The goal of this project was to design an affordable,
body-powered hand prosthesis that restores functionality after a partial hand amputation, enabling users to perform activities of daily life. The design particularly focuses on supporting soldiers and enhance their rehabilitation. Currently, options for individuals who lose their hand up to the MCP joint are limited. Well functioning prostheses are often too expensive, and insurance coverage is most of the times unavailable. Even when insurance is available, long waiting times and dependency on prosthesis companies for repairs increases the burden.

With the increasing number of partial hand amputations, particularly due to global conflicts, the need for affordable prostheses is urgent for soldiers. However, effective solutions remain limited. This project addresses this gap by creating a prosthesis that meets these needs.

The result of this project is a modularly designed prosthesis that is simple to repair instead of replacing the entire prosthesis. This feature ensures that repairs can be done anywhere and by anyone, thanks to the 3D printing production technique used. Unlike traditional prostheses that require specialist manufacturing, this prosthesis can be produced locally, making it more affordable and accessible. This prosthesis is the first step towards a hand that supports tripod and power grips. The newly designed finger mechanism enhances freedom of movement by representing an innovative approach to body-powered prosthetics.

The development of this concept involved multiple design phases. Throughout the project, an iterative process was followed, continuously integrating expert feedback to create a prosthesis that offers a new approach to prosthetic design.
The frame phase included a literature review, expert consultations, interviews with an occupational therapist, and patient observations, which provided valuable insights. These insights were integrated in the ideation phase, where nine design directions were explored based on the desired product’s sub functions. Two concepts were chosen, tested and refined and one concept was selected for further development. In the embodiment phase, each component of the prosthesis was detailed, integrated, and tested, resulting in a final design and prototype. The prototype was evaluated compared to the design requirements which led to positive results. Nevertheless, the amount pinch force could be improved.

The conclusion after this project is that the design is promising, but improvements are needed. Recommendations for next steps include testing the prosthesis with people who have a partial hand amputation to gain more insight and refine the design. The future implementation of this prosthesis depends on the outcomes of these tests.

Cardiovascular diseases (CVDs) are the leading cause of death globally with 33% (Dattani et al., 2023). Unfortunately, cardiovascular research has been primarily performed on men over the centuries (Wittekoek, 2017). It was not until the 1960s that more research was conducted on the female heart (Hartstichting Nederland, 2024). This was urgently needed, as heart conditions are responsible for more fatalities in women than in men, and the specific symptoms express themselves differently across gender (Wittekoek, 2017). Something else that doesn’t help is that cardiac analysis and -monitoring systems are predominantly designed with male physiology in mind (Market Analysis, 2024). This gap in care calls for a solution that is inclusive, user-friendly, and effective for all users, regardless of gender.

Whenever someone – male or female – suspects something is wrong with their heart, a general practitioner (GP) is consulted. Yet here, another problem arises. GPs often encounter patients with symptoms like palpitations, dizziness, or fatigue. To disclose whether the patient could have a suspected intermittent arrhythmia – such as atrial fibrillation, bradycardia, supraventricular tachycardia, ventricular tachycardia, or second- or third-degree atrioventricular block – long-term ECG tracking is often needed. However, as traditional ECG Holters are typically worn for only 24 to 72 hours, most of the conditions mentioned may not be detectable with such short-term ECG monitoring.

The company Diplora B.V. aims to address this need by developing an intelligent AI-driven ECG system where a sensor continuously collects 3-lead ECG input and reconstructs a 12-lead ECG for deeper clinical insights. By streamlining arrhythmia detection and providing actionable, real-time insights, the system empowers GPs and intermediate care providers to make confident, informed decisions regarding treatment or specialist referral. This innovation improves diagnostic accuracy, enhances early intervention, and contributes to better patient outcomes.
To embody this AI system, and to redesign the traditional ECG Holter, the project focused on three goals:

Primary goal
“Redesigning a wearable ECG device, prioritising user confidence, optimised for a reusable, two-week wearing period”

Side objective 1
Optimise the overall interaction of the app & process of application of the device and patch. This, to also support and empower the users confidence during the interaction.

Side objective 2
Explore strategies for repair, reuse and recycling and incorporate these findings in the main objective.

