design a more appropriate, effective solution.

Innovation Practitioner Programme We soon realised that, to build innovation capability in NHS staff, we had to cast these tools and individual products in a broader framework.

Although many of the Institute’s design-led programmes and products have been widely absorbed, NHS staff often requested support in using these tools and delivering their goals. So we started to think about how we could best build capability within the NHS and empower individuals to become ‘change agents’ themselves, knowing that people would be the best vehicles to spread and scale new ways of working. We developed the Innovation Practitioner Programme – a programme that supports individuals build the skills, knowledge, and understanding of what it means to be an Innovation Practitioner.

In a practical sense, the programme enables NHS staff to work in innovative ways and to learn employ design-led tools and techniques as part of a chosen live project within their own work context. Over a period of several months we support an Innovation Practitioner cohort through a series of workshops, inspirational seminars and tutorials and in creating a strong peer-to-peer network.

While the private sector has used similar approaches for years, these tools and programmes are new for the NHS. Where they have been used in the health service, they have amazing results, delivering the sort of care pathways that leave patients feeling safer, happier and more valued whilst making staff feel more positive, rewarded and empowered.

However, introducing design-led approaches was not without its challenges.

The greatest hurdle has been convincing healthcare staff of the value that design can bring to their services. We were often

faced with the comment “… but designers design chairs, don’t they?”. The design industry was not really considered an obvious partner to help in our scientific world of health services. There was also a distinct language barrier between the two professions with new phrases such as ‘co-design’ or ‘insight gathering’ and the use of highly visual communications being foreign to health workers. Equally the slang and abbreviations used within the NHS culture were at times unfathomable for Service Designers!

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designing from within

By Julia Schaeper, Lynne Maher and Helen Baxter

»Service Design can play a role in re-shaping health services, and to ensure the continued spread and adoption of its tools and techniques in the NHS.«

Moving forward Never before has the NHS needed innovation in service delivery in the same way – and, clearly, there is still a lot of work to be done. We believe that design thinking as an improvement strategy has great potential to help many health organisations bring about change. In combination with other improvement methodologies we believe Service Design helps pursue our prevailing political objectives of personalisation, participation, and co-production, as well as supporting the health priorities of quality, innovation, productivity, and prevention (QIPP). 8 But it will take time to win acceptance from healthcare professionals for the idea that Service Design can play a role in

re-shaping health services, and to ensure the continued spread and adoption of its tools and techniques in the NHS. Designers moving into the public sector can start facing that challenge now – helping to ensure that design thinking and principles become part of the everyday work of public service delivery. The design profession needs to become widely recognised as having evolved beyond form giving and material production into a sphere of making people and services more resourceful in themselves. 9 At the NHS Institute, we have the opportunity to look at things with fresh eyes – which means we can bring design in at an early stage, and encourage a dialogue before we develop any aspects

The Observation tool

The tool is an exercise designed to be used by NHS front line staff to show the value of observation from a more anthropological perspective than their predominant skill set of clinical observation which links symptoms, behaviour and diagnosis. It has helped teams understand the value of observation in understanding the challenge or issue.

Design principles are encouraging NHS teams to consider more than a benchmarking or measurement of how their service is doing against another – observing of what is actually happening from a variety of perspectives. It helps teams think outside of their usual parameters for solutions.

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of our work in more detail. By championing design techniques as an intrinsic part of healthcare innovation, we hope to support the development of better, more efficient services – right when they are needed most.

What is it like to work as a Service Designer with the NHS? The traditional approach for public sector organisations would be to commission Service Designers to undertake specific work. But, increasingly, the public sector is recognising the value of having Service Design skills available in-house.

At the NHS Institute for Innovation and Improvement for instance, we initially commissioned design support but have more recently employed a full time Service Designer as a core member of our interdisciplinary innovation team. Whilst we continue to work with Service Designers on some of our key programmes, we also recognised that in order to create a platform to expand Service Design to the NHS (and the NHS to Service Design) we had to have our own, institutional Service Design expertise. Even so, the role of the Service Designer within a health organisation remains similar to working in a design consultancy context.

Clearly, this is a new professional working context for the Service Designer with new challenges and slightly different skill requirements. As with all Service Designers, the job entails finding as well as solving problems. In-house Service Designers still facilitate collaborative design processes, enabling people to develop and implement solutions together.

The job still requires expertise in using a

»It is important to remember that working within a health organisation places the designer at the pulse of making change happen. It allows one to experience first-hand the impact Service Design approaches can have in people, ways of working and their outcomes.« visual language for breaking down complexity and communicating intangible relationships and interactions between people. And the role still demands the ability to create a more holistic picture, fitting all various elements together on a more strategic level to remodel entire business structures.

But moving to the public sector requires adaptation to a very different organisational culture. For one, working within an interdisciplinary team of health experts, former practitioners, psychologists and researchers means the in-house Service Designer needs to develop quickly an understanding of the bigger picture, and – crucially – the political drivers and policies involved. Practical design work has still to fit within the broader strategic touc hpoint | the jour nal of se rvi ce desi gn

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designing from within

By Julia Schaeper, Lynne Maher and Helen Baxter

Julia Schaeper is a Service Designer and Associate at the NHS Institute for Innovation and Improvement, UK. Before joining the NHS Institute, Julia worked as a Service Designer at Engine, helping private and public sector clients innovate their service offering. She has worked on service innovation projects for several companies including Mercedes-Benz, Norwich Union, Orange, AA and Dott 07. Julia has also lectured and run seminars on Service Design at several universities across Europe.

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objectives set out by the government, and has to be grounded in the specialised terminology used in the healthcare sector, if it is to remain engaged and relevant. This can be quite a challenge, given that few designers have direct experience of the policy arena. It is essential to have at least some understanding of the culture and key issues faced in the healthcare sector.

Secondly, working in-house means that the Service Designer has to deploy their skills across a much wider scale of potential applications. Projects might range from working closely on the ground with a GP to improve aspects of a surgery or patient experiences, to working on a much more strategic level, remodelling internal business structures or translating the newest policy documents into actionable opportunities for change. Facilitation skills, enthusiasm and tenacity are crucial, as it can take some time to gain acceptance for new ideas and approaches.

Even so, the internal design expert should remain a champion for the application of design as an integral component of healthcare innovation within the Institute and wider NHS. A large part of the work will consist of finding solutions that build the capacity and capability to innovate within healthcare providers, as well as coaching front line staff to use design techniques, transforming them into a new cohort of change agents.

Importantly, Service Designers posi-

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tioned within a public service organisation can help shape people’s associations and understanding of design, championing design as a problem-solving process rather than an exercise in making things look nice. They can bridge the gap between the design industry and health provision. For that, designers might need more training in translating their skills appropriately. Also, feeling comfortable with a certain ambiguity, dropping design terminology and accepting to work within the more political context of the health sector is important.

Whilst the scope of change might be limited by political and cultural realities as well as slow step-by-step progress at times, it is important to remember that working within a health organisation places the designer at the pulse of making change happen. It allows one to experience first-hand the impact Service Design approaches can have in people, ways of working and their outcomes.

footnotes 1 The NHS Conferderation, Dealing with the downturn, June 2009, http://www.nhsconfed.

org/Publications/Documents/Dealing_with_the_downturn.pdf 2 Design Council, Public services by Design, http://www.designcouncil.org.uk/en/Design-

Council/1/What-we-do/Our-activities/Public-services-by-design/ 3 RSA Design & Society, Social Animals: tomorrow’s designers in today’s world, Sophia

Parker, July 2009 4 Dott 07 (Design of the times 07) explored what life in a sustainable region could be like – and how design could help us get there, http://www.dott07.com 5 Public services by design’ was set up in response to the Government ‘Innovation Nation’

White Paper to help government create services that are not only cost-effective but that connect the public with the heart of policy making, http://www.designcouncil.org.uk/en/ Design-Council/1/What-we-do/Our-activities/Public-services-by-design/ 6 See various examples where different teams in the Institute used Service Design support

for their programmes; see the Open door Project Grimsby, www.managing-innovation. com/case_studies/Open%20Door.pdf; see HealthConnect – a design project with London based Service Design Agency Engine and Bucks County Council, see Alzheimer 100 project, www.alzheimer100.co.uk/ 7 The Operating Framework for the NHS in England 2008/09 8 The NHS set out to deliver its quality and efficiency commitments through a greater

focus on quality, innovation, productivity and prevention (QIPP). This will allow the NHS to drive up quality whilst improving productivity - a challenge which means harnessing and spreading innovation and new ideas. QIPP will be key to building upon the success and progress made in implementing the commitments set out last year in Lord Darzi’s High Quality Care for All. http://www.dh.gov.uk/en/News/Recentstories/DH_101712 9 RSA Design & Society, You know more than what you think you do: design as

Lynne Maher is the Head of Innovation Practise at the NHS Institute for Innovation and Improvement, UK. She leads work on innovation specifically focusing on the design and redesign of health services and processes to support the NHS. Lynne is a member of the Innovators Council formed by the Cabinet Office, a Fellow at the Health Service Management Centre, Birmingham University and a Fellow of the Royal Society of Arts. She is a reviewer for the British Medical Journal and Institute for Healthcare Improvement and an advisory board member for the Design Council.

Helen Baxter leads on the experience based design approach and the Innovation Practitioner Programme for the NHS Institute, as well as working with the team to develop and explore the application of novel processes, tools and techniques for the NHS. Helen completed an MSc in Continuing Professional Development (Health) at the University of Greenwich in 2005. Helen is a trustee at a local hospice, leading on the implementation of strategy and workforce planning and development. www.institute.nhs.uk

resourcefulness & self-reliance, Emily Campbell, July 2009

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By Cale Thompson

Designing for the social challenges of better health Exploring new ways of working. London Borough of Southwark is one of 33 local government authorities in London. The Council provides more than 200 services, including health, to their 275,000 residents. The task is becoming increasingly complicated due to the threat of significantly diminished budgets and a new assessment framework.

Cale Thompson Project Lead, Engine

The Southwark Rise project was set up in partnership with Engine as a platform for developing a multi-disciplinary, cross-departmental approach for connecting strategic policy making with the everyday lives of families in the borough.

Working with a core team of policy strategists, Engine was asked to explore two related and complex areas; childhood obesity and the challenges of creating better life chances for children from the most deprived backgrounds.

The project was carried out with a view towards enabling Southwark policy makers, through the transfer of skills and knowledge to • build a more complete picture of the complex lives of families living with economic hardship; and • become smarter in the way they identify and act on opportunities to support their residents.

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Generating a 360° view of families’ lives in Southwark Painting a rich and useful picture of the challenges faced by the most disadvantaged families is not easy. To begin with we needed to define the scope and audience of the research, choose the best approach and create the right conditions to support the approach.

A team of managers and policy staff from across the council helped to define key research areas during a workshop that explored complexity through the lens of a single family, including motivations and barriers to getting support and priorities and value systems.

It was important to understand topics such as employment, health, community, faith, and relationships in concert. To generate a deeper understanding of these interrelated topics we employed design ethnographies to study eight families in the borough. This qualitative approach

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designing for the social challenges of better health

By Cale Thompson

encouraged open and natural dialog and enabled us to gain access to day-to-day lives through the use of comfortable (home) environments, extended engagement periods and objective observation.

Informal stimulus materials helped to

unearth perceptions of support, mindsets towards council staff and services and permit conversations around sensitive or complicated issues inherent to health and family.

Collaborative service development with service users and health experts Building on insights revealed through design ethnographies we moved to the conception of preventative health services that can support Southwark families in addressing the challenges of childhood obesity.

Through a series of collaborative design workshops we led an ‘action research’ programme involving a design team of 20 parents and frontline Council staff interested in the topic of childhood obesity as a dimension of public health.

Design activities challenged team members to look at problems as opportunities and supported them to generate services that involved new partnerships and approaches. A series of unexpected services were developed, evaluated, refined, and modelled using tools such as service sketching, idea templates, customer journey mapping, desktop prototyping, and voting. This revealed underlying values related to provision, desired service journeys and considerations for new and existing touchpoints.

»Informal stimulus materials helped to unearth perceptions of support, mindsets towards council staff and services and permit conversations around sensitive or complicated issues inherent to health and family.« 36

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From the many service ideas and propositions emerged a series of key areas of support around health. The image of a remarkably different notion of health support was defined, one that shifts the

our space

»As Service Designers, our contributions go far beyond service creation to improving service capability and capacity.«

Everywhere in Southwark there is a space for your group. Southwark Council owns and operates many buildings and spaces that are used by different organisations during parts of the day, but are available the rest of the time. Not any more...

By joining Our–Space members are given a pass-key to dozens of venues across the borough where they can run group activity, from exercise classes, to cook & eat events.

All venues can be booked online and are certified safe and healthy environments.

Membership is free for group leaders and spaces will be charged by the hour (subsidies available to groups that qualify).

• Our-Space is available to all Southwark residents and encourages group activity by providing convenient, inexpensive venues.

• Digital pass-key to all participating spaces • Online profiles, reviews and booking of spaces

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»It’s about bringing in the right perspectives at the right time to create the capacity for creating solutions.

Service Design practise can play a leadership role here by sequencing these engagements and connecting them to a design process. Engine began the project by identifying and organically growing a project network of individuals, groups and organisations leading to the direct involvement of 70 people.« emphasis from providing support by health professionals to providing platforms that let residents support themselves in different ways such as: • Support the exchange of information and experiences between people.

• Support individuals to create tailored solutions for themselves through resources that allow them to organise, manage, and deliver themselves.

• Support the creation of new, combined, and informal service roles.

A full copy of the report will be available soon at www.enginegroup.co.uk

Making the case for Service Design in the public sector Based on Engine’s work exploring new 38

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ways of working with Southwark and other organisations in the public sector we have learned a great deal about the value of the particular contributions that Service Design practise can make.

Finding the root cause The services developed by the team had seemingly tenuous links to childhood obesity. For the families, the route causes of unhealthy weight were various including: family finances, the home environment, safety, and the neighbourhood.

The Council has a very comprehensive remit and has much to gain from drilling down to solve root causes, wherever they may lie. Service Design has a critical role to play in informing strategy, just as policy research might, and by engaging users in action research Service Design-

ers can help connect insight with strategic projects.

Engaging a project network Complex problems are best handled by groups as the knowledge, skills, and other resources necessary to address them are often diverse. Fortunately organisations will always have their staff and users as sources of insight, but getting them involved requires support. It’s about bringing in the right perspectives at the right time to create the capacity for creating solutions. Service Design practise can play a leadership role here by sequencing these engagements and connecting them to a design process.

Giving people capabilities For service providers in the commercial sector profit is the single bottom line. In contrast, dramatically reducing costs and building social capital are key drivers for the public sector. In this sense there is a greater recognition of the value of engaging service users in innovation through collaboration and delivery through coproduction. The Southwark Rise Project demonstrates the power of engagement and the need to design platforms not solutions to help citizens participate in delivering their own support. In the health sector such an approach lends itself to the imperative of co-production in improving health outcomes. Through the hybrid practise of Service Design, health service organisations are able to create relationships with users and staff that are more consistent, sustainable, generative, equal, and geared towards continual improvement.

Reducing complexity Complex problems can’t be addressed all at once. What we offer is a way to break them down into understandable parts. By choosing an effective method of framing, such as the family and using a sequential design process that moves from insight to idea to action, we are able to understand and communicate the problem in a way that sticks like statistics but provides more lasting understanding. Service Design has the power to bring people together around facts, experiences and motivations encouraging a shared view of the problem, which is incredibly valuable in siloed organisations.

Cale Thompson is a project lead on service innovation projects at Engine Service Design, UK. He has worked with private, public, and 3rd sector organisations such as BAA, Philips, Sony Ericsson, Kent County Council and Kiva.org to help them address complex challenges in health, air transport, microfinance, telecoms, retail and in the development of an innovation lab for local government. www.enginegroup.co.uk

Designing more than services As Service Designers, our contributions go far beyond service creation to improving service capability and capacity which is embedded in the people and organisations that we work with. Through the use of accessible methodologies and simple tools we provide useful frameworks for understanding the challenge and opportunities to build alliances both internally and externally coalescing in ‘infrastructures of understanding’. Of the twenty individuals involved in action research for the first phase of Southwark Rise, all twenty committed to further involvement.

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By Judith Altenau

Design in practise Enabling change and flexibility with health providers An Interview with Daniela Sangiorgi and Valerie Carr.

ImaginationLancaster is a creative research lab at Lancaster University, UK. One area of research focuses on investigation of Service Design in relation to contemporary issues such as sustainability and public services reform.

Daniela Sangiorgi Lecturer and researcher, ImaginationLancaster

Valerie Carr Research Associate, ImaginationLancaster

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Their current research project “Design in practise. Enabling change and flexibility within Health Providers”, which runs from May 2009 until October 2010, deals with how UK General Practitioners’ (GPs) practises are implementing the new Practise-Based Commissioning (PBC) framework of the British National Health Service (NHS). The NHS has set up an ambitious programme of change that touches all levels of the healthcare system: from buildings and infrastructures to new services, professional roles, quality targets and renewed patients’ rights and choices. This investment has been driven by the necessity to transform old hierarchical and paternalistic models into a modern health system built around the needs of patients and the delivery of a more personalised service. This focus on patients’ needs has shifted attention to local community services and front-line staff, with local GPs taking responsibility for commissioning services under the new PBC framework. Thus, front-line staff is now assuming a key role. The programme empowers local clinicians

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to better respond to local and individual needs and design new delivery modes and new services that are contextspecific.

