Creating a service system architecture for people living with multiple long-term conditions.

Purpose: To identify barriers and improvement opportunities for the effective management of care for people with multiple long-term conditions (MLTCs) and propose a service system architecture to ensure an integrated approach to achieving improved outcomes. Methods: A systems engineering process was used to derive stakeholder needs from multimorbidity case studies. An abductive analysis provided principles for system design. Hackathons using LEGO® SeriousPlay® helped co-create a service system architecture with patients and service providers. Results: Stakeholder needs captured through three metaphors (spaghetti, barriers, elephants in rooms) reflected concerns with current solutions; six principles for designing MLTC care services addressing service user and provider needs, mental health considerations, costs and system integration; and a service system architecture blueprint for MLTC care pathways. Conclusions: The novel system architecture increases equality and equity and provides a framework for holistic MLTC care spanning multiple clinical specialties and disciplines.