The healthcare sector is facing significant challenges that require a systems approach, resulting in a rapid growth in the application of systems approaches in healthcare since the beginning of the 21st century. Consequently, healthcare practitioners and policymakers now desire to understand the evidence-base for the approach, but little evidence of the kind desired exists. This paper is a first step in conducting a narrative review of the application of systems approaches in healthcare based on a systematic review of the academic and grey literature. First, the emergence of the approach in healthcare is explored. Second, specific examples of applications of systems approaches in healthcare are examined to identify any missing elements in current practice. Third, fourteen reviews of the approach in healthcare published in the last ten years are analysed. The results suggest that the use of the approach in healthcare will most likely continue to increase, however, significant work remains for the design and systems community to demonstrate the effectiveness of systems approaches, specifically in providing convincing measures of impact on patient and service outcomes.

Current healthcare delivery challenges are multi-faceted, requiring multiple perspectives to be addressed using a systems approach. However, a significant amount of healthcare systems design research work is carried out within single disciplines or at best a few disciplines working together. There appears to be little deliberate attempt to draw together a wide range of disciplines committed to working together to overcome differences and tackle some of the complex challenges in healthcare delivery. In this paper, we report on the initial outcomes of such an international initiative that, in the form of a workshop held at the University of Cambridge, brought together researchers and practitioners from a wide range of disciplines to explore the foundations of a community for Healthcare Systems Design Research and Practice.

Current risk identification practices applied to patient safety in healthcare are insufficient. The situation can be improved, however, by studying systems approaches broadly and successfully utilised in other safety-critical industries, such as aviation and chemical industries. To illustrate this, this paper first investigates current risk identification practices in the healthcare field, and then examines the potential of systems approaches. A systems-based approach, called the Risk Identification Framework (RID Framework), is then developed to enhance improvement in risk identification. Demonstrating the strengths of using multiple inputs and methods, the RID Framework helps to facilitate the proactive identification of new risks. In this study, the potential value of the RID Framework is discussed by examining its application and evaluation, as conducted in a real-world healthcare setting. Both the application and evaluation of the RID Framework indicate positive results, as well as the need for further research. Practitioner Summary: The findings in this study provide insights into how to make a better amalgamation of risk identification inputs to the safer design and more proactive risk management of healthcare delivery systems, which have been an increasing research interest amongst human factor professionals and ergonomists.

The paper describes an iterative development process used to understand the suitability of different inclusive design evaluation tools applied into design practices. At the end of this process, a tool named Inclusive Design Advisor was developed, combining data related to design features of small appliances with ergonomic task demands, anthropometric data and exclusion data. When auditing a new design the tool examines the exclusion that each design feature can cause, followed by objective recommendations directly related to its features. Interactively, it allows designers or clients to balance design changes with the exclusion caused. It presents the type of information that enables designers and clients to discuss user needs and make more inclusive design decisions.

A challenging area of healthcare delivery in the UK is mental health. There is a growing need to improve outcomes of care. This research is part of an ongoing study that brings Design and Systems Engineering approaches into mental health service design. The focus is on how to understand and describe the architecture of delivery systems. Results from earlier stages of the work, looking at the identification of system components, have been reported previously. In this paper, we report the findings from empirical work on understanding the nature of the relationships between system components.

We live in a post-WIMP world. The traditional Windows, Icons, Menus and Pointers of the PC graphical user interface are no longer present in many hand-held devices. There has been a dramatic rise in the use of smart phones in particular, with Apple selling their billionth iPhone in 2016. This trend in devices and the shift to touch interfaces has caused concern with regards to usability and has been described by some as a “usability crisis”. This alleged crisis is born out of a proliferation of product features combined with a trend towards minimalisation in user interface style. This means that user interface functions are potentially becoming less visible. The challenge is to try and quantify and understand what is happening with regards to UI visibility, which is deemed to be a critical component creating a usable interface. This paper demonstrates an approach to determining a “visibility score” for a product’s user interface. The approach is applied to the home screen of an iPhone. This produces a visibility score of less than 10% in other words over 90% of the functions available are not visible at the top level. Such a score needs to be treated with caution but can help inform the general debate as well as creating useful insights for the designers of products.

