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Digital health technologies, powered by digital data, provide an opportunity to improve the efficacy and efficiency of health systems at large. However, little is known about different approaches to the use of data for digital health design, or about their possible relations to system-level dynamics. In this contribution, we identify four existing approaches to the use of data for digital health design, namely the silent, the overt, the data-enabled, and the convergent. After characterising the approaches, we provide real-life examples of each. Furthermore, we compare the approaches in terms of selected desirable characteristics of the design process, highlighting relative advantages and disadvantages. Finally, we reflect on the system-level relevance of the differentiation between the approaches and point towards future research directions. Overall, the contribution provides researchers and practitioners with a broad conceptual framework to examine data-related challenges and opportunities in digital health design., Methodologie en Organisatie van Design, Design, Organisation and Strategy, Creative Processes

Treatment decision-making can be complex, notably when there are multiple treatments available, with different (probabilities of) benefits and harms, for example, survival and side effects.1 It is precisely in these complex situations that the preferences of the patient are of utmost importance, as the trade-offs of benefits and harms are subjective and concern patients' lives.2 In such trade-offs, shared decision making (SDM) has gained momentum as a strategy to include both the best available evidence and the patient's preferences.3, Methodologie en Organisatie van Design, Applied Ergonomics and Design

Designers are increasingly collaborating with data scientists to apply smart data technologies to understand large-scale user behavior during their design research. This is useful in specific impact domains with vulnerable users and unfamiliar contexts, such as healthcare design. Patient journey mapping is the most common design tool for developing and communicating patient-centred perspectives in healthcare design. However, creating a traditional patient journey map is labor intensive. Consequently, they often represent the experiences of a limited number of patients and, therefore, have limitations in including an extensive group patient experience. To overcome these challenges, we present a new data-driven and hybrid intelligent design approach that utilizes tens of thousands of online patient stories and machine-learning techniques through collaboration with data scientists. We set up two studies in the field of oncology and demonstrate that combining the two machine-learning techniques allows for quantifying the experiences of a wide range of patients, detecting relationships between co-occurring experiences within the journey, and detecting new design opportunities/directions. In these studies, designers gained a large-scale, yet qualitative and inspiring, understanding of a complex context in healthcare with reduced time and cost investments, Methodologie en Organisatie van Design, Design, Organisation and Strategy

In this study, we envision engineering design activities for collective computing, an upcoming era of complex systems of massive social interaction through a wide variety of connected computing devices. A literature review reveals how collective computing, compared to the previous eras of personal and ubiquitous computing, may lead to new design tasks and design processes, as well as new roles for designers. Based on this review, new design activities for the collective computing era are envisioned, and further revised in an interview study with 24 informants. The result is a vision for design in the collective computing era, with actionable guidance for designers in terms of a coherent set of new design activities proposed in relation to advances in computing., Methodology and Organisation of Design

Junior design professionals experience conflicts in collaboration with others, with value differences being one of the issues influencing such conflicts. In a retrospective interview study with 22 design professionals, we collected 32 cases of perceived conflicts. We used a grounded theory approach to analyse these cases, resulting in five conflict categories that group 24 distinct value differences arising in 10 critical moments, an event that causes the value-based conflict. Thus, value differences are underlying the perceived conflicts of junior design professionals on many different occasions during collaboration with others. Conclusions are drawn on setting up guidelines for addressing values in co-design practices and supporting junior designers in their professional development.

This article explores how junior design professionals cope with value-based conflicts. We interviewed 22 design professionals about past and current value-based conflicts and the coping strategies adopted. Applying a grounded theory approach, we identified 11 types of coping strategies employed by junior design professionals. Our findings allowed us to clarify the nature of the coping process and localise value-based conflicts in the process of collaborative practice. During the coping process, professionals learn how to handle value-based conflicts through emotional release, developing a broader action repertoire, and engaging in timely action. We also identified transitions between specific coping strategies as junior designers learned from past conflicts and developed as a professional.

