This graduation project focused on strengthening the blended cardiac rehabilitation pathway at Basalt Leiden by exploring how activity tracker data from The Box, a home-monitoring initiative developed by LUMC for cardiac patients, could be meaningfully integrated into daily practice. Basalt’s assignment was to identify possible bottlenecks in the integration of this data and, based on the identified insights and opportunities, a tool is designed that supports its implementation. Integrating step count data is important because it can provide physiotherapists with more objective insight into patients’ daily physical activity. Currently, remote coaching moments largely depend on patients’ self-reported activity, while Basalt aims to make rehabilitation more data-informed, personalised, and supportive of long-term behaviour change.

The project followed the Double Diamond process, moving from broad exploration towards a focused design proposal. A literature review was conducted on cardiac rehabilitation, blended care, hybrid care, technology adoption, and behaviour change. This was complemented by context research at Basalt, including semi-structured interviews, stakeholder walk-alongs, stakeholder mapping, thematic analysis, and journey mapping. Insights were gathered from patients, physiotherapists, other healthcare professionals, organisational stakeholders, and researchers to understand the current pathway, stakeholder needs, and barriers to implementation.
The research showed that blended care is already present at Basalt, especially within physiotherapy through physical training, home exercises via Physitrack, and evaluation phone calls. However, it is not yet clearly defined, consistently introduced, or structurally embedded in daily practice. Patients are not
always sufficiently onboarded, which contributes to limited engagement with digital tools. Physiotherapists also differ in how they apply blended care, partly due to the absence of a shared workflow. In addition, the findings showed that remote coaching currently relies strongly on subjective self-report. This supported Basalt’s existing ambition to integrate activity tracker data into the pathway, as step count data could provide physiotherapists with more objective insight into patients’ daily physical activity. However, the findings also showed that this data will only be useful if it supports coaching in a practical way and does not create extra workload.

Based on these insights, the design direction shifted towards supporting Basalt’s organisational team in onboarding physiotherapists to the use of activity tracker data. The final concept, Steps2Coach, consists of a physical pathway cube and a supporting poster. The cube visualises six phases of the physiotherapy trajectory: physio intake, physical treatment, home training, evaluation preparation, evaluation phone call, and aftercare. Each side explains the patient milestone, the physiotherapist’s role, the added value of activity tracker data, and a coaching prompt. The poster provides additional context about The Box and practical support. Together, these elements make activity tracker data visible, tangible, and connected to concrete coaching moments. Evaluation showed that Steps2Coach is clear, engaging, and relevant as a first step towards implementation, while further testing and practical integration are still needed.
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The Dutch healthcare system is under increasing pressure from demographic ageing, rising care demand, and limited specialist capacity. In rheumatology, this pressure is particularly visible: a growing share of patients referred to specialist care do not necessarily require specialist treatment, contributing to long waiting times and high workloads. Understanding why this happens requires looking at the system as a whole, rather than at isolated steps in the care pathway.

This project explored how design can contribute to balancing the inflow of patients with joint complaints and the capacity of rheumatology care, using the rheumatology department of Reinier de Graaf Gasthuis as its primary context. The research combined observations at four hospital settings, eighteen semi-structured interviews with patients, primary care professionals, secondary care professionals, and a systemic stakeholder, thematic analysis, and future visioning.

The research revealed four interconnected opportunities in the system: 'Bridging the gap between patient expectations and what care can offer', 'Primary care as a powerful filter for the right care at the right place', 'The patient as the most powerful factor in their own recovery', and 'Working smarter within the boundaries of a financially constrained system'. The design direction was focused on the opportunity where design could intervene most directly: supporting patients in taking a more active role in their own recovery in relation to lifestyle factors.

This led to the development of Jointly, a mobile application for people with non-inflammatory joint complaints in primary care. Jointly helps users reflect on their complaints, recognise the role of lifestyle factors, and translate these insights into small, feasible actions in daily life. The app uses an AI coach named Skelly to guide users through daily check-ins, personal insights, and concrete next steps, structured around the six domains of 'Het Leefstijlroer'. An optional community function allows users to connect with others in similar situations.

Jointly is positioned after the GP consultation and before referral to secondary care is considered, offering patients guidance and a sense of agency during a phase in which they are often expected to manage their complaints independently. Initial validation with a patient and two general practitioners confirmed the relevance of the concept, while also highlighting the importance of scientific credibility, continuity of support, and careful implementation. If successfully implemented, Jointly has the potential to contribute to fewer unnecessary referrals to rheumatology and a more active role for patients in their own recovery, though these effects require further longitudinal research to evaluate. ... Read more

