feat(instructions): add healthcare industry context template (#686)

# Pull Request

## Description

Add on-demand healthcare industry context instruction file
(`dt-industry-healthcare.instructions.md`) with healthcare-specific
vocabulary, constraints, empathy tools, and a reference scenario for DT
coaching teams working in healthcare settings.

Follows the same 6-section pattern established by the manufacturing
template (#587):
- **Industry Profile** — Sector, stakeholders, decision cadence,
regulatory environment, missing voices
- **Vocabulary Mapping** — 13-row bidirectional table (DT ↔ healthcare
terms including PDSA cycle, care pathway, clinical pilot)
- **Constraints** — Patient safety, HIPAA/privacy, clinical workflow
interruption, hierarchy dynamics, evidence-based culture, emotional
weight
- **Empathy Tools** — Patient journey mapping, clinician shadow, handoff
observation, wait time audit
- **Reference Scenario** — ED wait times with information flow
bottleneck discovery, triage-to-treatment communication redesign

## Related Issue(s)

Closes #589

## Type of Change

**AI Artifacts:**

- [x] Copilot instructions (`.github/instructions/*.instructions.md`)

## Sample Prompts (for AI Artifact Contributions)

**User Request:**
"Our team is working with a hospital system — load healthcare context."

**Execution Flow:**
1. DT coach detects healthcare industry context from conversation
2. Loads `dt-industry-healthcare.instructions.md` on demand (`applyTo:
''`)
3. Coach uses healthcare vocabulary (PDSA cycles, care pathways,
clinical pilots) instead of generic DT terms
4. Constraints (HIPAA, patient safety) inform coaching guidance
throughout all methods

**Output Artifacts:**
Healthcare-adapted coaching responses with domain-specific vocabulary,
constraint awareness, and empathy tool recommendations appropriate for
clinical environments.

**Success Indicators:**
- Coach uses healthcare vocabulary naturally in responses
- HIPAA and patient safety constraints are surfaced during relevant
methods
- Empathy tools are clinically appropriate (e.g., clinician shadow,
handoff observation)

## Testing

- `npm run plugin:generate` — 11 plugins generated, 0 errors
- `npm run lint:md` — 0 errors
- `npm run lint:frontmatter` — 0 errors, 0 warnings
- `npm run lint:collections-metadata` — 11 collections validated, 0
errors

## Checklist

### Required Checks

- [x] Documentation is updated (if applicable)
- [x] Files follow existing naming conventions
- [x] Changes are backwards compatible (if applicable)

### Required Automated Checks

- [x] Markdown linting: `npm run lint:md`
- [x] Frontmatter validation: `npm run lint:frontmatter`

## Security Considerations

- [x] This PR does not contain any sensitive or NDA information
- [x] Any new dependencies have been reviewed for security issues

