Empowering champions of innovation and change in large healthcare organisations using human-centred design

  • Christi Zuber

Student thesis: Doctoral ThesisDoctor of Philosophy


The rising cost of healthcare and the inability to provide the adequate care and access needed for an ageing and a more complex patient population are putting systems around the world under pressure to change. Healthcare is inherently risk averse (Cresswell, Cunningham-Burley, and Sheikh 2017) and has a complex infrastructure that resists change (Chin et al. 2012; Christensen, Bohmer, and Kenagy 2009). It has been stated that a key approach to addressing these issues is to equip healthcare organisations and a workforce within them with the capabilities to innovate (Berwick 2003; Bohmer 2010; Coughlan, Suri, and Canales 2007; Weberg 2013). Research has focused on how human-centred design (HCD) can be used as an approach to build innovation capability within organisations (Carlgren 2013b), but there is limited study of individuals using and developing HCD for innovation in the context of their work environment (Carlgren, Elmquist, and Rauth 2014; Carlgren, Elmquist, and Rauth 2016a; Liedtka and Ogilvie 2011; Seidel and Fixson 2013), particularly in healthcare (Berwick 2003; Bohmer 2010; Coughlan, Suri, and Canales 2007; Roberts et al. 2016). These gaps create challenges when attempting to address the pressure to change in healthcare. The aim of this research was to explore and create actionable approaches for leaders of change to build this capacity to learn and apply HCD to champion innovation and transform healthcare.

To do this, the research presented sought insights that could be applicable across a wide diversity of backgrounds and organisational roles to broaden the scope and reach of these change agents. This research conducted three different studies across a range of individuals from novices through to those who had over a decade of experience in learning and successfully applying HCD for innovation within large organisations.

The first study aimed to understand the conditions that enabled those inexperienced in organisational innovation and design to champion innovation and change more broadly. A total of 125 nurses took part in a workshop and empathy map-based study. The results surfaced seven key enabling conditions to champion innovation and change from the nurses’ viewpoints.

The second study conducted semi-structured interviews and user-led journey map exercises aimed at understanding the approaches taken by 15 successful exemplars across a broad range of industries. The goals surfaced commonalities in how they navigated the complexities of HCD for innovation in an organisational setting. The results indicated common themes in conditions and behaviours displayed.

To provide a real-time “in-the-wild” view into learners’ development and responses to organisational context, a third study was undertaken longitudinally over a twelve-month period. In this study, new HCD learners and those responsible for mentoring them were observed during a series of integrations with their coaches and peers both virtually and in person as they worked to actively apply HCD within their healthcare organisations. The transcribed interactions were thematically analysed to produce a new view of learning in this field.

The findings across the three studies were brought together to generate a novel set of interactive and actionable theoretical models. First, a design competency model creates an innovative approach to codify and track the developmental journey of new HCD learners. Second, a microclimate model and roadmap provides a new codified set of conditions and behaviours for developing HCD within a large organisation’s workforce directly from the experiences of exemplars in the field.

To date, studies have focused on how organisations overall can create structures to support innovation and design, leaving little guidance for individuals who want to help lead innovation and change within the workforce. These results make a significant contribution by providing tools inspired and shaped by user experiences to empower healthcare leaders to approach the needed changes in new and novel ways.

The thesis recommends future work in the development of curricula to support competency development along the newly defined stages of learning and in the testing of these tools in organisations over time to track the impact and outcome.
Date of Award2018
Original languageEnglish
Awarding Institution
  • Coventry University
SupervisorLouise Moody (Supervisor)

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