Service Design Tools as Supporting and Developing

The large dataset from sub-study I is introduced in the following subsections. Here, I will answer the research question: How can service design tools and collaborative practices be used to support and develop customer journeys and hospital management practices? The results can be categorized into two areas. First, I will describe how benchmarking as a tool in the design process can support the development of hospital management practices, and second, I will introduce the design method as a way to create and share a vision and understand ecosystems in the healthcare context.

4.1.1. Benchmarking as a Process to Develop Hospital Management Practices

Benchmarking is a widely used process in the healthcare field, and it can be seen as an iterative approach in the development of health-related services (e.g., Kay, 2007; West, 2021). It has value because it helps to avoid risks, defects, and limits to patients’ safety and can be used to improve service quality (Liedtke et al., 2017; Rasche et al., 2017). In sub-study I, the most significant effects of benchmarking were related to evidencing the development of lean management and “true north” thinking, which was the main objective of the case study 1. Evidencing is needed for

decision-making at the organizational and design levels, as it helps to drive learning and transformation forward (Foglieni et al., 2017). According to Fry (2019), evidence is important when new service processes and practices are introduced in hospitals.

Sub-study I determined that through benchmarking, we can ensure the quality, effectiveness, and timely availability of services and provide evidence through examples in the hospital context. Benchmarking has its value and contribution when agile experiments and evaluation practices are elaborated, making it particularly suitable for the agile development of a design sprint (Knapp et al., 2016). Benchmarking was seen as a way to learn more about hospital management practices based on lean, agile, and human-centered approaches. In addition, in sub-study II, we found that benchmarking was experienced as one of the fastest and most cost-effective approaches for a new hospital’s pre-construction phase, where the best practices for patient-centered care must be observed and investigated.

Sub-study I stressed that the challenge of developing the benchmarking itself was strategically important and that there is a true need to adopt new practices to refine a benchmarking process especially in the service design field. As highlighted in the theoretical background of this research in subsection 2.3.2, the existing practical handbooks of service design do not offer tools or templates for benchmarking. Thus, implementations of and commitment to new design practices developed during and after benchmarking were experienced as difficult parts of the process. In the following paragraphs, I will discuss the three needs identified from sub-study I.

First, there is a need for a required set of design tools to put ideas into practice. Here, the healthcare management had a need for visual ways to disseminate and communicate information from the benchmarking site visits to the local healthcare professionals, experts, and communities.

Visualization and concretization tools (Koh et al., 2011; Shneiderman et al., 2013) are highly important during the benchmarking process but should be used more broadly. In sub-study I, we found that visualization tools helped to create a shared understanding of healthcare ecosystems, which can support the implementation of lean strategies in healthcare processes. In addition, through visualizations, we can aim to create better communication and participation.

Second, when issuing mandates, there is a need to engage and commit people from the hospital, as noted by Wetter-Edman et al.

(2018), who stressed that stakeholders’ participation is crucial and that we can impact and change their behavior. In sub-study I, benchmarking

encouraged healthcare staff from the Lapland Hospital District to discuss not only service design approaches in healthcare but also lean practices in the healthcare context. The practical examples helped hospital management and service design practitioners understand how a service design approach would be an effective part of healthcare-related development in hospitals.

Third, there is a need for scaling up the service experiments in hospitals. Here, the service design practices and tools are ideal to zoom in and out to see the smaller details and the larger overview (Polaine, 2013).

During some of the benchmarking site visits done during the first case study in sub-study I, hospitals ran their experiments first in one unit and later scaled them up for the other units. We argued in sub-study I that the scaling-up step is one of the challenges in service design and human-centered development. Scaling up services is part of the change process, which requires peer-to-peer learning. Here, transformational change in the organizational culture and management’s strong commitment to benchmarking are needed to ensure that the results of the service design process are discernable. The scaling-up step can take innovations from experimentation to implementation and strategic day-to-day management.

The role of service design could offer solutions for meeting all the aforementioned needs. Service design tools can help to create and develop more effective benchmarking processes and generate support and commitment for service ideas, which affects the overall success of development projects. In sub-study I, we suggested that service design could use video personas and short commentaries and statements of healthcare professionals and patients from the benchmarked hospital and also develop tools for both designing and evaluating agile experiments based on benchmarking. The documented data from benchmarked hospitals can also provide evidence for the service development process and support the service designer in their role. This useful documentation could also bring service designers’ role closer to the early phase of the design process, when the designer can capture the contents and ideas generated during the benchmarking. The video recordings from the field and visual tools can also be valuable for internal purposes when aiming to improve the internal culture, initiating clinically meaningful changes in quality, and bringing about a “change in mentality” in an organization through benchmarking (Gleason & Bohn, 2017, p. 151).

4.1.2. Design Methods as a Way to Create and Share a Vision and Understand Ecosystems

In sub-study I, we found that even though healthcare professionals in different municipalities were actively working together, they were still missing knowledge of the service processes in different hospitals.

This challenge might make the services slower or even unobtainable, especially when a province consists of many municipalities that should seamlessly cooperate. Sub-study I demonstrated that visualization and concretization tools (Koh et al., 2011; Shneiderman et al., 2013) enabled better communication and participation in development processes and helped to create a shared understanding of healthcare ecosystems, which can support the implementation of such things as lean strategies in healthcare processes. In addition, as Hakio and Mattelmäki (2011) argued, participatory and visual design methods fit well into enhancing the cross-functional collaboration in a public organization. In the following paragraphs, I will stress the value of visualization and service design workshops especially from the very early phase of the development process.

Eight municipalities were involved in the development process in case study 2 of sub-study I, where we determined that one of the biggest challenges is regional barriers. Information is missing from municipality to municipality, which makes the services slower or even unattainable. We visualized the resources as a blueprint template, which helped participants in the rehabilitation program share the information among the professionals, and through that, to perceive the healthcare-related service ecosystems of municipalities. In the service ecosystem levels devised by Beirao et al. (2017), the resource blueprint is linked to the micro and meso levels in this research. At the micro level, professionals inside the hospital shared knowledge and information, and at the meso level, professionals in other hospitals created an interaction and communicated together. The blueprint is a useful tool for managing complexity (Polaine et al., 2013), and therefore, the blueprint visualization as a concretizing tool amasses different data, knowledge, service processes, and the district’s ecosystems for everyone to view. Here, the resource blueprint was done at the beginning of the development project, and it was laborious but definitely required at the starting point. The information and knowledge were finally reachable and understandable, which helped not only during the development but also later to understand what service design tools and methods the service designer can bring to the development. As Vetterli and Scherrer (2019)

stressed, patient-centered innovations are difficult to reach for because the resources are limited and there is no consistent understanding of the current situation in organizations. The resource blueprint supports the structuring of these situations.

The role of service design workshops was seen as a way to bring professionals “finally” together and, through design methods, to discuss and develop the health-related processes. As described in the second case study of sub-study I, the healthcare professionals saw the great value of having sufficient time to get to know each other and discuss among themselves. Although they might know each other by name and might also actively work together, for example, via phone or email, they may never have met face-to-face. The professionals from the rehabilitation field were curious to know more about the services, processes, and the entire district’s ecosystems as well as the resources and how these were distributed in the municipalities. In sub-study I, we discovered that workshops are not only a great platform for meeting people, but they also generate value for further development projects and increase motivation for service innovations.

Workshops as a co-design platform are also crucial when developing healthcare processes across municipalities, when it is crucial to foster trust, clear communication, and familiarity with other professionals. Here, the role of the service designer is particularly important for achieving equal, high-quality, and creative cooperation.