Patients staying in the oncology department have to deal with fears and worries about their treatment, diagnosis and the effects it brings on their life and those around them. These fears and worries remain often hidden, due to patients needing time to open up about them and healthcare providers not immediately noticing these. They take these fears and worries with them when leaving the hospital, creating a negative discharge experience that provides a lot of stress in a setting where they can familiarize themselves again. The current discharge takes a clinical approach that favors time efficiency with a focus on the direct patient’s needs while missing out on discussing hidden fears and worries of the patients, and no new knowledge is provided on how to effectively do this. This asks for new approaches and tools that can make these hidden fears and worries noticed by healthcare providers, being able to talk about them and prepare the patients and their close loved ones to leave the hospital with a confident feeling of being able to take care of themselves and provide the care necessary. This project aims at finding such new approaches and providing tools that can help turn the discharge experience more positive. A mixed method approach is used where in four phases the context of the oncology department is explored, analysed and designed for. This is supported by an empathy framework, discharge journey map and other models in order to provide a human soft touch to the discharge process. A good understanding of the current discharge process is formed and insights are gathered that influence the discharge experience. Concepts are created that incorporate the insights to evaluate the effects on the discharge process. The hidden fears and worries of patients and their close loved ones are the care not being of the same quality outside the hospital as within, their home turning into a second care home and them not being able to take care or provide the care. Healthcare providers hold on to their existing working methods due to their attitude of it working for some time without any form of self-reflective feedback. Six factors have an influence on the discharge experience that determine how everyone involved interacts with each other, of which confidence and expectations can be improved. A concept goal and direction are formulated that focus on the two factors and additionally raise awareness, allow everyone to share their fears and worries and give confidence to be able to take or provide care. This has given two concepts which in a total of six tests have been evaluated on their influence and changes to the discharge process. A final concept proposal is given with an implementation plan for future design that expands on the first steps created in this project. ... Read more

This thesis explores how human-centered design can improve both patient and healthcare-worker experiences within the breast cancer surgical pathway at the Reinier de Graaf Gasthuis. Breast cancer care is multidisciplinary, complex and emotionally demanding process. Patients navigate a pathway of consultations, receive treatments and make important decisions, while professionals work within tight schedules, interdependent processes and a high workload. Through literature review, observations, walk-along sessions, semi-structured interviews, thematic analysis (using NVivo) and patient journey mapping, the project uncovers key challenges in communication, emotional support and organizational coordination.

Patients describe the RdGG as empathetic, accessible and medically highly skilled. They consistently feel seen, heard and genuinely supported by the hospital staff. At the same time, several areas for improvement emerged, including clearer preoperative information and the avoidance of emotionally charged language. Patients also expressed that there is potential for further digitalization of the care process, like an easy accessibale app. A recurring theme was the desire for opportunities to connect with former patients (“buddies”) who understand the emotional impact of a breast cancer diagnosis and treatment. However, both the ‘patient satisfaction survey’ and the interviews confirm a more than positive experience, with RdGG scoring a 9/10 and patients expressing strong satisfaction with their care.

Healthcare professionals highlight a very different set of challenges. The scheduling of combined oncological and reconstructive surgeries (IBR) appears as the most significant bottleneck. Variations in surgeon availability, unpredictable procedure durations, sudden changes in schedules because of treatment changes and limited digital integration make planning frustrating and time-consuming. Despite high performance metrics (patient satisfaction survery), caretakers indicate that current systems require substantial manual coordination “behind the scenes” to maintain quality and availability.

The design brief arising from these insights focuses on improving communication, strengthening coordination and making the surgical planning process more predictable and transparent. This thesis presents potential interventions, including predictive scheduling methods, data-driven forecasting of IBR demand, an online planning tool, a patient opt-in system for flexible scheduling and clearer distribution of planning responsibilities among departments. A strategic roadmap outlines how these interventions can be implemented between 2026 and 2030, ultimately enabling a more integrated and efficient planning ecosystem.

Overall, this project shows that design can play an important role in connecting organizational needs with human experiences. By enhancing communication, supporting emotional needs and improving logistical workflows, the RdGG can offer breast cancer patients a consistent and comforting care journey, while reducing workload and increasing efficiency for its healthcare professionals. ... Read more

The Dutch healthcare system is under pressure. Standardizing digital data exchange is one of the strategies to improve quality and reduce costs. The BgZ will be the first standardized exchange implemented.

The Ministry of Health, Welfare, and Sport (VWS), healthcare institutions, Nictiz, and other stakeholders are collaborating to facilitate this standardization. However, they are struggling to deliver a truly usable system. Why is this?

My leverage analysis indicates that balancing power is the most crucial way to guide the system.
Balancing power is inherent in almost all relationships, as different interests vie for influence on decisions and priorities.

The most critical relationship where power needs to be balanced is that between the healthcare professional and their software supplier. System actors with power apply it to prioritize technical and societal developments. Healthcare professionals need to be empowered to push the system to create software solutions that provide meaningful use in healthcare context.

