“If your intention is to apply design thinking and skills to make a difference in healthcare, start with your own history and perspectives.” Each chapter begins with the story of Elena, a real patient. Jones weaves Elena’s patient journey into the opening of every chapter to introduce the respective themes and concepts. By grounding abstract concepts in tangible, lived experiences, readers can foster a stronger emotional connection to the systemic issues in healthcare systems and see their plights through patients’ eyes.

Similarly, while reading the text, I was able to draw parallels to my own personal anecdotes and find comparisons in how they align or challenge the author’s thoughts on design in care. As Jones writes, “Unlike other fields of design and management, personal experiences and common sense may harness your motivation and inform a sense of genuine empathy.” Relating the main takeaways to my own experiences were beneficial in allowing me to reflect on the practical relevance of Jones’ ideas, highlighting the universal applicability of some of the included advice.

There were many lessons from this book, as well as very useful tips about choosing the right generative research methods, but I have streamlined my learnings to eight main takeaways that I found most relevant to my research and vision as a designer. In each takeaway, I deepened my engagement with the text by reflecting on my past experiences and thought about how it could connect with my area of research: improving the patient experience through co-design.

Takeaway #1: Design vs Medicine — The Barriers of Entry
“The robots come out of the closet only when The Straits Times comes.” I have come back to this quote multiple times, but this sardonic quip by the director of a hospital unit I was talking to while working on a last mile delivery robot for hospitals has stuck with me till now. He claimed that despite all the futuristic technologies and benefits touted by these medical robots, hospital staff rarely used them because of the lack of integration into their existing protocol and legacy policies. The only time they were in full operation was when the mainstream newspapers came by to take photographs.

He followed up with more questions about the proposal — what are the exact benefits of the robot? Exactly how much time could it save? What is the exact weight of load the robot could carry? In this exchange, I tried to explain that these are things that would need to be uncovered through conversations with staff and iterative prototyping to determine the best answer. But he remained sceptical (understandably so).

The author acknowledges this scepticism. Designers may face obstacles when validating their contributions to their clinical counterparts who often shun design thinking in an evidence-based, institutional setting. After all, in a life-or-death situation, medical practitioners must know what they are doing or researching to prevent loss of life or causing harm to patients.

But design researchers do not always know what the outcome is — this fundamental difference in our research highlights the divergence in the way we think. This is common with the designers working in healthcare, where the value of their support is limited by lack of access to clinical practice and patients, and the need to produce evidence-based, quantitative proof before practitioners accept any form of collaboration.
Jones suggests that the best way for designers to close this gap is for the team to be more interdisciplinary in nature. By considering both perspectives, it would be easier to absolve the differences between exploratory and clinical research.

Takeaway #2: The Patient Story & Empathetic Design
I conducted a co-design workshop on exploring social isolation, loneliness and boredom in the cancer patient experience with the class. One of the activities was a collective dreaming exercise where participants were tasked with designing a small scale hospital. As the class were not patients, I provided each group with a persona. Instead of creating a fake profile, I used actual social media posts of real patients. These posts were actual stories of patients’ lived experiences. During the workshop, I observed that the groups created solutions that were tailored to the pain points of the patients and were able to better empathise.

In the book, Jones had similarly mentioned how unlike typical service design processes, methods used in healthcare settings have to be tweaked slightly to promote empathic research. One such example he brought up was the use of flattened, stereotypical personas that could create “a false intimacy and pretence of user knowledge”. As it is difficult to have access to real patients due to privacy issues, design teams may make up semi-realistic personas as proxies. However, it is difficult to say how ‘real’ these caricatures are.

Through the exercise that I did in class, I believe that it really showed that using an authentic narrative based on real patients and interview data can bring a persona to life. Participants, upon knowing that this persona is a real person, can pick up on emotions more vividly and identify the salient issues, creating solutions with more impact.

For designing in healthcare, it is impossible to characterise an entire user profile because each persons’ lived experience is inherently different; designers should always keep in mind that we are designing for real people.

Takeaway #3: Being Stuck — Agency & Patiency
When I was doing my undergraduate thesis on operational anxiety in paediatric patients undergoing surgery, one of the main insights I gathered was that patients, being in an unfamiliar environment, are inevitably moving from a state of control to a one without. This change results in a loss of autonomy, and the lack of choice they are given only exacerbates the anxiety they feel.

