De-anthropocentrising healthcare design

In design research and design practice we can see new ideas emerging around deanthropocentrising design in order to rebalance our place and sustainability within the global ecosystem. Ideas including Posthumanism, Actor Network Theory, Object Orientated Ontology, Xenodesign, and Multi Species Design begin to show new perspectives for how we design and where we place humans in value chains. Current healthcare design models put the human at the top of the pyramid with effects on the wider downstream ecosystem through negative outputs like medical waste being one of the consequences. Here we ask how this challenges the future of design in healthcare and begin to explore the new types of methods and thinking that we may need to adopt in order to realise the potential of this new approach. Our conclusions raise a number of key questions for meta level healthcare design approaches, ethics, value chains and gaps in new methods and practices that need to be considered for adoption

SlowMo / Mo - digital technology to provide support in coping with daily life.

This project builds on previous work bringing inclusive design methodologies and expertise to therapy for paranoid and suspicious thoughts in people with severe mental health problems. Culminating in an interactive digital platform to support service users both in and outside of therapy sessions, this prior work established core design principles, with the platform currently going through a multi-centre randomised controlled trial. This project seeks to extend the benefits of the digital platform beyond diagnosed mental health difficulties to include a standalone app for anyone seeking to better regulate emotions and cope with daily life. The fundamental therapeutic principles underpinning SlowMo include (among others) the ability to recognise unhelpful thoughts, to slow down ‘fast’ thinking (jumping to conclusions), and the identification of alternative explanations for the observed situation or upsetting thought. The design principles of SlowMo include (among others) representing thoughts as bubbles, resizing them, and slowing down ‘spinning’ bubbles to encourage the user to engage in slower thinking. A larger scale clinical trial will establish its clinical efficacy compared to treatment as usual. The project aim is to adapt and expand both the therapeutic and design principles to target a broader audience with common emotion difficulties experienced by the majority of the population. The team combined the ‘Double Diamond’ methodology with agile working with developers. Insights were gained through extensive interviews and workshops with a variety of potential users. Personas were built up from these insights, informing subsequent co-creation sessions. A number of extra functions and concepts were created, and refined using critical feedback. The additional app framework and functionality were refined, along with the visual language and branding. Rapid iterative design and coding work packages allowed for the collaborative development and testing of sections of the app

Designing out unwanted healthcare futures: A new framework for healthcare design innovation with intent

At the time of a global pandemic, it is becoming acutely evident that design has to intensify efforts to move beyond reactive tackling of healthcare challenges as they occur, towards a proactive approach of designing-out unwanted healthcare futures before they become a reality. As healthcare design navigates towards more distant horizons, the scale and magnitude of design challenges increase. New approaches to envisioning and negotiating preferable healthcare futures across disciplines are required in order to make that shift successful. In this paper, we discuss the application of a new trans-disciplinary approach applied within burst-mode healthcare design education of professionals from multidisciplinary backgrounds. This strategic design-led innovation approach distinguishes between desirable and undesirable futures. It employs futures scoping methods, alongside the identification of technology drivers and enablers, to understand the target landscape and to design strategic pathways toward paving design interventions. Tools, such as the four futures of Jim Dator and NASA TRLs, are used alongside collaborative moodboarding to visualise possible futures and facilitate concept generation utilising moonshot thinking and backcasting

Design for future of health and safety in commercial human spaceflight: Towards human-centred exploration medical ecosystem design infrastructure

