The Collaborative Service Design Playbook to plan, design, and implement sustainable health services for impact

Abstract

This paper sets out the Collaborative Service Design Playbook, to guide planning, design, and implementation of co-created health services. Successful health service development and implementation is best guided by theoretically informed approaches; however, organisations often lack design and implementation know-how and have difficulty applying it. This study seeks to improve health service design and potential for scale-up by proposing a tool to guide an end-to-end process, drawing together service design, co-design, and implementation science; and exploring the tool’s feasibility to establish a sustainable service solution developed with participants and experts that is scalable and sustainable. The Collaborative Service Design Playbook phases include, (1) Define the opportunity and initiatives, (2) Design the concept and prototype, (3) Deliver to scale and evaluate; and (4) Optimise to transform and sustain. This paper has implications for health marketing through providing an end-to-end approach with phased guidance for health service development, implementation, and scale up.

Keywords:

• Co-design
• equity
• health
• health services
• impact
• service design process

Introduction

Evidence-based innovations can impact wellbeing and improve quality of life, and support policy and decision-making, but only if successfully designed and implemented (Ritchie et al., 2020). Innovations backed by evidence can enhance health outcomes, yet successful implementation is complex, expensive and failure prone (Woolf, 2008). This indicates a need for improvement in the way health services are planned, designed, and delivered. Creating innovative solutions for complex, systemic health problems involves intertwining elements and touchpoints both inside and outside the sector (Parkinson et al., 2017). There is a need for revised service design frameworks that enable development and scale-up of services and interventions with specific stages, actions, and methods to increase uptake and impact (Milat et al., 2015).

This study’s empirical setting was the development of a preventive health service aiming to improve health behaviours in a population. The study builds on previous service design (Yu & Sangiorgi, 2018), and co-design research (Dietrich et al., 2017). This offers a potential approach to reframe health service design to develop an end-to-end process with step-by-step guidance to increase the consumer centredness, uptake, and scalability in health service innovation. First, it explores the process of service design, second it integrates approaches from multiple disciplines and finally, this study contributes to the health marketing agenda by providing an end-to-end process to guide design, develop and implement a sustainable preventive health service. The application of the Collaborative Service Design Playbook extends previous conceptualisations of service design to include consumers, experts, and evidence. The findings should be of interest to public health, health promotion, and social marketing practitioners developing transformative services or preventive health services.

Literature review

Health services and service design

To develop impactful health services, there is a need to incorporate service design techniques and applications. Service design is an exploratory enquiry for understanding service problems or opportunities that are unclear and emerge during the process (Kimbell, 2011), building on a design-thinking process of exploration, ideation, reflection, and implementation (Blomkvist et al., 2010; Brown, 2008). Service design employs a special focus on the service interface and customer experience (Secomandi and Snelders, 2013). The design also provides participatory design principles for involving different actors along the design process as well as experimentation through prototyping (Steen et al., 2011) and interactions with people through co-design (Trischler et al., 2018).

Co-design

Co-design is defined as “meaningful user engagement in research design and includes instances of engagement that occur across all stages of the research process and range in intensity from relatively passive to highly active and involved” (Slattery et al., 2020, pp. 2–3). Co-design facilitates the integration of user insights and expert knowledge (Trischler et al., 2018). In other words, co-design is the design process where designers and people not trained in design work together. For example, in transformative services, users are typically the consumers targeted by the transformative services program for behaviour change, while experts include health clinicians or services marketing professionals. Co-design subsequently means that users not trained in design collaborate with design experts throughout the whole span of a design process with the aim of achieving collaborative creativity (Sanders & Stappers, 2014). Dietrich et al. (2017) proposed a six-step co-design framework to guide co-design in services and social marketing. While this process is useful in guiding co-design, it excludes content experts and those who have delivered similar programs in the past from the process, as recommended in service design and human-centred design (Steen et al., 2013). However, research co-design while widely used, is seldom described, or evaluated in detail (Slattery et al., 2020). Further, there is limited evidence for how it is used to inform the scale up of developed initiatives.

