This master thesis tackles the questions: How to involve child patients in their clinical tests and their test results in a child-centred way? How to enable and encourage them to participate in the discussions around their care? It focuses on the not yet existing (July 2020) context of the Child Brain Lab, a clinical research project that is being set up at the Sophia Children’s Hospital. Here, child patients will undergo a wide variety of tests related to their brain that will take up several hours of their time. Their test results will then be discussed by the clinician and the child-patient family. Without the right supporting design, the Child Brain Lab (CBL) is subject to many of the issues that child patients generally face: Not being able to comprehend the conversations between parents and doctors, not getting the chance to voice their own needs and opinions and suffering anxiety about if, how and why clinical tests will be conducted. This project started with a broad context analysis. This included reviewing the literature, observing consultations, and interviewing a variety of healthcare professionals and child patients. This analysis revealed many possible reasons why child involvement is often limited. For example, it was found that by default, the child patients themselves typically take a rather passive role in discussing their care. These insights were then translated into design drivers that inspired several iterations of design ideas. Consequently, these ideas were used to learn from by discussing them with all main stakeholders of this project. This sparked a second iteration of design drivers that ultimately lead to the brain puzzle concept. The brain puzzle concept is a collection of avatar-based, personalized puzzle pieces the child patient collects as it goes through the CBL. Each piece comes with a different function and serves a different phase of the CBL experience: The first type of pieces shows the sequence of tests that will be conducted while the second type shows which brain functions those tests investigate. Before the consultation, the child patients also receive an indication of their test results in the form of stickers, which can be placed on the corresponding puzzle piece. With these stickers, both the clinicians and the children can indicate which part they want to discuss. These pieces are then brought to the consultation as a discussion tool and to structure the conversation with more regard for the child’s perspective. To evaluate this concept, a prototype was made and evaluated with child-patients, their parents, and their clinicians in over 17 interviews. The results show that the participants were unanimously positive about the overall design and they would like to see it being implemented. Especially parents and clinicians indicated that the concept would playfully guide the children through the CBL and enable them to discuss what they want to discuss. This thesis concludes by listing areas for improvement of the concept and discusses those in the broader context of informing children about their test results.

When flying with an infant, parents typically choose the option to travel with their infant on their lap. This is the cheapest way for an infant to travel by plane, and is an available option for all destinations with all European airlines. However, this travel method causes discomfort for parents, as they are constantly required to hold their infant and attend to the child s needs in a tight surrounding. The Amsterdam based company, Wick Wings, has come up with an idea that could offer parents a comfortable solution for travelling with their infant by plane: a baby carrier designed specifically for use on a plane*. This concept forms the base of this graduation project for the master Integrated Product Design, with the following objective: ‘Designing, building, and testing a hands-free travel solution in the form of a baby carrier for use on a plane, during medium-haul and long-haul flights with a baby of 0-12 months old, taking into account European regulations only.’* To complete this project, a design approach was used with a strong focus on prototyping to make decisions about the embodiment of the final product. The design process started with a research phase, which included research methods such as market analysis, expert interviews, participatory research, and the studying of many online sources. This research phase was followed by intertwined ideation, conceptualisation and embodiment phases, resulting in a working prototype for a new baby carrier design for travelling by plane with an infant. The research phase showed that there are many different baby carriers available on the market that meet the specific requirements to enable ergonomically sound carrying for both parent and infant. These carriers do contain some attributes that are convenient for travelling by plane, however they also contain attributes that are inconvenient for this use context. Baby carriers are not allowed for use on a plane during all stages of a flight, and must be detached when the fasten seatbelt light is turned on. However, baby carriers are not easy detachable in the tight space available to individual passengers on a plane. Additionally, parents’ desires to alternate parental duties during a flight requires easy attaching and detaching of a baby carrier as well. The product solution that was created for the project is The Wick Carrier. The product introduces a new baby carrier system, that allows for easy attaching and detaching of the infant to the parent, both while standing and sitting. The final prototype of The Wick Carrier was tested with parents and infants to validate the design, and formulate additional design recommendations for further developing the product for introduction on the market. * Slightly adjusted to follow an embargo on the results of this graduation report.

