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V. Pannunzio
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1
Cervical cancer is a cancer that is largely preventable, which is already addressed through screening programmes and diagnostic pathways. However, current programmes and pathways have their limitations. The current test is subjective, labour intensive, and contributes to unnecessary referrals and overtreatment, which creates an extra burden on patients and the healthcare system. These limitations create a need for an improved test which addresses these limitations. A solution is the methylation test, however, implementing a new test in the healthcare system is not simple.
This graduation project explored how the methylation tests could be positioned and implemented in the cervical cancer prevention and diagnostics market. This is explored in collaboration with Self-screen, that develops the methylation tests. Methylation tests are a promising alternative since they are objective, support better risk stratification, can reduce unnecessary referrals and treatments and are effective on self-samples.
Although the scientific evidence for methylation is strong, its adoption is still slow. The key challenge was how and where to position methylation in an already well-established healthcare system. Existing routines, limited awareness among gynaecologists, clinical guidelines, reimbursement and laboratory capacity all affect adoption.
This project followed a Double Diamond design approach and combined a literature review, stakeholder analysis, competitor analysis and interviews with different stakeholders. The findings from this research show that methylation tests are especially valuable in situations where the current test leaves uncertainty in the diagnostics of cervical cancer. Specifically in the situations where treatment should be avoided, such as younger women with a child wish and pregnant women. In addition, the research showed that the strategy should focus on increasing awareness, building trust and communicating the clinical added value of methylation tests to gynaecologists.
Based on these insights, a strategic and tactical roadmap for the gradual implementation of methylation tests is developed. Instead of implementation in the national screening programme, the proposed strategy focuses on implementation in cervical cancer diagnostics. This can be implemented more easily in the short-term and can help to create value earlier and build acceptance for later implementation in the screening programme. The designed roadmap is structured in three horizons. The first horizon focuses on creating awareness and identifying gynaecologist spokespersons. The second horizon focuses on sharing information with other gynaecologists through webinars and articles. The third horizon focuses on evaluating the use of methylation tests, improving the process and scaling the adoption by sharing results with more gynaecologists.
This strategy contributes to the implementation of methylation tests in the screening programme for cervical cancer, by first positioning methylation as a tool to support clinical decision-making in the diagnostics for cervical cancer. This strategy is effective since it supports clinical needs and decision-making processes, it fits within existing diagnostic workflows and enables the use of the test in practice. By first introducing the methylation tests in diagnostics, awareness and trust among gynaecologists can be built. This way, a strong foundation can be created for the long-term integration into the Dutch cervical cancer screening programme.
...
This graduation project explored how the methylation tests could be positioned and implemented in the cervical cancer prevention and diagnostics market. This is explored in collaboration with Self-screen, that develops the methylation tests. Methylation tests are a promising alternative since they are objective, support better risk stratification, can reduce unnecessary referrals and treatments and are effective on self-samples.
Although the scientific evidence for methylation is strong, its adoption is still slow. The key challenge was how and where to position methylation in an already well-established healthcare system. Existing routines, limited awareness among gynaecologists, clinical guidelines, reimbursement and laboratory capacity all affect adoption.
This project followed a Double Diamond design approach and combined a literature review, stakeholder analysis, competitor analysis and interviews with different stakeholders. The findings from this research show that methylation tests are especially valuable in situations where the current test leaves uncertainty in the diagnostics of cervical cancer. Specifically in the situations where treatment should be avoided, such as younger women with a child wish and pregnant women. In addition, the research showed that the strategy should focus on increasing awareness, building trust and communicating the clinical added value of methylation tests to gynaecologists.
Based on these insights, a strategic and tactical roadmap for the gradual implementation of methylation tests is developed. Instead of implementation in the national screening programme, the proposed strategy focuses on implementation in cervical cancer diagnostics. This can be implemented more easily in the short-term and can help to create value earlier and build acceptance for later implementation in the screening programme. The designed roadmap is structured in three horizons. The first horizon focuses on creating awareness and identifying gynaecologist spokespersons. The second horizon focuses on sharing information with other gynaecologists through webinars and articles. The third horizon focuses on evaluating the use of methylation tests, improving the process and scaling the adoption by sharing results with more gynaecologists.
