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Driving Change in Complex Social Systems: How to Design Healthcare Pathways

Published online by Cambridge University Press:  26 May 2022

A. Feldman ,
F. Patou  and
A. Maier
A. Feldman*
Affiliation:
Technical University of Denmark, Denmark
F. Patou
Affiliation:
Oticon Medical, Denmark
A. Maier
Affiliation:
Technical University of Denmark, Denmark University of Strathclyde, United Kingdom
*
[email protected]

Abstract

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How does change occur in healthcare settings? In this paper, we take a design-based approach to healthcare research. From researcher-patient interactions to information sharing between practitioners, we examine how clinical research can mediate a change of routines and illuminate potential new system structures. Using a hospital-based cognitive care clinic as an example, we demonstrate how the inclusion of new actors, tools and resources was able to shed light on the prevalence of hearing loss among mild cognitive impairment (MCI) patients and lay the framework for new care pathways.

Keywords

healthcare designcomplex systemshuman behaviourhearing carecognitive decline
Type
Article
Information
Proceedings of the Design Society , Volume 2: DESIGN2022 , May 2022 , pp. 1263 - 1272
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
The Author(s), 2022.

References

Akeroyd, M. A. (2009) ‘Are individual differences in speech reception related to individual differences in cognitive ability? A survey of twenty experimental studies with normal and hearing-impaired adults’, 10.1080/14992020802301142. Taylor & Francis, 47(SUPPL. 2). https://dx.doi.org/10.1080/14992020802301142.CrossRefGoogle Scholar
Balogh, E. P., Miller, B. T. and Ball, J. R. (2016) Improving diagnosis in health care. Washington, DC: The National Academies Press. https://dx.doi.org/10.17226/21794.Google Scholar
Craig, P. et al. . (2008) ‘Developing and evaluating complex interventions: new guidance’, BMJ (Clinical research ed.), 337, p. a1655. https://dx.doi.org/10.1136/bmj.a1655.Google Scholar
Cresswell, K. M., Worth, A. and Sheikh, A. (2010) ‘Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare’, BMC Medical Informatics and Decision Making 2010 10:1. BioMed Central, 10(1), pp. 1–11. https://dx.doi.org/10.1186/1472-6947-10-67.Google ScholarPubMed
Cropley, A. (2010) ‘In praise of convergent thinking’, Creativity Research Journal, 18(3), pp. 391–404. https://dx.doi.org/10.1207/S15326934CRJ1803_13.CrossRefGoogle Scholar
Doolin, D. B. and Lowe, D. A. (2002) ‘To reveal is to critique: Actor–Network Theory and critical information systems research’, Journal of Information Technology. SAGE PublicationsSage UK: London, England, 17(2), pp. 69–78. https://dx.doi.org/10.1080/02683960210145986.CrossRefGoogle Scholar
Feldman, A. et al. . (2020) Clinical Trial Registration of ‘Listen Carefully: An Exploratory Study of the Association Between Listening Effort and Cognitive Function’. Available at: https://clinicaltrials.gov/ct2/show/NCT04593290?term=hearing.Google Scholar
Feldman, A. N., Patou, F. and Maier, A. (2020) ‘From evidence to implementation: How systems design can foresee complex healthcare interventions’, Proceedings of the Design Society: DESIGN Conference. Cambridge University Press, 1, pp. 1891–1900. https://dx.doi.org/10.1017/dsd.2020.135.Google Scholar
Feldman, A. et al. . (2022). Listen Carefully protocol: an exploratory case–control study of the association between listening effort and cognitive function. BMJ Open, 12(3), e051109. 10.1136/BMJOPEN-2021-051109Google ScholarPubMed
Feldman, M. S. and Pentland, B. T. (2003) ‘Reconceptualizing organizational routines as a source of flexibility and change’, Administrative Science Quarterly. Johnson School at Cornell University, 48(1), pp. 94–118. https://dx.doi.org/10.2307/3556620.Google Scholar
