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.

Design education plays a crucial role in preparing students for professional practice, equipping them with the right tools to navigate the broadening field and practices of design. However, design education falls short when it comes to supporting design students in their personal-professional journey of becoming a designer.

Design students seem to struggle with articulating what they bring to the table, and knowing what their role can be within the field of design, or beyond. The fast evolving design field demands design practitioners that persist in working with complex (societal) issues and know how they can use their agency. Therefore, they have to stand strong, be resilient, and know how they can contribute with their specific qualities.

Knowing and understanding how these qualities can be of use in as a design practitioner is a powerful tool. However, design education seems to put emphasis on knowledge and skills, rather than discovering those personal qualities. The truth is that design education cannot fully prepare students for the future, since we do not know what it holds. This does not mean that we should miss the opportunity to deliver the best design students that feel empowered and have the agency to reach their full potential as design practitioners.

Therefore, this thesis proposes educational tools that can be used to support students with their personal-professional journey in becoming the desired designer they aspire to be. The tools proposed in this report consist of multiple principles and a video that can guide students in this journey. While the principles helps in discovering students’ unique set of qualities, the video helps them in showing the urgency to work on their personal journey.

By supporting design students in their authentic identity formation, ID education can better prepare students for their professional journeys. By implementing the proposed interventions students can be supported with their transition from novices to competent professionals.

This thesis explores combining Extended Reality (XR) with traditional co-creation methods to construct a unique and integrative design facilitation method named XR+. The XR+ method is intended to be used at the German Aerospace Center (DLR) to aid in the process of innovative cabin design. However, the method is not limited to cabin design and can be applied to various design cases.

This method came to be by uniting a multitude of factors, namely: The Flying-V aircraft, galley design, traditional co-creation methods and the immersive potential of XR technology. The choice to work with the Flying-V aircraft as a case study was intentional. The absence of a predefined galley design presented a unique opportunity to develop and test the XR+ method. 

Design, in this study, leans heavily on the collective problem-solving capabilities brought to the table by participants when engaging in co-creation. This is key for addressing issues too complex for individuals alone. It resonates with the insights of Sanders & Stappers (2006), who highlighted a shift in the design process towards collective, future-oriented design practices. Given that XR has gained significant popularity in recent years and found its way into the design world, it seems pertinent to explore how this technology can be combined into a method with these collective, future-oriented design practices. The first step for this was taken by DLR in a paper exploring XR for the cabin design process. 


The journey towards a design method combining co-creation and XR were significantly influenced by collaborating with KLM cabin crew. In total, five co-creation workshops were held, each dedicated to galley design for the Flying-V, and each serving as an iteration to refine and integrate the XR+ approach within co-creation methodologies. 

The workshops highlighted the unique strengths of both traditional co-creation and XR. As part of traditional co-creation, participants found physical elements, like blocks, easy to use and effective for initiating conversation and generating ideas. Once these initial concepts were built using 1:20 scale physical objects, the immersive environment of XR was introduced to further explore these concepts on a 1:1 scale. After immersing in XR, practical aspects of the initial physical design were brought to the forefront. Additionally, XR created a new spark of engagement and new creative possibilities were opened up, especially when participants took turns being in XR, creating a sense of curiosity in the non-immersed participants and wanting to be part of the immersion. Taking turns immersing led each participant to build on to the idea of the previous participant, each participant ‘hitchhiking’ onto each others’ ideas.

It was found that where idea generation stops in the physical world, it continues in the virtual world—highlighting the unique strengths of both traditional co-creation and XR.
The conclusion of this research presents a guide for DLR and other design stakeholders to integrate XR+ into their design processes and to use as an add-on to their current practices. 
Integrating traditional co-creation elements with XR stimulates ideation, deepens understanding of user needs, and leads to the discovery of innovative design solutions.

The aim of this research was to investigate if and how the project performance of integrated construction projects can be improved by focussing on empathy during the preconstruction phase. Big infrastructural construction projects often face a poor project performance which causes the sector is aimed at searching for strategies to deal with this. Looking at what drives project success it is said the people involved and their competences are main factors of influence. These people need to integrate working processes and collaborate with each other to successfully deliver the project. Experiences from practice and a literature review resulted in a strong expectation that especially the competence empathy is important to this in construction projects. This would be important during the preconstruction phase in specific to support the alignment and integration between project team members. The research focusses hereby on the preconstruction phase of integrated construction projects and follows the Integral Project Management (IPM) structure to describe the structure of construction project teams. Empathy is defined as ‘the ability to understand and share the feelings of another’. The research adopts a difference in internal empathy ( = empathy between people within the project organization) and external empathy (= empathy with the client and/or stakeholders).

The research first investigated in interviews with experts from the industry if and where during the preconstruction phase it would be important for the involved people to be empathic. Second the empathic ability of a construction project organization has been measured to indicate how empathy is distributed across project participants. The results showed that the construction professionals on average score low on empathic competence and that in certain situations it would be important for project participants to be empathic for a good project outcome. This results in a gap in the construction sector between required empathy and actual empathic competence which demonstrates there’s room for improvement in this area.

