Art based intervention through tool-kit-based modeling and serious play ? A case study from regional health care development in Japan

In the last several years health care systems and institutions in most countries have faced major challenges (e.g. Prybill 2003; Griffith & White 2005; Ginn 2006; Bandyopadhyay& Hayes 2009). In particular, they are confronted by having to balance any tension between quality of service and costs (e.g. Khatri et al. 2006). Therefore, learning, system improvement and innovations are seen as "fundamental for healthcare organizations cope with changed framework conditions. Thereby interfunctional and interdisciplinary interaction between the main actors – general practitioners, specialized physicians, nurses, therapists and health care administrators as well as health care policy makers – are crucial for the efficiency and enhancement of a health system. The heterogeneous knowledge, experience and motivation of the diverse actors as well as their ability to overcome institutional boundaries (Kerosuo 2006) significantly influence the performance of health care processes and institutions (Rondeau&Wagar 2002). Particularly, healthcare organizations are characterized by their incorporating various stakeholder and interest groups that influence structures, rules and practices. Organizations often exploit any creative potential by encouraging various stakeholder groups to take on change and development activity (Sanoff 2000; Reed et al. 2012). In these contexts new ideas are likely to emerge out of mutual reflecting and practicing (West & Farr 1990; Amabile 1996; West 2002; Sannino & Ellis, 2014). However, despite the creative potential of such activity, participants are confronted with diverse perspectives and understandings. At the same time, it is the diversity of the participants combined with their ability to share meaning and understanding which provides creative potential (Cropley 2006; West 2002). Moreover, this 14 exchange and collaboration bring into question power relations between these actors. Therefore, these subtle power struggles and the personal concerns of different stakeholder groups need to be taken into account. Such aspects are relatively strong in health care practices since e.g. nurses and doctors are often deeply personally engaged in their profession (Mintzberg 1989; Chambliss 1996; Larson 1977; Abbott 1988). Consequently the question arises as to how change, system development and learning processes in health care can be facilitated, countering this diversity of stakeholders. A major aspect of this is how a collectively shared understanding and language about the object of consideration can develop among the participants, which is an essential prerequisite in learning processes where different disciplines and professional cultures meet (Jacobs &Heracleous, 2006; Schulz, 2008). From our point of view haptic models, mock-ups and stories play an important role as metaphors for understanding and sense-making within development and innovation process (e.g. Buur& Matthews, 2008). Therefore, we will introduce a tool-kit-based modeling and serious playmethodology which actively integrate all stakeholders into learning and development processes, allowing them to gain awareness, exchange knowledge as well as to develop and discuss ideas within a group. The method is characterized in the following. As an empirical case study we refer to a development workshop applying the serious play methodology with diverse health care practitioners in leadership positions (e.g. head nurses, therapists, doctors, hospital managers, social workers, paramedics) of an urban region in Japan. They gathered to discuss problem areas of their current care processes and to construct a shared vision of future health care essentials in the region. We explore how such a heterogeneous group of health care practitioners apply the serious play method to expose ideas and concepts of change. Finally we discuss in what fields and stages of change and development processes in health care such methodology can be successfully applied.