Key Deliverables
A new research process of request articulation which is able to accurately represent and support the perspectives of healthcare professionals (figure 0.1a)

An interaction design that allows regular healthcare professionals to express their knowledge in a structured and accessible way (figure 0.1b)

A strategy to achieving the future vision by articulating 4 phases, and insights on specific actions and capacities to build to get there. ... Read more

Digitalisation is something most people have encountered in the last 20 years. People have gotten used to most of their life being digital, using phones every day, and working on computers. However, the healthcare system is falling behind in the field of digitalisation. The system does not work efficiently enough to facilitate the provision of care, hindering it instead. Patient - care provider interaction during transmural healthcare journeys can be improved to place the person once more at the centre of their own health care journey.

This project aims to create a strategy for the digital transition of patient – health care provider interaction during transmural health journeys. This is done by first completing a literature review and context analysis of the current system, followed by observations and interviews. The insights from this research were then summarised in a synthesis map, which highlights the interconnecting relations within the complex socio-technical system. Three system levels were analysed, splitting the system into macro, meso and micro influences. Macro influences come from legislation, meso influences from organisational strategy, and micro influences come from person-specific interactions.

The synthesis map identified six leverage points that can be used to improve the barriers for digitalisation at the Reinier de Graaf hospital:

1. Improve system interoperability
2. Improve system connections
3. Streamline the number of systems used in healthcare
4. Take ownership/ responsibility surrounding digitalisation at the RdGG
5. Make more space in the budget to spend time facilitating the digital interaction transition
6. Improve digital literacy

Using these points the following future vision was set up:

In the future, the RdGG simplifies patient - care provider interaction by using a shared data space for care plans, allowing patients to play an equitable part in their health journey.

Finally, a strategy was made for the digital transition of patient – care provider interaction at the hospital, visualised in a strategic roadmap and a tactical roadmap. The three main pillars of the future vision – patient clarity, time for care, and shared administrative burden – form the basis for the envisioned future of healthcare in the Netherlands.

To finalise the applicability of the digital transition strategy, it was tested with various involved stakeholders, including a director of the hospital, ICT staff, and care professionals. The thesis concludes with implementation recommendations, limitations and possibilities for future research. ... Read more

Digitalisation is becoming increasingly important in discharging the healthcare sector as our society ages, and long-term treatments of chronically ill patients are becoming necessary. However, adopting digital tools has not been smooth due to individual, organisational, and technical barriers. To overcome these barriers, a user-centred approach, co-creation, improved communication, and the involvement of the right stakeholders could help smooth the transition.

The GoMedFlow concept tool is a digital tool for healthcare professionals and organisational employees of the Reinier de Graaf Gasthuis that aims to improve the workflow of care processes and stimulate the use of digital tools. By creating a clear overview of care paths, improvements and digital tools can easily be noticed and implemented.

Using context mapping, stakeholders' wishes and needs were gathered at different levels of knowledge. A questionnaire revealed that stakeholders want to spend more time improving digitalisation, but not all have the time to contribute. Observations and conversations in the hospital uncovered insights into workflows and concerns, and generative sessions were held to dive even deeper and gather more insights. A design brief, including a design goal, was created to provide direction to the design process.

A co-creation session was held to involve stakeholders in the design process. Two groups provided ideas based on pre-created scenarios, and two different concept directions were created using Adobe XD. Before the concepts were created, a new corporate identity was created for GoMedFlow. Both concepts were tested during a care table and individually with stakeholders of care tables, and many insights were gathered. The second concept stood out more, but aspects of the first concept were still considered.

In order to finalise the concept of GoMedFlow, it is tested both during a care table and individually with stakeholders. The feedback and insights gathered from these tests are then combined to create the final design of the thesis. Additionally, a project journey is created to provide insights into the design choices made throughout the project. A roadmap is also developed to display the further steps that are required for a successful implementation of GoMedFlow. The thesis concludes with future research perspectives and a reflection.
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Problem definition

The healthcare sector faces escalating pressure due to its current inefficient practices in digital information exchange. The Integral Care Agreement (IZA) from the Ministry of Health, Welfare, and Sport (VWS) and overarching healthcare organizations is focused on creating a future-proof healthcare system. The Wegiz, introduced within the IZA, outlines standards for electronic data exchange among healthcare providers, with the focus on the Basic Dataset for Care (BgZ). However, the implementation of BgZ faces challenges, as insight in the influencing factors and facilitating interventions are limited.

Research outcomes

This research addresses this gap by employing literature reviews, (semi-structured) interviews, observations, and a thematic analyses within the healthcare ecosystem, specifically focused on the experience of medical specialists with the current organization of digital information exchange, to identify the factors affecting the BgZ implementation. A critical finding reveals a disconnect between macro-level legislation and micro-level healthcare practitioners, resulting in an oversight of the human aspect in decision-making and communication of changes. Furthermore, VWS encounters challenges in effectively engaging the target audience, according to medical specialists and organizational employees, leading to various disadvantages, including negative experiences with legislatively driven developments and a lack of awareness among healthcare professionals regarding BgZ and their pivotal role in the transformation. Furthermore, the limited awareness for standardization among specialists and the time and efficiency constraints are additional factors to be taken into account. Although, legislation is obliging interoperability between systems on a technical level, including the human aspect to evoke behaviour change towards standardization is currently limited. The cultural factors of the medical environment are challenging as well as autonomy and hierarchy is deeply rooted, which may influence the attitude towards change.

