Barriers to design in healthcare

Background: Health advisory bodies have suggested that external disciplines such as engineering and design, with their creative, structured approaches to user-focused problem solving, may contribute useful tools and techniques to healthcare service designers. However if external disciplines are to add value to healthcare systems, they need an understanding of current service design practice, and of the environment in which healthcare service designers operate. Method: In this ongoing study, using a grounded theory approach, data were collected from 20 anonymous participants connected to a UK NHS hospital. Semi-structured interviews were used to gather information on current design practice within 79 change projects, focusing on requirements elicitation. Open coding produced over 400 codes, organised under four main categories: Projects, Requirements Process, Design Methods (including tools and techniques), and Stakeholders. Via further analysis using theoretical memos and axial coding, the topic of barriers to effective design emerged as a strong theme that is discussed further in this paper. Results: Pragmatic barriers to the effective use of design include issues such as high impact of change, difficulties engaging stakeholders in design activities, cultural and behavioural differences, and problems with inherited systems. Such barriers reflect the highly complex nature of healthcare. Staff adopted a variety of approaches to help resolve complexity, but negative emotional reactions to the use of design methods themselves invite further investigation into whether their cause is the tools themselves, the types of projects they are used in, or the conditions in which they are used. Conclusion: This paper concludes that if design thinking is to become more prevalent in healthcare, there is a need for more awareness of, and investigation into, the interplay between pragmatic and emotional barriers to design.