6. Design research for healthcare service delivery improvement
Submitting InstitutionGlasgow School of Art
Unit of AssessmentArt and Design: History, Practice and Theory
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
Through the introduction of innovative design approaches, processes tools
and methods into the research of complex healthcare issues, a range of
individuals — including members of professional groups, e.g., in nutrition
management and physical rehabilitation, clinical trials managers,
healthcare professionals and patients (involved, e.g., in random
controlled trials), are now able to consider and use tools and approaches
that they did not use previously. These, policy-makers, leads in research
councils, charities, and members of lay user representative groups have
seen, through demonstrations, national and international presentations and
professional publications, advantages of these innovative tools and
approaches that enable more patient-centred treatment and enhanced
Complex patient-centric and technology issues, including those associated
with the ageing demographic and the accompanying significant and growing
component of patient rehabilitation, challenge healthcare service quality
delivery and its cost-effectiveness. Macdonald's research group has been
working in this field since 1995, building on his 1995 `Challenge of Age'
work, and supported since 2002 by RCUK-funded healthcare- and
ageing-related grants. Over the period to the present, their programme of
integrated people-centred, participative co-design approaches to
technologically-supported development has been used to: i) create new
tools and methods for research; ii) embody these in the design of
multidisciplinary healthcare-research projects; iii) use these to yield
new insights and knowledge; and iv) use these as the basis for proposing
improvements to healthcare delivery and professional practice. Those
projects delivered to date have impacted beneficially on the sector during
design, in use, and for envisaging future provision. For example,
`InclusiveCAD' (EPSRC/EQUAL, 2002-05, G1, Section 3) addressed problems
identified in under-utilised biomechanical expertise for use in design and
rehabilitation. Here, insights gained informed the development of a
prototype software tool visually presenting dynamic biomechanical data in
a novel manner and subsequently evaluated in `Envision' (ESRC/NDA,
2007-09, G4) whose final report and findings (O1) showed potential
benefits for use by people without training in biomechanics, both lay
people and professionals (e.g. clinicians, healthcare and design
practitioners). What was unknown at this point was what kinds of tools,
e.g., therapists would find useful for specific types of rehabilitation
for a range different patient needs and how patients would benefit.
Envisage (MRC/LLHW, 2010-2013, G6) addressed these issues by developing a
set of prototype visualisation tools tested as therapeutic interventions
in five feasibility clinical trials for stroke and musculoskeletal
rehabilitation. Loudon, (a GSA PhD student supported by the EPSRC EQUAL
project (G1); a research assistant from 2002- 2010; thereafter a research
fellow), a software engineering graduate, developed the programming,
software and tools during this series of projects above up to and
including the Envisage trials. Taylor (Research Fellow on Envisage,
2011-2013,G6) developed and tested a new qualitative methodological
framework arising from `Envisage' trials evidence to assist in the
analysis of data. This work has also attracted interest from Japanese
rehabilitation professionals, two-way exchanges to/from Japan supported by
the GBSF (G5). This methodological approach incorporated a technological
development and prototyping process using stakeholder engagement,
advancing further the approach used in `mappmal' (ESRC/NDA, 2008-12, G3)
to produce `hospitalfoodie' (O5), the latter resulting in a demonstration
prototype for a new food system for managing and monitoring the
nutritional needs of vulnerable, older in-hospital patients. Teal
(Research Assistant, 2008-2012, G3), a product design engineer, made a
significant contribution to the GSA development of this `hospitalfoodie'
prototype by the design of novel stakeholder engagement methods (O5).
Similar participative technology development approaches have also been
applied to pathogen visualisation resulting in a small suite of
demonstration prototypes evaluated for their potential for training
purposes for behaviour-change in hospital healthcare professionals to
prevent occurrence of healthcare acquired infections (G7). The specific
insights developed by Macdonald in patient-centred understanding of
healthcare pathways (first explored in G2) has been further evolved,
through commissioning by the Royal Society of Arts, supported by the
Sylvia Adams Trust, into an approach for involving spinal cord injury
(SCI) patients in developing skills to assist their own rehabilitation
(O6, S10) attracting and engaging the SCI clinical lead, and similarly
leading to an invitation to apply these methods in new work for the
end-of-life-care for dementia patients (G8).