Design goals

The study emphasizes the need to involve healthcare professionals, starting with the first step of engaging physicians in the change process. To address this, a serious game has been developed with the primary goal of raising awareness about the urgency of BgZ implementation and encouraging active participation and collaboration by provide positive experiences of the opportunities the BgZ includes. The game, evaluated through sessions with the target audience, has proven to be an effective intervention, achieving its set objectives.

Recommendations

As a recommendation, the game should be implemented in an interdisciplinary manner, involving physicians, assistants, IT personnel, organizational staff, and policymakers. This approach aims to connect perspectives and foster collaboration. Ultimately, the game serves as a tool to bridge the gap between policymakers and healthcare practitioners by providing insights into each other’s perspectives, fostering a collective and collaborative approach towards successful BgZ implementation.
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Even though many technologies are developed with the goal to support the healthcare sector in face of the ever-growing demands, many of them will never be implemented in hospitals. They fail either during the implementation process or when scaling up, what leads to unused opportunities, wasted time, effort, money and frustration on the side of all stakeholders. Using the implementation of a large language model during consultations at the Reinier de Graaf hospital as a case study, their current implementation process was evaluated. Through qualitative interviews and co-creation workshops many barriers in the collaboration between the organizational employees and key users on the side of the hospital, and the technology companies on the other hand were found.

This thesis explores how key users can be facilitated to turn the identified barriers into opportunities for successful implementation. A service for the organizational employees and technology companies was created, consisting of a book and poster that guide them through the most important milestones in their collaboration with key users: From forming the implementation team and finding the right key users, setting them up for the adaptation phase, preparing the department for the upcoming change and the go-live of the new technology all the way to sustaining and consistently monitoring its use.

This service was iteratively designed and evaluated with stakeholders of the context and design experts to provide a guided and empowering implementation experience. It also gives specific recommendations for the implementation of Autoscriber into the Reinier de Graaf and provides a foundation for future research into the practical aspects of how to effectively involve key users, a topic that is still explored very little by literature. ... Read more

The client of this graduation project, Dune Innovation, aims to facilitate and execute a structured design process for medical device development. This is a complex task most notably during the early ‘discover’ phase, or fuzzy front end. In medical device development, the first stages of the design process are crucial in ensuring the adoption chances of a new product. During the discover phase, the focus is to gather design inputs or requirements to reduce the uncertainty and risk in future project development. By logic, Dune Innovation does not have sufficient knowledge on all design criteria to solve these uncertainties. Therefore, the company seeks interaction with stakeholders to find unknown design inputs that can help to make progress. To do so, the intention is to organize meetings or interviews with these stakeholders. Unfortunately, this is no easy task. Stakeholders in the medical field often are short on time and don’t prioritize collaboration with Dune Innovation. Even if they manage to make time, standard interview methods are suboptimal for creativity and exploration. This struggle leads to ongoing uncertainties and longer lead times in projects.

This thesis project delivers a new approach to interview settings during the discover phase of medical device development for Dune Innovation. This is achieved by developing a tool which embraces co-design strategies during stakeholder interview settings. By providing transparency on the clients’ design process towards the interviewee, the desired effect is to increase engagement, improve the quality of discussion and outputs. The goal of the session is to generate new design inputs together with the interviewee that are relevant for the projects design process. The concept of the co-design tool is based on these issues and aims to enable a structured co-design session between a facilitator and a stakeholder in a physical interview setting. The tool offers a functionality that should help in reaching a shared understanding between both parties, as a foundation for the following co-design sessions. The tool should engage participants to actively contribute their expertise, insights, and ideas during a 90-minute interview session, with the goal to generate new inputs for the project. The printable design of the tool encourages the use of pens and post-it’s to spark design thinking and creativity.

Validation rounds showed a great potential of the tool. All participants shared their enthusiasm after concluding a session. It showed that during use of the tool participants were engaged for the entire length of the session. Both the facilitators and interviewees had enjoyable experiences. The validation rounds proved that shared understanding could be reached within 15 minutes. Validation also showed that the tool encourages sketching, writing, and unexpected discussion, which led to new design inputs for the client. Although more testing Is necessary, the concept shows great value for future implementation.
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This thesis describes the development of a bedside system concept for monitoring the microcirculation of intensive care patients.

Microcirculation refers to the smallest blood vessels in the body, including capillaries, arterioles, and venules. These tiny blood vessels facilitate the exchange of oxygen, nutrients, and waste products between the blood and the surrounding tissues. Microcirculation is critical for maintaining the health of tissues and organs, and any disruption in this process can lead to a variety of health problems.

