1.1 Definition and Evolution of Service Design Theory

The term service design emerged in the early 1980s to integrate the design of tangible products with the innovation of intangible service components – in effect, replacing unsystematic trial-and-error with a more deliberate, end-to-end logic. Shostack’s seminal work (Reference Shostack1982, Reference Shostack1984) framed this logic as a systematic planning exercise: every step in the service process should be mapped, tested, and iteratively refined so that each customer touchpoint delivers consistent value.

Building on this process view, Zomerdijk and Voss (Reference Zomerdijk and Voss2010) shifted attention from operational consistency to experience-centricity. They demonstrate that when designers understand the emotions, preferences, and desires that surface along the customer journey, they can deliberately script ‘moments that matter’, creating distinctive memories rather than merely efficient transactions.

As digital channels proliferated, Glushko (Reference Glushko2010) widened the lens again, classifying service interactions as person-to-person, person-to-machine, or machine-to-machine. This triad acknowledges that technology is now a co-actor in service delivery; designing smooth hand-offs among people and smart devices has become as critical as choreographing face-to-face encounters.

Kimbell (Reference Kimbell2011) then reconceptualised service design as an exploratory, open-ended inquiry. Instead of following a linear blueprint, designers are encouraged to embrace uncertainty, prototype early, and iterate often – an approach that keeps the process responsive to emergent user insights.

Recognising that experiences unfold in concrete settings, Secomandi and Snelders (Reference Secomandi and Snelders2011) foreground the service interface: the blend of material artefacts, physical environments, and embodied human interactions that mediate every encounter. Their holistic perspective reminds us that the tangible and intangible are inseparable in practice.

Andreassen et al. (Reference Andreassen, Lervik-Olsen and Snyder2016) translate these ideas into a managerial agenda, positioning service design as a vehicle for customer-centric transformation. By systematically surfacing and addressing user needs, organisations can boost satisfaction and loyalty while gaining operational insight.

Finally, Karpen et al. (Reference Karpen, Gemser and Calabretta2017) highlight the capabilities and culture required to sustain such efforts. Design thinking must permeate everyday routines, and cross-functional collaboration must be institutionalised if service design is to move beyond isolated projects and influence strategic direction.

Together, these contributions chart a progression – from systematic planning, to immersive experience crafting, to technology-mediated interactions, and finally to organisational capability building. This trajectory reveals service design as both a method (how to map and improve service processes) and a mindset (how to embed user-centred, exploratory thinking across the organisation). The next subsection builds on this foundation by examining how these principles extend to service design in the context of public service logic, demonstrating the continued evolution of service design in contemporary contexts.

1.2 Service Design in the Context of Public Service Logic

Research in the field of services provides important perspectives for public administration and management, contributing to the conceptual advancement within the developing Public Service Logic (PSL) (Hardyman et al., Reference Hardyman, Kitchener and Daunt2019; Mills et al., Reference Mills, Cucciniello, Keast, Nabatchi and Verleye2023; Strokosch & Osborne, Reference 82Strokosch and Osborne2023). Early service research distinguished services from tangible goods, highlighting consumer participation due to the distinctive characteristics of services – intangibility, inseparability, perishability, and heterogeneity (Zeithaml et al., Reference Zeithaml, Parasuraman and Berry1985; Nankervis et al., Reference Nankervis, Miyamoto, Taylor and Milton-Smith2005; Grönroos, Reference Grönroos2016; Johnston et al., Reference Johnston, Shulver, Slack and Calrk2020).

A foundational influence on this evolution has been the development of Service-Dominant Logic (S-D Logic) by Vargo and Lusch (Reference Vargo and Lusch2004, Reference Vargo and Lusch2008, Reference Vargo and Lusch2016), which reconceptualised service as the application of operant resources (e.g. skills and knowledge) for the benefit of others and positioned value as co-created by multiple actors rather than delivered unilaterally. S-D Logic introduced a shift from goods-dominant perspectives to a framework where service (singular) is the basis of all exchange, with key axioms including: service as the fundamental basis of exchange, actors as resource integrators, and value as phenomenologically determined by the beneficiary. These principles laid critical groundwork for PSL by foregrounding co-creation, actor interdependence, and the contextual nature of value (Vargo & Lusch, Reference Vargo and Lusch2017).

The transition towards a service logic in public administration, as advocated by Osborne and Strokosch (Reference Osborne and Strokosch2013), builds on and adapts these foundational ideas to the public sector context. PSL focuses on public services not as tangible products but as platforms for co-creating value through diverse user experiences (Hardyman et al., Reference Hardyman, Kitchener and Daunt2019; Osborne, Reference Osborne2020; Strokosch & Osborne, Reference Osborne2020; Osborne et al., Reference Osborne, Cucciniello, Nasi and Zhu2022a; Osborne et al., Reference Osborne, Cucciniello, Cui and Elgar2024). For instance, Osborne (Reference Osborne2020) emphasises that public service delivery does not involve ownership transfer, but rather is an intangible, relational process aimed at generating public value. Public services are characterised by user participation, shared responsibility, and context-dependent value, contrasting with the standardised, consumption-oriented model typical of manufactured goods (Osborne et al., Reference Osborne, Radnor and Nasi2013).

This conceptual convergence between S-D Logic and PSL underscores that value in public services emerges through lived experiences, interactions, and institutional arrangements – echoing S-D Logic’s focus on service ecosystems and value-in-context (Vargo & Lusch, Reference Vargo and Lusch2008, Reference Vargo and Lusch2016). It also reinforces that PSL is not a departure from but rather a contextual extension of S-D Logic, adapted to the governance, ethical, and institutional complexity of public services.

Bridging this discussion with the evolution of service design methodologies reveals a natural progression in how services are conceptualised and delivered. The emphasis on user experiences and interactions aligns with service design’s commitment to user-centredness, creativity, and empathy (Simon, Reference Simon1969; Bason, Reference Bason2017; Bason, Reference Bason2017; McGann et al., Reference McGann, Blomkamp and Lewis2018). Service design processes extend value co-creation principles by actively integrating the diverse knowledge, needs, and social contexts of service users into design and delivery. In doing so, service design reinforces the foundational S-D Logic notion that value emerges through collaborative, contextual, and dynamic engagements among actors within service ecosystems.

This integrative approach enriches both service design and PSL by emphasising that public value is not merely delivered but co-constituted through continuous, reciprocal interaction among diverse stakeholders.

Service design has attracted scholarly attention since the 1970s and has since emerged as a distinctive paradigm challenging expert-driven design methodologies (Simon, Reference Simon1969; Bason, Reference Bason2017; Bason, Reference Bason2017). Traditional approaches, emphasising instrumental rationality and expert knowledge, are contrasted by service design methodologies that prioritise creativity, curiosity and empathy, particularly through human-centredness, problem-solving, testing, and iteration (McGann et al., Reference McGann, Blomkamp and Lewis2018).The scholarly literature on service design in public sector organisations reveals a growing interest in enhancing public services through innovative design approaches. Human-centred design (HCD) has gained prominence as a valuable framework for addressing the evolving needs of citizens and stakeholders in the public sector (Brown, 2008) and widely adopted in public service innovation, particularly in public service innovation, due to its emphasis on empathy, user involvement, and iterative development (Bjögvinsson et al., Reference Bjögvinsson, Ehn and Hillgren2012; Bason, Reference Bason2017). The approach typically unfolds in phases – inspiration (understanding user needs), ideation (generating and prototyping solutions), and implementation (delivering and scaling interventions). In public service settings, HCD supports inclusive innovation by foregrounding empathy, user voice, and iterative learning (Bason, Reference Bason2010; Bjögvinsson et al., Reference Bjögvinsson, Ehn and Hillgren2012).

Researchers stress the importance of understanding the unique challenges of the public sector when applying service design principles (Meroni & Sangiorgi, Reference Meroni and Sangiorgi2011). To this end, service design in the public sector involves improving efficiency and fostering citizen engagement and satisfaction (Mulgan et al., Reference Mulgan, Tucker, Ali and Sanders2007). The integration of co-creation methods, where citizens actively participate in the design process, is identified as a key element in achieving more responsive and inclusive public services (Alves et al., Reference Alves, Fernandes and Raposo2016). Additionally, the literature highlights the role of digital technologies in augmenting service design efforts within the public sector (Haug et al., Reference Haug, Dan and Mergel2023). E-government initiatives, incorporating service design principles, aim to leverage information and communication technologies for more accessible, transparent and user-friendly public services (Chun et al., Reference Chun, Shulman, Sandoval and Hovy2010; Cucciniello et al., Reference Cucciniello, Porumbescu and Grimmelikhuijsen2017). Building on the aforementioned points, service design has evolved from focusing solely on the delivery of predefined, functional services to shaping the broader servicescape – the physical, social, and institutional environment in which services are experienced and co-created (Bitner, Reference Bitner1992; Wetter-Edman et al., Reference Wetter-Edman, Sangiorgi and Edvardsson2014; Sangiorgi & Prendiville, Reference Sangiorgi and Prendiville2017).

