Preliminary Preparation and Evidence

Previous studies have discussed where service design should have its place and impact in the development process (e.g., Almqvist, 2017, 2020;

Clatworthy, 2013; Raun, 2017; Yu & Sangiorgi, 2014). In fact, some of the recent literature has noted that the early phase of the design process, the so-called fuzzy front end, has already been investigated, and it is, therefore, time to focus on the later phases where implementation occurs. It has also been critically stated that different design-led processes and toolboxes have

been the only outcomes of organizational development and design has not reached the desired capacity (Holmlid & Malmberg, 2018; Malmberg, 2017). However, the front end is the most information-intensive phase, where different types of information from internal and external sources are brought into the project (Zahay et al., 2004) and the major decisions are made (Clatworthy, 2013); thus, we should put more effort into the early phase. It is also a moment where the team members get to know each other and the given brief and the team plans the details of the project.

In this research, preliminary preparation was provided through benchmarking and preparing the benchmarking data and design sprints.

The sub-studies introduced in this research found that there are elements that service designers should consider before starting a healthcare-related service development project. These elements are related to building trust and engagement among participants; understanding the service design and co-design; learning design practices, processes, and methods; and adapting the process to the everyday work practices. From the service design and co-design points of view, the preliminary preparations aim to evidence the potential of service design and the value of co-design through the entire development project and to avoid leaving the designers outside of the project with the important and deepest insights of the users in their hands, as Almqvist (2017, 2020) has explained. The different roles and participation of service designers and other stakeholders can then be justified more clearly throughout the project.

In addition, the preliminary preparations aim to avoid fuzziness at the beginning of the service development project. When the groundwork is planned, evidenced, and prepared well, we can establish a better understanding of the object to be developed on the basis of the initial knowledge and consequently provide more evidence for the organizational and design levels before the actual development project begins. According to Foglieni et al. (2017), evidence is needed for decision-making at both the organizational level and the design level, which helps to drive learning, change, and transformation step-by-step. At the organizational level, the evidence can be utilized while planning the structure of the design process for service development and creating a common understanding from it. The following questions can then be considered: What is the aim of development in complex organizations; what is included and excluded in the brief; how can we define the service under development; and what are the resources of each ward/hospital from the service development and process engagement points of view?

In this research, evidence was gathered through service design

methods, where the data collected from the field, for example, through benchmarking or questionnaires, were visualized by using different mapping tools. These mapping tools can be, for instance, service journey mapping or resource blueprints, which were also utilized and analyzed in sub-studies I, III, and IV of this research, and they can be beneficial for development especially in the beginning of the process. In addition, through other concrete design methods, such as prototyping and desktop walkthroughs, evidence can be created when concretely describing the experiences of stakeholders or stepping into the shoes of another. In this research, I saw the evidence as being concretized and observed strategic benchmarking process and visualization tools helping to perceive the complexities in the silo-structured organizations.

The value of using benchmarking is that it builds evidence that is gathered from other (healthcare) organizations. The evidence from the benchmarking can be, for example, how other organizations are producing a service, how the change has been implemented in an organization, or how they have successfully utilized and used design methods as part of service development. Benchmarking is already well known in the healthcare industry, where it has been used over the years for quality in healthcare services (Kay, 2007), and thus, the leap into new approaches is not significantly different.

The potential to further develop the benchmarking processes, visualization tools, and prototyping methods for both designing and evaluating agile experiments based on benchmarking exists. As prototyping saves resources, such as time and money (Blomkvist, 2014), it could be a beneficial tool in benchmarking, for instance, during new construction projects or in agile experiments during the design sprints in the early phase.

However, combining this benchmarking into visualization and prototyping requires preparations for which the service designer has expertise. As emphasized in sub-study I of this research, healthcare management has expressed a clear need to find visual ways to disseminate and communicate benchmarking information to larger audiences in their home communities.

Therefore, the design sprint with prepared benchmarking evidence could be one successful way to disseminate and communicate information.

Service design could, for instance, focus on using video personas and short commentaries and statements from individuals met during the site visits or on generating the digital benchmarked data for VR. The usage of VR in healthcare service development was found to be a good practice in sub-study II.