In Books

Design for Care

We Tried to Warn You

Team Design

Synthesis Maps from CanIMPACT | Mapping the clinical cancer system

The CanIMPACT project (Canadian Team to Improve Community-Based Cancer Care Along the Continuum) is a multidisciplinary pan-Canadian program studying how to improve cancer care to patients in the primary care setting. Funded by the Canadian Institutes of Health Research for 5 years (2013–2018, Grant no. 128272) the project was led by Dr. Eva Grunfeld, Director of Research at U Toronto’s Dept of Family and Community Medicine.  For the CanIMPACT synthesis map project, our sLab team (Jones, Smriti Shakdher, Prateeksha Singh).  Two synthesis maps were prepared to reflect the discovered insights from the multi-year investigation, a clinical system map and a patient-centred map informed by the CanIMPACT Patient Advisory Council. The resulting maps were published (a first for a system map method) in Current Oncology and presented at the first Canadian Partnership Against Cancer (CPAC) conference, and MedicineX 2017.

Jones, P.H., Shakdher, S. & Singh, P. (2017). Synthesis maps: Visual knowledge translation for the CanIMPACT clinical system and patient cancer journeys. Current Oncology, 24 (2), 129-134.

Synthesis mapping produces high-quality representations of insights drawn from research evidence,
It presents visual models of systemic patterns discovered through multidisciplinary observations, and
It communicates to stakeholders and interested observers the processes, interventions and possible strategies and policy interventions in a complex system.




















CanImpact Synthesis Map: Canadian Clinical System of Primary Care in the Cancer Continuum






















CanImpact Synthesis Map: Patient Experience of Primary Care in the Cancer Continuum
A Relationship-Centred View of Breast and Colorectal Cancer Survivorship

(PDF copies of both maps are available by selectness the image, (c) 2016 Strategic Innovation Lab.)

Studies from the CanIMPACT project have been published in the same issue as a special edition guest edited by Dr. Grunfeld. The summative workshop at which the maps were presented, with conclusions and recommendations, is found online at NLM and Current Oncology:

Discussion of the “two solitudes” or disconnected practices of primary care and oncology are described in Eva’s second article in the same issue:

The Current Oncology article presents a simplified summary of the design action research process we used in developing the synthesis maps in the CanIMPACT project. These steps would be representative of an evidence-driven approach, and while not all synthesis maps are models of system knowledge from evidence, it is a well-suited technique for a range of complex knowledge problems in healthcare, medicine, community and mental health, education, social policy, and other institutional and policy sectors.

  • Domain and Literature Review A scoping review of the CanIMPACT study and its references was conducted. Continuous searches informed emergent questions for representing mapping decisions.
  • Expert Interviews and Content Analysis, with Visual Notetaking. The CanIMPACT qualitative study, the Casebook survey of cancer initiatives, and administrative data substudy reports were analyzed, guided by interviews with study area leads.
  • Knowledge Synthesis to Design Maps in Stages In collaborative sessions, maps were hand-sketched to represent salient findings drawn from content analyses. Peer Critique of Electronic and Print Maps Structured critiques of the maps were held with the CanIMPACT and PAC experts at key stages of map development.
  • Iterative Map Design The clinical map was developed first, in stages that adhered to the method. The necessity for a patient-centred map was discovered during the peer critique step.


Soft Service Design: Interventions in Complex Social Determinants

Design for Health (2017)

Design for Health – Published by Routledge May 2017,   Edited by Emmanuel Tsekleves and Rachel Cooper (Editorial overview of book and chapters)

Chapter 3:  Soft Service Design around the Envelope of Healthcare (Peter Jones)

Better alternatives to improving population health have been sought by healthcare policymakers and the front-line clinicians who see patients in everyday care settings. While public health experts and primary care clinicians recognize the significant effects on health from social determinant factors they have limited tools for addressing these causal factors in their patient’s lives. Systemic improvements to a population’s social ecology are considerable challenges from within the “envelope” of a healthcare system. The service design challenge I propose and aim to answer is that of, can we better intervene outside of and around the envelope of the healthcare system?

In mental health and primary care contexts, we find that systemic factors and social determinants (such as environment, housing, social lifestyle, food accessibility) account for a significant proportion of presented conditions that are treated as mental illness. The primary care and mental health systems are not structured or funded to address social determinants – as they do vary in every micro-context. A community activation approach might be better aligned to community-level needs and cultures.

