20- Systemic Design for Healthcare Sustainability: Patients, consumers and “big box” healthcare

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Peter Jones and Pranay Arun Kumar

OCAD University, Toronto, Health Design Studio

This workshop delves into healthcare sustainability and understanding consumer choices in healthcare for design-aware citizens.

Any healthcare service or individual choice in the healthcare system triggers a set of actions, interactions with service providers, and material, energy and information flows from supply chains. Healthcare as an industry runs on a vast logistics system that provides medications, tests and equipment, and supporting processes but huge waste streams and redundant buffers of consumable use-once items such as latex gloves, masks, needles, and disposable containers.

Both public and corporate organizations are responsible all through the value chains and supply networks that comprise healthcare. Corporate practices are visible contributors to environmental impact because they produce the materials requisitioned in clinical settings – but are they the most responsible for impacts?

Healthcare sustainability

The hospital and other medical clinics, whether public or private, have been typically waived from having to guarantee strong sustainability programs. Ironically, we see that large institutions and corporations can offset (or carbon-trade) their responsibility and deflect blame for impact onto the everyday decisions made by individuals, meaning patients, the most vulnerable people in the entire system. Patients should not be pressured to be the pivot point of sustainability decisions. We must engineer healthcare sustainability into the decision points of upstream planning and management practices in public and private actors. Healthcare organisations should ultimately strive to create flourishing-sustainable business models to establish enduring processes that reduce total ecological impact and return value in the form of environmental regeneration.

These tensions in decision-making for healthcare sustainability have made consumers more conscious of their actions. Still, they have also created a lot of confusion about good and bad choices for the environment. Healthcare is one of those domains where decision-making is frequently complicated by multiple possible impacts, as doctors prescribe diverse treatment pathways, each with its own pros and cons. Patients have to think about the seriousness of their illness or condition, the morbidity it causes, its effect on their loved ones, the costs incurred on treatment, how it conveys to their peers, and how to effectively manage the situation while trying to lead a normal life. These are the various concerns before even factoring in the environment.

As designers, many of us understand the processes involved in creating devices, treatment services, care pathways and the broader environmental impact of our choices. We also understand how companies strive to persuade consumers into engaging with their services and the negative effects of these practices. Designers as consumers are thus, mindful of their choices and many of the factors that lead to these choices, creating dilemmas and affecting decision-making.

Mapping two case studies

The workshop proposes two case studies at opposite ends of the system scale: the complex healthcare system and the patient as a consumer within the system.  Participants work in two cohorts to develop four inter-related systems maps from the Systemic Design Toolkit – to explore the system, stakeholder relationships, and material activities in each of these two cases. Miro boards will be set up and pre-populated with the staged maps to give each cohort a dedicated place to develop the following set of system maps:

Actors map – Rapid stakeholder definition and relational mapping by power/knowledge and roles

Context map – Initial system scoping and assessment of meaningful trends, emerging innovations, and framing of the core systems issues

System map – Translation of the Context to the Systems map will provide a tool to inventory the system influences by the analysis of issues associated with eight capitals (multicapitals map)

Interventions map – Mapping of sustainability and service interventions across the twelve leverage points in the Toolkit’s Interventions map (based on Meadows’ “Twelve Places to Intervene.”)

This workshop delves into the complexities of design practice in considering the requisite variety of participants in the healthcare system. The special focus of the two cohorts was determined to create distinct value sets and arguments in tensions between the patient-as-consumer perspective (that has arguably developed worldwide in healthcare) and the healthcare system as an institutional, hospitalized, “big box” model of health services delivery. The ethical aim of the workshop is to identify the moral tensions in the needs of patients, their tensions in the expectation of participating as consumers, given their anticipated interests in sustainable health. The second cohort also uses system mapping to identify tensions between the healthcare system as a viable and cost-managed service model and the tensions with moving toward a sustainable operation and business model of operations.

The workshop poses hypothetical choice scenarios for designers making healthcare design decisions for systems and patients. The systemic design maps create the context to present arguments and reasoning for their decisions. Based on the choices, reasoning, and various criteria relating to age, gender, social and economic status, we determine the relationship between decision-making in healthcare and the environment for designers as consumers.

Workshop format

120 minutes | Online | maximum of 30 participants | using Miro

Workshop Agenda

Introduction to the workshop (15 minutes)

Distribution into two cohorts (5 minutes)

Mapping 1: Actor mapping and initial context mapping (30 minutes)

Regroup and discussion (10 minutes)

Break (5 minutes)

Mapping 2: Context mapping, System map, and Interventions model (45 minutes)
Discussion and final remarks (15 minutes)

Preparation

Participants will be given primary readings to be prepared to engage with each of the maps. Articles associated with the Systemic Design Toolkit and with each of the four maps will be provided. Depending on how workshop registration is to be done, we can send information out well in advance or at the start of the conference, once we have the established group of participants.

References

Jones, P.H. (2013). Design for Care: Innovating healthcare experience. Brooklyn: Rosenfeld Media. (Chapter One)

Donella Meadows. (1999). Leverage Points: Places to intervene in a system. Hartland, VT: The Sustainability Institute.

Mulgan, G., & Leadbeater, C. (2013). Systems innovation. London: Nesta.

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Attribution

RSD proceedings are licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. This permits anyone to copy and redistribute the material in any medium or form according to the licence terms.

Citation

Author(s) (20XX). Article title. In Proceedings of Relating Systems Thinking and Design (RSDX) 20XX Symposium. City, Country, Month X-X, 20XX.

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