This Strategic Product Design graduation project is carried out on behalf of the Civil-Military Centre of Expertise for Trauma Care (CETC). Based on insights from the research phase, the design direction iterated two times and evolved into ‘an interactive tool that supports person-centred value based health care (PCVBHC) during trauma rehabilitation, by making patients more actively involved in the design of their customized care plan and by facilitating effective interdisciplinary goal-setting. Additionally, the tool aims to help patients with acceptance, as this makes an essential contribution to quality of life’.

The designed tool is called Libra Care, which refers to ‘care that is in balance’. This means that the optimal customized care plan is created with medical input from the health care provider, but also with personal input from the patient. Patients are the only ones that can determine the value of various health outcomes for their quality of life. And therefore, Libra Care provides support for patients to actively participate in the process of aligning care provision with their personal values, goals and preferences.

Libra Care uses a guided exercise in combination with generative techniques and mind-switching to elicit personal values and the things that are important in the life of this patient. These techniques are used to extract deeper and more valuable personal information. The generated ‘What matters to me’-dossier is the starting point for consultation with different health care providers, and supports expectation management, shared decision-making and personal goal-setting. All goals a patient works towards with different health care providers are documented in relation to the overarching goal and patient reported outcome
measurements (PROMs) they support. This ensures that health care providers can align their care, facilitating effective interdisciplinary collaboration. Regular patient reported outcome measurements (PROMs) ensure continuous patient involvement and evaluation.

The information in the dossier can also be used by psycho-social workers to support conversations about acceptance. The dossier helps to broaden a patient's perspective, by making them realize that most of what is important to them remains unaffected by the trauma injury. Personal goal-setting focuses on what is still possible for the patient (or could be possible in the future). Libra Care provides patients with the opportunity to explore the coping strategies of other patients. This will help them to realize that quality of life can be achieved in many ways and that their losses can often be mitigated or compensated. Within Libra Care, patients can share their experiences, concerns, and emotions. Feeling supported and connected with other patients supports mental, physical and emotional health, and it improves the capacity to cope with losses.

Although the desirability and value of the tool was proven during patient and expert focus groups, the project and design have some limitations. Therefore, recommendations have been provided for further research and testing. The implications of this project offer actionable insights for transforming health care practices and policies, ensuring that care remains person-centered and value-driven, despite the challenges posed by increasing healthcare demands.

Neonatology, the medical subspecialty dedicated to newborn care, faces significant capacity challenges in Rotterdam. To address these issues, a research team from Erasmus Medical Center (EMC) in Rotterdam, in collaboration with the Amphia Hospital in Breda, launched the TeleNeo pilot project in January 2024. TeleNeo is a digital health service that enables audio-visual communication between healthcare professionals at EMC and Amphia, providing remote medical advice to prevent unnecessary patient transfers. The pilot marks the first use case in which TeleNeonatology is used in the Netherlands. This project is a collaboration between the TU Delft and EMC and aims to prepare for TeleNeo's implementation through an additional qualitative analysis.

The data collection of the project includes desk research on the TeleNeo pilot, a comprehensive literature review on digital health solutions, implementation settings, and service experiences. This research highlighted the common challenges faced when implementing digital health solutions, such as conflicting stakeholder values and the need for alignment with end-users and the broader healthcare system. An opportunity for design practice was identified through the use of visualizations as service prototypes by envisioning how solutions should ideally function and integrating them into existing healthcare systems.

In-depth stakeholder interviews and a Thematic Analysis on the obtained interview data revealed situation-specific barriers for implementing TeleNeo, including difficulties in planning and scheduling consultations, and unclear roles and responsibilities for healthcare professionals during the preparation, execution, and follow-up of consultations. Building upon the literature on existing visualization techniques and insights from expert interviews on visualization and co-design, the project's design phase emphasized the development of CoVisioning: a customized visualization guided co-design technique. This approach aimed to engage healthcare professionals in a collaborative session to address the situation-specific barriers through visual activities.

An iterative design process was adopted to incorporate feedback from designers and healthcare professionals, refining the visualization guided co-design technique. Utilizing the developed technique in a session with healthcare professionals from both hospitals, the project resulted in revised workflows for the NICU (EMC) and HC (Amphia) departments. These revised workflows integrated planned TeleNeo consultations, complemented with clearly defined roles for all involved.

CoVisioning proved instrumental in fostering a sense of ownership and collaboration among participants, leading to a more seamless integration of TeleNeo into routine healthcare activities and an initial step towards allocating TeleNeo responsibilities among involved healthcare professionals. Furthermore, the guidelines developed in this study for creating a similar visualization guided co-design technique can be applied to support the implementation of other digital health solutions dealing with scheduling and role allocation issues, promoting broader improvements in healthcare systems.

