Services: Service design in chronic health

In this chapter, we will explore the specific challenges presented by chronic health or longterm conditions and the role design might have in responding to these challenges. We will do this by describing the fundamental challenge to the traditional ways of delivering healthcare posed by long-term conditions and the paradigm shift required by health practitioners, commissioners, providers and patients to one of self-care. We will illustrate this through two case studies, which reflect the work of multidisciplinary research teams from Sheffield Hallam University, Lab4Living and two research teams from the National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care Yorkshire and Humber, User-centred Healthcare Design and Telehealth and Care Technologies. The Intelligent Shoe project is a technology project that used participatory methods in a larger social science health services research approach to develop a platform to support people to successfully undertake rehabilitation following a stroke. Methods from participatory design sat alongside qualitative and quantitative methods to deliver an intervention that has demonstrated clinical impact. The Better Outpatients Services for Older People project worked using a recognised model of design-led service improvement, experience-based design, to understand the experience of staff and patients of the medical outpatient department of a large teaching hospital. It used narrative to identify emotional highs and lows of the patient journey and mapped this to the 'touchpoints' of that journey. The team then facilitated co-design groups to address shared priorities for improvement and to implement and test them. Throughout these diverse projects there is the thread of participatory design theory and practice. We will close the chapter by reflecting on design's unique contribution to delivering innovative solutions to address the changing needs of today's and tomorrow's populations.