Designing for Dignity in Healthcare

Designing for Dignity in Healthcare | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Designing for Dignity in Healthcare Kristoffer Marsaa, Thomas A Schmidt, Maria O Jellington, Ingrid Haug, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9265257/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Modern healthcare systems increasingly struggle to address multimorbidity, frailty, and human diversity within standardized, diagnosis-driven models. At the same time, digitalization and system-level efficiency strategies risk introducing new barriers, particularly for individuals with reduced functional or digital capabilities. These tensions challenge the ability of healthcare systems to uphold human dignity in practice. This paper introduces “Designing for Dignity,” a framework that integrates Universal Design with Intensive Caring and Care That Fits to align healthcare systems with the lived realities of patients, informal caregivers, and healthcare professionals. Methods We conducted a cross-disciplinary concept-bridging synthesis drawing on three established bodies of knowledge: Universal Design (design science), Intensive Caring (clinical ethics), and Care That Fits (person-centered care). Through an iterative mapping process, clinical values were translated into system-level design principles, informed by the collective expertise of the author group. Results We recommend that the following Universal Design principles relate to Designing for Dignity as follows: 1. Equitable Use = Respected Identity and Unconditional Care; 2. Flexibility in Use = Adaptive Care Paths and Minimum Disruption; 3. Simple & Intuitive = Cognitive Ease and Kind Relationships; 4. Perceptible Information = Empowered Understanding; 5. Tolerance for Error = Forgiving Systems; 6. Low Physical Effort = Energy Conservation; 7. Size & Space = Relational presence Conclusions Designing for Dignity provides a coherent framework for rethinking healthcare systems as relational, inclusive, and adaptable infrastructures. By operationalizing dignity through design science, healthcare can move from requiring patients to fit standardized systems toward systems that fit the full spectrum of humans, supporting both quality of care and human flourishing. Digitalization dignity Universal Design Intensive Caring Care That Fits Background Modern healthcare systems face profound demographic, organizational, and economic change as populations age and increasing numbers of people live longer with chronic illness, frailty, and multimorbidity ( 1 ). Also, importantly healthcare access and care are becoming increasingly digitalized. This presents another modern-day health care related problem, because there appears to be a link between age and frailty and digital incapability ( 2 ). Because numerous digitally incapable people ( 2 ) cannot use digital health care platforms, they must surrender self-governance and privacy to rely on others to help them or give up, i.e., family members, friends or even non relatives. Healthcare has largely relied on standardized, one-size-fits-all approaches that seemingly prioritize efficiency, biomedical optimization, economies of scale and narrowly defined outcomes. While advances in evidence-based medicine and technology are essential, this dominant logic risks reducing patients to biological systems in need of repair, while neglecting aspects of care that many patients value such as equality, dignity, compassion, social connection, and meaning. The precise treatment guidelines that currently dominate healthcare have many strengths. They also narrowly focus on what to do in the encounter of well-defined diseases or medical conditions. Consequently, they have inherent limitations when addressing multimorbidity and general frailty ( 3 – 5 ). A review of 30 years of interventions addressing health disparities shows that the vast majority target patients as the object of change, while only a very small number focuses on transforming healthcare systems ( 6 ). Digitalization should not be a goal per se, but rather a means to an end, and if it does not meet that end, the digital platform in question should be redesigned. Healthcare systems that prioritize medical intervention while ignoring human factors—like dignity, hope, and grief—risk undermining patient and health care professional well-being ( 7 ). This approach often leads to higher costs and poorer outcomes, ultimately failing to align care with patients’ and informal caregivers’ lived values ( 7 ). Examples of a more human centered approach includes findings that participation in singing groups for people with chronic obstructive pulmonary disease (COPD) can result in physical outcomes comparable to those achieved through conventional COPD rehabilitation ( 8 ); that nursing homes actively working to reduce pharmacological treatment and increase care and compassion, resulting in residents receiving on average one regular medication per day, do not observe reduced life expectancy ( 9 ); and that integrating a palliative approach alongside standard oncological treatment can both reduce the use of aggressive chemotherapy in the final phase of life, improve quality of life, and be associated with significantly prolonged survival ( 7 , 8 ) The ability to access healthcare is the fundamental prerequisite for receiving it. Yet, as systems pursue efficiency through 'Digital First' strategies, they inadvertently build new, very significant barriers. In Denmark—one of the world’s most digitally integrated societies—nearly 43% of patients in an emergency department were unable to perform even basic digital tasks ( 2 ). This data suggests a somewhat systemic failure of 'digitalization.' When we design for an idealized, high functioning 'average,' we do not just exclude a minority; we risk failing nearly half the population in their moment of greatest need. This is not merely a technical oversight—it is a threat to the dignity of both the patients and the medical professionals. In Denmark, we are legally required (and rightly so) to provide physical access to our facilities for individuals with mobility impairments ( 10 ). In contrast, within a rapidly evolving digital society, it is often implicitly accepted that older people with visual, cognitive, or other functional impairments are left behind in terms of digital access. These challenges do not affect patients and informal caregivers alone. Healthcare professionals are also impacted when systems constrain their ability to respond to patients as humans. This mismatch between standardized systems and meeting individual patients’ needs contributes to moral distress, emotional harm, and burnout ( 10 – 13 ). In addition, social inequality in healthcare is a well-recognized global problem. This inequality also extends into medical research to such an extent that the 2024 