Could you briefly describe the new NHS “Practise-Based Commissioning” framework?

Practise-Based Commissioning (PBC) has been set up by the Department of Health as the framework within which GPs will be expected to engage with their patients. The goal is to use their underlying knowledge and experience of patients’ needs, to improve current provision of healthcare in their localities. GPs can choose to group with other practises to form PBC consortia and are given an indicative budget (based on historic spend) to commission healthcare services for their patients. The remit of PBC is to reconsider the traditional approach to patient care, which has involved a split between Primary Care (delivered by GPs in local healthcare settings) and Secondary Care (provided

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in more centralised hospitals) and design and commission improved local solutions where appropriate. PBC was initiated in 2003 and all practises were expected to sign up by end 2006.

How can Service Design contribute to enabling innovation at a local basis in the NHS in general?

Those working within the NHS have expressed disappointment at the inadequacy of existing management tools in meeting the ‘big’ challenges of transformational change in NHS. People have recognized the need for radical creative approaches to innovation to enable the NHS to evolve in order to provide quality healthcare in the 21st Century. Service

»The goal is to use their underlying knowledge and experience of patients’ needs, to improve current provision of healthcare in their localities.«

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Design supplies a reservoir of methods for Primary Care Trusts (PCTs) to involve users in planning, developing and delivering new models of healthcare, and generate forums for creative interactions between insider and outsider perspectives.

Service Design methods can be applied to express and integrate the day-to-day, latent knowledge of clinicians into the commissioning and design processes, which is at the moment an ill-expressed resource for innovation.

What is the role of your University within the context of the above-mentioned NHS project?

ImaginationLancaster is collaborating with Salford University as part of a research centre called HACIRIC (Health and Care Infrastructure Research and Innovation Centre). HaCIRIC’s focus is on the underlying built and technical infrastructure for health- and social care, and the interaction between this infrastructure and change and innovation in care services in UK. We are leading the research project and meeting periodically with the Salford team to guarantee the integration with their research on Benefit Realisation Management. We conduct an action research project – meaning that we engage with the Lancaster PBC group investigating their commissioning activities – while exploring design methods and skills that can be integrated in their day-to-day activities. In other words, we conduct research through designing.

»People have recognized the need for radical creative approaches to innovation to enable the NHS to evolve in order to provide quality healthcare in the 21st Century.«

What can you say in regard to the acceptance of the Designers by stakeholders?

As soon as people in NHS hear the word ‘design’ they assume that we’re talking about products or buildings, so it takes some explanation to help the participants grasp that design thinking can be applied to services also. It is often difficult for them to understand what design can bring to the table that is new. Within the

PBC framework they have been asked to develop skills and work processes that they are unfamiliar with (such as managerial and financial processes). They appreciate the potential to have a stronger role in directing the design of new services, but still struggle with finding the right balance between self-development as professionals and dependency on PCTs for resources and support. Within this transformation of their identity they show a general interest to explore what ‘cre-

Daniela Sangiorgi is a lecturer at ImaginationLancaster, Lancaster University, UK. Daniela’s research focuses on Service Design, which was also her PhD topic. She has investigated services as complex social systems, proposing holistic and participatory approaches to Service Design. Daniela was a researcher for the SDI Agency at the INDACO Department of Politecnico di Milano until April 2007.

Valerie Carr is a Research Associate at ImaginationLancaster, Lancaster University, UK. Valerie has a background in interior design and architecture. Her PhD focused on healthcare work environments and was part of a project funded

by Department of Health evaluating birth environments in UK. She worked for a year overseeing the building of an orphanage in Burundi, East Africa and that was a research assistant in School of Design at Dundee University. Her research interests focus on the contextual environment of behavior and how environments shape and are shaped by our behaviours.

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ative methods’ could do for them in their daily challenges.

Why is it so important to give a key role to frontline staff ?

»Service Design supplies a reservoir of methods for Primary Care Trusts (PCTs) to involve users in planning, developing and delivering new models of healthcare, and generate forums for creative interactions between insider and outsider perspectives.«

Frontline staff see, hear, and play an important part in the life stories of their patients, as they are involved in conversations about the most intimate aspects of their lives, such as mental health problems, sexual practises, and addictions.

Not many other professions provide the level of connection and intimacy associated with the patient–doctor relationship, where doctors also regularly visit some patients in their homes. Involving staff that have a deep understanding developed through years of interactions with patients, provides access to an extensive knowledge base. Helping these same staff to explore how some of their existing practises might evolve is the big challenge for Service Designers.

What is your experience of how frontline staff are currently implementing the PBC framework?

In most PBC consortia a few visionary GPs are driving most of the changes.

In some of the larger PBC groups, the PCTs have taken a strong guiding hand.

This has meant that the PBC group gives the impression of a top-down approach to what was meant to be a grass roots, clinically-led initiative. As is always the case in large organisations, bureaucracy abounds, and proposals for service innovations, which are meant to be considered within 8 weeks, are taking 25

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weeks to be accepted and another 25 to be implemented. GPs very quickly lose their initial enthusiasm and question the value of the amount of time they have to invest in creating and negotiating business proposals for service changes.

Could you already give some recommendations on how to improve the way GP practises envision and co-design their future practises?

The research project is only at its fourth month so it is difficult to have answers, but what is clearly emerging is the need to develop methods that can fit into clinician’s daily practise. It is important to recognize the fundamental role they can have in understanding and interpreting patients’ needs, but not add additional tasks. At the moment, this richness of knowledge often remains implicit or only manifested as a general concern.

Tom Pickering, Business Manager of Lancaster PBC, suggested that this makes it difficult then to evaluate if the concern is coming from a real need of users or from a personal interest of GPs or a mix of both. The richness of their experience doesn’t remain unused but it is ill-expressed. Service Design could surely support PBC groups to improve this aspect.

By Fernando Secomandi, Erik Jan Hultink and Dirk Snelders

From quality surveys to new touchpoints – a challenge for Service Design Quality was at the centre of service research for the last decades.

One of the main achievements of researchers in this field has been to devise ways to help organisations enhance service quality. There are now many tools available for that, most following a common rationale: first, organisations must understand how customers experience the quality of their services, and subsequently they should take the right measures to improve it.

Quality surveys can yield much knowledge about customer perceptions of quality. But our question is whether this information immediately leads to better services for organisations. In addition,

main quality issues for patients of gp practises in the u.k.  Staff who instils confidence in patients

 Staff who is consistently courteous

 Visually appealing facilities  Convenient opening hours

we ask: what is the role of Service Design in this process?

To investigate this issue we conducted an empirical study focusing on healthcare offered by general practitioner (GP) practises in the UK. GP practises are at the front-line of the British National Health Service (NHS). People go to GP practises for a number of primary care services, including medical examinations, vaccinations, medicine prescriptions, referrals to medical specialists and simple surgeries. Because there are so many practises and there are so many differences among them, there is a constant struggle to ensure that a high level of consistent quality is offered to all patients. In our study, we performed a traditional quality survey with the SERVQUAL tool to measure patient experiences with GP practises. The results show that patients judge the quality of practises fairly positive. In particular,

Fernando Secomandi Doctoral researcher, Delft University of Technology

Erik Jan Hultink Professor, Delft University of Technology

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from quality surveys to new touchpoints

By Fernando Secomandi, Erik Jan Hultink and Dirk Snelders

there are four issues which best represent how they form overall quality evaluations (see box on previous page).

Dirk Snelders Associate professor, Delft University of Technology

Next in our study, we contacted more than a hundred professionals who had worked at GP practises in the recent years, comprising both clinical staff (doctors, nurses, etc.) and clerical staff (managers, receptionists, etc.). In the questionnaire, we asked them to consider the usefulness of the quality assessments identified above and think of potential improvements to services at their practises. All four issues were rated useful.

Yet, the staff thought that “staff who is consistently courteous” was the most actionable one, whereas “visually appealing facilities” was the least actionable.

Quality information was judged actionable when it referred to areas under the influence and control of the staff.

In general, our findings suggest that quality surveys can provide accurate and actionable information for organisations.

Can it be concluded, then, that attaining quality improvements is straightforward? We believe this is not the case.

Having useful customer information is the initial step to improve an existing service. But this information, by itself, does not specify how a new service should be designed in place. For instance, a GP practise might wish to enhance their services by ensuring consistently courteous staff. But to become courteous the staff cannot just ameliorate their

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current conduct, they must also conceive of entirely novel behaviours that will result in better experiences for patients.

Another practise may want to increase its facilities’ opening hours to ensure convenience. But if there are no resources to hire additional staff, or if regional legislation is prohibitive, they must find alternative ways to address this same matter. The present skills of the staff may also be limiting. A practise wishing for more visually appealing facilities largely depends on external expertise for reconfiguring their physical space extensively.

Ultimately, service improvements are realized when the information from quality surveys is translated into better touchpoints for customers. But in moving from quality information to new touchpoints, organisations initiate a process marked by its own complexities, where factors like organisational culture, available resources, strategic plans, and competition have their roles to play. The critical task, the design task, confronting organisations is therefore to devise new or improved touchpoints that fulfil customer quality expectations while fitting the organisation’s intent.

As noted by many authors in the first issue of Touchpoint, in recent years Service Designers have been refining and applying a vast repertoire of approaches and tools to help different organisations design better services.

Some of these stand out as particularly

valuable for service quality improvement projects too. For example, visualisation techniques, such as drawings, mock-ups, storyboards, 3D animations, and prototyping of personal interactions, can be used by Service Designers to investigate ways to embody quality in different types of touchpoints. On the other hand, (co) design workshops involving key participants of quality improvement projects – customers included – can establish a common platform to share ideas and estimate the feasibility and desirability of incipient touchpoint plans.

What we suggest here is that Service Design can operate at a vantage point within organisations from where it helps conceive how multiple touchpoints cutting across disciplines, departments, and organisational units can be integrated into a coherent service experience for customers. A productive way forward for Service Design would be to develop knowledge that helps practitioners realise such positioning. This could include, among other things, models that explain how customer quality perceptions are grounded on various touchpoint types.

Developments along this line represent not only an opportunity for a fruitful contribution of Service Design to quality research and practise, it is also a natural inclination of the discipline and call for designers to create better services by doing what they know best.

Fernando Secomandi is a doctoral researcher in the Faculty of Industrial Design Engineering at Delft University of Technology, the Netherlands. He received his M.Sc. in strategic product design from the same university. His master thesis was written on the topic of service quality improvements. Currently, his is pursuing a Ph.D. by investigating ways to represent the object of Service Design activity.

Erik Jan Hultink is a professor of new product marketing in the Faculty of Industrial Design Engineering at Delft University of Technology, the Netherlands. He received his M.Sc. in economics from the University of Amsterdam and his Ph.D. from Delft University of Technology. His research investigates means for measuring and improving the process of new product launch.

Dr. Dirk Snelders is an associate professor of marketing in the Faculty of Industrial Design Engineering at Delft University of Technology, the Netherlands. He received his Ph.D. from the same university in 1995 and worked as assistant professor of Marketing at the University of Namur (Belgium) from 1994 to 1998. His research focuses on aesthetic product judgments and the role of branding and novelty in such judgments.

»What we suggest here is that Service Design can operate at a vantage point within organisations from where it helps conceive a coherent service experience for customers.«

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chapter preview

Hospitals and patient experience On the need of hospitals to communicate better, create memorable patient experiences and borrow from the hotel industry.

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Shaping the hospital of the future Tine Park

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We help our clients feel what their clients feel An Interview with Bob Cooper

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Service Design from within a healthcare organisation An Interview with Teresa Huber and Julian Hadschieff

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Revealing experiences. Service Design within a healthcare institution Hester van Thiel, Mike Janssen and Marc Fonteijn

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Brand positioning is the foundation for a memorable patient experience Hester van Thiel, Mike Janssen and Marc Fonteijn

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Systems | people. Overlaying user-centered and systems approaches for designing complex services Richard Hayami Z’Graggen

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By Tine Park

Shaping the hospital of the future How do you design a hospital so that it delivers good service – for patients, relatives, and staff? And save money? At Denmark’s largest hospital, Service Design is proving to be a powerful healing force.

The food is mediocre. The interior decor is uninspiring. And you keep getting lost because of a lack of good signposting.

Sounds like a bad hotel? This is in fact the reality of many hospital visits today.

All too often, hospitals deliver formidable medical service, but a less favourable service on other fronts. The result: dissatisfaction – not just amongst patients, but also relatives and staff.

Preparing for future challenges The need for service improvement at public sector hospitals is not only undeniable, but also urgent. In the future, public hospitals will face an array of socio-economic challenges, which together will present an unprecedented burden on the public sector.

Budget cuts will force hospitals to save money where possible. Healthcare staff will be in short supply. The elderly population will increase, as will the incidence of lifestyle diseases. And private hospitals, with their increasingly optimised service offering, will present tough competition.

Change at Denmark’s largest hospital Service Design presents an effective way of meeting these demands while, crucially, delivering a better service experience.

Designit, Scandinavia’s largest integrated strategic design consultancy, was asked to apply Service Design at Denmark’s largest public hospital, Odense University Hospital (OUH).

The project which started in January with funding from the Danish Enterprise and Construction Authority, is expected to serve as inspiration for future public healthcare improvements – in Denmark and abroad.

Tine Park Strategic design consultant, Designit

From hospital to hotel Designit’s task was to demonstrate how experiences from OUH’s award-winning and innovative patient hotel could be successfully developed and implemented in a new clinical department at OUH. Founded 12 years ago, the patient hotel offers physically independent patients a safe, flexible, and service-orientated alternative to traditional hospitalisation.

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shaping the hospital of the future

By Tine Park

»One of our recommendations is to roll out consistent counselling and coaching by, for example, establishing ‘patient schools’, where patients learn how to take an active role in their treatment.«

restaurant where relatives are welcome and individual rooms complete with TV, telephone and bathroom.

By integrating aspects of the patient hotel in a new clinical department at OUH, the project aims to deliver a better experience for patients, relatives, and staff – as effectively and efficiently as possible.

Ready, steady, go So how do you go about redesigning a hospital service? By observing and talking to people, identifying their needs, and involving people in finding a solution.

As designers, we don’t believe we have all the answers – particularly when working in specialist areas such as healthcare, where people’s lives are at stake. We believe that our clients hold the key to their future and that our job is to merely translate their knowledge into effective solutions. As such, Designit served as neutral facilitators in a process of greater change at OUH.

Holistic, user-driven approach We took a holistic, user-driven and cocreative approach, made possible by our multi-disciplinary team of strategists, anthropologists, graphic designers and product designers. This broad and integrated skill base allowed us to examine many aspects of service delivery and everyday life at the hospital and patient hotel. Our team conducted 52 interviews, 19 cultural probes and six workshops, resulting in a total of 82 respondents. To immerse ourselves in everyday hospital life, we slept overnight at the hospital, ate with patients, and drank coffee with staff.

We involved a wide range of users and 52

Building blocks for future hospitals

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 Seamless and effective patient flow

 Patient empowerment and selfcare

 Relatives’ involvement  Good working environment  High professionalism  Inspirational physical surroundings

 Considered and consistent communication

 Secure personal integrity  Effective collaboration across departments

 Healthy food

experts. Aside from collaborating with patients, relatives, and medical staff, we worked with non-medical staff on all levels – from kitchen hands and cleaners to top management and architects.

Our team incorporated user-driven co-creation whenever possible, from the very first meetings to concept testing. Our cultural probes, for example, consisted of an entire kit, enabling people to communicate their feelings, expectations, and visions through, for example, diary entries and photos. In our workshops, we facilitated structured cocreation to generate and test ideas on, for example, departmental layout.

To ensure we built upon existing expertise, our team examined theory and best practise examples from around the world. The results, collated over the course of just two months, were rich, diverse and revealing.

Prescription for improvement We found that an effective and seamless patient flow is a top requirement for a more service-orientated hospital. We believe this can be achieved by improving co-operation between departments and responding to patient needs.

Also important is patient empowerment.

We believe this can be achieved by creating new physical spaces, services, and communication. One of our recommendations is to roll out consistent counselling and coaching by, for example, establishing ‘patient schools’, where patients learn how to take an active role in their treatment. This not only puts patients in the driving seat, but also delivers savings and better health. Research shows that

patients who take an active role in their treatment have a speedier recovery.

Relatives need to be acknowledged and supported. We suggest providing specific services – such as being able to eat with their relative and stay overnight. We also recommend that relatives help staff by completing tasks, if they wish. Improving communication and managing expectations are crucial factors in delivering a good overall experience to relatives.

Staff also deserve a good working environment. Hospitals depend on being able to attract professional, motivated staff.