Existing service frameworks and limitations

Relatively few service frameworks focus on guiding the development of services for the express purpose of changing health behaviours. Among the frameworks that do, focus on digital interventions including Yardley’s person-based approach (Yardley et al., 2015), Ludden’s design research perspective (Ludden et al., 2015) and Mummah et al. (2016), IDEAS framework. Dietrich et al.’s (2017) co-design framework, applied to the iterative development of numerous transformative services and social marketing interventions (Durl et al., 2017; David et al., 2019; Hurley et al., 2021; Trischler et al., 2019), includes seven steps used in the development of services and interventions with users. However, it only touches on the ideation stage of service design and does not make use of the service design stages of problem identification and designing objectives or integrating theory. While Hurley et al. (2021), further develop the framework to integrate theory through an inductive approach, however, does not demonstrate or test the developed concepts as part of their process. The framework proposed by Trischler et al. (2019), includes stages for user feedback and evaluation and states the importance of using behavioural theory. However, does not make use of design thinking approaches such as ideation, brainstorming, or rapid prototyping, nor does it include specific guidance on behavioural strategies that may inform intervention design. Rundle-Thiele et al. (2021) propose a CBE framework (co-create, build, and engage) for social marketing programs, with a focus on implementing marketing techniques, however, has several limitations including the absence of intervention implementation strategies, and the absence of rigorous evaluation built into the process. Each of these approaches provides valuable guidance for researchers, however, each focus on a specific aspect of service development, only Mummah et al.’s. (2016), IDEAS framework provides guidance on behavioural strategies for use in service design through incorporating behavioural theory, however, is specifically developed for developing digital health interventions that can be tested in randomised control trials. A limitation of the framework is that it does not include a scale up stage or incorporation of feedback from the evaluation phase to improve the service through an iterative process to ensure it will be sustainable.

Using the best combination of recommended approaches to guide service design is important for effective and sustainable interventions to change health behaviour are to be developed. Researchers and practitioners rely on published frameworks to guide them in the development process for health interventions. To date there are no complete frameworks that provide a guiding process from beginning to end for researchers and practitioners when developing sustainable services seeking to support behaviour change (Mummah et al., 2016). That is, frameworks that draw on evidence and theory application to identify the problem and inform potential solutions before entering the ideation and design phases of service design.

Many of the current frameworks also lack the implementation and sustainability stages of service development. Thus, in consideration of gaps in methodology, we emphasise the need for balancing rigor with relevance that leverages and combines the strengths of multiple methodologies to yield a more comprehensive, nuanced, and robust process for the development of effective and sustainable preventive health services. Overall, the existing frameworks do not provide an end-to-end process guided by a sound methodology for developing sustainable services aiming to change behaviours.

Proposing the Collaborative Service Design Playbook

To address the identified gaps, a methodology is presented for an end-to-end process to guide the development of a preventive health service. This process integrates design, development, implementation, and evaluation to rapidly move from initial design through to implementation and scale-up of a preventive health service.

When addressing more complex service systems, such as public health services, the Collaborative Service Design Playbook proposes to engage participants and other network actors (e.g. Allied health professionals), considering their experience as a fundamental resource to envision new services. The Collaborative Service Design Playbook seeks to create better solutions, but also to promote more inclusive processes to enhance multiple actor engagement. In this case, the focus of involving potential participants and other actors is to capture information that is key for organisations to create a successful offering that will likely achieve key outcomes for participants while remaining grounded in real-world need and context to ensure it works through incorporation of voices from a range of stakeholders including the voice of resolution, the voice of design, the voice of experience and the voice of capability as outlined in Figure 1.

Figure 1. Incorporating a range of voices into collaborative service design for impact.

Previous approaches tend to take either an expert perspective or a consumer approach, however in the context of complex problems both perspectives are necessary. To address these limitations, this study draws on the design thinking process (Blomkvist et al., 2010; Brown, 2008), co-design (Dietrich et al., 2017), and implementation science to propose the Collaborative Service Design Playbook consisting of four phases as outlined next.

