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Dutch Healthcare: An Overview and Application

Abstract from article: The Dutch healthcare system has changed towards a system of regulated competition to contain costs and to improve efficiency and quality of care. This paper provides: (1) a brief as-is overview of the changes for primary care, based on explorative literature reviews; (2) provides noteworthy remarks as for the way primary and secondary healthcare is organised; (3) an example of an E-health portal illustrating implemented processes within the Dutch context and (4) a proposed research agenda on various e-health topics. Noteworthy remarks are: (1) government, insurer, healthcare provider and patient are main actors within the Dutch healthcare system; (2) general practitioners (GP’s) are gatekeepers to secondary and other care providers; (3) the illustrated portal with a patient oriented design, provides access to applications implemented at care providers resulting in increased electronic availability and increased patient satisfaction; (4) a variety of fragmented information systems at health care providers exists, which leaves room for standardisation and increased efficiency. We end with suggestions for future research.

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Dutch Healthcare: An Overview and Application

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Perspectives on the Acceptance and Social Implications of Smart Glasses

Smart glasses were perceived to be potentially revolutionary for healthcare, however, there is only limited research on the acceptance and social implications of smart glasses in healthcare. This study aims to get a better insight into the theoretical foundations and the purpose was to identify themes regarding adoption, mediation, and the use of smart glasses from the perspective of healthcare professionals. A qualitative research design with focus groups was used to collect data. Three focus groups with 22 participants were conducted. Data were analyzed using content analysis. Our analysis revealed six overarching themes related to the anticipated adoption of smart glasses: knowledge, innovativeness, use cases, ethical issues, persuasion, and attitude. Nine themes were found related to anticipated mediation and use of smart glasses: attention, emotions, social influences, design, context, camera use, risks, comparisons to known products, and expected reaction and might influence the acceptance of smart glasses.

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Perspectives on the Acceptance and Social Implications of Smart Glasses

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Acne healthcare in the Netherlands

Acne vulgaris is considered one of the most common medical skin conditions globally, affecting approximately 85% of individuals worldwide. While acne is most prevalent among adolescents between 15 to 24 years old, it is not uncommon in adults either. Acne addresses a number of different challenges, causing a multidimensional disease burden. These challenges include clinical sequelae, such as post inflammatory hyperpigmentation (PIH) and the chance of developing lifelong disfiguring scars, psychological aspects such as deﬁcits in health related quality of life, chronicity of acne, economic factors, and treatment-related issues, such as antimicrobial resistance. The multidimensionality of the disease burden stipulates the importance of an effective and timely treatment in a well organised care system. Within the Netherlands, acne care provision is managed by several types of professional care givers, each approaching acne care from different angles: (I) general practitioners (GPs) who serve as ‘gatekeepers’ of healthcare within primary care; (II) dermatologists providing specialist medical care within secondary care; (III) dermal therapists, a non-physician medical professional with a bachelor’s degree, exclusively operating within the Australian and Dutch primary and secondary health care; and (IV) beauticians, mainly working within the cosmetology or wellness domain. However, despite the large variety in acne care services, many patients experience a delay between the onset of acne and receiving an effective treatment, or a prolonged use of care, which raises the question whether acne related care resources are being used in the most effective and (cost)efficient way. It is therefore necessary to gain insights into the organization and quality of Dutch acne health care beyond conventional guidelines and protocols. Exploring areas of care that may need improvement allow Dutch acne healthcare services to develop and improve the quality of acne care services in harmony with patient needs.