Greenhalgh, T. (2008) ‘Role of routines in collaborative work in healthcare organisations’, BMJ. British Medical Journal Publishing Group, 337(7681), pp. 1269–1271. https://dx.doi.org/10.1136/BMJ.A2448.Google ScholarPubMed
Halpin, C. F., Iezzoni, L. I. and Rauch, S. (2009) ‘Medical record documentation of patients’ hearing loss by physicians’, Journal of General Internal Medicine. Springer, 24(4), p. 517. https://dx.doi.org/10.1007/S11606-009-0911-2.Google Scholar
Hawe, P., Shiell, A. and Riley, T. (2009) ‘Theorising interventions as events in systems’, in American Journal of Community Psychology, pp. 267–276. https://dx.doi.org/10.1007/s10464-009-9229-9.Google Scholar
Humes, L. E. (2019) ‘Examining the validity of the world health organization's long-standing hearing impairment grading system for unaided communication in age-related hearing loss’, American Journal of Audiology. American Speech-Language-Hearing Association, 28(3S), pp. 810–818. https://dx.doi.org/10.1044/2018_AJA-HEAL18-18-0155.Google Scholar
Organization, International Standards (2017) ISO - ISO 7029:2017 - Acoustics — Statistical distribution of hearing thresholds related to age and gender. Available at: https://www.iso.org/standard/42916.html.Google Scholar
Jayakody, D. M. P. et al. . (2018) ‘A novel study on association between untreated hearing loss and cognitive functions of older adults: Baseline non-verbal cognitive assessment results’, Clinical Otolaryngology. Blackwell Publishing Ltd, 43(1), pp. 182–191. https://dx.doi.org/10.1111/coa.12937.Google Scholar
Jones, P. H. (2014) ‘Systemic design principles for complex social systems’, in Metcalf, G. S. (ed.) Translational Systems Sciences. 1st edn. Springer, Tokyo, pp. 91–128. https://dx.doi.org/10.1007/978-4-431-54478-4_4.Google Scholar
Keshavarz, N. et al. . (2010) ‘Schools as social complex adaptive systems: a new way to understand the challenges of introducing the health promoting schools concept’, Social science & medicine (1982). Soc Sci Med, 70(10), pp. 1467–1474. https://dx.doi.org/10.1016/J.SOCSCIMED.2010.01.034.CrossRefGoogle ScholarPubMed
Law, J. (1992) ‘Notes on the theory of the actor-network: Ordering, strategy, and heterogeneity’, Systems Practice, 5(4), pp. 379–393. https://dx.doi.org/10.1007/BF01059830.CrossRefGoogle Scholar
Lin, F. R. et al. . (2013) ‘Hearing loss and cognitive decline in older adults.’, JAMA Internal Medicine. NIH Public Access, 173(4), pp. 293–9. https://dx.doi.org/10.1001/jamainternmed.2013.1868.Google ScholarPubMed
Lin, F. R. and Albert, M. (2014) ‘Hearing loss and dementia - who is listening?’, Aging & Mental Health, 18(6), pp. 671–673. https://dx.doi.org/10.1080/13607863.2014.915924.CrossRefGoogle ScholarPubMed
Livingston, G. et al. . (2017) ‘Dementia prevention, intervention, and care.’, Lancet (London, England), 390(10113), pp. 2673–2734. https://dx.doi.org/10.1016/S0140-6736(17)31363-6.Google Scholar
Livingston, G. et al. . (2020) ‘Dementia prevention, intervention, and care: 2020 report of the Lancet Commission’, The Lancet. Lancet Publishing Group, pp. 413–446. https://dx.doi.org/10.1016/S0140-6736(20)30367-6.Google Scholar
McLean, C. and Hassard, J. (2004) ‘Symmetrical absence/symmetrical absurdity: critical notes on the production of actor-network accounts’, Journal of Management Studies. John Wiley & Sons, Ltd, 41(3), pp. 493–519. https://dx.doi.org/10.1111/J.1467-6486.2004.00442.X.CrossRefGoogle Scholar
Moore, G. F. et al. . (2015) ‘Process evaluation of complex interventions: Medical Research Council guidance’, BMJ (Online). BMJ Publishing Group, 350. https://dx.doi.org/10.1136/bmj.h1258.Google ScholarPubMed