In the past decades, new techniques have been developed to visualise and study the microcirculation. One of these techniques is the hand-held vital microscope. It is a portable video microscope that can visualise superficial microcirculation, such as in the mouth. These hand-held vital microscopes have been used for research purposes, but due to limitations, these devices are not suitable yet for routine clinical applications.

Braedius Medical, a manufacturer of hand-held vital microscopes has commissioned this project to use their technology to develop a new device implementation. The goal is to solve the limitations of these hand-held microscopes with the intent of creating a sustainable competitive edge and long-term profitability.

The research consisted of a discovery phase to get a better understanding of the project context such as the physiology of microcirculation and the technology landscape.

This was followed by an analysis phase to get in-depth insights such as user pains and needs and the strengths and weaknesses of the company.

These insights were used to develop the concept vision: a hands-free automated monitoring system for the ICU that uses camera probes placed on the patient’s skin for video acquisition. Finally, a roadmap was made to visualise the strategic planning of all the key steps that need to be made in order to achieve this concept vision.
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This project explores the context of laboratory technicians at the NFI and CSIs with the police, and their experience using dry wipes and disinfectant dispensers at their work. It also delves into designing a new dispenser for them, which is the project aim, with a focus on prototyping and validating designs. ... Read more

The coming years, demand for healthcare will increase exponentially, resulting in increased pressure on the decreasing number of healthcare providers. A digital transition of healthcare is needed in order to be able to keep offering widely accessible, quality care.

Unfortunately, the healthcare sector has difficulties keeping up with the trend of digitalization in comparison with other sectors. This project aims to bring to light why the healthcare sector is struggling with the process of digitalization. Through this exploration it endeavors to design a solution with the intention of facilitating the digital transformation of the Reinier de Graaf Gashuis (RdGG). To keep the project scope limited it was decided to focus on digitalization of colorectal cancer care.

The following methods were used during the research phase of the project:

1) Conducting a literature review that explored the current state of affairs regarding digitalization in the context of colorectal cancer care and methods for digitalization of care processes.

2) Observing interactions between healthcare professionals and colorectal cancer patients and observing during meetings with different stakeholders in the RdGG.

3) Conducting interviews with colorectal cancer patients, healthcare professionals and organizational employees.

This led to the creation of a colorectal cancer patient journey map. The map displays the care process and reveals its ‘non-digital state’. The result showed that mapping a complete care process in a clear way is challenging. Most care processes are not linear or fixed; there are different treatment options and exceptional circumstances. It was discovered that there isn’t a journey mapping format available that is simultaneously comprehensive and user friendly.

The research outcomes revealed numerous factors hindering the digital transformation within the RdGG, some of which include:

1) The complexity of hospitals makes it difficult to keep overview over the process of digitalization.

2) Not all digital resources are perceived in a positive light, one reason being that they sometimes clash with existing workflows or care processes.

3) Patient journey maps and care pathways can help to prevent this from happening, but there are problems with the making of, managing and use of journey maps.

4) There are issues in the communication between healthcare professionals and organizational employees.

The following design goal was created:

Design an interactive journey mapping tool for care professionals and organizational employees at the RdGG, that helps to better comprehend care and digitalization processes, by offering overview, knowledge and easy communication.

This led to GoMedFlow. A design created to help hospitals transition into smart hospitals. It utilizes journey mapping as a facilitator for the digital transformation of healthcare. GoMedFlow offers:

1) Overview in the current state of affairs of digitalization of care processes

2) The opportunity to easily and cooperatively form, maintain and analyze care pathways and patient journeys.

3) Aid to effectively implement digital resources in care processes, assuring digital resources fit well within the care processes.

4) Easy communication between different stakeholders in the RdGG; healthcare professionals and organizational employees

Using GoMedFlow results in an efficient deployment of employees and resources in the future.







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Hand suturing is one of the most challenging tasks in laparoscopic surgery and requires high cognitive effort from the performing surgeon. Nevertheless, it is also one of the basic skills of minimally invasive surgery and it is a critical skill due to its high requirements and broad application.

During gastric bypass surgery, there are multiple moments of hand suturing which makes the procedure physically and cognitively challenging. This research focuses on possible alternatives for internal tissue closure to reduce the frequency of hand suturing. The main objective of the research was to develop a method which reduces cognitive effort and procedure time while enhancing comfort for the surgeon.

To get insights into the current procedure of hand suturing, it was analysed on the example of anastomosis closure. Observations of gastric bypass surgeries gave the required information to generate a detailed workflow which identified hand suturing as a key difficulty during the process. The analysis results gave a starting point for the ideation of a new closure method. Additionally, requirements for the closure method were formulated and taken into account during the development.