---------

Co-authored-by: Bill Berry <wbery@microsoft.com>

Author: chaosdinosaur

.github/instructions/design-thinking/dt-industry-healthcare.instructions.md

@@ -0,0 +1,92 @@
+---
+description: 'Healthcare industry context for DT coaching — vocabulary, constraints, empathy tools, and reference scenarios'
+applyTo: ''
+---
+
+# Healthcare Industry Context
+
+Load this file when the team identifies healthcare as their industry context. It provides healthcare-specific vocabulary, constraints, empathy tools, and a reference scenario that the coach weaves into method-specific guidance.
+
+## Industry Profile
+
+* **Sector**: Healthcare (hospitals, clinics, health systems, digital health)
+* **Key stakeholders**: Physicians, nurses, physician assistants, patients, family members, administrators, IT/informatics, pharmacy, lab technicians, social workers, billing/coding specialists, regulatory/compliance officers
+* **Decision cadence**: Clinical (real-time patient care), operational (daily staffing, weekly scheduling), strategic (annual budget, multi-year system implementations)
+* **Regulatory environment**: HIPAA, CMS conditions of participation, Joint Commission, state licensing boards, FDA (for devices), IRB (for research)
+* **Missing voices to seek out**: Night-shift nurses, patients with limited health literacy, non-English speakers, caregivers, outpatient/community health workers
+
+## Vocabulary Mapping
+
+Bridge DT language and healthcare language bidirectionally. Use healthcare terms when coaching healthcare teams.
+
+| DT Concept                | Healthcare Term                                        |
+|---------------------------|--------------------------------------------------------|
+| Stakeholder map           | Care team mapping, interdisciplinary team roster       |
+| Pain point                | Patient safety event, workflow friction, care gap      |
+| User journey              | Patient journey, care pathway, clinical workflow       |
+| Observation / field study | Patient shadowing, clinician ride-along                |
+| Prototype                 | Clinical pilot, simulation exercise                    |
+| Iteration                 | PDSA cycle (Plan-Do-Study-Act), QI iteration           |
+| Empathy                   | Patient perspective, therapeutic rapport               |
+| Success metric            | Length of stay, readmission rate, patient satisfaction |
+| Workflow mapping          | Care process mapping, value stream analysis            |
+| Risk assumption           | Root cause analysis, FMEA, sentinel event review       |
+| Constraint-driven design  | Clinical protocol, standing order set                  |
+| Alert system concept      | Rapid response team activation, code alert             |
+| Integration timing        | Care transition window, discharge readiness            |
+
+## Constraints and Considerations
+
+### Patient Safety
+
+Patient safety is the overriding constraint. Any design activity touching clinical workflows requires safety review. Solutions must never increase risk of adverse events, medication errors, or missed diagnoses. Changes involving patient-facing systems require clinical governance approval before deployment.
+
+### HIPAA and Privacy
+
+Research activities involving patient data require de-identification or IRB oversight. Empathy work must not access protected health information (PHI) without proper authorization. Prototypes handling clinical data need privacy review even in pilot form. Screen displays in shared spaces must account for incidental disclosure risk.
+
+### Clinical Workflow Interruption
+
+Clinicians operate under constant time pressure with high cognitive load. DT activities must minimize disruption to patient care. Schedule interviews and observation during natural pauses — shift changes, administrative blocks, or scheduled downtime. Never interrupt active patient care for research purposes.
+
+### Hierarchy Dynamics
+
+Medicine has a strong hierarchical culture. Attending physicians, residents, nurses, and support staff experience the same system differently. Stakeholder engagement must account for power dynamics — nurses and support staff may not voice concerns in the presence of attendings. Use separate sessions when hierarchy may suppress candid input.
+
+### Evidence-Based Culture
+
+Healthcare professionals expect evidence. DT insights must be framed in evidence-compatible language — pilot results, measurable outcomes, comparison data. Anecdotal observations carry less weight than in other industries. Connect DT findings to quality improvement frameworks the team already uses.
+
+### Emotional Weight
+
+Healthcare problems often involve patient suffering, loss, and moral distress. Empathy work requires emotional sensitivity and professional boundaries. Debrief after intense observation sessions. Respect that clinicians carry cumulative emotional burden.
+
+## Empathy Tools
+
+### Patient Journey Mapping
+
+Follow a patient's experience through a complete care episode: scheduling, arrival, registration, clinical encounter, discharge, follow-up. Map every handoff, wait, and information exchange from the patient's perspective. Reveals system design gaps invisible from the clinician side.
+
+### Clinician Shadow
+
+Observe a clinician through a shift or half-shift. Track decision density, interruption frequency, documentation burden, and informal workarounds. Use progressive questioning: start with "walk me through a typical shift" before targeting specific workflow steps. Respect sterile environments and PPE requirements.
+
+### Handoff Observation
+
+Watch clinical handoffs at shift changes, unit transfers, and discharge. These transitions are where information loss, safety risks, and workaround patterns concentrate. Compare what the sending team documents versus what the receiving team actually uses.
+
+### Wait Time Audit
+
+Map all waiting that patients experience across a care episode. Reveals the system from the patient's perspective — where time is spent, where anxiety builds, and where information gaps create uncertainty. Often surfaces problems that clinicians cannot see from inside the workflow.
+
+## Reference Scenario
+
+**Context**: An emergency department experiences long patient wait times and clinician burnout; patient satisfaction scores are declining quarter over quarter.
+
+**Discovery (Methods 1-3)**: Scope conversations reveal the initial request is "build a patient tracking dashboard." Patient journey mapping and clinician shadows across shifts uncover the real problem: information flow bottlenecks between triage, registration, and clinical assessment. Nurses repeat intake questions that registration already captured. Physicians lack triage severity context until they physically reach the patient.
+Wait times are driven by information asymmetry, not insufficient capacity.
+
+**Solution (Methods 4-6)**: Brainstorming generates solution themes: streamlined triage-to-treatment communication, shared intake data visibility, proactive patient status updates, and role-based information displays. Lo-fi prototypes — paper-based status boards and revised handoff checklists — reveal that nurses need different information than physicians, and that family members want progress visibility without clinical detail.
+HIPAA constraints surface during prototype testing when screen placement in shared areas risks incidental PHI disclosure.
+
+**Implementation (Methods 7-9)**: Hi-fi prototypes validate role-based views integrated with the EMR, tested through clinical simulation before live deployment. User testing across shifts reveals that night-shift workflows differ significantly from day-shift assumptions. ED throughput improves measurably during pilot, and nurse-reported handoff confidence increases. Iteration focuses on discharge communication gaps identified through patient follow-up calls.