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Developing design ability for innovation in healthcare practices

In solving systemic design challenges designers co-create with professionals from various fields. In the context of innovation in healthcare practices, this study investigates design abilities that healthcare professionals develop by participating in co-design projects. We conducted a mixed-methods research approach consisting of five retrospective interviews with healthcare researchers involved in co-design projects, and a multiple case study (three cases) on the collaboration between design researchers and healthcare professionals. The three cases all aimed at designing tools for healthcare innovation. The cases differ in the healthcare context and the professionals involved: Paediatric physical therapists in the treatment of babies (0-2 years), supervisors (e.g. in assisted living) of people with intellectual disabilities, and academic researchers in social sciences and design research developing e-health applications for elderly people with early stages of dementia. Literature states that healthcare professionals may be competent in specific abilities related to design, but they are not trained to mode-shift and to use two different ways of working for creativity. We found that the healthcare professionals involved in co-design projects developed design ability over time, and that the research setting was supportive. Based on design abilities that the five healthcare researchers explicated in the interviews as having adopted, we suggest eight mode-shift practices related to design, which we investigated in the cases. Findings of the case-study show that two mode-shift practices related to design and innovation are difficult to adopt for healthcare professionals: Generate and synthesize; and keeping track on overview and details. These two design abilities require more training and/or experience than the other six design abilities that ran smoothly in the cases, if healthcare professionals were facilitated in the process. Healthcare professionals specifically relate two of these practices to design: Collaboration and slow down – sprint. This study discusses these findings by referring to an analogy of kayaking on a wild water river: The collaboration aspect of switching between working in a group and by yourself, like a group of kayakers who collaborate in going down stream a river but peddle by themselves in their own boats; the slowdown and sprint aspect, like kayakers who oversee the river in turning waters and sprint in between, rather than go with the flow in a raft.

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People 1

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Sarah Mbawa

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Projects 14

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CHIWAWA: Creatieve onderzoeksmethodes

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CHIWAWA: Creatieve onderzoeksmethodes

Wat dragen creatieve onderzoeksmethodes bij aan vernieuwing binnen de zorg? We onderzoeken dit binnen tien projecten van het Create Health-programma van ZonMw. In deze projecten wordt kennis ontwikkeld over de toegevoegde waarde van creatieve manieren van werken bij e-health innovatie. Informatie over de onderzoeksresultaten is te vinden op de website: husite.nl/creatieve-onderzoeksmethodes en het artikel: CHIWaWA maakt samenwerking in create-health onderzoek inzichtelijk | Hogeschool Utrecht (hu.nl)Doel Het Create Health programma heeft tot doel om bij te dragen aan maatschappelijke uitdagingen rondom gezond en actief ouder worden. CHIWaWA werkt daarbij toe naar een conceptueel model dat manieren van werken in kaart brengt in create health projecten – gekoppeld aan theorie over boundary crossing en research impact – met betrekking tot projectuitkomsten en kennis-, persoonlijke-, en systeemontwikkeling van betrokken actoren. Resultaten onderzoek Kennis die zowel online als offline te raadplegen is, in een boek, in wetenschappelijke artikelen en op een website. Deze kennis bevat: Inzicht in kansen om impact van e-health innovatie in ‘create health’-samenwerking te vergroten; Projectnarratieven met ‘best practices’ voor interdisciplinaire samenwerking waarbij onderzoekers, creatieve industrie en zorgprofessionals betrokken zijn; Guidelines voor ontwikkelaars van e-health applicaties m.b.t. samenwerking met de creatieve industrie; Guidelines voor beleidsmakers m.b.t. het stimuleren van samenwerking tussen zorg en creatieve industrie en het gebruik van creatieve manieren van werken om onderzoek naar de praktijk te krijgen; Aanpak Vanuit een service-dominant logic perspectief wordt bekeken hoe toegepaste kennis en skills worden gedeeld tussen actoren die betrokken zijn bij de verschillende ‘create health’-projecten, wat de meerwaarde daarvan is en wat actoren van die uitwisseling – als proces – leren. De focus ligt op co-creatie van waarde, die door samenwerking en uitwisseling tot stand komt. Door middel van procesonderzoek wordt er toegewerkt naar bijdragen aan theorieontwikkeling op het gebied van boundary crossing en contribution mapping. Resultaten Eindpublicatie: Create Health: Samenwerking tussen zorg, wetenschap en creatieve industrie (2023) Boek: Create Ways of Working. Insights from ten ehealth Innovation research projects (2022) Website www.creatieveonderzoeksmethodes.nl (2022) Bijdragen aan conferenties en symposia Co-design in de anderhalvemetermaatschappij (whitepaper), Dutch Design Week 2020. Download de presentatieslides. Collaborating in complexity. Strategies for interdisciplinary collaboration n design work, Design4Health conference 2020 Grounding Practices. How researchers ground their work in create-health collaborations for designing e-health solutions, Design4Health conference 2020 Seven ways to foster interdisciplinary collaboration in research involving healthcare and creative research disciplines, DementiaLab conference 2019 Posterpresentatie: Health x Design, DementiaLab conference 2019 Meer informatie over het Create Health programma Het ZonMw programma Create Health heeft als doel om bij te dragen aan de maatschappelijke uitdaging rondom gezond en actief ouder worden. Binnen het programma worden activiteiten uitgezet waarbij de samenwerking tussen de creatieve industrie en zorg en welzijn voorop staat. Het gaat hierbij om publiek-private samenwerking (PPS).