Methods

The burden of chronic disease globally is growing (Bertram et al., 2018) and there is an urgent need to arrest and, over time, reverse this trend (Nugent et al., 2018). To address these challenges in Australia, the National Strategic Framework for Chronic Conditions (Australian Health Ministers’ Advisory Council, 2017), and My Health, Queensland’s Future: Advancing Health 2026 (Queensland Health, 2016) frameworks were prioritised. In response in October 2015, the government sought providers for a new diabetes and chronic disease prevention program to be named “My health for life.” The objectives of the program were identified as:

1. To effectively identify people at high risk of developing chronic disease, and provide them with appropriate lifestyle modification interventions;

2. To increase health literacy levels and the capacity of program participants to adopt and maintain positive lifestyle changes to manage their risk factors; and

3. To improve community awareness, knowledge and attitudes about chronic disease risk factors and making positive lifestyle choices.

The My health for life program (herein referred to as the program) was to be a state-wide program provided free of charge to eligible residents. A minimum of 10,000 participants were expected to complete either the telephone coaching or group-based programs within three years. The program was to target adults, specifically those assessed as being at high risk of developing Type 2 diabetes, cardiovascular disease, obesity, and specific cancers with links to obesity.

The innovation development process took the form of a collaborative academia-industry partnership in which researchers, consumers, and allied health professionals worked collaboratively throughout all phases. The Collaborative Service Design Playbook guided the process and was used for its integration of behavioural theory, user-centred design, implementation, and evaluation. There are four phases in the Collaborative Service Design Playbook that were employed in this case study as shown in Figure 2: (1) Define the opportunity and initiatives; (2) Design the concept and prototype; (3) Deliver the initiative, scale, and evaluate the solution; and (4) Optimise the initiative to transform and sustain the solution. As in other published accounts of health intervention development, each phase is used to inform the next, therefore the methods and results are presented sequentially (Figure 2).

Figure 2. Collaborative Service design Playbook phases.

Results

Phase 1: Define

Phase 1 requires identifying the opportunity and initiatives. This involves examining the problem or opportunity from several viewpoints and defining the wider context and associated issues involved (Cristancho et al., 2017). The purpose of this step is to articulate the problem in the simplest terms possible: “In order to achieve X in Y context, we need to undertake Z, as measured by W.” The problem statement clarifies the importance of the issue and helps secure resources to address it (Liu et al., 2020). A range of questions arise in the problem definition stage. This preliminary framing answers three questions: First, what is the basic need? This is the essential problem, stated clearly and concisely. At this stage it is important to focus on the need at the heart of the problem instead of jumping to a solution. Defining the scope is also important. The second question is, what is the desired outcome? Answering this question requires understanding the perspectives of priority or target group consumers and other beneficiaries which could include caregivers, support people, families, and other members of the community. Third, who stands to benefit and why? Answering this question requires an organisation to identify all potential stakeholders and consumers.

Phase 1: Results

Contextualise the problem

Contextualising the problem allows the identification of past efforts and their intricacies to provide a better understanding of potential solutions available. The purpose of this step is to find solutions that might already exist and identify those that have been successful or disproved. What approaches have been tried? By answering this question organisations can avoid reinventing the wheel or pursuing options that are not feasible. Examining past efforts to find a solution can save time and resources and generate innovative thinking. Three activities assist in answering these questions: First, consult the literature, both published and grey, to find solutions that might already exist and identify those that have been successful or disproved. This process also provides opportunities to benchmark the developed solution and identify behavioural theories to inform the behaviour change process. Second, consultation with experts, practitioners, or clinicians (people likely to deliver the initiative) provides an understanding of what has and has not worked in the past when addressing the target issue/s. Third, consult consumers to gain an understanding of barriers and enablers from their perspective.

