The World Health Organization (WHO) established the concept of Health Promoting Hospitals (HPH) in 1986, with the main aim to expand the role of hospitals from treatment-centred to health promotion-centred cultures and by doing so, empowering and facilitating deeper community context. Design research and social healthcare have permeated western studies. However, when it comes to design practice in Chinese HPH, research suggests hospital managements still tend to believe design is only a last-minute intervention rather than drawing comprehensively and synthetically from a design research perspective. This is the gap my PhD practice-led research aims to fill, by employing designerly research, Chinese HPH practitioners may access and apply a systematic, comprehensive understanding of what design thinking means for HPH implementation.

The research asks: Can design thinking create a supportive, sustained and creative community setting for Chinese HPH? Can the WHO philosophy of HPH and design epistemology be adapted and situated in Chinese hospitals through design research?

The practice in this research is reflected in field trips, two case studies and design frameworks. First, the research examines Chinese hospitals in Central and East China, looking at the role of design in HPH and investigating the level of design penetration within that context between 2017 and 2019 using field trips and action research. Second, two case studies were conducted with two focus groups through participatory communication design (PCD) research: (1) participatory action research into a low-literate group targeting medical consumption issues in Hantun village; (2) a participatory dental health promotion course for children aged 4-8 in Wuhan. Both case studies propose a change from “top-down” policymaking to adopting a “bottom-up” strategy; from expert-dominated to participatory and democratic approaches. The core of HPH activities is enabling people – patients, professionals and communities – to design their own experiences, services, tools and artefacts. Finally, the design frameworks offer a pluralistic, situated, nuanced and inclusive process for Chinese HPHs.

My main contribution to knowledge is within the Chinese HPH field, developing and proposing comprehensive design-thinking frameworks – designerly ways of knowing, thinking, and doing – increasing accessibility to the inclusivity of design ontology, epistemology and methodology, within Chinese HPH context. A secondary contribution to knowledge is situated in the design fields. It defines PCD through participatory design, communication design and communication theory as a blended theoretical construction, developing novel PCD methods and transitional communication methods as extensive methodology. These design contributions address gaps in current design research.