This emphasises the creation of positive experiences for those interacting with services, transcending immediate user needs to consider long-term impacts on users’ lives and societal transformation (Patrício et al., Reference Patrício, Fisk and Cunha2008; Kimbell, Reference Kimbell2011; van Buuren et al., Reference van Buuren, Lewis, Guy Peters and Voorberg2020). Service design achieves this goal by investigating stakeholders’ interactions, experiences and values through a methodology underpinned by the principles of openness, participation and inclusivity (Schwoerer et al., Reference Schwoerer, Kuehnl and Kuester2022).

A key to design methodologies within the PSL framework is to embed user-centredness throughout problem identification, understanding, and solution development in iterative processes (Wetter-Edman et al., Reference Wetter-Edman, Sangiorgi and Edvardsson2014). Accordingly, two approaches within service design, the informational and inspirational approaches, present different perspectives on how to embed user-centredness in the design process. The informational approach focuses on uncovering service users’ needs through scientific research, relying on principles of reliability, validity and rigor (Howlett et al., Reference Howlett, Mukherjee and Woo2015). In contrast, the inspirational approach roots itself in experimentation, focusing on ambiguity and generating future-focused solutions exemplified by policy or living labs (Sanders, Reference Sanders and 80Potter2005; van Buuren et al., Reference van Buuren, Lewis, Guy Peters and Voorberg2020).

The emphasis on participation and inclusion within service design holds particular relevance to public services, where collectiveness is fundamental to participatory processes and outcomes. Yet, despite the promises of innovation and a user-centred approach, challenges persist regarding the practical implementation of service design in the public sector. For example, some argue that existing attempts to apply service design principles are reductionary, focusing on constituent parts while neglecting the broader service ecosystem, which, in turn, may limit the transformative potential of this approach to public service design (Howlett, Reference Howlett2014; Vink et al., Reference Vink, Koskela-Huotari, Tronvoll, Edvardsson and Wetter-Edman2021a).

Moreover, questions arise as to whether public service organisations (PSOs) can fully embrace quick and iterative problem-solving approaches, given not only the sector’s perceived aversion to risk (Alves et al., Reference Alves, Fernandes and Raposo2016) but also the significant legal and procedural constraints they operate under. It is not simply a matter of risk aversion or inertia; many PSOs must adhere to strict due process requirements, including transparency, accountability, and fairness, which limit their capacity for rapid iteration. In some jurisdictions, public sector decisions are subject to judicial review, adding yet another layer of complexity and caution to their operations (Christensen & Laegreid, Reference Christensen and Lægreid2007). Therefore, while service design principles that promote iteration can be beneficial, they must be adapted to align with the institutional and legal frameworks governing PSOs. The challenge lies in balancing innovation with the need to uphold these obligations, ensuring that any iteration is careful and deliberate rather than rapid and flexible.

In view of these challenges, scholars emphasise the need for a nuanced understanding of the organisational and cultural factors influencing its successful implementation in the public sector (Gascó-Hernández & Torres, Reference Gascó-Hernández and Torres-Coronas2015). Furthermore, the measurement of outcomes and impacts remains a subject of ongoing research, with scholars exploring methodologies to assess the effectiveness of service design interventions in achieving their intended objectives (Demunter et al., Reference Demunter, Van Looy and Gemmel2019). Building upon this foundation, a recent study by Strokosch and Osborne (Reference 82Strokosch and Osborne2023) delves deeper into the application and implications of design approaches in public service settings. The authors carefully explore the focus and impact of design practice, marking a pivotal investigation into how human-centred design is operationalised within PSOs and its consequent effects on public service delivery (Strokosch & Osborne, Reference 82Strokosch and Osborne2023).

Ongoing research explores methodologies for evaluating outcomes and demonstrating the tangible benefits of adopting design principles in public service contexts. In summary, the scholarly literature on public service design underscores the significance of citizen-centric approaches, co-creation strategies, and the integration of digital technologies. Successful implementation requires attention to organisational and cultural factors, and ongoing efforts focus on refining evaluation methods to demonstrate the effectiveness and impact of public service design interventions.

1.3 Engagement as a Key Element of Service Design

Service design theory offers important insights for theory and practice as it creates a framework organisations can use to better understand and meet the evolving needs and expectations of their customers. Specifically, applying a service design approach allows those designing public services to uncover insights about customer preferences, pain points, and desires, which can then be used to create more meaningful and impactful services. Additionally, as service ecosystems become increasingly complex and interconnected, having a holistic understanding of how +different elements interact and influence each other is crucial for successful service innovation. From this perspective, service design theory is essential to service innovation because it brings ideas to life and creates a foundation for progress towards overall better services that more accurately and efficiently meet users’ needs.

These diverse perspectives demonstrate the evolution of service design theory from a basic approach to providing services towards a more experience- and user-centred framework. Today, service design theory is crucial due to its role in driving service innovation and value co-creation within service ecosystems. As service design has grown to be a user-centred, collaborative, and holistic approach, it has become instrumental in improving existing services and creating new ones. Embracing service design theory through a multidisciplinary lens has become a strategic imperative for both service researchers and practitioners.

1.4 Unveiling the Potential of Service Design for Value Co-Creation in Public Services

By framing public services as intricate ecosystems that integrate diverse resources, service design transcends the conventional focus on individual services to emphasise the overarching constructs of experience and context. Crucially, focusing on value co-creation processes serves as an important foundation for institutional change by incorporating the knowledge, skills, and backgrounds of diverse actors. Relatedly, this approach to designing public services acknowledges that services, even when carefully designed, undergo continuous adjustments. Applying design principles in public service contexts can significantly enhance the co-creation of value, provided there is a deep understanding of how various resources within a complex ecosystem integrate (Vargo & Lusch, Reference Vargo and Lusch2016; Grönroos, Reference Grönroos2019; Strokosch & Osborne, Reference 82Strokosch and Osborne2023). This approach shifts the focus from the provision of services to fostering service experiences and understanding the context in which these services are delivered (Jaakkola et al., Reference Jaakkola, Helkkula and Aarikka-Stenroos2015; Schwoerer et al., Reference Schwoerer, Kuehnl and Kuester2022). Recognising the processes of value co-creation is crucial for initiating the institutional changes needed to achieve the benefits associated with service design.

The term ‘Service’ refers to a value creation perspective, distinct from ‘services’, which denotes a specific product category requiring different design, production, and delivery approaches (Edvardsson et al., Reference Edvardsson2005). In SDL and SL, ‘Service’ represents the process of doing something beneficial with and for other actors, where value is co-created during use rather than produced and delivered as a finished product (Vargo & Lusch, Reference Vargo and Lusch2008, Reference Vargo and Lusch2016). Thus, value is co-created and context-dependent, shaped by the beneficiary’s experience and the social setting (Edvardsson et al., Reference Edvardsson, Tronvoll and Gruber2011). The following subsections further differentiate ‘service’ from ‘services’ by tracing key conceptual developments in SL and SDL, establishing the foundational elements of the service lens.

Service design captures the subjective and social dimensions of service, including the unique contributions of individuals’ knowledge, skills, and backgrounds. However, regardless of the initial design, services will inevitably be adjusted to meet the evolving needs and experiences of users, particularly in fields like education and healthcare, where empathy, equity, and fairness are paramount. The design process, adjustments, and resulting value are influenced by the service context, including institutional norms, societal values, and user expectations.

By prioritising experience and context, designing for service acknowledges the multifaceted nature of the value co-creation process.

Our contribution builds on and extends the PSL framework by clarifying the distinctions between ‘services’ as discrete offerings and ‘service’ as a dynamic, co-creative process, aligning with Trischler et al. (Reference Trischler, Røhnebæk, Edvardsson and Tronvoll2023) in advancing a more nuanced understanding of value co-creation within public service contexts. We contend that service design, woven into the fabric of interactions, plays a pivotal role in influencing design processes, service outputs, and the entire spectrum of service delivery. This holistic impact underscores the potential of service design to shape and enhance value accrual in the dynamic landscape of public services.

