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What has engineering design to say about healthcare improvement?

  • P. John Clarkson (a1)


This paper builds on the author’s keynote address to the Design Society’s 21st International Conference on Engineering Design in 2017 and in doing so provides a personal perspective to the question of the title. It begins by describing the engineering experience of the author which led to an understanding of the importance of taking a systems approach to the development of engineering products and services. This is followed by reflections on the development of a research portfolio focused on the design of complex engineering systems, inclusive design and healthcare improvement. The paper then reports on the recent work of engineers, clinicians and healthcare leaders, who came together under the guidance of the author, to explore how an engineering systems approach could be described that might simultaneously meet the needs of patients, carers and healthcare staff. It discusses the challenges associated with the translation of this narrative description of a systems approach (What?) into a practical implementation guide or toolkit (How?), supported by evidence of its effective use in health and care improvement practice. Finally, the paper reflects on the lessons to be learned from this process and their possible repercussions for design research and the practice of design.

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Armitt, J. 2011 Engineering the Olympics: The 2011 Lloyd’s Register Educational Trust Lecture. Royal Academy of Engineering.
Berwick, D. 2013 Improving the Safety of Patients in England. Department of Health.
Bevan, H., Plsek, P. & Winstanley, L. 2013 Leading Large Scale Change: A Practical Guide. NHS Institute for Innovation and Improvement.
Blessing, L. T. M. & Chakrabarti, A. 2009 DRM, a Design Research Methodology. Springer, ISBN: 978-1-84882-587-1.
Boehm, B. W. 1988 A spiral model of software development and enhancement. Computer 21 (5), 6172.
Bristol Royal Infirmary 2001 Learning from Bristol – The Report of the Public Enquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984–1995. Secretary of State for Health.
British Standards 2009 BS ISO 31000:2009 Risk Management – Principles and Guidelines. British Standards.
Cambridge Health Authority 2000 Methotrexate Toxicity – An Inquiry into the Death of a Cambridgeshire Patient in April 2000. Cambridgeshire Health Authority.
Care Quality Commission 2016 Better Care in My Hands: A Review of How People are Involved in their Care. Care Quality Commission.
Carthey, J. 2013 Implementing Human Factors in Healthcare: Taking Further Steps. Clinical Human Factors Group.
Clarkson, P. J. & Acarnley, P. P. 1988 Stability limits for the dynamic operation of variable-reluctance stepping motor systems. Institution of Electrical Engineers Proceedings Part B 135 (6), 308317.
Clarkson, P. J. & Acarnley, P. P. 1989 Simplified approach to the dynamic modelling of variable-reluctance stepping motors. Institution of Electrical Engineers Proceedings Part B 136 (1), 110.
Clarkson, P. J. & Coleman, R. 2015 History of inclusive design in the UK. Applied Ergonomics 46 (Part B), 235247.
Clarkson, P. J. & Hamilton, J. R. 2000 ‘Signposting’, a parameter-driven task-based model of the design process. Research in Engineering Design 12 (1), 1838.
Clarkson, P. J., Bogle, D., Dean, J., Tooley, M., Trewby, J., Vaughan, L., Adams, E., Dudgeon, P., Platt, N. & Shelton, P. 2017 Engineering Better Care: A Systems Approach to Health and Care Design and Continuous Improvement. Royal Academy of Engineering, ISBN: 987-1-1909327-35-1.
Clarkson, P. J., Buckle, P., Coleman, R., Stubbs, D., Ward, J. R., Jarrett, J. P., Lane, R. & Bound, J. 2004a Design for patient safety: a review of the effectiveness of design in the UK health service. Journal of Engineering Design 15 (2), 123140.
Clarkson, P. J., Simons, C. S. & Eckert, C. M. 2004b Predicting change propagation in complex design. ASME Journal of Mechanical Design 126 (5), 788797.
Cooksey, D. 2006 A Review of UK Health Research Funding. HM Treasury.
Cowper, D., Kemp, D., Elphick, J. & Evans, R. 2014 To V or not to V – that MUST be the question: knowing when to apply the right approach. In INCOSE International Symposium, June 30–July 3, Las Vegas, NV, Wiley.
Department of Health & Design Council 2003 Design of Patient Safety: A System-wide Design-led Approach to Talking Patient Safety in the NHS. Department of Health Publications, 32768.
Design Council 2007 Eleven Lessons Managing Design in Eleven Global Companies: A Study of the Design Process. Design Council.
Elliott, C. & Deasley, P.(Eds) 2007 Creating Systems that Work: Principles of Engineering Systems for the 21st Century. Royal Academy of Engineering, ISBN: 1-903496-34-9.
Erwin, K. & Krishnan, J. A. 2016 Redesigning healthcare to fit with people. BMJ 354 (i4536).
Evans, D. E. & Sheehan, M. C. 2002 Don’t be fobbed off: the substance of beer foam – a review. Journal of the American Society of Brewing Chemists 60 (2), 4757.
Evans, J. H. 1959 Basic design concepts. Journal of the American Society of Naval Engineers 71 (4), 671678.
