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This practice-based PhD investigates how integrated design approaches can support desirable shifts in complex, multi-stakeholder healthcare service systems. It adopts a research-through-design approach drawing on systemic, participatory and service design disciplines and applies these in the context of immunoglobulin (Ig) for infection prevention in people with blood cancer in Australia. Ig replacement therapy (IgRT) is framed as a service suited to design research methods through the lens of service-dominant logic. The research seeks to explore through diverse perspectives how this precious, high-cost, blood-derived therapy is accessed and delivered in practice, and to engage system stakeholders in designing alternative, preferable ways the therapy could be delivered by the many involved to those who need it.
Now in its second year, the PhD project is focussed on appreciating the complexity of the IgRT service system. Research activities have included a participatory workshop, interviews, and embedded design ethnography within a major hospital. Early findings from these phases are surfacing diverse and rich perspectives of the system. Workshop contributions from people with lived experience, clinicians, nurses, administrators, suppliers, policy actors, and researchers suggest that IgRT access and delivery are shaped by interacting factors across micro (patient context), meso (service configurations), and macro (e.g policy and geography) levels, contributing to variable and sometimes inequitable outcomes.
Embedded ethnographic research in a large Victorian hospital is revealing the highly interconnected, relational service contexts through which care relevant to IgRT is delivered. It provides insights into the in-practice barriers and enablers that shape care delivery across hospital and in-home settings, as experienced by patients, families, and staff.
Reflexive thematic analysis and visual synthesis mapping are being used to generate insights and render visible the relationships between them. Visual artefacts developed iteratively through the work are supporting shared understanding and engagement with stakeholders.
Various challenges have emerged relating to the practical complexity of participatory and ethnographic methods in healthcare, managing the quantity of data involved in attempting to research a complex system, and navigating tensions between healthcare and design research paradigms.
The next stage of research will shift towards engaging stakeholders to collaboratively reflect on new understandings of the IgRT system, identify impactful points for intervention, and develop future IgRT service configurations. The research contributes an applied account of working with health service system stakeholders to collectively and intentionally reshape how care is delivered in practice, to achieve preferable outcomes.
Keywords: Health System, Cancer, Participatory design, Systemic design, Service design