Service design theory offers valuable insights for the public sector that extend beyond the realm of service design. In the realm of public services, service design emerges as a pivotal strategy for value creation, aligning with the principles of PSL. Rooted in user-centredness, service design transcends traditional, product-centric approaches prevalent in the twentieth-century New Public Management (NPM) framework. Unlike the latter’s focus on internal efficiency and individual entities, service design’s methodology is built upon creativity, curiosity, and empathy. This paradigm shift emphasises the design of the ‘servicescape’ to not only satisfy immediate user needs but also create positive experiences that extend to long-term impacts on users’ lives and societal transformation.

Through participatory and inclusive practices, service design engages stakeholders in the public context, going beyond mere consultation to active co-design with citizens and service users. Service design’s emphasis on openness, participation, and inclusivity reflects a commitment to understanding and incorporating diverse perspectives, which is crucial for addressing complex social goals inherent in public service organisations. Despite challenges and cautions about implementation, service design in the public sector has the potential to foster innovation and an outcomes-focused approach, ultimately contributing to the creation of enduring societal value.

Service design theory plays a pivotal role in reimagining public services through its use of a user-centred approach and its emphasis on leveraging design principles to meet the dynamic needs and expectations of users, thereby acting as a catalyst for creating enduring societal value.

In summary, this section underscored the essential role of service design theory in understanding and improving public services. The adoption of a user-centred approach and the incorporation of design principles empower organisations to enhance service quality and encourage active citizen participation. Thus, service design theory, with its valuable insights and innovative frameworks, becomes a catalyst for creating services that align with the evolving needs and expectations of users.

2.1 How Are Services Designed in the Public Sphere?

This section delves into the pivotal role of service design in fostering value creation, with a special focus on engaging citizens through innovative methodologies and exploring essential principles supporting service design adoption and implementation (Downe, Reference Downe2020). Central to this discussion is the application of the Double Diamond design process, a key feature of service design theory that underscores the importance of validating the need for a service before delving into its development to ensure it meets the users’ and organisations’ requirements.

The transformative impact of service design, especially evident during the pandemic’s shift towards digital business models, illustrates its critical role in addressing contemporary challenges. In some cases, this period also sparked conversations around sustainability, though these shifts were less uniform.

It underscores the necessity for service researchers to anticipate and mitigate unintended consequences, such as exclusions and environmental impacts, through collaborative efforts with public sector organisations, healthcare, non-profits, and design firms. This section proposes that the iterative nature of service design is essential for not only developing services that meet user needs but also emphasising the significance of service design in the creation of value through citizen engagement. Co-design actively involves citizens/service users and draws on their past experiences to generate fresh ideas and support improvement and innovation (Donetto et al., Reference Donetto, Pierri, Tsianakas and Robert2015; Schwoerer et al., Reference Schwoerer, Kuehnl and Kuester2022). Citizens/service users are invited to actively contribute as an essential resource throughout the design process, including idea generation and the development of solutions (Wetter-Edman et al., Reference Wetter-Edman, Sangiorgi and Edvardsson2014). Subsequently, there has been a discernible upswing in the utilisation of explicit co-design principles in public services over the past decade, with a growing number of applications grounded in the concept of co-design for value creation (Blomkamp, Reference Blomkamp2018; Dudau et al., Reference Dudau, Glennon and Verschuere2019; Nasi & Choi, Reference Nasi and Choi2023). Exploring the impacts of power differentials on co-design (Farr, Reference Farr2018) and delineating the linkages between co-design and social innovation (Voorberg et al., Reference Voorberg, Bekkers and Tummers2015; Whicher & Trick, Reference Whicher and Trick2019) have emerged as pivotal themes in this evolutionary trajectory.

2.2 The Double Diamond: A Framework for Iterative and Inclusive Service Design

The Double Diamond design process originating from the Design Council in 2004 serves as a conceptual model elucidating the overarching stages traversed by numerous design innovation initiatives. This approach, notably adopted by the Scottish Government, emphasises an ethnographic methodology that draws heavily from service design theories, including the use of personas and other tools as key instruments for enhancing citizen engagement (Design Council, 2007; Scottish Government, 2019): ‘The design process reminds us that we have to be sure we’re creating the right thing before we can design something that’s fit for purpose and meets the needs of users, staff, or organisations’ (Scottish Government, 2019, p. 14).

The Double Diamond is a visual representation of the design and innovation process. It’s a simple way to describe the steps taken in any design and innovation project, irrespective of methods and tools used (https://www.designcouncil.org.uk).

The service design adopted by the Design Council presents a perspicuous, comprehensive and visually intuitive representation of the design process. Since its inception in 2004, the Double Diamond has garnered global recognition, with an extensive online repository of supporting research.

The Design Council’s utilisation of the Double Diamond effectively communicates a design process accessible to both experts in service design and non-experts. The two diamonds represent a sequential progression involving the expansive exploration of an issue (divergent thinking) followed by a focus on specific actions (convergent thinking). It is organised into the following four phases.

Divergent thinking characterises the Discover and Develop stages, encouraging designers to explore broadly whether to understand user needs and contextual dynamics in the Discover phase or to generate a wide range of possible solutions in the Develop phase (Brown, Reference Brown2008; Dorst, Reference Dorst2011). Convergent thinking, by contrast, underpins the Define and Deliver stages, where designers analyse and synthesise insights to clearly frame the problem and subsequently refine the most promising ideas into actionable solutions (Kimbell, Reference Kimbell2011; Bason, Reference Bason2017). This structured oscillation between expansion and narrowing supports creativity while maintaining strategic focus, making the Double Diamond particularly valuable in complex service contexts.

Discover (Exploration): This is the first phase of the Double Diamond process. It involves open-ended exploration and research. During this phase, designers seek to understand the users’ needs, motivations, and behaviours. This involves gathering insights and perspectives from a wide range of sources to fully comprehend the problem or challenge at hand. Techniques such as user interviews, observations, and focus groups are typically employed. The goal is to gather as much information and as many insights as possible without immediately seeking solutions.

Define (Creation): In this phase, the focus shifts from exploration to synthesising the gathered information to define the core problem(s) that need to be solved. This involves analysing the data collected in the Discover phase and identifying patterns, trends, and insights. Designers aim to articulate the problem clearly and succinctly, often in the form of a problem statement or a design brief. This phase is critical as it sets the direction for ideation by providing a clear and focused problem to solve.

Develop (Reflection): Here, the process opens up again into a phase of ideation and conceptualisation. With a clear understanding of the defined problem, designers begin to generate a range of ideas and potential solutions. This phase encourages creativity and the exploration of many different possibilities, using techniques like brainstorming, sketching, and prototype development. The aim is to explore a wide variety of solutions without immediately judging or dismissing them.

Deliver (Implementation): The final phase focuses on refining and testing the developed ideas to deliver effective solutions. It involves selecting the most promising ideas from the Develop phase and transforming them into practical and viable solutions. This often includes creating prototypes, conducting user testing, and iteratively improving the solutions based on feedback. The Deliver phase culminates in the final solution that can be implemented or launched.

Throughout the Double Diamond, the emphasis is on moving from a broad understanding of a problem space (diverging) to a focused and actionable solution (converging), thus ensuring a thorough exploration and validation of ideas and solutions. The process is inherently non-linear, a characteristic illustrated through the directional arrows present in Figure 1. Various organisations have observed that this approach often facilitates the uncovering of profound insights into fundamental issues, compelling a cyclical return to the formative stages of the process. The initiation and evaluation of preliminary ideas are integral components of the discovery phase, reflecting the principle that within the constantly evolving digital milieu, the concept of a ‘completed’ idea is obsolete. Feedback on the efficacy of services is systematically solicited and employed in an iterative cycle of enhancement based on the insights provided.

Figure 1 The Double Diamond

The Double Diamond can be used to navigate through a comprehensive process that encompasses the identification of needs, articulation of problems, formulation, and evaluation of solutions and the achievement of tangible outcomes and value. This process orchestrates user engagement, thus facilitating a fluid transition between the expansive exploration of broad concepts and the focused refinement of specific solutions. The construct of the first diamond serves a pivotal role in guiding the identification of the most pertinent challenges, ensuring a thorough comprehension of end-user requirements. Following this, the second diamond provides a structured framework for the design, enhancement, and realisation of the envisioned solutions, employing prototyping, and testing with both end-users and service providers to validate and refine the solutions.

