Background: Existing videolaryngoscopes do not meet the needs, budgets, and cleaning protocols of low- and middle-income countries. To solve these problems, a new videolaryngoscope, the Goodscope, has been developed which is less expensive, reusable and easy to clean. The aim of this study was to evaluate the efficacy of the Goodscope compared with a commonly used videolaryngoscope, the GlideScope, when used by experienced anaesthetists and residents in anaesthesia in both a normal and difficult airway scenario. Methods: Participants randomly intubated the manikin four times using both the Goodscope and the GlideScope twice in a normal and a difficult airway scenario. The primary endpoint was time to successful intubation. Secondary endpoints were time to glottic view, time to ventilation, number of intubation attempts, successful intubation rate, and ease of intubation. Results: A total of 73 participants were included in this study. The primary endpoint, time to successful intubation, showed no statistically significant difference between the Goodscope and GlideScope in both the normal (median Goodscope 10.3 s, inter-quartile range (IQR) 8.5, 12.2 vs GlideScope 10.1 s, IQR 8.4, 13.6, P = 0.614), and difficult scenario (median Goodscope 18.5 s, IQR 14.3, 25.3 vs GlideScope 18.4 s, IQR 13.7, 24.2, P = 0.238). Similarly, no significant differences between the two videolaryngoscopes were identified for all secondary endpoints in both scenarios. Conclusion: The findings of this study suggest that the Goodscope is non-inferior to the GlideScope since no significant differences between the Goodscope and the GlideScope were identified for all primary and secondary endpoints. Therefore, this study contributes to proving the concept of an affordable reusable videolaryngoscope without compromising on quality.

Sustainability is becoming more important in numerous industries, including healthcare. Action to achieve sustainability is undertaken by various means, such as the Green Deal Healthcare. Several tools exist that can assess the environmental impact of a certain industry or company, but no tools exist that aid in actively lowering this environmental impact. Therefore, the HSMEA (Healthcare Sustainability Mode and Effect Analysis) tool was developed. This method is based on the Lean philosophy and HFMEA (Healthcare Failure Mode and Effect Analysis) tool and consists of six steps that aid in making a healthcare process more sustainable, in terms of waste production, energy use, or water use. With this tool, processes that contribute to these factors are identified in a highly structured and systematic way, and practical solutions are created and executed for these situations by a multidisciplinary team. This tool was validated in the academic hospital in Leiden, the Netherlands (Leids Universitair Medisch Centrum). Next, it was applied to two clinical case studies, assessing two processes that are currently present in the operating rooms of the LUMC. The HSMEA tool showed that with the implementation of four solutions, great improvements can be achieved in terms of waste and CO2-equivalents production and recycling rate. These four interventions are currently being implemented in the LUMC. This novel sustainability tool has therefore proved its usefulness and clinical applicability in a healthcare setting. By implementing this tool throughout the hospital, it will support the hospital reaching its sustainability goals.