Greene, M., Gonzalez, R., Papalambros, P. & McGowan, A. M. 2017 Design thinking vs. system thinking for engineering design: what’s the difference? In Proceedings of the International Conference on Engineering Design, August 2017, Vancouver, Canada, The Design Society.
Ham, C., Berwick, D. & Dixon, J. 2016 Improving Quality in the English NHS: A Strategy for Action. The King’s Fund.
Hamraz, B., Caldwell, N. M. H. & Clarkson, P. J. 2013 A multidomain engineering change propagation model to support uncertainty reduction and risk management in design. ASME Journal of Mechanical Design 134 (10), 14pp.
Health Foundation 2013 Quality Improvement Made Simple: What Everyone Should Know about Health Care Quality Improvement. The Health Foundation.
Hollnagel, E., Wears, R. L. & Braithwaite, J.2015 From Safety-I to Safety-II: A White Paper. The Resilient Health Care Net, doi:10.13140/RG.2.1.4051.5282.
Horberry, T., Teng, Y. C., Ward, J. R., Patil, V. & Clarkson, P. J. 2014 Guidewire retention following central venous catheterisation: a human factors and safe design investigation. International Journal of Risk and Safety in Medicine 26 (1), 2337.
Hosking, I. M., Cornish, K., Bradley, M. D. & Clarkson, P. J. 2014 Empathic engineering: helping deliver dignity through design. Journal of Medical Engineering and Technology 39 (7), 388394.
Hosking, I. M., Waller, S. D. & Clarkson, P. J. 2010 It is normal to be different: applying inclusive design in industry. Interacting with Computers 22 (6), 439614.
Hussain, S. & Dornhurst, A. 2016 Integrated Care – Taking Specialist Medical Care beyond the Hospital Walls. Royal College of Physicians.
INCOSE 2009 UK Z-Guide 1: What is Systems Engineering: Creating Successful Systems. International Council on Systems Engineering.
INCOSE 2014 A World in Motion: Systems Engineering Vision 2025. International Council on Systems Engineering.
Keates, S. & Clarkson, P. J. 2003 Countering Design Exclusion – An Introduction to Inclusive Design. Springer, ISBN: 1-85233-699-4.
Koln, L. T., Corrigan, J. M. & Donaldson, M. S.(Eds) 2000 To Err is Human. The National Academy Press, ISBN: 0-309-06837-1.
Kurtz, C. F. & Snowden, D. J. 2003 The new dynamics of strategy sense-making in a complex world. IBM Systems Journal 42 (3), 462483.
Langley, G. L., Moen, R., Nolan, K. M., Nolan, T. W., Norman, C. L. & Provost, L. P. 2009 The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd edn. Jossey-Bass Publishers.
Leape, L.1997 Human Beings Make Mistakes Because the Systems, Tasks and Processes they Work in are Poorly Designed. Testimony before the President’s advisory Commission on Consumer Protection and Quality in the Health Care Industry, 19 November 1997.
Lucas, B. & Nacer, H. 2015 The Habits of an Improver Thinking about Learning for Improvement in Health Care. The Health Foundation.
Mankins, J. C. 2009 Technology readiness assessments: a retrospective. Acta Astronautica 65 (9–10), 12161223.
NASA2016 NASA Systems Engineering Handbook. NASA Center for AeroSpace Information, Hanover, MD, NASA/SP-2016-6105, Rev2, ISBN: 978-1979381475.
NHS England 2014 Five Year Forward View. NHS England.
NHS England 2015a Five Year Forward View – The Success regime: A Whole Systems Intervention. NHS England.
NHS England 2015b New Care Models: Empowering Patients and Communities, A Call to Action for a Directory of Support. NHS England, 04446.
Petroski, H. 2007 Diagnosing Dilbert. ASEE Prism 16 (8), 22.
Pronovost, P. J., Ravitz, A. D., Stoll, R. A. & Kennedy, S. B.2015 Transforming Patient Safety, A Sector-wide Systems Approach. WISH Patient Safety Forum, World Summit for Health, Qatar.
Reid, P. P., Compton, W. D., Grossman, J. H. & Fanjiang, G. 2005 Building a Better Delivery System: A New Engineering/Health Care Partnership. The National Academy Press, ISBN: 0-309-09643-X.
Rittel, H. W. J. & Webber, M. M. 1973 Dilemmas in a general theory of planning. Policy Sciences 4 (2), 155169.
Snowden, D. J. & Boone, M. E. 2007 A leader’s framework for decision making. Harvard Business Review (November), BR0711.
Vincent, C. & Amalberti, R. 2016 Safer Healthcare: Strategies for the Real World. Springer International Publishing.
Waller, S. D., Bradley, M. D., Hosking, I. M. & Clarkson, P. J. 2015 Making the case for inclusive design. Applied Ergonomics 46 (Part B), 297303.
Ward, J. R., Clarkson, P. J. & Buckle, P. 2004 The Packaging and Labelling of Solid Oral Medicines: A Study to Identify the Needs and Functionality for Safe Administration of Solid Oral Medicines Using Oral Methotrexate as an Example. University of Cambridge/National Patient Safety Agency.
Ward, J. R., Buckle, P. & Clarkson, P. J. 2010 Designing packaging to support the safe use of medicines at home. Applied Ergonomics 41 (5), 682694.
Wynn, D. C., Grebici, K. & Clarkson, P. J. 2011 Modelling the evolution of uncertainty levels during design. International Journal on Interactive Design and Manufacturing 5 (3), 187202.


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What has engineering design to say about healthcare improvement?

  • P. John Clarkson (a1)


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