Conversations in Healthcare Service Design – The characteristics and use of conversations in ecosystemic service design

Format: Papers, RSD9, Topic: Health & Well-being

Jonathan Romm
Palak Dudani
Shivani Prakash

The Oslo School of Architecture and Design (AHO) Norway


This study examines the impact of conversations in public healthcare service design. We define what constitutes design conversations and the role they play in design processes for complex adaptive systems (CAS). Then, we explore the nature and use of conversations in two embedded design lab interventions in two hospital settings. In our summary of preliminary findings and contributions, we suggest future steps.

Healthcare organizations as complex adaptive systems

Public healthcare organizations, such as hospitals, are recognized as CAS. CAS are explained as living organisms, that includes a variety of dynamically linked independent subsystems with a capacity to learn and respond to circumstances (Begun, Zimmerman, & Dooley, 2003). Innovation inside CAS is often characterized as emergent, meaning that higher-order novelty is achieved through interactions and relationships between lower-order system parts or agents (Lichtenstein, 2014).

The need for conversations in systemic healthcare service design

Systemic service design is increasingly used as an approach to support the developments of more sustainable healthcare offerings (Barbero & Pallaro, 2017; Jones, 2013; Vink, 2019). Designing within service ecosystems focuses on resource integration beyond organizational boundaries. Facilitated, multiple stakeholder conversations are used to support interdependence, participation and emergence (Sangiorgi, Patricio, & Fisk, 2017; Jones, 2018), adding value in organizational processes and social discourse (Buchanan, 2001; Dubberly & Pangaro, 2015). All design activities are pragmatically guided by communications on intentions for changing a situation.

Hence, conversations for systemic design must seek to expose positions and contributions of various stakeholders (Jones, 2018). Literature on design for systems of cooperative work identifies four main purposes of conversations as for orientation, clarification, possibilities and action (Winograd, 1986). Jordan et al. (2009) define conversations in healthcare interventions, as “a collaborative process in which meaning and organization are jointly created” (p.2). Similarly, the early stages of service design processes are focused on learning and sensemaking while the latter stages center around cocreation of propositions (Stickdorn et al., 2018). Throughout these stages, a variety of issues are discussed with multiple stakeholders on various levels, highlighting needs, desires and perspectives.

Despite all conversations taking place in service design, little attention has been given to the nature and use of conversations in such processes. Hence, we set out to investigate the following: What are the characteristics of conversations during processes of healthcare service design and how are conversations used strategically by healthcare service designers?




Citation Data

Author(s): Authors: Jonathan Romm, Palak Dudani, Shivani Prakash
Title: Conversations in Healthcare Service Design – The characteristics and use of conversations in ecosystemic service design
Published in: Proceedings of Relating Systems Thinking and Design
Article No.:
Symposium Dates:
First published: 4 October 2020
Last update:
Publisher Identification:

Copyright Information

Proceedings of Relating Systems Thinking and Design (ISSN 2371-8404) are published annually by the Systemic Design Association, a non-profit scholarly association leading the research and practice of design for complex systems: 3803 Tønsberg, Norway (922 275 696).


Open Access article published under the CC-BY-NC-ND 4.0 International License. This permits anyone to copy and redistribute the material in any medium or form according to the licence terms.

Suggested citation format (APA)

Author(s). (20##). Article title. Proceedings of Relating Systems Thinking and Design, RSD##. Article ##.

Publishing with RSD

Proceedings of Relating Systems Thinking and Design are published online and include the contributions for each format.

Papers and presentations are entered into a single-blind peer-review process, meaning reviewers see the authors’ names but not vice versa. Reviewers consider the quality of the proposed contribution and whether it addresses topics of interest or raises relevant issues in systemic design. The review process provides feedback and possible suggestions for modifications.

The Organising Committee reviews and assesses workshops and systems maps & exhibits with input from reviewers and the Programme Committee.

Editor: Cheryl May
Peter Jones
Ben Sweeting

The Scholars Spiral

In 2022, the Systemic Design Association adopted the scholars spiral—a cyclic non-hierarchical approach to advance scholarship—and in 2023, launched Contexts—The Systemic Design Journal. Together, the RSD symposia and Contexts support the vital emergence of supportive opportunities for scholars and practitioners to publish work in the interdisciplinary field of systemic design.

The Systemic Design Association's membership ethos is to co-create the socialization and support for all members to contribute their work, find feedback and collaboration where needed, and pursue their pathways toward research and practice outcomes that naturally build a vital design field for the future.


Verified by MonsterInsights