Literature search, theory identification and benchmarking

The purpose of the first step in Phase 1 was to (a) determine the international, national, and state policy framework in which the service will be implemented and evaluated; (b) describe best practice in the implementation and evaluation of chronic disease prevention programs. This section provides a brief overview of the early stages of insight gathering through formative research. To define the solution, a literature search evaluated the success of prevention programs targeting high-risk individuals for chronic diseases including type 2 diabetes and cardiovascular disease. The literature review provided a summary of evidence-based guidelines and characteristics of successful interventions, including theory application, social support and more than one session. The approach described by Manikam and Russell-Bennett (2016) can assist in the identification of an appropriate theory based on insights uncovered in the “design” research stage. Additionally, Luca and Suggs (2013) and Grainger (2022) provide overviews of behaviour change theories to assist in selection of a theory. Criteria for choosing a good theory are outlined in Table 1. The Health Action Process Approach model for health behaviour change (Schwarzer, 2008a) was chosen to underpin the program after a review of alternative behaviour change approaches and models. A key input to the program’s design was the IMAGE Toolkit (Lindström et al., 2010) which provided guidance on a range of factors for a prevention program.

Table 1. Criteria for choosing a good theory.

Criteria	Question to consider
Clarity of concepts	Has the case been made for the independence of constructs from each other?
Clarity of relationships between constructs	Are the relationships between constructs clearly specified?
Measurability	Is an explicit methodology for measuring the constructs provided (e.g., Likert scales)
Testability	Is the theory been specified to enable it to be tested?
Explanatory potential	Has the theory been used to explain or account for a set of observations?
Causality description	Has the theory been used to describe mechanisms of change?
Generalisability	Have generalisations been investigated across behaviours, populations, and contexts?
Evidence base	Is there empirical support to demonstrate effectiveness and efficacy of the theory

Adapted from Lincoln and Lynham (2007), and Bacharach (1989).

The review also answered the following specific research questions. For implementation: (1) How effective are large-scale lifestyle programs in reducing the risk of chronic disease?; (2) What are the key elements across large-scale lifestyle programs that constitute a successful program?; (3) What does recent research tell us about the scalability of chronic disease prevention interventions to population-wide prevention programs? For evaluation: (1) What outcomes are measured?; (2) What program parameters are measured?; (3) What other factors are measured?

Several key factors were identified for scaling up public health and health promotion interventions, including consideration of effectiveness, reach and adoption; workforce, technical and organisational resources; cost; intervention delivery; contextual factors; and appropriate evaluation approaches. Several studies emphasised the importance of rigorous evaluation, however most existing interventions have provided limited information on process evaluation and do not report on all important generalisability elements necessary to guide translation of prevention interventions. Further, the required methodology to scale up implementation trials to population-wide programs is still in its infancy, and limited information exists on the characteristics that constitute successful large-scale chronic disease prevention programs. Thus, the problem statement for this program is to explore new, innovative service delivery modalities that improve access to and delivery of, lifestyle modification health services aiming to reduce the risk factors for people at high-risk of developing a chronic disease.

Experts

To design the program, an intervention reference group was set up to include a range of experts in prevention. These experts, from a range of fields including health promotion or preventive health, behaviour change, and clinicians, provided input into the program design by offering their knowledge relevant to best practice chronic disease prevention and reviewing the strawman (a simple draft proposal to generate discussion) program. Workshops with the intervention reference group were co-facilitated by the non-government organisation and the university. Feedback from this group was critical to the program’s final design, with the strawman content and delivery framework for the face-to-face program developed. In total, 24 experts participated in the workshop as shown in Table 2.

Table 2. Expert workshop participants.

Organisation type	Number
′Total	24
University	7
NGO chronic disease	9
CALD and Aboriginal Organisations	2
Other Health agencies	5
Government Health Department	1

Consumer research

Formative consumer research identified behavioural barriers and enablers along with other insights. The study involved the conduct of three separate methodologies to reach three key audiences as shown in Table 3. Firstly, the public audience in Greater Queensland, secondly the proposed pilot locations. Finally, to ensure a representative number of the Aboriginal and Torres Strait Islander community, a specialised field services supplier was engaged to conduct face to face interviews.

