SDN Touchpoint Vol. 6 No.

2
Better Outcomes
Outcomes by
by Design
Design
Main Takeaways

CONTENT SUMMARY
Capture User Experiences As they happen
Using smartphones to gain user insights
Humanising Healthcare through hands, heads and hearts
Using Patient Insights to design future health solutions
Collaborating with patients through online communities.
Exciting Times to be in healthcare
Service Design work-out on innovation in healthcare
Health Matters: Reframing Design in Community Health Interventions
5% Design Action: Cancer Screening Service Innovation in Taiwan
Interview: Geke van Dijk and Bas Raijmakers
Better outcomes by design

CAPTURE USER EXPERIENCES AS THEY HAPPEN

Using smartphones to gain user insights
For more information please refer to pages 17-18 of this PDF.

75 %
Smartphone and tablet
penetration has risen to
seventy-five percent in
developed countries, paving the
way for mobile research to
become a serious alternative to
some more traditional methods.

Smartphones allow us to capture

data that is both real-time richer
in content, bringing us closer to
the moments when and where
experiences actually happen.

Whilst mobile research

participants won't give long,
drawn-out responses, it is
possible to keep 'checking in'
and to capture feelings and
behavior over a period of time
weeks, for example as opposed
to more traditional research,
which relies on spending an
hour or two with a respondent,
or an evening at most.

Humanising
Healthcare
through

HH

AANNDDSS
E EAADDSS
EARTS
EARTS

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

HEAD
HEART

HAND
Patients arent just lines in a spreadsheet,
records in a CRM system, or the list of ailments
in their medical records. They are people. And
while lots of healthcare companies are talking
about humanising the healthcare experience,
I get the feeling that theyre not always crystal
clear on what that means.
Kerry Bodine

To develop meaningful relationships and improve medical outcomes,

health service providers need to connect with their patients.
Specifically, they need to touch them at their hands, heads & hearts as follows:
For more information please refer to page 19 of this PDF.

Hands: by using wearable body

monitors that track everything from
miles walked and calories burned to the
quantity and quality of a persons sleep
and so on. To make health-related
wearables a reality, companies have
had to overcome significant technical
challenges like shrinking sensors and
extending battery life. But of course, the
real challenge now comes in developing
useful services that will allow us to
improve our health by taking full
advantage of our quantified selves.

Heads: Healthcare providers should aim to

make every single patient (and payer) interaction
as easy as possible. Good case: Josh Kushner,
founder of venture capital firm Thrive Capital
shared his frustration with the health insurance
space during a recent interview on CNBCs
Squawk Box, a U.S. cable news program.
I opened my insurance bill one day and I realized
that I had absolutely no idea what it meant. Im
educated, I run a growing business, and I didnt
know what my benefits were with doctors or
hospitals I had in my network, how to file a claim
Being the young entrepreneur that he is, Josh
decided to create a new type of health insurance
company from scratch. His goal was to make it
simple, transparent, understandable, and relatable
primarily through technology, data, and design.

Hearts: Medical providers need to

understand their customers underlying
emotional drivers both on the
aggregate and individual levels and
make sure that the patient experience
is aligned appropriately.

HH

AANNDDSS
EEAADDSS
EARTS
EARTS

USING PATIENT INSIGHTS TO DESIGN FUTURE HEALTH SOLUTIONS.

Collaborating with patients through online communities.
For more information please refer to pages 20-21 of this PDF.

Three potential routes for UCB

to facilitatepatient communication:
People with a chronic condition
are increasingly taking active
control of their health, sharing
information about treatments
and finding great support in
their interaction with fellow
patients.

Patients risk becoming isolated

if they fail to be understood by
their peers and loved ones.

Raise public awareness: Patients are not armed to

educate their broader circle of friends and
acquaintances about their condition and its impact.

Trigger communication planning: The excuse for

not engaging in the conversation about their
condition is often the lack of opportunity or that they
never planned to talk about it.

Chronic patients participating

in online communities become
more knowledgeable, feel
better supported socially and
more empowered
Articulate their status and talk to others.

EXCITING TIMES TO BE IN HEALTHCARE

For more information please refer to page 22 of this PDF.

Across the world, there is a realization and

understanding that existing healthcare systems
will not deliver what the future requires.

The World Economic Forum estimated that,

unless current trends reverse, chronic diseases
will cost the world $47 trillion in treatments and
lost wages by 2030.

At a time when healthcare finances are so constrained whilst

demands are increasing, the need to design more effective
solutions is self evident. Healthcare providers seem to face clear
choices: they can work towards containing healthcare spending by
restricting services, or request often-overworked staff to work even
harder. Alternatively, of course, they can seek to think differently
about the way they deliver their services using available resources
and design fundamentally different service innovations. But not
only is this harder to do, it also brings more risk than working with
existing process parameters because whole-service innovations are
more complex and likely to question existing organizational
boundaries, or to challenge current healthcare management.

EXCITING TIMES TO BE IN HEALTHCARE

For more information please refer to page 22 of this PDF.

Rather than viewing future predictions as overwhelming obstacles, healthcare

leaders and entrepreneurs are starting to see a landscape full of opportunities by
focusing on some emerging healthcare themes:

Empowered patients:
Equipped with more
knowledge about their
conditions and lifestyles,
citizens are starting to take a
key role in determining when
they interact with the
healthcare system and how
their care is delivered. New
services are emerging to help
empower patients with
technology and to provide
access to social communities
and peer-to-peer advice before
visiting a professional.

Nudging behaviors:

More joined-up care:

Digital platforms have evolved to
facilitate communication
between doctors, patients and
staff, ensuring that patient
records and treatment plans are
readily accessible and cutting
down internal inefficiencies.

New tools and incentives are

being designed to improve
decision making about personal
healthcare and treatment
options by promoting more
proactive models of health and
by helping people better track
and understand their
day-to-day behaviors.

SERVICE DESIGN WORK-OUT ON INNOVATION IN HEALTHCARE

For more information please refer to page 23 of this PDF.

An increasing number of people now

turn to the internet first to look up
their symptoms and then decide
whether or not to consult a
specialist, or to question a given
expert diagnosis.

Sharing personal experiences

between patients who have
similar diseases would enable
the exchange of tips and tricks
and help them to cope better
with a disease.

Take patients seriously.

Taking patients seriously entails

helping them to better understand
the complexity of their situation. For
instance, by making the costs of care
more transparent, and giving
patients the opportunity to better
compare different care providers,
patients can decide for themselves
what they find most important and
want to pay for.

SERVICE DESIGN WORK-OUT ON INNOVATION IN HEALTHCARE

For more information please refer to page 23 of this PDF.

BILL

Shifting the mindset of medical

staff from patients to
consumers is needed for the
high quality care the medical
professional should aim for.

Cutting costs does not

necessarily have to lead to a
lower level of service or a
decline in the patient
experience. The big
challenge for healthcare is to
become more efficient and, at
the same time, improve the
patient experience.

If hospitals differentiate their

service level to specific target
groups, This would give the
healthcare consumer more
freedom of choice, while the
hospital would be able to
manage their revenues and
margins more effectively.

SERVICE DESIGN WORK-OUT ON INNOVATION IN HEALTHCARE

For more information please refer to page 23 of this PDF.

PATIENT

One way of improving the service level

without extra costs would be to better
align specialists, based on a more
integrated patient approach. This could
lead to both an improved experience for
the patient and a smoother internal
process. Patients could also be given
better information and guidance
beforehand, so that they better know
what to expect. This would create a
better flow and experience during their
healthcare process.

PATIENT

EXPERT

Hospitals could, for instance, involve

previous patients as volunteer
experience experts to better prepare
the new patients. The new patients
would get more attention than currently,
which could lead to less stress, a
smoother care process, and an improved
experience at the same time.

HEALTH MATTERS: REFRAMING DESIGN IN COMMUNITY

HEALTH INTERVENTIONS
For more information please refer to pages 24-26 of this PDF.

obesity

s
e
t
e
b
a
i
d
!!

t
n
e
l
e
c
ex

Individuals with
chronic health
problems obesity,
diabetes, problems with
mobility would often
rate their health as
very good or even
excellent, exposing
the insufficiency of our
own understanding of
what health means to
this group.