The Double Diamond underscores the essence of service design as a dynamic and iterative process that is not merely focused on the creation of products and services but also dedicated to the cultivation of meaningful and impactful experiences that resonate with the complex and changing needs of users and stakeholders.

2.3 Placing the User’s Experience at the Heart of Public Service Delivery

This subsection discusses various service design methods employed for gathering information crucial to the development of public service system designs. Specifically, the focus is on assessing the efficacy of these methods in addressing the dual challenges of managing the complexities within service systems and comprehending user experiences. Drawing on established literature (e.g. Bitner et al., Reference Bitner, Booms and Tetreault1990; Edvardsson & Roos, Reference Edvardsson and Roos2001), we explore the application and effectiveness of some prominent service design techniques commonly employed in service design projects (Kimbell & Seidel, Reference Kimbell and Seidel2008; Diana et al., Reference Diana, Pacenti and Tassi2009; Segelström, Reference Segelström2009; Stickdorn & Schneider, Reference Stickdorn and Schneider2010; Zomerdijk & Voss, Reference Zomerdijk and Voss2010). Additionally, given their widespread usage in service design, a detailed analysis of these service design techniques is presented. To establish a foundation for the analysis, in this context, a service is defined as ‘something that assists individuals in accomplishing their necessary tasks’ (Down, Reference Downe2020).

Drawing on research by Trischler and Scott (Reference Trischler and Scott2015), Trischler et al. (Reference Trischler, Dietrich and Rundle-Thiele2019) and Popli and Rishi (Reference Popli and Rishi2021), it is imperative to prioritise the user’s experience in public service delivery. This entails embracing service design methods and frameworks that actively involve users as co-producers.

Service design employs a broad array of tools and methodologies to create and improve services that cater to the intricate requirements of users and stakeholders alike (Stickdorn & Schneider, Reference Stickdorn and Schneider2010). This vast toolkit encompasses various approaches, each designed to tackle distinct aspects of service design, from understanding user needs to prototyping and testing service concepts. In this subsection, we will introduce only a select few of these tools, focusing on the most popular and widely adopted approaches to service design (Kimbell & Seidel, Reference Kimbell and Seidel2008; Diana et al., Reference Diana, Pacenti and Tassi2009; Segelström, Reference Segelström2009; Stickdorn & Schneider, Reference Stickdorn and Schneider2010; Zomerdijk & Voss, Reference Zomerdijk and Voss2010). These methodologies, such as end user persona development, customer journey mapping, and service blueprints, are fundamental in facilitating a deep understanding of the service experience, allowing service design scholars and designers to craft solutions that are both innovative and user-centred. By employing these tools, a holistic and empathetic approach to developing services that genuinely meet the needs and expectations of their users can be ensured.

Persona development: The persona development concept, rooted in human-computer interaction research, emerges as a crucial mechanism for translating abstract customer segments into considerations based on individual perspectives. Defined by Cooper (Reference Cooper1999) as ‘fictitious, specific, and concrete representations of target users’, underscoring that their development is grounded in research rather than arbitrary invention, personas furnish a memorable and actionable framework. Personas are based on composite archetypes and help designers empathise with users’ needs, behaviours, and motivations (Pruitt & Adlin, Reference Pruitt and Adlin2006; Stickdorn et al., Reference Stickdorn, Hormess, Lawrence and Schneider2018). While demographic details such as age or occupation may provide contextual grounding, effective personas prioritise psychographic attributes such as attitudes, goals, frustrations, capabilities, and behavioural patterns – because these factors shape how users experience and interact with services (Goodwin, Reference Goodwin2009). Emphasising psychographics allows personas to capture the lived realities of service users and support the design of experiences that are both meaningful and context-sensitive. Personas serve as an invaluable resource for concentrating on the primary user by elucidating behaviour patterns and pinpointing user needs. The utility of personas extends beyond this focus, facilitating communication among stakeholders, informing decision-making processes, and providing a basis for evaluating concepts, as acknowledged by both academics and professionals (Pruitt & Adlin, Reference Pruitt and Adlin2006; Mulder & Yaar, Reference Mulder and Yaar2007). They assimilate contextual information pertinent to service challenges, capturing the requirements, needs, or desires typically associated with the persona, and are enriched with ‘softer’ details like personality traits to offer a more nuanced and personalised portrayal. The crafting of personas is fundamental in making the abstract notion of user bases tangible, thereby facilitating empathy and tailored engagement with specific user segments. Through the integration of demographic, psychographic, and behavioural insights, personas act as a guiding structure, enriching the process of developing solutions that resonate with user needs and expectations. Most personas are developed from research insights which are usually gathered from interviews and focus groups (Stickdorn & Schneider, 2011).

Personas help designers understand the diverse needs, behaviours, motivations, and challenges of different segments of the population. They are a design tool used to construct representative archetypes of the intended user groups for whom a service is being developed (Pruitt & Adlin, Reference Pruitt and Adlin2006; Cooper et al., Reference Cooper, Reimann, Cronin and Noessel2014). To ensure their effectiveness, personas must be grounded in empirical research and crafted to reflect the diversity, inclusivity, and variability of real users’ experiences, avoiding stereotypes, and oversimplification (Goodwin, Reference Goodwin2009; Stickdorn et al., Reference Stickdorn, Hormess, Lawrence and Schneider2018).

Here is an example of its application to the redesign of a Municipality Social Service Website. Imagine a local government wanting to redesign its online social services portal, which offers resources for employment, housing assistance, healthcare, and more. The portal is currently difficult to navigate, resulting in underutilisation by residents who need these services most. To improve the portal, the government could apply the personas methodology. Firstly, it is essential to gather data about the residents who use (or need to use) the social services portal. This could include an assessment of the user behaviours of the current website. To map needs and perceptions of satisfaction, it could also include assessments based on surveys and interviews with residents and users as well as focus groups with key population segments (e.g. seniors, low-income families, people with disabilities) as well as meetings with social service workers and community advocates.

Based on this research, it is possible to create a set of personas that represent the different types of users who will interact with the portal. Here are three examples of personas that could be used in this context such as a single mother named Mary, a retired citizen named John and Saman a recent immigrant with physical disability. For each of them it is important to depict their profile (e.g. Mary is a single mother of two, working a part-time job while juggling childcare. She has minimal free time and limited access to the internet, relying on her smartphone for most online services); goals (e.g. Mary wants quick access to housing assistance and affordable childcare services); challenges (e.g. Mary struggles with complex forms, lengthy application processes, and finding specific information on the portal. She often abandons the process halfway through because of time constraints) and needs (e.g. a mobile-friendly, easy-to-navigate interface with simple, clear instructions, and the ability to save applications to complete later).

Using these personas, the design team makes informed decisions about the portal’s layout, content, and features that can be tested with a small group of users representing each persona. Feedback is gathered, and adjustments are made to improve the service, ensuring it meets the community’s real needs

Customer journey mapping: Customer journey mapping is a vital tool that helps visualise user interactions and experiences throughout the service journey. It emphasises active stakeholder involvement in identifying pain points and areas for improvement, ultimately leading to user-centred design decisions. Furthermore, Customer journey mapping encourages cross-functional collaboration, thereby fostering alignment among stakeholders by establishing a shared comprehension of the service ecosystem. Visualising and mapping techniques play a crucial role in rendering service systems and processes more transparent. They clarify which components of the service system impact the overall user experience (Patricio et al., Reference Patrício, Fisk, Cunha and Constantine2011). The relevance of customer journey mapping is underscored by its ability to comprehensively capture the user’s experience throughout their journey and highlight the ‘touchpoints’ within the service system (Zomerdijk & Voss, Reference Zomerdijk and Voss2010). Active involvement of consumers in the analysis and design processes, as advocated by Sanders and Stappers (Reference Sanders and Stappers2008) and Ostrom et al. (Reference Osborne2010), is essential for fully integrating user experiences and gaining valuable insights. Collaborative design workshops have been effectively employed as part of these visualisation and mapping techniques to facilitate participants’ sharing of their experiences and the generation of innovative concepts (Bason, Reference Bason2010; Steen et al., Reference Steen, Manschot and De Koning2011).

For example, in redesigning an unemployment benefits service, a journey map follows a user like Rachel, who is a typical persona (e.g. she is a 45-year-old office worker who has just lost her job). The key stages in Lena’s journey to access unemployment benefits are identified as follows: awareness (e.g. Learning about the unemployment benefits programme); application (e.g. Applying for benefits); approval/denial, receiving benefits and reintegration (e.g. using resources to find new employment). Through customer journey mapping, the service designer understands the challenges she faces in accessing the service, such as difficult-to-find information, complex forms, long waiting times, and unclear payment processes. The map leads to improvements like clearer information architecture, simplified application forms, better communication, and integration with job placement services.