In conventional practice, medical systems requirements for human spaceflight are considered towards the end phases of a space systems engineering project, leaving little room for the integral medical requirement codification within spacecraft design parameters (NASA ExMC, 2021). As mission character increases in length and remoteness, the level of care and required medical capabilities increase dramatically. The longer and more remote the mission, the greater is the need for human-centeredness. To address that, it is crucial to incorporate a human-centric approach at the early stages of defining key mission architecture parameters and constraints of mission and vehicle/habitat planning. ‘[Human] spaceflight has reached a critical moment where the transition to a human-centric mission architecture must become reality if exploration missions are to succeed’ (Antonsen, 2017). This paper presents an overview of the current state of the art and the diversity of approaches within prospective orbital, suborbital and deep-space missions and scope opportunities within a design for health and safety in commercial space transportation. It provides a rationale for the development of Exploration Medical Ecosystem Design Infrastructure (ExMEDI) as a method and a tool to define medical capabilities required for specific future spaceflight contexts, and optimize design requirements for healthcare systems, such as a medical workstation or medical bay, to best support crew’s health. The ExMEDI would serve as a tool compatible with currently developed system architecture solutions to calculate health risk, and would allow to the integration of human-centered parameters, such as crew profile and needs, as well as medical capabilities, instrumentation, and material requirements, to optimize the solutions for specific mission contexts and characters, such as extended LEO habitation, space hotel facility, lunar space station, or transit to Mars

Transdisciplinary behaviour change: A burst mode approach to healthcare design education

With the future of health(care) shifting from treatment to prevention, design for behaviour change is an essential part of this movement. Although we have made significant breakthroughs in behavioural science and design for shaping behaviours there are still some significant gaps and opportunities unexplored. Developing new transdisciplinary approaches to the education of designers for behaviour change becomes of increased importance. New practice-based models are required to facilitate the connection between the understanding of behavioural theories and applying these to healthcare contexts. This paper illustrates a unique blended teaching model which fuses teams of mixed healthcare, design and other diverse backgrounds and the use of digital technologies to pre-empt unwanted behaviour and assist behaviour change. The course module combines asynchronous learning for behaviour change diagnosis with synchronous collaborative concept development and rapid-prototyping. Digital platforms are used to facilitate remote global teamworking alongside individual physical hands-on prototyping using sensors and electronics

Beyond the healthcare paradigm: Co-creating a new model for collaborative transdisciplinary healthcare design education

Although healthcare has long been a focus for design research dating from the 1960’s and Bruce Archer’s Industrial Design (Engineering) research unit, there remain very few academic programmes in the field of healthcare design and even fewer that go beyond classic user driven models. This paper reports on a unique collaboration between the Royal College of Art and Imperial College in London to develop an innovative partnership and programme structure between two diverse collaborating institutions. Moreover, the partnership has shown how new design and healthcare research methods have been used for innovative practice-based healthcare design projects. We reflect on the diverse skill sets and approaches that have evolved through collaborative teamwork between healthcare practitioners, designers and diverse disciplinary backgrounds. Our conclusions illustrate how a context driven programme provides evidence of a new ‘post-disciplinary’ mindset and explores implications for research and practice for the future of healthcare design

Developing the Double Diamond Process for Implementation

This paper details overarching methodological insights resulting from several Inclusive Design projects in healthcare spanning ten years. A number of lessons have emerged, both practical and methodological, and are applicable to future design work in healthcare and the implementation of innovation. The Double Diamond methodology was used in all projects, increasingly run in parallel / mixed with an agile approach and PDSA cycles, where rapid iterations of the methodology are run in series. The final phase of the Double Diamond concerns delivery. The exact form that ‘delivery’ takes is unique to each project and partnership, but merits careful examination. Implementation of innovation is notoriously difficult in healthcare (Morris et al, 2011). Typically this is seen as post-‘design’, and necessarily requires the commitment of any healthcare project partner. Whilst some of the best innovations win design awards, many award winning designs are not adopted into front line use. There may be more to be done in design terms. The practices of co-research, co-creation and co-design are well used. Co-implementation efforts should start well before the end of the ‘Discover’ phase. These efforts may involve the identification of implementation stakeholders (standard practice in much co-design), but also funding bodies, the development of business cases and the adoption of commercial constraints in the design. Adoption of innovation in healthcare takes time, and is fraught with many complicating factors. Many lauded design outputs are not in use, pointing to poor implementation strategies. The above benefits of the Double Diamond must be applied to implementation in order to help adoption. This not only means involving the relevant stakeholders and identifying the relevant funds for implementation earlier in the process, but crucially designing the output with an implementation strategy in mind. This practice of ‘co-implementation’ will improve future adoption of innovations

Co-visualise the impact of Sickle Cell: How can we use design thinking to investigate and visualise the impact of Sickle Cell?

