Generating ideas for an intervention can appear a daunting task. Either there may not be a clear intervention for the specific circumstances, or there may be a plethora of options that make it hard to pick just one. To guide the process of ideas generation, there are several different types of ‘thinking’ that have been proposed from different fields of practice.
Design thinking was originally developed in design engineering for use when developing new product ideas and is discussed in the book The Sciences of the Artificial by Herbert A Simon in 1969.(9) Design thinking is a useful foil for the development of arts interventions in healthcare when following the guidelines of this book as it encourages focus not just on the problem that is going to be solved (and how an intervention can tackle that specific problem), but also on imagining what a utopian future situation might be like. Indeed, this is where the true potential of the arts within health can be harnessed: the arts can be more than a ‘fix-it’ solution but can be rich, varied, and creative. For example, if the problem identified is that patients post surgery are not doing their rehabilitation exercises, the solution might well involve setting up specific classes that post-surgical patients can attend to do their exercises together to ensure they get done. This would be a problem-based solution. If we are looking at incorporating the arts, the equivalent problem-based solution could be a dance-based exercise class with the aim of making the exercise more engaging. However, design thinking would encourage the identification of a more utopian goal. This is where the arts can be of real value. The utopian vision might be that people are not just exercising more but experience a growth in self-confidence and feel proud of their achievements, leading them to encourage more exercise among their friends and family. A way of achieving this through the arts could involve getting participants to choreograph some of their own routines, put on a performance for family and friends, or make their own film raising awareness about dance for health. It might involve the use of CDs for participants to dance to music at home or trips to watch professional dance performances to inspire participants further. This more creative and varied activity, developed as part of design thinking through the aim of achieving more than just exercise, could lead to combined longer-term physical and psychosocial benefits. When undertaking design thinking, it can be valuable to hold a session for open ideas generation in which participants are encouraged to suggest as many ideas as they can, building on what other people say, even if they do not seem immediately feasible. Later, the full range of creative opportunities can then be honed down to an ambitious yet realistic intervention.
In addition, it may be useful to employ open innovation. This term was promoted in relation to technology by Henry Chesbrough, the faculty director of the Centre for Open Innovation at the Haas School of Business at the University of California.(10) It involves bringing in outside ideas and opinions as well as relying on internal ideas. In relation to arts in health, open innovation need not be confined just to technology. It might involve setting up a patient-public involvement (PPI) group involving patients or staff engaged in the area to discuss ideas, or partnering with an external organization to jointly develop a brief, or running an ideas competition in which people can propose projects that meet the brief. As with design thinking, open innovation can be an iterative phase, involving initial ideas, further project development, and even the piloting of suggestions. For example, if a project is being considered that involves the creation of a website page with short artistic educational films to encourage people to manage their diabetes, design thinking may lead to the development of more ambitious ideas about the content of the films, their target audience, and their aims. Open innovation may lead to working up ideas with an app company instead who propose developing an app rather than a website. At this point, it may be worth discussing the idea with a PPI group or even showing some proof-of-concept graphics ideas to some patients to see if they like the concept; maybe even putting out a competition call for artists to design their own logos for the project, with the winner going on to design the graphics for the films.
As the project develops through design thinking and open innovation, it is also worth applying systems thinking,(11) which is another concept developed in engineering, as well as in ecosystems research. Systems thinking involves considering an arts intervention not as a single individual entity but as a dynamic and complex system comprising different inter-related parts and nested within wider systems such as the healthcare organization involved. Consequently, an arts intervention does not act in isolation but can have wide-ranging knock- on implications (partly shown through developing a problem tree and the care process analysis undertaken in Steps 2 and 3). This may be a positive activity with respect to an arts intervention as it may demonstrate a larger reach of an intervention than initially anticipated. For example, a dance intervention in a hospital specifically designed to improve mental wellbeing among cancer patients could also improve body strength, social support networks, and self-esteem. However, systems thinking also involves considering other inputs that might jeopardize these potential benefits. For example, cancer treatments may lead to reduced energy levels and weaker bones, meaning that participants actually lose confidence as they see their strength diminishing. So the intervention may not be able to achieve its initial aims unless it is designed carefully. Furthermore, systems thinking also involves isolating potential implications for the project. For example, if some patients are quite frail, it may be necessary to have a nurse or a physiotherapist in the room while the intervention is taking place, which could have budget implications or place extra strain on staff. Early identification of the potential and the possible problems of an intervention allows planning to take place to make necessary adjustments, thus making the intervention run more smoothly.
Interventions should also be assessed to see if they have potential longevity: futures thinking. Investing in DVD players to show films in waiting areas does not make economic sense if these DVD players are going to be out of date within a couple of years. And murals painted onto a corridor wall may have to be removed if the area is scheduled to be repainted in a few months. As well as identifying hurdles such as these, cleaning, repairs, and general upkeep also should be factored into the design of projects so that there is budget set aside. Otherwise the project will not be sustainable in the long term. Sometimes it may be possible to plan in ‘redevelopments’ of the project, such as through periodic ‘improvement’ meetings, perhaps involving the PPI group. Or it may be possible to budget for upgrades of equipment where necessary. Even if it is not known whether an intervention will continue after its initial pilot phase, planning for this eventuality in the early stages will increase the likelihood of it being continued and demonstrate a more thought-through intervention, which may help with funding applications.