Introduction Hospice care is in a period of change, with redefined access, inequitable provision, diversified and ever-increasing demand, and advancements in technology transforming current models of care. Beyond a creative problem-solving activity resulting in product-level or service-level improvements and innovations, Design could also help reimagine alternative scenarios and lead to system-level transitions, acting as a strategic agent of change in future hospice care.

Aims We aim to co-define and co-imagine current and future hospice care as an ecosystem of people, objects, environments, technologies, interactions, practices and narratives of care. Objectives include; a) co-creating a systems map of the current hospice care; b) co-defining key existing and emergent values, requirements and challenges in the current system; and c) co-imagining new value propositions in future hospice care systems.

Methods We propose an advanced design approach to future hospice care informed by the principles of System-shifting design, Speculative design, Human centred and Inclusive design and Design framing. We adopt a Place-Based and a Service-not-Space based approach to hospice care and introduce a Designer-in-Residence model as a new innovative method for interdisciplinary investigation and collaboration.

An innovative collaboration between a Marie Curie hospice centre and an academic design research centre allows for a team of design researchers to undertake a 12-month residency in the hospice to gain first-hand contextual understanding and to conduct 1) Semi-structured interviews with staff, visitors and patients (N=10); 2) Observations of patients and staff (N=10); 3) Co-define and co-design workshops with all stakeholders (N=2).

Results First, a systems map of existing hospice care will help clarify and communicate how the system works, capture narratives, experiences, extremes and tensions, and underline strategic areas for future system-level transitions. Second, a system-shifting design map will help identify new value propositions for future hospice care.

Conclusions This design-driven study incorporates advanced design principles and for the first time, introduces the innovative Designer-in-Residence model in the context of hospice care. We expect the outcomes to stimulate interdisciplinary discourse and collaboration and inform research and practice.

Impact This first-ever Designer-in-Residence model is expected to impact both research and practice. Through documenting the principles and processes of the research and offering an auto-ethnographic account of conducting design research in the sensitive context of palliative and end of life care, we expect to inform and impact research in this area. We also expect to impact practice, through enabling better capture and communication of hospice care on a complex systems level, through the current and future systems maps created as outputs of the project.