Background: This study leverages the principles of design thinking and system thinking to investigate and visualise the impact of Sickle Cell. Sickle cell is a genetic disorder that affects millions of people worldwide and disproportionately affects people of African and Caribbean descent. Patients with this condition face a range of physical, emotional, and social challenges due to the unpredictable nature of the disease. The fundamental principle explored in this study is designing for empathy. Design for Sickle Cell (D4SC) initiative was developed to bridge the gap between art, design and science within the Sickle Cell landscape. Aim: This design research project aims to investigate and visualise the condition's impact from a multi-stakeholder perspective by developing art and design prototypes that can inform an innovative Sickle Cell exhibition. Methods: Techniques from social constructionism, phenomenological qualitative research and user-experience research were utilised to create a novel methodology for this small-scale study. The methodology involved a multi-step process combining the double diamond, system thinking, and action research frameworks to gather insights that guided the development of this design research practice. Semi-structured interviews were conducted with Sickle Cell experts consisting of patients, a healthcare practitioner and support staff. Common themes were generated from their experience of the condition's impact. D4SC collaborated with Imperial's Invisible Warrior Project, RCABlack, a PhD Archivist Researcher and Photographer at the Slade School of Fine Art, to develop visual prototypes for the exhibition. Results: The findings from these interviews informed the development of a range of workshops and prototypes. The prototypes were tested by Sickle Cell experts and healthcare designers, who provided feedback on the concept. The results showed that the design outputs and exhibition were well-received and had the potential to improve education and awareness of the condition and promote empathy. Design research in healthcare has the potential to create innovative solutions. With the use of a multidisciplinary approach, it can yield a positive impact. Conclusions: The project highlights the importance of design thinking, system thinking and collaboration in developing innovative healthcare solutions for this complex health condition. The study demonstrates the value of a multi-stakeholder approach to designing for empathy. It shows the potential of visualising the impact of Sickle Cell to promote understanding and awareness of the condition. To facilitate the further advancement of the concepts developed in this study, securing funding an

How inclusive, user-centered design research can improve psychological therapies for psychosis: Development of SlowMo

Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. This study aimed to optimize the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface. We conducted inclusive, user-centered design research characterized by purposive sampling of extreme users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council's double diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping, and a mood board; define, consisting of workshops to synthesize findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded. Consistent with our previous work, the Thinking Well case series showed medium to large effects on paranoia and well-being and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia, and provide tailored interpersonal support from therapists and peers, although they reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalization and normalization, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with 2 key concepts of thoughts visualized as bubbles and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A Web app supports the delivery of 8 face-to-face sessions, which are synchronized to a native mobile app. SlowMo makes use of personalization, ambient information, and visual metaphors to tailor the appeal, engagement, and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multicentered randomized controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface to optimize its impact in daily life. [Abstract copyright: ©Amy Hardy, Anna Wojdecka, Jonathan West, Ed Matthews, Christopher Golby, Thomas Ward, Natalie D Lopez, Daniel Freeman, Helen Waller, Elizabeth Kuipers, Paul Bebbington, David Fowler, Richard Emsley, Graham Dunn, Philippa Garety. Originally published in JMIR Mental Health (http://mental.jmir.org), 05.12.2018.

SlowMo - digital design to aid therapy for people with paranoid and suspicious thoughts

SlowMo is a digital platform (online tool and smartphone app) used in the cognitive behavioural therapy of people with paranoid and suspicious thoughts. It was developed in intensive user research and co-design with service users and psychologists at King's College, London. It has won the AXA PPP Healthtech & You 'One to Watch' Award 2016