Background: The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. Methods. Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. Results: Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. Conclusions: This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.@en

Diagrammatic representations, such as process mapping and care pathways, have been often used for service evaluation and improvement in healthcare. While a broad range of diagrammatic representations exist, their application in healthcare has been very limited. There is a lack of understanding about how and which diagrams could be usable and useful to health workers. In this study, ten mental health workers were asked to discuss positive and negative issues around their service delivery using one or two diagrams of their choice out of seven different diagrams representing their service: care pathway diagram; organisation diagram; communication diagram; service blueprint; patient state transition diagram; free form diagram; geographic map. Their interactions with diagrams were video-taped for analysis. The patient state transition diagram was the most popular choice in spite of relatively low previous familiarity. The overall findings provided insight into a better use of diagrams in healthcare.@en