Based on the results of the research it seems that the project performance of integrated construction projects can be improved by focussing on stimulating more empathy between client and contractor and towards stakeholders during the preconstruction phase (= external empathy). Especially in the relationship between client and contractor there’s room for improvement as there’s a gap in required empathy of the contractor. The reason that the performance of construction projects can be improved via external empathy is that when looking at what mostly causes projects to perform badly, it is said this is often related to a bad collaboration between client and contractor and/or insufficient involvement of stakeholders. The research results also showed that project performance can be improved by focussing on stimulating more empathy internally in the project organization within teams and between people from different disciplines. However, this has a lower effect on improving the performance of the project compared to stimulating external empathy. The research finally presents The Empathy Framework as a recommendation for the construction sector to be used as a strategy to improve project performance via empathy.

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.

Het huidige systeem rondom schulden biedt weinig ruimte voor een menselijke aanpak en dus voor het aansluiten op de behoeften van het individu. Dit heeft een slecht mentaal functioneren door stress als gevolg. Daarnaast zorgt het ervoor dat je gedrag meer aangestuurd wordt door emotie, wat kan leiden tot een grote stapel ongeopende enveloppen en het verzwijgen van schulden. Door beide redenen hebben veel mensen met schulden het gevoel dat ze niet meer deel kunnen nemen aan de maatschappij. In sommige gevallen leidt dit tot sociale isolatie en depressie. Dit alles wijst naar het taboe dat bestaat rondom schulden, wat ervoor zorgt dat veel schulden onzichtbaar blijven voor bijna iedereen. Het doel van dit project is daarom het ondersteunen van mensen met schulden bij het doorbreken van het taboe, door hun persoonlijke behoeften te beantwoorden. Waardoor uiteindelijk al deze negatieve consequenties kunnen afnemen. In het onderzoek heeft de persoon met schulden telkens centraal gestaan. Het onderzoek heeft zich gefocust op de wijk het Oude Noorden in Rotterdam, omdat 21% (Idem, 2016) van de huishoudens in deze wijk problematische schulden heeft. Daarnaast is de wijk aan het gentrificeren, wat een diversiteit in cultuur en inkomen als gevolg heeft. Daarom moet men behoedzaam zijn voor de verdringing van oorspronkelijke bewoners of conflicten tussen beide groepen. Uit dit onderzoek blijkt dat mensen met schulden het gevoel hebben geen erkenning te krijgen voor hun problemen en bestaan als persoon, bijvoorbeeld van hulpverleners, kennissen of buurtgenoten. Ook moeten zij vaak al hun autonomie uit handen geven wanneer ze hulp krijgen, hoewel het over belangrijke beslissingen gaat. Daarnaast verliest iemand het vertrouwen op zijn kunnen en is er tijdens het oplossen van schulden vaak weinig mogelijkheid tot het ontwikkelen van nieuwe competenties. Daarnaast blijkt dat er een mentaliteitsverandering nodig is, om ervoor te zorgen dat het taboe doorbroken kan worden. Daarom focust dit project zich op het teweegbrengen van een mentaliteitsverandering bij buurtgenoten en tegelijkertijd op het vervullen van de 3 fundamentele psychologische behoeften die mensen met schulden op dit moment missen: competentie, autonomie en erkenning. Dit alles wordt bereikt met het concept DEBT. Dit concept biedt de debiteur een podium om erkenning te krijgen voor zijn problemen door de nadruk te leggen op zijn eigen kracht. Het concept begint met een creatieve workshop waarin mensen met schulden brainstormen over wat ze allemaal kunnen doen met hun oude enveloppen die ze krijgen. De productideeën die in de workshop bedacht zijn worden uitgewerkt tot design producten, gemaakt van bijvoorbeeld belastingdienst of gemeente Rotterdam enveloppen. Om deze producten heen wordt vervolgens een campagne georganiseerd gericht op yuppen in de wijk het Oude Noorden. Door het in aanraking komen met de campagne, lezen zij het verhaal van een wijkgenoot met schulden. Dit zorgt ervoor dat ze uiteindelijk anders over hen gaan denken en zich meer betrokken voelen. Door DEBT. voelen mensen met schulden zich weer sterk genoeg om over hun schaamte heen te stappen en zo samen het taboe rondom schulden te verbreken.