Multiple concepts like differently shaped clips, hooks and staples were created and prototypes were built. Materials like metal wire staples and 3D printed prototypes were used and tested on foam, silicon and rubber. Through tests and interviews with healthcare professionals, one concept could be chosen and further detailed.

The newly developed method combines the advantages of both hand suturing and the commonly used stapling technique. The staples are attached in an alternating way on the edge of the tissues, while a suture is pre-threaded through the staples. When pulling the suture, the two sides approximate each other. The advantage of this method is that the tissue does not need to be positioned before the application which makes the procedure less challenging for surgeons.

A real scale prototype of the method was build to test manufacturability and proof of principle. Further optimization was done with Finite Element analysis and co-creation sessions with medical doctors. The evaluation of the concept was done in close collaboration with multiple bariatric surgeons, by conducting interviews and hosting discussion sessions.

The result of the evaluation showed that some of the safety requirements on anastomosis closure cannot be met with the newly developed concept. More suitable alternatives like the closure of mesenteric windows was investigated. Mesentery defects occur e.g. due to anatomic changes during gastric bypass surgery. If left untreated they may lead to internal hernia and small bowel obstruction. The newly developed method has the potential to close mesenteric windows time efficiently while enhancing the surgeon’s comfort. Risk assessment and further interviews showed that this application is safer and more accepted by surgeons which makes it a promising solution for hernia repair.
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Spinal cord injuries (SCI) occur when damage to any part of the spinal cord is sustained. Depending on what vertebrae segment the injury occurs, the patient will develop paraplegia or tetraplegia and have a complete or incomplete spinal cord injury. After sustaining a spinal cord injury, the patient must undergo rehabilitation.

For incomplete SCI patients, part of their rehabilitation is improving their mobility skills through gait training. To assess gait, the methods of the clinical eye and laboratory gait assessment are used. The starting goal of the project was to combine the quickness and easiness of conducting a gait assessment with the clinical eye with the objective data from a laboratory gait assessment into one system. This system consists of Xsens Awinda wireless motion trackers to collect the kinematic data and a user interface to view it.

User research was conducted in the form of questionnaires and focus groups. The research aimed to learn more about how physiotherapists and physicians within Rijndam Revalidatie currently assess gait, what features and parameters they would like in the user interface, and how they would prefer the selected parameters to be visualized (in numbers, graphs, or animations). Three physiotherapists and physicians were also interviewed to better understand the process incomplete SCI patients go through in gait rehabilitation and who is involved in each step.

From the results, a design direction and vision was created: “To develop an easy to use user interface that aids physicians and physiotherapists in selecting interventions for patients with incomplete spinal cord injuries in an objective and time efficient manner through intuitive data visualizations.”

Using design methods and tools, ideas for the data visualizations and the interface layout were formed, selected, and then made into concepts. The layout and visualizations concepts were evaluated through concept test sessions with physiotherapists and physicians. In the sessions, the interface layout was assessed in terms of usability and functionality. The data visualizations were evaluated based on if the participants, who had minimal pre-existing knowledge on gait analysis, could understand them. From the evaluation results, the final design of Gait Vision was created.

Gait Vision is an easy-to-use interface that allows physiotherapists and physicians to assess gait objectively and time-efficiently. It provides more accurate and objective information than can be obtained with the clinical eye, in a way that is more intuitive and comprehensible for clinicians with minimal gait assessment experience than laboratory gait assessment.

An interactive prototype of the final design was developed using Adobe XD. The interface prototype and the visualization concepts were evaluated through conducting individual user tests with seven physicians and physiotherapists. The interface and visualizations were tested with regard to usability, functionality, intuitiveness, and aesthetics. Overall positive feedback was received regarding the interface and visualizations. Testing was also conducted to compare gait assessment with the clinical eye versus with the interface. The interface was found to more objective than the clinical eye.

An implementation plan was developed to ensure Gait Vision survives in the long term. Future recommendations were also made to aid in the continuation of the development of Gait Vision. ... Read more