When designing health

interventions, the
patients voice should
be part of the design
development.

5% DESIGN ACTION:
CANCER SCREENING SERVICE INNOVATION IN TAIWAN
For more information please refer to pages 27-29 of this PDF.
13
8,2

The World Health

Organization has
predicted that in the next
two decades, the number
of global cancer patients
will rise by as much as
fifty-seven percent. Deaths
caused by cancer will also
rise from 8.2 million to 13
million per year.

To increase the cure rate

and reduce the cost of
cancer treatment, Taiwan
has begun the provision
of free-of-charge
screenings for oral
cancer, breast cancer,
colorectal cancer and
cervical cancer.

In fact, more than fifty

percent of cancers could
be prevented or diagnosed
earlier if people led
healthy lifestyles and
received regular cancer
screenings

5% Design Action was

able to determine
reasons behind peoples
decisions not to get
cancer screenings,
including the feeling that
they were too healthy, too
busy, too embarrassed or
too old to get one.

Interview: Geke van Dijk and Bas Raijmakers

For more information please refer to page 30 of this PDF.

,, When you aim to change how

governments engage with citizens
and other stakeholders in policy
development, or if you want to
develop a service in a traditional
product-oriented company,
organizational change is needed
and that wont be achieved with a
single project. It needs longer
partnerships that result in change
on an organizational level.

BETTER OUTCOMES BY DESIGN

The physician should not treat
the disease but the patient who
is suffering from it
Maimonides (12th century
scholar and physician)

Translating the human-centered

nature of service design into a
patient-centered focus for
healthcare and wellbeing is
happening worldwide.

REFERENCES

Capture User Experiences as

They Happen
Using smartphones to gain user insights

The advent of mobile research provides radical new opportunities

in the field of user research. Smartphones allow us to capture data
that is both real-time richer in content, bringing us closer to the
moments when and where experiences actually happen. While
some organisations have been active in the field of mobile research
for several years, it is still not being implemented across the
mainstream. However, smartphone and tablet penetration has
risen to seventy-five percent in developed countries, paving the
way for mobile research to become a serious alternative to some
more traditional methods.
Mobile research
advantages:

offers

several

Whenever, wherever: users wake

up and go to bed with their smartphones giving us constant access
to their daily lives, anywhere they
go, at any time.
Rich data: smartphones allow us
to collect all kinds of data like
video, audio, photos, quotes and
images, reflecting the diversity of
the users life.
In-situ data collection: capturing
the defining (true) moments as
they happen, instead of hazy
memories after the fact.

Metadata: smartphones automaticallyprovide us with valuable

metadata such as time, duration
and GPS locations. This combination of users active and passive
feedback (data and metadata,
respectively) blurs the traditional
line between qualitative and quantitative data.
Real-time monitoring: progress is
monitored in real-time, allowing a
leaner and more dynamic process
the learning comes faster.
The nature of smartphones means
that they are currently best suited
for capturing bite-sized responses,
instead of extensive, detailed feedback: users are not likely to engage
for more than a few minutes at a

time. Whilst mobile researchparticipants wont give long, drawn-out

responses, it is possible to keep
checking inand to capture feelings
and behaviour over a period of time
weeks, for example as opposed
to more traditional research, which
relies on spending an hour or two
with a respondent, or an evening at
most.While mobile research is still
in its infancy, new functionalities
will open up new opportunities and
applications in the future. The question is: where does its application
harness the best results? To date,
we have found that our mobile
research platform, Contextmapptm,
yields excellent results in the
following three types of user
research.
Mobile diary studies
Use it as a sensitiser, or as a
stand-alone explorative study to
capture behaviour over extended
periods (e.g. the course of a week)
and uncover the ebb and flow of
user needs.
Customer journey research
Let people map their experiences
and gain direct insight into their
needs throughout the customer
journey; discover how they experience a brands
touchpoints.
Explorative product and service
research
Zoom in on people while they are
preparing a meal, consuming media

or installing a digital television set.

Get a detailed impression of their
lives using photo and video, all the
while saving time by not having to
actually be with the respondent.

A practical look at
ContextmappTM
The work that we have done for
Philips Kitchen Appliances nicely
brings to life the benefits of using
mobile technology. The goal of the
research was to find out which
kitchen appliances people were
using: which ones they liked best;
why they preferred these; how they
were using them; and the overall
context in which they used them. In
pursuit of this, a group of people
were asked to participate in a
mobile diary study, over the course
of a week. With studies like this we
usually invite between fifteen and
thirty people. It is not a hard and
fast rule, but we find that this
sweet spot allows enough insight
to bring some robustness, without
beginning to be overwhelmed by
the volume of data. However, in this
particular case, we built a landing
page and asked, via Philips Twitter
account, for people to join, which led
to forty-five completed diaries. The
research was prepared using the
Contextmapptm dashboard. Our
dashboard enables one to easily
setup research projects by creating
several assignments. These assignments consist of a set of questions:
open, multiple choice, multiple
image (e.g. a set of emoticons) or
ratings/sliers and photo, audio or
video tasks. Depending on the type

of assignment being created, types

of question can be chosen, as well
as the statement to be reviewed. In
the case of Philips, we posed suggestions like: Take a picture of the
ingredients of your meal and asked
them questionssuch as: What
kitchen appliances do you like best
and why? Automated push notifications
helped
respondents
remember to complete assignments
at the right moment.
As soon as the project was live,
users were asked to complete
assignments on their smartphones.
Participants could choose the order
of assignment in the way that
suited them best. Results were
uploaded immediately, allowing
both us and the client to have
real-time monitoring of progress. In
other, more linear, projects, we could
set a particular order of assignments or it could be a set of repeatable assignments, allowing for
self-reporting.
As soon as the first participants
finished, the hunt for interesting
insights started! The online dashboard gives two options: Export
Data, which results in a downloadable Excel and folder with media
files, or Visualise Data, which
offers three choices:
A chronological timeline, where
all results are plotted.
It is a visual representation of the
journey of the participant, which
we call experience storyboards,
enabling a dive deep into one persons story
A selection of results, which can

be made in any format. Questions

are chosen and the results are
visualised for all participants,
which makes it easy to compare
differences between participants
Search for results, enabling one
to find all results that contain a
certain keyword, like blender or
irritating
The research Philips conducted
helped them to create a segmentation based on cooking behaviour
and pinpointed particular needs
and problems, per segment. The
team from Philips was particularly
excited about the richness of the
data. As the client said: It was good
to not only get the answer, Im cooking pasta, but to also be able to see
what kind of pasta it was, whether
or not the person cut the vegetables
themselves, the kitchen they were
preparing it in, and so on. We got
answers to questions we didnt
ask! Six mobile research principles Along with Phillips, we have
conducted many similar projects
and, in doing so, learned a great
deal. Based on our experiences,
here are six research principles:
simple guidelines that help you
set-up your project, should you be
interested in doing so.

1. Make it fun!
Using
visuals,
gamification
elements and a light tone of voice
helps to enhance the experience
and thus engagement of the participants: creating a place where they
can be creative helps to get more
out of them.

2. Fit around the users life

Try to anticipate and understand
how the research fits into the life of
the user; smart usage of push notifications and timely reminders can
help people remember to participate in a way that is also convenient
for them.

3. Improve and test

Always conduct the research
upfront yourself. Youll find that
some questions and assignments
are best asked differently. Iterate,
then iterate again.

4. Ask ambiguous
questions
Ambiguous questions allow your
participants to fill in the assignment
as they see fit. This way, you will get
the answers that really matter to
them, as opposed to steering their
answers in a certain direction.

