This contribution departs from an existing model, the Design Framework for Systems-of-Systems Resilience, to explore systems resilience issues across the health, environmental, and economic domains. The reported research activities include 1) a rapid review to collect a set of systems indicators and 2) a design workshop employing causal loop diagramming to map expected causal influences between indicators. Through this exercise, we examine key themes in this research domain and outline directions for further enquiry, while involving members of the design research community in an open dialogue.@en

Participatory systems approaches are readily used in multi- and inter-disciplinary exploration of shared processes, but are less-commonly applied in trans-disciplinary efforts eliciting principles that generalise across contexts. The authors were charged with developing a transdisciplinary framework for prospectively or retrospectively assessing initiatives to improve education and training within a multifaceted organisation. A common System Impact Model (SIM) was developed in a series of workshops involving thirty participants from different disciplines, clinical specialisms, and organisations. The model provided a greater understanding of the interrelationships between factors influencing the benefits of education and training and development as seen from various stakeholder perspectives. It was used to create a system for assessing the impact of initiatives on service-users/patients, trainees, and organisations. It was shown to enable a range of participants to connect on common challenges, to maximise cross-, multi-, and inter-disciplinary learning, and to uncover new strategies for delivering value, as system designers.

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While challenges around the creation of safe, ethical digital, virtual environments are as dated as the early attempts to create digital environments in the form of social games, more widespread conversations started only in recent years. With the recent developments in the Augmented Reality and Virtual Reality technology as well as the Metaverse there is a strong need to investigate challenges and opportunities in relation to the creation of safe, inclusive and ethical digital, virtual and immersive environments. With this article we frame a new conversation developed from previous qualitative research around the ethics of the Metaverse, alternatively called, Metavethics. Metavethics refers specifically to the ethics of human behavior towards the Metaverse, as it develops and grows as an advanced, pervasive immersive technology. Metavethics concerns with the study, assessment and safeguard of the ethical, integrity and social implications of the Metaverse, digital environments, virtual spaces and augmented reality content. To thrive, Metavethics requires the combined expertise of specialists from numerous disciplines, who must explore, study and develop critical knowledge to inform the creation of inclusive, safe and secure digital, virtual and immersive environments for all.

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The Inclusive Design Wheel (IDW) is an established inclusive con-cept design process, emphasizing iteration and early-stage evaluation. However, a structured evaluation of its effectiveness in practice has not been previously conducted. This paper describes how the IDW process was adapted for use in the design of digital mobility services. It was then trialled on five pilot projects in Italy, Spain, Belgium and the Netherlands. Questionnaires were completed by participants (both pilot partners and end-users) and interviews were held with pilot partners at the end of the project. Initial insights from the pilot experiences and the evaluation are described. The pilot teams found the IDW helpful and particularly valued its help in structuring the design process and offering clear steps and tools. Insights for improving the IDW focus on the importance and role of co-creation, issues with recording iteration and the balance between structure and flexibility. Implications are highlighted for improving the Inclusive Design Wheel and for inclusive design processes more generally.@en

Purpose: COVID-19 highlighted the potential value of improving knowledge sharing (KS) processes among hospital estates and facilities management (HEFM) departments. Organisational trust (OT) is a recognised predictor of KS interactions, but the interplay of impersonal and interpersonal OT components is yet to be investigated fully. In response to recent calls, this study aims to explore the effect of organisational features on personal trust and OT components required for KS episodes, in the context of the English National Health Service (NHS). Design/methodology/approach: A qualitative, exploratory grounded theory approach was selected, using primary data from 22 semi-structured interviews and secondary data from grey literature. A model of trust for KS among employees from geographically distributed units with pooled interdependence was synthesised from a review of the literature and used to connect the organisational features to different trust mechanisms. Findings: This study identifies four organisational features with a compound barrier-effect on impersonal-based OT, interpersonal-based OT and personal trust for KS interactions: lack of professional development, inappropriate reward and incentive systems, reorganisations/organisational change and benchmarking. Research limitations/implications: This study sought to generate theory about the interplay of organisational barriers and trust components required for KS, not to describe HEFM KS across the entire NHS. Future studies with more comprehensive data collections can build on this exploratory study by quantitatively testing the compound barrier effect of the organisational features. Practical implications: Practitioners can benefit from the insights into the barriers inhibiting trust mechanisms required for effective KS processes. These can inform policymakers in English and potentially other health-care systems in designing enhanced collaborative arrangements, which are required as future crises, e.g. pandemics and climate change hazards, will require increasingly complex solutions. Originality/value: This study addresses the interplay between personal trust, impersonal OT and interpersonal OT for KS by identifying the compound barrier effects of underlying organisational barriers common to personal trust and OT.