Technological advancements in genomic analysis have enabled the use of polygenic risk scores (PRS) to determine an individual's genetic predisposition to various diseases. The Estonian Health Insurance Fund (EHIF) is planning to introduce a service where 40-year-old women in Estonia can receive an indicator of their polygenic risk for breast cancer (BC). If a high PRS is detected, the individual is enrolled in the breast cancer screening program to help identify potential cancer earlier.
Although PRS itself does not pose a direct health threat, its communication may cause worry and lead recipients to seek support from healthcare professionals, adding strain to the healthcare system. Therefore, EHIF aims to convey PRS results through a digital channel that helps recipients understand their results without causing undue worry or prompting unnecessary consultations.
This graduation project focuses on the digital communication of BC PRS, aiming to provide recipients with peace of mind regarding their genetic risk. A literature review was conducted to analyze genetic risk, existing PRS services, and the informational and social support needs of recipients. To further understand the needs of 40-year-old women in Estonia, the target group for this service, 15 user and expert interviews were conducted.
Based on the insights from the interview studies and the literature reviews, the following aspects from genetic counseling are highlighted to create peace of mind for recipients receiving a BC PRS result:

• Use of empathic statements,
• reflective interaction with the recipients and clarification of PRS information,
• use of analogies,

• providing a sense of control to the recipient,

• framing genetic risk as a small change, and
• highlighting the value of PRS communication as an early warning.

As part of the conceptualization phase, a service blueprint and two roadmaps were developed. The service blueprint proposes the My Genetic Mirror concept, aiming to create an identity- focused perception of the service, simplify the PRS result using a fire safety metaphor, spread out information delivery to prevent overwhelming communication and provide resources for follow-up questions.
To consider future development of the service concept, both a strategic and a tactical roadmap were formulated. The future vision of these roadmaps for 2030 focuses on creating emotionally reassuring yet cost-efficient genetic health management for a peace of mind. A preliminary evaluation of the service concept was conducted with four design students. The thesis concludes by highlighting contributions to new knowledge, identifying limitations, providing recommendations, and offering a personal reflection.

Digital platforms harvest end-users’ data for providing personalised recommended content. However, this data is also used to predict individual end-users’ behaviours and hook them to the content, eventually influencing their worldviews. This raises ethical debates related to the development of serious societal issues, such as fake-news diffusion, increasing polarisation and threats to democracies. On the individual level, end-users are affected by data leaks and privacy intrusiveness. People are therefore increasingly concerned about sharing their data without knowing what they reveal, for what purpose and to whom, and are consequentially unable to exercise their digital right to privacy and consent, as also concluded by the European Commission (2015).

This thesis investigates how consent practices and disclosure interactions can be redesigned to instate future data practices and digital platform relations which both digital platform organisations and end-users desire. This thesis adopts a sociotechnical perspective on digital platforms, as in de Reuver et al. (2018) and Tilson et al. (2012). The hypothesis is that future visions on 1) digital platform relations, 2) data practices, and 3) consent practices and disclosure interactions, from digital platform organisations and end-users should be explored, defined and compared to identify commonalities that provide a foundation for solution exploration, and to identify fundamental tensions that need to be resolved to create the conditions in which new practices can be effective and meaningful.

Future visions are defined through semi-structured interviews and Context Mapping conducted with eight field experts and eight (sensitised) end-users, led by the Path of Expression line of inquiry and analysed accordingly to the Grounded Theory Method. For every future vision topic, one theoretical framework is made to extract values and sources of friction. While the first are the drivers of the future visions, the latter contain conflicting interests to resolve before they can occur. By comparing the values extracted from the future visions on consent practices and disclosure interactions from the experts and end-users, it is concluded that some values match and others clash, which are defined as value similarities and value tensions respectively.

Methods to leverage value similarities in consent practice redesign are investigated through creative sessions with (former) design students employing How To – Questions, Brainwriting and Creative Confrontation. As all values can be leveraged in different ways, strategies for creating new consent practices are defined by using a Morphological Chart. A similar creative session employing Personal Analogy, Role-Play and Scenarios is used to investigate how to resolve value tensions in a consent redesign. All common tactics used to reach agreements on the value tensions are analysed and applied to the redesign for resolving the value tensions. Eventually the design objective of the thesis is reached by creating new (aspects of) consent practices and disclosure interactions based on the design propositions, for a total of 21 design directions including 88 different ideas from several ideation activities.