revision of the Helsinki Declaration now explicitly addresses the need to ensure equitable access to research participation, stating that “ Groups that are underrepresented in medical research should be provided appropriate access to participation in research” ( 14 ). Together, these challenges point to an urgent need for a different healthcare design logic. Rather than treating patient diversity as a problem to be minimized, healthcare systems must be designed to embrace variation as “golden standard”. In this paper, we respond to this need by examining two complementary bodies of knowledge: healthcare literature on dignity and related human values, and design science literature on Universal Design. By bringing these perspectives together, we argue for designing healthcare systems that are fit for purpose in respecting and advancing the inherent dignity of all humans ( 15 ). The aim of this paper is to present 'Designing for Dignity,' as an integrative framework for healthcare system development. By synthesizing clinical insights from 'Intensive Caring' ( 16 ) and 'Care That Fits' ( 17 ) with the systemic principles of Universal Design ( 15 ), we provide a robust conceptual foundation to guide future research, policy, and the practical implementation of inclusive, dignified healthcare services. Our goal is to shift the developmental focus from individual patient 'deficits' to the systemic capacities required to honor human diversity. Methods This paper is the result of a cross-disciplinary synthesis involving researchers and practitioners from design science and healthcare. We employed a “concept-bridging” approach: identifying functional synergies between established clinical ethics (palliative and person-centered care) and design engineering (Universal Design). The framework was developed through an iterative process of mapping clinical values to design principles, using the collective scholarly and practical expertise of the author group. This approach allowed us to move beyond disciplinary silos, merging human-centric aspirations of healthcare with the systemic language of design science. To build a framework for Designing for Dignity, we drew on three established yet previously disconnected bodies of knowledge: Intensive Caring ( 16 ), Care That Fits ( 17 ), and Universal Design ( 15 ). Intensive Caring: A Relational Foundation Intensive Caring describes a way of being with patients who experience suffering or hopelessness. It is grounded in the principle that patients matter because they are who they are ( 18 ). With its roots in palliative care, it emphasizes non-abandonment, committed relational presence, acknowledgment of personhood, and therapeutic humility. Rather than seeking to fix what cannot be fixed, Intensive Caring affirms dignity by sustaining connection, compassion, and hope even in situations marked by frailty, uncertainty, and decline. While Intensive Caring defines the ethical "how" of the individual encounter, it requires a delivery model that respects the patient’s actual life circumstances. Care That Fits: A Delivery Model Care That Fits challenges care designed for “patients like this” and instead focuses on designing care for “this patient” ( 17 ). It emphasizes collaborative, person-centered care that accounts for patients lived circumstances and life goals. Care is understood as an ongoing, iterative process that must be responsive to individual situations while remaining minimally disruptive to patients’ and informal caregivers’ lives. In doing so, Care That Fits shifts attention from optimizing the outcome of isolated interventions toward making care workable and meaningful though care plans that expand beyond medical needs. However, for care to truly "fit" a life, the physical, process and digital infrastructure of the healthcare system must be inherently inclusive. This is where principles of human centered design science become essential. Universal Design: A Systemic Architecture Universal Design was originally defined by architect and disability rights advocate Ronald Mace in 1985 as “ the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design ”( 15 ) The concept initially focused on architecture and product design but has since spread to other areas such as digital technologies and work- and learning environments. It was included in the 2006 UN Convention on the Rights of Persons with Disabilities as the preferred design method, and promotion of Universal Design is one of the General Obligations codified in § 4 of the Convention. A central part of the Universal Design framework are the 7 Principles of Universal Design ( 19 ). For a rundown see Table 1 . Table 1 The Seven Principles of Universal Design 27 Principle 1. Equitable Use: The design is useful and marketable to people with diverse abilities. 2. Flexibility in Use: The design accommodates a wide range of individual preferences and abilities. 3. Simple and Intuitive Use: The design is easy to understand, regardless of experience, knowledge, language skills, or current concentration level. 4. Perceptible Information: The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities. 5. Tolerance for Error: The design minimizes hazards and the adverse consequences of accidental or unintended actions. 6. Low Physical Effort: The design can be used efficiently and comfortably and with a minimum of fatigue. 7. Size and Space for Approach and Use: Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility. They provide guidance for evaluating and designing working and living environments, products and services so they can be used by as many people as possible. The principles guide organizations in designing and delivering environments, products, and services that are broadly inclusive and human-centered, accommodating the diversity of abilities found among the population. In addition to the 7 Principles of Universal Design, design research has shown that using specific human abilities to describe users, such as the ability to see, to grip an object, or to focus on a task, significantly enhances our understanding of user needs and serves as an effective approach for implementing a Universal Design process ( 20 ). Abilities refer to the concrete capacities individuals may or may not possess at a given point in time. A loss of an ability can be permanent, temporary, or situational. For example, the ability to see may be permanently limited due to blindness, temporarily limited due to cataracts, or situationally limited when in a dimly lit room or having lost your reading glasses. A solution designed for people with permanent disability will add additional value to people with temporary and situational disabilities, thus overall resulting in significantly improved environments, products and services ( 20 ). For example, curb cuts are not only appreciated by wheelchair users, but also by people using