Introduction: Smart Medics Company is a startup from the Delft University of Technology, looking to bring an affordable Video laryngoscope (VL) into hospitals in low-resource regions. This research aims to seek the best suitable transparent material to act as a lens, sealing off a compartment containing an endoscope, as well as, bring forth a design optimisation that will create a waterproof environment for the incorporated electronics and prepare the device for disinfection according to the used disinfection procedures in low-resource regions. Method: Two approaches have been used to investigate the opportunities. The first approach was by using quantitative research, where glass and polymethylmethacrylate (pmma) were subjected to the disinfection chemicals used in hospitals in low-resource regions. These chemicals included, CIDEX® OPA, Isopropanol and JIK (3.5% active chlorine). This was done in three different experiments, the first experiment was conducted to find the short-term effects of the used chemicals. The second experiment was conducted to see the effect of rinsing with water in between the cycles, and the third experiment revealed the long-term effects of the used chemicals on glass and pmma. Furthermore, prices per material were compared to find the material with the best price-durability ratio. The second approach was by means of qualitative research. To generate optimisations for the current design of the VL, three methods were used. The first method, a state-of-the-art research combined with a literature search to find solutions that could aid in the process of designing. The second method was the usage of a morphological overview, to generate concepts according to the necessary requirements. Thirdly a Harris profile was created to score the concepts conforming to the context in which the VL will be placed in. Additionally the option to creating a wireless design along with the best method to incorporate the lens into the design were investigated. Results: Regarding the chemical resistance of both glass and pmma, they both showed to be resistant to the used chemicals. Although pmma showed a form of solvent crazing in the first two experiments, it did not show this in the third experiment, therefore, it is thought that the samples of the first two experiments were contaminated causing this phenomenon. Regarding the price-durability ratio, pmma scores the best as, for the price of one glass lens, 590 pmma lenses could be fabricated. The qualitative research generated three feasible designs, all three with unique features, in terms of connectivity, power and the disinfection process. The state-of-the-art technology inquiry presented multiple innovative patents that aided during the conceptualisation. The scoring according to the Harris profile revealed the applicability to the desired context. One of the concepts included a wireless design which was evaluated to see how feasible a wireless design would be in this context. This showed that although it was feasible, it would also entail more costs for certification and multiple trade offs are to be made in terms of component selection and thermal management. Lastly, placement of the lens could be during the production phase, as well as, in the post-production phase. The first phase has three options in which the lens could be placed, which bring about multiple disadvantages, such as, higher costs due to more man hours, in addition to, higher costs for the need of multiple mould. The later phase includes the use of a method called ultrasonic welding. This type of fabrication would create a seamless joint between the lens and the VL, which would not only seal the electronics compartment, but it would also ensure that the lens can not come undone, preventing serious harm to the airway during intubation. Conclusion: In terms of material properties, both glass and pmma are suitable to act as a lens for the VL according to the context it is placed in. However, as glass lenses cost 590 times more than the pmma lenses, this would be the best choice to incorporate into the VL. From the three generated concept designs, the second design was the most desirable as it would not only generate a waterproof design, but it also has the ability to keep its modularity, for both future development as well as optional maintenance in the case that a part breaks down. Although the wireless design is feasible, it is advised to postpone this design. Regarding the insertion of the lens, the preferred choice would be to place it in combination with ultrasonic welding, to create a seamless and waterproof seal for the electronics compartment.

The steep rise of advanced technology in healthcare and the required spe- cialisation of staff causes healthcare systems to have become increasingly complex. This increased complexity poses great challenges on the risk management of systems. Many different methods have been developed the past decennia to identify potential risks in these system to enhance safety. A commonly used prospective risk analysis method is HFMEA, which is based on the linear view on system safety. Another relatively new method is FRAM which meets the dynamic systemic view on safety and focusses more on potential risks in a system due to "everyday performance". An example of a complex healthcare system is proton therapy; a novel type of radiotherapy to treat tumours in the proximity of the central nervous system. The first operational clinic in the Netherlands providing this therapy is HollandPTC. During the therapy the tumours are irradiated with a high precision in multiple sessions. When anatomical variation is observed between these sessions, the treatment plan of a patient has to be adjusted. This critical process is called plan-adaptation and has to be both time-efficient and safe. To ensure the safety of the plan-adaptation process at HollandPTC, currently controls are designed based on potential risks identified with HFMEA. The aim of this thesis is to identify an effective strategy to identify which controls are able to monitor and mitigate risks associated with the process of plan adaptation at HollandPTC. Independently of the HFMEA, a FRAM was conducted on the plan-adaptation process at HollandPTC. The resulting set of potential risks were compared with the po- tential risks identified with HFMEA. Furthermore, the effectiveness of the controls proposed by HFMEA were assessed on the set of potential risks identified with FRAM. Based on these results a strategy is proposed to monitor and mitigate the potential risks. The analysis of the FRAM models revealed among others potential risks related to: informal communication lines between caregivers, discrepancies between caregivers ideas about task division and identified multiple causes for time delays. These risks were not identified with HFMEA. The controls proposed by HFMEA do not mitigate the potential risks identified with FRAM. By combining the strengths of both HFMEA and FRAM, an effective strategy is proposed to monitor risk and to identify effective controls. This strategy can be used as a prospective risk-analysis method and on ongoing processes.