Residential housing has to become more sustainable to meet global energy goals (Silvester et al., 2017), yet the challenge is to integrate the refurbishments that reduce energy with the way people live. The context of this project is the 2ndSKIN project, which refurbishes houses to become zero energy. Zero energy houses are more airtight as a result of improved insulation, therefore ventilation becomes increasingly important. Yet, residents struggle to integrate the new balanced ventilation system into their practices. Residents use the system different from how it is intended. This does not only impact energy goals (Behar & Chiu, 2013) but can also result in decreased comfort and unhealthy situations. Hence, the aim of the project is to support residents to transition their practices in zero energy homes. The project first described the practice of maintaining indoor air quality to identify points that hinder a transition of the practice. Insights show that the lack of feedback of the ventilation system makes residents insecure and makes it hard to understand the system. Besides, associations that mismatch the new material make residents reluctant to use the balanced ventilation systems. In the concept phase, I generated ideas to improve feedback and foster desirable associations with the ventilation system. Through the iterations, I learned feedback on functioning and on the systems’ activity helps residents. It helps them to trust the system is working, understand what the system is doing and develop appreciation for it. The final concept is the feedback fan. This add-on to ventilation valves spins on the supplied air. In a natural way, it provides residents with feedback. An evaluation proved that with increased feedback, residents are able to incorporate the system in their daily routines and even align their own actions to the systems’ activity. Future steps are to make a solid prototype and develop the service around it. Besides, future design projects can continue on other identified points that hinder the transition of practices. Moreover, insights about feedback of the ventilation system and the practice of maintaining indoor air quality will be valuable, when designing future ventilation systems. In conclusion, both the final design and the insights of the project can contribute to a transition of residents’ practices zero energy homes.

The U_CODE (Urban Collective Design Environment) project started to create an environment for urban co-creation with citizen. To achieve this, U_CODE has designed and developed a new kind of participatory platform for different European countries. To have an effective co-creation session, U_CODE facilitators need to have a good knowledge and understanding of different culture and values that can affect the co-creation sessions. The purpose of this project is to design guidelines for Super Moderators (SuMo) in U_CODE project to facilitate the co-creation sessions in the Netherlands, Germany, and France. First, I reviewed the literature to find the cultural differences in three countries based on available cultural dimensions models. Then, I made a blueprint for co-creation sessions using U_CODE documents and interview I had with U_CODE specialist. Adding the cultural differences to the blueprint, I made guidelines for each of three countries, which was validated by professional facilitators. Then, I ideated some concepts to find the most effective interaction between the guidelines and facilitators. I tested the concepts with interaction designers who had an experience in facilitating co-creation sessions. Based on the feedbacks and the company’s priority, I designed an app for the guidelines. Finally, I evaluated the final design with a culture professional, an international facilitator and a corporate facilitator. This report is concluded with a discussion and a list of limitations and recommendations for this project.

Empathy is an essential part of a collaboration and is often referred to in the design field. Not only it helps designers to step into their users’ shoes, but it also smoothens the communication between the designer and their stakeholder, client and, team members. If empathy is so important for collaboration in design and establishing human-centered working alliances, how come, then the focus is mainly on the user research and how come designers are not taught of the related skills, attitudes and behaviors? The gap in the design education field about empathy training for professional contexts creates an opportunity for design. In this project based on knowledge from multidisciplinary literature review, the following design goal has been formulated: designing a training material which can be used in the educational setting by design educators & coaches to help design students increase their awareness of the six key attention points of empathy as a design skill.’’To create the basis of the training material, a long list of skills, attitudes and behaviors related to empathy is structured from fields of healthcare, human-centered therapy, business, social and positive psychology and design. Then, in collaboration with the design educators and design students from the Delft University of Technology, the long list has been scaled down to six key attention points; willingness, active listening & attending, open-mindedness, embracing differences, sensitivity and holistic view.With the inspiration of training methods used in above-mentioned fields, these six attention points are used in the ideation rounds as the basis of the training concept. After several iterations, the concept is refined and tested with design students. ‘‘Empathy as A Design Skill : Practicing Six Key Attention Points’’ is a training material set consisting of printable materials which are designed to be used during the five steps; describe, internalize, sensitize, apply and evaluate. Each attention point is described with examples, internalized with exercises and the students are sensitized with homework each week. After six of the attention points are introduced, a real-life interview is arranged as a means of applying the six attention points. This interview is asked to be video recorded which is used for the final step; evaluate in which the design students are asked to reflect on their performance. The final test for user evaluation with design students reveals that this self-reflective training material helps design students to be more conscious of the attention points then, recognize these points both in their professional life and their daily lives.

People with diabetes who are treated with an intensive insulin treatment have to manage their disease independently. The success of an intensive insulin treatment is dependent on the ability of someone to determine his carbohydrate intake: when you know how much carbohydrates you eat, you know how much insulin you have to inject. However, determining your carbohydrate intake is experienced as ambiguous, complex and confusing. This assignment focuses on people in an intensive insulin treatment who have to enter the grams of carbohydrates that they are about to eat into a blood glucose meter.

Research shows that people need more support at home to be able to learn to determine their carb intake than is currently offered. Four design research cycles uncovered how and when people need extra support the most. A final design proposal is made that trains people with diabetes in intensive insulin therapy in estimating their carb intake by supporting them with exercises and insights so they can learn to intuitively apply their knowledge and skills.