rollator walkers and parents pushing strollers. By explicitly acknowledging variation in abilities, Universal Design shifts attention away from examining which people fit the systems they require and towards examining whether the systems fit the people they serve. Results Developing a new perspective: Designing for Dignity It is the obligation of the healthcare system to provide quality of care and access to citizens – it is not the citizens obligation to fit themselves into idealized categories. By combining Universal Design and human-centric healthcare approaches, a new framework emerges (Table 2 ). Table 2 Universal Design principles and their alignment with Care that Fits and Intensive Caring Universal Design Principle Care That Fits Intensive Caring 1. Equitable Use Care fits the patient’s and informal caregiver life context Affirms equal human worth and non-abandonment 2. Flexibility in Use People’s needs, desires, capacities, capabilities, and personal or medical situations may change. Care plans should therefore be flexible and continuously modified. Sustains care despite decline 3. Simple and Intuitive Use Reduces treatment burden by enabling all individuals to experience empowerment and inclusion. Thereby reducing disruption of patient lives. Intensive Caring offers a way for all health care professionals to be with patients confronting the enormity of human suffering. 4. Perceptible Information Person-sensitive communication, tailoring both the content and the manner of their conversation to their needs, abilities and to the situation Meaningful information ensures patients feel informed, valued and as partners in the care process 5. Tolerance for Error Allows care to continue when plans fail Protects dignity in moments of struggle. Intensive Caring requires therapeutic humility 6. Low Physical Effort Limits burden on patients and informal caregivers and Healthcare professionals Avoids making dependency undignified by Knowing What’s Possible 7.Size and Space for Approach and Use Care fits everyday life. The physical environment and practical aids should minimally disturb the individual and, as far as possible, support relationships under conditions of disruption. Supports participation and presence for patient, informal caregivers and Healthcare professionals Instead of compensating for deficits at the individual level, Universal Design recognizes that people differ—not only permanently, but also temporarily and situationally—and that we must design for that difference, not against it. It shows that people thrive with surroundings, organizational structures, and tools that are designed for all human beings, rather than an industry standard human. We propose that healthcare systems should be intentionally designed to safeguard and enhance dignity by designing for real-life diversity, rather than implicitly expecting a respect for dignity as a by-product of good intentions. This requires reframing universal design principles to explicitly account for human relationship and human interaction as dimensions of care. Thus, ‘Designing for Dignity’ builds on the original seven principles of Universal Design and seeks to integrate the human-to-human interaction into its design philosophy. This creates a need to expand the understanding of these principles beyond their original formulation. Designing for Dignity explicitly includes the perspectives of the person living with illness, the informal caregivers, and healthcare professionals. Within Designing for Dignity, a healthcare system, a clinical encounter, or an object can only provide dignity for one if it provides dignity for all in the interaction (Table 3 ). Table 3 Designing for dignity Universal Design Principle Designing for Dignity: Clinical & Systemic Application 1. Equitable Use Respected Identity and Unconditional Care : Systems provide care without segregation or stigma. Beyond physical access, it ensures support to the "individual life lived", recognizing that dignity is when individuals feel like a person rather than a list of tasks. 2. Flexibility in Use Adaptive Care Paths and Minimum Disruption : Healthcare services accommodate changing priorities, capacities, and decline. It moves beyond "Digital vs. In Real Life" to provide a range of engagement methods that adjust as the patient’s condition – and the patient population – fluctuates. 3. Simple & Intuitive Cognitive Ease and Kind Relationships : Interfaces and pathways are understandable regardless of language barriers, disabilities, physical and mental illness, cognitive impairment, human vulnerability, and frailty. The system assumes the burden of clarity , so the patient or caregiver doesn't have to. 4. Perceptible Information Empowered Understanding : Information is delivered in ways that ensure that individuals feel seen, respected, and included . It bridges the gap between "receiving data" and "achieving meaningful participation." 5. Tolerance for Error Forgiving Systems : Systems anticipate human variability—such as treatment, non-adherence or caregiver burnout. Errors are viewed as systemic stresses rather than individual failures , allowing care to continue without blame or stigma. 6. Low Physical Effort Energy Conservation : The system minimizes the demand for individual strength or endurance . It is the system's obligation to "make the reach" toward the individuals, rather than requiring the individuals conform to the system. 7. Size & Space Relational Presence : Services, physical and digital environments enable kind and comfortable relationships to support presence. The healthcare system provides time and space to connect as humans. It demands that the healthcare systems and health-technologies support being seen, heard, and valued as a dignified person. ‘Designing for Dignity’ offers a coherent framework for integrating human dignity and system-level design strategy. Discussion Future development of healthcare systems must address all elements of human life, rather than isolated biomedical components. ‘Designing for Dignity’ requires attention to the full human ecosystem of care, including patients, informal caregivers and healthcare professionals, whose experiences and capacities are deeply interdependent. At the same time, dignity is shaped by the material and organizational conditions of care: buildings, management and communication structures, clinical pathways, treatment plans, and everyday technologies such as beds, patient call systems, pill dispensers, insulin pens, and digital tools. These elements must be designed as an integrated whole, recognizing that they all shape human dignity. This paper provides a conceptual foundation for future research, where specific assistive technologies, digital tools, and organizational interventions can be systematically developed, implemented, and evaluated through future scientific studies, combining methods