We suggest creating an inspiring interior

»As designers, we don’t believe we have all the answers – particularly when working in specialist areas such as healthcare, where people’s lives are at stake. We believe that our clients hold the key to their future and that our job is to merely translate their knowledge into effective solutions. As such, Designit served as neutral facilitators in a process of greater change at OUH.«

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shaping the hospital of the future

By Tine Park

Tine Park is a strategic design consultant with Designit, Scandinavia's largest integrated strategic design consultancy, with offices in Copenhagen, Aarhus, Munich, Oslo, Paris and Shanghai. By combining human needs with business strategy, Designit acts as an agent of change for businesses and society. Tine has an MA in Industrial Design from Aarhus School of Architecture, Denmark. She has also studied anthropology at the University of Copenhagen, Denmark. Her focus is user-driven innovation and life-improving design. www.designit.com

design, facilitating cooperation and sharing knowledge between departments and reducing staff workload. All these recommendations and more have been compiled into three Service Design concepts that deliver improvements in three key areas: service offerings, physical environment and core clinical services. While different in their focus, each integrates service components from the patient hotel concept with patient involvement, self-care, and choice.In order to show how the concepts can work in practise, we have delivered a communication plan, scenarios, and visualisations of physical spaces.

From concept to reality Soon some of these recommendations will become reality in everyday life at OUH – and our concept put to the

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ultimate test. Initial implementation is expected this autumn, with a more extensive roll-out planned for early next year. Designit’s recommendations will also provide inspiration for the new OUH hospital, due to open in 2018.

The question how the concept will be implemented is still to be decided.

Certain is, however, that OUH believes they now have a flexible solution that can bring about positive change in their dynamic and political organisation.

Also certain is that designing a hospital is a challenging but extremely rewarding experience. As designers, we dream of making a difference – and what cause could be more worthy than a hospital?

We hope our work helps create a better experience for patients, relatives, and staff and set new standards for future healthcare.

By Judith Altenau

We help our clients feel what their clients feel An Interview with Bob Cooper.

Bob Cooper is the founder and President of Frontier Service Design, a US consulting firm that he has launched after 25 years of experience in marketing, branding, technology development, interactive media, business design and executive leadership.

Frontier Service Design works with corporate clients to identify, design, build, and launch innovative services that create new and recurring revenue streams.

What do you offer under the label of “Service Design” to institutions and companies, particularly in the health sector?

We primarily work with companies who are providing services or products to the providers in the health sector.

This includes pharmaceutical and biotechnology companies, clinical research organisations, and a wide variety of support companies that provide medical writing, professional recruiting, insurance, etc. Frontier Service Design helps these companies identify and design new and/or recurring sources of revenue.

We do this by integrating their core business with the true needs of their current and prospective customers, often using the newest developments in technology and an understanding of trends in society and business.

The health sector, particularly in the

United States, is very complex because of all the various players, agendas, and economics. A lot of our work revolves around getting our clients to see their business through the eyes of the customers. Service Design’s principles can help instill in our clients a sense of empathy for their customers. This is particularly important in the health sector because you're not just talking about good service experiences but rather pain, anxiety, fear, and even death. So the stakes are much higher. And too often, the people in these companies sometimes only see these as “markets” or “demographics” as opposed to real life people.

We see it as our job to reconnect our clients to those people, and help our clients feel what those people feel. To that end, we do a lot of ethnographic research, shadowing, and observation in the field.

From there, we start the innovation process to ask questions like “what if” and

Bob Cooper President and founder, Frontier Service Design frontierservicedesign.com

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we help our clients feel what their clients feel

By Judith Altenau

“why not?” We look into the future and help our clients imagine what healthcare and their business will be like, or could be like, three or five years down the road. Then we help them prioritize what needs to be done, and actually help them implement those changes. In some case we might develop components in-house or else we find best of breed providers and manage the overall project.

That’s a differentiator for us at Frontier, because we don’t just design the new service and leave it at our client’s doorstep – we take them through the launch phase, both inside their company as well as to the market, often helping them benchmark and gauge the results. As

»I think one of the biggest challenges we are going to grapple with related to health services are ethical issues. With advanced technology we “can” do amazing things in medicine, but “should” we?.«

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we ask our customers to consider their customer, so we consider our clients and all of our touch points with them.

Service Design is a rather new discipline. How would you differentiate between Service Design and Marketing?

What are the similarities, what are the differences?

The fundamental difference between Service Design and marketing is the point of view. Whereas marketing is all about coming up with “your” message and blasting it out to as many people as possible, Service Design takes the opposite approach and focuses on the needs and desires of the customer or prospect first. For clients who grew up in traditional marketing, they can get frustrated with this approach because they perceive that it takes too much time to really understand the customer. These companies are anxious to start “telling their story” and don’t realize that they will save significant time and money by slowing down and looking at their business through the eyes of their customers.

Having started out in advertising and marketing, I can tell you that the quickest way to lose a new client engagement was to question the client about the validity of the service they were about to launch. “What? That’s not your job! We want your creative ideas on how we can sell more of these products/services. We already know what the customers want!”

When, in fact, they never really talked with any customers at all.

This mentality is what often leads to such churn in the advertising and mar-

keting industry. On average, about 50% of clients are frustrated or dissatisfied with their incumbent marketing firm. Why? For the very reason listed above. Too often neither the client nor the marketing firm really spent the time listening to, talking with or understanding the customers or prospects. As a result the client spends a great deal of money over with very little return on investment.

What do you think are the most important demands for Service Design if it wants to match future challenges within the context of health services?

I think one of the biggest challenges we are going to grapple with related to health services are ethical issues. With advanced technology we “can” do amazing things in medicine, but “should” we?

These questions are at the root of the problems in healthcare. To what ends do we go to keep a person alive, and how is that balanced with the resulting quality of life for that patient? How much is too much to spend? Whose life is worth more – a child’s or a senior’s? How do healthcare systems deal with people who can’t or won’t take responsibility for their own health, related to lifestyle issues which lead to chronic diseases such as cancer, diabetes, etc.? Is healthcare a right or a privilege? How to connect the technology with these very human ethical issues is a classic Service Design conundrum.

I am glad to see some momentum gathering around Service Design, specifically in the healthcare sector. I think that sharing success stories is key. I know that the NHS in the United Kingdom has

»The fundamental difference between Service Design and marketing is the point of view. Whereas marketing is all about coming up with “your” message and blasting it out to as many people as possible, Service Design takes the opposite approach and focuses on the needs and desires of the customer or prospect first. « published a “how to” book and DVD on their initiative around experience-based design at various hospitals. By actually “seeing” the process in action via video, health administrators in other organisations can learn best practises and bring the processes into their own facility.

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By Judith Altenau

Service Design from within a healthcare organisation An interview with Teresa Huber, Service Designer at PremiaMed Management, and Julian Hadschieff, CEO PremiaMed Management

Teresa Huber Service Designer, PremiaMed Management

PremiaMed Management is the major operator of private hospitals in Austria. The company runs private as well as public health organisations, which contain more than 750 beds and employs over 1,100 people. So far, PremiaMed Management is the only Austrian health organisation that has established the function ‘Service Design’ as a constant part of its quality management.

Service Design is thought to analyse and optimize the clinics’ structures and processes from the costumers’ view and, by this, benefit the customers significantly. Tourism expert Teresa Huber was employed as an in-house Service Designer 1.5 years ago.

Ms. Huber, why do you think Service Design is important – particularly in the health sector?

Julian Hadschieff CEO, PremiaMed Management

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Teresa Huber: Customers in the health sector – I call them ‘customers’ instead of ‘patients’ on purpose – are becoming more and more responsible; they make their own decisions. It is particularly important for private health organisations to differentiate themselves from others in terms of their service quality, as the medical competence is very high anyway.

This is why issues like freedom of choice, individuality, ambience, and hotel-like service offers are becoming more and more important. It is this ‘Service Plus’ that makes the difference.

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Coming from the hotel- and tourism sector yourself, do you think that it is particularly important to import expertise from this field to the health sector?

Teresa Huber: Our management was deliberately looking for someone who brings in a new, service-focused perspective and who simply does not know why certain structures are organised as they are. The working environment of a hospital was completely new to me. This is why I spent my first weeks getting to know the new surroundings – I have worked with different groups of people, sitting at the reception, giving out breakfast to patients or making beds. I got a whole bunch of new impressions and

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service design from within a healthcare organisation

By Judith Altenau

asked questions that someone used to the routine of a hospital wouldn’t ask.

And what does your work routine look like today?

Teresa Huber: Apart from our daily customer surveys, there is no real work routine. Let’s take this week. On Monday, for example, we made welcome cards for our private hospital in Salzburg. They contain important information for our customers – for instance, the fact that a range of amenities is available for free.

»It is particularly important for private health organisations to differentiate themselves from others in terms of their service quality, as the medical competence is very high anyway. This is why issues like freedom of choice, individuality, ambience, and hotel-like service offers are becoming more and more important. It is this ‘Service Plus’ that makes the difference.«

On Tuesday, I visited one of our hospitals in Graz. There is a Service Design project in progress, in which all hospital room interiors are being re-designed, to look like hotel rooms rather then sickrooms.

For the project, two showrooms were built and patients were asked to test them for two days and fill in questionnaires. Customers clearly favoured one of the two rooms and we went along with the decision of our customers.

Isn’t it a difficult task to actively involve patients during their stay at the hospital?

Teresa Huber: Surprisingly, not. The return rate of our questionnaires is 30% – much higher than the Tourism Sector, despite the fact that the questionnaire is quite long. Whenever a customer’s rating falls under a certain grade, or if he or she states a specific complaint, we call them afterwards, apologizing for the inconveniences and asking for more details and suggestions for improvement.

The customers are usually pleasantly surprised and at the same time, we gain many insights about the quality of our services from the customers’ point of view.The patients in house are highly involved, too. It is easy to involve them because things like the showrooms in Graz are simply fun – for the customers as well as for our staff.

So the clinics’ personnel is involved, too. Are they always willing to integrate ‘Service-Plus’ into their work?

Teresa Huber: Well, sometimes this

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needs some sensitivity. Yesterday, for instance, we had a meeting with the people from our Patient Service in Vienna, discussing a new checklist that should remind our staff to personally talk to our customers about some general things at the reception. The idea is that they should take time for a brief chat, especially when a customer visits our house for the first time. And, yes, this is certainly extra work. But at the same time, we are also asking about things that are inefficient for staff. It turned out that it is unbelievably tedious to work with certain materials that create a huge, unnecessary effort. So we changed these materials, and the clinic personnel accepted the new checklist. This is how we find trade-offs, simplifying things, which leave room for other tasks. Without the staff’s commitment, I could come up with many ideas – but they would never reach the customer.

It’s all about little things. Before Service Design was implemented, there was nobody who would plan things comprehensively. If there is no-one coordinating above certain interfaces, small problems are often not solved as they are assigned to different divisions.

Apart from the Patient Service, who are your everyday co-operation partners?

Teresa Huber: Interestingly, it is always a balancing act. I work a lot with occupational groups that were a bit out of our focus before. These are the people that work directly with our customers at the front line but who did not get so much training or instruction before. This

»It’s all about little things. Before Service Design was implemented, there was nobody who would plan things comprehensively. If there is no-one coordinating above certain interfaces, small problems are often not solved as they are assigned to different divisions.« is mainly Patient Service, who are often in the hospital rooms – the cleaning staff, nursing staff, and administrative personnel. If there is a certain ‘hierarchy’ within the hospital, I work with both ends, the staff as well as the management, and try to negotiate between the two.

A positive side effect of my work is that some occupational groups gain much more appreciation. For instance – this was really charming – we had a training day for Patient Service. During the event, touc hpoint | the jour nal of se rvi ce desi gn

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service design from within a healthcare organisation

By Judith Altenau

»Of course, I am still confronted with statements like ‘we care about the health of our customers, why should we make such a hustle about the details?«

Teresa Huber is a Service Designer at PremiaMed Management, the major operator of private hospitals in Austria. She works as a lecturer for marketing in healthcare at the University of Applied Sciences for Health Management and Health Promotion, Pinkafeld, Austria, as well as for health and spa tourism at the IMC International Management Center, Krems, Austria. She holds a graduate degree in Tourism Industry from IMC and has worked In Marketing, Consulting, Guest Relations and Health Tourism Europe-wide.

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one of the first things was to rename them, ‘Patient Service’ rather than ‘Department Assistants’.

We wanted to point out the relevance of their work, as they are the first and main customer contact people. Also, we had engraved name tags made for them, which we gave to them, together with a certificate, at the end of the day. And they were really touched!

We have talked about the involvement of patients and staff already, but what about management? Do you experience any difficulties when you try to communicate the financial benefits of Service Design?

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Teresa Huber: I think that by integrating the function Service Design, the awareness for service quality was clearly intensified. Of course, I am still confronted with statements like ‘we care about the health of our customers, why should we make such a hustle about the details?’.

But sometimes it is coincidence that solves the problem – one of our critics came directly to a PremiaMed hospital and experienced it from the customer’s perspective. After that, most criticism ended. But yes, in general it needs a lot of convincing; especially when more work or higher investments and costs are involved. One example is the international patient market segment, which we are planning to focus on. International customers are usually self-pay patients which is why, in economic terms, a higher rate of the profit remains with us. Increasing the number of customers within this sector is only possible if the first patients visiting us are satisfied with our house and our services. It is only then that more patients will follow.

Our service has to be in line with their expectations – or even better, exceed them. All efforts put into the acquisition of patients are in vain when the first personal contact isn’t perfect. Everybody understands this argument.

Are there concrete numbers showing that your work is economically efficient?

Teresa Huber: It is always difficult to trace such figures back to specific projects and activities. What we can say is,

for instance, that the segment of international customers is already growing.

Also, we hardly feel any consequences of the economic crisis – not even in the segment of self-pay patients. That is certainly a factor of success!

Recently, we are comparing our organisation with hotels, spa hotels and rehab clinics; we do benchmark beyond our own branch and we can see our customers’ satisfaction rate is very high in comparison and it is also changing for the better. This was particularly discernable in relation to a Service Design project dealing with complaints. In all our clinics, a Complaints Manager was employed, serving a co-ordinating function.

He can act across all departments and is not constrained by certain structures.

Since this co-ordinating function was implemented, we are noticing that the number of complaints is decreasing and the satisfaction concerning the handling of complaints is much higher.

Also, we do have a Balanced Score-card, which, until recently, contained mainly economic figures. I re-organised it with the help of my colleagues from the controlling department, adding more customer-related figures. The result is that customer satisfaction in general gains a whole new significance.

All this sounds really positive. Do you sometimes reach certain limits? Are there also frustrating moments, when you cannot go ahead as you’d like?

Teresa Huber: Sure. It can be a long rocky road to the final implementation of

a concept. If the decision-makers aren’t convinced, it won’t work out, and if the personnel is not involved, I can come up with hundreds of nice ideas but nothing will happen. Those are the limits.

Compromises and trade-offs have to be made – again and again.

Thank you very much for the interview, Ms. Huber!

»All efforts put into the acquisition of patients are in vain when the first personal contact isn’t perfect. Everybody understands this argument.«

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service design from within a healthcare organisation

By Judith Altenau

Julian Hadschieff is co-founder and CEO of PremiaMed Management GmbH and Humanocare Management-Consult GmbH, a Management Holding of several care facilities for older and disabled people. Before, Julian Hadschieff has worked for the state government Tyrol as the project manager in the establishment of TILAK, Tiroler Landeskrankenanstalten GmbH (Tyrolese State Hospitals).

He is chair- and spokesman of the association of health organisations of the Austrian Federal Economic Chamber (WKÖ) and president of the board of directors of Best Health Austria (Society for Health Tourism).

Mr. Hadschieff, the decision to integrate the function ‘Service Design’ into your organisation was made 1.5 years ago.

What were the reasons?

Julian Hadschieff: Three years ago, I attended a presentation by Birgit Mager on Service Design in Tourism. I thought that service ambitions of businesses in tourism should also be a task and challenge for us. I have then delved into service issues for a while and focused my marketing strategy on it.

Did you look for a Service Designer from the tourism sector in particular?

Julian Hadschieff: Yes, we were looking for someone familiar with the tourism sector. When it comes to finding a discernable competitive advantage, with competitors from the private or public sector, quality and process management is one thing. This is what we have been investing in for years. But the other thing is the establishment of something that our costumers can identify with.

We can only be successful when our costumers perceive observable quality.

And this was the reason to implement Service Design and borrow from tourism in particular.

Would you say that service aspects should be one of the top issues within healthcare institutions? What about medical competence?

Julian Hadschieff: I think that the service field is a wide one. Medical and care services are of course an important part

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of health institutions. But customers take medical competence for granted. Austria achieves top scores in the European Health Consumer Index and our population is quite happy with our health system. So especially for private costumers, it is a feeling of wellbeing that makes the difference. They can hardly judge the healing process but they understand if they like the food, how friendly a welcome is, how complaints and suggestions are handled and how pro-active services are implemented. I think these are the things that generate wellbeing. It’s not really about the question of whether a surgery was professionally done or not.

Did you experience any difficulties convincing other management members or the hospital management of your decision to implement Service Design as an in-house function?

Julian Hadschieff: Being the CEO I could simply say that I like an idea and that I want to implement it. But it is always better to convince people – and I think that people finally understood what it is all about. Not everyone is equally enthusiastic but it was put through in the end and today, everyone backs the new function. They have understood that it is an important part of ‘best performance’ to which we aspire.

Can you tell us in how far the function Service Design affects economic aspects within your organisation?