BACKGROUND: Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. OBJECTIVE: The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. METHODS: Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. RESULTS: The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. CONCLUSIONS: Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

Designing technology products that embrace the needs and capabilities of heterogeneous users leads not only to increased customer satisfaction and enhanced corporate social responsibility, but also better market penetration. Yet, achieving inclusion in today's pressured and fast-moving markets is not straight-forward. For a time, inaccessible and unusable design was solely seen as the fault of designers and a whole line of research was dedicated to pinpointing their frailties. More recently, it has become progressively more recognised that it is not necessarily designers' lack of awareness, or unwillingness, that results in sub-optimal design, but rather there are multi-faceted organisational factors at play that seldom provide an adequate environment in which inclusive products could be designed. Through literature review, a detailed audit of inclusivity practice in a large global company and ongoing research regarding quantification of cost-effectiveness of inclusive design, this paper discusses the overarching operational problems that prevent organisations from developing optimally inclusive products and offers best-practice principles for the future.

The paper discusses the challenges encountered defining suitable methods to test the hypothesis for research investigating inclusive design in the industry. It outlines the outcomes of an exploratory study with designers and clients in order to describe how the research hypothesis was formulated. The hypothesis considers the impact of information about inclusivity into the design decisions made by clients and designers during design meetings. The paper reflects on ways in which the hypothesis could be tested in order to preserve the scenario as closed as possible to the reality of the industrial process. It considers the advantages and the disadvantages of industrial and laboratory settings. The overall focus is to identify the setting and methods that would result in realistic answer to the research question. The paper concludes by proposing a scenario which could benefit from the current research context without affecting their applicability to design practice in industry.

Engineering change has grown steadily in prominence both as an important issue for industry and as an active academic research area. This paper provides a categorised overview and perspective on the published academic literature on engineering change. The aim is to give new researchers an understanding of the field's breadth and depth, as well as pointers towards additional information, and established researchers a non-dogmatic summary perspective on the work accomplished in this area. Change is defined as an alteration made to parts, drawings or software that have already been released during the product design process and life cycle, regardless of the scale or the type of the change. A change may encompass any modification to the form, fit and/or function.

The UK health service, which had been diagnosed to be seriously out of step with good design practice, has been recommended to obtain knowledge of design and risk management practice from other safety-critical industries. While these other industries have benefited from a broad range of systems modelling approaches, healthcare remains a long way behind. In order to investigate the healthcare-specific applicability of systems modelling approaches, this study identified 10 distinct methods through meta-model analysis. Healthcare workers' perception on 'ease of use' and 'usefulness' was then evaluated. The characterisation of the systems modelling methods showed that each method had particular capabilities to describe specific aspects of a complex system. However, the healthcare workers found that some of the methods, although potentially very useful, would be difficult to understand, particularly without prior experience. This study provides valuable insights into a better use of the systems modelling methods in healthcare. Statement of Relevance: The findings in this study provide insights into how to make a better use of various systems modelling approaches to the design and risk management of healthcare delivery systems, which have been a growing research interest among ergonomists and human factor professionals.

Many issues in design and design management have been explored by building models which capture the relationships between different aspects of the problem at hand. These models require computer support to construct and analyse. However, appropriate modelling tools can be time-consuming to develop in a research environment. Reflecting upon five design research projects, this paper proposes that such projects can be facilitated by recognising the iterative and tightly-coupled nature of research and tool development, and by attempting to minimise the effort of solution prototyping within this process. Our approach is enabled by a software platform which can be rapidly configured to implement many conceivable modelling approaches. This configurability is complemented by an emerging library of modelling and analysis approaches tailored to explore design process systems. The platform-based approach enables any mix of modelling concepts to be easily created. We propose it could thus help researchers to explore a wide range of questions without being constrained to existing conventions for modelling - or for model integration.