from evidence-based medicine and design science, in service of creating an efficient, effective and dignified healthcare system. Conclusions Healthcare systems are increasingly challenged by multimorbidity, frailty, and human diversity that extend beyond what standardized, diagnosis-focused approaches can adequately address. In this paper, we propose Designing for Dignity as a unifying framework that integrates insights from healthcare and design science. By combining principles from Intensive Caring, Care That Fits, and Universal Design, a new framework - ‘Designing for Dignity’ is conceived. ‘Designing for Dignity’ offers a coherent framework for rethinking how healthcare systems, processes, and technologies can be shaped to better support patients, informal caregivers, and healthcare professionals across diverse abilities and life situations. By operationalizing dignity through design science, we can transition from a system that demands patients 'fit' into standardized boxes to one that actively accommodates the full spectrum of human experience. The result is a healthcare system that is not only efficient and effective but fundamentally dignified for patients, informal caregivers, and professionals alike. Abbreviations COPD Chronic obstructive pulmonary disease Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable. All authors consent to authorship Competing interests None Funding There was no external funding of the work Author Contribution KM, TAS, MOJ, IH, CKEBBN and JO conceived, developed and participated in the iterative process. JO coordinated the study throughout. KM wrote the first draft of the manuscript. All authors were involved in reading and amending the manuscript. TAS wrote the final draft. Acknowledgement We thank Jesper Juul Larsen for valuable discussions. Availability of data and materials Data and materials are available in the text References Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365–75. 10.1016/S0140-6736( . 19)31786-6 PubMed PMID: 31609228. Bundsgaard Andersen L, Juul Larsen J, Marsaa K, Rosenmai G, Seemann H, Andersen Schmidt T. Quantitative evaluation of patients’ digital capability evaluated in an emergency department setting: a cross-sectional study. 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Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 May, 2026 Reviewers agreed at journal 11 May, 2026 Reviewers invited by journal 24 Apr, 2026 Editor invited by journal 02 Apr, 2026 Editor assigned by journal 01 Apr, 2026 Submission checks completed at journal 01 Apr, 2026 First submitted to journal 30 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9265257","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634389603,"identity":"8d2a75e9-db1b-417d-9313-068d7025dd33","order_by":0,"name":"Kristoffer Marsaa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYDCCA2xQBnsDkDCwIEULzwGQFglStEgkgEnCOviOt6Vu+LmnTp5/5vOrG34USDDwt3cn4NUieebYsZs9zw4bzridU3azB+gwiTNnN+DVYnAjve0Gz4EDjA23c9Ju8AC1GEjkEtZy88+BOvv5N8+k3fxDnJa0Y7d5DjAnbrjBDmQQowXol7TbMgcOJ288k8N2W8ZAgoegX4AhZnbzzYE623nHjz+7+eaPjRx/ey9+LUiAxwBMEqscBNgfkKJ6FIyCUTAKRhAAAGDJUgyhJO27AAAAAElFTkSuQmCC","orcid":"","institution":"Steno Diabetes Center Copenhagen","correspondingAuthor":true,"prefix":"","firstName":"Kristoffer","middleName":"","lastName":"Marsaa","suffix":""},{"id":634389614,"identity":"96ed37ab-207f-46d7-bcbf-349febea9a55","order_by":1,"name":"Thomas A Schmidt","email":"","orcid":"","institution":"North Zealand Hospital","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"A","lastName":"Schmidt","suffix":""},{"id":634389623,"identity":"e34cd140-2cd2-46ed-aa5d-450c69301870","order_by":2,"name":"Maria O Jellington","email":"","orcid":"","institution":"North Zealand Hospital","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"O","lastName":"Jellington","suffix":""},{"id":634389627,"identity":"5eda743d-94a4-4fbc-8fe6-1542f59dbb68","order_by":3,"name":"Ingrid Haug","email":"","orcid":"","institution":"Technical University of Denmark","correspondingAuthor":false,"prefix":"","firstName":"Ingrid","middleName":"","lastName":"Haug","suffix":""},{"id":634389631,"identity":"bf03d723-44b7-4928-9c68-93105a80e498","order_by":4,"name":"Camilla K. 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Also, importantly healthcare access and care are becoming increasingly digitalized. This presents another modern-day health care related problem, because there appears to be a link between age and frailty and digital incapability (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Because numerous digitally incapable people (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) cannot use digital health care platforms, they must surrender self-governance and privacy to rely on others to help them or give up, i.e., family members, friends or even non relatives.\u003c/p\u003e \u003cp\u003eHealthcare has largely relied on standardized, one-size-fits-all approaches that seemingly prioritize efficiency, biomedical optimization, economies of scale and narrowly defined outcomes. While advances in evidence-based medicine and technology are essential, this dominant logic risks reducing patients to biological systems in need of repair, while neglecting aspects of care that many patients value such as equality, dignity, compassion, social connection, and meaning.\u003c/p\u003e \u003cp\u003eThe precise treatment guidelines that currently dominate healthcare have many strengths. They also narrowly focus on what to do in the encounter of well-defined diseases or medical conditions. Consequently, they have inherent limitations when addressing multimorbidity and general frailty (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). A review of 30 years of interventions addressing health disparities shows that the vast majority target patients as the object of change, while only a very small number focuses on transforming healthcare systems (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDigitalization should not be a goal per se, but rather a means to an end, and if it does not meet that end, the digital platform in question should be redesigned. Healthcare systems that prioritize medical intervention while ignoring human factors\u0026mdash;like dignity, hope, and grief\u0026mdash;risk undermining patient and health care professional well-being (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This approach often leads to higher costs and poorer outcomes, ultimately failing to align care with patients\u0026rsquo; and informal caregivers\u0026rsquo; lived values (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Examples of a more human centered approach includes findings that participation in singing groups for people with chronic obstructive pulmonary disease (COPD) can result in physical outcomes comparable to those achieved through conventional COPD rehabilitation (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e); that nursing homes actively working to reduce pharmacological treatment and increase care and compassion, resulting in residents receiving on average one regular medication per day, do not observe reduced life expectancy (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e); and that integrating a palliative approach alongside standard oncological treatment can both reduce the use of aggressive chemotherapy in the final phase of life, improve quality of life, and be associated with significantly prolonged survival (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe ability to access healthcare is the fundamental prerequisite for receiving it. Yet, as systems pursue efficiency through 'Digital First' strategies, they inadvertently build new, very significant barriers. In Denmark\u0026mdash;one of the world\u0026rsquo;s most digitally integrated societies\u0026mdash;nearly 43% of patients in an emergency department were unable to perform even basic digital tasks (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis data suggests a somewhat systemic failure of 'digitalization.' When we design for an idealized, high functioning 'average,' we do not just exclude a minority; we risk failing nearly half the population in their moment of greatest need. This is not merely a technical oversight\u0026mdash;it is a threat to the dignity of both the patients and the medical professionals.\u003c/p\u003e \u003cp\u003eIn Denmark, we are legally required (and rightly so) to provide physical access to our facilities for individuals with mobility impairments (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In contrast, within a rapidly evolving digital society, it is often implicitly accepted that older people with visual, cognitive, or other functional impairments are left behind in terms of digital access.\u003c/p\u003e \u003cp\u003eThese challenges do not affect patients and informal caregivers alone. Healthcare professionals are also impacted when systems constrain their ability to respond to patients as humans. This mismatch between standardized systems and meeting individual patients\u0026rsquo; needs contributes to moral distress, emotional harm, and burnout (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, social inequality in healthcare is a well-recognized global problem. This inequality also extends into medical research to such an extent that the 2024 revision of the Helsinki Declaration now explicitly addresses the need to ensure equitable access to research participation, stating that \u0026ldquo;\u003cem\u003eGroups that are underrepresented in medical research should be provided appropriate access to participation in research\u0026rdquo;\u003c/em\u003e (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTogether, these challenges point to an urgent need for a different healthcare design logic. Rather than treating patient diversity as a problem to be minimized, healthcare systems must be designed to embrace variation as \u0026ldquo;golden standard\u0026rdquo;.\u003c/p\u003e \u003cp\u003eIn this paper, we respond to this need by examining two complementary bodies of knowledge: healthcare literature on dignity and related human values, and design science literature on Universal Design. By bringing these perspectives together, we argue for designing healthcare systems that are fit for purpose in respecting and advancing the inherent dignity of all humans (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe aim of this paper is to present 'Designing for Dignity,' as an integrative framework for healthcare system development. By synthesizing clinical insights from 'Intensive Caring' (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and 'Care That Fits' (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) with the systemic principles of Universal Design (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), we provide a robust conceptual foundation to guide future research, policy, and the practical implementation of inclusive, dignified healthcare services.\u003c/p\u003e \u003cp\u003eOur goal is to shift the developmental focus from individual patient 'deficits' to the systemic capacities required to honor human diversity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis paper is the result of a cross-disciplinary synthesis involving researchers and practitioners from design science and healthcare. We employed a \u0026ldquo;concept-bridging\u0026rdquo; approach: identifying functional synergies between established clinical ethics (palliative and person-centered care) and design engineering (Universal Design).\u003c/p\u003e \u003cp\u003eThe framework was developed through an iterative process of mapping clinical values to design principles, using the collective scholarly and practical expertise of the author group. This approach allowed us to move beyond disciplinary silos, merging human-centric aspirations of healthcare with the systemic language of design science.\u003c/p\u003e \u003cp\u003eTo build a framework for Designing for Dignity, we drew on three established yet previously disconnected bodies of knowledge: Intensive Caring (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Care That Fits (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and Universal Design (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eIntensive Caring: A Relational Foundation\u003c/h2\u003e \u003cp\u003eIntensive Caring describes a way of being with patients who experience suffering or hopelessness. It is grounded in the principle that patients matter because they are who they are (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). With its roots in palliative care, it emphasizes non-abandonment, committed relational presence, acknowledgment of personhood, and therapeutic humility. Rather than seeking to fix what cannot be fixed, Intensive Caring affirms dignity by sustaining connection, compassion, and hope even in situations marked by frailty, uncertainty, and decline.\u003c/p\u003e \u003cp\u003eWhile Intensive Caring defines the ethical \"how\" of the individual encounter, it requires a delivery model that respects the patient\u0026rsquo;s actual life circumstances.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCare That Fits: A Delivery Model\u003c/h3\u003e\n\u003cp\u003eCare That Fits challenges care designed for \u0026ldquo;patients like this\u0026rdquo; and instead focuses on designing care for \u0026ldquo;this patient\u0026rdquo; (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). It emphasizes collaborative, person-centered care that accounts for patients lived circumstances and life goals. Care is understood as an ongoing, iterative process that must be responsive to individual situations while remaining minimally disruptive to patients\u0026rsquo; and informal caregivers\u0026rsquo; lives. In doing so, Care That Fits shifts attention from optimizing the outcome of isolated interventions toward making care workable and meaningful though care plans that expand beyond medical needs.