Julian Hadschieff: Despite the critical economic situation at the moment, our

organisation’s capacity figures are still slightly increasing. And this cannot be taken for granted; particularly as the health standard in Austria is very high anyway. In customer surveys, 98% say that they would recommend our hospitals. This is an extremely high score, even compared to the top hotel businesses. These figures show that we are on the right track. And this can certainly be connected to a wellbeing that we establish for our patients. Our international patients are a good index for our quality as well, because for them, it does not matter whether they fly to Moscow, Munich or Vienna.

We did not calculate how high the Return on Investment is regarding the position of Ms. Huber. Such figures can hardly be attributed to specific things.

But both in quality and risk management and in our certification efforts it has become clear that the approval of our customers is increasing. This was particularly discernable in areas where Service Design projects were implemented. And this is certainly the best that can happen to us.

Do you think that an in-house Service Designer like Teresa Huber does offer an advantage over external Service Design agencies?

Julian Hadschieff: I find a comparison quite difficult. I can only say that we want our organisation to show a clear commitment concerning services, putting the customer clearly in the centre of the scene. This is why we established the function within our holding – so to

say, at the ‘head’ of the company. We are convinced that Service Design is an area that directly influences in-house communication and that is why the function Service Design was deliberately positioned within the marketing and communications department. When we started to think about Service Design, we broke new grounds in Austria. The option of contracting with an external agency was not really there. It’s all about a certain business culture, a change of values within the company, which has to be initiated internally, rather then externally.

»Our population is quite happy with our health system. So especially for private costumers, it is a feeling of wellbeing that makes the difference.«

One last question: For you, what is the most interesting part of Ms. Huber’s work?

Julian Hadschieff: Most of all, it was interesting to understand that a Service Design process has to start at the very beginning of the service chain, when a patient contacts our house for the very first time. When he calls us, comes in for the first time and is accompanied to his room. This is where the process of rethinking has to begin. A ‘big bang’ at the very beginning of the experience cannot be made up for later. It’s just interesting to see that the culture has changed. Our employees now think differently about these things than they did two years ago.

Thank you very much for the interview, Mr. Hadschieff!

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By Christine Janae–Leoniak

Revealing experiences Design challenge questions and deliverables in Service Design at the Mayo Clinic The Center for Tobacco Free Living is the result of an innovation project conducted for the Mayo Clinic Nicotine Dependence Center that illustrates two Service Design process issues – the importance of the initial design challenge question and deciding what, and what is not in the scope of the project.

Mayo Clinic, NDC and SPARC Christine Janae–Leoniak Innovation Catalyst and Experience Designer, The Mayo Clinic Center for Innovation

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The Mayo Clinic is a not-for-profit medical practise that brings together some of the best care teams in the world for nearly every type of complex illness. With Mayo Clinic’s integrated care model patients come to Rochester, Minnesota; are seen by as many doctors or specialists as needed, stay for several days to see doctors, have lab work done and undergo imaging studies. For most patients in the United States, this is a different type of care experience, because what can take months at other medical institutions can be done in days at the Mayo Clinic. The 33,000 people employed at Mayo Clinic Rochester (MCR) make up numerous departments and workgroups. The three shields in the Mayo Clinic’s logo stand for practise, research and education and all three come together to deliver cutting-edge medical services.

Mayo Clinic also has a long history of Innovation. The new Center for Innovation (CFI) is an example. The CFI’s mission

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is: “To transform the way healthcare is experienced and delivered by providing project oversight and coordination, education, tools, resources, and consulting services.”

Serving as both an internal and external enabler, the CFI connects people, projects, and funds to help imagine and design the future of healthcare.

At the core, the Center for Innovation is a multidisciplinary team comprised of physicians, administrators, project managers, designers, as well as individuals from information technology, systems & procedures, finance, and operations.

CFI teams collaborate seamlessly with divisions, workgroups, and individuals in an effort to continue to facilitate innovation across Mayo Clinic.

The SPARC Innovation Programme is the Design/Research component of the Center for Innovation. SPARC, which stands for See, Plan, Act, Refine, Communicate, was founded in 2005 and was the first design group embedded within

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revealing experiences

By Christine Janae–Leoniak

»A 1,000 square foot space located along the beautiful windowed wave-wall on Gonda 18 became available. Several hundred people would walk by this location everyday and the high profile space would be centrally located to their partners in Pulmonary where they see many patients with tobacco addictions.« a clinical care space in the United States.

SPARC offices are embedded in the care facility – sharing a corridor with General Internal Medicine – where patients are treated every day. The walls of the offices are floor to ceiling glass, so when patients walk by they are as interested in seeing what we are doing as we are in their experiences. The SPARC staff has grown over the years. Currently, there are seven Design Researchers with professional backgrounds including: Interaction Design, Anthropology, Economics, Industrial Design, Communication Design, Architecture, and Service Design. With such a breadth of experience, SPARC’s capabilities are 68

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far reaching, with a common goal to improve the experience of care through design research, and design thinking.

The Mayo Clinic Nicotine Dependence Center (NDC) opened in 1988, the same year that all Mayo Clinic facilities went smoke-free. At the NDC, master’s level counsellors trained in tobacco cessation work with patients and their physicians on the journey to a tobacco-free life. The counsellors utilize motivational counselling and a ‘meet you where you are’ approach. Their knowledge of cutting edge education and treatment makes them the best in the world for tobacco cessation counselling. More than 38,000 people have been treated at the NDC in an effort to help them stop using tobacco.

Of the patients treated, 30% are tobaccofree one year later. This is remarkable, considering that usually only 3 to 5% of people are able to quit on their own.

There are a variety of ways a patient can experience the services of the NDC, including telephone counselling, worksite programmes, group sessions, and an eight-day residential treatment programme.

The NDC and SPARC collaboration The collaboration began because the NDC was taking over a new 1,000 square foot space located along a beautiful windowed wave-wall on the 18th floor of the relatively new Mayo Clinic Gonda Building. Dr. Krowka from the Pulmonary Division had contacted Dr. Richard Hurt, head of the NDC, and asked him if they might take over the available space. The head of the NDC jumped at this opportu-

nity. Several hundred people would walk by the location every day and the high profile space would be centrally located to their partners in Pulmonary where they see many patients with tobacco addictions. It was a great match.

The main NDC offices, located two blocks away from the primary Mayo Clinic buildings, are usually only visited by physician-referred patients. The NDC team wanted to create something very special in the highly trafficked space to promote their services. Not knowing what could or would be special; they enlisted SPARC to help. In the spring of 2007, the SPARC NDC project team was selected and the project began.

Topic-Framing and changing the design challenge question.

SPARC projects start with a “topic-framing” phase. In this phase the team distills the needs, questions, and unknowns about a project into a single question known as the design challenge question.

This question is crucial to guiding the work successfully. For the NDC project,

the initial design challenge was: “How might we create the moment between patient and NDC counsellor?”

With the topic framing complete, and our design challenge set, the team began the research phase. The process started with participatory observations and interviews with patients and the NDC care team. Because the design group is embedded, designers are able to observe patients and providers or care teams in action and at a moment’s notice. Being embedded provides countless opportunities for learning, observing and sharing.

Because Mayo Clinic is a research and teaching clinic, 90% of patients allow teams to observe. To observe the delicate experience of the patient within a clinical visit, researchers typically go alone so they can blend into the background.

Individual observations are shared, using storytelling. The observation phase almost always reveals surprises or insights.

The NDC project was no exception.

During one of the storytelling sessions, the team realized the design question was not capturing the holistic NDC

»The walk to the Nicotine Dependence Center from the Mayo Building«

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revealing experiences

By Christine Janae–Leoniak

»The NDC opened in 1988, the same year that all MCR facilities went smoke free.

To date, more than 38,000 people have been treated at the NDC in an effort to help them stop using tobacco.«

experience. Through these preliminary observations the team found that the counselling visit – the heart of the entire NDC experience – should not be the focus. Instead, the goal would be to help get more people to the counselling experience through education by illuminating what happens within a counselling visit, in order to set expectations about what the services might be like. This early insight challenged the team, one week into four-week project changing the research focus. However, if the focus was wrong, the solutions would not be as strong. The team revised the design question. The new question became: “How might we get people to seek out nicotine cessation services?”

The early observational research illustrated that although the NDC has incredible success rates, they counsel a modest number of patients. The ‘a-ha moment’ was that the NDC could expand their audience to include anyone who wanted to learn more about the NDC’s services not just those addicted to Nicotine. This multiplied the possibilities for what the

NDC’s new space on the 18th floor of the Gonda building might become.

Research and Synthesis.

The team conducted more observations, re-focusing the research with the new challenge question in mind. The new focus was to understand more about the mindset of individuals coming into the counselling visit. For better context of the holistic NDC experience the team observed the entire journey patients take and their thoughts and feelings associated with getting to the visit, the counselling experience itself, leaving the visit, and going home. During this research phase the team observed or spoke with a broad array of stakeholders ranging from NDC counsellors, current and past smokers, family members, and friends of people with a nicotine dependency.

Amy’s Story is an excerpt from one of the counselling visit observations (see on the next page).

In addition to patient- and care team observations, SPARC often invites indi-

»The CFI’s mission is: “To transform the way healthcare is experienced and delivered by providing project oversight and coordination, education, tools, resources and consulting services. « 70

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amy’s Story Amy’s Story is an excerpt from one of the counselling visit observations: Amy is 45 years old. She started smoking when she was 15.

Amy’s family encouraged her to try smoking and she has been smoking 3–4 packs a day ever since. Recently Amy cut down her smoking to half a pack a day and then she quit because she had been diagnosed with brain cancer.

She quit in order to aid her body in the healing process after surgery. Quitting was very difficult for Amy, but her brother, father, mother, and her boyfriend have also started to quit smoking and that has been very helpful. This will be Amy’s first attempt to quit in her 30 years of smoking.

Currently Amy is taking a drug used to help her quit and she feels confident that she’s finished smoking. The counsellor talks to Amy about her decision to quit, her smoking history, and how she feels about quitting. When asked how long it has been since she had a cigarette Amy hesitates and looks at the calendar, “about 2 or 3 weeks, I think.”

The counsellor looks down at her paperwork and notes the day Anne quit and counts the weeks on the calendar aloud, “ 1, 2, 3, 4!” The counsellor is positively reinforcing the length of time. She tells Amy, “ wow, that is great, are you proud of yourself?”

Amy smiles and says she is proud of herself. The counseling visit continues, and they discuss her follow-up visits and goals.

viduals from various departments and workgroups around the clinic to discuss and give feedback on topics or projects.

By engaging this full multidisciplinary group the design team gathers thoughts, insights, and perspectives that expand their understanding of particular experiences, as in this case, nicotine addiction and treatment.

For context, the team toured the 18th floor Gonda location and the environment surrounding the 1,000 square foot space. The Pulmonary Division had

not fully moved in, so the team had to imagine the traffic, the people wandering by, parents with young children, grandparents with their grown kids, people on their own and members of the care team.

The one thing passersby would all have in common is that they would be coming or going from Pulmonary.

The team also looked at parallel experiences such as retail shops, museums, welcoming home settings, gallery spaces, and exceptionally well-designed Mayo Clinic spaces to learn more about what touc hpoint | the jour nal of se rvi ce desi gn

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revealing experiences

By Christine Janae–Leoniak

»Because so many of our team have been touched by the effects of tobacco use we came together as a team so well, no egos, no agendas.

We all cared so much about the work.«

brings a person into a space and holds their attention. Through the stories, perspectives, processes, observations, site visits, data, and interview patterns began to emerge, signalling the need to begin the synthesis phase.

In synthesis, key findings from stacks of observational notes and data are bucketed together into themes. The seven NDC insights that emerged from the synthesis process helping to shape the recommendations for the NDC space follow:

and moment between the patient and the counsellor – was the heart of the experience. However, to influence this core piece of the experience, the environment is a major factor to consider and should have the following essential elements:

1. For patients, a meaningful piece of the nicotine cessation process is the ability to tell their story.

2. Motivational interviewing encourages patients to express the reasons they want to quit, which helps them create realistic goals.

3. Patients often feel encouraged by the disease model, releasing them from the idea of failure due to lack of will power.

4. When patients enter their initial NDC experience, they have different perceptions of what will happen.

5. Patients have personal relationships that integrally impact their experience, both positively and negatively.

6. The environment should support the positive, non-judgmental messages of counselling.

7. The environment should attract, provide access, promote action, and offer assurance.

 Access Create more channels of

The seventh insight provided us with a framework of essential elements to help translate our research into recommendations for the space. We recognized that the counselling visit – the conversation 72

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essential elements  Attract Captivate the individuals to seek out services.

entering into the NDC experience.

 Action Provide opportunities for individuals to engage with the various services, tools and resources at the NDC.

 Assurance Offer support for individuals beyond the initial experience

The 4-A’s framework was applied to the space through zones shown in this diagram. This allowed the design and development team to visualize how to use the research when thinking about the space and environment.

The deliverables and scope: What to share, what not to share.

Once synthesis is complete, the team develops recommendations. The NDC research yielded two kinds of recom-

»The 4-A’s framework was applied to the space through zones shown in this diagram. This allowed the design and development team to visualize how to use the research when thinking about the space and environment.«

mendations, primary and secondary. Our two primary recommendations were to: 1. Create an exhibit space on Gonda 18.

2. To communicate a positive, non-judgmental and clinically related message such as “The Science of Quitting” within that exhibit.

These two recommendations echoed the insights and provided a clear foundation for the design- and development team.

In addition, the NDC research led to some recommendations that fell outside of the scope of the project. The team included these additional recommendations in the final document and presentation, delivering one of the recommendations through a story, communicating what the current patient experience was like, travelling to the NDC main office in the Colonial Building via the subway (see next page). touc hpoint | the jour nal of se rvi ce desi gn

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revealing experiences

By Christine Janae –Leoniak

Christine Janae–Leoniak is an Innovation Catalyst and Experience Designer who specializes in connecting human needs with strategic opportunities using participatory research methodologies and foresight work. Christine is a healthcare experience expert. Through her current work at the Mayo Clinic Center for Innovation, USA, she has developed a deep understanding for the complexities that people, institutions, companies and governments face in healthcare.

a current patient experience

In addition, the NDC research led to some recommendations that fell outside of the scope of the project. The team included these additional recommendations in the final document and presentation, delivering one of the recommendations through a story, communicating what the current patient experience was like, travelling to the NDC main office in

mayoresearch.mayo.edu

the Colonial Building.

»Walking from the Mayo Building to the NDC via the subway. The Mayo to Gonda Building transition is filled with warm light, woodwork, and uplifting sights such as artwork and water fountains. The walk changes as we move away from the main clinic space. The visuals change from artwork to more standard Mayo Clinic-wayfinding signs. Some of the first signs that become visible are for the Pulmonary Lab, the Enema Prep, and the Erickson Hair & Skin Center. Changes in emotions and mood occur as we move deeper into the Eisenberg subway; feelings of confusion about location and direction of the NDC arise. However, a Mayo Clinic-wayfinding sign appears that has an arrow pointing the direction of the Nicotine Dependence Center to confirm that we are still on the right path. However, the rest of the path is surrounded by visuals that are agitating and discomforting – gurneys labelled with Post-It notes and a surgery supply area. Then the ceiling drops, revealing a system of pipes and the hallway narrows. Through this long journey, thoughts of whether or not this is the right path and value of going through this journey crosses our mind. More importantly this subway walk creates self-doubt in making the decision to come this way to get cessation counselling, whether or not we would succeed in getting there for an appointment and even succeed in quitting smoking.«

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During the final presentation one of the smoking cessation counsellors commented that perhaps their “no-show patients” could be directly attributed to this disturbing trip through the subway.

This example (see box on the previous page) illustrates the importance of considering the holistic patient journey when creating new elements of the NDC experience. In this case, the role the literal journey from one of the primary Mayo Clinic facilities to the NDC facility plays in the patient’s overall experience.

So, although not directly within the scope of recommendations for the Gonda 18 space, the team’s recommendation was to redesign the subway walk. The subway walk has since been remodelled.

»The NDC design and development team created the vision based on the needs of our patients and what stands in the Gonda 18 space today is not only an incredible example of what can be created through the design of an experience, Gonda 18 is a gateway for thousands of people to learn more about living a tobacco-free life. «

The Center for Tobacco Free Living Gonda 18 is now the Center for Tobacco Free Living which is operated by the NDC. There were more than 1400 visitors to the Center during the first quarter of 2009. About half were Mayo patients, while others included family members or caregivers and Mayo Clinic employees. Approximately 700 of the visitors learned of the Center simply because they were walking by. Many others were referred by their physician or heard about it some other way. Only a fraction of these visits would have occurred at the main offices in the Colonial building. Perhaps the most exciting result is that the number of referrals to the NDC doubled from 43 to 86 during this first quarter. More patients are experiencing nicotine cessation services.

The Pulmonary Division and the NDC

had an idea. Design research uncovered stakeholder needs, and offered recommendations and insights, the seeds of what could be.

The NDC design and development team created the vision based on the needs of Mayo Clinic patients and the experience of the Gonda 18 space today is not only an incredible example of what can be created through conscious design, the space has the potential to change thousands of people’s lives by learning more about living tobacco-free.