References to the research
3.1 Key Outputs (O)
O1 Macdonald, A.S., Loudon, D., and Docherty, C. (2009). Innovation in
envisioning dynamic biomechanical data to inform healthcare and design
guidelines and strategy. Findings. NDA Research Programme, University of
Sheffield. Report submitted to ESCR available at
O2 Loudon, D., Carse, B., & Macdonald, A.S. (2011) Investigating the
use of visualisations of biomechanics in physical rehabilitation. In M.M.
Cruz-Cunha, J. Varejao, P. Powell, R. Martinho (Eds.), Proceedings of
Enterprise Information Systems, CENTERIS 2011, CISS 221(1), (pp.
30-39). Springer-Verlag, Berlin Heidelberg (REF2).
O3 Loudon, D., and Macdonald, A.S. (2011) Enhancing dialogues between
rehabilitation patients and therapists using visualisation software. In Pervasive
Health, 5th International ICST Conference on Pervasive Computing
Technologies for Healthcare, Dublin Ireland 23-26 May. ISBN
O4 Loudon, D, Macdonald AS, Carse B (2012) Developing visualisation
software for rehabilitation: investigating the requirements of patients,
therapists and the rehabilitation process. Health Informatics Journal,
18(3) 171-180. Sage. DOI: 10.1177/1460458212443901 (REF2).
O5 Macdonald, A.S., Teal, G., Bamford, C., & Moynihan, P.J. (2012)
Hospitalfoodie: an inter-professional case study of the redesign of the
nutritional management and monitoring system for vulnerable older hospital
patients, Quality in Primary Care, 20(3):169-177 (REF2).
Macdonald, A.S. (2013) The inner resource: enabling the designer within
us all — a case study. The Design Journal, 16(2). Pp 175-196. DOI:
3.2 Key Grants (G)
G1 InclusiveCAD: integration of biomechanical and psychological
parameters of functional performance of older adults into a new CAD
package for inclusive design. To: University of Strathclyde, Nicol
(PI), Conway (Co-I), Grealy (Co-I); Glasgow School of Art, Macdonald
(Co-I); Queen Margaret University, Rowe (Co-I). EPSRC / EQUAL (Extending
QUAlity of Life) initiative. 2002-2005. £390K. Grant Ref: GR/R26856/01.
G2 Ideal states: towards a joint knowledge and operating framework
for design and medical practices. To: Glasgow School of Art,
Macdonald (PI). AHRB/EPSRC Designing for C21st. 2005. £50K.
G3 Mappmal: multidisciplinary approach to develop a prototype for the
prevention of malnutrition in older people: products, people, places and
procedures. To: Newcastle University, Moynihan (PI); Glasgow School
of Art, Macdonald (Co-I); University of Reading, Methven (Co-I). ESRC New
Dynamics of Ageing Programme. 2008-2012. £1.35M. Grant Ref:
G4 Envision: innovation in envisioning dynamic biomechanical data to
inform healthcare and design guidelines and strategy. To: Glasgow
School of Art, Macdonald (PI); University of Strathclyde, Nicol (Co-I).
ESRC New Dynamics of Ageing Programme. (2007-2009). £130K Grant Ref:
G5 Inclusive approaches to healthcare provision for ageing and
disabled populations. To: Glasgow School of Art, Macdonald (PI).
Great Britain Sasakawa Foundation (GBSF) Butterfield Award. (2007-2010).
£12K. (3 years' funding for research exchange).
G6 Envisage: promoting physical independence through dynamic
visualisation of biomechanical data. To: University of Strathclyde,
Rowe (PI); Glasgow School of Art, Macdonald (Co-I); Glasgow Caledonian
University, Baillie (Co-I). MRC Lifelong Health and Wellbeing Programme.
£1.5M FEC (2010-2013). Grant Ref: GO900583.
G7 vis-invis: visualising the Invisible: developing innovative
approaches to visualisation to help NHS staff prevent and control
healthcare associated infections. AHRC/SFC, A Healthier Scotland
initiative. To Robert Gordon's Uni, MacDuff (PI), co-applicants including
Glasgow School of Art, Macdonald £99.3K (2011-2012).
SEED: supporting excellence in end of life care in dementia via an
integrated care pathway (ICP). NIHR Programme Grant. Awarded to
Newcastle, Robinson (PI) Multiple co-applicants including Glasgow School
of Art Macdonald £1.9M (non-FEC) (2013-2018). Grant Ref: RP-PG-0611-20005.
