Kahmin Ong, Elizabeth B.-N. Sanders, Yvette Shen, Theresa Berner, Carmen DiGiovine
The wheelchair acquisition and service delivery process is characterised by a complex interplay of regulatory constraints, arduous insurance protocols, and misaligned incentives among key stakeholders, including wheelchair users, caregivers, clinicians, manufacturers, suppliers, and insurers. Traditional service delivery models, largely linear and bureaucratic, fail to accommodate the dynamic, relational nature of stakeholder interactions. These systemic inefficiencies contribute to delays, fragmented communication, and often inequitable outcomes for users. In response to these challenges, this research adopts a design-led inquiry that integrates a co-design approach into the policy and service model framework. By adopting a relational perspective, the research aims to illuminate the underlying interdependencies within the system and propose potential reforms that are adaptive, transparent, and people centric.
The research engages wheelchair users, caregivers, clinicians, suppliers, manufacturers, and insurers through co-design workshops and interviews. Participants shared their experiences and identified critical friction points along the service delivery journey. To capture the complexities of these interactions, gigamap-inspired visualisations were created to visualise the entire stakeholder journey, highlighting interdependencies, delays, and friction points. This diagnostic tool provided a comprehensive view of the process, enabling participants to pinpoint key areas for reform. The visualisations were then transformed into an interactive visual model, allowing stakeholders to explore different scenarios and examine specific segments of the service delivery process.
Findings reveal significant systemic barriers that impede effective service delivery. The analysis identified that insurance protocols and regulatory constraints are not only sources of delay but also miscommunication among stakeholders. Furthermore, the analysis uncovered a fragmented landscape where stakeholders operate in silos, with limited cross-functional communication. The visualisation of the stakeholder journey provided a clear illustration of how these systemic inefficiencies contribute to an overall disjointed service delivery process, thereby reinforcing the need for a relational approach to policy reform.
Integrating design approaches into policy governance offers a transformative pathway to overcome these entrenched systemic inefficiencies. By redefining the roles and interactions among stakeholders, policy design can evolve from a top-down, prescriptive model to one that is participatory and responsive. In this way, “relating as designing” reimagines policy and governance as dynamic processes that adapt to real-world challenges and stakeholder needs. This contribution invites policymakers, industry leaders, and researchers to reimagine policy design as a living, adaptive process, one that not only recognises but actively leverages the relationships at the heart of a complex system.
Keywords: Co-design, participatory design, wheelchair service delivery, interactive modelling, complex rehabilitation technology