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By Hester van Thiel, Mike Janssen and Marc Fonteijn

Brand positioning is the foundation for a memorable patient experience

Hester van Thiel Senior marketing consultant, Mixe

Mike Janssen Founder, Mixe

Marc Fonteijn Co-founder, 31 Volts

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A memorable patient experience is key to a hospital’s success.

Brand positioning is all about creating a unique, relevant, and attractive offering to your customer that makes you stand out of the crowd. Service Design brings that positioning to life. Result?

Happy patients, happy hospital. More hospitals in the Netherlands are ‘under competition.’

Competition means choice. Choice for healthcare insurers where to procure healthcare services for their customers, choice for general practitioners where to refer to and choice for patients where to get the treatment they need. If choices are being made, you should be the one they prefer.

Four compelling reasons to work on the patient’s experience • A positive experience improves clinical outcome.

If patients feel they are in good hands, it enhances recovery. For example, in one hospital every patient gets a massage just before surgery. Surveys indicate that they experience less pain, are less anxious, have fewer complications, and go home sooner.

• A positive experience improves quality perception.

Instead of judging medical quality – which they can’t – they use observable aspects such as room cleanliness and the responsiveness of the organisation to assess

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whether the treatment is trustworthy.

• A positive experience increases retention.

If the evaluation of the experience is positive, patients tend to choose the same hospital again next time.

• A positive experience feeds important sources of information.

The patient’s own experience is his most important source of information about that hospital. It determines if the patient will return and also feeds word-of-mouth.

In short, the patient experience matters!

Three basic needs of patients admitted in a hospital Dutch research has uncovered three basic needs of patients admitted to a hospital: The first is the need to escape the domain of being ill. Inspiration for Service Design: a hospital that doesn’t look, feel, smell, and sound like a hospital, and as little confrontation with other suffering patients as possible.

Hester van Thiel is senior marketing consultant at Mixe, the Netherlands. After years of marketing management experience in consumer goods, she made a transition towards marketing consulting for healthcare. It is Hester’s ambition to bring the ‘outside world’ and ‘inside world’ for healthcare organisations together in a way that is relevant and authentic.

The second is the need for calm and silence. The reduction of stressful factors is a key element here. That may translate into a quiet and soothing interior, lots of light and space and patients from the same social and cultural background.

The third is the most profound: the patient’s need to regain control over his life, while being in a situation where he is totally dependent. Control is more or less restored if you trust the organisation and people who you have to depend on. Competent, responsible, and compassionate care givers are what patients want.

There is, however, a question that remains from a marketing point of view: how distinct, how uniquely attractive, are those experiences?

What to focus on?

While the hospital’s strategy serves as the guiding principle for the brand, it is the brand positioning that should be the foundation for the patient experience.

Brand positioning is all about creating a

unique, relevant and attractive offering to your customer that makes you different from the competition. Moreover, it prioritizes and focuses time and energy.

It makes people do the things that really matter.

Service Designers and marketeers: team up! Service Designers and marketeers share their passion for the customer. It’s their primary focus and source of inspiration. Marketeers should set the strategic direction and combine customer insights with business goals, to formulate an attractive promise. For the delivery of the promise, the patient experience is essential. Service Designers have the mindset and tools to design a positive patient experience. Together, they can create experiences that serve both customers and business: an experience that is different, salient, and memorable, and that inspires people to tell the story.

Mike Janssen is a graduated economist from Erasmus University Rotterdam, the Netherlands, and founder of Mixe, a leading medical marketing agency that works primarily for hospitals and medical device and diagnostics companies. Mike’s drive is helping boards and marketing managers make the deliberate and consistent choices that are so crucial when creating strong medical brands.

Marc Fonteijn is the cofounder 31Volts, a Service Design agency based in Utrecht, the Netherlands.

Coming from a background in new media, online and mobile he is currently applying his knowledge in an environment where the focus lies on people instead of technology.

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By Richard Hayami Z’Graggen

Systems | People Overlaying user-centered and systems approaches for designing complex services

Richard Hayami Z’Graggen

Director of User Experience, LVL Studio

User-centered design offers effective methods for research, design, and validation. But when complexity overwhelms, systems design can help bring order into the problem-solving challenge.

And with a humanistic twist, it can lead to interesting explorations. Cold, rational, and linear, systems design can be perceived as being incompatible with our emotional and sometimes irrational human nature. But its modular approach can be useful when Service Design problems are complex. And with a humanistic “twist”, it can be a useful tool for use-case exploration. The twist? Insert emotions and other human states into the systems equation.

A recent trip to the orthodontist got me thinking about systems and Service Design, and how they might interlace.

New and improved user experience A lot has changed since my teenage orthodontic experiences. Haunted by memories of dull spaces, old magazines, smelly glues, and the weekly taste of pliers in my mouth, I was not expecting the new and improved service that greeted me as I brought my young son in for a first consult. After a few minutes in the smartly designed reception area, the dental specialist arrived to greet my son and me.

No white lab coats that day. Jennifer and the others were sporting magenta tees over red long-sleeve baseball shirts. Smil78

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ing, she took us through a guided tour of the clinic. My son was introduced to the X-ray area, the tooth-brushing area, and the mould-making station. A half-hour later, we were back in the reception area, booking the next appointment.

He got a toy of his choice. I got a card with the date of the next visit – and a URL to view the X-rays on my computer at home.

It was clear that the experience had been designed with consideration for the child’s ease of mind, and the parents’ convenience. We can also recognize the brand experience at play in the choice of magazines, the interior design, youthful uniforms, and the e-conveniences. So back to our systems and user modeling.

Systems perspective So how can a systems view add to the discourse? It can address something as mundane as the size and number of seats in the waiting area. What if my first experience was to stand waiting in a crowded room? Nice furnishings and fun web site features would not fix my negative first impressions. Let’s create a simple component view of the clinic.

It has inputs: patients entering, supplies delivered, energy. It has outputs such as patients leaving, information imparted, toys dispensed. And it has functions that change the states of the inputs and outputs. A “black box” view might look like the graphic below: So to address the number of seats in the waiting area, we would just look at the

input/output of patients and parents. Obviously in a small clinic the administrators know intuitively how many patients to book per hour, and there is enough “play” in the system to accommodate variances. But in a larger system, more precise figures are needed. Queuing theory and system simulation techniques can be used to evaluate average, maximum, and minimum wait times.

A more accurate “black-box” of our reception sub-system has two points of contact within this space.

• Receptionist 1 greets new arrivals, and confirms presence on the computer.

Thirty minutes later, • Receptionist 2 processes patients who have just completed their treatment: booking the next appointment, accepting

»When the problem gets complex, magenta tees and X-ray teeth may not be enough to solve the challenges. The black box can be a very useful little tool.«

clinic Clinical stations

Computer X-rays

process

Mould making

Reception

Inputs • Patients & parents • Suplies • Eneergy

Outputs • Patients & parents • Toys • Information

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systems | people

By Richard Hayami Z’Graggen

Richard Hayami Z’Graggen is currently the director of user experience at LVL Studio, Montreal. He holds a BFA in Design Art from the Concordia University, Montreal and a BASc in Systems Design Engineering from the University of Waterloo, Ontario. Richard has worked as a Design Manager, Art Director and Lead Interface Developer, in the web services, film, and e-learning industries.

payment, and printing a receipt.

Broken down in this way with simple inputs, outputs, and operating parameters, the reception area can be optimized for number of seats, and reception staffing.

jennifer

Modularity: Divide and conquer

my son

While this reception model is very simple, the real benefit of the systems approach is to make complex problems manageable. Systems design offers a means of breaking down a large problem into smaller ones. And this lends itself to a model of specialized teams or units that can resolve more specific challenges.

In a larger system, this component view would then lead to other analyses such as computer software requirements (scheduling systems and e-mail notifications), supply/procurement procedures, financial/accounting processes, and so on.

Bringing it back to the user This cold and rational abstraction may seem at odds with the human experience. But why not black box a person? A desired outcome of this element can be, for example, to create a positive emo-

Hear son´s name

Jennifer

See smile

Show relief My son

tional state (less fear for my son; confidence and satisfaction for me).

The patient has inputs: he receives information (verbal instructions on dental hygiene; the visual stimulation of colourful uniforms; a smile). He has processes, operating parameters, disturbances, and feedback loops. At this granularity and with the focus on experiential/emotional factors, the analysis starts to resemble that of a user journey. Expand it to other individuals and we start to get a complete picture of the human experience: receptionists, Jennifer, me, and – in the case of a large hospital – all the hundreds

divide and conquer Reception

Clinical arena

Arrive

R1

To treatment

Depart

R2

From treatment

Function

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Smile

of people interacting with others, with equipment, and within computer, financial, legal, and regulatory sub-systems.

So we think about the user at the beginning and end of this story. Start with a user journey analysis (imagining what it’s like to go through the orthodontic “experience�). Then we switch to a systems approach in modelling the components and dividing up the problem. Finally, get so granular with the system that we are back to the user as an individual component.

More possibilities?

This case is a simple exercise in modularity. But systems design offers robust analyses such as feedback control and sensitivity analysis, which could be explored further. Of course, this type of theoretical puttering can be wasted effort for a project with an obvious route to a solution. But when the problem gets complex, magenta tees and X-ray teeth may not be enough to solve the challenges. The black box can be a very useful little tool.

Special thanks to Dr. Paul H. Korne, D.D.S., M.CI.D, Orthodontist www.korneortho.com

scad seeks professor of service design The Savannah College of Art and Design seeks candidates for a full-time faculty position for a new programme in Service Design offering B.F.A. and M.F.A degrees.

SCAD seeks a highly motivated designer with a background in designing interactions, services and consumer products for wellknown brands.

The position requires a minimum of five years experience as a designer developing innovative concepts and experiences at a senior level; extensive experience designing interactions within the context of consumer products and/or for the Web; the ability to work across a range of digital media from 2-D to 3-D; a thorough understanding of research and design methods; excellent communication skills; and a passion for inspiring and teaching. Qualified candidates should possess an M.F.A. or M.Des. in a design-related subject. College-level teaching experience preferred.

For complete submission requirements and to apply online, please visit: https://scadjobs.com/applicants/Central?quickFind=51642 scadfaculty@scad.edu Savannah College of Art and Design Attn: HR- Savannah Faculty P.O. Box 3146 Savannah, GA 31402-3146

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chapter preview

The care chain On the emotional aspects of healthcare journeys, the importance of self determination and the need for information and accessibility of services.

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Great expectations: The healthcare journey Gianna Marzilli Ericson

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The dilemma of the care recipient & The journey through the care system as mentally disabled Elin Kolterjahn, Ă…sa Adolfsso and Stefan Holmlidff

100 Healthcare innovations under pressure: The Pressure Cooker event Peter van Waart, Ingrid Mulder, Carolien van den Akker, Justien Marseille

104 In the service of health services: Why co-creation matters

By Judith Altenau

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By Gianna Marzilli Ericson

Great expectations: The healthcare journey Every healthcare experience is formed from a collection of interacting systems. Much has been written about the operational, technological, diagnostic, and treatment structures of healthcare delivery. Less often explored is the emotional system at play. Existing alongside its more tangible counterparts, it involves expectations, perceptions, motivations, behaviours, and decisions.

We count three key stakeholders in healthcare’s emotional system: the patient, the practitioner, and the patient’s caregivers (their family and friends). The patient is an obvious hub to this network, as their health and treatment is at the heart of most action and reaction. Effective experiences must be designed to provide appropriate information, a sense of control, and an atmosphere of trust and care. Practitioners affect patients, caregivers, and peers, while serving as emotional actors in their own right.

Caregivers, however, are often silent stakeholders in this ecosystem. They are subject to the emotional variance of the patient but perhaps without acknowledgment or direct support. Indeed, they themselves often support the patient emotionally without being equipped with tools that would help them navigate their – or their loved ones’ – experience.

Exploring and addressing caregivers’

emotional needs and acknowledging their central role in healthcare systems is essential to developing solutions that improve wellbeing.

Our Service Design oriented approach focuses on the important role of expectations in shaping the emotional landscape of both patients and caregivers. We recognize that expectations change as people move through their healthcare journeys. By actively managing those expectations over time, we can design services that better meet the emotional needs of patients and those who care for and about them.

Gianna Marzilli Ericson Brand Strategist, Continuum

Understanding Expectations The healthcare experience is loaded with expectations. They could be about the way treatment will progress, the way practitioners should provide care, or the amount of time a visit might take. Once set, expectations provide the backdrop touc hpoint | the jour nal of se rvi ce desi gn

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great expectations: the healthcare journey

By Gianna Marzilli Ericson

»Effective experiences must be designed to provide appropriate information, a sense of control, and an atmosphere of trust and care.«

Project Recap  Challenge Improve The MADI Resource Center’s web offering, within grant-funded constraints, in ways that communicate their expertise in psychiatric research and their mission of supporting people in pursuit of mental healthcare.

 Process Co-create, through workshops with their Advisory Board, journey maps to better understand the patient and family experience of seeking care.

 Solution Reorganize existing content based on the mental healthcare journey, making it easier for people to access relevant information.

Recognize the integral role of expectations in the emotional landscape and design toward the goal of actively managing them over time, in order to help people progress toward wellness.

 Results An expert but approachable resource that helps patients and their families better manage their care and emotional health by teaching them what to expect when living with and seeking treatment for mental health disorders.

for emotions to develop as an experience unfolds. People do not like to be disappointed or unpleasantly surprised, particularly in the context of their own or their loved ones’ health. Yet when expectations are set too high, or aren’t set appropriately, that is exactly what’s likely to happen. Patients and caregivers can be blindsided by information or events they aren’t prepared for. They may feel angry, stressed, or distrustful of their practitioners. These are all emotions that detract from their ability to 86

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focus on the health issues at hand.

Designing for positive and productive emotional experiences necessarily involves being able to identify, empathize with, and anticipate people’s expectations as they form and as they change.

In order to do this well in a healthcare setting, Service Designers need to understand both the patient and caregiver journeys over time. Mapping a healthcare journey – that means, identifying the sequence of events that forms a particular experience – is an essential

process. It results in a tool that allows us to understand not just tangible touchpoints, but emotional ones too. Once we build the initial journey map structure based on the procedural steps of different actors in a system, we can add emotional touchpoints to it. These are ideally based on ethnographic and experiential research, and include interpersonal interactions, anxieties and triumphs experienced, and expectations formed.

Building such a comprehensive journey helps us to see how expectations can be influenced or changed as people move through it. By setting initial expectations deliberately, and then monitoring and adjusting them going forward, we can help people make better-informed decisions and prepare emotionally for possible outcomes.

compelling ways. Continuum worked with the MADI Resource Center Advisory Board to understand the experience of their target audience and design an approachable content strategy.

Drawing on board members’ wealth of expertise in psychiatric research, clinical care, and the impact of mental health disorders on everyday life, we began by co-creating a mental healthcare journey map illustrating the steps along the road to treatment. We identified major stages of seeking and experiencing mental healthcare including: awareness, learning, the struggle, the search for help, diagnosis, treatment, and maintenance care. Within each stage, we mapped

Methods in Practise: Designing a New Content Strategy for The MADI Resource Center at Massachusetts General Hospital Navigating the mental healthcare system is not a simple process, and is an experience rife with emotional complexities. The Mood and Anxiety Disorders Institute (MADI) Resource Center at Massachusetts General Hospital exists to make that process easier. They translate the latest research advances in psychiatry into practical information to help people get the most accurate diagnosis and best possible treatment results. With a grant to create a pilot website to improve their online offering, the MADI Resource Center contacted Continuum. They were sitting on a wealth of useful research but needed help in organizing it in clear and

»Mapping a healthcare journey – that means, identifying the sequence of events that forms a particular experience – is an essential process. It results in a tool that allows us to understand not just tangible touchpoints, but emotional ones too.« touc hpoint | the jour nal of se rvi ce desi gn

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great expectations: the healthcare journey

By Gianna Marzilli Ericson

Mental Health Care Journey

»We began by co-creating a mental healthcare journey map illustrating the steps along the road to treatment. We identified major stages of seeking and experiencing mental healthcare including: awareness, learning, the struggle, the search for help, diagnosis, treatment, and maintenance care.«

tangible, experiential, and emotional touchpoints. Through the journey mapping exercise, three major insights emerged that would guide the remainder of the project. The first was the importance of caregiver support to a patient’s journey: resources for family and friends would be given the same priority as resources for patients when developing content for the new site. The second was the prevalence and influence of expectations that diverge from actual events and outcomes: these expectations need to be actively managed in order for people to progress toward wellness. The third 88

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was that expectations change over time: such changes need to be recognized and understood before they can be effectively managed.

Insight 1: Consensus on an Audience Members of the Department of Psychiatry at MGH have done a great deal of work in the area of Collaborative Care, a model in which patients’ family and friends take an active role in their care and commit to helping them manage their treatment. Those family and friends need support of their own in that en-

deavor so they can effectively support the patient. Karen Blumenfeld, the director of the MADI Resource Center notes, “The journey is at least as stressful to the family members as it is to the patient and that stress can negatively effect their own health as well, leading to additional strain on the entire family.” Focusing our initial efforts on patients’ support networks would allow us to help both groups.

medication is working. A loved one may expect their family life to quickly return to “normal” once treatment has begun when it might take many months to receive an accurate diagnosis, let alone reach maintenance care. Setting appropriate expectations at the outset helps people understand what’s happening to them. It equips them with knowledge to make informed judgments and decreases the likelihood that they will be emotionally overwhelmed.

