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.