Introduction
Social Innovation Through Design in Healthcare: An Emerging and Multidimensional Approach

My only desire is to enrich myself with new inspiring thoughts.1

René Magritte, quote from the Magritte Museum, Brussels

If Volume 1 of this book succeeded in enriching readers with inspiring ideas, Volume 2 should continue to do so. Volume 1 showed that social innovation through design in healthcare is a topic that is becoming more and more important in the academic and professional landscape. This concept, which lies between management, design and health sciences, aims to transform healthcare services and environments by integrating collaborative and human-centered approaches. It is part of a dynamic process of redesigning practices and organizational models in order to meet the contemporary challenges of the healthcare sector, characterized by growing tensions between quality of care, economic constraints and shifting societal expectations (Sebai 2021).

While the idea of social innovation has gradually established itself as an innovative approach to solving major societal issues (Moulaert et al. 2007; Richez-Battesti and Vallade 2012), its connection with design, particularly in the healthcare sector, remains relatively unexplored. Design, historically associated with the creation of products and objects, has evolved toward a more systemic approach as a driver for organizational transformation (Catoir-Brisson and Watkin 2021). Applied to healthcare, it enables innovation by not only rethinking infrastructure and medical devices, but also care processes and interactions between the various actors in the healthcare system (Catoir-Brisson and Royer 2017).

I.1. A rapidly changing healthcare sector

The healthcare sector faces many challenges, requiring a transdisciplinary and innovative approach. These challenges include the rise in chronic diseases, the uneven distribution of healthcare services across the country, increased economic pressure on healthcare institutions and changing patient expectations, with patients wanting to be more involved in their care pathway (Courie Lemeur et al. 2024). These profound changes thus require that healthcare organizations and management models be redesigned (Sebai and Szostak 2024).

From an economic perspective, healthcare spending represents a major budget item in European countries. According to Eurostat (2022)2, it accounts for an average of 7.6% of GDP, with significant disparities between countries. France, for example, spends 9.1% of its GDP on healthcare, while Germany allocates 8.5% and Italy 7.1%. This growing budgetary pressure is forcing healthcare organizations to adopt more efficient and sustainable management models.

From a human perspective, the crisis in hospital resources is a well-documented reality. The World Health Organization (WHO 2022) warns of the aging healthcare workforce and the lack of appeal for healthcare professions, particularly due to increasingly demanding working conditions. Furthermore, the growing digitization of healthcare raises new questions about the integration of technologies and their acceptance by professionals and patients (Muller et al. 2024).

I.2. Design as a driver for social change in healthcare

Given this situation, this book aims to show that social innovation through design can be a relevant response. It is based on a user-centered approach, where patients and healthcare professionals actively participate in the co-design of innovative solutions (Sebai and Szostak 2024). This approach differs from technocratic and top-down approaches in that it values the participation of all stakeholders and the experimentation of new practices in healthcare organizations (Findeli 2003).

Design thinking, in particular, has demonstrated its potential to promote collective intelligence and the co-creation of solutions adapted to the realities in the field (Catoir-Brisson and Watkin 2021). By facilitating a deeper understanding of user needs and professional constraints, design makes it possible to reinvent care pathways that are more seamless and better adapted to a variety of situations (Szostak and Muller 2024). However, this approach still faces organizational and cultural obstacles that limit its large-scale implementation (Courie Lemeur 2024). Solutions still need to be identified and tested.

Following on from Volume 1, this second volume offers an in-depth exploration of the synergies between social innovation and design in the field of healthcare. The first part of Volume 1 laid the theoretical and conceptual foundations for social innovation through design in healthcare, applying frameworks from innovation management, design and social sciences. The second part presented case studies illustrating the implementation of these approaches in various contexts. This second volume opens up perspectives for research and development on future developments in this field. It draws on recent academic work and feedback from concrete projects carried out in hospitals and medical-social environments. The goal is to provide a structured reflection on the opportunities and challenges associated with integrating design methodologies into the organization of care and the management of healthcare facilities.

Aimed at an audience of researchers, practitioners and decision-makers, this book aims to contribute to the dissemination of best practices and the development of a culture of innovation within healthcare organizations. Through an interdisciplinary approach, it seeks to demonstrate that design can be a powerful driver for reshaping healthcare services and promoting a transition to more inclusive, effective and sustainable models.

I.3. Feedback and challenges of social innovation through design in healthcare

This second volume comprises six chapters, including two testimonials. The objective here is to demonstrate the challenges involved in implementing social innovation through design in healthcare, in both practical and concrete terms. The authors share their experiences and proposals for successfully developing this type of innovation.

In his testimony, Antoine Fenoglio explains that design, as a discipline combining theory and practice, finds its value in its ability to co-create with users. This approach has been implemented in health-related projects (outpatient surgery pathways, therapeutic gardens, etc.), where designers have used academic, professional and experiential knowledge to improve care conditions. This practice reveals a collaborative and pragmatic aspect of design, transforming healthcare settings into truly caring environments. He explains that in 2017, after a 15-year career in design spanning various fields such as objects, culture and communities, he felt an ethical unease about the way design is often used to serve purely commercial interests. Inspired by figures such as William Morris, Charlotte Perriand and László Moholy-Nagy, he therefore refocused his practice by incorporating ethical and political reflection, notably through a series of seminars with philosopher Cynthia Fleury. This approach led him to explore the links between design and the ethics of care, an approach centered on caring for people and environments, based on listening, diversity and responsibility.

According to Antoine Fenoglio, given the tension between managerial demands and care practices, ethical design offers an alternative by integrating the principles of care, according to which attention, responsibility, competence and responsiveness are essential. This perspective goes beyond simple service design and embraces the act of caring for life itself, collectively engaging caregivers, patients and managers in inclusive and transformative approaches. In 2020, the idea of a "climate of care" was brought to life in an exhibition in Lille. It brought together projects that explored how to care for individuals, society and environments. These initiatives reflect a conception of design as an enveloping, attentive and committed practice, placing care at the very center of how we inhabit the world.

In their chapter, Marie Coirié and Carine Delanoë-Vieux explore how social design can redefine user participation in psychiatric hospitals, particularly through the concept of "demopraxy". This approach, which complements the healthcare democracy established by the 2002 law on patients' rights, is based on the co-design of care environments and collaboration between users, professionals and designers. The text examines two empirical experiments conducted at the GHU Paris psychiatrie & neurosciences (Paris Psychiatry & Neurosciences University Hospital Group): the creation of a reception charter and the transformation of an isolation room into a calming space.

The authors show how user participation in the healthcare system continues to be limited by institutional and cultural barriers, despite legal and conceptual advances such as healthcare partnerships, which value patients' experiential knowledge (Pomey et al. 2015). The psychiatric sector, in particular, has a history of stigmatization and authoritarian practices (Laval 2015). In this context, social design offers an innovative approach. Focused on users, it uses collaborative tools and creative approaches to rethink care environments, valuing both material and relational aspects. The two projects studied reveal the significant contributions of such an approach. In the case of...