Social determinants are embedded in a community setting, are multi-causal and interrelated, have indeterminate risk, and are not typically perceived by individuals as health threats. A community’s population and traditional primary providers have few resources for intervening or changing source social causes and contributing factors that diminish individual well-being. Without addressing these social sources and determinants through channels other than insured care delivery, their pervasive influence will persist and will continue to be accommodated as effects in larger healthcare systems.

A systemic design approach developed from the theories of flourishing mental health and flourishing societies has been adapted to identify and guide supports for socializing collective health. Flourishing entails individual and family health, the movement toward “a good life,” and ultimately the sustainment of human and all life. Toward these ends we present a framework for community-centred approaches to facilitate flourishing through the design of soft services. Current cases in university campus mental wellness, and peer health coaching are developed as models for eliciting design principles and approaches that have been effective in interventions in the social systems surrounding practices of care, outside the envelope in which the healthcare system operates.

The chapter presents a summary of the ongoing OCADU studies conducted from 2012-2015 by Peter Jones and SFI graduate students Adam Starkman and Karen Oikonen. A brief article on the soft service design approach to mental health was previously published in the service design journal Touchpoint.

The 4C Journey Map model and method were developed in the mental health study and advanced and refined in conference workshops, including RSD4 (Banff) and the Delight 2015 conference in Portland. The shown here was developed in this study. The sketch presents a service system mapping model .

The Four C’s refer to the mapping and design for Context, Constraints, Cues, and Communications. (Care is unique to healthcare contexts and not all maps).

The model has been adapted and evaluated in recent OCADU research by new SFI graduate Jyotish Sonowal for his MRP study, the Hospital as  Flourishing Business.

I cannot do justice to Sonowal’s work in this short piece, so I will encourage those in healthcare service design to download and read his contributions to this developing area.  Jyotish started with a hospital-based study evaluating the (by now) well-known Flourishing Business Model (Canvas) for clinical service models in a regulated public hospital. He further develops the study to cover:

  • The application of the Flourishing canvas as a process for serious stakeholder conversations for sensemaking in advance of service design.
  • The bridging of new business model thinking to service modeling, presenting the clinical service in its functional complexity using the 4C Journey map process.
  • The proposal of service design tools for engagement across the large organizational context of the hospital. Sonowal describes how to adapt the early design discussions to the concrete contexts of hospital front line managers.

















4C Journey Map for soft service design / inside and outside the healthcare envelope. (Click for full image, (c) 2017 J. Sonowal)

RSD6 Symposium & Keynotes Announced

Relating Systems Thinking and Design 6

Held this year again at Oslo School of Architecture and Design (AHO)  October 18-20, 2017

The accepted keynotes for RSD6  promise an inspiring range of perspectives on the changes to design practice and education emerging from the demands of civilizational turbulence and continuous complexity of our services, systems and societies.  RSD6 holds a centre for inquiry into human and ecological flourishing, as relevant to the re-envisioning and redesign of business, policies, organizations and our own methods for design, including those methods for governing ourselves in modern civilization:


Lucy Kimbell

John Ehrenfeld

Toshiko Mori 

Richard Buchanan

Sabine Junginger

Karl Otto Ellefsen







Following two years in Canada, join us this year in Oslo as RSD returns to its home location for the RSD6 Symposium.  Early registration for the RSD6 symposium is now open.

Our theme this year encompasses the contexts for flourishing in democratic societies, and exploring the opportunities for systemic design in:

  • Democratic participation and policy innovation
  • Strongly sustainable business innovation
  • Flourishing communities
  • Design of architectures, settlements and built environments

These themes include the continuing topics of

  • Social impact in flourishing and change programs
  • Health and population wellness
  • Ecological design and bioregion development
  • Human-scaled and regional economies
  • Sociotechnical and technological systems
  • Other themes in Systemic Design


RSD5 Symposium Proceedings

Every year we publish the proceedings of the RSD Symposium as an Open Access online serial, following the conference, in a post-publication model allowing authors to gain feedback from participants and fold community insights into their publishable work.  The following RSD5 presentations have PDF decks, sketchnotes, and published articles now available. See the RSD5 site for papers, keynotes, and photographs.

Proceedings of Relating Systems Thinking and Design (RSD5) 2016 Symposium. Toronto, Canada, October 13-15, 2016.

Published by: Systemic Design Research Network        Toronto, Canada
ISSN 2371-8404 

Published Articles

All articles and abstracts are copyright (c) 2016 by the respective authors, unless stated otherwise.