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The growing demand for better quality of care, together with an increasing awareness of limited resources, is bringing attention to the need for design in healthcare. In mental health, considered the largest single cause of disability in the UK, the need is great. Existing services often fail to meet current levels of demand and do not consistently deliver good quality care for all service users. The design of better delivery systems has the potential to improve service user experience and care outcomes. This paper reports how through the interactive and participatory method of storytelling, the key components of a mental health delivery system were identified. We explain each of the ten components and discuss their implications for system understanding and service design. A model of a mental health delivery system has also been proposed.

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Objective: The effectiveness of filtering facepiece respirators such as N95 respirators is heavily dependent on the fit. However, there have been limited efforts to discover the size of the gaps in the seal required to compromise filtering facepiece respirator performance, with prior studies estimating this size based on in vitro models. In this study, we measure the size of leak necessary to compromise the fit of N95 respirators. Methods: Two methods were used to create a gap of specific dimensions. A set of 3D-printed resin spacers and hollow steel rods were used to generate gaps in N95 respirators while worn on 2 participants. Occupational Safety and Health Administration (OSHA) quantitative fit testing methods were used to quantify mask performance with gaps between 0.4 and 2.9-mm diameters. Results: Gap size was regressed against fit factor, showing that overall, the minimum gap size to compromise N95 performance was between 1.5 mm2 and 3 mm2. Conclusions: These findings suggest the fit of a N95 respirator is compromised by gaps that may be difficult to visually detect. The study also adds to the body of evidence supporting the routine use of quantitative fit testing to ensure that masks are well-fitting.

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Some approaches to representing the diverse range of capabilities within the population focus on representing those with severe losses in a sin-gle capability, such as vision or mobility. This approach follows the simplistic view that people are either able-bodied, or have a single severe capability limita-tion. This paper challenges this view using data from a population representative survey of the 2019 adult population in Germany. This survey asked participants whether they had any limitations in daily activities because of their vision, hearing, memory, concentration, hands, reach or mobility. Out of 1002 valid responses, 158 participants reported that something was ‘very limited’. However, 145 of these par-ticipants (92%) had a limitation in more than one capability category. Therefore, representing the diverse range of capabilities within the population necessarily requires describing people with co-occurring limitations. The full set of capabil-ity limitations for an individual is defined herein as their ‘capability fingerprint’. Within the German survey, the top 16 capability fingerprints represented 80% of the survey participants. Presenting the most prevalent capability fingerprints is advocated as a better approach for understanding the diversity of the population. These capability fingerprints could be used to develop population-representative personas, or to better understand the sample that took part in small-scale user research.@en

Inclusive Design has been widely promoted in the fields of product, engineering, and user experience design. Despite the educational efforts made by scientists, practitioners, and institutions to raise awareness about accessibility and inclusion, Inclusive Design has not been widely embraced in architectural design practice, where it is often associated with design for disability. This multidisciplinary study, spanning behavioural science, ergonomics, and the social sciences of architecture, explores the challenges architectural design practitioners face when designing inclusively, and identifies opportunities to promote the adoption of Inclusive Design. The results of a questionnaire completed by 114 architectural design practitioners underscore the lack of client awareness of the benefits of inclusive design, highlight the important role practitioners can play in advocating for Inclusive Design, and emphasize the need to develop practices and tools that enhance the design and post-design phases of buildings to ensure inclusion, diversity, equity, and accessibility.