The research was structured around four pillars: product requirements, optimal placement, user needs, and sustainability. These pillars formed the foundation for the iterative design process, which focused on six key themes: comfort, attachment, application, adjustability, feedback, and practicalities. Confidence emerged as the overarching topic, tying these themes together, ensuring the final design addressed both physical and psychological user needs. With the created personas Edith and Emily in mind, multiple iterations were tested with diverse user groups.

Key findings from the research and iterative phases revealed critical insights into user behaviour and design requirements. Participants highlighted the importance of clear feedback mechanisms, intuitive application methods, and designs that accommodated diverse body shapes. Comfort and attachment were important in ensuring long-term wearability, while the use of sustainable materials and modular components was evaluated for environmental impact reduction.
The final design integrates all these insights into a solution combined of three main components: the device, the patch, and the app / manual. The device features a durable and waterproof casing, designed for comfort and effective placement. The patch is made from a Mepitel One-inspired material, ensuring secure attachment and user comfort. The app provides intuitive guidance for the device setup and monitoring, emphasising on confidence and usability. Together, these elements form a system that addresses both functional and emotional needs.

Moving forward, several recommendations have been identified to ensure the project’s success. The device proves to be desirable, as shown by positive user feedback, but some additional refinements could benefit the feasibility and viability of the product. Manufacturing processes must be optimised for cost efficiency, the patch requires additional iterations to improve durability and adhesion, and clinical testing under MDR guidelines remains necessary. The FMEA analysis identified potential risks that need addressing, considering the device, patch and overall system. A roadmap has been developed to guide future steps, with short-, mid-, and long-term goals on the horizon.

A positive digital patient experience can improve health and care outcomes, but a positive digital patient experience does not just happen; it refers to understanding, evaluating, and improving the entire patient journey through digital health. Human-centered design is often applied to understand patients’ needs and improve patient experiences when designing digital health solutions. However, human-centered design for digital health is demanding. It often involves multiple stakeholders with different values and requires evidence for implementation. Patient perspectives routinely differ from those of other stakeholders. Even within the same patient group, individual situations are also often different from each other. Yet, it is not always apparent that patients were engaged in the design process and were empowered enough to voice their opinions. Listen to the patients’ voices and uncover their unique needs; designers are expected to speak for patients. This thesis aims to support designers in improving the quality of care in digital health by defining, evaluating, and designing digital patient experiences. This thesis is divided into three parts to achieve this goal.

Part A: defining digital patient experiences
To build a common understanding of digital patient experiences among design, technology, and healthcare communities and to facilitate transdisciplinary knowledge exchange and learning between these different fields for driving digital health innovation, this part contains one chapter and focuses on defining digital patient experiences. In chapter 2, we proposed the term “digital patient experience” as a common phrase to describe the patient experience in digital health and defined “digital patient experience” by synthesizing the reported patient experience or user experience of varied digital health interventions from multiple reviews. Specifically, the concept of the digital patient experience was defined as “the sum of all interactions affected by a patient’s behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channelling digital health.” In addition, we identified information on influencing factors and summarized them into 9 categories (i.e., patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment). These categories were classified into positive, negative, and double-edged factors based on their positive, negative, or dynamic impacts on digital patient experiences. Furthermore, we uncovered 4 design constructs (i.e., personalized, information, navigation, and visual design) and 3 common design methods (i.e., user-centered design or human-centered design, co-design, and inclusive design) as design considerations for addressing digital patient experiences. Finally, we proposed a framework and 9 design guidelines to help digital health designers and developers improve digital patient experiences throughout the entire design process.