Service blueprinting: A service blueprint is a visual and systematic representation of a service that helps organisations comprehensively analyse and design service processes. It maps out the entire service journey, illustrating customer interactions, frontstage activities, backstage processes, and support systems involved in service delivery. This blueprinting process is crucial for identifying potential pain points, improving efficiency, and enhancing the overall customer experience. As described by Shostack (Reference Shostack1984), a pioneer in service blueprinting, it is a method to ‘chart the sequence of events and interactions in a service process’. This involves delineating customer actions, frontstage and backstage processes, support processes, and physical evidence encountered during service delivery. Bitner et al. (Reference Bitner, Ostrom and Morgan2008) emphasise service blueprinting as a ‘practical technique for service innovation’, highlighting its utility in fostering innovation and improving service design. The technique aids in identifying touchpoints, understanding customer emotions, and aligning various components to deliver a seamless and efficient service. Service blueprinting serves as a valuable tool for organisations to visually map and analyse their service processes, leading to enhanced service delivery and customer satisfaction. It helps to reveal the process behind critical service elements that define the user experience (Stickdorn & Schneider, 2011).

2.4 Benefits of Service Design Tools for Designing Public Services

The use of persona development, customer journey mapping, service blueprints, and focus groups in service design underscores their pivotal roles in achieving the following:

• User-centred design: Both persona development and customer journey mapping champion a user-centred ethos, instilling empathy among designers and stakeholders (Brown, Reference Brown2008).

• Holistic service understanding: The fusion of personas and journey maps engenders a holistic grasp of the service ecosystem. This comprehensive perspective empowers public managers and scholars to tackle challenges across various touchpoints, culminating in more effective service design (Meroni & Sangiorgi, Reference Meroni and Sangiorgi2011).

• Enhanced collaboration: These tools act as catalysts for collaboration among cross-functional teams, providing a shared visual lexicon and unified comprehension of user requirements (Junginger & Sangiorgi, Reference Junginger and Sangiorgi2009).

• Bias mitigation: When intentionally applied to reflect structurally disadvantaged user groups, such as low-income individuals or digitally excluded populations, these tools help surface inequities and design barriers, enabling practitioners to develop services that are more inclusive and less biased toward users with greater resources (Steen et al., Reference Steen, Manschot and De Koning2011; Le Dantec & Fox, Reference Le Dantec and Fox2015).

The tools and processes presented in this section are indispensable cornerstones of service design. They offer a structured, user-focused framework for crafting and enhancing services, and their integration forms a robust foundation for designing services that resonate with users, nurture empathy, and navigate the intricacies of the service landscape. As service design continues to evolve, these tools retain their fundamental role in shaping impactful services for users.

3.1 Research Context

Governments aim to enhance public well-being and meet stakeholder expectations through actions such as regulation, service delivery, policy formulation, and public goods provision (Bellé et al., Reference Bellé, Belardinelli, Cucciniello and Nasi2023). Historically, most governments have failed to assess the value they create with citizens and involve them in service design (Osborne et al., Reference Osborne, Radnor and Nasi2013; Nasi et al., Reference Nasi, Osborne, Cucciniello and Cui2024). Additionally governments often struggle to govern the nexus between objectives, needs and outcomes (Knapp, Reference Knapp1984).

The COVID-19 pandemic sparked a debate on the value of government services as local governments grappled with changing citizen expectations and priorities shaped by the new daily routines. To meet such expectations, governments have to comprehend the evolving context in terms of needs, capacity, preferences and value, ensuring consistency with the existing status quo while making necessary adjustments. This process entails recognising and supporting changes in value rather than inventing entirely new solutions.

3.2 Methods

We used service design tools to deepen insights into both citizens’ and providers’ experience with services. In doing so, we gained a better understanding of user expectations, the user journey, and organisational processes. This information allowed us to formulate recommendations to redesign the services that create value for their users.

A research methodology combining focus groups and directed observational studies was selected for its interactive nature. Importantly, the methodology adopted a systemic and holistic view, acknowledging and incorporating complexity, chaos, ambiguity, fuzziness, and dynamic forces rather than simplifying them for analytical ease (Gummesson, Reference Gummesson2006). This was particularly relevant for our research, where the complexity and uncertainty were heightened due to the numerous interactions between users and service providers (Sparks, Reference Sparks2001). Therefore, this method was deemed most suitable for the depth and breadth of analysis required in this study.

3.3 Findings

3.4 Discussion and Conclusions

This study explored the application of service design methods to understand citizens’ evolving expectations and experiences with municipal services in the post-COVID-19 context. Through exploratory and confirmatory focus groups involving citizens, entrepreneurs, and public managers, we identified key tensions between lived realities and institutional logics, particularly in the domain of urban mobility services.

Three pivotal factors emerged as shaping the post-pandemic user journey:

1. (1) a revised schedule of daily events,

2. (2) the widespread adoption of smart working practices, and

3. (3) a growing need for customisation and inclusivity in public services.

These factors were reflected in concrete experiences and expectations across stakeholder groups. The findings in Subsection 3.3 illustrate how these shifts challenge conventional assumptions in service design – particularly around eligibility, accessibility, and infrastructure – and reveal the need for adaptive, user-informed innovation.

4.1 Background

Public service organisations face the formidable task of catering to the diverse and often heterogeneous needs of large populations. The complexity of these needs defies the simplicity of ‘one-size-fits-all’ solutions. Furthermore, the value that an individual ascribes to a service is intrinsically linked to their unique personal needs, values, expectations, and experiences – factors over which PSOs have limited direct influence.

4.2 Methods

In this section, we investigate how service design tools can be utilised to engage citizens in public service design and delivery. Anchoring our approach to service design theory, we focused on the active and collaborative involvement of users, positioning them as ‘experts of their experience’ in addressing complex societal issues (Sanders & Stappers, Reference Sanders and Stappers2008). This approach leverages the collective creativity of diverse team members (Steen, Reference Steen2013) and aims to enhance the capacity of a local government in framing and solving service-related problems. We adopted a mixed-methods strategy, encompassing both quantitative and qualitative sequential studies.

Our sequential study design unfolded in two interactive phases: the collection and analysis of quantitative data to establish the initial scope and qualitative data analysis for an in-depth exploration of the findings (Ivankova et al., 2006; Teddlie &Tashakkori, Reference Teddlie and Tashakkori2006; Stentz et al., Reference Stentz, Clark and Matkin2012). This dual approach allowed for a comprehensive understanding of the research problem, leveraging the strengths of both methods while addressing their individual limitations (Creswell & Clark, Reference Creswell and Plano Clark2007; Mele & Belardinelli, 2019).

We adopted the Design Council’s Double Diamond design process (2007), which includes four distinct phases, namely (i) Discover, (ii) Define, (iii) Develop, and (iv) Deliver (see Section 2 for more details on this methodology). To tailor the Double Diamond process to our specific needs, we implemented the following modified approach.

Discover and Define (Phases 1 and 2): For the Discover phase, which involves a comprehensive approach to understanding the problem at hand and includes gathering extensive information to immerse oneself in the experiences and perspectives of those impacted by the issue, thereby gaining deep insights and avoiding assumptions, we developed a quantitative observational survey to retrospectively examine user experiences with public services, focusing on identifying gaps in the value they provide. This involved categorising the public services offered by the municipality into key types, such as institutional services (e.g. local taxation), services to individuals (e.g. education), and territorial services (e.g. maintenance and waste management). These services were available through multiple channels, including in-person and online.

We then conducted a quantitative analysis to evaluate the discrepancies in perceived importance and satisfaction across these services, asking citizens to rate each on a seven-point Likert scale, where 1 indicated the lowest level of importance or satisfaction and 7 indicated the highest.

Utilising the insights gained from the survey, we focused on defining the problem more clearly. We selected one public service that exhibited a significant gap in importance versus satisfaction. Our goal was to deepen our understanding of the underlying issues, priorities, and user preferences through qualitative design strategies. We selected this service to explore in greater depth, using qualitative design strategies to examine user experiences, expectations, and pain points. Through this process, we developed a well-defined problem statement: ‘How might we redesign the service to accommodate diverse user scenarios while ensuring ease of access, fairness, and administrative feasibility?’ This problem framing captured both the technical and experiential dimensions of the challenge and provided a concrete foundation for guiding subsequent co-design and solution development efforts.

