The rapidly aging Dutch baby boom generation threatens to overwhelm the healthcare system in the Netherlands (Hoedeman & Koki, 2020). The elderly, more than any other age group, are more prone to experiencing a steep decline in physical and cognitive health during hospitalization (Brown, 2020; Mathews, Arnold & Epperson, 2014). 61% of the elderly Dutch are unnecessarily admitted to emergency wards (G. de Kousemaeker of Fluent, personal communication, January 16, 2019). Likewise, the elderly, especially those from rural areas, are fueling more than a 50% increase in the number of persons 65+ who require nursing care at a home (CBS, 2019). A complex network of stakeholders interacts in the healthcare value chain to provide interventions for this vulnerable group. Yet, healthcare providers (HCPs) who collaborate together to diagnose, treat or adjust medications for the elderly are under immense pressure (SCP, 2019a). With its technology-enabled services, DiaMediPort aims to solve the shortages of HCPs by sending triage nurses to the homes of the elderly in distress and by virtually connecting them to general practitioners and medical specialists via information logistics. The research section of this project highlights the advantages of ensuring person-centered triage care in the Dutch elderly person’s home during the period of 2020. I conducted secondary and primary research (e.g. ethnographies, contextual maps, qualitative interviews) with an elderly couple in their extramural home, informal caregivers, district nurses and elderly care specialists from intramural facilities, ambulance and mobile night teams and elderly call centers. Five key conclusions are made based on the insights generated on triage moments, information flow, technology and the healthcare value chain. 1) There is an obvious disconnect between the government’s response to the elderly and what the elderly want. The Dutch Minister of Health, Sports and Wellbeing stated the role of each Dutch person is to care for other persons in the community; while the elderly interviewed state that independence is a core value and it must be accounted for during the development of an elderly triage service. 2) Triage moments are a source of needless and redundant suffering for the elderly person who lives in an extramural home. The informal caregiver must communicate with HCPs during these moments so that the decisions made on behalf of the elderly person are dynamic. Although nurses can handle a litany of triage moments, the healthcare system prohibits them from taking action without the supervision of a medical doctor. 3) The mobile night team becomes a part of the traditional medical system. When an informal caregiver or district nurse is unavailable, triage nurses perform unexpected tasks at night. 4) Information flow and open communication reduce the usage of human and financial resources and improve the elderly person’s medical outcomes. 5) The nurses who work at elderly care centers rely on ICT system information. Often the elderly’s digital records and other necessary information are not yet entered or updated. Hence, triage nurses must act in an information vacuum. The appearance and complaints of the person suffering from old age is the only information at their disposal. It is very difficult to read him. Sometimes, he lacks the words to express what is wrong. As a result, nurses cannot make informed medical decisions. DiaMediPort is ideally poised to tackle these issues and concerns. Besides, its services give reassurance to beneficiaries (e.g. elderly person and informal caregiver) and facilitate their independent living at home. The design section offers 2 tools that I created for DiaMediPort. Their 2 objectives were to 1) visually inform how HCPs and beneficiaries interact within the existing healthcare system and 2) convince HCPs and decision-makers (e.g. insurance providers, hospitals, governmental bodies) to adopt DiaMediPort’s services. The tool Stakeholder Perspectives has two components: 1) “DiaMediPort in Film” presents short films of elderly persons in triage situations; these stories are produced with cartoon cutouts and voice-overs. And 2) “DiaMediPort Platform” will be used in a co-creational workshop. It gives an overview of the DiaMediPort beneficiaries and stakeholders, their social context and how DiaMediPort acts as intermediary. The tool Layered System Overview illustrates the triage phases wherein DiaMediPort is capable of providing services.

The purpose of this project has been to examine ways in which to increase adoption of a digital employee-facing tool by involving its users in the implementation. This was achieved by examining innovation, adoption and the existing theories around those, looked at through the lens of the company context and corporate challenges. The current implementation process and user involvement were examined, allowing for a comparison of the literature and reality. Studied innovation and adoption theories include the UTAUT model, growth hacking and ADKAR, amongst others. This research revealed that relevance of an innovation to its target group is one of the most important adoption determinants, as well as its ease of use. A combined model is introduced that shows the application of user-centeredness to increase adoption. Considering the existing implementation process includes an agile feedback loop that is focused on cultivating ease of use, a focus on expanding that user involvement is chosen. Expanding it into the decision-making level on the business side of the application’s development creates opportunities to make the decisions more user-centered, causing a trickle-down effect. The design goal is reformulated as “Increasing adoption by representing user input (aided by growth hacking strategies) in the prioritization process for A2H, to help the airline achieve their goal of making operations more efficient and customer-centric through digitalization.” Focusing on this prioritization process revealed some areas for improvement regarding the current way of working, as well as a need for more evidence to support decisions. Intersecting this opportunity with the user involvement goal of the project led to the development of a framework that allows for the collection of direct user input to provide evidence for decision-making. Additionally, studies and interviews were conducted to establish whether user input in the prioritization session would yield different results than the current way of working, and it was found to have influence on the decisions made. This framework, the ‘User Value Framework’, was established using insights from contextmapping, observations and interviews. It includes an intervention that supports the process of collecting user input to be used in the prioritization session. It is presented as part of a strategy to increase UX maturity in the company and move toward more explorative research and user-driven business. To achieve this, it includes a validation and expansion strategy over the long term to accommodate in-between proof of value of user-centeredness. Additionally, recommendations are made for the different levels of UX maturity beyond the presented intervention, resulting from the observations and research results.

The high workload of nurses could be decreased by solutions that improve the work environment. Solutions that are currently made are not implemented effectively on the units. This report will describe a design project leading to a way in which nurses can be involved in improving their own work environment which will lead to a decreased workload an more job satisfaction. The first part of the report shows that improvement opportunities nurses face do not reach the departments that could solve these opportunities. To involve nurses, in order to decrease their workload and increase their job satisfaction, it is not only important for them to be involved in projects that are started at the technical departments. Participatory design theory shows that by giving users a voice in what could be improved in their work, not only will the solutions fit the context better, having a say in what happens will by itself add to the job satisfaction.
The following chapter elaborates on different personas of nurses, what they currently do with improvement opportunities and what limits them in doing so.
Nurses currently improve the processes on their own units. This can be done by the nurses themselves. If an opportunity can not be improved on by nurses themselves, this opportunity will not be documented or improved upon.
Based on the insights of this research a design goal was formulated:
Design a participatory design process to improve the work environment of nurses, in which all relevant stakeholders are included and actively involved.
The ideation phase describes how the active role of nurses was chosen.
For a nurse to be actively involved, they need time and the ability to take responsibility. Though activating nurses without other relevant stakeholders also having time and responsibility, the workload and job satisfaction will not improve. Therefore the design of “De Ontwerkgroep” was made. “De Ontwerkgroep” is a multidisciplinary team that has the goal of improving the work environment of nurses. This team exists of three roles, the DesigNurse, the Design Engineer and the Design Facilitator. These three roles work together in an improvement process where the DesigNurses gather improvement opportunities from the units. The team shares the improvement opportunities and prioritizes them. The entire team even the DesigNurses are involved in generating solutions. After which the Design Engineers make or buy a prototype to test. This design shows the roll of all the stakeholders that need to be involved for a nurse to be able to be actively part of improving their own work environment. It takes away the beforementioned limitations and creates a clear process in which improvements can be made. It allows nurses to use the critical mindset some of them already have. This design is a communication tool, to show a board of a hospital what is needed in order for nurses to be actively involved in improving their work environment. Which is in line with the vision of continuous improvement and innovation.