Part B: evaluating digital patient experiences
In the second part, we discussed the importance of evaluating digital patient experiences, developed an evaluation guide to help digital health researchers, designers, and developers further evaluate digital patient experiences, and conducted a case study to evaluate digital patient experiences in a clinical setting. Following the research findings of Chapter 2 on defining the digital patient experience, in Chapter 3, we first identified five typical evaluation objectives and related stakeholder groups. We then described potential evaluation timing considerations in terms of 4 intervention maturity stages and 3 evaluation timings. We also collected knowledge on evaluation indicators of digital patient experiences and grouped them into 3 categories: intervention outputs, patient outcomes, and health care system impact. These were then classified into 9 themes (i.e., intervention functionality, usability, care quality, patient emotional outcomes, perceptual outcomes, capability outcomes, behavioral outcomes, clinical outcomes, and system economic outcomes) and 22 subthemes. Furthermore, we noted a set of common study designs, data collection methods, and instruments, as well as data analysis methods, that can be used or adapted to evaluate digital patient experiences. To facilitate the standard evaluation of digital patient experiences, we recommend 6 directions for further research on digital patient experience evaluation. In Chapter 4, we conducted a prospective observational study to evaluate digital patient experiences of using virtual reality distraction in wound care for pain management. This chapter can be used as an example for guiding digital health designers and developers to evaluate digital patient experiences in clinical settings. It also offers inspiration to improve the design, development, and implementation of the virtual reality distraction in wound care for better digital patient experiences. For example, We found that patients who had high levels of technology acceptance, pain during previous wound care, or previously used VR distraction in wound care were more willing to use VR distraction in wound care. These findings indicate patient behavioral determinants have an influence on their intention to use digital health solutions, which supports our findings in Chapter 2 that patients’ behavioral determinants influence patient perceptions of using digital health. In addition, in Chapter 4, no evidence was found on the effectiveness of virtual reality distraction in significantly reducing pain or anxiety during wound care. Although many studies have indicated the effectiveness of using virtual reality distraction in wound care for pain management, our research results do not support this argument. To avoid ineffective digital health implementation, we encourage more rigorous research on investigating the effectiveness of virtual reality distraction in wound care or how to improve its effectiveness through design. Besides, on average, the digital patient experience and patient satisfaction with using virtual reality distraction in wound care were positive, which reveals that although digital health solutions do not always lead to a significant better health outcome, they can contribute to a better treatment experience, which is also very valuable.

Part C: designing digital patient experiences
In the final part, we focus on guiding the design of digital patient experiences. We investigated the general human-centered design process in digital health and synthesized all research findings to generate a web-based design guide to support the understanding, evaluation, and improvement of digital patient experiences. In chapter 5, we mapped the (re)design and continuous improvement processes in digital health into 8 stages and grouped them into 4 phases: preparation, problem-thinking, problem-solving, and implementation. We also identified 12 challenges and classified them into 4 categories: contextual, practical, managerial, and commercial challenges. Furthermore, we outlined 8 corresponding strategies, recommended by the participating designers, to address each challenge type. Finally, we created a framework including design deliverables, activities, involved stakeholders, design challenges, and related design strategies for each design stage. The framework not only aids designers in understanding the design practices in the healthcare industry but also guides them when managing their digital health design processes towards the improvements of digital patient experiences. In chapter 6, we presented a web-based digital patient experience design guide that synthesized the previous research findings, and we further evaluated the design guide. We show that our digital patient experience design guide was evaluated as usable with good content quality, but that it needs further improvement in providing relevant, detailed, and resourceful content, intuitive and interactive interfaces, as well as simple and ready-to-use templates. We believe these improvement insights are relevant for developing and evaluating design guides in general. In addition, participants reported conflicting tensions in the guide’s design, requiring a balance between specific and general, less and more, as well as fixed and flexible. These tensions reveal the diversity and conflicts in students’ needs for useful and effective design guides. On the one hand, users want design guides to hold relevant, detailed information and content, provide a systematic overview, include complete conceptual explanations, detailed design cases, and integrated design resources, enabling them to use the design guide as a resource library for flexible exploration. On the other hand, they want a design guide to be simple and easy to use, offering concise and clear information with low learning and usage costs, enabling them to effortlessly complete efficient designs. We believe this study serves as an example, inspiring future design researchers to develop and evaluate their own design guides.

In conclusion, this thesis contributes theoretically (via new knowledge) and practically (via the design guide) to facilitate a scientific impact on the definition, evaluation, and design of digital patient experiences from a human-centered design perspective, thus, supporting the improvement of the quality of care in digital health solutions.@en

With an increasing population and more prevalent staff shortages in healthcare, digital technologies can play a crucial role in bridging the gap to deliver value-based healthcare. Therefore, any additional service integrated into their workflow must either enhance efficiency in delivering care or add significant value to the care provided. Anything less would not align with their context of use and, consequently, would not effectively reach the end-user (patient).

As a market leader in joint arthroplasty, Zimmer Biomet introduced the mymobility care management platform. This platform offers remote patient monitoring, personalized care plans, telehealth services, and real-time data analytics to enhance patient engagement and streamline healthcare delivery. However, the adoption rate of this platform remains low, particularly when compared to the company's broader success in the implant market.

Through an analysis of quantitative patient outcome data and demographic data related to its use, it was found that one of the primary barriers to adoption was the low eagerness among healthcare professionals (HCPs) to use the care-management platform.

