Medical education has traditionally focused on mastering biomedical knowledge, clinical skills, and professionalism. Yet it remains poorly equipped to prepare doctors for the complex, rapidly changing health systems they will work in. Despite repeated calls for transformative learning, progress in teaching system innovation has been limited. Current curricula produce clinicians adept at treating disease but often underprepared to address system failures or contribute to organizational change. Embedding patient-centered innovation within training may help address this gap. This approach integrates design thinking, value-based health care, and co-design with patients to cultivate the metacompetence required to engage with system change. Emerging examples suggest that innovation education is most effective when integrated within existing activities such as quality improvement initiatives, multidisciplinary collaboration, and protected time for improvement work. Teaching these principles early may help normalize innovation as an integral component of clinical practice rather than a peripheral activity. Lessons from the successful integration of communication skills and ethics into medical curricula demonstrate that such cultural shifts are possible. Practical approaches may include incorporating design-thinking exercises, patient co-creation activities, and innovation projects alongside existing quality improvement and leadership programs. Reframing innovation as part of professional responsibility may empower clinicians to act as catalysts for system improvement. From anatomy to innovation, medical education must continue to evolve, preparing doctors not only to treat patients but also to engage with the systems that shape health care delivery.

Health innovation and entrepreneurship are increasingly essential for addressing the mounting challenges of global healthcare systems. This paper presents a hybrid, project-based learning model implemented in the HM Munich University of Applied Sciences (Health Entrepreneurship Seminar. Drawing inspiration from the Lean Startup methodology, the course integrates interdisciplinary teaching teams, a flipped classroom approach, structured coaching, and active industry engagement. Data collected over eight iterations involving 307 students demonstrate that this approach enhances student engagement, interdisciplinary collaboration, and practical problem-solving skills. Nonetheless, challenges such as high workload intensity, team formation dynamics, and limited post-course venture continuation remain. These findings contribute to refining entrepreneurship education in highly regulated sectors like healthcare.

Background: Digital support for adolescent and young adult cancer survivors is fragmented and results in lacking a reliable overview of support services available to them. Collaborative design promises to integrate perspectives of diverse stakeholders and could help to develop an online platform, which increases access and has a long-term perspective. However, it has not yet been explored how collaborative design can be used more strategically to develop an online platform with these aims.

Objective: This study aimed to explore how a collaborative design approach could be applied to develop an online platform for adolescent and young adult cancer survivors, focusing on three key objectives: integrating existing resources, improving accessibility, and ensuring long-term financial sustainability.

Methods: In this action research study, we reflect on a collaborative design process to develop an online platform for adolescent and young adult cancer survivors. A quantitative questionnaire was sent out to adolescent and young adult cancer survivors and health care professionals. Stakeholders were actively engaged in stakeholder consensus meetings, and project management was carried out through monthly design meetings to facilitate coordination and decision-making of the development of the platform. Afterwards, a focus group was conducted among the project group to evaluate the collaborative design approach, analyzed using an inductive thematic approach.

Results: Through the collaborative design approach, several Dutch organizations collaborated to develop, enhance, and combine online services for adolescent and young adult cancer survivors and their relatives. A dedicated online "young and cancer" platform for adolescent and young adult cancer survivors was developed, which integrates different types of information tools and supportive interactive elements from different sources. The integration of different resources into one platform improves the access and user experience of adolescent and young adult cancer survivors when it comes to online support. Through the reflection about the collaborative process, three themes were identified: (1) value of stakeholder participation; (2) conditions for working with adolescents and young adults with lived experience; and (3) collaboration between adolescents and young adults with lived experience and professionals from different backgrounds and organizations.

Conclusions: A collaborative design approach can be used to efficiently develop an online platform for adolescent and young adult cancer survivors. The collaboration among professionals, including online developers, researchers, and adolescents and young adults with lived experience facilitated a direct translation of insights into the platform, while the support of the national cancer platform provides long-term sustainability. This study highlights the importance of strategic stakeholder selection and the intense involvement of stakeholders through a collaborative design approach.