This strategy contributes to the implementation of methylation tests in the screening programme for cervical cancer, by first positioning methylation as a tool to support clinical decision-making in the diagnostics for cervical cancer. This strategy is effective since it supports clinical needs and decision-making processes, it fits within existing diagnostic workflows and enables the use of the test in practice. By first introducing the methylation tests in diagnostics, awareness and trust among gynaecologists can be built. This way, a strong foundation can be created for the long-term integration into the Dutch cervical cancer screening programme.
...
Cervical cancer is a cancer that is largely preventable, which is already addressed through screening programmes and diagnostic pathways. However, current programmes and pathways have their limitations. The current test is subjective, labour intensive, and contributes to unnecessary referrals and overtreatment, which creates an extra burden on patients and the healthcare system. These limitations create a need for an improved test which addresses these limitations. A solution is the methylation test, however, implementing a new test in the healthcare system is not simple.
This graduation project explored how the methylation tests could be positioned and implemented in the cervical cancer prevention and diagnostics market. This is explored in collaboration with Self-screen, that develops the methylation tests. Methylation tests are a promising alternative since they are objective, support better risk stratification, can reduce unnecessary referrals and treatments and are effective on self-samples.
Although the scientific evidence for methylation is strong, its adoption is still slow. The key challenge was how and where to position methylation in an already well-established healthcare system. Existing routines, limited awareness among gynaecologists, clinical guidelines, reimbursement and laboratory capacity all affect adoption.
This project followed a Double Diamond design approach and combined a literature review, stakeholder analysis, competitor analysis and interviews with different stakeholders. The findings from this research show that methylation tests are especially valuable in situations where the current test leaves uncertainty in the diagnostics of cervical cancer. Specifically in the situations where treatment should be avoided, such as younger women with a child wish and pregnant women. In addition, the research showed that the strategy should focus on increasing awareness, building trust and communicating the clinical added value of methylation tests to gynaecologists.
Based on these insights, a strategic and tactical roadmap for the gradual implementation of methylation tests is developed. Instead of implementation in the national screening programme, the proposed strategy focuses on implementation in cervical cancer diagnostics. This can be implemented more easily in the short-term and can help to create value earlier and build acceptance for later implementation in the screening programme. The designed roadmap is structured in three horizons. The first horizon focuses on creating awareness and identifying gynaecologist spokespersons. The second horizon focuses on sharing information with other gynaecologists through webinars and articles. The third horizon focuses on evaluating the use of methylation tests, improving the process and scaling the adoption by sharing results with more gynaecologists.
This strategy contributes to the implementation of methylation tests in the screening programme for cervical cancer, by first positioning methylation as a tool to support clinical decision-making in the diagnostics for cervical cancer. This strategy is effective since it supports clinical needs and decision-making processes, it fits within existing diagnostic workflows and enables the use of the test in practice. By first introducing the methylation tests in diagnostics, awareness and trust among gynaecologists can be built. This way, a strong foundation can be created for the long-term integration into the Dutch cervical cancer screening programme.
This graduation project explored how the methylation tests could be positioned and implemented in the cervical cancer prevention and diagnostics market. This is explored in collaboration with Self-screen, that develops the methylation tests. Methylation tests are a promising alternative since they are objective, support better risk stratification, can reduce unnecessary referrals and treatments and are effective on self-samples.
Although the scientific evidence for methylation is strong, its adoption is still slow. The key challenge was how and where to position methylation in an already well-established healthcare system. Existing routines, limited awareness among gynaecologists, clinical guidelines, reimbursement and laboratory capacity all affect adoption.
This project followed a Double Diamond design approach and combined a literature review, stakeholder analysis, competitor analysis and interviews with different stakeholders. The findings from this research show that methylation tests are especially valuable in situations where the current test leaves uncertainty in the diagnostics of cervical cancer. Specifically in the situations where treatment should be avoided, such as younger women with a child wish and pregnant women. In addition, the research showed that the strategy should focus on increasing awareness, building trust and communicating the clinical added value of methylation tests to gynaecologists.
Based on these insights, a strategic and tactical roadmap for the gradual implementation of methylation tests is developed. Instead of implementation in the national screening programme, the proposed strategy focuses on implementation in cervical cancer diagnostics. This can be implemented more easily in the short-term and can help to create value earlier and build acceptance for later implementation in the screening programme. The designed roadmap is structured in three horizons. The first horizon focuses on creating awareness and identifying gynaecologist spokespersons. The second horizon focuses on sharing information with other gynaecologists through webinars and articles. The third horizon focuses on evaluating the use of methylation tests, improving the process and scaling the adoption by sharing results with more gynaecologists.