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Decisions made in the concept generation phase have a significant effect on the product. While product- related risks typically can be considered in the early stages of design, risks such as supply chain and manufacturing methods are rarely easy to account for in early phases. This is because the currently available methods require mature data, which may not be available during concept generation. In this paper, we propose an approach to address this. First, the product and the non-product (manufacturing and/or supply chain) attributes are modelled using the enhanced function means (EF-M) modelling method. The EF-M method provides the opportunity to model alternative solutions-set for functions. Dependencies are then mapped within the product and the manufacturing models, and also in between them. An automatic combinatorial method of concept generation is employed where each generated instance is a design concept-manufacturing method pair. A risk propagation algorithm is then used to assess the risks of all the generated alternatives.

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Background: Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue's resistance to decades of improvement work. Aim: To understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement. Design & setting: A qualitative exploration of the secondary-to-primary care communication system surrounding a large UK hospital. Method: A systems approach, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n = 18) of clinical and administrative staff from both sides of the primary-secondary care interface, and a subsequent focus group. Results: The largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates.

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In an increasingly interconnected world, changes of uncertain nature and impact affect the functioning of human societies that depend on health, ecological, and economic systems. The proposed framework for systems-of-systems resilience explains ways of accommodating and responding to these challenges while encompassing the interfaces of the health, environment, and economy domains and their effect on communities. Resilience is defined as a continuous process and we distinguish between four system properties, five resilience capacities, and a variety of system activities.

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Introduction During the course of the COVID-19 pandemic, there have been suggestions that various techniques could be employed to improve the fit and, therefore, the effectiveness of face masks. It is well recognized that improving fit tends to improve mask effectiveness, but whether these fit modifiers are reliable remains unexplored. In this study, we assess a range of common "fit hacks"to determine their ability to improve mask performance. Methods Between July and September 2020, qualitative fit testing was performed in an indoor living space. We used quantitative fit testing to assess the fit of both surgical masks and KN95 masks, with and without 'fit hacks', on four participants. Seven fit hacks were evaluated to assess impact on fit. Additionally, one participant applied each fit hack multiple times to assess how reliable hacks were when reapplied. A convenience of four participants took part in the study, three females and one male with a head circumference range of 54 to 60 centimetres. Results and discussion The use of pantyhose, tape, and rubber bands were effective for most participants. A pantyhose overlayer was observed to be the most effective hack. High degrees of variation were noted between participants. However, little variation was noted within participants, with hacks generally showing similar benefit each time they were applied on a single participant. An inspection of the fit hacks once applied showed that individual facial features may have a significant impact on fit, especially the nose bridge. Conclusions Fit hacks can be used to effectively improve the fit of surgical and KN95 masks, enhancing the protection provided to the wearer. However, many of the most effective hacks are very uncomfortable and unlikely to be tolerated for extended periods of time. The development of effective fit-improvement solutions remains a critical issue in need of further development.

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Objective: Qualitative fit testing is a popular method of ensuring the fit of sealing face masks such as N95 and FFP3 masks. Increased demand due to the coronavirus disease 2019 (COVID-19) pandemic has led to shortages in testing equipment and has forced many institutions to abandon fit testing. Three key materials are required for qualitative fit testing: the test solution, nebulizer, and testing hood. Accessible alternatives to the testing solution have been studied. This exploratory qualitative study evaluates alternatives to the nebulizer and hoods for performing qualitative fit testing. Methods: Four devices were trialed to replace the test kit nebulizer. Two enclosures were tested for their ability to replace the test hood. Three researchers evaluated promising replacements under multiple mask fit conditions to assess functionality and accuracy. Results: The aroma diffuser and smaller enclosures allowed participants to perform qualitative fit tests quickly and with high accuracy. Conclusions: Aroma diffusers show significant promise in their ability to allow individuals to quickly, easily, and inexpensively perform qualitative fit testing. Our findings indicate that aroma diffusers and homemade testing hoods may allow for qualitative fit testing when conventional apparatus is unavailable. Additional research is needed to evaluate the safety and reliability of these devices.