Beslissingen over medische behandelingen worden steeds vaker gezamenlijk genomen door de arts, de patiënt en diens naasten. In deze gedeelde besluitvorming (of Shared Decision Making - SDM) over diagnose en behandeling worden ook de waarden en voorkeuren van patiënten meegenomen (Stiggelbout et al., 2015). Onderzoek heeft aangetoond dat gedeelde besluitvorming voordelen oplevert voor patiënten en zorgprofessionals, zoals meer vertrouwen in de beslissing, grotere tevredenheid met het consult en betere therapietrouw van de patiënt (Shay & Lafata, 2014). Toch blijft een effectieve implementatie van gedeelde besluitvorming beperkt, ondanks de ontwikkeling van keuzehulpen en aandacht voor gedeelde besluitvorming in de medische opleidingen. Een goede implementatie van gedeelde besluitvorming in de complexe zorgpraktijk blijkt moeilijk., Methodologie en Organisatie van Design, Applied Ergonomics and Design

To unravel the complex challenges addressed by design, oftentimes it can be necessary for researchers to participate in design processes rather than make observations from outside. However, ‘participation’ has different meanings in different kinds of design research, and research outcomes will depend on the form of participation chosen. Through a Dimensional Analysis, we establish seven dimensions on how participation in design research can be classified in terms of 1) the researcher-designer role, 2) the aim of the project, 3) the main contribution, 4) the activities of the researcher, 5) if it is a single or multi-case study, 6) the scientific reporting on the project, and 7) the kind of knowledge produced. This overview aims to assist researchers in communicating how choices for a particular participatory approach contribute to knowledge production in design research., Methodologie en Organisatie van Design, Design, Organisation and Strategy

Purpose: Solutions to improve the implementation of shared decision making (SDM) in oncology often focus on the consultation, with limited effects. In this study, we used a service design perspective on the care path of locally advanced pancreatic cancer (LAPC). We aimed to understand how experiences of patients, their significant others, and medical professionals over the entire care path accumulate to support their ability to participate in SDM. Participants and methods: We used qualitative interviews including design research techniques with 13 patients, 13 significant others, and 11 healthcare professionals, involved in the diagnosis or treatment of LAPC. The topic list was based on the literature and an auto-ethnography of the illness trajectory by a caregiver who is also a service design researcher. We conducted a thematic content analysis to identify themes influencing the ability to participate in SDM. Results: We found four interconnected themes: (1) Decision making is an ongoing and unpredictable process with many decision moments, often unannounced. The unpredictability of the disease course, tumor response to treatment, and consequences of choices on the quality of life complicate decision making; (2) Division of roles, tasks, and collaboration among professionals and between professionals and patients and/or their significant others is often unclear to patients and their significant others; (3) It involves “work” for patients and their significant others to obtain and understand information; (4) In “their disease journey,” patients are confronted with unexpected energy drains and energy boosts, that influence their level of empowerment to participate in SDM. Conclusion: The service design perspective uncovered how the stage for SDM is often set outside the consultation, which might explain the limited effect currently seen of interventions focusing on consultation itself. Our findings serve as a starting point for (re)designing care paths to improve, Methodology and Organisation of Design, Industrial Design Engineering, Applied Ergonomics and Design

This contribution explores the potential of lead user research for early-stage designing for intelligent ecosystems through a literature review and a single case study concerning a lead user research initiative on blood pressure monitoring. The results suggest advantages of executing lead user research in early-stage designing for intelligent ecosystems from the points of view envisioning broad initial ecosystem boundaries, developing first intelligence components, and overcoming research challenges related to technical issues., Methodology and Organisation of Design

Design for Sustainability, Methodology and Organisation of Design

Junior design professionals experience conflicts in collaboration with others, with value differences being one of the issues influen-cing such conflicts. In a retrospective interview study with 22 design professionals, we collected 32 cases of perceived conflicts. We used a grounded theory approach to analyse these cases, resulting in five conflict categories that group 24 distinct value differences arising in 10 critical moments, an event that causes the value-based conflict. Thus, value differences are underlying the perceived conflicts of junior design professionals on many different occasions during collaboration with others. Conclusions are drawn on setting up guidelines for addressing values in co-design practices and sup-porting junior designers in their professional development., Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public., Methodologie en Organisatie van Design

