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Understanding Complex Problems in Healthcare: By Applying a Free-Flowing Design Practice
Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.ORCID iD: 0000-0001-8829-6288
2016 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare in Sweden is in need of a transformation. The increase of chronic conditions poses a great challenge to the organisational structure of healthcare, which still largely remains based on acute, rather than chronic care. Development in the healthcare realm is commonly conducted in fragmented processes and from the professions', rather than the patients', perspective.

A new type of design methodology has in recent years entered the field of healthcare development and innovation. It has progressively been used to enable the reorganisation of the healthcare system itself rather than solely developing artefacts, IT-systems or services within it. This thesis focuses on problems that can be described as open, complex, dynamic, networked, or wicked. The following research questions are investigated:

   I.     How can designers' competence contribute to healthcare innovation?

 II.     How can designers support the identification of complex problems in healthcare?

Empirical data were collected during two healthcare innovation projects in which the author took an active role as both designer and researcher. The research work was based on qualitative data that were gathered using ethnographic methodology (i.e., interviews, participant observation and field notes). The data were analysed using open coding principles and activity theory.

The results highlighted the valuable role of free-flowing design practice, supporting a thorough understanding of complex problems. The free-flowing design practice entails that the problem space and the solution space co-evolve. These spaces expand iteratively, continuously affecting each other while redefining problems in search of solutions that aim at radical innovation and not merely incremental ameliorations.

Abstract [sv]

Hälso- och sjukvården är i behov av förändring. Ökningen av kroniska tillstånd utgör en stor utmaning för sjukvårdsorganisationens struktur som fortfarande till stor del baseras på akut, snarare än kronisk vård. Sjukvårdsutveckling sker ofta i fragmenterade processer, och utifrån professioners, snarare än patienters perspektiv.

En ny typ av designmetodologi har på senare år börjat tillämpas för att utveckla och skapa innovationer inom hälso- och sjukvården. Den har allt mer börjat användas för att utveckla sjukvårdsorganisationen i sig, snarare än att bara utveckla dess produkter, IT-system eller tjänster. Avhandlingen fokuserar på problem som kan beskrivas som öppna, komplexa, föränderliga, sammanlänkade eller 'wicked' [onda]. Följande forskningsfrågor undersöks:

   I.     Hur kan designers kompetens bidra till innovation inom hälso-och sjukvården?

 II.     Hur kan designers bidra till att identifiera komplexa problem inom hälso- och sjukvården?

Empirisk data har samlats in i samband med två innovationsprojekt inom sjukvården där författaren haft en aktiv roll som såväl designer som forskare. Forskningen baseras på kvalitativ data som har samlats in genom etnografisk metodologi (dvs. intervjuer, deltagande observationer och fältanteckningar). Datan har analyserats enligt 'open coding'-principer och aktivitetsteori.

Resultaten lyfter fram värdet av en 'free-flowing design practice' [fritt föränderlig designpraktik] för att förstå komplexa problem. Den fritt föränderliga designpraktiken medför att problem-rymden och lösnings-rymden sam-utvecklas. Dessa rymder expanderar iterativt, medan de kontinuerligt påverkar varandra mot en omdefiniering av problem, i syfte att hitta lösningar som kan leda till radikal innovation, snarare än bara inkrementella förbättringar.

Place, publisher, year, edition, pages
Stockholm: Stockholm University, Department of Computer and Systems sciences , 2016. , 89 p.
Series
Report Series / Department of Computer & Systems Sciences, ISSN 1101-8526 ; 16-005
National Category
Human Computer Interaction
Identifiers
URN: urn:nbn:se:su:diva-129710OAI: oai:DiVA.org:su-129710DiVA: diva2:923909
Presentation
2016-05-18, L 30, Borgarfjordsgatan 12, Kista, 14:00 (English)
Opponent
Supervisors
Available from: 2016-04-28 Created: 2016-04-27 Last updated: 2016-05-11Bibliographically approved
List of papers
1. Beyond ICT: How industrial design could contribute to HCI research
Open this publication in new window or tab >>Beyond ICT: How industrial design could contribute to HCI research
2015 (English)In: Swedish Design Research Journal, ISSN 2000-964X, no 1, 22-29 p.Article in journal (Refereed) Published
Abstract [en]