Insight 2: The Power of Expectations

Insight 3: Change is Constant

Patients and their caregivers often arrive in the office of a practitioner not only with preconceived ideas about what it means to have a mental health disorder, but also with unrealistic or inaccurate expectations of what the treatment process will be like, what they can expect once treatment has started, and how it will (or won’t) affect their lives. A patient may not know how to tell if a particular

Visually mapping the journey led the Advisory Board to realize that the mental healthcare journey is rarely a straight and simple march from awareness to treatment. Each time a new treatment is tried, or a new episode occurs, the patient may circle back to the learning stage, repeating in various forms the struggle, the search for help, and perhaps even a diagnosis. Since each repeat carries with

Service Design take-aways  Use journey mapping to understand emotions and expectations, not just physical touchpoints

 Recognize that effective expectation management requires understanding how expectations change over time

 Consider all actors and redefine which ones play a central role, reframing information so that it speaks appropriately to target audiences

 Co-create journey maps with clients as appropriate

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great expectations: the healthcare journey

By Gianna Marzilli Ericson

»Journey mapping illustrates and makes explicit each stage in the process of seeking healthcare, and thereby provides a framework for understanding patients’ and caregivers’ emotions and expectations.« The new website is online at www.moodandanxiety.org.

it experiences and memories from the previous time(s), people’s expectations rarely remain static. Effective expectation management involves understanding the dynamic nature of experiences, and preparing for that by designing healthcare interactions and information reflects that understanding.

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Redesigning the Content Guided by these insights, we restructured the site to deliver information based primarily on the stages of the mental healthcare journey. Disorder-specific information is still available, but the journey-based structure makes it easier for people to find information relevant to their current needs. To help manage expectations, introductory content for each stage is delivered in the form of short first-person videos. To better connect with caregivers, they feature family members and friends as well as patients and practitioners.

The videos describe personal experiences of seeking mental healthcare and candidly address common questions (How do I make the most of my 15-minute appointment? Should I tell other people about my diagnosis? How do I encourage my family member to get help?). They also translate research into practical information (How do I know if I’m getting better? What can I do to help make it easier for my family member to adhere to a treatment plan? How do we decide which medicine is best?). Providing such transparent information sets the stage for more positive emotional experiences during the healthcare journey. It also gives everyone involved a resource that they can share in their efforts to increase others’ understanding of their experiences.

Project Results In working with the MADI Resource Center, we used the guided creation of a mental healthcare journey map as a tool for exploring who we should target and

how best to talk to them. Working with the vast amount of knowledge already residing within the organisation, we revamped the way it’s delivered so it can be a more helpful resource to the people it’s intended to serve. Reflecting back on the project, the Advisory Board said, “We were exhilarated both by the process and the outcome. [The process] was unbelievably helpful … we had knowledge, but we didn’t really have a model or framework for organizing or presenting it. You really got us to that point, not by telling us what to do, but by asking us the questions that led us there. The journey mapping exercise was an effective and different way of getting people to put themselves in the position of others, to have empathy.”

Since the site’s launch in early 2009, the Director of the MADI Resource Center has presented the new site to three conference audiences, one of treatment providers and two of patients and families. They were extremely well received, with each audience giving positive feedback about the site’s ability to resonate with their experiences as practitioners, patients, and family members and to provide needed information in a gentle, appropriate tone.

likely already compromised. When people don’t know what to expect or how to react, anxiety and stress can result, both of which are detrimental to health. The effect can be compounded when those who are attempting to offer patients emotional support are themselves stressed and unsupported. Helping people understand what questions to ask, providing transparent answers, and teaching people what to expect from their experiences can alleviate some of that stress and enable them to support each other.

Journey mapping illustrates and makes explicit each stage in the process of seeking healthcare, and thereby provides a framework for understanding patients’ and caregivers’ emotions and expectations. When Service Designers understand how and when expectations come into play, they can better design content, communications strategies, and interactions. The journey-mapping method provides a window into the emotions and expectations that are necessary to engage with in order to equip people with the best resources for their journey toward health.

Gianna Marzilli Ericson is a Brand Strategist, Innovation & Experience Design at Continuum, a global innovation and design consultancy, West Newton MA, USA. She is a core member of the Continuum Service Design team. Gianna draws upon her background in research and design to collaborate on design workshops and programmes for clients across the healthcare, retail and non-profit sectors. Prior to joining Continuum, Gianna worked in clinical research and in health communications at Massachusetts General Hospital. www.dcontinuum.com

The new website is online at www.moodandanxiety.org.

Concluding Thoughts Managing expectations across a journey is a key component of designing for emotional systems. It is particularly important in healthcare settings because other aspects of people’s wellbeing are touc hpoint | the jour nal of se rvi ce desi gn

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By Elin Kolterjahn, Åsa Adolfsson and Stefan Holmlid | Illustrations by Gunilla Gullbrand

Photo: Johan Gunséus

The dilemma of the care recipient

Elin Kolterjahn

Photo: Johan Gunséus

Industrial –& Service Designer, Struktur Design

Åsa Adolfsson

Industrial–& Service Designer and Project Manager, Struktur Design

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If we found ourselves in a situation where we needed assistance and medical care to manage our daily life, most of us would prefer to live in our own home as long as possible. We would also like to maintain our social relations and to be in charge of our own lives. In a project called TILLIT (an acronym meaning “trust”), managed by the County Council of Västerbotten and the Municipality of Umeå, Sweden, Struktur Design looked closer at senior citizens in need of both medical and practical care while still living at home.

As a consequence of an interview study, we found that a lack of collaboration and communication between the different care providers results in nobody seeing the “whole picture”. The right person most often does not have the right information in the right situation. How does this affect the care recipients? Do they even know who is responsible for what and whom to contact when in need of help? We worked our way through the maze to find out.

Initial analysis The interview study included care recipients, their next of kin and the different care providers, with focus on the care recipient’s situation. Some general questions that we wanted answered were: What information do they need to feel

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secure? What do they need to communicate with the care providers? Do they know what help is available? Do they trust to receive the help they need when they need it?

From the interviews we were able to identify different problems and needs.

In most cases there are no routines for collaboration amongst the different care providers. The consequence is then that it becomes up to the recipient to make sure that adequate help is provided and coordinated without the necessary insight to be able to achieve this. It is not clear to the care recipient what help is actually available or even less who is responsible for which type of assistance/ care.

As it is today, the care recipients often don’t know who comes to visit them at

There are several different care providers working with this care situation, representing two separate responsibilities, the County Council and the Municipality.

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the dilemma of the care recipient

By Elin Kolterjahn, Åsa Adolfsson and Stefan Holmlid | Illustrations by Gunilla Gullbrand

Current Situation: Tilda is getting impatient. It’s already noon, but still no one from the “home assistance service” has arrived. Someone should be here by now to take her for a walk. She sighs “If I had known this in advance I could have accepted that appointment at the hairdresser”. Tilda knows that unforeseen things happen, which can delay the home assistants, but that they don’t show up at all, is unusual.

where the care recipients, their next of kin, as well as the care providers have the information they need.

Some basic demands on the information are: • The care recipients need to be well informed on what help they will receive, when and why. They also need to have easy access to gathered information on what help is available.

Stefan Holmlid

Assistant professor, Linköping University

home and why. They simply don’t know what decisions have been made regarding the care that they are going to receive, when they are going to receive it or even why. The care providers with the deepest insight into the recipient’s situation are often not involved in the decision-making process. Inaccurate decisions are made due to this and the care recipients feel insecure and left in the dark. The involved care providers also get frustrated.

Despite their best efforts they are unable to provide satisfactory and secure care.

Communicating the problem Based on the analysis, we visualized the situation as it is today. The scenarios clearly illustrate how the shortcomings of the system cause the care recipients’ and their next of kin problems. We also visualized desirable future scenarios 94

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Current Situation: Tilda hears a signal from the kitchen. On the screen of her web portal she sees a message. Her walk has been postponed. The home assistant will come tomorrow at 11 to take her for a walk.

“But I have an appointment at the dentist tomorrow”, Tilda thinks for herself, picks up the phone to rearrange the time for the walk. As she hangs up, she hears another signal from the web portal. The new appointment for her walk is activated in the schedule. With this new equipment she feels less bound at home.

Vision: Martin, Tilda's son, worries a lot about his mother. She doesn’t remember what happens during the days and he rarely meets the care providers, since he is at work while they visit his mother.

Suggested design The final suggested concept is a home assistance web portal, where a synchronized schedule of daily activities is the main feature. Other important features are messages and contact information.

The web portal not only provides the care recipient with accurate information, but also helps to enhance the collaboration between the care providers.

The most important qualities of a well functioning care system will always be collaboration and human interaction, but by providing the care recipients and their next of kin accurate information, you enable them to take control of the situation and to find their way through the maze.

• The care providers need to synchronize their schedules to enable everyone concerned to see the whole picture and to avoid double-booking. They also need to communicate changes in the schedule.

• The care providers need to share important information on the recipient’s situation and what they have carried out, with each other (they may however never meet in person) as well as with the recipients and their next of kin, and vice versa.

These visualizations were used in the communication with care givers as well as politicians to illustrate the complexity of the care recipient’s situation. In this project we were not able to reorganize the care system. By providing everyone involved with the same information, however, the situation for the recipient will improve a lot.

Vision: With the new system, Martin can communicate with the care providers both through voice messages and text messages. The providers enter into the system what they do at Tilda’s during the days and Martin can feel secure that his mother receives the care she needs.

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By Elin Kolterjahn, Ă…sa Adolfsson and Stefan Holmlid | Illustrations by Struktur Design

The journey through the care system as mentally disabled A vision of a care chain, built on the needs of the care recipients There are large demands put on the systems of healthcare. The system should provide large amounts of help initially, and be adaptive and flexible with respect to individual needs over extended periods of time. The care recipient should be allowed and invited to participate and cooperate. The system should be capable of configuring, sustaining, and developing multi-professional teams to meet the

needs of care recipients.

In Sweden these demands are challenged by a set of problems; there are several different operators involved in the care chain, with two different funders; the dependence on individuals in the system is large; there is no shared overview of planned and executed actions across the operators.

These demands and challenges where found by Struktur Design, in a project managed by the County Council of

Figure 1: When out of emergency care, getting the right treatment can take several years of administrative handling 96

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Stefan Holmlid, Phd is an assistant professor in Interaction and Service Design at Linköping University, Sweden. He teaches Interactive Media projects for Graphic Design and Communication, user-driven product development and Service Design.

Elin Kolterjahn is an Industrial and Service Design at Struktur Design, a Design consultant Bureau in Umeå, Sweden. She was educated at the Umeå Institute of Design, Sweden, where she also teaches herself. Åsa Adolfsson is an Industrial Designer, Service Designer and Project Manager at Struktur Design AB, Umeå, Sweden and at the Umeå Institute of Design, Sweden. Åsa has run her own Design consultant bureau and has worked at DeLaval International AB in Stockholm.

Figure 2: The many contacts managed by the care recipient in the care network

Västerbotten and the Municipality of Umeå, when we looked closer at the case of a journey through the system for a mentally ill person. We conducted an interview study to understand how the care system works and to gather information on the needs of the mentally disabled. The purpose of the project, called TILLIT (an acronym but it also means Trust), was to create a coherent care chain across the county council, the municipality and private contractors.

The current situation Some major problems within the system were identified as well as important demands, which if they were fulfilled would improve the situation for the mentally disabled considerably. One of these problems is the long time spans (Figure 1). Another is the sheer amount of contacts that the ill person has to handle herself in order to get the correct treatment (Figure 2). A third is the lack of communication between organisations, touc hpoint | the jour nal of se rvi ce desi gn

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the journey through the care system

By Elin Kolterjahn, Ă…sa Adolfsson and Stefan Holmlid | Illustrations by Struktur Design

Figure 3: Lack of communication between organisations which can cause devastating problems for the care recipient (Figure 3).

The care chain is incomprehensible to the uninitiated, even the care providers does not see the whole picture, and yet we expect the mentally disabled, who often have difficulties dealing with human relations, to control the situation.

The suggestion To deal with the identified challenges we created a new model for the care chain, starting with the needs of the care recipients. It meant that we reduced the number of people that the care recipient herself had to keep in contact with. We also suggested that a support-person is introduced into the care chain already at the emergency stage. By doing that the 98

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care recipient is relieved of the pressure to manage contacts and care givers. The lack of communication will be less obvious because the contact person interacts with the different organisations.

Final thoughts Using visualizations such as scenarios and simple actor maps for the current care chain and the future model was powerful. They helped express problems, solutions, and possibilities. We used these visualizations to communicate within the project, with care providers and with politicians. It enhanced the insight among the care providers and was a useful tool to create understanding for the consequences of a malfunctioning system.

Figure 4: The contacts managed by the care recipient in the new care network

Figure 5: The care chain where a support person is introduced at an early stage

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By Peter van Waart, Ingrid Mulder, Carolien van den Akker and Justien Marseille

Photographer: Emiel Bakker

Healthcare innovations under pressure: The Pressure Cooker Event

Peter van Waart

Photographer: Emiel Bakker

Lecturer and researcher, Rotterdam University of Applied Sciences

Ingrid Mulder Associate professor, Delft University of Technolgy

Today’s Dutch healthcare is faced with many challenges. Demographic developments such as an aging population, diabetes and dementia, and other chronic conditions in elderly people, in combination with a culture shift towards a more demanding consumers’ society and an economical trend to privatize the healthcare system, put pressure on the healthcare sector. On top of this the potential working population is set to undergo a further substantial decline. Innovation in the health sector is not only needed, radical innovation is crucial.

These societal trends together with current technological development open a wealth of opportunities for the Netherlands to become a true innovative service society.

In keeping with this vision a Pressure Cooker event has been organized by the Rotterdam University of Applied Sciences, City Council of Rotterdam, the Rotterdam creatives network Nieuwe Garde, and The Future Institute, to cook innovative concepts for the 2029 Dutch health sector.

The recipe Preparation is the key for good cooking.

Therefore expert teams of healthcare professionals, lecturers, and professors gathered the ingredients (literature and other resources) to prepare six healthcare subjects: lifestyle, identity, healing envi100

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ronment, healthcare system finance, work satisfaction in healthcare, and care 2.0.

The Pressure Cooker event itself took place in July 2009, at an isolated location where 53 participants stayed for 5 days, 24 hours a day. One central hall and six separate team rooms were available.

The participants were skilled and highly motivated students and lecturers from several disciplines, and professionals from the healthcare sector. All participants were divided into 6 teams. The teams worked each day from 9 a.m. to 9 p.m. in an intensive programme and were guided by moderators specialized in Pressure Cooker sessions.

Over the first two days, the aim was to diverge on the future of healthcare.

Teams worked to find appropriate ways to collaborate across disciplines. Several future state scenarios were developed

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Photographer: Emiel Bakker, Rotterdam University of Applied Sciences

healthcare innovations under pressure

By Peter van Waart, Ingrid Mulder, Carolien van den Akker, Justien Marseille

Photographer: Emiel Bakker, Rotterdam University of Applied Sciences

around the teams’ subjects. The second day started with lectures from healthcare professionals and experts as inspiration.

In the afternoon, a ‘Speed Date’ took place in which the teams received firstperson experiences from patients and professionals in the healthcare sector.

On day three, the teams started to converge around solutions for the dilemmas in healthcare. Starting with inspiration lectures in the morning, the teams pinpointed the topics of dispute to bring in into the ‘World Café’ in the late afternoon where professionals and visitors from the health sector met up with the teams, testing their assumption.

»What did the Pressure Cooker bring on the table? Discussions and investigations made clear that policy makers and health organisations seemed to approach healthcare in a computational way that does not allow human wellbeing to function as a system performance indicator. « 102

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Day four was reserved for finalising the team’s solutions. The boiling point of the Pressure Cooker week was the grand finale; on the fifth day outcomes were presented to the clients and the audience of approximately 250 professionals, educators, students, stakeholders, and policy makers interested in healthcare and public governance.

Tasting the results What did the Pressure Cooker bring on the table? Discussions and investigations made clear that policy makers and health organisations seemed to approach healthcare in a computational way that does not allow human wellbeing to function as a system performance indicator. Obviously, these preliminary observations on the lack of humanism didn’t only illustrate the added value of our initiative, it also stressed the fact that patients and care providers suffer from this lack of humanism.

The most important recommendation resulting from Pressure Cooker was to put the individual in the centre of his care with respect to his personal identity and right of self-determination. Compared to commercial situations, patients are in a much more disadvantageous position than consumers. The healthcare sector is highly privatised nowadays, but due to governmental regulations and lack of consumer choice, market mechanisms are compromised. Centering the care around the individual affects the patient’s positive perception of the received care as well as clinical outcomes.

This paradigm shift might turn the perception of healthcare from a burden

Conclusion The Pressure Cooker proved to be a valuable generic method for innovation. The Speed Date with users provided valuable first-person experiences for getting customer insights, the World Café gave insight into a broader public opinion on discussion topics. The diversity of participants and the intensity of collaboration resulted in inspiring ideas for the specific cases, which were not restrained by sector-specific can-dos.