Access to safe and affordable surgery is nothing short of a basic human right and people from all walks of life are entitled to it. But, five people from resource-constrained low and middle-income countries are vulnerable and left to fend for themselves when the need for surgery is a life governing event. Inhabitants of these regions are scourged by high mortality and morbidity due to surgical infection caused by the use of unclean and unsterile surgical instruments. Reduction in infections can be achieved by using clean and sterile surgical instruments. Laparoscopy, is a promising technique of surgery developed to efficiently perform complex abdominal surgeries with the use of small and minimum incisions on the patient. Laparoscopy’s minimally invasive nature allows complex surgeries to take place without the need of an absolutely sterile operating room, although the sterility of the surgical instruments cannot be compromised. The added benefit of faster recovery from smaller wounds makes it even more desirable for this context. The Minimally Invasive Surgery and Interventional Techniques Lab of the TU Delft has initiated projects addressing the health and well-being of resource-constrained, underdeveloped communities like rural India through frugal innovation. Rural Indian hospitals are grossly underfunded, under-maintained, and understaffed. Sterile processing practices in rural India are rudimentary compared to high-income hospitals like the ones in the Netherlands. In high-income hospitals, all used surgical instruments are cleaned and sterilized in dedicated central sterile processing departments (CSSD) by highly trained and well protected sterile processing technicians. However, rural India usually employs small teams of local undertrained and semi-literate nurses to carry out every primary and ancillary duty in the hospital. The lack of dedicated CSSDs exacerbates the nurse’s workload and exposure to harmful pathogenic surgical instruments. Laparoscopic instruments developed in high-income nations are seldom designed keeping low resource contexts in mind. The geometrical complexity of instruments keeps increasing but cleaning methods in rural India have stagnated. Resource constraints are a major reason as to why proper international and national guidelines for reprocessing cannot be followed. Hence hospitals cannot guarantee 100% safe and sterile instruments as compared so standardized outcomes in high-income hospitals. In this graduation project, the distinct reprocessing journey of surgical instruments for the two diverse economic contexts were studied. A comparative analysis of both reprocessing journeys uncovered severe unsafe and unfavorable practices in rural India. Significant data and insights from the research have hence paved the way for focusing on the “Cleaning” stage of the laparoscopic instrument reprocessing journey in rural India. This MSc graduation project aims at designing a frugal solution for cleaning and repurposing laparoscopic instruments, dedicated to hospitals in rural India where the demand for laparoscopy is high but surgeries are less due to resource constraints like lack of laparoscopic instruments and repurposing devices. The involvement of an Indian nurse and laparoscopic surgeon provided first-hand information about the problems and requirements in the rural Indian context. Prototyping and testing of various cleaning setups were conducted to extract the most viable design solution. Insights from the research and testing were combined into the concept design of a frugal mechanical washer and subsequently an “Envisioned Reprocessing Journey” for rural Indian hospitals to suggest a standard protocol for keeping most of their existing infrastructure in mind. Evaluations with the Indian nurse revealed that this device could indeed be a game-changer to the existing practices of reprocessing laparoscopic instruments in rural India.

People who suffer from tremor, experience uncontrollable, involuntary movements. Depending on the underlaying cause, these movements occur during rest, or simultaneous with voluntary movements. STIL is a YES!Delft based, med-tech startup that is developing a non-invasive, anti-tremor orthosis that helps people with tremors in their upper limbs. The current anti-tremor orthosis helps with the reduction of upper limb tremor. However, it limits the mobility of the user’s hand and wrist. Motion in the Wrist Radial and Ulnar Deviation (WRUD) degree of freedom are limited due to the way the orthosis is designed. By redesigning several parts of the orthosis, a new degree of freedom has been added to the device. This increased mobility makes the orthosis more comfortable in daily use, and could even be beneficial to the suppression of upper limb tremor. By integrating a small mechanical damper, the friction in the WRUD degree of freedom can be controlled. A system of interlocking parts, supported by dampers ensure a durable and smooth rotation when the wrist is moved. The fully functional prototype was manufactured and handed over to STIL bv for further testing, along with recommendations to optimize the design .