5. Monitor progress

behaviour, it inspires during

ideation and concept development
and it convinces clients, because
they can literally see what is going
on. Altogether, mobile research is
an area in rapid development,
where a lot of (technical) innovation
is still to be expected. Think about
text mining, smart algorithms, automatic face and image recognition,
integration of iBeacons, co-research and automatic data processing and visualisation. And we havent even mentioned wearables,
such as Google Glass.
Were entering an exciting new
time, where we dont think of
people as simply consumers, but as
collaborators in the design process.
We have built our mobile tool with
that philosophy at its centre. And
although were not fully there yet,
we have learned a lot and keep
learning more every day. And
improving. And learning. And
improving. Were interested in
getting in touch with other agencies that want to share or gain
experience with mobile research.

See who is on track and help slower

respondents if needed. This is far
better than a cultural-probe exercise being completed just before the
actual interview takes place, as we
have sometimes experienced using
traditional methods.

6. Visualise results
Use the rich data that you have
gathered. It helps you during analysis to understand needs and

Robbert-Jan van Oeveren

Humanising
Healthcare
through

HH

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EARTS
EARTS

The following should not be news to you, but its sometimes easy to
forget: Patients arent just lines ina spreadsheet, records in a CRM
system, or the list ofailments in their medical records. They are
people. Andwhile lots of healthcare companies are talking about
humanising the healthcare experience, I get the feeling that
theyre not always crystal clear on what that means.
To develop meaningful relationships
and improve medical outcomes, health
service providers need to connect with
their patients. Specifically, they need to
touch them at three key body parts.
(Dont worry. This doesnt require a
physical exam, and it wont be awkward at all.)

Hands
With four long fingers and nifty opposable thumbs, our hands help us do
things. As healthcare consumers, we all
have things that were trying to do
when we visit a particular provider
like fixing a chipped tooth, filling a
prescription, or filing an insurance
claim. Healthcare companies help us
accomplish these goals (or perhaps you
prefer to call them tasks or jobs to be
done) by developing useful services
and getting them into our hands. Wearable body monitors represent a major
advancement in this area. Up until
recently, weve had limited ability to

continuously monitor whats happening in our bodies. In 2004, I worked for

BodyMedia, the maker of one of the
first wearable body monitors on the
market. Today, a host of companies like
Jawbone (which acquired BodyMedia
last year), Nike, and Fitbit market
wearable devices that track everything
from miles walked and calories burned
to the quantity and quality of a persons
sleep. To make health-related wearables a reality, companies have had to
overcome significant technical challenges like shrinking sensors and
extending battery life. But of course,
the real challenge now comes in developing useful services that will allow us
to improve our health by taking full
advantage of our quantified selves.

Its our heads that help us navigate

health insurance websites and fill out
intake forms at the doctors office.
These experiences shouldnt make our
heads hurt. Healthcare providers
should aim to make every single patient
(and payer) interaction as easy as possible. Josh Kushner, founder of venture
capital firm Thrive Capital shared his
frustration with the health insurance
space during a recent interview on
CNBCs Squawk Box, a U.S. cable news
program. I opened my insurance bill
one day and I realised that I had absolutely no idea what it meant. Im educated, I run a growing business, and I
didnt know what my benefits were
with doctors or hospitals I had in my
network, how to file a claim Being the
young entrepreneur that he is, Josh
decided to create a new type of health
insurance company from scratch. His
goal was to make it simple, transparent,
understandable, and relatable primarily
through technology, data, and design.
The result is Oscar, a New York
City-based startup with more than
40,000 physicians in its network. The
Oscar website includes a robust provider search that includes physician fees
and patient reviews; an online quoting
tool that enables prospective customers
to fill in their marital status, number of
kids, income, and zip code in a quick
and easy Mad Libs format; a Facebook-like timeline of the subscribers
medical history; and, of course, clear
billing information thats aggregated
per visit.

Heads

Hearts

The head is the seat of our cognitive

faculties and information processing
functions like perception, recognition,
and memory recall.

The heart is our metaphorical emotional

core. And although we might try to deny
this, its impossible to disconnect our
functional needs from our emotional

ones. This is obvious when were looking at a patient whos going through
chemotherapy or a woman whos
giving birth to her first son but its
equally true when were just trying to
eat a healthy take-out meal or join a
gym. And dont forget that we bring our
emotions with us when we go to work,
so businessto- business healthcare
companies arent off the hook in this
area! Medical providers need to understand their customers underlying
emotional drivers both on the aggregate and individual levels and make
sure that the patient experience is
aligned
appropriately.
To
help
childrens medical imaging go from
terrifying to terrific, GE Healthcare
created its Adventure Series, a set of
decals that turns CT scanners, MRI
machines, and entire imaging rooms
into a pirate ships, jungles, and coral
reefs. Similarly, my own dentist in San
Francisco has placed flat screen monitors on the ceiling and plays comedy
shows during exams to help patients of
all ages refocus their attention and
reduce their anxiety about their dental
procedures.

Kerrys Take
At its essence, humanising the healthcare experience means remembering
that patients are human and
connecting with patients hands, heads,
and hearts is a critical step towards
this goal. But the three Hs of customer
anatomy are equally valuable for any
service designer in any industry. So
keep them with you as youre working
today and ask: Will this decision or
action connect us with our customers
hands, heads, and hearts?

Kerry Bodine

Using Patient Insights to

Design Future Health Solutions
Collaborating with patients through online communities

The challenges of living with a chronic disease

Today, patients have more information than ever before about their
diseases and treatment options. Think about the wealth of data on
the online community PatientsLikeMe, where more than 220,000
patients share their stories about over 2,000 conditions and
Patient.co.uk, which has 16 million visits each month. Patient
empowerment is one of the main trends in todays digitalised
healthcare landscape. People with a chronic condition are
increasingly taking active control of their health, sharing
information about treatments and finding great support in their
interaction with fellow patients.
But while large numbers of
patients connect with distant
fellow sufferers via online communities, they often have a
harder time communicating
about their disease in their
immediate environment: with
family, friends, neighbours or
colleagues. Those close to them
do not always seem to understand them as well as fellow
patients do, leaving them at
times feeling powerless, rather
than empowered. The problem is
that many symptoms such as
fatigue and depression and
their impact are hard to explain.
Patients struggle to communi-

cate these less-tangible problems to the people closest to

them, causing physical and emotional distress. Living with a
chronic illness, for example
rheuma toid arthritis (RA), can
take its toll on the patients wellbeing and personal relationships. To overcome communication challenges in relation to
these significant others and to
avoid social isolation, InSites
Consulting and UCB, a biopharmaceutical company focused on
chronic diseases, created a
research community for patients
diagnosed with a chronic condition. The goal was to identify

opportunities for patient solutions that help them improve

their ability to communicate
about their illness to their loved
ones and others who they socialise with.

Empowering patients in an
online community
We invited fifty US participants
with chronic health conditions,
more specifically RA (62%) and
epilepsy (38%). A three-week
online research community was
the backbone of this patient
research project. The objectives
of the community were to
connect participants from all
over the country on an online
closed platform
enable participation in a flexible asynchronous way to maximally accommodate patients
abilities and
allow participants to share
their stories and exchange tips
and tricks in an inspiring learning environment
The community research project
started with patient immersion,
a one-week online ethnographic
multimedia
module
where
patients shared their personal
stories with the moderator in a
private forum. In the second
week, the participants were
invited to connect with peers
who were suffering from the
same research is merely the
starting point in tackling a big

problem for patients dealing

with a chronic disease, it can
inspire the health industry to
take patient-support services
forward. Why is it relevant to
service design? This study illustrates the huge potential of
patient collaboration for the
health industry to co-create relevant patient chronic condition, to
discuss common grounds and
shared needs in an online discussion forum. In the last week,
we invited all participants
together (across therapy areas)
for the patient brainstorm discussions, to ideate about potential patient communication support services for the future. This
gradual
approach
helped
patients to open up to the moderator and to each other, resulting
in 2,552 posts and 367 photos
and video testimonials. Furthermore, the community approach
helped to bring new insight to
the table and bring down the
silo thinking of the different
departments involved within the
organisation. Carl Vandeloo from
UCB explains:
It was very interesting to allow
patients with epilepsy and RA
to communicate with each other,
as patients struggle to express
themselves in both disease
areas. This was a great way to
group the UCB teams of different
areas to think about solutions
serving more than one patient
group.