To further explore the identified service gaps, we organised focus groups comprising both citizens and service professionals. These sessions were instrumental in uncovering real-world challenges as perceived by users.

Develop and Deliver (Phases 3 and 4): In the third phase of the Double Diamond process, which emphasises the development of solutions, our approach was to further refine and expand upon the insights gained in the earlier phases.

To support the development of innovative service ideas, we organised additional focus groups. In line with standard methodological practice, each individual focus group was composed of relatively homogeneous participants – such as citizens, entrepreneurs, or public managers – to create a safe and comfortable environment for discussion, reduce potential conflict, and facilitate the open exchange of ideas within shared experiential contexts. This structure also allowed us to clearly capture distinct stakeholder perspectives. Multiple focus groups were then employed to ensure diversity across the broader dataset and to capture the range of perspectives necessary for comprehensive service design.

These sessions were specifically designed to foster creative thinking and collaborative problem-solving, focusing on the generation of innovative service ideas that could significantly improve overall value. This collaborative environment was crucial for brainstorming sessions, enabling participants to build on each other’s ideas and leading to the development of potentially transformative solutions. The objective of these sessions was to leverage the collective intelligence and creativity of the group to explore a wide array of service innovations. These could range from incremental improvements to existing services to groundbreaking new offerings that could redefine user experiences.

By facilitating these discussions in a structured, yet open-ended, manner, we aimed to uncover unique insights and ideas that could be further developed and tested in subsequent phases of the model.

This step was instrumental in transitioning from understanding and defining the problem space to actively creating and shaping potential solutions. The focus groups served as a dynamic platform for synthesising the gathered knowledge and translating it into actionable service design concepts that could enhance value for users and stakeholders alike. Furthermore, in the last phase, we aimed to validate the feasibility and alignment of the proposed solutions with both citizens’ values and the organisation’s capabilities. Methodologically, this phase employed user testing, prototype development and iterative design methods. Solutions were evaluated based on their feasibility, effectiveness, and potential impact, leading to the finalisation of the most viable solution for implementation. We employed a method known as ‘organisational impact analysis’, a service design technique for assessing an organisation’s capacity to deliver new services. This approach links the designed user experiences with the organisation’s structure and capabilities (Reason et al., Reference Reason, Løvlie and Flu2015). A final focus group with service professionals was conducted to review the proposed service ideas and solutions and select those that both created value and aligned with the organisation’s operational capacities.

4.3 Findings

4.4 Discussion and Conclusion

5.1 Background

This section delves into the relevance of focusing on vulnerable groups such as patients with lung cancer. Lung cancer imposes a substantial burden, exceeding the combined mortality rates of breast, colon, and prostate cancers (World Cancer Research Fund/American Institute for Cancer Research, 2017).

Worryingly, the five-year survival rate for lung cancer remains among the lowest of all major cancers. According to the American Cancer Society, the overall five-year relative survival rate for lung cancer is approximately 27 per cent, significantly lower than that for colon (64 per cent), breast (91 per cent), and prostate (97 per cent) cancers (American Cancer Society, 2024). Tragically, more than half of individuals diagnosed with lung cancer die within one year of diagnosis (National Cancer Institute, 2023).

On a more positive note, advances in screening, diagnostics, and treatment have led to meaningful improvements. The American Lung Association reports that the national five-year survival rate increased by 22 per cent over five years, from 21.7 per cent in 2015 to 26.6 per cent in 2019 (American Lung Association, 2023). Furthermore, global initiatives such as the Lung Ambition Alliance aim to double the five-year survival rate for lung cancer by 2025, through investments in early detection, targeted therapies, and integrated care models (Meng et al., 2024).

However, this improved survival rate presents the challenge of increased healthcare costs; even after completing active cancer treatments such as surgery, chemotherapy, or radiotherapy, patients continue to grapple with persistent physical and psychological symptoms, necessitating ongoing specialised care (Mayer et al., Reference Mayer, Nekhlyudov and Snyder2014; Miller et al., Reference Miller, Siegel and Lin2016). While these patients may enjoy extended lives, they also contribute to the caregiving burden, resulting in higher hospitalisation rates, more frequent emergency room visits, and the increased adoption of palliative treatments. These heightened healthcare demands translate into increased costs for healthcare systems, patients, and caregivers, potentially compromising the patients’ overall quality of life.

5.2 Research Method

In this subsection, we describe the research process, commencing with our initial intervention: the design of an mHealth app tailored for the case management of patients with lung cancer. The primary objective behind developing the mHealth app was to enhance communication between patients and healthcare providers, a factor consistently linked to improved patient outcomes and reductions in preventable expenditures, such as emergency department visits.

To construct the app, we followed several key steps:

1. 1. We initiated the process by soliciting input from diverse stakeholders, including clinicians and patients with cancer. Additionally, we organised a workshop involving 100 international stakeholders to gather a wide range of perspectives.

2. 2. We then proceeded with the development of the mHealth app, incorporating the insights and feedback obtained from stakeholders.

3. 3. We conducted rigorous end-user testing to ensure the app’s functionality and usability met the desired standards.

4. 4. Finally, we evaluated the efficiency and efficacy of the app based on its performance in real-world scenarios.

Surprisingly, the initial mHealth app received a lukewarm reception not only from some newly onboarded research team members but also from our advisory clinicians, including five oncologists we had previously consulted. Both groups contended that significant revisions were necessary to make a meaningful contribution to both research and practical applications. To address these concerns and better serve the end-users, we received recommendations to broaden our stakeholder base. This involved engaging patients with cancer, as well as collaborating with new clinicians and patient advocacy groups, and expanding the scope of outcomes addressed by the app.

In alignment with this advice, we embarked on a second intervention, engaging in focus groups with severely ill patients with lung cancer.

These discussions prompted us to reflect critically on how we measure service quality and challenged our assumptions about who the primary end-user of the service is.

Following service design principles, we structured the revision process into four iterative phases:

1. 1. Stakeholder Re-engagement: We expanded our engagement to include previously underrepresented voices – especially patients, caregivers, advocacy groups, and additional clinicians – to ensure a more holistic view of needs and expectations.

2. 2. Reassessment of Needs and Value Propositions: We revisited our original design assumptions and gathered in-depth feedback on unmet needs, focusing on aspects such as usability, relevance of features, emotional burden, and clinical utility.

3. 3. Redesign and Prototyping: Based on this feedback, we redefined core functionalities, prioritised features that directly addressed user pain points, and developed revised prototypes that better aligned with user journeys and decision-making processes.

4. 4. Testing and Iterative Refinement: The revised prototypes were tested in low-fidelity and then medium-fidelity formats with target users, allowing for rapid cycles of feedback, refinement, and validation before final development.

This structured revision process not only improved the app’s alignment with user needs but also reinforced the value of participatory service design in healthcare. Rather than treating user input as an afterthought, we embedded it throughout the design cycle, ensuring that both patients and clinicians contributed meaningfully to the co-creation of a tool designed to support lung cancer care.

5.2.2 Developing LuCApp 1.0

Upon gathering the necessary requirements, we commenced the development of LuCApp. Based on a comprehensive examination of emerging themes from the survey, workshop, roundtable, and expert interviews, we structured our design guidelines into three categories: design process, functionality and usefulness. Figure 2 provides a snapshot of the app’s main screen, highlighting its key elements. LuCApp also incorporates automatic alerts, reminders and tips that complement the patient’s therapy. The app offers two modes: clinician mode and patient mode.

Figure 2 Screenshot of LuCApp

Involving Stakeholders Using a Service Design Approach

Following the completion of the initial version of LuCApp, we conducted a series of focus groups to assess and refine the app further.

Initial Feedback from Advisory Clinicians via Focus Group

For the initial focus group, we revisited our advisory clinicians to present our prototype.

Following the approach outlined by Tremblay and colleagues (Tremblay et al., Reference Tremblay, Hevner and Berndt2010a), which leverages focus groups to evaluate an IT artefact, we opted not to test the app in real use but to employ the focus groups as partial field tests for assessing proposed designs and features with stakeholders. This approach, as noted by van Aken et al. (Reference van Aken, Chandrasekaran and Halman2016), can yield valuable insights and lead to more relevant management implications. This approach has been validated in various research projects (e.g. Aier et al., Reference Aier, Fischer and Winter2011; Miah & Mckay, Reference Miah and Mckay2014; Prat et al., Reference Prat, Comyn-Wattiau and Akoka2015; Recker & Mendling, Reference Recker and Mendling2016) and also allowed direct interaction with the central target populations of LuCApp, facilitating probing on functionality and usefulness.

