Keywords : Speculative Design, Design Fiction, Service Design, Healthcare Systems, Technological Paradigms, Digital Transformation.

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This work reflects on the challenges of Digital Transformation (DT) in healthcare (HC) organizations; through a model that attempts to combine speculative design and co-design within the framework of Service Design (SD) to draw upon future HC systems.

To clarify the context, we would like to define our main concepts. According to Livework (2021) “Service Design approach helps organizations execute new ideas more effectively address customer expectations, break down silos and create business value”. Second, we understand Digital Transformation in HC as the integration of digital technology into all areas of an organization. Ultimately, Speculative Design “generates futures that act as a catalyst for public debate and discussions” (Dunne & Raby, 2013, pg. 6) and Design Fictions (DF) as “imaginary products and services that situate (...) new developments within everyday material cultures” (Dunne & Raby, 2013, pg. 49).

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Subsequently, we will elaborate on the identified issues. HC innovation is frequently made for people, not with the people (Pau & Hall, 2021); therefore, it lacks a user-centric approach. Instead, economy, workforce and experts agendas remain the drivers of innovation within the HC system (Loy & Haskell, 2018). We believe a patient’s perspective is relevant to define the use of technology, as it would lead to a vast change in the future HC systems.

 

Furthermore, current SD tools fall short to visualizing the experience as a whole (Pasman, 2016) which is extremely relevant as HC organizations are often complex systems. Speculative Design can contribute to this by engaging different stakeholder’s views inside a panoramic perspective through co-created narratives (Lupton, 2017).

 

Finding

Based on our literature review and analysis of Speculative Design and Co-design applied within the healthcare system, we identified different connections that lead us to develop the following model.

 

Co-designing fictions

One of the primary tools that researchers have applied are Speculative Co-design workshops. During those, it was determined that Co-design brings in a range of perspectives, and speculating through DF conceives possibilities for addressing issues that were out of HC experts’ focus (Tsekleves et al., 2019). In a case study of a hospital, it was evident that, during the co-creation of DF, the place transformed into a safe zone for ideation and development of ideas (Reay et al., 2017). Such activities facilitate a common future vision between diverse stakeholders.

 

There are opportunities and benefits in confronting problems through engagement of actors. During a co-design workshop, certain issues in HC derived from the increasing population’s life span (Tsekleves et al., 2017) were clarified by the engagement of older citizens in the co-creation of DF. When integrating the patient’s visions regarding technological futures, the perspective broadens as they become more realistic and grounded.

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Discussion about futures​

These interactions lead to discussions about futures that bear different benefits. For instance, DF is a way to interrogate service innovations (Harwood et al., 2020), because it helps to define system requirements while exploring possible implications of technology. During a workshop, a DF object prompted participants to discuss the significance of euthanasia policies in the UK (Tsekleves et al., 2019).

Speculative Design democratizes these implications (Dunne & Raby, 2013), as it prompts a debate on provocative ideas. This helps to connect and contrast diverse views into a collective future technological scenario.

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Visualizing service complexity

It is often difficult for non-experts to understand future scenarios from the lens of experts. In such situations, DF narratives provide a method for critical evaluation of complex services scenarios in a holistic way (Harwood et al., 2020). It is a way for technology-enabled service innovations to be visualized so that they become recognizable to a wider public.

 

The main purpose of DF narratives is to have the stakeholders participating and starting a dialogue. Diverse disciplinary viewpoints are valuable to provide an integrative perspective of complex issues (Vaajakallio et al., 2013). Therefore, we can state that Speculative Design can be employed as a powerful visualization tool for service innovations.

Service opportunities in new technologies

Design for HC innovation involves a blend of scientific knowledge and practices that require us to explore the opportunities of digital health technologies. They offer potentially valuable solutions for patients, HC providers, community groups and health industries to create and exchange information about health, medicine and care (Reay et al., 2017). Furthermore, digital developments provide opportunities for optimizing hospital resources and time (Lupton, 2017). In fact, DT enables HC organizations to evolve from the clinical aspect, to ones that inspire wellness.

Perspective shift in Healthcare organization

This model could shift the perspective in HC organizations to one that considers the patients as experts of their own experiences, and to perform an active role in their own wellbeing (Tsekleves et al., 2017). It could support the process of extending the HC system reach through new services and technologies; for example, by envisioning primary HC services going from the hospital to their homes (Loy & Haskell, 2018). In other words, enabling HC services to go beyond care, to prevention.

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Discussion

We summarized the findings in a framework, (Fig. 1) which underlines the importance of involving perspectives from diverse fields and engaging stakeholders as an added value for HC institutions, as they could potentially achieve more patient-centered services. For instance, the combination of Speculative and SD tools in workshops (i.e. diegetic prototyping, scenario building, interviews and opportunity mapping) to define service touchpoints.

 

SD and Speculative Design complement each other to bring a multi-layered perspective. Speculative Design could use the ethnographic research aspects of SD to know more about the context in which the design process would be developed. On the other side, we found that Speculative Design might be a way to address the complexity and diversity of HC service innovations.

Based on our findings, we can also state that the model offers a multi-stakeholder vision for DT. For once, it brings both, healthcare workers and patients to the same level, and this exchange from opposite sides of the table might help to identify the gaps from different sides of the system.

 

On the other hand, the integration of new technology in HC organizations implies potential questions such as ethical concerns, cost-effectiveness, and distribution inequality. Through this model, new health care technological environments might be envisioned to address these dilemmas. In other words, foresee transformation to challenge what we know today as medical care.

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Conclusion

Our model proposes a direction for future studies, in which co-design of services and Speculative Design might help to clarify complex issues regarding DT in HC systems. It would potentially bring a macro view on the HC system and its users, because it develops a coherent narrative that visualizes the proposals in a holistic way.

 

This service framework enables future HC scenarios as means for stakeholders to translate their desired ideas into DF, bearing much clearer insights and dialogues about the implementation of technologies. This could facilitate the DT in HC systems by imagining better services involving different actors.

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