Identity development of design students is a dynamic entanglement between personal and professional identities. Yet, literature primarily focuses on professional identity, based on institutionalized definitions of design to which students must conform. In contrast, we explore personal motivations for wanting to become a designer. An instrumental case study explores how an undergraduate design student develops personal principles for good design, and a personal vision for designing. Results show these principles and underlying vision are applied in the student’s design work, leading to development of a holistic identity (personal and professional). Finally, we note this exercise necessitated a plural and dynamic understanding of design (education). We therefore encourage design students and educators to co-design educational spaces and processes to stimulate enriched potentiality of design culture., Methodologie en Organisatie van Design, Marketing and Consumer Research

Junior designers are not trained to cope with critical situations and conflict at work. Most design schools do not educate their design students to prepare them for (potential) conflict. As a result, junior designers often do not have conflict-handling skills to handle critical situations and conflicts. While some tools and methods exist to help them make responsible design choices, these often address value differences underlying (potential) conflict without taking the perspective of the designer, and thus without supporting young designers to start by reflecting on their own intrinsic values. The aim of this study is to find a way to help junior designers to reflect effectively on critical situations, thereby improving their conflict-handling skills. Data was collected through four steps in an action research. Researchers collaborated with an identity programme for junior design professionals. Insights from try-outs and small interventions were transferred into design requirements for an approach to educate and facilitate junior design professionals to reflect more effectively on critical situations., Methodology and Organisation of Design

The Quadruple Aim is a framework which prioritizes four 'aims', or dimensions of performance, for innovating in the healthcare domain, respectively: 1) enhancing the individual experience of care; 2) improving the work life of health care clinicians and staff; 3) improving the health of populations; and 4) reducing the per capita cost of care. In this contribution, recent literature providing examples of design research in the eHealth domain is reviewed to answer the research question: 'in which measure has design research contributed to each of the 'four aims' of eHealth innovation in the past five years?'. The results of the review are presented and employed to draw three main observations: 1) design researchers in eHealth seem to be largely focused on improving experiences of care, either patients' or health professionals'; 2) design researchers' contribution on reducing per capita costs of care appears to be less pronounced, which is outlined as a point for improvement; and 3) in a considerable amount of reviewed contributions, design researchers appear to be contributing to multiple 'aims' at once. In this subgroup of reviewed contributions, several disciplinary areas and types of stakeholders interact and integrate through design research activities. The latter observation leads to a reflection on the strategic role of design research in the contexts of the convergence revolution and of the non-communicable disease crisis. Implications of this reflection for design researchers are recognized in the opportunity and timeliness to develop eHealth-specific ways to orchestrate design integration. A direction for further research in this sense is identified in the use of sensory and self-monitored data as a boundary object for eHealth innovation. The prospective value of this direction is finally exemplified through the case of blood pressure., Methodology and Organisation of Design

Within the third wave of digital service innovation, framing is becoming increasingly complex. Accordingly, design practice finds itself in a transition from designing single service solutions that are shared, to designing systemic solutions that are shareable. We report a case study in which we use Cultural Historical Activity Theory (CHAT) to analyze the framing process that a designer went through when designing a digital service for a Connected Care startup. Results show the importance of the designer’s activity awareness and the challenge of dealing with relational complexity when framing the digital service innovation. With this work, we hope to inspire researchers and practitioners with the potential that CHAT has to offer for the reflective practice in digital service innovations., Methodology and Organisation of Design, Marketing and Consumer Research

