This PhD research by practice aims to explore the ways in which design can contribute to improving communication between parents and doctors and facilitate active parental involvement in neonatal care in China. The exploration is built on a cybernetic, performative, forward-looking journey based on human-centred design and co-design practice at Peking University Third Hospital Neonatal Department. My approach to the research question is based on a “research through design” approach.

In China's public hospitals, most neonatal treatment does not involve parents. In my research, I analyse closed-treatment mode of neonatal care, which occurs when parents cannot access the neonatal unit to accompany their infant. For instance, in my cooperating hospital, Peking University Third Hospital, the only way parents can participate in their baby’s treatment is by talking with doctors, which is normal practice in China. From the perspective of traditional healthcare culture, neonatal development history and the science-dominated modern medical environment, the Chinese neonatal context differs significantly from that of economically advanced countries.

With the development in Chinese neonatal medicine over the last forty years, diagnosis and treatment levels have improved, which has reduced the premature baby mortality rate and improved health outcomes. However, the level of participation by parents in their newborns’ care has not significantly changed overall. Despite the fact that some neonatologists in China have started addressing this problem and learning from the latest participatory model, Family Integrated Care (FICare), there is still a gap in the knowledge of how the Chinese context can be transformed from its current status to a participatory model. My PhD research differs from prior studies in that it explores an alternative model and focuses on current communication practices and the needs of doctors and parents in the Chinese context.

Current medical communication research solutions have focused mainly on improving specific communication scenarios and on offering training in verbal skills for the medical profession to enhance the parental engagement experience. Despite these advances, studies concentrating on parent-doctor communication have failed to consider communication as an adaptive process – that is, a process based on a theoretical framework of second-order cybernetics that connects communication with cognitive change to enable parents to be actively involved in their infant’s care, which will ultimately benefit their infant in the long run. This process should be constructive rather than transmissive.

My research has followed a recursive pattern consistent with second-order cybernetics and is carried out through practice and reflection. My fieldwork at Peking University Third Hospital over the last three years brought design into a scientific field that has not experienced design research intervention to date; it has guided the design of a new communication paradigm, which can empower the participants (doctors and parents) by using a designerly approach to understand their roles in the neonatal care and long-term healthcare of premature infants. The research has significant implications for design, medicine, and cross-professional collaboration.