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ComfyHand

A feeling of worry, anxiety, loneliness and anticipation are commonplace in both medical and non-medical arenas such as elderly care. An innovative solution such as the ‘simple and effective’ comfyhand would offer better patient care and improved care efficiency with a high chance of long-term, economic efficiency. ComfyHand is a start-up in the healthcare sector that aims to develop sustainable products to improve patient wellbeing in healthcare settings. It does this by emulating the experience of holding a hand which gives the person comfort and support in moments where real human contact is not possible. Right now the comfyhand is in the development phase, working on several prototypes for test trials in elderly care and hospitals. In this project we want to explore the use of 3D printing for producing a comfyhand. Desired properties for the prototype include optimal heat transfer, softness, regulation of sweat, durability and sustainability. The goal of this study is to develop a prototype to test in a trial with patients within Envida, a care centre. The trial itself is out of scope of this project. This proposal focuses on researching the material of choice and the processability. Building on knowledge gained in a previous Kiem GoChem project and a Use Case (Shape3Dup) of a currently running Raak MKB project (Enlighten) on 3D printing of breast prostheses, several materials, designs and printing parameters will be tested.

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Developing a Hospitality Social Sustainability Accreditation Framework

The Dutch hospitality industry, reflecting the wider Dutch society, is increasingly facing social sustainability challenges for a greying population, such as increasing burnout, lifelong learning, and inclusion for those distanced from the job market. Yet, while the past decades have seen notable progress regarding environmental sustainability and good governance, more attention should be paid to social sustainability. This concern is reflected by the top-sector healthcare struggles caused by mounting social welfare pressure, leading to calls by the Dutch government for organizational improvement in social earning capacity. Furthermore, the upcoming EU legislation on CSRD requires greater transparency regarding financial and non-financial reporting this year. Yet, while the existing sustainability accreditation frameworks offer guidance on environmental sustainability and good governance reporting, there must be more guidance on auditing social sustainability. The hospitality industry, as a prominent employer in the Netherlands, thus has a societal and legislative urgency to transition its social earning capacity. Dormben Hotel The Hague OpCo BV (Dormben) has thus sought support in transitioning its social sustainability standards to meet this call. Hotelschool, the Hague leads the consortium, including Green Key Nederland and Dormben, by employing participatory design to present a social sustainability accreditation framework. Initially, Dr. David Brannon and Dr. Melinda Ratkai from Hotelschool The Hague will draft a social sustainability accreditation framework informed by EFRAG. Subsequently, Erik van Wijk, from Green Key Nederland, the hospitality benchmark for sustainability accreditation, and Sander de Jong, from Dormben, will pilot the framework through four participatory workshops involving hospitality operators. Later, during a cross-industry conference, Dr. David Brannon and Dr. Melinda Ratkai will disseminate a social sustainability toolkit across their academic and industry networks. Finally, conference and workshop participants will be invited to form a social sustainability learning community, discussing their social earning capacity based on the revised sustainability accreditation.