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The metaverse, a digital immersive environment in which people interact by using immersive technologies, is shaping a new way for people to interact and socialise. Forecasts predict that by 2026 a quarter of the population will spend at least an hour a day in the metaverse. This projection requires the consideration of several challenges and opportunities that will influence the design of the metaverse. A qualitative ethnographic study with industry experts was carried out to explore the social impact of the metaverse through the lens of inclusion, diversity, equity, accessibility and safety with the goal to identify directions business have to undertake. The results indicated the vast nature of future research questions that will need to be answered and facilitated the creation of good practices for designing an inclusive, accessible, safe metaverse that guarantees equity and diversity. These good practices are a starting point to develop a narrative, spark conversations, brainstorm questions and eventually provide answers for designing a metaverse as a place for people that does not substitute the physical world but complements it.@en

Notwithstanding the increased number of regulations there is a general lack of awareness about Inclusive Design among building industry professionals. This is partly due to the scarcity of available tools to evaluate occupancy feedback on inclusion, diversity, equity and accessibility. How can we implement a tool to evaluate occupancy feedback on inclusion, diversity, equity and accessibility that works for the building industry? This study aims to inform the development of a post-occupancy method to evaluate Inclusion, Diversity, Equity and Accessibility (IDEA) in the built environment. This article reports the results of a multifaceted Delphi study which culminated with co-designing the IDEA audit, a post-occupancy evaluation method to collect data on people's perceptions of inclusion, diversity, equity and accessibility. With the IDEA audit, researchers, building owners, design teams, developers, facility managers, tenants, and organisation leaders can achieve a baseline of understanding of what people feel in regard to inclusion, diversity, equity and accessibility, clearly identify pockets of inconsistency and use data to decide how to address challenges and points of exclusion.

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Characterising a socio-technical system by its underlying structure is often achieved by cluster analyses and bears potentials for engineering design management. Yet, highly connected systems lack clarity when systematically searching for structures. At two stages in a clustering procedure (pre-processing and post-processing) modelled and external information were used to reduce ambiguity and uncertainty of clustering results. A holistic decision making on 1) which information, 2) when, and 3) how to use is discussed and considered inevitable to reliably cluster highly connected systems.

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Designing accessible and inclusive buildings is essential if they are to provide enjoyable and inspiring experiences for all their occupants. Research revealed that many architectural design professionals perceive a lack of awareness of the aspects to consider when designing to be a limiting factor in the uptake of Inclusive Design. By involving expert stakeholders this study provides evidence for the demand to create an Inclusive Design Canvas, a strategic design template offering an educational springboard for building industry professionals to embed Inclusive Design in the design process.

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The design of the built environment strongly influences people's needs, how they learn, behave, and build relationships. Education and learning are part of the nature of human beings, and allow them to develop skills, advance culture, and answer needs. In the current context, the incremental use of technological devices inside spaces has brought several positive outcomes, but also various challenges due to increased complexity. Limitations in considering the diversity of human needs confronted with architecture and technologies may raise stigmatization and exclusion. This article explores the links between the learning theories and the paradigms of user-centered design, providing theoretical affinities able to reduce the exclusion of people during interaction with spaces and objects. The process of the inclusive spatial learning experience aims to stimulate designers to deliver inclusive spaces that provide a progressive discovery of their characteristics and technologies, with the final goal to improve the experience for people with different abilities, age, gender, culture, and various roles within the specific architecture they use and live.

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The concept of Health Systems is ubiquitous in the healthcare literature. However, the question 'what is a Health System' is not easy to answer. The emerging field of Health Systems Design is by nature multi-disciplinary, involving several disciplines with different ontological commitments and diverse perspectives and interpretations of health and system. To avoid confusions in communication and facilitate engagement between the design and health communities, it is important to begin an open exploration of the fundamental concepts of Health Systems. This paper is a first step in that endeavour

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