Before each focus group, moderators introduced the app, outlined the objectives and provided general information about the focus group. The planning process included creating a script (Tremblay et al., Reference Tremblay, Hevner and Berndt2012) to probe participants for

• suggestions for improving the current app version and

• feedback on how clinicians’ use of LuCApp in managing patients with cancer could impact patient health monitoring, evaluation and overall decision-making.

Qualitative analysis of the focus group responses highlighted four primary concerns raised by clinicians, including

1. (i) doubts about LuCApp’s differentiation from existing apps or those documented in prior research,

2. (ii) lack of clear evidence supporting LuCApp’s potential to enhance efficacy and efficiency,

3. (iii) uncertainty regarding how LuCApp could benefit both clinicians and patients in lung cancer disease management and

4. (iv) concerns, particularly among the elderly, about potential challenges in using the app.

Involving a New Group of Clinicians

The concerns raised by our advisory clinicians were pivotal to our process. Recognising the need for more stakeholder input to improve the mHealth app, we assembled a new panel of clinicians. This panel consisted of oncologists who had not previously interacted with our research team or LuCApp but possessed familiarity with the mHealth app environment and could potentially become users of the proposed mHealth app.

This group of clinicians appreciated the real-time information provided by patients about their symptoms and severity, enabling swift contact with patients and immediate suggestions for next steps. They found the trend component of the app significant (see Figure 2). However, they recommended removing this functionality from the patient’s version of the app due to concerns that observing negative trends could distress and demoralise patients if their conditions did not improve over time. One clinician (C1) articulated this concern as follows: ‘Displaying side effects, temperature and weight in the charts can influence the patient’s behaviour and have a negative impact on their quality of life’ (C1)

Another participant (C2) noted that the app could revolutionise current practices, as clinicians often communicate with patients through email and WhatsApp, leading to fragmented conversations; LuCApp offers a more systematic, innovative, and efficient solution.

A participant (C4) stressed the importance of considering the disease stage and type, as patients with severe symptoms might struggle to use LuCApp independently as their conditions worsen. Simplifying the symptom descriptions for easy recognition and accessibility was also recommended by clinicians. This experience underscored the value of involving experts in the process to enhance utility and user-friendliness.

Engaging with Patients with Lung Cancer through Focus Groups for the Design of LuCApp

Initially, we had reservations about engaging with patients with lung cancer due to their challenging circumstances: they were often seriously ill and nearing the end of life. However, we recognised the importance of enhancing patient and family engagement in self-care and streamlining care and communication, especially for high-need, high-cost populations. Therefore, we embarked on the demanding task of recruiting and conducting focus groups with patients to enhance our app.

Conversations with patients shed light on functionalities that could provide reassurance to patients, their families, and their caregivers while also improving communication with clinicians. One patient aptly described the app as follows:

‘This app reminds me of a great diary that I could fill in every day and share in real-time with my clinicians.’

(Pt1)

The patients emphasised the significance of symptom monitoring, recognising that it could collect data to enhance not only their treatment plans but also those of other current and future patients.

The patients also shared that LuCApp instilled a sense of security in them as it allowed them to report their symptoms in real time, particularly when they were mild or moderate, which could be indicators of serious issues that might otherwise go unreported to clinicians. The participants believed this reporting could advance medical knowledge, offering insights into when mild or moderate symptoms might lead to adverse outcomes. One patient put it succinctly: ‘I think the app helps me to feel safer, not only because I know I am being followed by the doctor but also because I can see that clinical research is moving forward. We all hope, or at least I hope, not so much to heal but to stop the disease …’ (Pt3).

A crucial revelation emerged regarding how LuCApp affected the relationship between patients and their caregivers. Participants noted that caregivers, often attentive to their loved ones’ needs and health, could benefit from LuCApp as a tool to stay informed about the patient’s health conditions. Some suggested creating a login ID and password for caregivers to access vital patient care information. This feature would be particularly reassuring when caregivers were spouses or children.

The patients believed that LuCApp could enhance their relationship with clinicians by providing real-time access to all relevant data and information in one place, improving the signal-to-noise ratio. While they understood that the app couldn’t replace in-person visits, they felt it would keep clinicians better informed about their well-being. As one patient said, ‘It will be like having the doctor with me at home all day long!’ (Pt2).

This highlighted the promising role of technology in healthcare as a secure and easily accessible tool to enhance communication between patients and doctors.

Furthermore, when asked about LuCApp’s potential impact on the overall care process, the patients saw its value in sharing information about their conditions and symptoms among different healthcare organisations and clinicians, including general practitioners and specialised oncologists.

These valuable insights from the patient focus groups challenged our previous assumptions and contradicted the opinions of some expert clinicians and existing research on clinician–patient interactions. This led us to reassess our understanding of using IT for lung cancer care. Enabling patients and clinicians to co-create value in unexpected ways suggests that intentionally involving challenging-to-reach clients, such as severely ill patients, in the service development process may be the key to enhancing service provision.

Redefining Quality of Life as a Healthcare Service Outcome: Success and Value Co-Creation through mHealth

Our engagement with patients with lung cancer through focus groups not only challenged the perspectives of some expert clinicians but also contradicted previous research on clinician–patient interactions (Min et al., Reference Min, Lee and Shin2014; Sundberg et al., Reference Sundberg, Wengström and Blomberg2017; Uhm et al., Reference Uhm, Yoo and Chung2017). Reflecting on these disparities between clinicians and patients forced us to question our initial assumptions regarding IT-based care management for lung cancer. We revised and refined our understanding of how an IT intervention can be utilised to manage patient care and reshape the design and use of an mHealth app. This process enabled patients and clinicians to co-create value in unforeseen ways, emphasising the importance of actively involving challenging-to-serve clients, such as severely ill patients, in the service development process to enhance service delivery.

5.3 Discussion and Conclusions

In conclusion, this section underscored the pivotal role of both patients and front-line healthcare professionals within service organisations – particularly in healthcare – where their actions and interactions are integral to the service production process. There is a growing imperative to consider the individual needs and preferences of patients to ensure efficient and effective care delivery. This recognition positions the patient as a central actor in the design and management of healthcare systems, as emphasised by Bretthauer and Savin (Reference Bretthauer and Savin2018).

Information and communication technologies (ICTs) are reshaping customer experiences during service encounters and their interactions with service providers, echoing the insights of Scherer et al. (Reference Scherer, Wünderlich and von Wangenheim2015). Customers have evolved from passive recipients to active participants in the process of service delivery, aligning with the concepts put forth by Prahalad and Ramaswamy (Reference Prahalad and Ramaswamy2004). This transformation underscores the changing dynamics of service interactions and the evolving role of customers in shaping the service landscape.

6.1 Advancing a Citizens-Centred Strategic Orientation for Public Service Design Research

While service design research emphasises user engagement in different stages of service provision, what remains unclear is just what types of value citizen-centred service design creates and for whom. Specifically, as discussed in Sections 1 and 2, a key theme in service design research is that through the use of co-design and co-creation techniques, service providers are able to engage with service users to align different aspects of a service with user preferences and needs. Yet as we also discuss, user preferences vary in time and by group. This variation makes the implementation of a citizen-centred strategic orientation in the service design process fraught by questions over implementation such as who to involve and when. Importantly, findings from our empirical sections help to address some of these important implementation questions that were identified in Sections 1 and 2. They do so in two keyways. First, noting the tendency for user preferences and needs to change over time, our findings highlight the importance of repeated exchanges between service providers and users. Co-design plays a crucial role in aligning assumptions regarding service provision between these two entities, and co-creation establishes a forum for iterative exchanges to ensure that service provision evolves in ways that continue to create value for users. Our findings help contribute toward a more strategic approach to engaging service users in co-design and co-creation by illustrating how significant events, at either the individual or the society level can result in a shift in user expectations and, in turn, a demand for modified service provision. Thus, in order to ensure that services evolve in ways that continue to create value, a key implication of our findings is that service providers must focus on creating processes to continual solicit feedback from users who are experiencing significant life events (e.g. having children, retirement, or experiencing illness) and also to create feedback loops for irregular societal events, such as, in our case, the COVID-19 pandemic. All told, to advance a citizen-centred strategic orientation, service providers must create different mechanisms to capture evolving expectations of service users, once focused on predictable, yet significant, life events and a second that focuses on societal events that are more difficult to predict.