This paper takes an industrial design practitioner perspective to reflect on the articulation of ’design’ in Human Com- puter Interaction (HCI) research – one of several research fields, articulating and contributing to design knowledge. The paper critically reflects on the importance of more holistic perspectives for design activities, and the articulation of design in HCI research. We argue that industri- al design practitioners can contribute to HCI research by broadening the design knowledge and the practice within the field not to view ICT as a self-evident part of either a solution or as a tool in the pro- cess of specifying the problem or finding a solution. This may not only improve the articulation of design and design activities, but more importantly point towards an opportunity to support more socially and environmentally sustainable solutions in society.

National Category
Information Systems
Research subject
Man-Machine-Interaction (MMI)
Identifiers
urn:nbn:se:su:diva-123928 (URN)10.3384/svid.2000-964X.15122 (DOI)
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2016-05-11Bibliographically approved
2. Hindering Contradictions in Healthcare: An activity-theoretical analysis of a design-led investigation in primary care
Open this publication in new window or tab >>Hindering Contradictions in Healthcare: An activity-theoretical analysis of a design-led investigation in primary care
2015 (English)In: Proceedings of the Third European Conference on Design4Health 2015, Sheffield, 13 - 16 July 2015 / [ed] Kirsty Christer, Sheffield, UK: Sheffield Hallam University , 2015, 1-9 p.Conference paper, Published paper (Refereed)
Abstract [en]

The Swedish healthcare system has been reformed in a significant way during the last decades resulting in several challenges. One of those challenges, addressed in this paper, concerns the relation between decreased resources and patient-centred care. Thus, this paper poses the question of why healthcare faces difficulties in transforming itself to become more patient- centred. To investigate the question, a case study previously unprecedented in Sweden was conducted at a primary care unit: The first author was employed by the county council as in-house service- designer in a nationally funded1 project with a placement at one specific primary care unit over 15 months. The project was initiated in 2014 and investigated the use of design methodology to explore the needs for future improvement in primary care. Collected data has been analyzed through Activity Theory, resulting in the identification of two major contradictions that emerge between the overarching activity of the organization and two inherent systems: the patient/citizen's activity system of getting help to gain better health and the doctor's activity system of providing care.

Place, publisher, year, edition, pages
Sheffield, UK: Sheffield Hallam University, 2015
Keyword
Healthcare, activity theory, design methodology, patient-centred, service design
National Category
Information Systems
Research subject
Man-Machine-Interaction (MMI)
Identifiers
urn:nbn:se:su:diva-123952 (URN)978-1-84387-385-3 (ISBN)
Conference
Third European Conference on Design4Health 2015, Sheffield, 13 - 16 July 2015
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2016-05-11Bibliographically approved
3. On the value of design thinking for innovation in complex contexts: A case from healthcare
Open this publication in new window or tab >>On the value of design thinking for innovation in complex contexts: A case from healthcare
2015 (English)In: ID&A Interaction design & architecture(s), ISSN 1826-9745, Vol. 27, 159-171 p.Article in journal (Refereed) Published
Abstract [en]

This paper discusses the use of different approaches to design in complex contexts, exemplified through a case from healthcare. Specifically, the value of Design Thinking (DT) for understanding of a problem at hand is discussed. The paper argues that a design approach based on a holistic understanding of problems constitutes a prerequisite for innovations in complex contexts where problems are open, complex, dynamic, networked and have a wicked character. The argument is made for the importance of differentiating design approaches with respect to their ability to support broader and more open explorations of the underlying problems, especially those in complex contexts. A case from healthcare illustrates the value of DT and is used to discuss the importance of avoiding what I refer to as deceptive problems. The potential of DT to increase the relevance of innovations through a better understanding of underlying problems is discussed.

Keyword
Design thinking, deceptive problems, complex contexts, HCI, innovation, healthcare
National Category
Information Systems
Research subject
Man-Machine-Interaction (MMI)
Identifiers
urn:nbn:se:su:diva-129719 (URN)
Available from: 2016-04-27 Created: 2016-04-27 Last updated: 2016-05-11Bibliographically approved

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