This strategy contributes to the implementation of methylation tests in the screening programme for cervical cancer, by first positioning methylation as a tool to support clinical decision-making in the diagnostics for cervical cancer. This strategy is effective since it supports clinical needs and decision-making processes, it fits within existing diagnostic workflows and enables the use of the test in practice. By first introducing the methylation tests in diagnostics, awareness and trust among gynaecologists can be built. This way, a strong foundation can be created for the long-term integration into the Dutch cervical cancer screening programme.
Closing the gap between what we know and what we do
Designing an implementation tool for infection prevention
Healthcare-associated infections and antimicrobial resistance threaten patient safety, yet the everyday measures that prevent them, such as hand hygiene and the correct use of personal protective equipment, are applied inconsistently in hospitals. Physicians are often poorer compliers, and the cause is rarely a lack of knowledge. Compliance is shaped by time pressure, habit, hierarchy, and local ward culture, and it varies widely between departments. Hospital-wide campaigns therefore rarely produce lasting change. What works instead is tailoring: matching interventions to the behavioural determinants at play in a given context.
Within the STIP programme at Amsterdam UMC, evidence-based strategies to improve physician compliance have already been developed, but infection prevention professionals lack a structured way to bring them into practice. This project addresses that gap. Following an iterative, human-centred design approach grounded in context analysis, interviews, and the COM-B model, it delivers STIP-assist: a digital, AI-supported decision aid. The tool guides infection prevention professionals from a contextual analysis of barriers, to a set of matched and explained strategies, to a concrete action plan, without depending on external experts. This report describes the problem framing, the design insights, the current prototype, and the steps planned towards user testing and delivery. ...
Within the STIP programme at Amsterdam UMC, evidence-based strategies to improve physician compliance have already been developed, but infection prevention professionals lack a structured way to bring them into practice. This project addresses that gap. Following an iterative, human-centred design approach grounded in context analysis, interviews, and the COM-B model, it delivers STIP-assist: a digital, AI-supported decision aid. The tool guides infection prevention professionals from a contextual analysis of barriers, to a set of matched and explained strategies, to a concrete action plan, without depending on external experts. This report describes the problem framing, the design insights, the current prototype, and the steps planned towards user testing and delivery. ...
Healthcare-associated infections and antimicrobial resistance threaten patient safety, yet the everyday measures that prevent them, such as hand hygiene and the correct use of personal protective equipment, are applied inconsistently in hospitals. Physicians are often poorer compliers, and the cause is rarely a lack of knowledge. Compliance is shaped by time pressure, habit, hierarchy, and local ward culture, and it varies widely between departments. Hospital-wide campaigns therefore rarely produce lasting change. What works instead is tailoring: matching interventions to the behavioural determinants at play in a given context.
Within the STIP programme at Amsterdam UMC, evidence-based strategies to improve physician compliance have already been developed, but infection prevention professionals lack a structured way to bring them into practice. This project addresses that gap. Following an iterative, human-centred design approach grounded in context analysis, interviews, and the COM-B model, it delivers STIP-assist: a digital, AI-supported decision aid. The tool guides infection prevention professionals from a contextual analysis of barriers, to a set of matched and explained strategies, to a concrete action plan, without depending on external experts. This report describes the problem framing, the design insights, the current prototype, and the steps planned towards user testing and delivery.
Within the STIP programme at Amsterdam UMC, evidence-based strategies to improve physician compliance have already been developed, but infection prevention professionals lack a structured way to bring them into practice. This project addresses that gap. Following an iterative, human-centred design approach grounded in context analysis, interviews, and the COM-B model, it delivers STIP-assist: a digital, AI-supported decision aid. The tool guides infection prevention professionals from a contextual analysis of barriers, to a set of matched and explained strategies, to a concrete action plan, without depending on external experts. This report describes the problem framing, the design insights, the current prototype, and the steps planned towards user testing and delivery.
Reimagining Type 1 Diabetes Care
Chatbots, Value and Integration
The primary objective of this thesis is to explore and design the implementation strategy for Leefmaatje, a self-management chatbot for type 1 diabetes (T1D), by developing a business case focused on value proposition, key stakeholders identification, and the key activities and resources required to ensure long-term sustainability of the service. Using strategic design approaches, the project aims to enhance the efficiency of future T1D patient care at Radboudumc. This is achieved by mapping the care journey, identifying stakeholders and their value exchanges, and creating an implementation concept that improves, rather than adds complexity to, the existing T1D care system.
...
