Background Processes to implement injectable end-of-life symptom control medications in the community are complex and can have an adverse impact on patient safety. Recurring patient safety incident types and their contributory factors remain underrecognised, inh ibiting systemwide learning. Aim To understand injectable end-oflife symptom control medication incidents, their contributory factors, the impact on patients/families, and identify priority areas for improving safe, effective, and timely care. Design and setting Mixed-methods analysis of nationally reported injectable medication patient safety incidents involving adults in the community in England and Wales between 2017 and 2022. Method A stratified random sample of 2150 incidents from the National Reporting and Learning System were screened for eligibility. Incidents that involved end-of-life injectable medications in the community were included and analysed. Deductive coding was undertaken to classify incident types, the contributory factors involved, the impact on the patient, and harm severity. An iterative thematic analysis was then conducted to identify patterns between recurring incident types and contributory factors. Results In total, 419 patient safety reports detailed injectable medicationrelated patient safety incidents: 59.7% (n = 250) of incidents described harm to patients. Frequently reported patient safety incidents included: medication administration issues (49.2%, n = 206); delayed and inadequate assessments (10.3%, n = 43); and prescription issues (8.6%, n = 36). Incidents often involved multiple services and delays. Recurrent, and often interacting, contributory factors included inadequate continuity of care, distractions and mistakes, poor equipment design, and insufficient staffing levels. Conclusion Interventions to improve injectable end-of-life symptom control care should focus on ensuring timely access to assessments and prescriptions, enhancing continuity of care, and mechanisms to ensure rapid visits to administer medication.

ABSTRACT: Long-COVID is a complex, multi-system condition with variable care across the UK. Using a systems and design engineering approach underpinned by Model-Based Systems Engineering (MBSE), this study examined Long-COVID clinic pathways through semi-structured interviews with 15 clinicians and patients. Thematic analysis identified five domains—attitudes, relationships, service integration, technology adoption, and safety netting. The final synthesised swimlane diagram revealed opportunities to improve coordination, operational efficiency, and patient safety within evolving care models.

BACKGROUND:Injectable anticipatory medications are routinely prescribed ahead of need in many countries to help manage distressing end-of-life symptoms. However, little is known about the lived experience of patients and informal caregivers as they navigate their prescription, supply and use. AIM:To explore and map patient journeys in navigating anticipatory medication care, and to identify healthcare interactions with the greatest potential for enhancing patient and informal caregiver experiences of care. DESIGN:Qualitative secondary analysis of longitudinal interview data using framework analysis and patient journey mapping techniques. SETTING/PARTICIPANTS:Adults (18+) prescribed anticipatory medications (n = 6), informal caregivers (n = 9) and health care professionals involved in their care (n = 5). RESULTS:Visually mapping journeys highlighted that patients and informal caregivers' experiences of anticipatory medication processes varied greatly and were influenced by the context of care. All participants appreciated access to injectable medications for future symptom control. However, journeys repeatedly highlighted suboptimal information exchange between patients, informal caregivers and healthcare professionals, regarding their purpose and threshold for use. Navigating unfamiliar and complex end-of-life medication support systems was more challenging when patients lived alone or experienced communication difficulties. CONCLUSIONS:Patient and informal caregiver experiences of timely symptom control could be improved by healthcare professionals having open and ongoing conversations about the role of anticipatory medications. Simplified and well-signposted routes for accessing healthcare professional advice and medication input are needed. Using journey mapping offers a novel way to visually illustrate different patient and informal caregivers lived experience and can be adapted for researching experiences of various care pathways.

This study introduces a transition from manual approaches, such as assessment tools, to a software-driven solution for assessing the health friendliness of healthcare facilities. When the specifications of a facility are entered into the software, it automatically calculates the impact of Architectural Variables (AVs) on Health and Care Outcomes (HCOs), providing quantitative insights. It demonstrates how various AVs affect different HCOs. To do so, the software relies on a computational model created by modeling the interactions of AVs on HCOs. It considers all interactions, including AV-HCO, AV-HCO-HCO, and AV-AV-HCO. The Model-Based Systems Engineering (MBSE) approach is used to model these interactions and is integrated into the software as its calculation engine. The software is developed as a case study in the context of dementia-friendly design in nursing homes, involving 40 AVs, 36 HCOs, and 396 interactions. However, its structure is adaptable to other healthcare facilities. Moreover, this web-based software offers enhanced usability by providing digital fields for receiving design specifications and automated calculations. Compared to previous assessment tools, it provides a wide range of data insights for informed decision-making and enables the creation of design assessment benchmarks through its coherent database. This research contributes to the advancement of performance-oriented, occupant-centered design evaluation methods and aligns with current efforts in digital transformation of the architectural design process. It demonstrates how computational tools can bridge architecture and health, offering a replicable and adaptive framework for assessing the impact of environmental design on human well-being.

