The Paths We Choose: What Footpath Shortcuts Can Teach Us About Healthcare's Future

Walk through any park, and you'll see them: diagonal lines carved through worn-down lawns, cutting across carefully planned footpaths. Urban designers call these "desire paths," the routes people actually take, rather than the ones they're supposed to take. These informal paths, worn into existence by countless footsteps, reveal a fundamental truth about human behaviour: given the choice between institutional design and natural inclination, we'll often forge our own way.

As healthcare systems worldwide continue to move toward home-based and digital care delivery, desire paths have offered practitioners of urban planning great insights into how they execute their design work. This raises the question: what role do "desire paths" have in health service design, and what insights and intuitive pathways should healthcare designers and strategists like myself take into our practice whilst trying to reimagine this complex health ecosystem?

Just as urban planners might install official pathways only to watch people create their own shortcuts, the healthcare industry, including designers, is learning that consumers' preferred journeys through the system don't always align with carefully architected care protocols or product offerings.

The Paths People Actually Take

Consider the rising popularity of hospital-in-the-home programs across Australia. Healthcare organisations, driven by a multitude of reasons—including operating pressures, workforce shortages and improved remote monitoring technology—see these programs as efficient and attractive substitutes to traditional hospitalisation in some clinical use cases. The "official pathway" is clear: consumers receive "hospital-level" care in their homes, reducing acute bed usage and costs whilst also improving consumer comfort, familiarity and recovery outcomes.

But like those urban planners, healthcare providers and payers are discovering that consumers and carers do not always fit these specified, predetermined pathways, which often means by default they fall back into "traditional legacy pathways" of inpatient acute care, unable to create their own desire paths through these potential service and product offerings.

For example, an elderly consumer in regional Victoria might prefer brief hospital visits over home-based care, valuing both the social interaction and sense of being "properly" treated, also feeling that their life partner should not be burdened with acting as a "substitute" nurse or orderly for those few days, and that they will feel safer in hospital even though clinically they are appropriate for the hospital-in-the-home pathway. Conversely, a young professional in metropolitan Sydney might embrace remote monitoring but resist scheduled video check-ins, preferring asynchronous communication that fits their workday.

The Tension Between Design and Desire

This disconnect between institutional design and user preference isn't just about convenience—it's about power, autonomy, and the fundamental human need to shape our own experiences. When Danish urban planner Jan Gehl advocates for observing where people naturally walk before laying down pavements, he's really arguing for something broader: systems should be built around human behaviour, not in spite of it.

Healthcare design and transformation presents a similar challenge and opportunity. While providers and payers see clear benefits in home-based and virtual care platforms—including reduced costs, broader access, and streamlined operations—consumers do not always fit the rigid models or defined pathways currently offered.

Consumers of the Australian health system, if offered choice, would likely choose their own hybrid journeys—their own "desire paths"—mixing digital and physical touchpoints in ways that weren't part of the original institutional design. A consumer might use in-person care for their initial consultation or short-stay hospitalisation, then step down to hospital or rehabilitation in the home or telehealth models for follow-up, or vice versa.

Finding Common Ground

The genius of modern urban design isn't in eliminating desire paths but in learning from them in real-time. Some cities now wait to see where people walk before paving areas. Similarly, forward-thinking healthcare organisations not only build user voice into the strategy and design process, they embed rich user insights from research phase through to the design of their entire health system, including backend processes, but also continue to hold this consumer voice through iterative processes, embracing these "desire paths" rather than depending on top-down design processes that can lead to poor uptake of products and services or misalignment between strategy and execution of operations.

So how do we start considering this opportunity within our organisations and design processes?

Here are some steps towards embedding "desire paths" in practice:

• Flexible care models that allow consumers to switch between virtual and physical care settings (where clinically appropriate)

• Digital platforms that adapt to user behaviour rather than forcing rigid protocols

• Iterative processes – being bold in design and operational approaches, moving with consumers when they vote with their feet through their usage and journey

• Payment systems that accommodate non-linear consumer journeys, working within Medicare and private health insurance frameworks

• Following rich data insights – leaning into both qualitative insights from diverse Australian communities, not just quantitative figures

• Care coordination that respects both clinical best practices and consumer preferences, particularly considering the unique needs and opportunities to support rural, remote, and underrepresented communities

The Path Forward

The lesson from desire paths isn't that all formal structures should be abandoned—far from it, pathways exist for good reasons, like clinical excellence, safety, and operational efficiency. Instead, it's about finding the sweet spot between organisational necessity, human nature, and consumer conversion.

For healthcare organisations navigating both the move towards home-based care and digital health integration, this means creating frameworks that are stable enough to ensure quality care and governance but flexible enough to accommodate the natural variations in how people seek and preference to receive treatment. It means understanding that the most elegant solution on paper might not be the most effective or preferred in practice.

As we continue to reshape healthcare delivery in Australia, perhaps the most valuable insight from desire paths is this: the best systems aren't those that force compliance or linear choices, but those that evolve to reflect how people actually use them. In the end, the path to better healthcare might not be the one we originally designed or conceptualised, but the one our consumers help us discover.

By observing and learning from these healthcare desire paths—these organic patterns of consumer behaviour—we might just find ourselves creating a system that works better for everyone, not just in theory, but in practice. This is particularly crucial as we work to close the gap in health outcomes across our diverse Australian communities and ensure equitable access to quality healthcare for all.

If you're interested in exploring how centring desire paths in your service or product design can enhance innovation in your healthcare organisation, or in integrating or strengthening these principles in your own practices, please reach out via info@dialecticalconsulting.com.au or contact me via LinkedIn.