The primary objective of this thesis is to explore and design the implementation strategy for Leefmaatje, a self-management chatbot for type 1 diabetes (T1D), by developing a business case focused on value proposition, key stakeholders identification, and the key activities and resources required to ensure long-term sustainability of the service. Using strategic design approaches, the project aims to enhance the efficiency of future T1D patient care at Radboudumc. This is achieved by mapping the care journey, identifying stakeholders and their value exchanges, and creating an implementation concept that improves, rather than adds complexity to, the existing T1D care system.
Smarter prehospital triage
Integrating user needs into workflow design for the SMART Triage platform
Acute care in The Netherlands is under significant pressure due to increasing demand, growing complexity, staff shortages, and rising costs. To address these challenges, the Leiden University Medical Center (LUMC), in collaboration with regional hospitals and healthcare institutions, initiated the SMART Triage project (SMART Medical Applications for Regional Triage Use). This project aims to improve pre-hospital triage by enabling real-time visual and audio communication between ambulance personnel and physicians.
This thesis explored how the SMART Triage platform could be effectively integrated into daily workflows, ensuring that the technology aligns with user needs and existing working routines. A service design approach was used, involving stakeholder engagement, workflow analysis, and iterative prototyping.
The final Service Blueprint and platform interface designs reflect the needs and expectations of neurologists, cardiologists, pediatricians, and ambulance personnel for the SMART Triage platform. They clearly describe the user’s actions during each step of the triage process, their interaction with the technology, where patient data is stored, and how it can be accessed.
In addition, a roadmap was developed to guide the platform’s growth from 2025 to 2030. Over time, the platform could integrate data from GPs and pharmacies, enabling ambulance nurses and physicians to assess patients’ conditions in the prehospital phase more accurately. The roadmap also outlines how the SMART Triage platform can be expanded to other regions and healthcare organizations in the Netherlands in the future. ...
This thesis explored how the SMART Triage platform could be effectively integrated into daily workflows, ensuring that the technology aligns with user needs and existing working routines. A service design approach was used, involving stakeholder engagement, workflow analysis, and iterative prototyping.
The final Service Blueprint and platform interface designs reflect the needs and expectations of neurologists, cardiologists, pediatricians, and ambulance personnel for the SMART Triage platform. They clearly describe the user’s actions during each step of the triage process, their interaction with the technology, where patient data is stored, and how it can be accessed.
In addition, a roadmap was developed to guide the platform’s growth from 2025 to 2030. Over time, the platform could integrate data from GPs and pharmacies, enabling ambulance nurses and physicians to assess patients’ conditions in the prehospital phase more accurately. The roadmap also outlines how the SMART Triage platform can be expanded to other regions and healthcare organizations in the Netherlands in the future. ...
Acute care in The Netherlands is under significant pressure due to increasing demand, growing complexity, staff shortages, and rising costs. To address these challenges, the Leiden University Medical Center (LUMC), in collaboration with regional hospitals and healthcare institutions, initiated the SMART Triage project (SMART Medical Applications for Regional Triage Use). This project aims to improve pre-hospital triage by enabling real-time visual and audio communication between ambulance personnel and physicians.
This thesis explored how the SMART Triage platform could be effectively integrated into daily workflows, ensuring that the technology aligns with user needs and existing working routines. A service design approach was used, involving stakeholder engagement, workflow analysis, and iterative prototyping.
The final Service Blueprint and platform interface designs reflect the needs and expectations of neurologists, cardiologists, pediatricians, and ambulance personnel for the SMART Triage platform. They clearly describe the user’s actions during each step of the triage process, their interaction with the technology, where patient data is stored, and how it can be accessed.
In addition, a roadmap was developed to guide the platform’s growth from 2025 to 2030. Over time, the platform could integrate data from GPs and pharmacies, enabling ambulance nurses and physicians to assess patients’ conditions in the prehospital phase more accurately. The roadmap also outlines how the SMART Triage platform can be expanded to other regions and healthcare organizations in the Netherlands in the future.
This thesis explored how the SMART Triage platform could be effectively integrated into daily workflows, ensuring that the technology aligns with user needs and existing working routines. A service design approach was used, involving stakeholder engagement, workflow analysis, and iterative prototyping.
The final Service Blueprint and platform interface designs reflect the needs and expectations of neurologists, cardiologists, pediatricians, and ambulance personnel for the SMART Triage platform. They clearly describe the user’s actions during each step of the triage process, their interaction with the technology, where patient data is stored, and how it can be accessed.