collections/design-thinking.collection.md

@@ -14,6 +14,7 @@ This collection includes agents, prompts, and instructions for:
 - **DT Method 02: Design Research** — Interview techniques, research planning, environmental observation, and insight extraction patterns for systematic discovery of end-user needs through direct engagement across three phases: planning, execution, and documentation
 - **DT Method 03: Input Synthesis** — Pattern recognition, theme development, synthesis validation, and Problem-to-Solution Space transition readiness for transforming fragmented research data into unified problem understanding
 - **DT Method 03 Deep** — Advanced affinity analysis with multi-pass clustering, insight frameworks with observation-inference-insight formula, HMW question scaffolding, problem statement articulation, and manufacturing synthesis patterns
+- **DT Industry: Healthcare** — Healthcare-specific vocabulary mapping, constraints (HIPAA, patient safety, clinical workflow), empathy tools (patient journey mapping, clinician shadow), and an ED wait-time reference scenario for on-demand industry context loading
 - **DT→RPI Handoff Contract** — Exit-point definitions, artifact schemas, per-agent input contracts, graduation awareness behavior, and quality markers for lateral transitions from Design Thinking coaching into the RPI workflow
 - **DT Method 07: High-Fidelity Prototypes** — Technical translation, functional prototypes, and specifications for Implementation Space entry with three-hat architecture and progressive fidelity modeling
 - **DT Method 07: Deep Expertise** — On-demand fidelity translation, architecture trade-off analysis, specification writing patterns, and manufacturing-specific prototyping guidance for complex Method 7 coaching scenarios

collections/design-thinking.collection.yml

@@ -32,6 +32,8 @@ items:
     kind: instruction
   - path: .github/instructions/design-thinking/dt-coaching-state.instructions.md
     kind: instruction
+  - path: .github/instructions/design-thinking/dt-industry-healthcare.instructions.md
+    kind: instruction
   - path: .github/instructions/design-thinking/dt-rpi-handoff-contract.instructions.md
     kind: instruction
   - path: .github/instructions/design-thinking/dt-method-01-deep.instructions.md

collections/hve-core-all.collection.yml

@@ -166,6 +166,8 @@ items:
   kind: instruction
 - path: .github/instructions/design-thinking/dt-coaching-state.instructions.md
   kind: instruction
+- path: .github/instructions/design-thinking/dt-industry-healthcare.instructions.md
+  kind: instruction
 - path: .github/instructions/design-thinking/dt-industry-manufacturing.instructions.md
   kind: instruction
 - path: .github/instructions/design-thinking/dt-method-01-deep.instructions.md
@@ -230,5 +232,5 @@ items:
 - path: .github/skills/shared/pr-reference
   kind: skill
 display:
-  featured: true
   ordering: alpha
+  featured: true

plugins/design-thinking/README.md

@@ -33,6 +33,7 @@ copilot plugin install design-thinking@hve-core
 | dt-method-sequencing         | Method transition rules, nine-method sequence, space boundaries, and non-linear iteration support for Design Thinking coaching                                                                                                             |
 | dt-quality-constraints       | Quality constraints, fidelity rules, and output standards for Design Thinking coaching across all nine methods                                                                                                                             |
 | dt-coaching-state            | Coaching state schema for Design Thinking session persistence, method progress tracking, and session recovery                                                                                                                              |
+| dt-industry-healthcare       | Healthcare industry context for DT coaching — vocabulary, constraints, empathy tools, and reference scenarios                                                                                                                              |
 | dt-rpi-handoff-contract      | DT-to-RPI handoff contract defining exit points, artifact schemas, and per-agent input requirements for lateral transitions from Design Thinking to RPI workflow                                                                           |
 | dt-method-01-deep            | Deep expertise for Method 1: Scope Conversations, covering advanced stakeholder analysis, power dynamics, and scope negotiation                                                                                                            |
 | dt-method-01-scope           | Method 1 Scope Conversations coaching knowledge for Design Thinking: frozen vs fluid assessment, stakeholder discovery, constraint patterns, and conversation navigation                                                                   |

plugins/design-thinking/instructions/dt-industry-healthcare.md

@@ -0,0 +1 @@
+../../../.github/instructions/design-thinking/dt-industry-healthcare.instructions.md

plugins/hve-core-all/README.md

@@ -100,6 +100,7 @@ copilot plugin install hve-core-all@hve-core
 | uv-projects                  | Create and manage Python virtual environments using uv commands                                                                                                                                                                                             |
 | dt-coaching-identity         | Required instructions when working with or doing any Design Thinking (DT); Contains instructions for the Design Thinking coach identity, philosophy, and user interaction and communication requirements for consistent coaching behavior.                  |
 | dt-coaching-state            | Coaching state schema for Design Thinking session persistence, method progress tracking, and session recovery                                                                                                                                               |
+| dt-industry-healthcare       | Healthcare industry context for DT coaching — vocabulary, constraints, empathy tools, and reference scenarios                                                                                                                                               |
 | dt-industry-manufacturing    | Manufacturing industry context for DT coaching — vocabulary, constraints, empathy tools, and reference scenarios                                                                                                                                            |
 | dt-method-01-deep            | Deep expertise for Method 1: Scope Conversations, covering advanced stakeholder analysis, power dynamics, and scope negotiation                                                                                                                             |
 | dt-method-01-scope           | Method 1 Scope Conversations coaching knowledge for Design Thinking: frozen vs fluid assessment, stakeholder discovery, constraint patterns, and conversation navigation                                                                                    |

plugins/hve-core-all/instructions/dt-industry-healthcare.md

@@ -0,0 +1 @@
+../../../.github/instructions/design-thinking/dt-industry-healthcare.instructions.md