Published: 24/02/2005, Volume II5, No. 5944 Page 27

In the field of service improvement and organisation development, 'big ideas' periodically emerge. They capture the spirit and issues of the time and help reframe the way we think about systems and organisations.

A fast-growing big idea is design science; applying the perspective and methods of architects, engineers and software designers to complex organisational issues. Articles about applied design science are appearing in the most prestigious management journals. Some commentators even predict that design science will become the prevalent approach to organisational change.

The biggest problem facing all designers is to conceive and plan what does not yet exist, and what cannot be known in advance. It is the same problem we confront in the NHS. We seek to implement a radical reform agenda, yet how do we know what will work? How can we assess the knock-on consequences?

We can learn a lot from design experts. They all seek to understand the goals required in a given situation. They all work out the unique characteristics of the situation and use 'design rules' based on their experience and expertise.

We are currently experimenting with design rules for NHS transformation:

codifying the knowledge and experience of the most successful improvement leaders for use by others in a range of local contexts to get better, quicker outcomes. Just think what might be achieved if such a systematic approach was adopted across the NHS.

Design is about engineering and performance: creating products and services that are reliable, durable and fit for purpose. But design is also about aesthetics - the emotional and sensory connection that the customer or user makes with the service.

How can we design services that are as much about how patients feel, and about their whole experience, as they are about functionality? 'Userbased design' should become a core NHS principle - recognising patients, carers and families as producers and participants rather than just service users. We need to enable users to play a much greater role in identifying needs, proposing solutions, testing them out and implementing them jointly with care providers.

The toolkit that designers give us includes some exemplary approaches.

The well-established NHS practice of 'process mapping' can be enhanced by 'experience mapping'. Here, service users and families do the mapping rather than staff. They do not focus on every step, but rather the critical points where they come into contact with the service. They use their collective experience of the system to build a model for service design.

We are also using design science in the field of 'delivery design' for the 10 high-impact changes. Our evaluation activities show a high degree of awareness, but much less evidence of them being systematically implemented. We are using user-based design principles to develop a new generation of support materials.

Architects, engineers and other designers frequently consider the legacy they will leave for future generations of designers. Perhaps we should have the same focus as healthcare leaders. How will we codify and distil what we have learnt so our successors do not have to reinvent the wheel? What will our legacy be? Design science may help us with the answers.

Helen Bevan is director of the innovation and knowledge group at the Modernisation Agency. The ideas in this column are the result of a collaboration between the Modernisation Agency, Paul Bate and Glenn Robert (University College London) and Paul Plsek.