While service design has been highlighted as a promising approach for driving innovation, there are often struggles in realizing lasting change in practice. The issues with long-term implementation reveal a reductionist view of service design that ignores the institutional arrangements and other interdependencies that influence design efforts within multi-actor service systems. The purpose of this article is to build a systemic understanding of service design to inform actors' efforts aimed at intentional, long-term change in service systems. To achieve this aim, we inform the conceptual building blocks of service design by applying service-dominant logic's service ecosystems perspective. Through this process, we develop four core propositions and a multilevel process model ofservice ecosystem design.The conceptualization of service ecosystem design advances service design theory by illuminating previously taken for granted aspects; explaining how intentional, long-term change emerges; and expanding the scope of service design beyond projects. Furthermore, this research offers a foundation for future research on service design that involves extending the systemic conceptualization of service design, conducting more holistic empirical investigations, and developing practical methods and approaches for the embedded, collective processes of designing.

Innovation in healthcare requires changing the institutional arrangements or whatare often referred to as “the rules of the game.” Such a change demands that actorsdo institutional work—intentionally creating, disrupting, and maintaining theentrenched ways of operating within the system. This chapter explores how servicedesign practices contribute to changing the rules of the game in healthcare byintegrating research on service design and institutional work. Based on a literaturereview, five characteristics of service design practices—multidisciplinary, experiential, participatory, experimental, and reflective—are highlighted and linkedto the antecedents of institutional work. Illustrative examples of service designprojects from Experio Lab, an embedded service design group in the Swedishhealthcare system, are used to contextualize the findings. In doing so, this chapterprovides a clear rationale for how service design practices enable innovation inhealthcare and offer insights for healthcare practitioners interested in workingtoward institutional change through service design.

Purpose: The purpose of this paper is to analyze how service design practices reshape mental models to enable innovation. Mental models are actors’ assumptions and beliefs that guide their behavior and interpretation of their environment. Design/methodology/approach: This paper offers a conceptual framework for innovation in service ecosystems through service design that connects the macro view of innovation as changing institutional arrangements with the micro view of innovation as reshaping actors’ mental models. Furthermore, through an 18-month ethnographic study of service design practices in the context of healthcare, how service design practices reshape mental models to enable innovation is investigated. Findings: This research highlights that service design reshapes mental models through the practices of sensing surprise, perceiving multiples and embodying alternatives. This paper delineates the enabling conditions for these practices to occur, such as coaching, diverse participation and supportive physical materials. Research limitations/implications: This study brings forward the underappreciated role of actors’ mental models in innovation. It highlights that innovation in service ecosystems is not simply about actors making changes to their external context but also actors shifting their own assumptions and beliefs. Practical implications: This paper offers insights for service managers and service designers interested in supporting innovation on how to catalyze shifts in actors’ mental models by creating the conditions for specific service design practices. Originality/value: This paper is the first to shed light on the central role of actors’ mental models in innovation and identify the service design practices that reshape mental models.

Within the discourse connecting design and innovation, there has been a growing emphasis on the importance of cognitive processes in relation to design methods. However, the over-emphasis on cognition fails to clearly identify the triggers of change necessary for service innovation. In response, this article draws on classic American pragmatism and service-dominant logic to highlight the underappreciated role of actors' bodily experiences when using design methods for service innovation. The authors of this paper posit that design methods stage aesthetic disruption, a sensory experience that challenges actors' existing assumptions. In doing so, the use of design methods can lead to destabilizing the habitual action of participating actors, helping them to break free of existing institutions and contribute to service innovation.