“Ideas from Pressure Cooker are more creative. And the results show that it is not about how to cure people but much more about how to make people feel well. Politicians and policy makers really have to think again what they should invest in”, said one of the participating healthcare professionals. The ideas will be used as solution directions for new projects with the healthcare institutions and policy makers. Above all, Pressure Cooker appeared to be an invaluable and meaningful experience for students in their education.

Ingrid Mulder, PhD, is an associate professor of design techniques at ID-StudioLab, Faculty of Industrial Design Engineering of Delft University of Technology, the Netherlands and a research professor of human centered ICT at Rotterdam University of Applied Sciences, the Netherlands. As a researcher she has been involved in methodological innovation in the domain of psychometrics; as an interaction designer she promoted human-centered design of emerging technologies.

Photo: Johan Gunséus

Peter van Waart, MA, is a lecturer of experience branding and a researcher in the human centered ICT group at Rotterdam University of Applied Sciences, the Netherlands. As project manager at AND International Publishers, he was involved in the development of educational multimedia and digital reference works. At Motivaction International, he worked as market researcher and consultant for human value based brand strategies.

Justien Marseille, Lecturer and researcher, Rotterdam University of Applied Sciences

Justien Marseille, MA, is a lecturer of media innovation theory and researcher in the human centred ICT group at Rotterdam University of Applied Sciences, the Netherlands. In 1999, she started the Future Institute BV, a trend research company with a focus on social, economic and media paradigm shifts.

Carolien van den Akker, MA, is a lecturer of media theory at Rotterdam University of Applied Sciences, the Netherlands. She received her MA Public Administration and her MA Art History from Leiden University. She worked as a curatorial assistant at The Phillips Collection in Washington DC and as a teacher, researcher and curator in the Netherlands.

Photo: Johan Gunséus

into a joyful experience. In the future, more and more people will have one or more physical or psychological anomalies that they should not ‘suffer’ from, but that they themselves and the social environment should perceive as distinct personal characteristics that should not disqualify one’s personality or identity.

Shared control of service between care provider and patients and real opportunities for personal choices of patients will respect their identity and self-determination.

Carolien van den Akker, Lecturer, Rotterdam University of Applied Sciences

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By Judith Altenau

In the service of health services: Why co-creation matters A report on a research project of Intel´s Digital Health Group, Ireland This is the story of how research evolved into a co-created community directory of services produced by a multidisciplinary research team within Intel’s Digital Health Group, and the Stoneybatter community. This is also the story of how the research project supported the community’s older people in developing a sense of themselves as empowered citizens and users.

Introduction For the last year, a team of Intel researchers has been involved in a programme with a seniors group in Stoneybatter, Dublin, aimed at developing and creating a directory of services for local older people. Jessamine Dana, an ethnographic research intern, and Stefan Müller, a designer, began to work with the older people of Stoneybatter in order to understand how inhabitants and providers access, experience, and organize locally available resources for health- and social care. The project focused on providing insights into how services and related technologies can be developed to help people age in an independent and dignified way.

Background and approach The project began as a general research

by Intel’s Digital Health Group into the ways in which local older people experience services in the health-, social 104

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care and voluntary sector. It was soon understood that the community would clearly benefit from a directory that collates local services and is accessible at home. This is why the Intel team decided to work closely with the ‘Stoneybatter Senior Citizen’s Outreach Project,’ a local community development group, in order to develop and print such a directory. Although the research team do not explicitly consider themselves Service Designers, user-centred design and research-led thinking about users is firmly embedded within Intel, and helped frame their approach.

The need for information For the research team, it became soon clear that there was a strong need for information about available services in Stoneybatter. Older people, caregivers and service providers needed a service that allowed each of them to better engage and co-operate with one another.

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why co-creation matters A Report by Judith Altenau

ÂťFor the research team, it became soon clear that there was a strong need for information about available services in Stoneybatter. Older people, caregivers and service providers needed a service that allowed each of them to better engage and co-operate with one another.ÂŤ 106

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ÂťThe Intel team began to create a directory aimed at informing and empowering older people to participate in services relevant to them. Researchers and older people collaborated to find a way to create a directory that stimulates and supports the pursuit of existing services in its organisation of information, its language and tone as well as its form.ÂŤ

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why co-creation matters A Report by Judith Altenau

This became particularly vivid with services that have significant impact on older people’s potential to remain within their home as they age: some help with cleaning and laundry, having a rail installed in the shower, or information about opportunities for social participation. It is often small things that enable not only healthy living but quality of life and a sense of being. Despite their importance, such services are often very hard to find and/or access.

people in Stoneybatter. Service narratives were used to capture their personal experiences with services. These narratives helped the team understand why it is often nearly impossible to find a service offer in the first place – let alone access it. Subsequently, ‘top-down’ research into statutory and third sector providers was conducted and compared with the findings of the ‘ground-up’ investigation.

This revealed a fundamental difference between the residents’ knowledge of local service offers and their actual availability. Differences were mainly related to the information about their existence, how they can be delivered as well as how residents access them. In order to understand and investigate those problems, participants were asked to create visual representations of real and ideal pathways they had taken while attempting to engage with certain services. In workshops it was discussed why – from their perspectives – some had been successful and others not. In addition, obstacles to service access were captured and suggestions for improvements were made. Similar exercises were carried out with service providers, juxtaposing their assumptions with those of the older people’s service pathways.

These methods informed the team that information about available service offers is essential to access. This is not limited to the fact that a service exists but also about how to participate and engage in the service.

The research

The directory of service

In a ‘ground-up’ investigation, the Intel team investigated the lives of older

Based on these insights, the Intel team began to create a directory aimed at

»The older people felt involved and thus, gained a strong sense of empowerment and ownership regarding the project and its outcomes. In fact, the process of co-creation was not only fundamentally important for the success of the service but also gave participants a new outlet for their social life and a sense of wellbeing and involvement.«

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informing and empowering older people to participate in services relevant to them. In another round of workshops, researchers and older people collaborated to find a way to create a directory that stimulates and supports the pursuit of existing services in its organisation of information, its language and tone as well as its form.

During the whole design phase, the team encouraged collaboration between users and providers, supported by a weekly mock-up of the directory. In the end, the final directory consisted of five service categories: ‘health’, ‘local community and support services’, ‘churches’, ‘in your home services’ and ‘information, advice and groups’. It also provides a map that allows retrieving services by their geographical location as well as a fold-out timetable of weekly activities and events in the area.

The importance of co-creation During Intel’s research project, cocreation was crucial to the researchers, the users and providers, as well as the success of the directory. The older people felt involved and thus, gained a strong sense of empowerment and ownership regarding the project and its outcomes.

In fact, the process of co-creation was not only fundamentally important for the success of the service but also gave participants a new outlet for their social life and a sense of wellbeing and involvement. Certainly, the directory was a success when measured by the local people’s positive feedback and its distribution rate. And its success was dependent on the participants’ contribution and the

fact that they felt strongly about ‘their’ directory. They were keen to get as much visibility for it as possible and enthusiastically organized the launch and dissemination. In order to develop sustainable products and services that bring real and positive change in everyday life, the establishment and utilization of reciprocal relationships between designers, users, and providers is a valuable strategy. The directory became a success because it is the product of a collaborative approach to research and, at the same time, reflects the perspectives of individuals.

The “Directory of Services for Older People in the Stoneybatter Area” was officially launched by Aine Brady, Minister of State at Health and Children with responsibility for Older People & Health Promotion, on 1st July 2009.

»The directory became a success because it is the product of a collaborative approach to research and, at the same time, reflects the perspectives of individuals.«

Thanks to Stefan Müller and Jessamine Dana for comprehensive background and information material!

Stefan Müller, Designer, Intel's Digital Health Group, Dublin, Ireland Jessamine Dana, Research Fellow, National University of Galway and Technology Research for Independent Living Centre (TRIL), Dublin, Ireland

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chapter preview

Service Design Snapshots from around the world

112 Docstop – a medical service for European truck drivers Julia Schirok

112 Design and sexual health (DASH) Lauren Tan, Benedict Singleton, Jenna Singleton and Mike Smart

113 360° health – an experience design approach for healthcare innovations Lekshmy Parameswaran and Laszlo Herczegh

114 Designing healthy services: Exploring the role of conflict when implementing change John Curran

114 Why Service Designers are healthy for innovative projects – a client’s perspective Annika Hertz and Martin Beyerle

115 New channels for community health engagement David Hicks

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Improving the visual communication of complex information in the health sector Sheily Pontis

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service design snapshots

from around the world #1.

docstop – a medical service for european truck drivers Today truck drivers are often on the road for a long time – constantly pressed for time. Serious accidents happen because drivers feel compelled to drive with health impairments or under the influence of self-medication. In order to minimize risks for all road users, the non-profit association “DocStop für Europäer e.V.” established a medical support network called

»In order to minimize risks for all road users, the nonprofit association “DocStop für Europäer e.V.” established a medical support network called DocStop in 2007. «

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access to the service system: provide a hotline as a concierge, and a proactive multi-channel interface (hotline, web, local).

• Retain control: Address concerns with a simple, uniform process: information about time and costs, signage, feedback facilitation.

For full project results see www.psuw. de/docstop

Julia Schirok, co-founder of PSUW DESIGN, Germany www.psuw.de

DocStop in 2007. Drivers in need of medical attention leave their truck at selected truck stops, and a shuttle service takes them to the nearest co-operating surgery that assures special treatment of drivers.

When PSUW DESIGN conducted a service review, we found refinements that led to three re-design principles: • Tell the solution: Inform drivers about the problem and the service approach: welcome package, step by step folder, lavatory campaign.

• Meet them halfway: Allow easy 112

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design and sexual health (dash) DaSH was a project of the Dott 07 (Designs of the Time) programme operated by the Design Council and regional development agency One North East. Dott 07 considered how design could contribute to driving public sector innovation.

In 2004, the UK Government published The National Strategy for Sexual Health and HIV to provide “major benefits for overall health

»In 2004, the UK Government published The National Strategy for Sexual Health and HIV to provide “major benefits for overall health and wellbeing” in England. « and wellbeing” in England. It suggested that “shaping services around patients, their families and their carers” would help achieve its ambition and DaSH aimed to demonstrate how this could be done by design.

DaSH brought together a co-design team of designers and healthcare professionals from Gateshead Primary Care Trust (PCT) to conduct research and explore a peoplecentred sexual health service.

Findings were captured in a Service Experience Document and Blueprint outlining service recommendations

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and opportunities, inclusive of: • Service Design principles • Service provision models • Promotion and awareness • Communication gateways • People-centred clinic experiences In July 2008, a new sexual health clinic was built at Bensham Hospital incorporating these recommendations. The clinic enables patients to be seen within 48-hours of first contact and over 50% of patients visit, based on recommendations from friends . DaSH has since been implemented across other PCTs in the UK including Wakefield and Portsmouth.

Lauren Tan, PhD candidate, Northumbria University and Design Council, UK Benedict Singleton, Designer and PhD candidate, Northumbria University, UK Jenna Singleton, Service Designer and Researcher, Sense Worldwide, UK Mike Smart, Design Strategist, Design Council, UK

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360° health — an experience design approach for healthcare innovation Health is a personal experience. Every one of us experiences health and the loss of it in different ways. Current healthcare services are disconnected, inconsistent and confusing, forcing people to navigate through numerous organisations, institutions, and service providers to find their way back to healthy life.

»The 360° Health approach puts people and the way they experience health in the centre of innovation. Using a framework that identifies opportunities for design intervention.«

illustrate the 360° Health approach: • NHS Patient Experience Master Class, Scotland How can experience design methods and tools be transferred to health service innovation teams to improve service delivery?

• Active Welfare, Italy How can an experience design process harness local resources and sustainably transform a health system around the needs of its citizens?

•Considering Elderly, Spain How can design rethink the experience of aging in today’s society?

Lekshmy Parameswaran co-founder of fuelfor, Barcelona, Spain Laszlo Herczegh, co-founder of fuelfor, Barcelona, Spain www.fuelfor.net

The 360° Health approach puts people and the way they experience health in the centre of innovation.

Using a framework that identifies opportunities for design intervention at an urban scale, as well as at a personal and community level, the approach can connect healthcare players from the public, private, and third sectors to deliver integrated services for a consistent quality of experience. Visit www.fuelfor.net/ sdn and read three case studies that touc hpoint | the jour nal of se rvi ce desi gn

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service design snapshots

from around the world #4.

designing healthy services: exploring the role of conflict when implementing change Designing innovative health services is a key driver in health services in the UK for three general reasons.

1) Innovation done well leads importantly to better patient care.

2) Innovation done well empowers teams to drive the change and manage its implementation.

3) Innovation based on points 1 and 2 is cost-effective.

These three reasons enable teams to put the recovery of the patient at the heart of their everyday work.

An excellent example of this is the work being done at the NHS Institute of Innovation. Through projects such as “Productive Ward”, “Think Differently” and “Experience-Based Design” (ebd) they are radically installing a way of thinking that promotes transformational change and paradigm shifts in how health services view themselves.

However, innovation, and the change that it brings, comes at a cost because all change, good or bad, causes some form of conflict at a personal, professional, and organisational level. Therefore innovation must also approach the concept of conflict in a creative way because 114

understanding conflict hotspots enables the management of change to be more fluid and productive.

What is key here is to understand the different narratives at play and how these narratives are visible both physically, metaphorically, and symbolically on a daily level within healthcare settings. Understanding the organisational culture from an anthropological viewpoint would

»Through projects such as “Productive Ward”, “Think Differently” and “ExperienceBased Design” (ebd) the NHS are radically installing a way of thinking that promotes transformational change and paradigm shifts in how health services view themselves.« create deep insights into the drivers and barriers relating to the implementation of innovative thinking.

Dr. John Curran, social anthropologist, organisational consultant and workplace mediator, UK

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why service designers are healthy for innovative projects - a client´s perspective After our second successful cooperation with the health insurance company Siemens Betriebskrankenkasse (SBK) we, project managers at sedes research, asked Cathleen Wenning, SBK innovation and portfolio manager, to explain what added value and which limitations she sees in the application of Service Design in the context of health services. Our latest project with the SBK investigated how to motivate customers towards a healthier lifestyle.

Cathleen Wenning points out that she appreciates the holistic, practical, creative, and human-centred approach that Service Designers take.

In contrast to other partners working in collaboration with the SBK, Service Designers do not limit their activities to the research phase, but also support the SBK in the process of translating research findings into service innovations. She notes the potential for Service Designers to take the lead in health projects that involve other disciplines, helping the team move from project development to final implementation.

She also sees the advantage of using qualitative, human-centred research as a way of exploring issues in the

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#6. customer’s day-to-day life, rather than relying only on assumptions and opinions of experts. Enhancing the qualification within their own company, the SBK currently invests in their teams to implement the Service Design approach.

Reviewing the project and the interview it becomes apparent that the holistic approach of Service Designers offers on the one hand great opportunities, and on the other brings its own challenges regarding co-operative work within future projects. From our perspective a future emphasis should therefore be placed on the development of common tools and a common language for all parties involved in the process and implementation of Service Design projects. Only this allows all collaborative partners to make best possible use of gained insights and to empathize with the customers in order to produce high quality, tailormade results.

Annika Hertz, Service Designer, sedes research, Cologne, Gernany Martin Beyerle, Service Designer, sedes research, Cologne, Gernany www.sedes-research.de

new channels for community health engagement

(BCC) is working with the project Board and its various suppliers in a collaborative network, to help in the design of key services. This work ranges from initial community Lambhill Stables is an innovative engagement, through the use of a community-based project, in early book, documentary film, online and development, that has at its core new community workshops (the foundachannels and methods for delivertion phase) to developing the main ing health, wellbeing, learning, and services that the building will offer. lifestyle services in a deprived area Valuable tools BCC have been using include storytelling, visual thinking ÂťIntegrating health educaand visual facilitation, distributed tion within a broader service brainstorming, and action learning.

For further information see: www. provision for the local crossingtheborder.co.uk and www. community means that it lambhillstables.co.ukv

becomes more accessible and has a higher profile than a single initiative provided through the public health system alone.ÂŤ

David Hicks, founder of Border Crossing Associates, UK

of Glasgow, Scotland.

The site is a derelict but culturally and historically significant building.

The aim of this project is to renovate the building as a central community hub in an area of high social deprivation.

Integrating health education within a broader service provision for the local community means that it becomes more accessible and has a higher profile than a single initiative provided through the public health system alone.

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Copyright by Hester van Thiel, Mike Janssen and Marc Fonteijn

#7 #7.

improving the visual communication of complex information in the health sector The representation of complex information, whether scientific or from other areas, is being adapted for clearer understandings of, for example, how to obtain a better service or how to learn about specialized knowledge easily. Some

»In the recent years, mapping has become a way of making sense of things, with diagrams being an often used and effective visual tool for representing complex information.

Mapping has been adopted to represent all kind of nongeographic narratives, from scientific projects to medical explanations. « authors (Zender and Crutcher, 2007) suggest the need of new tools to find a better solution to communicate those complex contents. In the recent years, mapping has become a way of making sense of things, with diagrams being an often used and effective visual tool for representing complex information. Mapping has been adopted to represent all kind of non-geographic narratives, from

scientific projects to medical explanations (Owen, 2002).

