Systemic Design for Sustainable Healthcare. Designing for the treatment of chronic diseases

Health systems are facing significant societal and organizational challenges that require enhancing their resilience and sustainability. Public expenditure on health care and long-term care is expected to increase: health systems are searching for new solutions to controlling spending, implementing the use of available technology and engaging patients in prevention and self-care. The transition toward more sustainable health systems is both delicate and complex, and it needs radical changes of perspective as regards the patients’ role and the holistic and multi-disciplinary approach to health care. Over the past years, interest in what is called “Sustainable Healthcare” has grown globally: there is no common definition, but all the approaches to this emerging domain focus on making health care environmentally, economically and socially viable. Although design could successfully address some crucial environmental issues of health care (from waste reduction to resource optimization), design research made almost no contribution to this field. The present work aims at investigating the role of design towards Sustainable Healthcare, to propose, through case study experience, a systemic vision of the topic. Specifically, the research addressed the environmental issues of chronic haemodialysis, a life-saving treatment for people suffering from Chronic Kidney Disease. Medical treatments imply significant challenges because of their technical and operational complexity, that is further complicated by strict regulations and the presence of several users. Design should address environmental sustainability in such a complex system while maintaining the focus on user-centred care. Traditional design approaches cannot tackle the complexity of health care; therefore, a holistic approach is needed. Systemic Design integrates systems thinking and human-centred design methodologies to support designers working on complex design projects in multi-stakeholder and multi-environment systems. The doctoral research is deeply rooted in the framework of Systemic Design, aiming at defining how design strategies can improve the environmental sustainability of medical products, services, and systems, considering its close relationship with the social (people empowerment) and economic (feasibility) aspects. The first part of the research focused on the definition of all the items which make up the system, and the users that directly or indirectly interact with them. Four system items have been identified: products (packaging, disposables, devices), equipment (dialysis machine), treatment (haemodialysis as a whole) and local environment (policy and management strategies). In the second part different approaches, borrowed from sustainable design and human-centred design, have been combined to analyse each item. In order to establish a general frame, three different dialysis units and hospitals based in different European countries (Italy, Sweden, Denmark) were compared. This comprehensive analysis allowed to set specific guidelines for dialysis products, equipment, and treatment. The comparison of three international case studies highlighted how design should work on product and equipment to improve environmental sustainability on a global scale while addressing local systems and their specific needs to improve sustainability on a local level. The outcome of the research is a set of design strategies for the healthcare sector that take into account the technical, operational, social and environmental requirements of chronic treatments. This final result aims at providing a practical tool for designers and health stakeholders to address the design of new solutions for Sustainable Healthcare, considering the needs of direct and indirect users.