Details of the impact
The nature of this work is collaborative involving multi-disciplinary
teams with diverse healthcare-related research and practice expertise.
Impact is a collective achievement but the particular contributions of
Macdonald's group are described. 4.1. InclusiveCAD (G1), envision
(G4), envisage (G6) Health and welfare: As
explained in Section 2, user-engagement in the co-design of technology and
the visual tools enriched the communication between patients and
healthcare professionals. Evidence of this can be found in the `Envision'
findings (ESRC/NDA, 2007-09, O1) and end-of-project report (S3) which
report on the benefits experienced by lay people, patients, clinicians,
healthcare and design practitioners without training in biomechanics.
Further evidence is available for the impact from the use of the
visualisations of movement data and tools further developed for therapists
and in-trials patients in a set of 5 individual physical rehabilitation
pilot clinical trials in 2012-2013 for `Envisage' (O2,3,4). The visual
tools enabled clinical leads, therapists and patients to view movement
data, with overlays of supplementary information (e.g. target — and
achieved -limb movement angles, symmetry or rate of walking) for real-time
feedback and discussion, allowing therapists to select exercises and views
best suited to patients' individual rehabilitation needs. Loudon's and
Taylor's analysis of the data in the three stroke trials reveals the
relationship between improved: i) patient understanding of correct
movements for their rehabilitation treatment; ii) communication between
patient and professional; iii) objective understanding of progress (S7) —
challenges previously perplexing to successful rehabilitation using
current tools. Society, culture and creativity: `Envision'
work won Glasgow School of Art a Nexxus (life sciences) Innovation Award
2011 acknowledging the most innovative product or service recently on the
market, or close to market, from a Scottish life sciences institution or
company. The further knowledge acquired in the subsequent `envisage'
project has stimulated public debate and improved understanding of the
issues facing rehabilitation healthcare in meetings of rehabilitation and
therapy specialists (at conferences, workshops, demos, and networking
meetings addressing the diverse constituents of the sector, 9 press
releases, 2 policy document contributions, 3 TV pieces (e.g. one patient
was shown using the system in-trial on BBC TV Scotland (31/1/13:
S8)), and 1 radio interview. Additionally lay, professional and policy
audiences have viewed this work presented in numerous forums including
Lifelong Health and Wellbeing (LLHW) showcase events in Newcastle
(11/2011), Edinburgh (12/2012), and London (11/2013); AgeUK; to 70
academic, lay public and professional members at SPARC (11/2008);
Innovations Centre Scotland (12/2010); NHS24 (10/2011), and International
Longevity Centre and Actuarial Profession (05/2012). Macdonald received a
Great Britain Sasakawa Foundation Butterfield Award (for Medicine and
Health) (G5) to visit a number rehabilitation centres in Japan to discuss
this work, resulting in reciprocal visits. Public policy:
findings from `envision' (O1) were used as part of a 2008-09 Department of
Health report `(Research and Development work relating to assistive
technology) to Parliament pursuant to section 22 of the Chronically Sick
and Disabled persons Act 1970'. The MRC selected the `envisage' work as
one of only two LLHW demonstration projects selected for an RCUK
Parliamentary Showcase, House of Commons, (5/12/12). The Chief Scientist
Office (Scotland) reported this work in its e-bulletin (03/2013). The MRC
Researchfish portfolio of evidence is available for the full `envisage'
team's engagement and impact activities with findings from envisage (S7)
produced in November 2013. 4.2 Mappmal (G3).
Practitioners and services: Mappmal impacted on a range of
professional disciplines, exemplified by invitations to contribute to
professional magazines, e.g. `NHD' Dietitians magazine, the British
Association of Parental and Enteral Nutrition (BAPEN) newsletter, British
Journal of Community Nursing, and invitations to speak at Industry-led
study days to speech therapists, nurses and dietitians. Following a
mappmal symposium, the Care Alliance invited the PI to deliver a study day
on our findings to care home managers. Utilising our participative
stakeholder and technological development approach, `mappmal' research
made significant contributions, e.g., by: i) identifying new service
principles to optimise food provision and nutritional management; ii)
increasing technical knowledge of valid computerised means of monitoring
and tracking food intake against individual patient's nutritional
requirements amongst dieticians, nurses, health care assistants and
clinicians working in the care of older people in hospital and care homes.