As part of a PhD research project we have identified the following stages for improving the creation of mappings: 1) Multidisciplinary work teams 2) Organisation of information in a regular and systematic way 3) Adoption of a design method The adoption of design methods and multidisciplinary teams as a normal part of practise (Conley, 2004) and applying them in the health sector would be key for obtaining more effective communicative results.

navigational systems. Essays by William Owen. London: RotoVision.

• Zender, M.; Crutcher, K. A. (2007), The expression of scientific concepts.

Visible Language, Vol. 41.1, pp. 23–49.

For further information: sheilapontis.wordpress.com sheilapontis@gmail.com

Sheila Pontis, PhD candidate, University of Barcelona, Spain and University of Arts London, UK

Examples of Mappings • http://scimaps.org/maps/map/ mapa_fisiologico_del_68/ [Accessed 25 July 2009] Physiology map (Argentina, 2006).

Interdisciplinary team work.

• http://history.wordpress.com/progetto/ [Accessed 25 July 2009] Hospital System. Narrative medicine (Italy, 2007). Work team.

References • Abrams, J.; Hall, P. (2006), Else/ Where: Mapping. New Cartographies of networks and territories. Minneapolis: University of Minnesota Design Institute • Conley, C. (2004), Where are the design methodologists? Visible Language Vol. 38.2, pp. 196–215.

• Fawcett-Tang, Roger (2002), Mapping. An Illustrated guide to graphic touc hpoint | the jour nal of se rvi ce desi gn

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By Anette Hiltunen and Reetta Kerola

Customer Profile anita and grandpa kaarlo kuopio, finland

»Whlal t if I fanight?« at

The following customer profile tells about a carer and her father, from Kuopio, Finland. The profile is based on interviews with experts and elderly people living at home with the help of family care, observations, and survey of quality of elder services. The background research brought up lifestyle, wishes, fears, disappointments and experiences of the elderly. It became clear that the elderly wish to live at home, but there is a huge lack of services that could improve the quality of life among the elderly and their family carers. Mind maps demonstrate the “jungle” of services that an elderly person with low income and his or her carer are confronted with. The following fictional story by design students describes potential services that aim for long-term, quality home care despite income level.

My name is Anita. I’m a 47-year-old woman from Kuopio, Finland, where I live together with my family near the city centre. I’m the carer of my 85-year-old father, Kaarlo, and single mum with two children: my daughter Laura, 8 years, and my son Toni, 13 years. Originally I’m a countryside girl and a daughter of village shopkeepers. Mum and dad were both hard-working people, so we, four children, learned early the way to work for example by working at the shop. Dad was well-liked and appreciated, because he used to introduce unforeseen products in the village. I remember that we were the first ones to taste flavoured yoghurt in the Kuopio region. I think banana was the best and the most exotic flavour I had ever tasted!

When I was sixteen, my best childhood friend, neighbour Maija, started studying at the business school in the real city centre, in Kuopio. During school holidays, she

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visited home and had always new, fashionable city girl’s clothes, like those brand new Lee jeans “Made in USA”. Oh my goodness, how much I admired her! It was then I also decided to move to the city as soon as I turned eighteen. I informed my parents about my decision already one year in advance, and started to count down the days to my birthday. Dad had wished for that one of us children would take over the shop some day, so I was very thrilled that mum and dad encouraged me to apply for the business school, like Maija.

I did get into the business school, but I never became a village shopkeeper. The city life, my work as a bank official and Kuopio that grew to a modern city with brand new apartment buildings fascinated me more. The fancy, new kitchens and household equipment felt so up to date. I was like a kid in a candy store! Now afterwards, I think, it would have been better, if they had preserved the beautiful, old wooden architecture of the town.

My older brother wanted to follow our father’s footsteps and take over the shop.

He managed to run the shop until 1985, which was quite good for a village shop. It was very usual that one village shop after another had to be shut down when the moving from rural areas to towns started in the 1960’s. Young people were not interested in the country life anymore. The towns and cities drew people with jobs in office, and with all the entertainment, heat and beat. I was one of them that heard the call.

To shut down the shop was a hard thing to our father. However, mum and dad stayed in the countryside until mother passed away in 2002. Death of mother was depressing for our father, and he started to become reclusive. We felt it was very difficult to help him, because we lived in the city, so I invited him to move in with us. With a wistful feeling he had to leave our old good home but he couldn’t have survived the everyday life alone anymore.

So, today, my family consists of grandpa, my two lovely children and me. We live in an apartment building that is specially designed for family care needs. In total, there are 20 apartments in the building and families with various size and income level. The apartment we have rented has four rooms and a kitchen, and it is specially designed for the needs of my aging dad.

It would have been financially impossible for me to stay as father’s carer only with the municipal allowance (around 400 Ð net), especially as a single parent. Now, I can earn more money by taking care of our neighbour Eerik, who lives together with his son’s family. Because both Eerik’s son and his wife have a full-time job, and Eerik has a

better retirement pension than our grandpa Kaarlo, they can, together with the municipal supplement, pay me for taking care of Eerik as well. I don’t have to work 24/7, like most carers usually do, thanks to assistants and evening activities that our housing cooperative offers for evenings and weekends and for Thursdays so that I have a chance to get a free day. This service is included in the rent for the apartment.

There are joint afternoon activities arranged for children and the elderly in our house’s common facilities, and once every two weeks I have a chance to lead a group. It bothers me that nowadays the young and the elderly don’t meet and connect with each other that often anymore it’s sad, but luckily our community makes a difference!

It reminds me of my own childhood and our lively, warm-spirited village, where we learned by listening stories of older people …

Thanks to the care services of our housing cooperative, I haven’t had to give up my career and leisure time entirely. Instead, I can take turns with other carers in neighbour apartments and the professional assistants that our house provides. After the business school I studied pedagogy (as adult education at University of Applied Sciences), and now I work as a part-time teacher in accounting at the business school on Thursdays. And once a week I also go to a foxtrot dance course with my

»it would chear me up to have some company for coffee«

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customer profile | anita & kaarlo

By Anette Hiltunen and Reetta Kerola

»all my mates have gone«

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boyfriend Janne. I feel I’m happy, and I feel that I’m able to live close to my family and help them, and still have my own life.

I’m fortunate, because I know how hard life can be for most of the care giving relatives in Finland.

Maria, secretary of our housing cooperative, has also specialised in IT services, and she updates the website of our house. The aim of the website is to work as an information board to the residents concerning benefits and service needs of the elderly. The website also concentrates all the services in one place. Earlier it used to be a problem to find all the services because they created such a scattered and complicated network it was like looking for a needle in a haystack!

Two years ago my father was diagnosed with dementia, which means that we can’t really trust his memory anymore.

Luckily, there are still three of us trying to keep the ideas and thoughts in present day. It’s quite nice to notice that the times with our mum, the times when the shop was founded and when we children were small, appear to be the most memorable times in my father’s life. The care services we receive have been designed to pay attention to this kind of personal needs,

touc hp o in t | the jo u rn al of s ervice d es ign

like illness and mood. I’ve created an own profile for my father and me on the website, including information about us, our likes and dislikes and wishes for activities. We wanted a web service that would suggest us how to spend the leisure time according to condition and mood. Grandpa Kaarlo likes to go to the municipal activities. For example, at the “Coffee Break” they use to sing old evergreens that bring up memories from times they were young.

In their youth, it was popular to go to dance hall and listen to, for example, Finnish tango. Like many couples, my parents met each other at a dance. Today, my father also takes part in gymnastics once a week, and that’s how he keeps his condition relatively good.

The web service informs of local activities, their content and prices, and of other possibilities to spend time. It can also plan memorable experiences for the elderly or the carer. There are, for example, special events, which provide information, education, and peer support for carers. I attended one of these events last month!

After the day, I usually write down my thoughts of the day on the website and mark the care products that have ended.

Through the housing cooperative we have also an access to a joint MPV that reminded me of that I have to make a reservation for next week! Grandpa and children want to see some childhood countryside …

- Municipalcarer support

Carer support services

Public institutional care services

- Amount - Unclarity of services Accessibility

Private activity services

Day activity services

- Fear of Lonelines

- Low pension

- Busy Home care services

Society

Environment

Municipality + Carer

Home care

- Lonelines

+ Family

Free day

+ Home

+ Living Conditions

Public institutional care services

Health assessment Meal services Cleaning aids Medical aids Transportation aids

Social relationships

- Few left

+ Price Entertaining Lack of resources - Unclarity of services Curch Municipality Organizations

+ Accessibility + Resources Price

- Exhaustion - Negative state of being

+ Friends - Accessibility - Lack of Resources - Unclarity of services + Price

Customer service journey

Private health services

Mental health

Health

Publiac health services

- Physical health

- Dementia

- Physical dementia

Average service experience

index

Anitas service journey Kaarlos service journey Alternative service journey

- Carer´s mental health

Carer

Able to stay at home

Physical health care

Private health services lines present the different service journeys

Medication Therapy

Mental health care

+ Price - Accessibility Lack of Resources

- Price Resources Accessibility

- Lonelines Average service experience

- Price

- Exhaustion - Poor service experience

+Resources + Accessibility - Price

Public health services

+ Price Lack of Resources - Unclarity of services - Accessibility

Home nursing Health centre Hospital Voucher

- Poor service experience - Negative state of being

colours present the functionality of services and their qualiy by experience + Positive, warm, clearness, good resources • Tolerable, chilly, varying quality and resources - Negative, cold, unclarity, lack of resources

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dos & don’ts service design

Swine Flu Pandemic Hotline

She was stunned by his diagnosis and started to explain again her flu-like The National Pandemic Flu Service is symptoms. The man disappeared set up to ease pressure on the NHS for a moment, came back to the and GPs by helping to diagnose swine phone and without further comment flu online or via the phone. A friend of continued just asking more questions. mine recently contracted the flu and My friend felt that he didn’t have had a slightly disappointing service medical knowledge to start with, and experience when calling the pandemic that he was essentially reading down hotline. According to the call centre a heavy script without listening to worker who asked a couple of basic what she was saying. questions around her health, she was on the verge of death and should In the end she almost felt more phone 999 immediately. distressed than before she made the

call. Of course, with an estimated 100,000 new cases of swine flu in a week, the pressure on the NHS to act quickly was enormous and therefore providing an excellent service whilst coping with such high demand presented a real challenge! There is nothing more exasperating than people treating you like a number and reading from a script that doesn’t solve your problem.

Julia Schaeper, London, UK

share your service experiences The Do’s and Don’ts-page in Touchpoint is a special feature, which provides space for our readers to publish their apictures and experiences from the world of services. Make use of this opportunity and share service flaws or outstanding service successes with an international audience!

the assignment If you would like to see your story published here, please send in a photo, together with a text describing the situation depicted, which illustrates your personal (positive or negative) Service Design highlights, to: journal@service-design-network.org The Service Design Network Office collects all stories and chooses three to four examples to be published in each issue.

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Medical advice Access to medical advice is a basic requirement for health. In the developing world, for example in Malawi, thousands of people live far away from any medical supply.

The open source system FrontlineSMS” allows people living hundred of miles away from an hospital to connect with doctors

Stupid signing This sign was on the front doors of the accident and emergency unit in Stoke Mandeville Hospital, England, UK. Lauren Currie, Scotland

Alexandre Robert, Zürich, Switzerland

Beach wheelchair

Librarians taking bookings for local health services, this is excellent!

I found this wheelchair at the beachcafe „Our Seaside“ in Renesse, Netherlands. It‘s a really nice service that allows handicapped people and their companions to make a walk on the beach.

Paul Thurston, UK

Cher Paternoster, Cologne, Germany

Local health services

Pajamas at Maternity Ward (Hospital) in Åland The Maternity Ward at the main hospital in Åland got new pj's for the female patients. The pj's were so disgustingly ugly that not only the patients complained but the personnel started a protest because they "have to watch the hideous patients all days long". I think this is an excellent case on 'corporate fashion' - how clothes can make a difference. Everyone who has ever delivered a baby, knows that even if it is a great event, it thoroughly shakes your femininity: you are emotionally and physically extremely vulnerable.

You do not need a horrible disturbing pajamas to underline the fact that you are sore, swollen and leaking ;-) And you definitely don't want to wear that thing in all the tens of pics your husband and relatives are taking at the hospital - and be reminded of it each time the rest of your life.

No need to tell that the city officials thought that hospital personnel and patients were ungrateful and stupid and refused to get nicer pjs...

Susanna Sucksdorff, Helsinki, Finland

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dos & don’ts service design

Fake Bus Stop I recently finished a design project for dement emergency patients. During our research we visited a number of specialized residences for elderly people who suffer from Alzheimer’s disease. The nursing home staff informally categorizes some of the patients as ”runners” – patients who get overwhelmed by the constant irruption of “new” sensations and everyday requirements. They get anxious and nervous very easily and then try to escape from that threatening situation. Those patients pose a great challenge for the staff: They endanger themselves and others when they try to leave the residences, but all nurses and doctors wehave talked to strongly opposed fixations and medical sedation as well.

the walls where the patients could sit safely and “wait” for the bus. At first it struck us as odd and maybe even condescending, but we quickly realized that the unadorned trompe d’oeil picture was able to calm down patients as well as nurses. After a while, the patients forgot what upset them in the first place and staff could use their energy for more meaningful tasks than monitoring the elderly residents. A great example of usercentered design.

Monika Frech , Berlin, Germany

One residence came up with a simple, yet very effective work-around: They painted a bus stop on one of

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Donation Blood The Swedish Blood Centre (www. geblod.nu) has realised a few nice service ideas to get blood donations.

One simple service idea is that they are moving closer to potential donators. For example you can give blood in shopping centres but there are also blood buses, which operate in cities, country villages and also visit larger companies. A recent innovation is mobile communication – a customised SMS is sent out when there is a specific need. "We are in need of your bloodgroup. Please come in and give blood when you get a chance." Postcards are used to inform donators: "Your blood saved a life today." This kind of relevancy makes a huge difference in how people interact with a public service as it creates the shift from "they probably have enough donors" to "I can make a difference" Stefan Moritz, Stockholm, Sweden

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member map

service design network

Finland Culminatum Ltd Oy , Espoo Laurea University of Applied Sciences , Espoo KONE, Espoo Taivas, Helsinki Grey Direct & Digital, Helsinki University of Art and Design Helsinki, TaiK, Helsinki Jyväskylä University of Applied Sciences, Jyväskylä Kuopio University of Design, Kuopio Lahti University of Applied Sciences, Lahti Sweden Tieto Corporation, Älvsjö Business & Design Lab University of Gothenburg, Göteborg Linköping University, Linköping Doberman, Stockholm Norway Designit, Oslo AHO University, Oslo United Kingdom Virgin Atlantic Airways Ltd, Crawley Imagination Lancaster, Lancaster Engine, London IDEO, London live|work, London Prospect , London Seren Partners, London STBY, London thinkpublic, London Imperial College Business School, London NHS Institute for Innovation and Improvement, Warwick Ireland Centre for Design Innovation - Institute of Technology Sligo, Sligo Portugal University of Madeira–Madeira Interactive Technologies Institute, Funchal USA SCAD University, Savannah, GA Mc Donald´s Corporation, Oak Brook, IL Continuum, West Newton, MA Frontier Service Design, Malvern, PA Carnegie Mellon, Pittsburg, PA Canada lvl studio, Montreal Ascent Group, Vancouver Brazil UFRJ/COPPE- Federal University of Rio de Janeiro - DESIS group, Rio de Janeiro Igorsaraiva.com, Brasilia

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Korea Creative Design Institute, Sungkyunkwan University, Suwon Taiwan Chili Consulting Corp., Taipei Institute for Information Industry, Taipei Australia Proto Partners, Sydney BT Financial Group, Sydney Austria ISN - Innovation Service Network GmbH, Graz MCI Management Center Innsbruck, Innsbruck Mobilkom Austria, Vienna Italy Domus Academy, Milano Politecnico di Milano - Facoltá del Design, Milano Experientia, Torino Germany Sturm & Drang, Hamburg sedes / KISD, Köln Macromedia Hochschule für Medien und Design, München Rudolf Haufe Verlag, Wolfsburg Volkswagen AG, Wolfsburg Denmark Aalborg University - School of Architecture and Design, Aalborg 1508 A/S, Copenhagen Copenhagen Living Lab, Copenhagen Switzerland Luzern Universtiy of Applied Sciences and Arts, Luzern The Netherlands Delft University of Technology , Delft 31Volts, Utrecht Utrecht University of Applied Sciences, Utrecht T+Huis, Eindhoven TietoEnator Netherlands, Amersfoort DesignThinkers, Amsterdam Edenspiekermann, Amsterdam Informaat, Baarn Rotterdam University of Applied Sciences, Rotterdam Mixe - medical marketing, Zeist Spain FunkyProjects, Bilbao

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beyond basics service design conference 26-27 th october 2009 madeira, portugal This year´s Service Design Network Conference takes place on Madeira, Portugal from 26 to 27 October 2009. For more information and to register visit: www.service-design-network.org/conference The annual sdn Members Day is scheduled for 25 October. Save the date!

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