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eHealth, data protection and privacy

During the coronavirus pandemic, the use of eHealth tools became increasingly demanded by patients and encouraged by the Dutch government. Yet, HBO health professionals demand clarity on what they can do, must do, and cannot do with the patients’ data when using digital healthcare provision and support. They often perceive the EU GDPR and its national application as obstacles to the use of eHealth due to strict health data processing requirements. They highlight the difficulty of keeping up with the changing rules and understanding how to apply them. Dutch initiatives to clarify the eHealth rules include the 2021 proposal of the wet Elektronische Gegevensuitwisseling in de Zorg and the establishment of eHealth information and communication platforms for healthcare practitioners. The research explores whether these initiatives serve the needs of HBO health professionals. The following questions will be explored: - Do the currently applicable rules and the proposed wet Elektronische Gegevensuitwisseling in de Zorg clarify what HBO health practitioners can do, must do, and cannot do with patients’ data? - Does the proposed wet Elektronische Gegevensuitwisseling in de Zorg provide better clarity on the stakeholders who may access patients’ data? Does it ensure appropriate safeguards against the unauthorized use of such data? - Does the proposed wet Elektronische Gegevensuitwisseling in de Zorg clarify the EU GDPR requirements for HBO health professionals? - Do the eHealth information and communication platforms set up for healthcare professionals provide the information that HBO professionals need on data protection and privacy requirements stemming from the EU GDPR and from national law? How could such platforms be better adjusted to the HBO professionals’ information and communication needs? Methodology: Practice-oriented legal research, semi-structured interviews and focus group discussions will be conducted. Results will be translated to solutions for HBO health professionals.

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Epy Drost as a Living Lab

A world where technology is ubiquitous and embedded in our daily lives is becoming increasingly likely. To prepare our students to live and work in such a future, we propose to turn Saxion’s Epy-Drost building into a living lab environment. This will entail setting up and drafting the proper infrastructure and agreements to collect people’s location and building data (e.g. temperature, humidity) in Epy-Drost, and making the data appropriately available to student and research projects within Saxion. With regards to this project’s effect on education, we envision the proposal of several derived student projects which will provide students the opportunity to work with huge amounts of data and state-of-the-art natural interaction interfaces. Through these projects, students will acquire skills and knowledge that are necessary in the current and future labor-market, as well as get experience in working with topics of great importance now and in the near future. This is not only aligned with the Creative Media and Game Technologies (CMGT) study program’s new vision and focus on interactive technology, but also with many other education programs within Saxion. In terms of research, the candidate Postdoc will study if and how the data, together with the building’s infrastructure, can be leveraged to promote healthy behavior through playful strategies. In other words, whether we can persuade people in the building to be more physically active and engage more in social interactions through data-based gamification and building actuation. This fits very well with the Ambient Intelligence (AmI) research group’s agenda in Augmented Interaction, and CMGT’s User Experience line. Overall, this project will help spark and solidify lasting collaboration links between AmI and CMGT, give body to AmI’s new Augmented Interaction line, and increase Saxion’s level of education through the dissemination of knowledge between researchers, teachers and students.

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Ergotherapie en Do-It-Yourself technologie