\u003c/p\u003e \u003cp\u003eHowever, for care to truly \"fit\" a life, the physical, process and digital infrastructure of the healthcare system must be inherently inclusive. This is where principles of human centered design science become essential.\u003c/p\u003e\n\u003ch3\u003eUniversal Design: A Systemic Architecture\u003c/h3\u003e\n\u003cp\u003eUniversal Design was originally defined by architect and disability rights advocate Ronald Mace in 1985 as \u0026ldquo;\u003cem\u003ethe design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design\u003c/em\u003e\u0026rdquo;(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe concept initially focused on architecture and product design but has since spread to other areas such as digital technologies and work- and learning environments. It was included in the 2006 UN Convention on the Rights of Persons with Disabilities as the preferred design method, and promotion of Universal Design is one of the General Obligations codified in \u0026sect;\u0026nbsp;4 of the Convention.\u003c/p\u003e \u003cp\u003eA central part of the Universal Design framework are the 7 Principles of Universal Design (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). For a rundown see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Seven Principles of Universal Design\u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrinciple\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Equitable Use: \u003c/p\u003e \u003cp\u003eThe design is useful and marketable to people with diverse abilities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Flexibility in Use: \u003c/p\u003e \u003cp\u003eThe design accommodates a wide range of individual preferences and abilities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Simple and Intuitive Use: \u003c/p\u003e \u003cp\u003eThe design is easy to understand, regardless of experience, knowledge, language skills, or current concentration level.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Perceptible Information: \u003c/p\u003e \u003cp\u003eThe design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Tolerance for Error:\u003c/p\u003e \u003cp\u003eThe design minimizes hazards and the adverse consequences of accidental or unintended actions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Low Physical Effort:\u003c/p\u003e \u003cp\u003eThe design can be used efficiently and comfortably and with a minimum of fatigue.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Size and Space for Approach and Use:\u003c/p\u003e \u003cp\u003eAppropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThey provide guidance for evaluating and designing working and living environments, products and services so they can be used by as many people as possible. The principles guide organizations in designing and delivering environments, products, and services that are broadly inclusive and human-centered, accommodating the diversity of abilities found among the population.\u003c/p\u003e \u003cp\u003eIn addition to the 7 Principles of Universal Design, design research has shown that using specific human abilities to describe users, such as the ability to see, to grip an object, or to focus on a task, significantly enhances our understanding of user needs and serves as an effective approach for implementing a Universal Design process (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAbilities refer to the concrete capacities individuals may or may not possess at a given point in time. A loss of an ability can be permanent, temporary, or situational. For example, the ability to see may be permanently limited due to blindness, temporarily limited due to cataracts, or situationally limited when in a dimly lit room or having lost your reading glasses. A solution designed for people with permanent disability will add additional value to people with temporary and situational disabilities, thus overall resulting in significantly improved environments, products and services (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). For example, curb cuts are not only appreciated by wheelchair users, but also by people using rollator walkers and parents pushing strollers.\u003c/p\u003e \u003cp\u003eBy explicitly acknowledging variation in abilities, Universal Design shifts attention away from examining which people fit the systems they require and towards examining whether the systems fit the people they serve.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDeveloping a new perspective: Designing for Dignity\u003c/h2\u003e \u003cp\u003eIt is the obligation of the healthcare system to provide quality of care and access to citizens \u0026ndash; it is not the citizens obligation to fit themselves into idealized categories.\u003c/p\u003e \u003cp\u003eBy combining Universal Design and human-centric healthcare approaches, a new framework emerges (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUniversal Design principles and their alignment with Care that Fits and Intensive Caring\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversal Design Principle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCare That Fits\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntensive Caring\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. Equitable Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCare fits the patient\u0026rsquo;s and informal caregiver life context\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAffirms equal human worth and non-abandonment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Flexibility in Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeople\u0026rsquo;s needs, desires, capacities, capabilities, and personal or medical situations may change. Care plans should therefore be flexible and continuously modified.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSustains care despite decline\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Simple and Intuitive Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduces treatment burden by enabling all individuals to experience empowerment and inclusion. Thereby reducing disruption of patient lives.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntensive Caring offers a way for all health care professionals to be with patients confronting the enormity of human suffering.