A modified stakeholder participation assessment framework for design thinking in health innovation.

Increasing pressure to improve health outcomes of populations with limited resources has prompted an emphasis on innovation. Design thinking has been proposed as a systematic approach to innovation in health, owing to its human-centred methodology that prioritises deep empathy for the end-users' desires, needs and challenges, which results in a better understanding of the problem in order to develop more comprehensive and effective solutions. A key feature of design thinking is stakeholder participation. If design thinking is going to be used as an approach to design and implement effective, equitable and sustainable health solutions, assessing stakeholder participation should be integrated into the process. Therefore, the purpose of this review is to i) provide an analysis of the literature on assessing stakeholder participation in health and ii) propose a framework based on the literature analysis that can be used to assess stakeholder participation during the design thinking process in health innovation. Drawing from participatory research in health, where stakeholder participation is recognised as a core principle that facilitates the implementation of solutions, we integrate stakeholder evaluation tools into the design thinking approach. We draw on an assessment framework that describes levels of stakeholder participation by their involvement in making decisions about their health. Using a 5-point continuum where the lower end represents the medical approach (professionals make all the decisions) and the upper end represents the community development approach (all stakeholders are key decision makers), we propose a modified assessment framework to evaluate stakeholder participation during the design thinking process. The modified framework provides a simple and practical tool to evaluate stakeholder participation. Stakeholders can rate their perceived level of participation, as well as that of the other stakeholders. Evaluation of participation in a design thinking project may be used to improve participation, and therefore the uptake and sustainability of innovations. The framework may also be used in design thinking beyond health applications.