Table 3. Respondent sample characteristics.

		Total sample	Online methodology	CATI methodology	Face to face methodology
Eligibility			40 years + Living in Queensland	40 years + Living in Queensland	Aboriginal and Torres Strait Islander 18 years +
Total		1,159	402	707	50
Gender	Male	480	200	256	24
	Female	679	202	451	26
Age	18–30	39	4	3	32
	31–50	190	77	103	10
	51–60	137	50	82	35
	55–64	336	141	192	3
	Over 64	457	130	327	0

Results

Research undertaken with priority groups prior to program development at the project’s commencement indicated there was a demand for a prevention program among those at high risk of chronic disease. A large proportion of people had a good understanding of sources of trustworthy information on weight, diet, and exercise. The findings indicated that any chronic disease prevention program needed to have key inclusions, including access to a personalised program, face-to-face contact, access to qualified experts and drive long-term behaviour change. The consumer research revealed the importance of providing social support in a program aiming to achieve behaviour change by addressing individual needs.

Phase 2. Design

The following presents the design phase, through co-production of the concept and prototype. This phase draws on insights uncovered from the first phase and was guided by the research question: What approaches may work for this group, in this context? The first step involved the facilitation of consumer-led co-design by service design and context experts, undertaken with members of the priority or target group. Following co-design, prototyping was undertaken, drawing together insights from the first two stages and synthesising them to develop the program prototype. Then organisation readiness for implementation was assessed, and a clear action plan developed. Finally, through the concept proof and piloting stage, the feasibility and viability of the program were assessed.

Phase 2: Results

Co-design process

The co-design session development extended Dietrich et al. (2017) six-step co-design framework to an eight-step co-design process as shown in Figure 3. The first step in the process involved resourcing appropriate themes and intervention designs from scholarly and secondary literature. The initial program design was drawn from a range of scientific and grey literature as outlined above.

Figure 3. Eight-step co-design process.

A partner organisation recruited participants using intercepts in an outer metropolitan shopping centre where they undertook a health check conducted by a trained health professional. One hundred people were invited to participate in the co-design sessions. They covered a broad range of cultural and demographic groups (Aboriginal and Torres Strait Islander, Pacific Islander, women who have had gestational diabetes etc.). Thirty-two people participated in five co-design workshops (See Table 4). Each workshop ran for approximately 90 minutes. All 32 participants who attended the co-design workshops were at high risk of developing a chronic illness such as type 2 diabetes as identified through the health check or through previously having gestational diabetes. They voluntarily gave their informed consent to participate. Griffith University provided ethical clearance. Co-design workshops were audio-recorded and transcribed for ease of analysis.

Table 4. Co-design participants.

		Total sample	Group1	Group 2	Group 3	Group 4	Group 5	Group 6
Total		32	1	6	11	1	8	5
Gender	Male				3	1	3	2
	Female		1	6	8		5	3
Age	18–30			1
	45+		1	5	11	1	8	5

‘Evaluating’ the co-design outcomes occurred through thematic analysis. Themes were identified from discussions prior to the co-design session, observations of the concept-proof sessions and the final focus groups where the program prototype was presented to participants. The insights gained across the program of research activities underpin the recommendations for further development of the program for scaled-up delivery.

Co-design results and discussion

Based on findings from the co-design phase, with refinement of the prototype by the health professionals from the lead organisation, resources for the concept proof were developed along with key messages for the program and its promotion. The concept proof testing and evaluation is presented next.

Concept proof and pilot: testing and evaluating the solution

The program prototype designed using a concept proof should be tested to identify areas of success and improvement. Service providers should deliver the concept proof to test in a more realistic way with the priority or target group. As part of the testing stage, an evaluation of the proposed solutions should be undertaken. For example, follow-up qualitative research with participants of the concept proof is important to ensure that the program design is truly human-centric, meets the needs of the priority or target group, and achieves the desired outcomes as defined in Phase 1.

