Co-design, organisational creativity and quality improvement in the healthcare sector: ‘designerly’ or ‘design-like’?
Co-design, organisational creativity and quality improvement in the healthcare sector: ‘designerly’ or ‘design-like’?
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医疗保健领域的协同设计、组织创造力和质量改进：“设计式”还是“类设计式”？
DOI：
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
A. Macdonald
中科院分区：
文献类型：
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作者：
G. Robert;A. Macdonald
在服务设计的许多领域，服务改进的科学方法与其评估之间存在明显的紧张关系。从他们各自的医疗服务设计经验，一个从设计背景，其他从组织社会学的角度来看，作者质疑的方式“证据”的概念化，并用于评估新的干预措施在医疗保健的相对有效性。在这样做的过程中，他们挑战了实证主义范式对质量改进运动的主导地位，这种范式以指导方针、记分卡、指标和测量系统为基础，提供了大量基于科学和技术的解决方案。这种模式通常不适合日常生活的复杂性，特别是在医疗保健组织中，“经过验证的”创新必须成为多个团队的常规实践的一部分，这些团队由具有非常不同的学科背景和等级地位的个人组成。作者认为，实施的挑战是由文化，语言和认知，身份和公民身份等较少关注的问题显着塑造。本文讨论了实施“差距”，并认为，设计为基础的社会科学的观点（与他们的共同起源）可以作出重大贡献，调和科学/艺术的鸿沟，以改善服务的好处。它探讨了设计师的定位，与医疗服务组织一起工作或在医疗服务组织内工作，以及他们随后需要与不同的测量系统和语言相关，以实现合法性，并将他们的方法融入日常实践。最后，从医疗保健方面所产生的问题和论点进行了讨论，其更广泛的价值和相关领域的服务设计作为一个整体。
Across many areas of Service Design a clear tension is found between a scientific approach to service improvement and its evaluation. Drawing from their respective healthcare service design experiences, one from a design background, the other from an organisational sociology perspective, the authors question the way ‘evidence’ is conceptualised and used to assess the relative effectiveness of new interventions within healthcare. In doing so, they challenge the domination of the quality improvement movement by a positivist paradigm with its plethora of scientific and technology-based solutions based on guidelines, scorecards, metrics and measurement systems. This paradigm often does not sit comfortably with the complexities of daily life, particularly within healthcare organisations where ‘proven’ innovations must become part of the routine practice of multiple teams comprising individuals with very different disciplinary backgrounds and hierarchical status. The authors argue that the implementation challenge is significantly shaped by less well-attended issues such as culture, language and cognition, identity and citizenship. This essay addresses the implementation ‘gap’, and argues that design-based and social science perspectives (with their common origins) can make a significant contribution to reconciling the science/art divide to the benefit of service improvement. It explores the positioning of designers in relation to working alongside or within healthcare service organisations and their consequent need to relate to different measurement systems and language to achieve legitimacy and see their approaches assimilated into routine practice. Finally, the issues and arguments arising from the healthcare context are discussed for their wider value and relevance to the field of Service Design as a whole.