From the standpoint of public service design research, the potential for different paths to ensure a given service continues to create value for users breaks ground on new directions for future research. One important area that deserves further attention concerns the implications of different approaches to co-design and creation for social equity and inclusive public service provision. While studies have highlighted the importance of incorporating user feedback into service design and provision, past evidence suggests that doing so often benefits the affluent at the expense of those who are less affluent (Holbein, Reference Holbein2016; Porumbescu et al., Reference Porumbescu, Piotrowski and Mabillard2021; Osborne et al., Reference Osborne, Powell, Cucciniello and Macfarlane2022b). The possibility of strategically incorporating groups into the processes of co-design and co-creation creates the potential to mitigate this reinforcement effect. However, important questions remain. For example, given that biases in service provision are complex and a function of historic disparities and current life circumstances, which groups stand to benefit from inclusion in co-design and co-creation processes is an important question to be explored by future research. Put differently, while co-design and co-creation are powerful tools in improving the value of public services, further research is needed to understand which types of service biases are capable of mitigating. Relatedly, future studies that employ mixed methods designs capable of leveraging insights from focus groups as well as quantitative data to assess impact are needed.

A second important area for further research in the realm of a citizen-centred strategic orientation are the legal and political dimensions of representation within service design processes. Specifically, while service providers and service users may both desire to collaborate on the design and provision of public services, politics, laws, and regulations may make these forms of collaboration difficult. For example, the provision of means-tested benefits are heavily regulated and, as a result, may offer limited opportunities for service users to engage in co-design activities with service providers in ways that meaningfully influence the value created by these services for users (Moynihan et al., Reference Moynihan, Herd and Harvey2015). Furthermore, political dynamics can influence the distribution of power and resources within service design processes, potentially marginalising certain groups from meaningful participation (Arnstein, Reference Arnstein1969). In some cases, entrenched interests or power structures may prioritise the perspectives of specific stakeholders over others, leading to unequal representation in co-design initiatives (cf. Clark, Reference Clark2022a). Additionally, the political climate surrounding public services may create formal or informal barriers to participation for marginalised or underrepresented communities, further exacerbating existing disparities in service provision. Understanding these political dynamics is crucial for developing strategies to promote inclusivity and equity in co-design efforts, ensuring that all voices are heard and valued in the design and delivery of public services.

6.2 Using Digital Technologies to Engage Vulnerable Groups

Determining who to bring to the table and when are important elements of service design theory; however, an issue that has received less attention is how. The question of how to mediate interactions between service users and providers is important because it influences the resources individuals need to participate and, as such, helps determine who can participate in co-design and co-creation initiatives. Put differently, mediums used to facilitate engagement between service providers and users have important implications for the value service design creates. As prior research documents, in person participation mechanisms, that require individuals to be physically present at a particular place and time require a relatively significant amount of resources from members of vulnerable groups (Fung, Reference Fung2015). Given the significant resource demands, members of these groups often opt out of participating (Delli Carpini & Keeter, Reference Delli Carpini and Keeter1996).

Technology is often discussed as a means of alleviating these resource constraints and, by doing so, empowering members of vulnerable groups to be heard (Bimber, Reference Bimber2001). Indeed, there is a growing body of research on digital coproduction, with research in this vein frequently documenting the potential to ensure the needs of more vulnerable groups are being addressed (Clark et al., Reference Clark, Brudney and Jang2020; Osborne et al., Reference Osborne, Cucciniello, Nasi and Strokosch2021; Young, Reference Young2022). However, research on the potential for digital tools to facilitate co-design and co-creation remains limited. Our findings help to address this gap, with evidence across all three studies documenting the potential of technology to improve interactions between service users and providers, and for this relationship to be strongest among members of more vulnerable groups. Our findings dovetail with previous research highlighting the mobilising potential of digital technologies, but also shed light on important implications in terms of how to leverage these tools to improve the value proposition that results from service design theory. One implication concerns the potential of technology to alleviate resource constraints the keep members of vulnerable groups from participating in processes. While research on digital coproduction has shown how technology can enable members of vulnerable groups to actively participate in service delivery by, for example, uploading pictures of service issues in their community, we show that digital platforms can facilitate participation among members of these groups throughout the entire service lifecycle. This is important because it has profound implications for the value co-design and co-creation. A second key implication of our findings concerns the importance of using technology can play in fostering more inclusive public service design. As we document, mismatches are commonplace, where service providers often make incorrect assumptions about user needs and demands. These incorrect assumptions have significant negative implications for service delivery, especially for members of groups with special needs. To this end, the use of technology to make it easier for members of vulnerable groups to participate in co-design can help to ensure services are designed in ways that promote inclusion and social equity.

These implications also create opportunities for new research. One area requiring further research concerns understanding what vulnerable groups digital platforms can enable participation in co-design and co-creation for. Specifically, determinants of participation are complex and while resources are important, so are other factors such as perceptions of self-efficacy and trust in government (Shim & Park, Reference Shim and Park2016b; Clark, Reference Clark2018; Mergel et al., Reference Mergel, Bellé and Nasi2021). Both perceptions of self-efficacy and trust in government tend to be lower for members of vulnerable groups, meaning that the lack of engagement, at least for some groups (cf. Cutrona et al., Reference Cutrona, Russell, Hessling, Brown and Murry2000). This implies that efforts to reduce resources members of vulnerable groups need to engage with service providers, on their own, may not be enough. That is, digital platforms may not be a silver bullet for engaging all vulnerable groups in co-design and co-creation and, by extension, contributing to inclusive service provision among all entities that have difficulty having their voices heard. However, they do have the potential to improve representation of some groups. To this end, further research is needed to understand which groups stand to benefit from the use of digital platforms and which groups other interventions are needed.

A second area that would benefit from further research concerns efforts to refine our understanding of the types of digital platforms that can enable participation in co-design and co-creation. As technology evolves, so too do the ways individuals can interact with government, from synchronous to asynchronous, from video-based communication to text-based interactions. A key question that emanates from this diversity is just what features, and technologies more generally are most effective at engaging service users. A related point is that answers to this question will inevitably depend on specific groups. For example, individuals who have difficulty expressing themselves verbally may feel more comfortable with platforms that enable text-based interactions, whereas the elderly may feel more reassured by platforms that enable video or synchronous forms of engagement. All told, more research is needed to develop a more systematic understanding of what types of technologies are most effective for whom when attempting to foster greater and more inclusive engagement in co-design and creation.

6.3 A Vision for the Future of Public Service Practice

As this Element has demonstrated, the integration of service design principles into public service delivery is not merely a methodological refinement – it represents a deeper reorientation of public service practice around the lived realities of those it seeks to serve. The evidence presented across our empirical sections reveals that service design offers a powerful framework for making public services more inclusive, adaptive, and responsive. Looking forward, we see five core principles that should guide the future practice of public service design:

1. 1. From Users to Co-Producers: Public services must increasingly treat citizens not simply as end-users but as co-producers of value. This implies early and sustained engagement in the design and delivery of services, recognising the expertise users bring from lived experience. Co-design and co-creation are not add-ons but foundational to achieving relevance and legitimacy in public service delivery.

2. 2. Embrace of Iteration and Flexibility: As our findings show, user needs are not static – they evolve with personal life events and broader societal shifts. Future public services must embed continuous feedback mechanisms and iterative processes, allowing services to adapt over time. Flexibility must become a core design criterion, not an exception.

3. 3. Equity through Intentional Inclusion: Service design must actively resist the tendency to default to the ‘average user’ and instead foreground diversity – particularly among vulnerable or underserved groups. This requires targeted outreach, accessible engagement formats, and inclusive design processes that recognise different forms of participation.

4. 4. Technology as Enabler, Not Solution: Digital platforms hold real promise for improving participation and service responsiveness, but their effectiveness depends on thoughtful, user-centred implementation. Future public service practice must focus on matching technological tools with the capabilities, preferences, and constraints of different user groups – especially those historically excluded.

5. 5. Culture Change in Public Institutions: To embed service design meaningfully, a shift in organisational culture is needed. This includes valuing user insight as strategic knowledge, legitimising experimentation and iteration, and building the capabilities of public managers to facilitate participatory design processes. Leadership must model and support this shift.

In sum, the future of public service practice lies not in adopting a single method or technology but in embracing a relational, participatory, and iterative mindset. Service design, when understood in this broader sense, offers a pathway to reinvigorate public services as spaces of shared value creation – responsive to real needs, grounded in trust, and committed to equity.

Public managers, policymakers, and researchers alike must collaborate to move this vision forward – not only by advancing service design as a toolkit, but by fostering the institutional conditions in which meaningful co-creation can flourish.