A significant achievement here was Teal's (with our Newcastle partner)
development of an innovative `wipe' app assisting the visual recording of
food eaten by patients (O5). Impact has been achieved through >16
conference presentations, including presentation of our demonstration
prototype at 6 international conferences in disciplines of Computing
Science, Design, Nutrition, Sociology, 3 symposia and 6 UK exhibitions
(British Society of Gerontology (BSG) Plymouth 10/2011; Design4Health,
Sheffield (07/2011); British Geriatrics Society (BGS), Brighton (07/2011);
British Association of Parental and Enteral Nutrition (BAPEN), Harrogate,
(11/2011); and Hospital Caterers' Association (HCA), Reading (04/2012)
(S1). The website www.hospitalfoodie.com (S2) has disseminated the
findings to >30 countries resulting in enquiries from overseas teams to
hold discussions and/or view the prototype. Two formal discussions were
entered with IT companies regarding the interactive software and interface
knowledge transfer partnerships resulting in one KTP. Policy:
Following the launch of the `hospitalfoodie' prototype at an exhibition at
BSG, the Chair of BAPEN invited the team to work collaboratively to align
`hospitalfoodie' with BAPEN strategy and facilitate its adoption by
healthcare providers. S1 provides impact details. 4.3 VisInVis
(AHRC/SFC, 2011-2012, G7) achieving local and national coverage in 2013
for our work (including S9).
Sources to corroborate the impact
S1 Mappmal (G3): `multidisciplinary approach to a prototype for
prevention of malnutrition in older people: products places people and
procedures'. End of project impact report for ESRC. provides a
statement of the collective mappmal team impact and the individual
S2 Mappmal (G3): virtual exhibition and hospitalfoodie website:
S3 Envision (G4): `Innovation in envisioning dynamic biomechanical
data to inform healthcare and design guidelines and strategy'. End
of project report for ESRC (available on request). All outputs publicly
available at: http://www.esrc.ac.uk/my-esrc/grants/RES-352-25-0005/read
S4 Envision (G4): `Innovation in envisioning dynamic biomechanical
data to inform healthcare and design guidelines and strategy'
project findings for ESRC New Dynamics of Ageing: Macdonald, A.S., Loudon,
D., and Docherty, C. (2009). NDA Research Programme, University of
Sheffield. Available at http://www.newdynamics.group.shef.ac.uk/nda-findings-1.html
S5 Envision (G4): NEXXUS Life Sciences Innovation Award (West).
Documentation from the (now defunct) NEXXUS website regarding the
contribution made through the envision research to the life sciences
community plus a double-page article in their newsletter.
S6 Envision (G4): 2008-09 Department of Health report (Research and
Development work relating to assistive technology) to Parliament
pursuant to section 22 of the Chronically Sick and Disabled persons Act
1970. Available at:
S7 Envisage (G6): promoting physical independence by involving users
in rehabilitation through dynamic visualisation of biomechanical data.
Website describes the project as a whole but Macdonald's group's findings
of: i) the over-arching qualitative methodology and ii) findings of the
use of the visualisation tool.
S8 Envisage (G6): BBC Scotland website article showing the use of the
visualisation software in a patient trial providing the views of the
patient and therapist (31/01/13). Available at
S9 vis-invis (G7): visualising the Invisible: developing innovative
approaches to visualisation to help NHS staff prevent and control
healthcare associated infections. AHRC/SFC, A Healthier Scotland
initiative. News item on AHRC website
and Health Sciences Scotland
S10 Royal Society of Arts (RSA) report on the Glasgow School of Art
pilot project with the Queen Elizabeth National Spinal Injuries Unit
(QENSIU) discussed as part of the RSA's larger national project.
Report available RSA's public website:
viewable at: <http://www.thersa.org/action-research-centre/enterprise-and-design/design/design-and-rehabilitation
Further contacts available:
Royal Society of Arts (Action and Research Centre) and former Head of
Design at the RSA and initiator of this project) now Director of
Programmes, Creative Education Academies; Clinical Director, Queen
Elizabeth National Spinal Injuries Unit (QENSIU) Glasgow, Southern General
Hospital would all be able to confirm the claims for the impacts from the
methods used and the way this is helping in the re-consideration of how
rehabilitation might be delivered in a spinal cord injury rehabilitation