We are at a pivotal moment. The future of healthcare innovation can no longer be defined solely by technological advancement or institutional efficiency. While digital tools, therapies and platforms continue to evolve, they must be embedded within a broader transformation, one that places the human experience at the centre of how we design, deliver and evaluate care. This patient-centred renaissance calls for the integration of both horizontal and vertical forms of knowledge: connecting services across the care continuum. From the literature and our experience, an unexpected byproduct of co-production with patients in health innovation and care delivery is a reduction in complaints, litigation and a significant increase in treatment compliance.¹⁹ This results in a reduction in misdiagnosis,²⁰ over investigation and treatment, giving a reduction in costs in the overall healthcare economy. Empowering patients as innovators is not a symbolic gesture. It is a practical imperative if we are to create pathways that are not only clinically effective but also meaningful and responsive. Fragmented systems that overwhelm or disorient must give way to cohesive and compassionate journeys, designed with and for the people they are meant to serve. This is a call to rethink not only what we innovate, but how and with whom. Let us commit to building systems that honour not just the science of healing, but the individuals we treat. In doing so, we move closer to a future where innovation and empathy are no longer treated as separate domains, but as interdependent pillars of truly transformative care.

Transformative research is a broad and loosely connected family of research disciplines and approaches, with the explicit normative ambition to fundamentally question the status quo, change the dominant structures, and support just sustainability transitions by working collaboratively with society. When engaging in such science-practice collaborations for transformative change in society, researchers experience ethical dilemmas. Amongst others, they must decide, what is worthwhile to be researched, whose reality is privileged, and whose knowledge is included. Yet, current institutionalised ethical standards, which largely follow the tradition of medical ethics, are insufficient to guide transformative researchers in navigating such dilemmas. In addressing this vacuum, the research community has started to develop peer guidance on what constitutes morally good behaviour. These formal and informal guidelines offer a repertoire to explain and justify positions and decisions. However, they are only helpful when they have become a part of researchers’ practical knowledge ‘in situ’. By focusing on situated research practices, the article addresses the need to develop an attitude of leaning into the uncertainty around what morally good behaviour constitutes. It also highlights the significance of combining this attitude with a critical reflexive practice both individually and collaboratively for answering questions around ‘how to’ as well as ‘what is the right thing to do’. Using a collaborative autoethnographic approach, the authors of this paper share their own ethical dilemmas in doing transformative research, discuss those, and relate them to a practical heuristic encompassing axiological, ontological, and epistemological considerations. The aim is to support building practical wisdom for the broader research community about how to navigate ethical questions arising in transformative research practice.

Background: Diverse knowledge and ways of thinking are claimed to be important when involving stakeholders such as patients, care professionals, and care managers in a generative co-design (GCD) process. However, this claim is rather general and has not been operationalized; therefore, the influence of various stakeholders on the GCD process has not been empirically tested.

Objective: In this study, we aimed to take the first step in assessing stakeholder diversity by formulating a procedure to assemble a group of diverse stakeholders and test its influence in a GCD process.

Methods: To test the procedure and assess its influence on the GCD process, a case was selected involving a foundation that planned to develop a serious game to help people with cancer return to work. The procedure for assembling a stakeholder group involves snowball sampling and individual interviews, leading to the formation of 2 groups of stakeholders. Thirteen people were identified through snowball sampling, and they were briefly interviewed to assess their knowledge, inference experience, and communication skills. Two diverse stakeholder groups were formed, with one more potent than the other. The influence of both stakeholder groups on the GCD process was qualitatively assessed by comparing the knowledge output and related knowledge processing in 2 identical GCD workshops.

Results: Our hypothesis on diverse stakeholders was confirmed, although it also appeared that merely assessing the professional background of stakeholders was not sufficient to reach the full potential of the GCD process. The more potently diverse group had a stronger influence on knowledge output and knowledge processing, resulting in a more comprehensive problem definition and more precisely described solutions. In the less potently diverse group, none of the stakeholders had experience with abduction-2 inferencing, and this did not emerge in the GCD process, suggesting that at least one stakeholder should have previous abduction-2 experience.

Conclusions: A procedure to assemble a stakeholder group with specific criteria to assess the diversity of knowledge, ways of thinking, and communication can improve the potential of the GCD process and the resulting digital health.