This paper proposes a categorization of existing approaches to healthcare-related engineering design based on systems thinking principles. Three existing approaches to healthcare-related engineering design are isolated which contribute differently to health systems fundamental purposes and interconnections. The three approaches are labeled as 'silent', 'overt', and 'convergent' health design. Each approach is defined and illustrated through an example. Following, practical advantages and disadvantages of each approach are discussed. A reflection is offered on the expected relevance of the convergent health design approach for present and future societal challenges in the health domain, and specifically on the recently growing field of e-health. Finally, open methodological challenges related to convergent health design are outlined and characterized as opportunities for future research., Methodology and Organisation of Design

Societal problems concern the complexity of technical, organisational, social, and political issues. The enormous negative impacts of these problems and the inability of problem solvers to deal with high levels of complexity cannot be overcome without a paradigm shift in how we understand and engage with such issues. Two domains have been helpful in bringing about such a shift: Systems Thinking and Design. Although these domains express mutual interest in social–technical systems and complex problem solving, in the literature there are few attempts of bringing the compatibility between them to the attention of designers. This paper aims to contribute to this endeavour by uncovering the role of integrating systems thinking for design, and by providing an overview of the emerging field of systems-oriented design approaches. An extensive literature review outlines significant aspects underlying systems thinking to support its use and further development in design. This paper provides a conceptual framework structured in five clusters: mindset, methodology set, knowledge set, skill set and tool set. The framework is meant to assist designers in integrating systems thinking into design and thereby enable them to better handle complex societal problems., Design for Sustainability, OLD Management and Organisation

Radical innovations are designs that alter the meaning of our life experiences. In order to realize such innovation, a designer needs a vision, a strong personal view on the world. The identity and values of designers however, are often denied in modern design processes. onsequently, (junior) designers have difficulties in connecting with their values and standing for their ideals, especially when designing within a corporate setting. We report a case study that demonstrates how nurturing a designer’s personal understanding of ‘good design’ and integration of this understanding in his work, influences a design-driven innovation project and outcome. Our findings suggest that a designer’s principles for good design, enable him to design more in tune with his identity and related ideals. Personal principles for good design empowered the designer’s creativity, decision making, process planning, and drive to design and promote the acceptance of a radical idea within a corporate setting. We hope to inspire designers to use personal values and identity for design-driven innovation, and would like to start a discussion with design research and education communities to ponder on how designers can be supported in this journey., OLD Management and Organisation, Marketing and Consumer Research

This paper addresses the potential contribution of service design for improving the implementation of shared decision-making in healthcare. The iterative approach of design research is compared with the more linear, (social) scientific approaches often seen in health services research. Five foundational principles of service design are explored regarding their potential contribution to the improvement of the implementation of shared decision-making. Thus, this position paper can be seen as a call on service designers and healthcare professionals to combine their efforts to improve the implementation of shared decision-making in healthcare., Applied Ergonomics and Design, OLD Management and Organisation

This research uncovers seven cross-category design styles and demonstrates how people’s preferences for these design styles are based on social distinctions. Knowledge of these cross-category design styles and the research approach might assist designers when faced with the challenge of how to address different market segments, and how to play with stylistic conventions., Product Innovation Management, Industrial Design Engineering

This paper investigates the degree of control that designers might have over human relations in services. For this purpose, a number of speculative service designs were devised to address work-related stress. We focus on three of the generated designs, where design interventions have made changes to the material circumstance in which contacts among users and providers take place. The paper looks into the capacity of design to promote discussion and social support, and its capacity to make objects act as ‘quasi-others’ in social encounters. Through the case studies we show how different levels of designerly control can be exercised in practice., Product Innovation Management, Industrial Design Engineering

OLD Design Theory and Methodology, Marketing and Consumer Research

This article looks to the tendency of a country’s crafts and industries to produce in a particular industry style. Industry styles are value-expressive, often established through implicit design features that companies apply undeliberately. Two studies are carried out on the web design of small and medium sized ICT companies in Germany and Spain. The first study shows how industry styles can be understood and designed as expressive of a country’s value orientation. It thus provides a method for design according to a local industry style. The second study demonstrates the effectiveness of cultural adaptation to an industry style. It shows that users in Germany and Spain find web pages with industry styles adapted to local culture more trustworthy and appealing.

Industrial Design Engineering