In addition, a roadmap was developed to guide the platform’s growth from 2025 to 2030. Over time, the platform could integrate data from GPs and pharmacies, enabling ambulance nurses and physicians to assess patients’ conditions in the prehospital phase more accurately. The roadmap also outlines how the SMART Triage platform can be expanded to other regions and healthcare organizations in the Netherlands in the future.
Designing the road to the implementation of Heart for Health's eHealth solution at general practitioners
Formulating advice for future development
The Dutch healthcare system is currently under a lot of stress. Contemporary social, technological, economic and political trends demonstrate an emerging pressure on both primary and secondary care. The trend with the most profound impact, is the growing amount of chronically ill patients, causing a high pressure on the workforce and on limited resources. Additionally, during the past number of years, healthcare costs have been growing substantially. Simultaneously, people expect more services and more involvement in their health. Partly caused by those trends, Heart for Health seeks for a solution to work towards a "future where remote healthcare prevents unnecessary CVRM patient visits at general practices". But, it has been found that there are currently many obstacles to be overcome for the implementation of such solutions. This thesis aims to create a complete overview of the complex environment where Heart for Health is currently working in. Even though all stakeholders strive to work towards a healthier population, many conflicts of interests were found. Besides, the concerned stakeholders have complex expectations and desires, that are not easily satisfied. Like others, Heart for Health has experienced that overcoming those obstacles is challenging. The aim of this thesis is to research and propose how Heart for Health can create new business within the general practitioner sector. Therefore, an extensive research has been done into the current care pathway of CVRM patients and the desires of the stakeholders. In order to create a comprehensive overview, many stakeholders were involved throughout this project. A product vision has been created to formulate what a product for monitoring CVRM patients at general practitioners should contain. Besides, multiple requirements were found to develop such products. This thesis discusses why Heart for Health is currently struggling with the development and implementation of their pilot. And explores how this struggle could be overcome by taking a more customer centered approach. To do so, an explorative session has been executed to find opportunities for creating new values. This exploration has led to a proposal for a more comprehensive product than Heart for Health is currently making. To realise the development of this product, a step-by-step approach has been proposed. It is argued that Heart for Health should first focus on creating a product for patients before including general practitioners. The proposed approach is translated into a roadmap, describing the different steps that Heart for Health can use to work towards the future that they envision. This thesis strives to give a realistic and strategic perspective on the proposed solution by repeatedly testing on desirability, feasibility and viability.
...
The Dutch healthcare system is currently under a lot of stress. Contemporary social, technological, economic and political trends demonstrate an emerging pressure on both primary and secondary care. The trend with the most profound impact, is the growing amount of chronically ill patients, causing a high pressure on the workforce and on limited resources. Additionally, during the past number of years, healthcare costs have been growing substantially. Simultaneously, people expect more services and more involvement in their health. Partly caused by those trends, Heart for Health seeks for a solution to work towards a "future where remote healthcare prevents unnecessary CVRM patient visits at general practices". But, it has been found that there are currently many obstacles to be overcome for the implementation of such solutions. This thesis aims to create a complete overview of the complex environment where Heart for Health is currently working in. Even though all stakeholders strive to work towards a healthier population, many conflicts of interests were found. Besides, the concerned stakeholders have complex expectations and desires, that are not easily satisfied. Like others, Heart for Health has experienced that overcoming those obstacles is challenging. The aim of this thesis is to research and propose how Heart for Health can create new business within the general practitioner sector. Therefore, an extensive research has been done into the current care pathway of CVRM patients and the desires of the stakeholders. In order to create a comprehensive overview, many stakeholders were involved throughout this project. A product vision has been created to formulate what a product for monitoring CVRM patients at general practitioners should contain. Besides, multiple requirements were found to develop such products. This thesis discusses why Heart for Health is currently struggling with the development and implementation of their pilot. And explores how this struggle could be overcome by taking a more customer centered approach. To do so, an explorative session has been executed to find opportunities for creating new values. This exploration has led to a proposal for a more comprehensive product than Heart for Health is currently making. To realise the development of this product, a step-by-step approach has been proposed. It is argued that Heart for Health should first focus on creating a product for patients before including general practitioners. The proposed approach is translated into a roadmap, describing the different steps that Heart for Health can use to work towards the future that they envision. This thesis strives to give a realistic and strategic perspective on the proposed solution by repeatedly testing on desirability, feasibility and viability.