Three roads towards

improved communication
The research confirmed that
patients risk becoming isolated
if they fail to be understood by
their peers and loved ones.
Patients participating in the
research brought up three
potential routes for UCB to facilitate patient communication. The
first and most important route
according to patients is to raise
public awareness. Patients are
not armed to educate their
broader circle of friends and
acquaintances about their condition and its impact. Examples of
how to raise public awareness
include more general public
campaigns about their condition
or simple instruction sheets
explaining to outsiders which
critical incidents may occur.
Patients would benefit greatly
from the public having an
increased knowledge about
their condition. They would
experience it less as a stigma
and would not need to explain
things that are self evident. The
second route is to trigger communication planning about their
condition with their significant
others. The excuse for not
engaging in the conversation
about their condition is often the
lack of opportunity or that they
never planned to talk about it.
Patients do not even realise that
their significant others others

cannot read minds and that they

need to integrate routines for
discussion into their lives. A systematic self-reflection by the
patient can be of great help, such
as a diary to keep ones finger on
the pulse of ones status and current services. First of all, chronic
patients participating in online
communities
become
more
knowledgeable, feel better supported socially and more empowered. Second, the results
present new opportunities for
health care providers such as
UCB to improve the patient
experience, for caregivers and
for patients living with a chronic
disease.needs.
It
stimulates
talking about the condition,
avoiding frustration or even
isolation. The third route is to
support
patient
expression.
Patients who have a difficult
time expressing their thoughts
and feelings about their disease
should have tools that facilitate
communication,
particularly
when they need practical support or emotional relief. The community members made us realise that many patients are in
need of simple status expression
aids. For example, refrigerator
mood magnets are a tool that can
enable patients to express their
status, both in terms of how they
are feeling and for rating the
physical burden.

Three potential routes

for UCB to facilitate
patient communication:

Raise awareness

Trigger planning

Support expresion

These 3 routes could help

patients better reflect on their
feeling, articulate their status
and talk to others. While this services. First of all, chronic patients
participating in online communities become more knowledgeable, feel better supported socially and more empowered. Second,
the results present new opportunities for health care providers
such as UCB to improve the
patient experience, for caregivers and for patients living with a
chronic disease.

My husband said to me,

Honey, I love you, but if you
dont tell me how youre
feeling how am I supposed
to know how I can help
you? I cant read your
mind. He was so right. I
had to trust him enough to
confide in him when I expected him to be there to
support me. RA patient

...

Anouk Willems
Magali Geens

Exciting Times to be in
Healthcare
Across the world, there is a realisation and understanding that existing healthcare systems will not deliverwhat the future requires. The World Economic
Forum estimated that, unless current trends reverse, chronic diseases will cost
the world $ 47 trillion in treatments and lost wages by 2030.1
At a time when healthcare finances
areso constrained whilst demands are
increasing, the need to design more
effective solutions is self evident.
Healthcare providers seem to face clear
choices: they can work towards
containing healthcare spending by
restricting
services,
or
request
often-overworked staff to work even
harder. Alternatively, of course, they
can seek to think differently about the
way they deliver their services using
available resources and design fundamentally different service innovations.
But not only is this harder to do, it also
brings more risk than working with
existing process parameters because
whole-service innovations are more
complex and likely to question existing
organisational boundaries, or to challenge current healthcare management.
This, lets face it, is a scary prospect for
some. And yet, we know that simply
removing unwanted variation and non
value-added activities from existing
healthcare processes wont deliver the
more significant quality and productivity gains we need. While the economic
realities of current healthcare models
tell a different story, we are starting to
see compelling signs of change against
some of the unsettling healthcare challenges. The NHS responded by creating its own Change Day and School for
Health and Care Radicals, two frontlineled movements designed to inspire

and mobilise staff, patients and the

public to collaboratively improve health
and care.2 Despite slow governance
processes, a multitude of health,
lifestyle, wellness and social tools are
also being developed for the healthcare
industry. As designers, in this context
we are presented with a great chance
to help healthcare leaders create and
embrace new service innovations and
develop services that are poised to
improve health outcomes in the long
run. Rather than viewing future
predictions as overwhelming obstacles,
healthcare leaders and entrepreneurs
are starting to see a landscape full of
opportunities by focusing on some
emerging healthcare themes:3
Empowered patients
Equipped with more knowledge about
their conditions and lifestyles, citizens
are starting to take a key role in determining when they interact with the
healthcare system and how their care
is delivered. New services are emerging to help empower patients with
technology and to provide access to
social communities and peer-to-peer
advice before visiting a professional.
As a result, patients will be better
prepared to communicate with their
doctors during consultations to ensure
optimal health outcomes and treatment
plans.
The Healthtap4 start-up offers an

online service that lets you instantly

connect with a clinician via the net and
ask personalised touchpoint 6-2 51
better outcomes by design medical
questions to help diagnose common
conditions professionally and quickly. It
is reported that more than 7 million
people visit the site each month, trading
questions and answers with a pool of
about 46,000 doctors.
More joined-up care
Healthcare providers are starting to use
new technologies, social platforms and
data systems to streamline the way
information is spread across organisations to deliver a more personal and
consistent model of care. Secure online
platforms are offering new ways for
doctors to share research and advice
about conditions that fall outside of
their expertise, while analytics tools
interpret patient data to support diagnosis. Digital platforms have evolved to
facilitate
communication
between
doctors, patients and staff, ensuring
that patient records and treatment
plans are readily accessible and cutting
down internal inefficiencies.
The NHS Hack Day5 aims to understand some alternative models for
procurement within health technology
and brings together healthcare and
technology professionals to improve
NHS IT. Patients Know Best6 lets
patients and clinicians easily access
medical records that would typically be
trapped in siloed IT systems. It gives
patients anytime access to their medical
records and to doctors who may be
located across the world, and can, for
instance, interpret blood tests remotely.
Nu dging behaviours
New tools and incentives are being
designed to improve decision making
about personal healthcare and treatment options by promoting more proactive models of health and by helping
people better track and understand
their day-to-day behaviours. Mobile

technologies provide deeper insights

and individualised coaching to activate
users around wellness and exercise.
New feedback loops often encourage
users to make small behavioural
changes over time. Early outcomes
show healthier citizens less reliant on
public resources. Sherpaa7 provides
patients and businesses with 24/7
access to doctors over the internet to
stem rising healthcare costs and to
provide more personalised patient care.
Online consultations are designed to
resolve health concerns quickly and
conveniently, whilst companies' healthcare spending is analysed to suggest
ways to save money, boost benefits and
to expand coverage to more employees.
Across the globe, we can see early
adopters acknowledging some of the
emerging healthcare themes and
creating alternative services that have
the potential to make the wider system
more resourceful. This presents an
exciting new paradigm and framework
for designers to work within too, where
healthcare is seen as an ongoing
conversation between people, rather
than something that happens when
someone falls ill
References
http://www.wef rum.org
/news/non-communicablediseasescost-47-trilion-2030-new-study-relea
sedtoday
2
http://changeday.nahs.uk and
https://changeday.nhs.uk/healthcarer
adicals
3
http://www.psfk.com/publishing/futu
re-of-health-2014
4
https://www.healthtap.com
5
http://nhshackday.com
6
http://www.patientsknowbest.com
7
https://sherpaa.com
1