Background Standardisation has improved hospital discharge summaries. However, problems remain for recipient GPs, such as inadequate detail for whole-person continuing care. Hospital authors often lack sufficient understanding of expert generalist practice in community post-discharge settings and so may over-rely on generic information standards or simplified summary template headings. Aim To explore how expert generalist GPs practically use discharge information, including the challenges they face, to shape new understanding of what discharge communication should look like. Design & setting A qualitative exploration of GP perspectives on challenging post-discharge management scenarios. Method Fifteen semi-structured interviews of GPs and GP trainees were conducted with use of a mock vignette and the think aloud method. Thematic analysis was informed by the ‘4Es of expert generalism’. Results An interpretive process of ‘Holistic Adjustment To Context after Hospital discharge’ (HATCH) was found to underpin expert generalist GP decision-making in this transitional care phase. The sub-processes of rationalisation and integration exemplified the use of the expert generalist interpretive paradigm. Insufficient communication of explanation and context surrounding key hospital decisions was found to hinder the HATCH process and risk the quality and safety of post-discharge care. GPs could remediate such situations, but this still had hidden risks and costs. Conclusion Understanding the HATCH process and how contextual and explanatory information supports it emerged as key steps for authors to further improve discharge summaries. Adaptations to information standards and summary templates are key opportunities to address this issue, alongside incorporation into AI software and updated training for all parties.

Background The use of injectable end-of-life symptom control medications is complex and a risk-prone healthcare activity in the community. Attention is often directed towards the immediate causes of medication-related incidents; however, valuable learning can be gained by examining ‘origin incidents’, the first adverse event occurring in incident chains that resulted in patient harm or the potential for harm. Understanding these origin incidents can underpin improvements in system resilience to ensure the provision of timely, effective and safe symptom management. System resilience arises from capacities at individual, team and structural levels that enable a complex system to adapt practices and maintain essential functions under varying conditions. Objective To understand the nature of reported origin incidents involving injectable end-of-life symptom control medication in the community and to identify how system resilience can be improved. Design Retrospective observational study and mixed-methods analysis of nationally reported community injectable medication patient safety incidents, sourced via the National Reporting and Learning System database. Setting(s) Community-based care in England and Wales. Participants A stratified random sample of 2150 incidents was screened for eligibility: 317 incident reports were included. Incident reports involving injectable end-of-life symptom control medications were included. These related to adult patients (aged 18+) receiving end-of-life care in the community, between 2017 and 2022. Methods Eligible incidents involved reported chains of incidents (events) influenced by an origin incident. Incident narratives were coded to classify incident types, contributory factors, patient impact and harm severity. Data analysis utilised a mixed methods approach. An initial quantitative descriptive analysis informed subsequent qualitative thematic analysis lines of inquiry. Results Ineffective and unsafe symptom control care is influenced by injectable medication origin incidents occurring across the full range of medication management processes. 67.5% (214/317) of reports described actual harm to patients. System resilience was impeded by ineffective transfers of care, difficulties sourcing timely symptom management input from clinical teams, and medication stock and supplies issues. Chains of negative incidents were often exacerbated by discontinuity of care, inadequate communication between in-hours and out-of-hours care providers, mistakes and omissions, failure to follow protocols and insufficient staffing capacity. Conclusions Examining upstream origin incidents generated valuable system-wide insights, as these initial events influence subsequent actions and system resilience. Enhancing system resilience to support timely and safe symptom management requires improved coordination during transfers of care, reliable access to equipment and valid permission to administer charts, and adequate staffing to provide responsive, cross-organisational care.

Abstract Background With rising numbers of people dying at home, often with complex multimorbidity, community healthcare professionals are increasingly responsible for providing end-of-life care. This care is usually led by community nurses, many of whom do not have specialist palliative care training. A core part of their role is providing end-of-life symptom control using injectable medications prescribed ahead of need and stored in patients’ homes. However, cross-organisational systems around injectable medication processes are complex and time consuming. We aimed to explore community nurses’ perceptions of their changing roles in end-of-life care and how they navigate injectable medication processes to provide timely symptom control. Methods A qualitative study using in-depth interviews with community nurses undertaken in two counties in England. Data were analysed using reflexive thematic analysis. Results Fifteen community nurses took part. Nurses’ roles in end-of-life care were characterised by increasing scope and complexity, making it challenging to offer the holistic care they wanted to. Using their practical knowledge and wisdom, nurses navigated and sometimes adapted (changed) challenging injectable medication processes to ensure timely symptom control for patients. This involved considerable additional hidden work conducted on behalf of patients, families, nursing colleagues and general practitioners. Some nurses appreciated the autonomy and independence they had in navigating and adapting injectable medication processes. However, others perceived their expanding remit in end-of-life care and the increasingly blurred boundaries between their role and that of general practitioners as sources of anxiety and professional risk. Conclusions To ensure community nurses feel confident, empowered and professionally safeguarded to take on this multifaceted and increasingly complex work, further experiential learning with palliative care colleagues is required, in addition to assured support from regulatory organisations. Exploring how other healthcare professionals, including pharmacists and paramedics, alongside families, navigate and adapt injectable medication care can make other hidden work visible and identify priority areas for system-wide improvements.