Understanding how medical-grade Chemical Sterilization and High-Level Disinfection (HLD), and usage of the device in context affect the integrity of the device within its expected lifetime, and to suggest material choice, manufacturing method and recommend design changes for a syringe extension device, to be used for Manual Vacuum Aspiration Procedures in East Africa.

In medical applications such as medical endovascular catheters, adaptable and morphing devices capable of changing shape and properties become important. These devices allow for safer therapeutic and diagnostic procedures by reducing time to reach target vessels and organs, trauma to the vessel wall and physical stress on the body while increasing the accuracy, benefits and positive outcomes. A catheter with these properties will also reduce X-ray exposure during procedures, recovery time and could save lives in the acute setting. In the field of emerging materials, several materials demonstrate variable properties when exposed to a stimulus. This, when combined with the field of minimally invasive surgery, holds significant potential for the development of a catheter with variable shape and properties. This thesis investigates the latest developments in endovascular catheter design through a materials lense. It begins with a thorough examination of material-based advancements in catheters with variable properties, and puts a particular focus on shape memory materials. Using a combination of literature review, field work examination and expert consultations, the design of a catheter with variable properties is comprehensively analyzed and evaluated. Prototyping was done to evaluate the potential of two material systems to achieve variable behaviour in the design of a catheter. The study presents a conceptual shape memory material-based design for a catheter with variable shape and properties and demonstrates this with a visual prototype. Additionally, potential directions for further refinement of this conceptual design are explored. This thesis serves as an initial reference and guiding framework for designers working with emerging materials in the field of medical devices and in particular the development of endovascular catheters with variable properties.

-What- Medicines are used for all types of surgeries in the operating room (OR). They are needed to provide safe and effective care. However, the use of medicines also results in waste. Research conducted by Barbariol et al. (2021) highlighted that a substantial proportion, ranging from 20% to 50%, of medications prepared in the OR ultimately remain unused and are consequently discarded. The Leiden University Medical Centre (LUMC) and ‘Nationaal Netwerk de Groene OK’ aim to minimize the waste of medicines at the OR. -Why - The environmental impact of medicines Research conducted last year by RIVM presented that the contribution of chemical products, including medicines in particular, is responsible for 41.2% of healthcare CO2 Medicine scarcity The ‘Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie’ (KNMP), presened that last year in 2022 the highest number of medicine shortage ever occurred. They predict that these kind of issues will only grow more in the further, so it is important to stay mindful about medication prescription, use and disposal. Ethical obligation Medication waste raises ethical concerns within the healthcare context. The waste of medications contradicts the principles of equity and justice, as resources that could have been allocated to patients in need are wasted. -How?- DrugWise Consequently, a final concept called ‘DrugWise’ was devised. This sustainable approach targets medicine waste prevention in the OR through a holistic approach. DrugWise consists of five critical steps: 1. Measure the waste to gain an understanding of the current situation. 2. Prioritize areas for action based on the measurements. 3. Raise awareness amongst OR staff regarding the extent and implications of medicine waste. 4. Initiate action in four key areas: medicine use, prescribing practices, stock management, and disposal. 5. Evaluate the effectiveness of the interventions implemented. The target audience of the approach is the Anaesthesia Green Team. The DrugWise approach was developed in collaboration with the primary stakeholders involved in medication use - anesthesiologists and anaesthetic nurses. This collaboration ensured that the solution was rooted in their practical experience and professional knowledge. -Future steps- Looking ahead, LUMC will serve as the pilot hospital for the DrugWise approach. Upon successful implementation and review, the intention is to broaden the reach to other hospitals, advocating for a nationwide effort in reducing medicine wastage in the OR.