Julia Schaeper

Service Design Work-out on

Innovation in Health Care

In April 2014, the Dutch chapter of the Service Design Network

organised the 6th Service Design Work-out. Around thirty
participants from various backgrounds came together to discuss
the added value service design can bring to the healthcare sector.
The session kicked off with a presentation by Jiska de Wit,
innovation manager at the UMC (Utrecht Medical Center). She
discussed the trends and issues the care sector currently faces.
After a brief Q&A, the participants worked in groups on tackling
the three questions below. This article summarises some of the
outcomes of these discussions.
How to better support increasingly
demanding care consumers? While
adecade ago it was still obvious to first
turn to a specialist in case of medical
problems, patient routines have gradually changed. An increasing number of
people now turn to the internet first to
look up their symptoms and then
decide whether or not to consult a
special- ist, or to question a given
expert diagnosis. As a result, the interaction with the medical professional
has changed. How to deal with this
trend? And how can this be turned into
an advantage for better services?
Taking the patient seriously is at the
core of answering this trend. Shifting
the mindset of medical staff from
patients to consumers is needed for
the high quality care the medical
professional should aim for. A service
design approach can support this, for
instance by identifying different type of
patients, and indicating the different
ways one can interact with them.
Taking patients seriously also entails
helping them to better understand the
complexity of their situation. For
instance, by making the costs of care
more transparent, and giving patients
the opportunity to better compare
different care providers, patients can
decide for themselves what they find
most important and want to pay for.
Further thought should also be given

on how to use this trend as an advantage. What type of information would

be most useful to provide to patients?
Sharing personal experiences between
patients who have similar diseases
would enable the exchange of tips and
tricks and help them to cope better
with a disease. Also, providing high
quality information on what is good,
and why, could be useful for prevention
purposes. Related to this is the idea of
the quantified self: by developing a
better understanding of your own body
and behaviour, behaviour change can
be triggered in a positive way. In
return, this data for research purposes
can be very interesting for the medical
professionals.

Can a hospital improve its

service level despite the need to
cut costs?
The first remark made here was that
cutting costs does not necessarily have
to lead to a lower level of service or a
decline in the patient experience. The
big challenge for healthcare is to
become more efficient and, at the same
time, improve the patient experience.
Could hospitals differentiate their
service level to specific target groups?
This would give the healthcare
consumer more freedom of choice,

while the hospital would be able to

manage their revenues and margins
more effectively. The group questioned
if this airline-type of service segmentation approach could be translated to
healthcare, while safeguarding sensitivity to ethical issues. Another way of
improving the service level without
extra costs would be to better align
specialists, based on a more integrated
patient approach. This could lead to
both an improved experience for the
patient and a smoother internal process.
Patients could also be given better
information and guidance beforehand,
so that they better know what to expect.
This would create a better flowand
experience during their healthcare
process. Hospitals could, for instance,
involve previous patients as volunteer
experience experts to better prepare
the new patients. The new patients
would get more attention than currently,
which could lead to less stress, a
smoother care process, and an
improved experience at the same time.
How can service design thrive in a
health care sector that is dominated by
a focus on eff iciency and measuring
effects? Instead of opposing the
efficiency and evidence-focused management approach, it seems more effective to explain that service design is
actually valuable in a complementary
way. In many sectors, efficiency control
and experimentation are equally
important to safeguard continuity and
innovation. It would definitely help
service designers to develop a useful
metaphor to explain the value of service
design in terms that resonate with management aspirations. For instance, how
does a five-star restaurant innovate?
Building up a portfolio of best practices
from projects in other organisations and
sectors is also a useful way to convince
stakeholders in management. These
references show how service design
contributes to effective change and
innovation. This evidence from parallel
fields gains ambassadors in the organisation permission to experiment on
pilot projects and to demonstrate their
value.These ambassadors can be found
on any level in the organisation. They
are willing to try things out and showcase the results to their colleagues.
Service designers should help them to
show the added value of service design.
Creating visual evidence from all stages

in the project to illustrate how service

design contributes to real change. As
the management team does not have
the direct experience on the ground,
they rely on this type of evidence. Make
sure the ambassadors can tell the story,
it will have a stronger impact when
they tell the story. Attention should also
be given to actively creating opportunities to measure the success of the
service design project from the start.
This issue should be addressed early
to be able to integrate ways to measure
the value of the results. This could be
increased customer satisfaction, but it
might also be a new type of key performance indicator (KPI). In health care,
and specially in academic hospitals, it
seems that being the best in class or
the first to do something, is very
important. service designers should
thus also look for aspects that will help
hospitals be the best or first in something.

Conclusion
In a plenary wrap-up to the session, we
shared the results from the various
group discussion and reflected with
Jiska how this could contribute to her
daily work in the UMC. She mentioned
that the discussions really inspired
her: it was good to be amongst
service designers again. She also
seemed very fired up by the last
discussion and indicated that it would
really help if service designers were
able to find a way to the connect the
efficiency and measuring culture of
hospitals, thereby lowering the threshold of experimenting with it. The objective of the Service Design Work-outs is
to offer an opportunity for people working in service organisations to present
some of the issues they face in their
work and ask the service design community to think along with them. The
informal setting enables the members
from the network to mingle and share
their thoughts. We tend to focus on
unusual suspects for service design,
meaning those organisations that
currently do not yet hire service
designers for projects, but who might if
they knew better what it was and what
they may get.

Julia Schaeper

Health Matters: Service

Design in Community Health
Interventions
Garden on the Go is an obesity-prevention effort initiated by
Indiana University Health. This year-round, mobile,
producedelivery program provides fresh, affordable vegetables
and fruit to Indianapolis neighbourhoods in need. In 2013, design
researchers from the Herron School of Art and Design, Garden on
the Go leadership from IU Health and scientists from the
Fairbanks School of Public Health (FSPH) at Indiana University
initiated the Health Matters study. Health Matters aims to
understand how individuals in underserved urban communities
define health in order to make health interventions more relevant
to community health perceptions. This paper, specifically focusing
on an interdisciplinary academic research process, will discuss
the challenges and roles of designers in integrating their
disciplinary practice into health care interventions.
What does health mean to YOU?
The objective of Health Matters is to
identify new, people-centred definitions of health. We know that health
perceptions affect self-care: in other
words, if you think youre healthy when
you actually arent, you wont pay attention to your health. Biometric readings
such as weight and blood pressure are
clinical measurements that dont reflect
peoples perception of being healthy
from individual perspectives. How
might we make these measures meaningful to people to motivate them to
improve their health? What other measures are relevant to health perceptions and how might we learn what

they are? From a service design course

came an interdisciplinary partnership
In 2012, we developed a project in the
course entitled People Centred Service
Experience Design in which we partnered with Garden on the Go to
conduct a customer survey to learn
about customers and their needs.
Instead of pursuing a conventional
survey method, we applied service
design methods such as a customer
journey map1 and personas2 that
provided Garden on the Go leadership
with a comprehensive description of
the people who use their service.
Garden on the Go conducted a health
assessment survey with the Richard

M. Fairbanks School of Public Health

the previous year to see if and how the
program impacted health through various biometric measures (weight, blood
pressure, etc.) The study revealed that
the traditional methods of collecting
qualitative information in health
assessment were inadequate for comprehensive health measurement in
underserved urban populations, and
provided limited information. The team
noted that individuals with chronic
health problems obesity, diabetes,
problems with mobility would often
rate their health as very good or even
excellent, exposing the insufficiency
of our own understanding of what
health means to this group. Having seen
our participatory approach to customer
research, Garden on the Go and the
researchers from FSPH saw the potential of service design methods to help
better understand their population and
proposed to develop a collaborative
research project between the Herron
School of Art and Design, Fairbanks
School of Public Health and IU Health.

Working together: designers, public health scholars,

and service providers
Since the project launched in 2013,
Herron has served as the primary
research conveners and has taken the
lead in developing research methods,
gathering data and data analysis. As of
June 2014, the study is concluding its
data collection phase. At the completion
of the study, Herron will be responsible
for disseminating study findings back
to the communities involved. The FSPH
partners, based on their community
based research practice in the public
health context, have provided consultation and assistance in aligning service
design
practice
with
academic

research process and protocols. They

will also collaborate with the design
researchers in preparing the reports,
abstracts and manuscripts to disseminate findings to the academic community. IU Health has provided logistical
support and access to Garden on the
Go customers. Additionally, IU Health
will assist in sharing the research fin
ings with the community when the
project is completed.