This document reports the exploration of the development of a context-specific strip reader for an innovative lateral flow test detecting schistosomiasis. Schistosomiasis is a common poverty-related parasitic disease in many Sub-Saharan African countries. Transmission happens in infested water, putting especially children at risk. Schistosomiasis can be effectively treated. In order to do that, accurate diagnostics are needed at the point of care to target communities at risk. Leiden University Medical Center is developing a lateral flow test that detects the antigen CAA with high accuracy, using upconverting particles. The test has great potential in terms of accuracy, but a dedicated reader is needed to interpret the test result. A reader typically limits the accessibility of a test in low-resource settings, because of its size, high costs, and limited user-friendliness and robustness. On the other hand, one could benefit from the opportunities that come with such a device, such as reducing human error, quantifying results, and real-time data collection. The starting point was to explore the possibilities of developing a context-specific strip reader dedicated to the new test. The approach of this project was based on systemic design methodologies. It deals with complexity by creating interventions that move the system to a more desired state in incremental steps. Transitions towards desired states were described on four different levels of abstraction. On a global level, we aim towards leaving no one behind, making healthcare accessible for everyone. Big forces, like climate change and COVID-19, and smaller forces, like stigmas and technological challenges, are risk factors that could steer change away from the desired direction Meanwhile, opportunities arise, such as the rapid digitization of Sub-Saharan Africa. From a systemic viewpoint, it became clear that new frames are needed to create a strong and attractive narrative for the role of strip readers in diagnostics. Based on the insights, an intervention strategy was proposed to accelerate the development of a context-specific strip reader by early involvement of stakeholders. The strategy consists of two elements. 1) Three new narratives are proposed as an alternative to the current, negative frame of the use of readers in low-resource settings. These narratives were used to formulate multiple development paths of different technical concepts. 2) The Block Reader was developed to support the narrative with evidence and as a means for collaborative prototyping. It enables to gain and share insights, and to communicate with stakeholders. The device is fully modular, allowing the user (developers) to iterate on the technology and user-interaction quickly. Lastly, an outline of the next steps is discussed. ... Read more

During the course of this thesis, the design of a knee brace that improves the quality of life for people with arthritis in the knee, is being researched. The knee joint is covered with articular cartilage which protects the bones from being damaged. Arthritis of the knee is a pathology where this cartilage is damaged potentially even to the extent that direct bone-to-bone contact occurs. The most common symptoms for the patient are pain and inflammation, affecting their mobility and quality of life. Firstly, research is conducted on the arthritis knee disorder, the patients and their interests, and the technical aspect of a knee brace in relation with the knee kinematics. The following main insights are revealed by the analyses: -Arthritis in the knee is wear and tear of the articular cartilage caused by loading. This can be the result of extensive sports, overweight, incorrect alignment of the joint or aging. -There are no treatments available that cure the damaged cartilage tissue. It is in the patient’s interest to slow down the deterioration process. When the disorder impacts the quality of life too much, replacement surgery can be opted for. -Replacement surgery is the last resort option due to its invasiveness, possible complications and high rate of dissatisfied patients. It is therefore preferred to delay the need for a surgery if possible. -The deterioration process can be slowed down by exposing the knee joint to less load. Partially unloading the joint can be beneficial during demanding activities or even daily activities, depending on the stage of arthritis. -A customized fit of the knee brace is preferred for increased comfort and effectiveness. Secondly, during the development phase, two main challenges are explored, being the custom fit of the brace and the unloading mechanism. To make a perfectly fitting brace design, many mock-ups are created and evaluated on their comfort and secure fit. The insights are translated into a standard model that can be shaped around the patient’s 3D scan of the leg. This experimental approach is also applied to find an unloading mechanism that can be integrated in the brace. The concepts are tested by attaching them to the brace mock-ups that were created when exploring the perfect fit. Thirdly, a design proposal is created, resulting in the LVATE brace that can be integrated in Orthobroker’s product-service platform. During the patient’s appointment with an orthotist, a 3D scan of the leg is made and uploaded to a digital platform. The platform morphs the LVATE brace around the 3D scan in such a way that it distributes pressure among tolerant zones of the leg. The brace can then be ordered right away. The unloading mechanism is activated by rotating a knob that is positioned on the lateral side of the brace. Finally, the brace is evaluated on its feasibility, desirability and viability. A conclusion is derived from the evaluation feedback and recommendations are prepared for a further development of the design proposal. ... Read more

The implementation of digital innovations is becoming vital in the provision of healthcare. Only this way, issues concerning employee decline and increased demand for care can be tackled. Furthermore, it is seen as the key towards Person Centered Care, a concept where patients and health professionals act as partners. Many digital multi user innovations have already been developed to a conceptual level. However, the cohesion between these concepts and their future potential is yet under researched. This projects aims to investigate both, with a new service model and service roadmap as a result. A service roadmap can be seen as a future timeline for the service model and its supporting elements. The project tried to answer the following research question: ‘How can service roadmapping enable an integrated service delivery using digital healthcare innovations?’ Orthopedic care was used as a case study for this research, based on 41 concept demonstrators aimed at improving the orthopedic care journey. To answer the research question, a concept demonstrator analysis was performed, focusing on function, user and technology. This analysis showed that most concept demonstrators contained a service model focusing on achieving patient self-management, by obtaining insight, in the form of an app-wearable combination. The user analysis showed that the patient, General Practitioner, Orthopedic surgeon and the Physiotherapist should be the multi user group. And finally, the technology analysis showed a need for technological enhancements in the concept demonstrator setup. Next to the concept research, research on the Orthopedic care context was performed, with special interest in treating hip Osteoarthritis. The research was focused on stakeholder explorations; both desk research and performing interviews in the field. Next to that, a trend research in both the socio-cultural and technological area was performed. This research highlighted the need for a shared learning aspect; both for the service users and the service itself. Furthermore, a need for enhanced personalisation, information and communication was found, with the preservation of the ‘human’ aspect. Based on this research as a whole, a selection of 13 concept features from the concept demonstrators was done. These form the basis of the service model. It consists of an patient app, on body wearable and a plugin for health professionals, making it a multi user service. The service model will focus on providing information and feedback to all users in a personalised manner, about the patient status within the Osteoarthritis treatment. Furthermore, it allows for digital communication to occur. Future adjustments are primarily focused on improving the back end of the service, by adopting shared learning with help of Artificial Intelligence. Ultimately, patient and health professional become partners in the Osteoarthritis treatment. To summarize both the drivers for innovation, the service model setup and the back-end enablers in the context of time, a service roadmap was developed. This roadmap can be used by the Smart Care Lab of the TU Delft to start further dialogue with stakeholders in orthopedic care, as well as a starting point for new research projects. ... Read more