Rural India faces many challenges in providing adequate health care for all. Health awareness among the Indian population is low due to poor functional literacy and low emphasis on education within the health sector. Minimally Invasive Surgery (MIS), such as laparoscopy, offers many advantages, including smaller incisions, less tissue damage and faster recovery for patients compared to traditional open surgery. The use of laparoscopy in low- and middle-income countries (LMICs) is particularly influential because it can minimise the morbidity associated with laparotomies and provide benefits such as fewer postoperative infections and faster return to work. The laparoscopic instruments must be carefully cleaned and sterilised after each use to prevent infection. In any surgery, there is a risk of infection. Postoperative wound infections (POWIs) occur after surgery on the part of the body being operated on. Globally, the rate of POWIs varies between 0.5 and 15 per cent, while in India, rates between 23 and 38 per cent are consistently measured (Arora et al., 2018). These complications lead to revision surgery, delayed wound healing, increased use of antibiotics and longer hospital stay, all of which have a significant impact on patients and healthcare costs. Antimicrobial resistance (AMR) is one of the greatest threats to human health we face worldwide. (World Health Organisation, 2012a, 2012b). This project focuses on making minimally invasive surgery such as laparoscopy safely applicable in low- and middle-income countries through a medical washer. It aims to find a research-based solution to improve the reprocessing of laparoscopic instruments to reduce POWIs and the need for antibiotics. The current method of reprocessing in hospitals in rural India does not result in sterile laparoscopic instruments and is harmful to patient, nurse and all other staff present in the OR. Instruments are also damaged during the cleaning process. These problems mainly stem from lack of training of nurses, time pressure and due to lack of cleaning equipment. The project approach was implemented using the Double Diamond Design Model. In the final phase, a prototype was built and this prototype was evaluated in the context of rural India. The aim of this study was to investigate the medical washer loading system for laparoscopic instruments in rural hospitals and to understand how the loading system is used by nurses without any prior explanation. We also investigated how the concept of the medical washing machine is perceived by the end user. The medical washer for laparoscopic instruments for the context of rural India has been developed can improve current reprocessing practices. By automating the cleaning process, the medical washer reduces the risk of human error and ensures that instruments are thoroughly cleaned. The inclusion of a loading system that can be used without extensive training ensures that the system can be used safely and correctly by all healthcare workers. With the combination of these systems in an integrated design, the medical washer can additionally provide value by reducing cleaning time and allowing nurses to take rest breaks or do other tasks.

This project was performed for the Dutch department of Johnson & Johnson Medical Bv. In order to complete their energy portfolio, Johnson & Johnson acquired Megadyne, a producer of electrosurgical devices. These devices are a new addition to the Johnson & Johnson portfolio, however already available on the Dutch market. The challenge was to come up with a marketing strategy to position Megadyne in the Johnson & Johnson portfolio and implement the Megadyne devices on the Dutch market. To fulfill this challenge, both Johnson & Johnson and Megadyne were analyzed, as well as the market and competitors. The insights of this analysis led to the creation of a marketing strategy. The strategy defines the objectives for Megadyne in 2023. It then elaborates on the targeting of hospitals, providing a list of potential hospitals. This is followed by plans for Megadyne promotion split into promotion for both user and buyer. Finally, the strategy offers pricing solutions and portfolio recommendations that in combination with the targeting and promotion solutions contribute to achieving the objectives.

This graduation report describes the design of a new suitable menstruation product for Beppy that collects blood, is reusable, has a similar (deployable) size and function as a tampon, and which is perceived as less intimidating to insert and extract than a menstrual cup. The new design, the Beppy Clover, is made from silicone and has Nitinol, which is a shape memory alloy (SMA), wire embedded. Before insertion, the Clover has a diameter similar to a single use tampon by folding it in three sections. There is no constant external force needed to keep the Clover folded. Once the product is inserted and gets into contact with the body heat and blood in the vagina, the SMA wire (Af = 35°C) reacts and will return to its programmed shape. This results in the three sections with the SMA loops embedded deploying and adapting to the vagina canal. The product will stay in place, collect blood and after 8 hours or less, depending on the flow, can it be retracted by the loop or the attachable silicone extraction cord. The cleaning process works the same as a menstrual cup, rinsing between uses and sterilising at the beginning or end of the period. To come to this final concept, an analysis, development and evaluation were performed. In the analysis, relevant information about the menstrual cycle, the dimensions of the vagina and current insertable (period) products is gathered. Furthermore, interviews with ten people were conducted to get insights into the user experience regarding their period and period products. At last, the materials and production methods of the Beppy cup are inspected, and new possible materials are looked at to integrate into the product, like shape memory alloy. This information is brought together in a list of requirements. In the development, three main challenges are tackled: how to integrate deployment (1), insertion (2), and extraction (3) in the design, which would satisfy the requirements and, in particular, make it look less intimidating than a cup. Prototypes were made with silicones out of 3D printed moulds to test shapes, and the proof of concept of the composite of SMA wire with silicones was tested. A concept is made from the combinations of ideas and evaluated by three people focussing on perception and first impression of the Beppy Clover. With the feedback a final design is created. The end result of the project is a promising final concept that could be the first step in the right direction regarding development of reusable blood collecting tampons. Utilising emerging materials was interesting to research its possibilities in period products. More tests and research on the combination of silicones and SMA wire reacting to body temperature will be necessary to optimise the force of the deployment of the product. Nevertheless, the Beppy Clover achieved its goal of being a blood collecting, reusable product that is perceived as less intimidating than the cup and has a similar (deployable) size and function as a tampon.