Three different, but shared,

aims
Often, health promotion intervention
programs are developed and implemented for target populations by public
health professionals who possess
validated, yet incomplete, understandings of the people they are trying to
serve. When designing health interventions, the patients voice should be
part of the design development.3 When
this inclusion does not happen, the
programs are not as effective as they
could be or, worse yet, may be rejected
out of hand. The findings of our study
aim to improve understanding of the
culture of our target population
Garden on the Go customers with
regard to their perceptions of health
and what they perceive to be a healthy
diet. Under this overall study objective,
each project partner has defined a
specific goal. The IU Health Garden on
the Go aims to gain a better understanding of what fruits and vegetables
would be attractive to their customers
as well as how to assist them in the
selection, preparation, and presentation
of fresh fruit and vegetables as part of
a healthy diet for their families and
themselves. They are also interested to
know how they might improve their
service overall, and expand their
On-the-Go model to other programs that

would be relevant to their customers.

The Richard M. Fairbanks School of
Public Health aims to develop new,
relevant and patient-centred measures
for health, in alignment with currentresearch agendas seeking patient
centred outcomes. The service design
researchers at the Herron School of Art
and Design aim to establish a collaborative research model by providing relevant design methodology for rich data
collection and deep analysis, connecting patients and healthcare providers/
researchers by co-designing for
healthcare outcomes. measures for
health, in alignment with current
research agendas seeking patient
centred outcomes. The service design
researchers at the Herron School of Art
and Design aim to establish a collaborative research model by providing relevant design methodology for rich data
collection and deep analysis, connecting patients and healthcare providers/
researchers by co-designing for
healthcare outcomes.

Design research in academic partnerships: new territory for designers

The main purpose of this article is to
share our experiences and challenges
as designers in interdisciplinary
academic research settings, and to
address how we can integrate our
disciplinary practice into health care
interventions as equal collaborators
with research partners. Our research
process consists of six stages: pre-research, research design, recruitment,
data collection, analysis and dissemin
tion. The project is currently concluding the data collection stage and we
expect to reach the dissemination
stage in the fall of 2014.

Pre-research: An articulation of ethical practice in

research
Academic research goes through a
pre-research phase in order to ensure
that studies are ethically sound. The
institutional review board (IRB) also
known as an independent ethics committee or ethical review board
receives research proposals involving
human subjects and reviews and monitors biomedical and behavioural studies to protect the safety and rights of
participants. IRB approval is required
for all such research undertaken at the
University. Current IRB review is
designed for specific disciplines such
as medical or social science research
and is not optimally designed for
design research practice. The vocabulary and overall framework of the IRB
approval process emphasises ethical
codes of medical research, including
those relating to invasive procedures
(such as drawing blood) and full disclosure of research methods. It also
addresses coercion, inequities in
power and social status and other
potential psychological impacts. The
shift into an academically rigorous
research practice entails a steep learning curve for design researchers in
order to navigate the review system
from submission to approval. The IRB
process is valuable for design
researchers for considering the ethical
aspects of research in design work.
Questions of recruitment bias (manipulated selection of research participants), misrepresentation of study
processes and potential forcoercion at
any point in the study are among the
issues that can cross the boundaries of
respect and trust and ultimately undermine the validity of the findings.
What we learned: design researchers

who wish to use interdisciplinary

collaboration as a venue and means for
validation, and those who wish to
disseminate the impacts of design to
the public need to become familiar with
the IRB in order to engage at a level on
par with specialists in other fields.
Those who do not receive certification
(typically, via an onlineeducational
module) are not permitted to interact
with study participants or potential
study participants. As design research
becomes more integrated into interdisciplinary research, it is time for design
to define its code of ethics from a disciplinary perspective, to integrate it into
institutional mechanisms for research
such as IRB and to educate designers
about established research standards
outside of commercial practice.
Research design: what is beyond methods and tools? In developing interdisciplinary research projects specifically
when establishing a new project
there are a few things that require
mutual understanding from project
partners: what are the common goals of
the research endeavour, what is the
disciplinary
language
related
to
research processes and what are the
methods to achieve the goal?
Although this study was developed
based on a shared view of the novelty
and value of design research in data
collection, we design researchers had
only a vague notion about what data
analysis entailed in public health. In this
study, we used photo, voice and group
discussion as methods for data collection. Participants take photos of their
daily lives relating to health, food and
lifestyle and participate in informal, but
structured, follow-up discussions with
the research team.
These combined methods generate
three types of data: photographs, journal entries and discussions. A cohesive
approach to data analysis across data

types was necessary, particularly

because of the mix of disciplines
within our team. Our partners openness to learn alternative approaches in
data analysis enabled usto lead the
process of analysis. This stage provided opportunities for us to reflect on the
differences between public health and
service design in data analysis and to
further articulate the methodological
aspects of design research. While data
analysis in public health is executed by
individual
researchers
(generall
speaking) using a theoretical framework that feeds new knowledge back
to the discipline, service designers
externalise the analytical phase and
facilitate collective analysis including
all stakeholders who share an understanding of the defined population. For
instance, we invited the Garden on the
Go counter staff and a community
liaison for data analysis. While they are
not certified academic researchers,
they possess an intimate knowledge
and the most profound understanding
of the audience through their frequent
interactions. What we learned: current
literature in design research tends to
focus on methodology and tool making.
Designers who wish to work in partnership with academics will increasingly find it necessary to develop a
disciplinary understanding of design
research that encompasses the process
of inquiry beyond the collection of data.
We need to define our own disciplinary
position.

Recruitment: building the

team
Recruiting participants for research
projects is frequently difficult, time
consuming and inefficient. Additionally, once participants are secured, there
is often a problem with adhering to the

research process: participants drop out

or fail to comply to research protocols.
Health Matters was at an advantage in
relation to study recruitment: we
consulted with our partners at the IU
Health outreach team and selected four
of the active Garden on the Go stops as
our research sites and began working
with community leaders at each stop to
coordinate days for recruitment,
camera pick-up and discussion. Our
communication with the leadership at
each of the sites was key: we were
introduced at community and resident
meetings, used community meeting
time for discussion groups and we
were able to leave boxes for camera
pick-up on site in office spaces. Interactions outside of labs enabled us to
build relationships with the participants, to have a better understanding
of the organisational cultures and to
adjust our research plan accordingly.

Data Collection: Designing

an experience of engagement
Framing the participants experience
from a service design point of view, we
aimed at optimisation by identifying
and connecting the touchpoints
involved in the research process. From
recruitment to data collection at
discussion sessions, every touchpoint
in engaging with research participants
was carefully designed in order to
optimise their experience.
Our
approach in designing the participants
experience was complementary to our
partners expertise in the area of
health research. The attention that we
paid to the participant experience in
the data collection process prioritised
the person rather than the data and, in
effect, put us, as designers, in a more
protective role aligned with the princi-

ples for ethical treatment of human

subjects as regulated by the IRB.