Jones posits that “a person will take action (agency) on matters of their choice and will also accept and seek care from others (patiency).” While patients have to accept care and do what the doctors tell them to do, they are still individuals with choice, and they have their own agency to make decisions. Restricting a patient from making their own decisions only allows them to fester in disengaged states.

As designers, it is easy to focus on making the experience more effective for patients, while practitioners just want their patients to be cured of the disease. We may create solutions thinking this is for the good of the patient — but is it really? Jones states the importance of needing to listen and give the patient the autonomy to practice their own agency. We should be designing for the patient experience, not just the clinical experience.

Takeaway #4: Nobody Chooses to be a Patient
In an online survey I did with cancer patients in 2024, one respondent wrote “I wish I was treated like a human and not a slab of meat.” An interesting point brought up by Jones was that of the “patient identity”. Often times, once people are diagnosed, they are automatically classified under the label of their disease. In the hospital, they are simply patients, identified by a string of numbers.

Dr Wes Ely, author of Every Deep Drawn Breath, wrote “I saw now that I, too, had showed callous disregard for some of my patients. I had thought it innocuous to use Gallbladder in Room 557 to consolidate both person and diagnosis, without digging any deeper. I wasn't seeing my patients as fully human. Did they know? Now, looking back, I suspect many did.”

Jones emphasises that designers cannot use typical research methods to categorise patients; “a patient is not fully a true consumer or customer.” The reality is that healthcare is a public good. But good care is a moral issue. Nobody chooses to be a patient. They cannot choose their medical team, sometimes not even the hospital they are admitted into. Patients receiving poor care have a limited ability to compare. They face information asymmetry and are not at liberty to find alternatives for themselves. And this makes patients different from a normal consumer; they are discouraged from asserting agency and remain vulnerable to the market power of healthcare policy.

In the design for healthcare as a public service, designers must consider who we are designing for and the context we are designing in. There is no single service line of business in healthcare — patient-provider relationships are complex and diffuse. Designing in healthcare entails being aware and sensitive to the institutionalised nature of systems, and being able to reconcile the patient’s sense of self with doing what is best for them.

Takeaway #5: Socialisation, a Bottom-up Strategy
“Professionals do not generally like change when it happens to them.” Design interventions usually mean changes to legacy, where actors in the a system are required to unlearn the old process and learn a new one. Habits are entrenched in day-to-day routines, and amidst high-stress, time-crunch environments, healthcare practitioners are understandably unwilling to welcome changes to their system and thus, reject innovation.

In 2023, I created a patient journey template from triage to discharge for the OB/GYN department of a hospital with the aim of improving the expectant mother experience. The design department had talked to the clinicians about the need for innovation and educated them on design methods. They slowly opened to the idea and began to use the template. Fast forward to 2024, we worked with them again on a project about their plan for a new smart ward. The clinicians were much more open to the co-creation process and were very willing participants.

This interaction is what Jones terms as “socialisation”. Instead of taking a top-down approach where the management tier tells the departments what to do, we had used a knowledge-creation perspective. An organic demand for the value of design is first developed over time with a smaller pilot team, allowing the organisation to discover and witness the benefits of the design process, and thus adopt it other situations. With peer-to-peer communication, the collaboration between the departments was much smoother, and this distributed, lateral approach to participation was effective in creating new ideas without being delayed by institutionalised processes.

Takeaway #6: No Feedback is Good Feedback
Healthcare systems are ultimately tied down by capitalism. There are always considerations when it comes to cost of implementation, cost of manpower, cost of maintenance and so on. For hospital management, a ‘good’ design is one that meets their success metric of more profits, better rankings and other quantitative measurements. But as Jones asserts, “[in] the care market, human lives are at stake, not merely profits.”

What then, is the success metric of a patient, the main beneficiary of the system? Jones discerns that patients are not expected to be repeated customers and thus have little comparison to other care providers. The patient experience of healthcare innovation is therefore invisible. Any improvement made for the patient experience can only be appreciated by its absence and perhaps measured by not noticing. It is an invisible statistic of errors or experiences that did not occur.