This graduation project consists of the journey of developing a context-specific training system for nurses to administer a paracervical block (PCB) using the medical Chloe Syringe Extension Device (SED). This six-month during project is being carried out on behalf of TU Delft and Chloe Company. The aim of the project is to enable nurses in sub-Saharan Africa (SSA) in low-resource settings (LRS) to competently use the Chloe device for pain management during Manual Vacuum Aspiration (MVA). The outcome of this project is a two-component training system: a job aid and a demonstration device designed to enhance the training experience and guidance for use. The project approach was implemented using a context-driven design approach, consisting of Research & Analysis, Ideation, Conceptualisation and Evaluation. Literature research on the topic and its context is carried out, while further knowledge is gathered through contacts with sixteen Dutch and Kenyan medical professionals. In addition to individual interviews, two studies are conducted in the Dutch and Kenyan contexts. A six-week field trip to Kisumu, Kenya, during which ten medical professionals in three hospitals were visited, made it possible to ensure that the design truly fits its context. These medical professionals provided valuable input to the iterative design process and helped to shape the final concept design of the training system. Further designing is enabled through prototyping, the use of decision-making methods and continuous iteration. This allowed new ideas to be generated, tested, and therefore new improvements to be made. Ultimately, new requirements could be identified, providing the opportunity to create even more valuable designs. Future research should focus on further developing these designs, giving them an embodiment, and creating the possibility of actually implementing the training system in its intended context.

This project explores the integration of a microfluidic system within the MedRing device, aimed at enhancing women’s health monitoring by non-invasively tracking fertility-related biomarkers. The primary goal is to leverage MedRing’s capabilities to provide real-time, accurate health insights, thereby contributing to the advancement of personalised healthcare technologies. The advent of wearable technologies has opened new avenues for personal health monitoring. This project focuses on the MedRing, a device designed for continuous health data collection, specifically targeting women’s reproductive health. By incorporating a microfluidic system, the project aims to extend the device’s functionality to include precise fertility monitoring, addressing the growing demand for non-invasive health management solutions. The development process involved performing desktop research, interviews with experts, and analysing the current market. Then it moves on to designing and simulating the microfluidic system using computational fluid dynamics. Simulations were conducted to evaluate fluid flow, ensuring the system’s compatibility with the compact form factor of the MedRing. A microfluidic system that can be assembled into the MedRing was designed. CFD simulations confirmed that the system achieves the objectives set in terms of laminar flow and fluid path, crucial for the system's correct operation. Design adjustments were made to optimise fluid path efficiency and ensure comprehensive sampling within the system’s reading chamber. The simulations demonstrated the system’s potential to accurately monitor, store, transport, and gather molecular samples within the constraints of the MedRing’s design. While the project successfully demonstrated the theoretical feasibility of integrating a microfluidic system into the MedRing, the transition from simulation to real-world application necessitates further development. Future work should focus on prototyping and extensive testing to validate the system’s functionality in practical settings. Collaboration with biomedical experts will be essential to refine the system’s design, ensuring it meets both technical specifications and user needs. This project lays the groundwork for future innovations in wearable health technologies, emphasising the importance of integrating advanced diagnostic capabilities into everyday devices.