Conclusions
Our work with IU Health/Garden on the
Go and the Fairbanks School of Public
Health demonstrated the potential for
simultaneous interdisciplinary collaboration in both the public realm and the
academy. Design research methods
yield rich, contextualised data for
service design (applicable to Garden on
the Go as they expand their menu of
services) and, for improved understanding of underserved populations, it
is a key learning outcome for public
health. In the process of our research,
our partnership has raised the profile
of all three groups in community health
circles through community presentations. On the academic end, the work is
a cutting-edge example of community-engaged
research
in
health,
currently a broadly supported area of
health research in the United States.
Our process was made efficient by the
clear definition of each of our roles: our
association with Garden on the Go
provided institutional support that
helped with recruitment, the School of
Public Health provided a theoretical
and discursive home for the study,
contextualising our data as new findings in a field unfamiliar with design
research
and
design
provided
patient-centred methods. Our next
steps include codifying our methodology within public health research, and
with an ultimate aim of institutionalising design research as a legitimate
complement to existing data collection
methods for patient-centred research.

of the following people: Lisa Cole and

Kaliah Ligon, Indiana University Health;
Terrell Zollinger and Cindy Lewis, Richard M. Fairbanks School of Public
Health; Ashley Bailey, Brian Crain, Bridget Hawryluk, Andrea Haydon, and
Nick Walters, Herron School of Art and
Design; Niki Girls and Lynn Rodgers,Concord Neighbourhood Centre;
Tysha Sellers, Edna Martin Christian
Centre; Valerie Moore, Indianapolis
Housing Agency.
Health Matters was funded in part with
support from the Indiana Clinical and
Translational Sciences Institute funded,
Grant Grant # UL1TR001108 from the
National Institutes of Health, National
Centre for Advancing Translational
Sciences, Clinical and Translational
Sciences Award.
References
Stickdorn, M., & Schneider, J.
(2010).This is service design thinking :
basics-tools--cases. Amsterdam: BIS
Publishers.
2
Lidwell W, Martin B. (2012) Universal
Methods of Design, 100 Ways to
Research Complex Problems, Develop
Innovative Ideas, and Design Effective
Solutions. Gloucester, Mass: Rockport
Publishers
3
PCORI Methodology Committee, (2013),
The Patient Centred Outcomes
Research Institute Methodology
Report. http://www.pcori.org/research-wesupport/ research-methodology-standards/
1

Youngbok Hong

Acknowledgments
This paper would not have been possible without the generous contributions

Helen Sanematsu

...

Helth
talks

What youre
eating?

5% Design Action:
Cancer Screening Service
Innovation in Taiwan

Designers
have
consistently
encountered obstacles when trying
to introduce innovative ideas into
public health services, and the
cancer screening service serves as
a good example of this in three
ways:

Process and concepts of 5%

Design Action
Public health service is a complex and highly specialised
discipline, which has made it a tough nut to crack in terms of
effective service design. Making use of an open and innovative
structure, this article aims to share a public health service
innovation in Taiwan an innovative and sustainable design for a
cancer screening service through which we hope to discover
how organisations engage in learning and co-creation with their
stakeholders.
The World Health Organisation1 has
predicted that in the next two
decades, the number of global
cancer patients will rise by as much
as fifty-seven percent. Deaths
caused by cancer will also rise from
8.2 million to 13 million per year.
Cancer has been at the lead of the
top ten causes of death in Taiwanfor thirty years running. On average, one Taiwanese person is diagnosed with cancer every five minutes and forty seconds. An even
more astonishing fact is that the
Taiwanese government spends U S
$1.83 billion on cancer-related
treatment a year, which accounts
for twenty-seven percent of the
total budget of the National Health
Insurance system. In fact, more than
fifty percent of cancers could be

prevented or diagnosed earlier if

people led healthy lifestyles and
received regular cancer screenings. To increase the cure rate and
reduce the cost of cancer treatment,
Taiwan has begun the provision of
free-of-charge screenings for oral
cancer, breast cancer, colorectal
cancer and cervical cancer, but the
number of people who have taken
up this opportunity has been low
thus far, resulting in unnecessary
increases in social and medical
costs and, despite the good intentions behind the program, placing a
great burden on the shoulders of
health and welfare policies.

Service innovation: a weak

spot in cancer screening

First, innovative ideas simply based

on user orientation seem to be
incompatible with the inherent specialisation and authoritativeness of
cancer screening services and,
therefore, medical and public health
personnel may not be able to implement such ideas. On top of users
needs and feelings, the validity and
legitimacy of the service provider
are essential parts of service
design. In addition, Taiwans cancer
screening service involves a wide
range of stakeholders, including
government departments, medical
institutions, and relevant non-profit
organisations. Because of this, holistic innovative experience cannot be
implemented unless these stakeholders are effectively incorporated
therein. Second, public health
services are resistant to innovation.
Unlike general privately owned
business, public services do not face
frequent external competition and
the pressure to continuously innovate and make breakthroughs. Most
public health service personnel
offer only one standard option, just
like the Ford Model T. The profes-

sionalism and authoritativeness

that have been established in the
health discipline result in peoples
firm adherence to specific services.
Such adherence is a major obstacle
standing in the way of innovation:
for example, demanding that physicians with authority to take into
account the needs of their patients
and their families or persuading
hospitals with enormous profits to
introduce service design is a task of
tremendous difficulty. Third, a
certain level of social cost may be
inherent in public health service.
The National Health Insurance
program is a compulsory service in
Taiwan, and everyone has the
right to get cancer screenings, but
most people do not realise that such
screenings are also somewhat of an
obligation. The additional medical
costs caused by late diagnosis are
shared by society as a whole,
including those who get regular
cancer screenings. This strange
form of social inequality needs to be
changed by incorporating an innovative model into cancer screening
services.

5% Design Action: innovation in cancer screening

services
Social innovation relies not so
much on ideas of design as practical design action. Such is the principle behind 5% Design Action, a
non-profit design platform initiated
by Taiwanese designers in the

spring of 2013. However, in the past,

there are few opportunities for
many designers to participate in
the service development process,
even though they are passionate
about social issues. As a result, 5%
Design Action plays a critical role as
being a platform that invites
designers and other professionals
from a range of fields to pitch in five
percent of their free time. Therefore, they can join 5% Design Action
with the main service providers
and stakeholders to provide their
knowledge and professional skills
in designing new solutions to societal issues or challenges. Centred
around service design, the objective of 5% Design Action is to uncover potential innovation opportunities and solutions, and the platforms first project was titled Innovating in Screening Services and
Cancer Prevention. The project
consisted of five stages:

1. Target
2. Recruit
3. Co-Create
4. Transfer
5. Share
Target
From the very beginning of this
project, 5% Design Action wanted
the participation of designers with
an ambition for social innovation. To
cut straight to the core of the problems involved, the platforms

research team started to collect and

analyse secondary data, invite relevant stakeholders to take part in
in-depth interviews and to construct a network of cooperation. At
this stage, the primary goal was to
identify problems and focus on
producing practicable results that
satisfied the needs and conditions
of service providers. This goal was
achieved
through
discussion
between organisations and experts
who had been working in this field.
Through these initial results, 5%
Design Action was able to determine reasons behind peoples decisions not to get cancer screenings,
including the feeling that they were
too healthy, too busy, too embarrassed or too old to get one. At the
end of this stage, the objective of
this project was agreed upon: to
improve the overall cancerscreening experience and increase peoples screening acceptance and
participation rates.

Recruit
After discussing with the stakeholders, clarifying the problems,
and agreeing upon the objective, 5%
Design Action made the next step
forming a cooperative connection
with various organisations, including:
1. Government institutions (Health
Promotion Administration and
Department of Health of the Taipei
City Government);
2. Executive departments (Taipei

City Hospital and twelve health

service centres in Taipei City); and
3. Non-profit organisations (four
cancer prevention foundations).
At this stage, 5% Design Action
recruited volunteer designers with
an interest in this theme: a total of
eighty volunteer designers were
willing to participate in this project,
with areas of expertise spanning
graphic design, product design,
interactive design, service design
and fields related to public health.

Co-create
In the third stage, 5% Design Action
divided
the
eighty
volunteer
designers that they had recruited
into twelve groups. Each group
worked individually in exploringnservice gaps and innovation opportunities pertainingnto oral cancer,
breast cancer, colorectal cancer andncervical cancer. The exploration
results were discussednby the connected organisations as 5% Design
Action sent representatives to the
screening sites to observe and
interview the people there. Service
design inspired 5% Design Action to
visualise the needs of ordinary
people and service personnel to
guide co-learning. It also helped in
identifying the core problems in the
complicated context of a service
system. Moreover, a series of discussions were conducted in the form of
workshops and online platforms to
develop innovative design concepts
and service models.

Transfer
Near the end of this project, 5%
Design Action developed ten concrete-innovative concept designs,
such as visualising the cancer
screening process to reduce peoples fear of it, establishing brand
images that related to the citizens
lifestyle and promoting cancer
screening
service
through
networks of friends, family and
neighbours. While the guest
designers have returned to their
work, the research team continues
to exploit the result. Many details
and minor modifications still
remain to be worked out through
discussions with executive departments. After six months of discussion, 5% Design Action is preparing
to launch four new services in the
third quarter of 2014, and is aiming
to continuously innovate in various
service procedures.