Purpose: Participatory design (PD) is a collective creative design process involving designers and nondesigners. There is limited reporting on the experience of using PD for adolescent and young adult (AYA) care. This study summarizes lessons from employing PD to develop care for AYAs with cancer. Methods: A qualitative multiple-case study method was conducted of three PD processes addressing food (FfC), intimacy and sexuality (I&S), and integrative medicine (IM) in caring for AYAs with cancer. Results: Local key stakeholders, who were exposed to a problem and had not been successful at solving it individually, were recruited to ‘‘dream’’ together. Through this synergy, a shared understanding of the problem and a joint mission emerged to find a solution. PD tools were used to develop a problem definition. An open mind and explorative research helped to understand the problems, and stakeholders were managed such that idea-sharing and learning were enabled. Designers translated ideas into prototypes. The PD process was prolonged due to the hierarchical hospital environment, business considerations, and additionally required evidence. The FfC program produced an effective new food service for the whole hospital. The I&S initiative developed a podcast, two articles, and a prototype website. The IM project developed a pilot study. Conclusions: For a PD process to successfully develop care for AYAs, one needs to use designers and skilled people, PD tools, and an open-ended approach to visualize and materialize new forms of care. Furthermore, recruitment and facilitation techniques help leverage knowledge and create a synergy in a democratic environment between stakeholders.

At the age of fourteen, Arthur Anderson, has trouble breathing. His mom takes him to the hospital. Soon after being diagnosed with a terrible life threatening disease, he discovers he faces far worse battles with darkness and demons. As this continues to torment him, Arthur encounters wise teachers.They show Arthur a path of light through the darkness, but this is not just any path. This path leads him to ask fundamental questions about life, the universe, everything. The wise teachers bestow upon him a terrible quest born from ancient secrets.

During the coronavirus disease (COVID-19) pandemic, cardiologists have attempted to minimize risks to their patients by using telehealth to provide continuing care. Rapid implementation of video consultations in outpatient clinics for patients with heart disease can be challenging. We employed a design thinking tool called a customer journey to explore challenges and opportunities when using video communication software in the cardiology department of a regional hospital. Interviews were conducted with 5 patients with implanted devices, a nurse, an information technology manager and two cardiologists. Three lessons were identified based on these challenges and opportunities. Attention should be given to the ease of use of the technology, the meeting features, and the establishment of the connection between the cardiologist and the patient. Further, facilitating the role of an assistant (or virtual assistant) with the video consultation software who can manage the telehealth process may improve the success of video consultations. Employing design thinking to implement video consultations in cardiology and to further implement telehealth is crucial to build a resilient health care system that can address urgent needs beyond the COVID-19 pandemic.

Background: Generative participatory design (PD) may help in developing electronic health (eHealth) interventions. PD is characterized by the involvement of all stakeholders in creative activities. This is different from the traditional user-centered design, where users are less involved. When looking at PD from a research through design perspective, it is important to summarize the reasons for choosing a certain form of generative PD to further develop its methodology. However, the scientific literature is currently unclear about which forms of PD are used to develop eHealth and which arguments are used to substantiate the decision to use a certain form of generative PD.

Objective: This study aimed to explore the reporting and substantiation of generative PD methodologies in empirical eHealth studies published in scientific journals to further develop PD methodology in the field of eHealth.

Methods: A systematic literature review following the Cochrane guidelines was conducted in several databases (EMBASE, MEDLINE Ovid, Web of Science, and CINAHL EBSCOhost). Data were extracted on the recruitment and management of stakeholders, the use of tools, and the use of outcome measures.

Results: Of the 3131 studies initially identified, 69 were selected for qualitative synthesis. The reporting was very variable, depending to a large extent on whether the study stated that reporting on the PD process was a major aim. The different levels of reporting and substantiation of the choices of a recruitment strategy, stakeholder management, and tools and outcome measures are presented. Only a few authors explicitly used arguments directly related to PD guiding principles such as democratic, mutual learning, tacit and latent knowledge, and collective creativity. Even though PD principles were not always explicitly discussed in the method descriptions of the studies, they were implicitly present, mostly in the descriptions of the use of PD tools. The arguments used to substantiate the choices made in stakeholder management, PD tools, and the type of outcome measures adopted point to the involvement of PD principles.

Conclusions: Studies that have used a PD research methodology to develop eHealth primarily substantiate the choice of tools made and much less the use of stakeholders and outcome measures.