Cancer is the second leading cause of death globally. Researchers are continuously investigating new ways to develop and improve cancer treatments. Currently, remarkable progress has been made in immunotherapy. This treatment uses monoclonal antibodies to enhance or recover the patient’s immune system to destroy the cancer cells. However, these new treatments are expensive and not tailored to the patient’s need. As a solution, Prof. Schellekens, from the Pharmaceutical department at the university in Utrecht, and his colleagues, proposed to add the antibody manufacturing to the magistral preparation procedures in a pharmacy. This allows the pharmacist to produce medicine for only one individual patient which does not have to comply with the regulations commercially produced medicine have to. This would result in a less expensive medicine which can be adapted to the patient’s specific needs. To realize this idea, pharmacists need to be able to manufacture those antibodies. Therefore, the concept arose for creating a manufacturing unit to enable pharmacists to produce personalized medicine for patient use. This concept is called: the Bio-Nespresso. Through user, context and technology analysis, the vision arose for designing a machine that enables a hospital pharmacist’s assistant to manufacture 30 grams of monoclonal antibodies in a sterile and reliable way, without requiring any specific knowledge about antibody manufacturing. To realize this, a new party was introduced: The Supplier. This party delivers all antibody production-specific elements to the hospital pharmacy, enabling the pharmacist and pharmacist’s assistant to only focus on patient care and executing the production process. This project resulted in a first design of the Bio-Nespresso. The machine provides the ability to produce different doses of medicines, up to an entire treatment. All production-specific elements are integrated into four disposable units, which together form a closed system to prevent contamination. The machine will guide and monitor the users actions when installing these disposables. The design demonstrates what the stationing of the Bio-Nespresso at a hospital pharmacy should look like. This resulted in concrete challenges which can serve as a starting point for the development of the proof of concept.

Asthma is one of the most common chronic diseases worldwide, and it is expected that the prevalence of asthma will only increase in the coming years (Masoli et al., 2004). Medical self-management by asthma patients will be of essential importance to keep the burden of disease as low as possible. Medical self-management is critical in obtaining asthma control. Research suggests that the majority of patients can obtain asthma control, yet most adults are still living with uncontrolled asthma. Both extensive literature research and qualitative research with asthma patients and healthcare providers were executed to uncover what the barriers are that asthma patients face in medical asthma self-management. The research uncovered three main problems that form barriers to efficient self-management.: beliefs, low motivation, and inability. Each of these problems has its underlying causes. Beliefs are caused by (1) paternalistic care, (2) lack of stimulation, (3) shortcomings in knowledge sources. Low motivation is the result of (1) paternalistic care, (2) lack of awareness, (3) discouragement due to inadequate tools. At last, inability is caused by (1) lack of knowledge, (2) lack of skills (3) lack of insight. Several opportunity areas to enhance the self-management of asthma patients were discovered: (a) patient education, (b) self-tailoring, and (c) increasing competence. Patient education can be enhanced by creating awareness and providing a better knowledge source through (1) personalization, (2) spreading knowledge. Enabling the patient to self-tailor can induce more active participation of the patient. Increasing the asthma patient’s competence can be done by (1) increasing self-knowledge (2) enabling action. To overcome the barriers to self-management a design was proposed: vea. Vea consists of an app and a physical product. The app enables the user to set goals and supports the user to achieve these goals. Through working on the goals, the app learns about the user and gets personalized. The physical device supports the app by measuring the air quality in the home of the user and gives feedback on this. Key user benefits of the design are: Personalization Vea is designed to match the patients’ needs. Through personalizing its approach and content, the app becomes relevant to the user. Being in control The user is in charge of the goals they want to achieve. The app assists them by making the once invisible complaints and effects of self-management explicit. Increased capability Vea provides structured tools that increase the capability of the user to self-manage their asthma. Through seamlessly collecting data and providing relevant feedback and tips, the user is motivated and capable of acting. User evaluation demonstrated that the proposed design is undoubtedly promising. Both asthma patients and general practitioners indicated that the design could lead to increased insight, motivation, and enhanced competence of medical self-management. The main limitation of this master thesis is, however, determining the long-term effect of the design. Although the design has shown to be promising, unfortunately, no statement can be made of the long-term effect of vea on the actual improvement of medical self-management. To be able to do so, the design should be further developed and tested in the long term.