Concept proof and pilot results

Twenty-three people participated in at least one of four fortnightly concept proof program pilot sessions (see Table 5). Participants attended one of the three available program sessions each fortnight and each session ran for approximately 90 minutes, facilitated by two allied health professionals from the non-government organisation. Two researchers from the university observed the concept proof sessions. All 23 participants who attended the program sessions were identified as part of the priority group for the intervention.

Table 5. Concept proof participants.

	Session 1	Session 2	Session 3	Session 4
Group 1	11	4	6	7
Group 2	7	4	5	4
Group 3	5	5	2	4
Total	23	13	13	15

After the concept proof sessions had taken place, two follow-up focus groups provided feedback on the draft program. Fifteen people who had attended at least one of the concept proof sessions participated in one of the two focus groups (n = 7; n = 8). Each focus group ran for approximately 90 minutes. Participants voluntarily gave their informed consent to participate. The university provided ethical clearance.

The concept proof and piloting stage tested a range of aspects of the program including social marketing and community engagement, organisational readiness and assisted in the development of a clear action plan for roll out.

Summary of concept proof

In summary, the concept proof highlighted a range of important elements to be included in a program for this priority group. A six session, group-based program embedded with adult learning principles and guided by behaviour change theory and its associated behaviour change strategies was developed. This highlights the importance of testing programs and interventions before scaling up to ensure that solutions developed do indeed serve their purpose to achieve behaviour change; testing allows for iteration and refinement of concepts and ideas. Social marketing and community engagement activities were finalised through trialling consumer language, identifying engagement processes to secure participants for health checks, testing messaging to engage with health care providers, testing use of electronic direct mail to targeted groups.

Assess organisational readiness and develop a clear action plan

To ensure organisational readiness for program delivery a range of activities were undertaken for example, identifying what local healthcare providers expected from such a program including remuneration, incentives, collateral and support; testing the process of enrolment via the referral call centre and its success in translating referrals into program participants, determining ways to schedule group sessions to optimise participation, and testing program messages, activities and support, and testing the draft evaluation tools and methodology for data collection. To develop a clear action plan for roll out several streams were established to oversee the various aspects of the program. These included intervention, evaluation, community engagement, social marketing, culturally and linguistically diverse, Aboriginal and Torres Strait Islander, IT, and primary care engagement. An action plan (with associated key performance indicators aligned to the program’s contract) was developed with a risk register, and operational management committee to oversee were established to support the implementation of the action plan.

Phase 3. Deliver: Scale and evaluate

Phase 3 involves scale up and evaluate. The first step involves refining the program based on concept proof and piloting stage to fully develop the program or service to be scaled-up and rolled out. The final goals and objectives of the developed solution need to be developed. The second step prior to program roll-out, is to develop an implementation enhancement plan (Delaforce et al., 2023) and an evaluation plan using an implementation science approach to ensure enablers and barriers have appropriate strategies to address each are developed. An evaluation approach should be guided by evaluation frameworks and conceptual models to strengthen the evaluation questions and analysis.

The third step is to bring the program to life through controlled implementation and scaling. The use of translational research frameworks and implementation models add rigor to the evaluation of real-world programs, whilst considering key factors of both implementation and impact. The use of a framework ensures critical constructs for evaluating public health impact at both participant and service level are included. Fynn et al. (2020), provide an overview of evaluation frameworks and their applications. They identified 71 frameworks applicable to physical activity and/or dietary change programme evaluation demonstrating there is an abundance of frameworks available to support programme evaluation. Their typology and mapping provide guidance on where specific framework components can be found, where there is overlap in their scope and content, and where there are gaps in the guidance. Practitioners and evaluators can use Fynn et al.’s (2020) typology and mapping to identify, agree upon and apply appropriate frameworks. Moullin et al. (2020), provide recommendations for using implementation frameworks in research and practice. Their recommendations provide a structure for describing guiding, analysing, and evaluating implementation efforts.

