Case study

Prehab Service Scalability

  • Client: Hospital Clinic
  • Year: 2018

Exploring the role of Design Thinking to enhance the service workflow, aiming at fostering large scale deployment.


The efficacy of prehabilitation (PreHab) to reduce surgical complications, and facilitate post-surgical recovery, has been demonstrated. Deployment of PreHab, as a mainstream service at Hospital Clínic de Barcelona, is showing effectiveness and potential for cost savings. However, there is a need for PreHab refinement to address regional scalability.


We generated a roadmap for three DT sessions, each of a five-hour duration, aiming to address the core aims of the study, namely:
Identify actionable factors modulating regional scalability of Prehab;
2 Enhance efficiencies of the service with the use of information and communication technologies;
Design a business model contributing to sustainable adoption of the service.
The ultimate aim was to foster regional scalability of Prehab in Catalonia (7.5 m citizens).

We carried out in-depth face to face interviews with five patients and their respective caregivers who had participated in PreHab, aiming at capturing the patient experience perspective of the service. Patients surveyed in this phase had been candidates for cardiac transplantation, resection of lung parenchyma or major abdominal surgery due to cancer.

The three DT workshops included all the stakeholders’ profiles: healthcare professionals and managers, designers, health-technology agents, business school representatives and policy makers.

Session I:


The central aim of the first workshop was to gain further insight on actionable factors limiting the scalability of PreHab and to identify opportunities for service improvement; that is, creative focus. The process for structuring the creative focus encompassed four main areas covering specific actions: i) analysis and elaboration of a patients’ experience map during PreHab, based on the information gathered during the preliminary work alluded to above; ii) generation of an empathy map aiming at maximizing the engagement of patients and professionals; iii) formulation of a context map identifying external factors and main driving forces that modulate the scalability of PreHab; and, iv) definition of a priority map elaborated as a contribution to conform a future strategy for the regional deployment of the service.

Session II


The objective of the second workshop was to generate, evaluate and develop both ideas and plans to solve the creative focus identified in the first session. The expected output of Session II was to generate a customer journey that should contribute to define a viable strategy for regional deployment of PreHab.
The Ideation Session was divided into three parts, i) two initial inspirational presentations aiming to stimulate creativity; ii) small group-based creative sessions for generating potential solutions; and, iii) pooling the ideas resulting from the two previous steps into a positioning map depicting the PreHab potential in terms of both adherence and scalability.

Session III


Finally, the third session aimed to consolidate the concepts resulting from the second workshop, focusing on service optimization and financial sustainability in order to achieve full regional coverage of the service. Accordingly, the final outcome of the session was to define a viable strategy for regional deployment of a refined service workflow. The session ended with a synthesis of the outcomes of the three groups aiming at defining the pillars of a viable strategy for the regional deployment of PreHab.

PreHab Service Blueprint

Design thinking methodologies were useful for defining the traits of a general strategy for the regional deployment of the prehabilitation service, which has demonstrated effectiveness and potential for cost-savings at Hospital Clinic of Barcelona. Moreover, the approach shows high potential for service refinement in other complex healthcare interventions.

Dr Josep Roca Hospital Clinic Barcelona

Thanks to our partners Ferran Pruneda and Xavier Ayneto for sharing their knowhow and experience during the workshops.

Especially grateful to Fernando Ozores from Buenaidea to join stimulo team to find new services and user experience. We love Fernando’s ability to react and adapt to a constantly changing environment.