Systemic Design for Pediatric Palliative Care: Service Strategies for Butterfly Home in China

Pediatric palliative care in China is still in its early stages. As awareness grows and demand increases, welfare institutions face the pressure to improve both emotional care and service coordination. This study focuses on how systemic design can support this transition by offering better tools, stronger networks, and more sustainable service models. This research explores how systemic design can improve pediatric palliative care within Chinese welfare institutions by addressing emotional, operational, and institutional challenges. Through a mixed-method approach—including field research, stakeholder interviews, case study analysis, and co-design workshops—the study identifies 29 opportunity points and narrows them down to 10 strategic interventions. These are embedded into a multi-layered system map that integrates emotional flow, trust networks, and task structures. The interventions are grouped into 4 strategic directions: Emotional Support, Efficiency and Resilience, Communication and Fundraising, and Network Collaboration. Each strategy targets specific painpoints, from caregiver burn-out to low public awareness. A case matrix and international benchmarking further inform localization strategies, ensuring cultural relevance and scalability. Outcome analysis is conducted across three systemic levels: micro (individual), meso (organizational), and macro (societal) and categorized into 6 impact types: stress reduction, efficiency optimization, emotional wellbeing, cultural resonance, funding support, and system readiness. These classifications allow for a nuanced understanding of how design-led initiatives can generate both immediate and long-term change. From a full analysis of system needs and stakeholder roles, I propose a practical roadmap, which prioritizes early wins (e.g., stress relief for staff), mid-term trials (e.g., intelligent task platforms), and long-term goals (e.g., multi-stakeholder governance). It also anticipates systemic transitions such as the platformization of services and the use of data for policy advocacy. This thesis contributes to systemic design by demonstrating its capacity to not only improve service touchpoints but also influence institutional structures and governance. While grounded in a single site in Changsha, the strategies offer scalable insights for wider application. Ultimately, the study highlights the transformative potential of design in building compassionate, efficient, and resilient care ecosystems for the most vulnerable children.