Moore, G. F. et al. . (2019) ‘From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation.’, Evaluation (London, England: 1995). SAGE Publications Ltd, 25(1), pp. 23–45. https://dx.doi.org/10.1177/1356389018803219.Google ScholarPubMed
Noël, G. (2017) ‘Health Design: Mapping current situations, envisioning next steps’, 10.1080/14606925.2017.1352746. Routledge, 20(sup1), pp. S2304–S2314. https://dx.doi.org/10.1080/14606925.2017.1352746.Google Scholar
Paton, B. and Dorst, K. (2011) ‘Briefing and reframing: A situated practice’, Design Studies. Elsevier, 32(6), pp. 573–587. https://dx.doi.org/10.1016/J.DESTUD.2011.07.002.Google Scholar
Peelle, J. E. (2018) ‘Listening effort: How the cognitive consequences of acoustic challenge are reflected in brain and behavior’, Ear and Hearing. Lippincott Williams and Wilkins, 39(2), pp. 204–214. https://dx.doi.org/10.1097/AUD.0000000000000494.Google ScholarPubMed
Pichora-Fuller, M. K. et al. . (2016) ‘Hearing impairment and cognitive energy: The framework for understanding effortful listening (FUEL)’, Ear & Hearing, 37(Supplement 1), pp. 5S–27S. https://dx.doi.org/10.1097/AUD.0000000000000312.Google Scholar
Rivard, L., Lehoux, P. and Hagemeister, N. (2021) ‘Articulating care and responsibility in design: A study on the reasoning processes guiding health innovators’ “care-making” practices’, Design Studies. Elsevier, 72, p. 100986. https://dx.doi.org/10.1016/J.DESTUD.2020.100986.CrossRefGoogle Scholar
Rouse, W. and Serban, N. (2014) Understanding and managing the complexity of healthcare. Boston: MIT Press.Google Scholar
Strauss, D. J. and Francis, A. L. (2017) ‘Toward a taxonomic model of attention in effortful listening’, Cognitive, Affective, & Behavioral Neuroscience 2017 17:4. Springer, 17(4), pp. 809–825. https://dx.doi.org/10.3758/S13415-017-0513-0.CrossRefGoogle Scholar
Sundhedsdatastyrelsen (2020) Sundhedsdatastyrelsens register for udvalgte kroniske sygdomme og psykiske lidelser. Available at: https://www.esundhed.dk/Registre/Udvalgte-kroniske-sygdomme-og-svaere-psykiske-lidelser (Accessed: 3 November 2021).Google Scholar
Sundhedsstyrelsen (2013) National klinisk retningslinje for udredning og behandling af demens. Copenhagen.Google Scholar
Sundhedsstyrelsen (2018) National klinisk retningslinje for diagnostik af mild cognitive impairment og demens. Copenhagen.Google Scholar
Thomas, K. and Farrell, M. B. (2015) ‘How to Write a Protocol: Part 1’, Journal of Nuclear Medicine Technology. Society of Nuclear Medicine, 43(1), pp. 1–7. https://dx.doi.org/10.2967/JNMT.114.147793.CrossRefGoogle ScholarPubMed
Thorpe, J. (2018) Engineering systems design in healthcare: Smart mobile and wearable technology for support and monitoring in dementia rehabilitation. Technical University of Denmark. Available at: https://orbit.dtu.dk/en/publications/engineering-systems-design-in-healthcare-smart-mobile-and-wearabl.Google Scholar
Thorpe, J. R. et al. . (2016) ‘Pervasive assistive technology for people with dementia: A UCD case’, Healthcare Technology Letters. Institution of Engineering and Technology, 3(4), pp. 297–302. https://dx.doi.org/10.1049/htl.2016.0057.Google ScholarPubMed
Uhlmann, R. F. et al. . (1989) ‘Relationship of hearing impairment to dementia and cognitive dysfunction in older adults.’, Journal of the American Medical Association, 261(13), pp. 1916–9. https://dx.doi.org/10.1001/jama.1989.03420130084028.CrossRefGoogle ScholarPubMed
World Health Organization (2021) Fact Sheet: Dementia. Available at: https://www.who.int/news-room/fact-sheets/detail/dementia (Accessed: 23 July 2019).Google Scholar
Yilmaz, S. and Daly, S. R. (2016) ‘Feedback in concept development: Comparing design disciplines’, Design Studies. Elsevier, 45, pp. 137–158. https://dx.doi.org/10.1016/J.DESTUD.2015.12.008.CrossRefGoogle Scholar