Design for Public Value

  • Philippe Beaulieu-Brossard: US SOCOM Goes Google
  • Tareq Emtairah, Helen Avery and Khaldoon Mourad: Visioning Labs with displaced academics as a design strategy for sustainable post-conflict reconstruction
  • Bridget Malcolm, Mieke van der Bijl-Brouwer: Developing a systemic design practice to support an Australian government regulatory agency

Advanced Policy Design

  • Nenad Rava: Designing for policy and institutional change in governance
  • Silvia Barbero & Agnese Pallaro: Systemic Design & Policy Making: The Case of the Retrace Project
  • Karen Ingerslev & Trine Naldal: Citizens as Co-designers: Facilitating systemic change at the policy level

Process Innovation

  • Alex Ryan, Alexander Baumgardt & Paul Pangaro: Playing with Fire: Designing With and for tension in Groups
  • Fredrik Eive Refsli & Dino Karabeg: Enabling Systemic Transformations
  • Philippe Vandenbroeck & Kristel Van Ael: Codifying Systemic Design: A Toolkit
  • Gordon Rowland: Systemic Design as an Explanation of Powerful Learning Experience
  • Mieke van der Bijl-Brouwer: Human-Centred Design for Social Complex Service Systems
  • Allenna Leonard: The Viable System Model and Team Syntegrity process
  • David Ing & Susu Nousala: Curriculum Making for Trito Learning: Wayfaring into a meshwork of systems thinking

Service Design for Care and Wellness  

  • Katharine Zywert: Medicine in the Anthropocene: Modern Healthcare and the Transition to an Ecologically Viable Society
  • Peter Pennefather, West Suhanic, Katie Seaborn, & Deborah Fels: Eudaimonic Flourishment though Healthcare System Participation in Annotating Electronic Health Records
  • Vanessa Rodrigues & Josina Vink: Shaking up the Status Quo in the healthcare system 
  • Karen Oikonen, Paul Holyoke, Rizzi, Stephenson, & Sethi: The Reflection Room: Shifting from death-avoiding to death-discussing

Theory & Method

  • Birger Sevaldson: A Library of Systemic Relations
  • Manuela Aguirre, Natalia Agudelo, & Jonathan Romm: Facilitating generative emergence within large-scale networks
  • Mehdi Mozuni & Wolfgang Jonas: A Morphological Analysis tool for complex future-oriented scenarios
  • Joshua Bloom & Ahmed Ansari: Time and Transition
  • Jeremy Bowes & Peter Jones: Synthesis Maps: Systemic Design pedagogy, narrative, and intervention
  • Tim Tompson: Visualising project actor-networks with oral histories
  • David McKenzie, Darwin Muljono & Elizabeth B.-N. Sanders:  Collective dreaming in a virtual world: The first step
  • Thomas Wendt: Arational Design

Design for Sustainability and Flourishing

  • Swayang Das, Beda Prakash Das, Sushant Arya & Praveen Nahar: Democratizing Social Innovation: Establishing the platform of Internet of Things in India through Systemic design Thinking and Design
  • John Cassel: Permaculture Assessment: Finding reliable processes for assembling closed resource cycles and effective energy pathways
  • Joanna Boehnert: Mapping controversy in environmental communication
  • Sarah Tranum: Case Study: Using a systems design model to bring clean water to rural and slum communities in India

Design of Future Systems

  • Kimberley Peter & Michael Schaus: Understanding Bitcoin currency and Blockchain technology as a media system
  • Eleonora Fiore: Ethical challenges of the Internet of Things in the household environment
  • Carlos Teixeira & Laura Forlano: Digital manufacturing and the future of innovation systems in Chicago

System and Service Design

  • Eunki Chung: Designing Service Entanglements: Towards stakeholder-centered perspectives in design
  • Nourhan Hegazy, Prateeksha Singh, Christina Doyle & Caralyn Quan: Made-In-Canada system ecology: Towards a more sustainable garment industry
  • Perin Ruttonsha: Form follows meaning, meaning follows form: Surrendering the innocence of design

Design for Complexity

  • Evan Barba, Yasir Majeed and Christopher Miller: Hierarchy-in-flux: Co-evolving a distributed user interface for orbiting robots
  • Greg vanAlstyne & Robert Logan: Designing for Emergence : Integrating systems and design
  • Sine Celik, Jo Van Engelen, Han Brezet, Peter Joore & Linda Wauben: Managing Creativity: Oxymoron or necessity?