Project Background
In the UK, around 1 in 3 people live with Multiple Long-Term Health Conditions (MLTC), and this number is growing. By 2035, more than two thirds of the UK’s over 65s are predicted to have MLTC. Those with MLTC have poorer quality of life, greater care needs and higher risk of early death.
MLTCs are functions of interacting and multiple biological, lifestyle, social and environmental factors that vary over the lifecourse. They affect all communities, but those facing socioeconomic disadvantage are affected 10-15 years earlier. Combined mental and physical MLTCs are more prevalent in these populations and are associated with premature mortality (20-year lifespan reduction) alongside reduced health-span (years lived in good health).
Digital transformation has the potential to tackle the challenges posed by MLTCs. However, the prevention and management of MLTCs poses challenges for traditional research and services, where the race to harness new technologies tends to focus on single issues, not complexity. Complex systems approaches are needed to avoid one-size-fits-all over-simplification of MLTC.
Developing ‘SysteMatic’
‘Systematic’; Systems Engineering Innovation Hub for Multiple Long-Term Conditions (MLTC) project is a strategic collaboration between The University of Liverpool and The University of Glasgow, shaped around their local populations’ extreme socioeconomic disadvantage.
SysteMatic is funded by NIHR & EPSRC as one of the 9 successful centres in the UK which will be eligible to apply for up to 6 million pounds of funding to establish the full-scale hubs.
Over 18 months (2023-2024), the interdisciplinary project team will establish the blueprint for the full-scale Innovation Hub; identifying, prioritising and co-designing a programme of work focused on key challenges to health & care systems throughout the lifecourse.
As the central Design knowledge partner, The Inclusionaries Lab is leading SysteMatic’s “People Insight” and partnering in the “Systems Futures” learning labs, embedding advanced participatory, inclusive, human-centred, speculative and systemic design principles and methodologies in this strategic national health and social care systems innovation initiative.
Design Co-operative 0.1
SysteMatic are convening a co-operative of people with lived or caring experience of MLTCs, health and care professionals, scientists, engineers, social scientists and designers.
Working across 3 learning labs, SysteMatic’s interdisciplinary team aim to leverage big data and ‘thick’ data approaches to offer intelligence & insights across: “People Insights”; “Systems Futures” and “Health Intelligence”.
The learning labs initially work divergently and in parallel, before converging to 1) co-identify and co-prioritise problems; system elements and failure points; complexities and interdependencies; and stakeholder relations and narratives; 2) co-define systems visions, targets and potential solutions; and 3) co-produce the SysteMatic business plan.
Advanced Design-led Participation; ICER
To ensure a diverse and representative range of participants are included, The Inclusionaries Lab are iteratively developing, refining and utilising a working framework called ICER; the ‘Inclusive, Creative, Equitable and Responsible’ Participant Engagement Framework. The framework has three distinct aims;
- To ensure interventions and clinical/care decisions informed by real-world user research do not exacerbate inequalities.
- To ‘design with equity’ from the outset, moving beyond ‘tackling inequalities’.
- To maximise creative, generative, meaningful and responsible participant engagement, using design-driven participatory mindsets and methods as well as incorporating cross-disciplinary best practices from Health and Life Sciences and Humanities and Social Sciences.
The framework maps typically marginalised groups and highlights various personal and contextual considerations which could result in differences in lived experiences relating to having MLTC (i.e. age; gender; race; socioeconomic status; culture; attitude to non-essential participation; and geographic location).
Three Orders of Systems Science
We apply three orders of systems science to health & social care systems, distinguished by: a) how they define a system; b) the associated research methods; and c) the tools, frameworks and techniques:
1st-Order optimises discrete components with clear boundaries, quantified inputs/outputs, crude ontologies and a governing process with feedback and error correction.
2nd-Order is the mainstay of systems engineering in healthcare. Modelling is ontological, but tolerates ill-defined boundaries, uncertainty and unknowns, and may adopt simulation methods, or statistical process control.
3rd-Order extends to soft systems with porous boundaries, nonlinear behaviours, and contextual sensitivity. Key approaches are participatory; Patient and public engagement and involvement (PPIE) with practitioner co-design, action research, systemic design, and transition design. This approach suits transitioning from single condition/pathway/service optimisation to integrated MLTC approaches.
If you’re interested in opportunities to participate in this design research, please get in touch with Isobel Leason by emailing: isobel.leason@liverpool.ac.uk or if you would like to find out more about the SysteMatic project please email Dr Farnaz Nickpour: Farnaz.nickpour@liverpool.ac.uk
The Inclusionaries Lab 