The digital platform organisation Flickr served as a real-life case for applying the research insights and design directions. A new consent journey proposal which balances privacy considerations from end-users and interests of the AI community is created for obtaining users’ photos to create image data sets. The proposal is validated with representatives from Flickr, Flickr’s end-users and the AI community, and evaluated as desirable, sufficiently feasible and viable, with part of it effectively contributing to solving the design case. Additionally, the proposal enables the exercise of end-users’ digital right to privacy and consent. It’s effect on individual-level relations also contributes to solving data practice-related societal issues.

This thesis concludes that consent practices and disclosure interactions can successfully be redesigned by leveraging the set of identified value similarities and resolving the set of identified value tensions. It is also found that ensuring a match between desired practices and reducing opportunities for dissension allows redesigning consent practices to be effective and meaningful. The early assumption that the identified sources of friction are solved limits however this thesis’ effective implementations, possibly requiring future research and investigations in these regards.

The COVID-19 health crisis at the beginning of 2020 saw a dramatic number of adaptations to health systems around the world. One of these adaptations was the accelerated shift towards e-health solutions. This rise happened because of the inability of the medical system to serve patients of non-respiratory related illnesses during the pandemic. This was experienced as a rise from 1% to 70% of remote general practitioners consultations in the early months of 2020(Mueller, 2020).
Key to these consultations is the use of medical devices to gather information relating to the patient's state. New medical device categories now allow people with little or no training to collect accurate information (European Commission, 2017), including by using wearables first intended for tracking activity-related metrics that are currently being fitted with state-of-the-art sensors that allow them to become a realistic alternative to strict medical devices (Raja et al., 2019). Despite this, several key issues impede their use in standard medical practice and are more commonly used as informational tools only (Raja et al., 2019).
The use of wearables as informational tools has the potential to increase the awareness of people of the effect of the things they do on their wellbeing, an essential part of the concept of preventative medicine. A concept that aims to enhance wellbeing is wellness, with health being a state of being and a goal to achieve (Stoewen, 2015).
Wellness is also a concept that is well entrenched on the product lines of the brands of Arçelik, and is seen as an important opportunity to grow medical capabilities in the products they already dominate.
This thesis project presents a service design concept that aims to help people create their own wellness journey by passively tracking habits and receiving advice based on this information. The concept is based around the gathering of information through smart home appliances, focused around four modules: nutrition, activity, sleep and vitals.
The project concludes that the proposed service solution brings the possibility to integrate the capabilities that Arçelik needs to enter the larger healthcare market while staying in the product categories that it dominates.

Artificial intelligence (AI) is an emerging field which unleashes massive new (business) opportunities. The potential growth and broad application of the AI technology has great economic benefits however also severe societal implications. Simultaneously, ethical challenges arise with its development. Questions of values and ethics are becoming urgent, as systems can be negatively biased and the decision processes are often not traceable, while impacting our lives. Abstract concepts such as fairness and values need to find their way into the fast and agile AI development processes. The contemporary (research and practice) fields tackle these challenges by technological feats, ethical AI principles and strategies. However, it are the decisions made by humans today and tomorrow that will shape our future. It is, therefore, alarming the translation of ethics to that day to day work of the AI development team is missing. Hence, the central aim of this thesis is to explore and design support for AI teams with the creation of more ethical AI systems, bridging the gap between ethical AI principles and current practice. By that, design for organizational capacity for the development of fairer AI by using strategic design and critical design approaches. In this thesis, due to the diversity and magnitude of ethical challenges in AI, particular attention is paid to two challenges, fairness and value-alignment, to benefit from a design perspective. Three streams of expertise are brought together to tackle these challenges: AI, applied ethics and design. Ethics bears critique, and this thesis argues that it can benefit from a design perspective, using imagination in the solution space and synthesized thinking for implementable ideas instead of solely discussion. The thesis focuses on ways how design approaches can supplement the ethical ones and thereby stimulate the ethical uptake in the AI field. Instead of defining what fairness is, this thesis takes a novel approach in unraveling ten unfairness sources in the AI development. It is aspired to reduce these sources of unfairness in AI, in project specific fashion. In AI practice, the ways ethics is incorporated and how value tensions are resolved is under-researched. In depth interviews, generative tools and provotypes are conducted and designed to research and critique the contemporary AI field in relation to ethics, both with IBM and their clients. Simultaneously to inquire novel value tensions in its development. Five main value tensions are unraveled in its relation to fairness. All above is consolidated a framework to design for organizational capacity and team support leading to the creation of fairer and value-aligned AI systems. With this framework an organizational role is designed, the ethical coach, to aid the AI team with cocreating fairer and value-aligned AI systems with an accompanying modular toolkit. The modular toolkit is iterated upon multiple times and uses the AI dish metaphor. Finally, two evaluation sessions with IBM and their clients as well as the conversations concerning of the implementation of the toolkit led to recommendations for further development including education and implementation directions.