Phase 3: Results

The program was refined based on the co-design, concept-proof, and piloting stages. Resources were developed for a six-session group-based program (GBP) and a telephone health coach (THC) program. The full program is reported in Parkinson, McDonald, et al. (2022).

Implementation and evaluation planning

Understanding how complex public health interventions are implemented has the potential to impact their success and sustainability (Hall et al., 2022). Reducing the gap between research and practice in public health interventions is a priority which has driven the development of numerous implementation theories and frameworks to evaluate implementation outcomes of large-scale prevention programs (Keith et al., 2017). Damschroder et al. (2009) developed the Consolidated Framework for Implementation Research (CFIR) to synthesise constructs across existing theories into a typology to advance our understanding of implementation across a range of settings and intervention types. Thus, CFIR was chosen to guide the implementation evaluation of this program and full details and tools including the CFIR-ERIC Implementation Strategy Matching Tool are available at this website, https://cfirguide.org/. The full results of the implementation will be reported elsewhere.

Summary of implementation

Multiple factors influencing service-level implementation of the program were identified and categorised into three broad themes, acceptability, delivery, and implementation factors, each accompanied with appropriate subthemes. Several themes emerged that could be useful for future large-scale interventions. For instance, current findings suggest aspects of the program itself, such as the structure of program sessions and availability of support services, play a critical role in enhancing the program’s delivery. However, it is also beneficial to consider the available resources and confidence of the individual facilitators as well as their own personal values and motivations for wanting to deliver the program. Lastly, the implementation findings suggest that on-going monitoring and evaluation of the program may assist in identifying areas for improvement or barriers to program implementation. Taken together, these findings identify several important features that could enhance future large-scale behaviour change interventions.

Summary of evaluation

The program commenced design and development in May 2016 and became fully operational in May 2017 in a staged rollout including development of a monitoring and evaluation framework based on the ‘Conceptual Model of Implementation Research’ (Proctor et al., 2009) and ‘RE-AIM framework’ (Glasgow et al., 1999) as outlined in the evaluation protocol reported (Parkinson, McDonald, et al., 2022) and reported program primary outcomes (Seib et al., 2022). In May 2018, the initiative was brought to life through controlled implementation and scaling. In the second year of operation the program pipeline and promotional activities were reviewed and restructured to increase enrolments in the program. The evaluation enables data-driven decision making for program improvement and innovation.

Phase 4: Optimise

To transform and sustain the initiative, there is a need to build in stakeholder support to embed the initiative as business as usual. This requires the enablement of leadership, tools, stakeholders, and platforms to ensure the initiative can continually adjust and adapt to the changing environment and needs of consumers. Drawing on frameworks such as collective impact, learning systems that include shared measurement systems must be embedded to monitor progress and opportunities for evidence informed enhancement based on feedback and insights (Parkinson, Hannan, et al., 2022). This also ensures financial and non-financial benefits and value to all stakeholders are realised.

Results

The optimise phase of this program (Parkinson, Hannan, et al., 2022) outlines that because of consolidating the first three phases of program design and development, to ensure there is integration and coordination across services, the program was refined, and resources developed for a group-based program (GBP) and a telephone health coach program (THC). Additionally, four translated programs (Arabic, two Chinese versions and Vietnamese); a simplified English version modified for a Pacific Islander audience; and a modified version for Aboriginal and Torres Strait Islander participants were developed. The program is underpinned by HAPA (Schwarzer, 2008b) which is incorporated into each of the six sessions.

Summary of optimise phase

The final My health for life program targets adults who are at high risk of developing chronic disease, as identified by screening tools for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), i.e., coronary heart disease and stroke. As outlined by Parkinson, Hannan, et al. (2022), to build sustainability and embed learning systems, a collaborative approach where organisations share resources and abilities is required. This includes drawing on the six-foundations for practice enabling successful collective partnerships, focus on program and system strategies; use data to continuously learn, adapt, and improve through shared measurement systems; design and implement the initiative prioritising equity; recruit and co-create with cross-sector partners (and government bodies); implement authentic and inclusive community engagement; and importantly, build a culture that fosters relationships, trust, and respect.

