Many features of our current healthcare system are not fit for purpose. There is an abundance of literature that emphasizes the urgent need to create healthcare systems that are more person centered and connected and that provide greater value, effectiveness, and efficiency. However, health systems are slow to change, and advances in health services research that could inform much needed reforms are often incremental in nature.

For a number of years, I have worked with a team of researchers as part of an Australian National Health and Medical Research Council Centre of Research Excellence in End of Life Care. The center's research program focuses on improving access to quality palliative care. A key objective of our work has been to build the evidence base to inform the design of service delivery models, which achieve better integration between acute care services, specialist palliative care services, and primary care providers. For example, one of our studies has produced promising findings about the benefits of nurse practitioner models of care in achieving more connected care.1 However, I am well aware that we are only touching the surface and that more transformative approaches are needed to address the complex problems associated with providing palliative care.

My colleagues in the Business School at Queensland University of Technology have championed design thinking strategies as 1 way to overcome traditional ways of thinking about complex problems. Design thinking has been defined as an "analytic and creative process that engages a person in opportunities to experiment, create and prototype models, gather feedback, and redesign."2 Design thinking has been described as a systematic innovation process that "prioritizes deep empathy for end-user desires, needs and challenges to fully understand a problem in the hopes of developing more comprehensive and effective solutions."3

On the face of it, this description does not sound that different to some of the research approaches that are familiar to cancer nurses, such as action research, which emphasize partnerships with patients in the research process. However, 1 clear distinguishing feature of design thinking is its emphasis on creativity and innovation.

I wondered whether design thinking could help our team to achieve breakthroughs in our thinking about how primary and palliative care services could be more effectively integrated. We asked our Business School colleagues to facilitate a design thinking workshop with this goal in mind. We invited individuals from a variety of professional, government, consumer, and not-for-profit groups to participate. The facilitators used a specific method to promote the development of innovative ideas called systemic ideation.4 This model of innovation incorporates 4 different strategies that can promote innovation. These strategies included (1) "enhance," where participants mapped out the problem and tried to improve steps along the process; (2) "derive," where participants considered the problem from the perspective of how other organizations with very different practices might address the issue; (3) "utilize," where participants built on unidentified opportunities; and (4) "design," where participants designed a new process or practice.

The workshop was energizing and productive. We generated new insights into care processes and developed several interesting ideas about what we could do to address problems with integration of care, early identification and planning for palliative care, and community awareness of dying. However, with other problems, such as funding models, we did not get very far. This could be because we did not have the right mix of people to address the problem or because the complexity of such issues requires a more extensive design thinking work than could be achieved in 1 day. I have also reflected on the fact that the design thinking workshop was only 1 part of the process of innovation. Some ideas were "out of the box" and require a lot more refinement. The innovation process in itself also does not occur in isolation, and the design thinking workshop is not an end in itself. Drawing on other theoretical perspectives and evidence to enhance the process has been useful to inform specific recommendations and an action plan for future work. I also need to be comfortable with the fact that not all solutions generated will succeed but that the insights and learnings gained from design thinking activities can be important to advancing knowledge.

Design thinking has been applied in developing new products or designs of spaces in healthcare.5 Although there is a growing body of literature on the role of design thinking in healthcare research, its application to important challenges, such as developing more integrated care delivery models, is not as widespread.5 I can see the potential that design thinking has as part of the nursing research process as we seek to identify more creative ways to address the complex problems facing healthcare today. Its focus on user involvement is very suited to nursing practice. Nursing's typically pragmatic approach could also provide an ideal frame of reference to ensure that what might be quite radical solutions are translated into practical strategies for further research and development. I have learnt from the process and will definitely try it again.

Sincerely,

Patsy Yates, RN, PhD, FAAN, FACN

Editorial Board Member, Cancer Nursing: An International Journal for Cancer Care

School of Nursing and Institute of Health and Biomedical Innovation,

Queensland University of Technology, Queensland, Australia

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