Touchscreens have transformed digital interactions, but the absence of physical feedback may disadvantage users with reduced tactile sensitivity. This study investigates vibrotactile feedback for touchscreen home appliances to enhance comfort and certainty across young adults (18-55) and late middle-aged and older users (55+), highlighting inclusive design for multigenerational smart-home environments. Using a washing machine touchscreen , 32 participants experienced 28 vibration conditions varying in duration, intensity, and frequency. Mixed ANOVAs indicated significant main effects of all three parameters on certainty (all p < .05). Comfort ratings in the 18-55 group were influenced by intensity and frequency (both p < .05), while the 55+ group showed reduced parameter sensitivity. Settings around 100-200 ms, 0.55-0.70 g, and ∼230 Hz jointly maximised certainty and comfort across groups. This study demonstrates how parameters adjustments can optimise usability for late middle-aged and older users, fostering inclusivity in touchscreen interaction.

Co-design in healthcare settings requires teams to utilize each other's knowledge effectively, but practical guidance and simple methods for observing collaboration are often lacking. We tested whether a lightweight AI assistant that guides the process-and automatically logs who speaks, when, and how work progresses-can make teamwork easier to manage and easier to track. Six four-person teams completed the same five-phase session. The assistant nudged timing, turn-taking, and artifact hand-offs; all interactions were recorded in a shared workspace. We assessed usability and acceptance, expert-rated product quality (technical performance), perceived team performance, and self-rated technical contribution, and we summarized basic log signals of participation and pacing (e.g., turn-taking balance, average turn duration). Analyses were descriptive. All teams finished the protocol with complete logs. Outcomes were favorable (expert ratings averaged 4.18/5; perceived performance 6.14/7; self-rated contribution 4.08/5). Teams with more balanced participation and clearer pacing tended to report better performance, whereas simply having more turns did not. A process-guiding AI assistant can quantify teamwork behaviors as markers of collective intelligence and support reflection in everyday clinical co-design; future work will examine the generalizability of these findings across different sites.

Inclusive design has evolved as a design approach and a research topic in the last three decades. Despite its evolution, there are new frontiers to consider in the context of two phenomena: global ageing populations and the digital transition of services, particularly healthcare. This state-of-science paper presents challenges to be considered when taking an intersectional perspective and its impact on the development of digital health intervention (DHI). We present evidence highlighting how health inequalities can impact digital skills, affecting the use of DHI and potentially exacerbating existing health disparities. We offer a more nuanced understanding of ageing, considering multiple levels of disadvantage and its impact on people benefiting from DHI. We speculate on the future of digital interactions powered by artificial intelligence, which can guide the future development of inclusive design. We conclude by proposing a roadmap embracing a more intersectional inclusive design with routes for human factors research, practice, and policy.

Design Science is the discipline that studies the creation of artifacts – products, services, and systems and their embedding in our physical, virtual, psychological, economic, and social environments. This editorial is a collective effort of the Design Science Journal’s editorial board members, past and present. The journal’s inaugural 2015 editorial, “Design Science: Why, What and How,” reflected the thoughts and vision of that first editorial board for the new journal and the discipline it represented. The present contribution offers the reflections of editors who served the journal in the past 10 years. The individual contributions were not primed and are presented here unedited for conformity or consistency. Differently from the 2015 editorial, there is no effort to synthesize the individual contributions, leaving the task to our readers, who can draw their own conclusions about the Design Science Journal and community accomplishments to date, and the challenges ahead.

Objective This study explores the current development and findings of Medical Co-design (MCD) in the era of artificial intelligence (AI). As design objects evolve from products addressing single-function needs to complex systems catering to diverse stakeholders' values, medical designers face the challenges of overcoming high knowledge barriers and coordinating multiple interests. MCD is regarded as an effective approach to addressing these challenges. Methods This paper adopts a scoping review approach to analyse the progress and limitations of existing research in the field of MCD, with a particular focus on overcoming knowledge barriers. Additionally, the study examines the integration of AI technologies, particularly the application of large language models (LLMs), exploring their evolving roles in co-design and their impact on participants, providing new insights into human-AI co-design. Results The research reveals that traditional human-centred co-design has gradually evolved into human-AI co-design and even AI-AI co-design. This paper presents a theoretical framework for multi-agent collaboration, preliminarily identifying the interaction patterns between humans and AI agents during the design process and their potential impact on design outcomes. Conclusion This study offers a theoretical foundation and practical guidance for future AI-assisted MCD practices. The findings will contribute to a better understanding of the intrinsic mechanisms of human-AI co-design and provide insights for optimizing knowledge integration and innovation processes in MCD. © 2001 Elsevier Science. All rights reserved