Design In Practice

Flexibility and change for healthcare service providers

18 month research project as part of an EPSRC funded innovation centred called HACIRIC (Health and Care Infrastructure Research and Innovation Centre).

The aim of the Design in Practice project is to investigate how GP practices are currently implementing the Practice Based Commissioning (PBC) framework, how they apply their knowledge into the design of new health and care service models and facilities and what creative and/or design skills could support this new role to make it more effective.

Project Context

Design In Practice

The research project has investigated the Practice Based Commissioning (PBC) framework focusing on the North West of England. Our work has been conducted, in particular, at three main levels:

  1. NW Strategic Health Authority, where we examined how PBC has been implemented with a focus on the diversity of models of governance, support and collaboration;
  2. PBC groups: three case studies of how PBC groups re-design care pathways in practice, mapping examples of their service redesign and commissioning processes;
  3. Medical Practice level, case study of one large GP practice, investigating how clinicians re-design services as part of their daily activities, through participating in their meetings and conducting interviews and short design interventions.

Through these investigations, interpreting PBC activities as a co-design process, the team sought to understand if and how design, and other creative methods and tools drawn from design, could support commissioners’ activities to provide a deeper understanding of the applicability of ‘design thinking’ as a means of facilitating innovation, and developing interdisciplinary methods of participatory design.

Project findings

Key issues related to PBC, highlighted by this project include:

a) difficulties associated with relationships between PCTs and PBC such as: lack of clarity over roles and responsibilities of PBC within PCTs; mistrust between hospital managers (particularly financial managers) and GPs; perceptions of poor support from PCTs and excessive bureaucracy associated with PBC business cases; poor data provision impeding development of  commissioning projects;  

b) difficulties associated with lack of motivation and engagement of ‘rank and file’ GPs in PBC such as: lack of realistic and effective incentives to motivate clinicians to become involved in PBC; a perception that time devoted to PBC is not adequately rewarded through PBC frameworks; concerns related to practice workload and continuity of care for patients; lack of confidence in ability to analyse data and produce business cases

c) difficulties associated with articulating a common local vision for healthcare which can result from conflicts of interest between PBC groups, PCTs representing primary care and the secondary care or Foundation Trust system

PBC has initiated a cultural shift toward a more collaborative, integrated and community centred commissioning of care, but it will need significant infrastructural changes and further experimentation to reduce barriers to collaboration, enhance integration of provision and properly engage with the public. To support this transformation, design can supply tools and methods developed in co-design and transformation design projects.

Project recommendations

It is proposed that, instead of focusing exclusively on GP responsibility for commissioning, the focus should be on the broader communities that could be involved in commissioning (communities of co-creation) as an integral part of the consortia or federations, and not only as a point of reference for individual projects. In addition the narrow focus on redesign of individual disease pathways might profit from an expanded approach involving development of a wider ‘scenario for change’ that considers health and wellbeing at its centre. A shift from a ‘GP centred commissioning’ to ‘community centred commissioning’ recognises the key role of GP consortia as facilitators (together with local authorities) of commissioning networks, but focuses on co-creation as main strategy for service innovation.

Project Team

SangiorgiSangiorgi Daniela Sangiorgi Service Design, Design for Public Services, Service Innovation
CarrCarr Valerie Carr Design for health and wellbeing, therapeutic environments, workplace design, post occupancy evaluation, community engagement, design for social innovation, codesign
CooperCooper Rachel Cooper Design Management, Design Policy, Design Thinking, Urban Design, Urban Sustainability, Socially Responsible Design, Design Against Crime, Design & Manufacture
JungingerJunginger Sabine Junginger Design in the Organization, Design and Change, Design Management, Design Thinking, Human-Centered Product Development, Design Theory
BüscherBüscher Monika Büscher Sociology / Anthropology / Cultural studies of mobilities, Technology (futures), Video Ethnography and Design, Ethnomethodological studies
No picture available Karine Freire Prof. at Universidade do Vale do Rio dos Sinos

Partners / Funders


Service Prototyping Seminar

Event7 years and 10 days ago

5th of October 2012, Aalto University, Helsinki

Seminar part of Designing Services course at the Department of Design at Aalto University Arts Design and Architecture.

As part of my 1 month visit to Encore team in Aalto University (Helsinki), I participated to a 1day seminar...Read full update

Presentation of "Design in Practice" project

Presentation of "Design in Practice" project

Presentation of "Design in Practice" project at Service Design Thinks Leeds 04

Few times a year Kathryn Grace (KGBD: Consultancy) organises an evening with guests to talk about Service Design. The 25th of October I presented results from the project "Design in Practice". Really...Read full update

Integrating Evidence-Based Design and Experience-Based Approaches in Healthcare Service Design

OutcomeJournal Paper

Health Environments Research and Design Journal (Summer 2011) Objective: To investigate the connections between, and respective contributions of, evidence-based and experience-based methods in the redesign of healthcare services. ...More information

Commissioning and Design event

Event8 years, 8 months and 7 days ago

8th of February 2011, Design Council, London

Event bringing together Service Designers and GPs to exchange views and practices related to the newly developed programme of GP Commissioning

‘GP Commissioning and Design’ was a half-day event that brought together Service...Read full update

Designing Spaces for Creative Collaboration and Co-Design

Event8 years, 6 months and 14 days ago
Designing Spaces for Creative Collaboration and Co-Design

4th of April 2011, Storey Creative Industries Centre

The Designing Spaces for Creative Collaboration and Co-design workshop brought together a multidisciplinary group of designers, designer makers and craftspeople to spend a half day within the shell of the 3rd floor ‘art school’...Read full update

Design in Practice final report

Design in Practice final report

This report summarises findings from our research project 'Design for flexibility and change with Healthcare Service Providers' focused on the implementation of Practice Based Commissioning in North West England.

This project, funded by the EPSRC research centre HACIRIC investigated existing...Read full update