Share
In the last stage, Share, 5% Design
Action yielded results that were not
specifically targeted at the design
of the cancer screening service, but
rather for the co-learning and
co-creating process, as a cooperation between designers from a variety of fields and related participating institutions. The course of this
project has also been made into a
documentary2, in an effort to systematically accumulate and transfer
knowledge or to create new values

in the future built on the existing

foundation. In 2013, 5% Design
Action also organised a premiere
and a conference built around the
project
documentary,
inviting
people from important organisations related to cancer. The premiere was a huge success, attracting social and media attention, as
well as constructing a channel for
communication between cancer
screening service providers. Furthermore, 5% Design Action developed a design thinking toolkit for
training healthcare personnel. With
the toolkit and the results of this
project, more people will be able
take part in service innovation in
cancer screening. In addition, this
project was invited to share its
results and findings at the 2013
National Cancer Prevention Conference, in which more resources
were expected to be provided for
5% Design Action in the future, and
the phrase innovation in cancer
screening services and cancer prevention was adopted to convey to
healthcare experts the value of
service design.

Discussion and conclusions

5% Design Action has been developing service innovations for cancer
screening and other healthcare
issues. Given the results and findings of this project, we have come to
the following conclusions, provided
as a reference for others working
on the practical side of service
design:

Co-seeing, co-learning and

co-creating
Empathising with users may be
important for good service design,
but designers and service providers must respect each others
professions and attempt to communicate from each others perspective. A superior service design
involves a long dialectical process,
by which attractive, practicable
solutions can be co-created. This
faintly echoes the collective
impact proposed by Kania and
Kramer (2011). Complex social innovation should not be confined to a
closed system of thoughts involving
only one area or unit. Interdisciplinary observation (of demands and
problems), learning and action are
the only solution for applying comprehensive thought and innovation
to a service system.

The crucial role played by

nonstakeholders
Innovation is far from a new thing to

both the organisations and the personnel involved in cancer screening: the problem is that competition
and
dependent
relationships
within the ecosystem have led to a
lack of communication and cooperation. Organisations would rather be
described as being responsible
than invest effort in finding ways to
improve the service experience
and increase screening test-partic-

ipation rates. In response, the

designers of 5% Design Action
engaged this problem from the
angle of the non-stakeholder: they
provided
assistance
to
these
responsible organisations in implementing feasible innovations. This
approach, surprisingly, increased
these organisations willingness to
cooperate. This is similar to the concept of the free agent, as developed
by Kanter and Fine (2010). They
believed that, in the social networking era, free agents will be regarded
as necessary promoters of social
innovation and design through
crowdsourcing.

vative ideas in a systematic way.

With the experience and knowledge acquired from this project, 5%
Design Action expects executive
departments
to get acquainted
with the ideas behind the methods
and values of service design and to
gain innovative energy from inside
their organisations. In addition,
design can be introduced to more
healthcare areas, thereby co-creating more innovative solutions and
opening up more valuable opportunities.

Recording,
accumulating
and re-creating knowledge

Kania, J., & Kramer, M. (2011). Collective impact. Stanford Social

Innovation Review, 9(1), 36-41.
2
Kanter, B., & Fine, A. (2010). The
networked nonprofit: Connecting
with social media to drive change.
San Francisco, CA: Jossey-Bass

The average tenure of a public

health nurse in Taiwan who performs cancer screenings is 2.7
years. This high turnover has
obstructed the passing on of experience. To accumulate results for
long-lasting participation, a documentary was made about this project, and thepremiere and events
established an interdisciplinary
platform of dialogue.
Moreover, 5% Design Action has
summarised its research findings,
as well as the demands and perspectives of users and of executive
departments, for the purpose of
educational
training.
It
even
produced innovative ideas cards to
accumulate knowledge and continue encouraging the output of inno-

References
1

Chen-Fu Yang
Chih-Shiang Wu
Shu-Shiuan Ho
Tung-Jung Sung

Interview: Geke van Dijk and

Bas Raijmakers
In this issue, editor Jesse Grimes interviews Geke van Dijk and Bas
Raijmakers and learns about their involvement in service design
networks, their Anglo-dutch company STBY, and design research.
Back in 2008, you both took part in
the the first of the SDNs GlobalConferences, in Amsterdam. That
puts you in a good position to look
back on the growth of service
design in Holland in the years
since then. What are the developments youve seen, and what challenges remain for Dutch service
design practitioners?
In 2008 only a relatively small group of
people in The Netherlands were aware
of service design. There has been a
huge growth in the involvement of
practitioners in this field since then.
There has been an strong uptake in
industry (among both agencies and
client organisations) as well as in education and government. By now service
design has firmly spread across many
different sectors, such as health care,
utilities, transport, telecom, and hospitality. It has also been integrated in
pioneering
innovation
programs
between industry and academia, such
as the CRISP programme (2011-2015)
where 60 organisations from academia
and industry collaborate to create
knowledge about designing Product

Service Systems. The main challenge at

the moment in all these settings is to
move from projects to partnerships.
Projects simply dont achieve enough
lasting or systemic change and the
issues that are addressed are often too
big or wicked to be solved in a single
project. When you aim to change how
governments engage with citizens and
other stakeholders in policy development, or if you want to develop a
service in a traditional product-oriented company, organisational change is
needed and that wont be achieved
with a single project. It needs longer
partnerships that result in change on
an organisational level.

There has been the (independent)

Service Design Netwerk Nederland established for many years.
Who makes up that group, and
what activities have you carried
out?
In the summer of 2008 we initiated the
Dutch service design network as a
result of an inspiring meet up between
the four agencies who were at that
time pionering under the banner of

service design. The initial meet up was

actually triggered by clients who told us
that it was crazy that we did not know
each other yet. So we had a drink and
decided to organise shared activities
for a wider community. One of our first
activities was to support SDN with
organising the international service
design conference in Amsterdam. Since
then we have organised more than 50
local events, such as talks, discussions,
workshops, drinks, etc. After a few
years of happily co-existing next to the
international SDN, we discussed this
year to maybe to transform the Dutch
network into a chapter within the international network. It makes more sense
now the field is growing so much and
also consolidating internationally. We
have now extended the core group of
organisers with extra people for industry and academia. It is a nice mix of
enthusiast professionals.

STBY operates both in the UK and

Holland, two countries where
service design is at its most established. How do you handle this way
of working, and what prompted this
expansion?
When we founded STBY 10 years ago,
we immediately started in both London
and Amsterdam. So there was never an
expansion from one country to the other,
STBY is a truly Anglo-dutch company.
We saw equal opportunities in in both
countries, and were already spending
much of our time in London, so for us as
directors it really made sense to establish ourselves in both countries. The
two studios virtually operate as one,
with projects sometimes happening
across the two locations. As the directors, we spend about 50% of our time in
each studio, and the rest of the team
also has a lot of contact with each other,
to share knowledge and sometimes

offer a different perspective. These

different perspectives come naturally
with the two locations we work in, but
also the multinational and multicultural
team we have, with currently five
nationalities. Our perspectives and
local knowledge are even much more
diverse with Reach, STBYs partner
network for global design research
currently comprising 11 companies
around the globe. For global companies
we do design research in several countries simultaneously, always with locally based teams.

Design research is your area of

expertise, and its an area that I
believe is sometimes overlooked by
service design practitioners. What
recommendations would you make
to Touchpoint readers on how to
incorporate research into their projects, especially if they face time or
budget limitations?
The most important advice is to not see
design research as separate from
service design. It is an integral part and
cannot be separated from the rest. It
does not make sense to do one without
the other. To do proper service design
you need to do proper design research.
This way of thinking and doing also
removes the time and budget limitations: if you have little time and budget
for a service design project, you have to
be modest with your ambitions for the
service you are creating, and not just
modest with your research ambitions.

Geke van Dijk

Bas Raijmakers

THANK YOU!