I once talked to a design researcher from Philips who had worked with healthcare for some time. He mentioned that pain memory is short-term. “The brain erases the [pain] memory...[but] as an adult you can remember the surgical experience. The experience memory stays for very long.” I too had experienced something similar. When I was 12, I underwent surgery for appendicitis. I cannot recall exactly how painful it was after the surgery, not do I recall what the care team talked to me about. But what I do recall was the wait after the surgery.

After the surgery, I woke up in the hospital bed in the post-anaesthesia care unit completely alone, reeling from a sharp pain in my abdomen, surrounded only by curtains and the incessant beeping sounds of the monitoring machinery. I was lost, confused and unsure if I should call for somebody to let them know that I was awake. Nobody had told me what to do or expect. And so, I waited until a nurse finally noticed. Looking back, I may have waited for only five to ten minutes. But back then, it felt like eternity. In an otherwise world-class experience – after all, I was cured — my patient journey was marred just by this single blip. It became the main moment that I remembered from this experience till now, overshadowing all the good things that the staff may have done for me.

As such, designers should remember that in designing for experiences, we have to consider the entire journey. Negative memories stick more than positive ones, and only by creating a holistic journey can we actually improve the patient experience. No feedback is a sign that there is no negative feedback.

Takeaway #7: Understanding the System
To design holistically, we need to understand the context we are designing in. Healthcare systems are especially complex and interconnected in unexpected ways. In many countries, it is the largest employer and includes clinical practices of all sizes, their business and policy ecosystem, and medical schools. As an outsider to this system, designers have to tread on careful ground to map out the intricate relationships between different powers and people, navigating institutional secrecy and privacy concerns.

There are also communication challenges between the academic and commercial sectors. There was one project I worked on that involved a three-way partnership: a hospital, a design department from the university and a robotics company. This tripartite agreement resulted in many meetings about proprietary rights. It left me feeling frustrated — we were trying to solve a problem to elevate basic care for patients, but the other two parties were more fixated on intellectual property? I was incredulous, but it opened my eyes to how multi-dimensional systems can be, and how designers need to be aware of how other stakeholders interact with each other.

Jones talks about generative research methods, and how working grounds-up is the best way to get people involved. I very much agree – co-design is one of the best ways to break down this barrier. I had the chance to organise a co-design workshop on assistive mobility with stakeholders from different hospitals and faculty from design and other engineering departments. As the main outcome of the workshop was to create knowledge for sharing, everybody worked well together. Without the weight of the institutional policies weighing over them, I saw practitioners from different clusters discussing ideas enthusiastically and sharing contact information with each other.

Co-design presents a very good method that brings people together. In complex systems, it is an effective method of sharing different perspectives from various stakeholders who would typically be unable to interact with each other. This is also a reminder that I should learn more about how the US healthcare system works if I were to conduct research with the practitioners here.

Takeaway #8: Can Systems Truly Care?
One of the biggest questions Jones asks in Design for Care is “Can systems care?”. Jones, an advocate for systems thinking, mentions how healthcare has many wicked problems. We cannot solve entrenched systemic issues, but we can endeavour to tackle small parts of the problem through system inquiry.

“A long habit of not thinking a thing wrong gives it a superficial appearance of being right.” This quote by Thomas Paine in his book Common Sense perfectly encapsulates Jones’ argument about systems and the tendency for actors to fall back on homeostasis. Systemic patterns are left to form with a blind maintenance of existing practices. Improving patient experiences is thus difficult because of institutional bureaucracy and a lack of incentive to change.

But Jones suggests that this is changing with time as more and more practices are recognising the important of patient satisfaction. As this was written in 2013, there are many more healthcare systems that are addressing this issue. The Beryl Institute, for instance, is a global community of practice committed to transforming the human experience in healthcare created in 2017. Some hospitals and practices also have in-house design labs that aid internal departments in using design thinking to streamline processes and solve problems.

It takes a long time before change can be seen in systems, but it is clear that there has been a gradual shift in the way healthcare works. More people are subscribing to the belief that “the patient is at the centre of the system, not the disease.” Patient-centred care is a growing focus in the system, and designers can lead the forefront of innovation in this area through social, service transformation and generative research methods.