This graduation project is on behalf of TU Delft and Zimmer Biomet in collaboration with Orthopedic surgeons from Bergman Clinics, Orthopedic Clinic, in Naarden. The aim of this master thesis was to design a product which could reduce the pollution of harmful noise during hip replacement surgery. Noisy workplaces and especially within this procedure carry a large risk of noise-induced hearing loss, as sound levels of more than 120 decibels are generated by the usage of (powered) instruments. In the analysis phase observations in the operating theatre and interviews with experts are conducted to get insights and background information about the total hip arthroplasty procedures. It was found that noise levels experienced during surgery generated levels above the human pain threshold, ranging between 120-130 decibels and caused temporary and long-term noise induced hearing loss. Via a design vision and a list of requirements multiple concepts where generated. In the embodiment and evaluation phase, cadaver and saw bone testing showed that the new instrument design functioned and implant parts and/or tools could be implanted successfully. The outcome of this project is a new surgical instrument, which can press-fit (impact) and extract various implant components used during surgery. The instrument has multiple unique selling points compared to the currently used mallet as it reduces the noise level with more than 15 decibels and scores better on aspects of safety when looking into the risks at musculoskeletal disorders by improving surgical ergonomics. The instrument could be improved further when looking at the design and the current surgical workflow. Further research and clinical testing is necessary to see if this product is suitable for hip replacement surgery.

Featback is an online self-help program for people with eating problems. Someone has an eating disorder (ED) when their whole life revolves around food and body image (Saha et al., 2022). Featback is developed by GGZ Rivierduinen Eetstoornissen Ursula. It has proven to be effective in reducing ED symptoms (Aardoom et al., 2016a; Rohrbach et al., 2022). For eight weeks, users have to answer four questions per week. Based on these questions, they receive one of 1250 handwritten personal messages. Even though Featback is effective, not many people use it. Project goal: Make Featback appeal to more adolescents who are struggling with a developing eating problem or eating disorder. The target group is adolescents, as most people develop their eating disorder as a teen. It takes years before people seek help (de la Rie et al., 2008). However, the sooner someone gets help, the better the chance of recovery (Zipfel & et al., 2015). So, more adolescents must find Featback at the beginning of their eating problems. Research questions are created to achieve the project goal. These are answered by using contextmapping and literature research. People do not recognise an ED because of stigmas, denial and poor mental health literacy. Many believe only thin, young, white girls have EDs (Romano & Lipson, 2019). People with an ED do not recognise themselves in this image. Not even when they are extremely underweight. Additionally, people of all sizes, genders and ages can suffer from an ED. Because it is found that people do not recognise an ED and thus are not looking for (online)help, the design must improve mental health literacy. The design goal is: Create a website that helps adolescents who are developing an eating disorder improve their mental health literacy regarding eating disorders, to increase self-awareness, so that they will seek help sooner. The redesign In phase 1: Mental health literacy, users are educated on eating problems. They get presented with stories of situations related to eating problems. They are asked to judge these stories; his creates distance between the user and the story and creates an interactive experience. In Phase 2: Recognition, users can do a self-test to create recognition for their eating problems. The self-test results guide them to Phase 3: Help. In phase 3, users can make use of the online help. They can directly start with week one of the eightweek program without creating an account. In this way, users can experience the interaction without committing, lowering the threshold to use Featback. The redesign is evaluated with ED patients and experts. Conclusion The redesign helps young people understand eating problem symptoms better and stimulates them to seek help. People with an ED feel seen by the website and can reflect on their own behaviour using the stories. The redesign must use other platforms like TikTok, Instagram, and Proud2Bme to attract people to the website. Finding help is hard for people with EDs; they need encouragement to do so. They often do not believe they deserve help. A safe space like fEATback can lower this threshold.