Discussion

This paper addresses an important gap in the literature where existing frameworks do not provide an end-to-end process guided by a sound methodology for developing sustainable services aiming to change behaviours. Thus, this paper presents the Collaborative Service Design Playbook—a holistic tool that not only considers the opinions and experience of experts but simultaneously considers the context, needs, wants and experiences of the priority or target groups as called for in prior research (Slattery et al., 2020) and builds in implementation, evaluation, and optimisation to enable scale up of initiatives. This four-phase process enables data-driven decision-making to inform future program innovations and improvements. This is important, particularly given that governments and organisations are increasingly seeking to develop sustainable public health programs and initiatives (Milat et al., 2015) that can continue to be delivered and not rely on limited funding cycles.

The Playbook provides an end-to-end process for service designers to follow to develop not only an evidence-based service but one that consumers will readily engage with and is sustainable over time. This study contributes to extending the service design concept from design-activity-centric descriptions to an integrative approach for multidisciplinary organisational service innovation. The Collaborative Service Design Playbook proposed takes a participatory approach, which is based on the use of techniques that communicate, interact, empathise, and stimulate the people involved, obtaining an understanding of their needs, desires, and experiences, which often transcends that which the people themselves realise. This study therefore contributes to the health service system agenda by examining a service aiming to improve its participants’ health and wellbeing through a co-designed health service.

Practical implications

This paper has several practical implications. The Collaborative Service Design Playbook provides a practical tool through an end-to-end process for health service managers to follow when developing programs or services. This design approach understands what people want and need and considers their context, motivators, and barriers beyond the assumptions of researchers and service providers. Additionally, it provides step-by-step guidance on the how-to of co-designing, concept proofing, implementation, evaluation and scale up of the initiative. The use of this Playbook in health service design may also assist in reducing in both unintended consequences and the implementation of ideas that seem great in theory but fail in practice through the integration of insights from past evidence, experts, and target participants. This is particularly important when seeking to develop equitable programs or services for people with different levels of underlying social advantage or disadvantage, including markers of social stratification such as wealth, power, or prestige (Sadana & Blas, 2013). Additionally, drawing on the six-foundations for practice (Parkinson, Hannan, et al. 2022), enables successful collective partnerships and will lead to initiative sustainability. This paper also provides a worked example of how to apply the Collaborative Service Design Playbook, which will be useful to health service designers and managers when designing and developing health services, including preventive health services.

Social implications

The Collaborative Service Design Playbook presented in this paper offers several social implications. There is growing acknowledgement that involving consumers or participants from priority groups in the service design process will lead to better adoption of public health or other social behaviour change programs (Slattery et al., 2020). Better participation or higher levels of adoption will result in improved health and wellbeing outcomes—for not only program participants but also for the broader community, in which these individuals live, work and play. This will also result in a reduced burden on the health and welfare system. Developing programs with the people who are the intended users also provides opportunities for organisations to mitigate unintended consequences that may otherwise occur and develop equitable offerings for people with different levels of underlying social advantage or disadvantage (Sadana & Blas, 2013), and those from priority groups who may have different needs to the general population. In turn, this has the potential to improve uptake rates and outcomes in the long term.

Limitations and future research

This study has limitations that future research can address. First, the research took place in one organisational setting. As such, future research to generalise the findings beyond one context should be conducted. The Collaborative Service Design Playbook presented in this paper should be tested in other contexts to enable further refinement and should be tested for digital health services to understand its applicability in this context.

Disclosure statement

Joy Parkinson was paid to undertake the co-design and evaluation of the program by Queensland Health. Kristen Clark and Tegan McIntosh were employed by Diabetes Queensland who were responsible for the development and implementation of the program.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.