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Perceptible Information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerson-sensitive communication, tailoring both the content and the manner of their conversation to their needs, abilities and to the situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeaningful information ensures patients feel informed, valued and as partners in the care process\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5. Tolerance for Error\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAllows care to continue when plans fail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProtects dignity in moments of struggle. Intensive Caring requires therapeutic humility\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6. Low Physical Effort\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLimits burden on patients and informal caregivers and Healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvoids making dependency undignified by Knowing What\u0026rsquo;s Possible\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7.Size and Space for Approach and Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCare fits everyday life. The physical environment and practical aids should minimally disturb the individual and, as far as possible, support relationships under conditions of disruption.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupports participation and presence for patient, informal caregivers and Healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eInstead of compensating for deficits at the individual level, Universal Design recognizes that people differ\u0026mdash;not only permanently, but also temporarily and situationally\u0026mdash;and that we must design for that difference, not against it. It shows that people thrive with surroundings, organizational structures, and tools that are designed for all human beings, rather than an industry standard human.\u003c/p\u003e \u003cp\u003eWe propose that healthcare systems should be intentionally designed to safeguard and enhance dignity by designing for real-life diversity, rather than implicitly expecting a respect for dignity as a by-product of good intentions. This requires reframing universal design principles to explicitly account for human relationship and human interaction as dimensions of care.\u003c/p\u003e \u003cp\u003eThus, \u0026lsquo;Designing for Dignity\u0026rsquo; builds on the original seven principles of Universal Design and seeks to integrate the human-to-human interaction into its design philosophy.\u003c/p\u003e \u003cp\u003eThis creates a need to expand the understanding of these principles beyond their original formulation. Designing for Dignity explicitly includes the perspectives of the person living with illness, the informal caregivers, and healthcare professionals.\u003c/p\u003e \u003cp\u003eWithin Designing for Dignity, a healthcare system, a clinical encounter, or an object can only provide dignity for one if it provides dignity for all in the interaction (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDesigning for dignity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversal Design Principle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDesigning for Dignity: Clinical \u0026amp; Systemic Application\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. Equitable Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRespected Identity and Unconditional Care\u003c/b\u003e: Systems provide care without segregation or stigma. Beyond physical access, it ensures support to the \"individual life lived\", recognizing that \u003cb\u003edignity is when individuals feel like a person\u003c/b\u003e rather than a list of tasks.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Flexibility in Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAdaptive Care Paths and Minimum Disruption\u003c/b\u003e: Healthcare services accommodate changing priorities, capacities, and decline. It moves beyond \"Digital vs. In Real Life\" to provide a range of \u003cb\u003eengagement methods that adjust\u003c/b\u003e as the patient\u0026rsquo;s condition \u0026ndash; and the patient population \u0026ndash; fluctuates.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Simple \u0026amp; Intuitive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCognitive Ease and Kind Relationships\u003c/b\u003e: Interfaces and pathways are understandable regardless of language barriers, disabilities, physical and mental illness, cognitive impairment, human vulnerability, and frailty. \u003cb\u003eThe system assumes the burden of clarity\u003c/b\u003e, so the patient or caregiver doesn't have to.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Perceptible Information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEmpowered Understanding\u003c/b\u003e: Information is delivered in ways that ensure that \u003cb\u003eindividuals feel seen, respected, and included\u003c/b\u003e. It bridges the gap between \"receiving data\" and \"achieving meaningful participation.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5. Tolerance for Error\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eForgiving Systems\u003c/b\u003e: Systems anticipate human variability\u0026mdash;such as treatment, non-adherence or caregiver burnout. \u003cb\u003eErrors are viewed as systemic stresses rather than individual failures\u003c/b\u003e, allowing care to continue without blame or stigma.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6. Low Physical Effort\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEnergy Conservation\u003c/b\u003e: The system \u003cb\u003eminimizes the demand for individual strength or endurance\u003c/b\u003e. It is the system's obligation to \"make the reach\" toward the individuals, rather than requiring the individuals conform to the system.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7. Size \u0026amp; Space\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRelational Presence\u003c/b\u003e: Services, physical and digital environments \u003cb\u003eenable kind and comfortable relationships\u003c/b\u003e to support presence. The healthcare system provides time and space to connect as humans.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIt demands that the healthcare systems and health-technologies support being seen, heard, and valued as a dignified person. \u0026lsquo;Designing for Dignity\u0026rsquo; offers a coherent framework for integrating human dignity and system-level design strategy.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eFuture development of healthcare systems must address all elements of human life, rather than isolated biomedical components. \u0026lsquo;Designing for Dignity\u0026rsquo; requires attention to the full human ecosystem of care, including patients, informal caregivers and healthcare professionals, whose experiences and capacities are deeply interdependent. At the same time, dignity is shaped by the material and organizational conditions of care: buildings, management and communication structures, clinical pathways, treatment plans, and everyday technologies such as beds, patient call systems, pill dispensers, insulin pens, and digital tools. These elements must be designed as an integrated whole, recognizing that they all shape human dignity.