The design process of the Zeker app is a graduation project of the TU Delft faculty of Industrial Design Engineering in collaboration with Capgemini Invent. Capgemini Invent is evoked by the increased safety measure in the pharmaceutical supply chain. The European legislation: The Falsified Medicine Directive, ensures additional serialisation of medication packaging with QR-codes. This raised the question which stakeholders can be involved in user-centred opportunities these QR-codes have when brought in to the home of patients. With this project, these user-centred opportunities and who and how current and future stakeholders are involved in medication safety and e-Health interventions are explored.

This report describes the user-centred design process that explores opportunities on how patients, taking medication, can be helped in their day to day lives. The research revealed bottlenecks in the medication care process that cause unsafe medication care. Unsafe medication care can cause (preventable) hospitalisation. Research focuses on patients that are most likely to encounter problems due to medication. These are patients with polypharmacy and multi-morbidity, taking medication that influences the cardiovascular system.

Patient group
Five in-depth, semi-structured interviews are done with patients to set up a Patient Journey. This journey illustrated pain points in the patient’s live to do with their medication and care. These were taken on as a design challenge to resolve, namely:
To empower patients in searching for a regimen in which living with medication is not restrictive and to take away strong negative emotion around adjustments to the medication regimen.

The interviews also showed a gap between norms for safe pharmaceutical care, to relieve bottlenecks, and patient’s experience. This project aims to resolve these problems areas from the patient side through patient empowerment. With the four aspects of patient empowerment the following design vision was made: 1) Patients will better understand their responsibilities in keeping and transferring their medication overview. 2) Patients will gain knowledge to engage in a consult conversation about their medication treatment. 3)Patients experience that their home and the consult environment is facilitated for safer medication treatment. 4)Patient experience their healthcare skills regarding their medication treatment are anticipated.

The Zeker App
Trends in the pharmaceutical and healthcare market shows opportunities in using e-Health as a significant part of the solution. The Zeker app embodies e-Health for improved accessibility, effectiveness, efficiency, safety and quality, of medication care for patients. The Zeker app is designed using brainstorming, wireframing and digital user interface mock-ups. For patients with polypharmacy, the Zeker app gives reliable personalised answers in finding a medication regimen. When medication is restrictive it will reduce negative emotion by taking patients seriously and helping in the search as to why and what are alternatives for patients. Knowledge and giving overview empowers patients in increasing medication safety together with their caregivers:

“Together Sure about your medication.”

Stakeholders
The Zeker app operates in the complex pharmaceutical health care network. For concept validation and further research into the future stakeholders in medication safety and e-Health interventions stakeholder interviews are conducted. Representatives of KNMP, NVZ, VIG, BOGIN and the Patient Federation with expertise in this field, were questioned about their opinion of the mock-ups. As well as their organisation’s and other stakeholder’s roles in these kinds of developments.

It was made clear collaboration with many different stakeholders required to get this concept of the ground. Both on an organisational level, like involving branch organisations. As well for utilising existing databases and content as building blocks for the app. This project distinguishes three types of data to consider for collaborative development: static data, resilient data and timely data.

The research puts forth the need for nationally arranged (big) data analysis of medication side-effects. This can be used in pharmaceutical development as well as in improvement and personalisation of medication treatment. It is believed the existing side-effect registration centre Lareb can fulfil this role. By digitising Lareb can expand its data collection and increasingly offer analytics as a service.

The government should increase its efforts towards e-Health acceptance and adoption for both patients and caregivers. Current numbers on use of e-Health show patients are still slow to adopt. Besides, patients are unwilling to pay for e-Health. Therefore, it is expected e-Health will increasingly be reimbursed by health insurance companies.

Viabilty
For the Zeker app, this implies that it should be developed with or by a GP information system provider. Initial data exchange can be set up swiftly. The GP has an overview of all medication which the specialist has not. The GP has the ability to change the prescription, which the pharmacist has not. Reimbursement for e-Health by the GP is already arranged under patient self-monitoring.

With the collaborative development of PGOs and the changes in the financial model towards Value-Based Healthcare it is likely e-Health will soon be reimbursed as a separate type of care transcending individual caregivers.

The last iteration of the Zeker design is based on user-research. Thirteen in scope participants indicated that they understood the app and its four main functions. If it would help or whether they would use it frequently depended on whether they experienced problems with their medication before and if they had not already fixed the problems in another way. These patients also, indicated that they would not pay for such an application unless it needs little effort. When they are clearly shown the benefit as opposed to their current ways of working. The iteration improved the clarity of- and simplified the Zeker app design. Besides this, it was decided to make a clearer distinction between self-measurement and side-effects by adding a menu function.