In revalidatie-behandelteams zijn ergotherapeuten de ‘primus inter pares’ voor advisering over hulpmiddelen; hulpmiddelen die mensen met beperkingen ondersteunen bij activiteiten in zelfverzorging, onderwijs, spel, arbeid en wonen. Behoud van deze expertrol vraagt van ergotherapeuten om de nieuwste technologieën te integreren in de praktijk. Een snelgroeiende ontwikkeling betreft technologie waarmee men zelfhulpmiddelen kan ontwikkelen, maken of aanpassen. Zogenaamde do-it-yourself-technologie (DIY) met 3D-printing als bekendste voorbeeld. Revalidatie-ergotherapeuten van Adelante, Libra en Sevagram willen met DIY-technologie aan de slag om hulpmiddelen meer op maat, goedkoper en sneller te vervaardigen in nauwe samenwerking met hun cliënten. Onduidelijk is echter hoe een revalidatiedienst met DIY-technologie eruit kan zien, hoe deze in te bedden is in de dagelijkse praktijk, en hoe doorontwikkeling bewerkstelligd kan worden. Maken van hulpmiddelen met DIY-technologie past bij de identiteit van de ergotherapeut, maar vraagt om nieuwe werkwijzen en samenwerkingsverbanden om nieuwe kennis over techniek, ontwerpen en over materialen. Daarnaast spelen vragen van medische, financiële, ethische en juridische aard een rol. Met de ergotherapeuten kwamen we tot de volgende hoofdvraag: Hoe maken we als ergotherapeuten DIY-technologie, zoals 3D-printen, tot een integraal onderdeel van onze praktijk om met onze cliënten tot maatwerk-hulpmiddelen te komen? Deze vraag wordt binnen de drie centra, in vier fasen (analyse, design/testen, implementatie, doorontwikkeling) opgepakt met actieonderzoek als centrale methode en een diversiteit aan kwalitatieve en kwantitatieve manieren van gegevensverzameling. Partners in deze projectaanvraag (revalidatie-professionals, kennisinstellingen, brancheorganisaties, cliëntenorganisaties en ondernemers) zijn overtuigd dat DIY-technologie meerwaarde biedt voor het aanbod aan hulpmiddelen en invloed heeft op de eigen regie en participatie van cliënten. Met ondersteuning van hun uitgebreide expertise wordt de nieuwe dienst beschreven en wordt een toolbox DIY-technologie ontwikkeld en geïmplementeerd. Ook wordt een database voor zelfgemaakte hulpmiddelen en een DIY-community gerealiseerd. Deze kennis wordt gebruikt in het onderwijs van ergotherapie, Healthcare Engineering en Communication and Multimedia-Design.

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MOdelling Dynamic Lifecycle Impacts of Circular Procurement in Healthcare (MODLI)

The COVID19 pandemic highlighted the vulnerability in supply chain networks in the healthcare sector and the tremendous waste problem of disposable healthcare products, such as isolation gowns. Single-use disposable isolation gowns cause great ecological impact. Reusable gowns can potentially reduce climate impacts and improve the resilience of healthcare systems by ensuring a steady supply in times of high demand. However, scaling reusable, circular isolation gowns in healthcare organizations is not straightforward. It is impeded by economic barriers – such as servicing costs for each use – and logistic and hygiene barriers, as processes for transport, storage and safety need to be (re)designed. Healthcare professionals (e.g. purchasing managers) lack complete information about social, economic and ecological costs, the true cost of products, to make informed circular purchasing decisions. Additionally, the residual value of materials recovered from circular products is overlooked and should be factored into purchasing decisions. To facilitate the transition to circular procurement in healthcare, purchasing managers need more fine-grained, dynamic information on true costs. Our RAAK Publiek proposal (MODLI) addresses a problem that purchasing managers face – making purchasing decisions that factor in social, economic and ecological costs and future benefits from recovered materials. Building on an existing consortium that developed a reusable and recyclable isolation gown, we design and develop an open-source decision-support tool to inform circular procurement in healthcare organizations and simulate various purchasing options of non-circular and circular products, including products from circular cascades. Circular procurement is considered a key driver in the transition to a circular economy as it contributes to closing energy and material loops and minimizes negative impacts and waste throughout entire product lifecycles. MODLI aims to support circular procurement policies in healthcare organizations by providing dynamic information for circular procurement decision making.

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Editorials 1

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Taboes doorbreken op de Zwarte Cross

Products 1.614

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Dutch Healthcare: An Overview and Application

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Perspectives on the Acceptance and Social Implications of Smart Glasses

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