How business design principles are contributing to the digitisation of healthcare

The digitisation of the healthcare system is strongly encouraged, but in practice it is often carried out in a careless and haphazard way. Successful transformation requires not only technical expertise in the healthcare sector, but also design expertise from the business world.

The shortage of healthcare professionals has been shown to have a negative impact on patient safety (Blegen et al., 2018; Rosenberg, 2019; Scogin, 2022). The consequences are neglected care, higher mortality rates or reduced satisfaction with the quality of care.

Digital transformation of healthcare can remedy this and alleviate the shortage of skilled workers (Kraus et al., 2021), recognisable by better quality of care without additional costs. Consistent digital transformation eliminates many time-consuming tasks, allows more time for human-to-human interaction and enables everyone involved to act in a more informed way.

Arguments against digitisation

However, discussions with practitioners show that there are also arguments against digital transformation. Some fear that improved quality will be accompanied by increased costs. For example, it is argued that the inclusion of wound and diabetes specialists via a digital platform increases costs twice: the inclusion of specialists costs money and the platform leads to additional expenditure. However, this argument is flawed: if expertise is lacking where it is needed, it actually leads to extra costs for care services and more suffering for patients.

It is also argued that“in real life”, digitisation often brings fewer benefits than promised. Examples include the lack of user-friendliness of electronic patient records, the aimless increase in data collection without proper use, the lack of interoperability, the inadequate quality of data, and so on. All these shortcomings can be observed in the real world. All these deficits can be observed in practice, but they are always the consequences of inadequate digital design.

Digitisation without strategy

The reasons for poorly designed digital solutions in healthcare are manifold and often seemingly paradoxical: Vested interests are at stake, there are “hidden agendas” or diffuse fears about them, exaggerated claims divert attention from the real challenges, too narrow a design is chosen for convenience, lack of interest in context and poor understanding of processes lead to gross errors, complexity is denied, future users are not sufficiently involved, incorrect resource planning hampers implementation and communication tailored to the target group does not take place (Iyanna et al., 2022; PRAEVENIRE, 2022; Ricciardi et al., 2019; Thilo et al., 2022). However, the two most fundamental causes are a lack of willingness to invest sufficiently and a lack of curiosity about the mechanisms of action. In other words, digital transformation is done without strategy and care, and there is no verification that the transformation is working and having an impact.

Successfully designing the transformation process requires not only specialist expertise in the healthcare sector, but also knowledge of digital design principles and transformation models. This is why the Digital Health innovation area of the Department of Health at the Bern University of Applied Sciences, in collaboration with the Institute for Digital Technology Management of the Department of Economics, is focusing on the practice of digital transformation in healthcare. This will shed light on the professional and generic aspects of the transformation process.

The focus of the research is on the people involved in digital transformation processes: which approaches and practices work well, which work poorly or not at all? How should digital solutions be designed to be accepted and bring benefits to everyday life? How can we empower people to use digital tools? What tasks should managers take on as part of the digital transformation process? How can they prepare for this? What should the digital transformation process look like at organisational level, so that it reinforces the values specific to the subject? What communicative interventions are needed to ensure the success of a digital transformation project?

Bringing together technical and design expertise

Collaboration between specialist expertise in nursing research and digital transformation expertise in business research is a key to successful digital transformation processes in healthcare institutions and their employees. BFH experts are supporting the digital transformation of Spitex Bern. The example of data management shows the benefit of collaboration: systematic data management enables organisations to better understand their customers and improve the quality and efficiency of their services. In the case of Spitex Bern, services are provided by carers with different levels of education, training profiles, language skills and professional experience. They use digital tools for the care process, internal coordination, communication with clients and relatives and cooperation with referrers. These tools not only support their work, but also provide data. This data provides a better understanding of the characteristics and needs of customers, the services provided and any problems encountered during the process. It allows care, resources and expertise to be better targeted. To achieve this, data must be managed professionally, i.e. it must be regularly collected, analysed, interpreted and communicated, and staff must have the appropriate tools and skills.

The approach to developing data management almost always faces the same challenges: strategy, leadership, culture, technical architecture and governance. Equally important in this regard is design expertise from enterprise research, profession-specific knowledge and expertise from nursing research, and digitisation experience from different contexts.

Digitalisation can and must strengthen professional action in the healthcare system and improve its quality – with the aim of achieving these two objectives: Healthier patients and efficient, satisfied healthcare professionals. However, this requires multi-skilled expertise, which can only be provided through the cooperation of complementary partners.


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  3. Kraus, S., Schiavone, F., Pluzhnikova, A. and Invernizzi, A. C. (2021). Digital transformation in healthcare: An analysis of the current state of research. Journal of Business Research, 123, 557-567.
  4. PRAEVENIRE (2022). PRAEVENIRE white paper on health strategy 2030. In PRAEVENIRE Health Forum.
  5. Ricciardi, W., Pita Barros, P., Bourek, A., Brouwer, W., Kelsey, T., Lehtonen, L., & Expert Panel on Effective Ways of Investing in, H. (2019). How to govern the digital transformation of health services. European Journal of Public Health, 29(Supplement_3), 7-12.
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  7. Scogin, A. (2022, April 14). Nursing Staff Shortages and Patient Outcomes [Poster Presentation]. Epsilon Sigma at-Large Research Conference, Morristown, TN, USA.
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AUTHOR: Friederike J. S. Thilo

Prof. Dr Friederike Thilo is Head of Innovation Field "Digital Health", aF&E Nursing, BFH Health. Her research focuses are: Design collaboration human and machine; technology acceptance; need-driven development, testing and evaluation technologies in the context of health/disease; data-based care (artificial intelligence).

AUTHOR: Reinhard Riedl

Prof. Dr Reinhard Riedl is a lecturer at the Institute of Digital Technology Management at BFH Wirtschaft. He is involved in many organisations and is, among other things, Vice-President of the Swiss E-Government Symposium and a member of the steering committee of TA-Swiss. He is also a board member of, Praevenire - Verein zur Optimierung der solidarischen Gesundheitsversorgung (Austria) and, among others.

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