This graduation project aimed to enhance the patient handovers at the Intensive Care Unit (ICU) by design based on experienced qualities and pain points by the ICU team, existing of doctors and nurses. At the ICU, care is delivered by multidisciplinary healthcare teams who strongly rely on teamwork and communication. Patient handovers are scheduled moments of communication, where information between different healthcare professionals is exchanged. However, there exists an unaccepted rate of unintended patient harm which can be attributed to failures in communication. These failures can be the result of educational, psychological, and organisational factors. To discover how design can overcome these failures in information sharing, observations and interviews within the ICU context were done. The aim of the observations was to understand and interpret the behaviour of ICU doctors and nurses throughout the day and during handovers. The purpose of the interviews was to get a deeper understanding of their personal experience with the different handover moments. The observations provided insights in the interactions between doctors, nurses, and both groups. Discovered communication breakdowns were captured in three different work models. The interviews revealed the experienced qualities and pain points during handovers. Altogether, both activities resulted in three ingredients which need to be considered while designing for enhanced handovers: information sharing, teamwork, and context.
Based on the findings, ICoon was developed in extensive collaboration with the ICU team. ICoon is a tool facilitating that the patient handovers are experienced as more effective and efficient. The tool exists of three different components: ‘overdragen’, ‘overhebben’, and ‘overzien’. ‘Overdragen’, allows that the complete ICU team will have the same expectations of each handover moment and entails that only relevant information is shared in an efficient way. ‘Overzien’ is an addition to the current Patient Data Management System (PDMS), allowing the ICU team to have a proper overview of the patient population on each unit and is supportive in efficiently handing over patients during shift changes. The last component, ‘over hebben’, will enable the ICU team to continuously reflect together on their handover process triggering organisational change. The last step of this design process was to elaborately evaluate ICoon with the ICU team. The aim of the evaluation was twofold: figuring out the added value of ICoon within the ICU regarding the experienced effectiveness and efficiency and assessing the support ‘overzien’ facilitates during patient handovers. Compared to the current situation, the ICU team agreed that ‘overdragen’ provides focus and structure, ‘overzien’ brings overview, and ‘over hebben’ can have a positive impact on the teamwork within and between the team of nurses and team of doctors. The concept ICoon in combination with the involvement of the ICU team resulted into tools and capacities for the realization of innovation at the ICU. The adopted human-centred design approach and engagement with the doctors as well as the nurses resulted into co-commitment of the ICU team, which turned out to be an important first step towards implementation of design solutions within the ICU. Therefore, ICoon turned out to serve as tool for transformation rather than a design solution only. ... Read more

This project is an initiative of the Department of Surgery in Maasstad Ziekenhuis. In the department, two types of patients undergo abdominal surgery: 1) mobile obese patients and, 2) patients with cancer. These types of patients need personal contact and guidance, especially patients with cancer. However, nurses are overwhelmed with work and utilize a great amount of their time to manually measure the vital signs of patients three times a day. These vital signs are heart rate, blood oxygen level, respiration rate, tympanic temperature, and blood pressure. The current method of measuring vital signs is highly inefficient and prone to error. Additionally, there is also a lack of an alarming system that can notify nurses when patients’ health condition deteriorates. Due to this, patient deterioration cannot be detected in time and complications cannot be avoided. When manual measurement of vital signs is digitalized, patients can be continuously monitored. Due to this, small changes in the patient’s health condition can
be detected and nurses can intervene immediately. Current wearable devices in the market do not meet the needs and wishes of the user group. Therefore, the initial goal was to design a wearable device that is able to continuously and noninvasively measure vital signs of patients, taking into account the level of comfort for patients and level of user-friendliness for nurses. After extensive research, conceptualization, and testing, one final proposal is presented: Omnivisi Earable, a compact and lightweight wearable device that can measure all aforementioned vital signs in a continuous and non-invasive way. Due to its small form, it does not limit patients from performing their daily activities. It is also user-friendly for nurses due to the lack of wires and extra modules. This makes it easy for nurses to attach the product on the patient's body. ... Read more