\u003c/p\u003e \u003cp\u003eThis paper provides a conceptual foundation for future research, where specific assistive technologies, digital tools, and organizational interventions can be systematically developed, implemented, and evaluated through future scientific studies, combining methods from evidence-based medicine and design science, in service of creating an efficient, effective and dignified healthcare system.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eHealthcare systems are increasingly challenged by multimorbidity, frailty, and human diversity that extend beyond what standardized, diagnosis-focused approaches can adequately address. In this paper, we propose \u003cem\u003eDesigning for Dignity\u003c/em\u003e as a unifying framework that integrates insights from healthcare and design science. By combining principles from Intensive Caring, Care That Fits, and Universal Design, a new framework - \u0026lsquo;Designing for Dignity\u0026rsquo; is conceived. \u0026lsquo;Designing for Dignity\u0026rsquo; offers a coherent framework for rethinking how healthcare systems, processes, and technologies can be shaped to better support patients, informal caregivers, and healthcare professionals across diverse abilities and life situations.\u003c/p\u003e \u003cp\u003eBy operationalizing dignity through design science, we can transition from a system that demands patients 'fit' into standardized boxes to one that actively accommodates the full spectrum of human experience. The result is a healthcare system that is not only efficient and effective but fundamentally dignified for patients, informal caregivers, and professionals alike.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable. All authors consent to authorship\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThere was no external funding of the work\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKM, TAS, MOJ, IH, CKEBBN and JO conceived, developed and participated in the iterative process. JO coordinated the study throughout. KM wrote the first draft of the manuscript. All authors were involved in reading and amending the manuscript. TAS wrote the final draft.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank Jesper Juul Larsen for valuable discussions.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eData and materials are available in the text\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 19)31786-6 PubMed PMID: 31609228.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBundsgaard Andersen L, Juul Larsen J, Marsaa K, Rosenmai G, Seemann H, Andersen Schmidt T. 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DTU Universal Design Guide [Internet]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://universaldesignguide.com/ability-prompt-cards/\u003c/span\u003e\u003cspan address=\"https://universaldesignguide.com/ability-prompt-cards/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Digitalization, dignity, Universal Design, Intensive Caring, Care That Fits","lastPublishedDoi":"10.21203/rs.3.rs-9265257/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9265257/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eModern healthcare systems increasingly struggle to address multimorbidity, frailty, and human diversity within standardized, diagnosis-driven models. At the same time, digitalization and system-level efficiency strategies risk introducing new barriers, particularly for individuals with reduced functional or digital capabilities. These tensions challenge the ability of healthcare systems to uphold human dignity in practice. This paper introduces \u003cb\u003e\u0026ldquo;Designing for Dignity,\u0026rdquo;\u003c/b\u003e a framework that integrates Universal Design with Intensive Caring and Care That Fits to align healthcare systems with the lived realities of patients, informal caregivers, and healthcare professionals.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a cross-disciplinary concept-bridging synthesis drawing on three established bodies of knowledge: Universal Design (design science), Intensive Caring (clinical ethics), and Care That Fits (person-centered care). Through an iterative mapping process, clinical values were translated into system-level design principles, informed by the collective expertise of the author group.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe recommend that the following Universal Design principles relate to Designing for Dignity as follows: 1. Equitable Use\u0026thinsp;=\u0026thinsp;Respected Identity and Unconditional Care; 2. Flexibility in Use\u0026thinsp;=\u0026thinsp;Adaptive Care Paths and Minimum Disruption; 3. Simple \u0026amp; Intuitive\u0026thinsp;=\u0026thinsp;Cognitive Ease and Kind Relationships; 4. Perceptible Information\u0026thinsp;=\u0026thinsp;Empowered Understanding; 5. Tolerance for Error\u0026thinsp;=\u0026thinsp;Forgiving Systems; 6. Low Physical Effort\u0026thinsp;=\u0026thinsp;Energy Conservation; 7. Size \u0026amp; Space\u0026thinsp;=\u0026thinsp;Relational presence\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDesigning for Dignity provides a coherent framework for rethinking healthcare systems as relational, inclusive, and adaptable infrastructures. By operationalizing dignity through design science, healthcare can move from requiring patients to fit standardized systems toward systems that fit the full spectrum of humans, supporting both quality of care and human flourishing.\u003c/p\u003e","manuscriptTitle":"Designing for Dignity in Healthcare","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-05 12:11:30","doi":"10.21203/rs.3.rs-9265257/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-13T20:25:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224536434059478888094931309534506201883","date":"2026-05-11T13:01:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-24T11:52:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-02T14:47:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T02:36:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T02:35:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-30T09:54:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c4e41248-4f16-4472-86c1-080d8f238f5f","owner":[],"postedDate":"May 5th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-13T20:25:42+00:00","index":74,"fulltext":""},{"type":"reviewerAgreed","content":"224536434059478888094931309534506201883","date":"2026-05-11T13:01:51+00:00","index":73,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T12:11:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-05 12:11:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9265257","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9265257","identity":"rs-9265257","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}