LimitationsSeveral limitations in this review should be acknowledged. Inconsistent search terminology and indexing may have resulted in excluding eligible studies. Additional strategies were used to locate studies, including reference list review and hand searching. The lack of experimental and quasi-experimental designs, the prevalence of descriptive and qualitative studies with low levels of interpretation, and infrequent use of theoretical frameworks account for the limited additions to the knowledge base.The complexity inherent in synthesizing findings in integrative reviews may contribute to a systematic bias and error at any stage of the review. In this review, facilitators of and barriers to design thinking were initially elicited from each study and synthesized to recognize the most influential factors of the design thinking process.Understanding moderators and mediatorsAlthough the evidence in this review is based on a small sample, the findings suggest that more research is needed to investigate the moderators and mediators of design thinking. This review provides an evidence base for developing interventions to enhance facilitators of and reduce barriers to design thinking in healthcare environments.