The Intensive Care Unit (ICU) of the Leids Universitair Medisch Centrum (LUMC) focuses on vitally threatened patients, who cannot survive without daily intensive treatment. As the patients in this department could easily deteriorate and (potentially) pass away, the staff members of LUMC’s ICU often need to act rapidly and make decisions within a short period of time, while they experience severe (time) pressure. This pressure causes stress and increases the chance of human errors by the staff members, which eventually could lead to adverse events (incidents that caused irreversible damage to patients). In order to minimise the human errors made by the staff members and thereby, the amount of adverse events, the ICU physicians and nurses of the LUMC currently need to participate with two training exercises, called Advanced Life Support+ (ALS+) and Crew Resource Management (CRM). Despite the fact that they are encouraged to reflect on- and expand their non-technical skill set, the (ALS+/CRM) trainers still notice that the non-technical skills of the staff members differ with their expectations. Initially, they believed that the difference in desired behaviour (by the trainers) and shown behaviour (by the staff members) is caused by the current set-up of the ALS+ and CRM training. However, it was found that this difference is mainly caused by two other factors. First, although they need to participate with the ALS+ and CRM training, the staff members still have little awareness about their behavioural impact on acute procedures, meaning that they do not precisely know how they can stimulate effective teamwork. Second, the staff members are barely triggered to reflect on their behaviour or to apply their learnings/action points (in practice) once they participated with the ALS+ and CRM training. As a result, (sustainable) behavioural change is not established and the staff members continue to show their old behavioural patterns. Based on these two factors, I developed the iCare-initiative. The iCare-initiative consists of four product solutions: an application, renewed (digital) patient boards, pocket cards and debriefing-flyers. In the short term, the staff members can reflect more structuredly on their behaviour with the use of the debriefing-flyers. Next, they are reminded of their action points and other important behaviours (during acute procedures) via the pocket cards. In the long term, once the staff members feel more comfortable to think about- and reflect on their behaviour (in teams), the application and renewed patient boards will be launched. The application offers a platform to the staff members to individually develop/train their non-technical skill set and reflect more consciously on their behavioural impact. Furthermore, the patient boards aim to create continuous awareness amongst the staff members to reflect on their behaviour, but also to encourage them to share useful insights via a convenient (accessible) platform. Although the iCare-initiative consists of four separate product solutions, they all work together in one integrated system. This system mainly aims to prepare the staff members for acute procedures, to expose which non-technical skills they should improve, and to allow the staff members to individually develop their non-technical skills. Eventually, these new opportunities will accelerate the transition towards desired behaviour in LUMC’s ICU.

The healthcare system in the Netherlands has trouble finding solutions for its complexity and fragmentation. Until now challenges like shortages, long lead times and lack of communication between stakeholders led to less satisfied customers. Welzorg wants to be able to provide more sufficient service. The customer is often overlooked. So the main question is: What are the needs of the customer and how can we improve satisfaction? WZ wants to tackle these problems. The target group analysed in this project are young families with children with a disability who request a manual wheelchair. Research findings in the user analysis show a distinction between functional and emotional needs. WZ can meet the functional needs but emotional needs are especially important for this target group and are understated. WZ wants to be a leader in mobility and knows that this is only possible if they start thinking from the customer’s perspective. Hence the question of how to meet these emotional needs. The exploration of the Customer Journey Maps and interviews with stakeholders (such as advisors and occupational therapists) led to the insight that the most important emotional needs are clarity, being listened to and having a say in the matter. To get WZ aboard and more willing to change a vision and three horizons are created and integrated into a roadmap: Horizon 1, a short-term concept: The Praatplaat, a tool to better inform and engage with the care givers via consultation at the occupational therapist or revalidation center. This makes it easier for the young families to keep track, be engaged and have an overview of the process. For WZ it is an opportunity to strengthen relationships with stakeholders and use attributes they already possess: experience and expertise about the medical devices. Horizon 2, a process optimization, in which information exchange between stakeholders (the advisor and the occupational therapist) is proposed for smoother cooperation and sharing of knowledge after conversations with customers. This results in the customer having a sense of recognition and not having to repeat itself every appointment. Horizon 3, a long-term concept: setting up test-pilots with customers and new suppliers, to improve the product portfolio together and builing new relationships. The result is having the customer feel more understood and involved and for WZ to have validation of the added value to the portfolio. In conclusion, the new proposals in the roadmap substantiate possibilities for WZ to innovate and to play into the emotional needs of the customer. This is essential as the goal is to become a leader in the field of mobility and be a step closer to its customer focused vision by offering relevant products.