Purpose

The purpose of this paper is to contribute knowledge concerning the dynamics and potential cultural tensions that occur when applying user involvement and design thinking (DT) for improving quality in a health-care setting.

Design/methodology/approach

This paper is based on a case study following a quality improvement (QI) project in a medium-sized Swedish county council in the field of somatic care. The project involved eight health-care professionals, one designer, four patients and two relatives. A multiple data collection method over a period of ten months was used. It included individual interviews, e-mail correspondence and observations of workshops that covered the QI project.

Findings

The result shows tensions between QI work and the daily clinical work of the participants. These tensions primarily concern the conflict between fast and slow processes, the problem of moving between different fields of knowledge, being a resource for the individual clinic and the system and the participants’ expectations and assumptions about roles and responsibilities in a QI project. Furthermore, these findings could be interpreted as signs of a development culture in the health-care context.

Practical implications

There are several practical implications. Among others, the insights can inspire how to approach and contextualize the current concepts, roles and methods of DT and user involvement so that they can be more easily understood and integrated into the existing culture and way of working in the health-care sector.

Originality/value

This study provides a unique insight into a case, trying to uncover what actually is going on and perhaps, why certain things are not happening at all, when user involvement and design practices are applied for improving health-care quality.

中文翻译：

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应用设计思维来提高医疗质量时的文化动力和紧张气氛

目的

本文的目的是提供有关在应用用户参与和设计思维（DT）来改善医疗保健环境中的质量时所发生的动态变化和潜在的文化张力的知识。

设计/方法/方法

本文基于一个案例研究，该案例是在瑞典中型县议会的躯体保健领域中的一项质量改进（QI）项目之后进行的。该项目涉及八名卫生保健专业人员，一名设计师，四名患者和两名亲戚。使用了十个月内的多种数据收集方法。它包括个人访谈，电子邮件通信以及对涵盖QI项目的研讨会的观察。

发现

结果表明，QI工作与参与者的日常临床工作之间存在紧张关系。这些紧张关系主要涉及快速和慢速流程之间的冲突，不同知识领域之间的转移问题，是各个诊所和系统的资源以及参与者对QI项目中角色和职责的期望和假设。此外，这些发现可以解释为在卫生保健背景下发展文化的标志。

实际影响

有一些实际的含义。除其他外，这些见解可以启发如何将DT的当前概念，角色和方法以及用户参与的方式和背景化，以便可以更轻松地理解它们并将其整合到卫生保健部门的现有文化和工作方式中。

创意/价值

这项研究提供了一个案例的独特见解，试图揭示实际发生的情况，以及当采用用户参与和设计实践来改善医疗质量时，为什么某些事情根本没有发生的原因。