By leveraging the usage data currently collected by Zimmer Biomet and conducting qualitative inquiries, barriers to adoption were identified and opportunity areas were mapped. These insights led to the creation of a strategic roadmap designed to boost the adoption of the mymobility platform over the next five years.

This project aimed to facilitate information support between clinicians and patients that is dynamic to the milestones in their care path and can be incrementally adapted to different chronic diseases at ErasmusMC. The project strived to envision a foundational service that informs holistically about the doubts and concerns of patient communities throughout their care journey and can be progressively incorporated into clinicians’ workflows.

Research was done to find patterns between the online patient stories from community support forums and to identify value opportunities for intervention that align with the clinicians’ aspirations, motivations and needs. The research activities included:

Desk research of relevant literature (Chapter 2).
Contextual inquiry through a combination of human interpretation of patient experience data and computational analysis (Chapter 3).
Co-creation sessions to gather information about opportunities for improving information support from a data-enabled design perspective (Chapter 4).

The data categories derived from the contextual inquiry were used to map transactional services in the online patient support groups and ideate on new transactional services for the context of remote patient monitoring. The co-creation sessions inspired a service vision and a set of guiding principles that were used to conceptualise a service system for information support, which could improve the curation of patient support knowledge resources. It was decided to focus on information support among the different types of social support due to the co-exploration of the data categories with clinicians.
Ideation on a service system enabling dynamic and incremental information support resulted in three essential modules or features of the service system:
The first module, dynamic guidance, enables Erasmus MC to use recurrent milestones in the personalised care plan of patients to standardise the provision of information resources in templates. The patient community could progressively rate the usefulness and clarity of such resources to provide recommendations to the rest of the patient community.
The second module, PX data collection, offers the efficient collection of patients’ self-reported concerns and doubts for internal system and content improvements.
The third module, community appraisal, discusses how the development and moderation of conversations among peers could not only facilitate patients’ self-evaluation and emotional support but also the periodic research of shifting or uncovered areas of concerns, experiences and doubts among the patient community.
The interconnections between these modules have been conceptualised through a service blueprint, which was presented to ML and AI researchers to refine the supporting software processes.
These service features or modules could strategically be developed and implemented within existing eHealth applications within specific departments or in a foundational self-monitoring application for ErasmusMC that is shared by different departments (e.g., surgical oncology, pulmonology).

Outcomes
Thematic categorization of patient experience data has been established, which can be used to cluster results of unsupervised topic modelling for other patient communities and compare the results. A better understanding of guiding principles to design data-enabled services and systems, which facilitate information support for patient communities, has been achieved. A service system is proposed to standardise and incrementally fine-tune resources for different patient communities. Future developments are envisioned which encompass state-of-the-art machine learning techniques and interface/service design.

This thesis, titled "Designing for the Wellbeing of Healthcare Professionals: Using AI to Reduce the Administrative Load of Healthcare Professionals & Improve Their Job Satisfaction," explores the critical issue of healthcare professional wellbeing. It delves into the factors affecting their job satisfaction and the potential of artificial intelligence (AI) to alleviate administrative burdens. This research is part of a Master's graduation project in Strategic Product Design, specializing in Medisign, at the Faculty of Industrial Design Engineering, TU Delft.

Key Findings
The study identifies three major domains impacting the wellbeing of healthcare professionals: efficiency of practice, culture of wellness, and personal resilience. Efficiency of practice is influenced by workplace systems and processes, such as electronic medical records. Culture of wellness encompasses the values, attitudes, and behaviors within an organization that promote self-care and growth. Personal resilience refers to the skills, behaviors, and attitudes contributing to an individual's physical, emotional, and social wellbeing.

The research employs a desk research methodology, followed by semi-structured interviews with healthcare professionals, to explore these domains further. The findings highlight the importance of job demands and resources, including social support, skill utilization, autonomy, and job security, in influencing healthcare professionals' wellbeing.

Conclusions
Wellbeing in healthcare professionals is a complex interplay of job demands and resources, with significant implications for patient care quality and healthcare system vitality. The study underscores the need for a supportive work environment that fosters professional fulfillment and engagement. It also points to the potential of AI in reducing administrative burdens, thereby improving job satisfaction among healthcare professionals.

Recommendations
The thesis recommends focusing on enhancing the efficiency of practice, fostering a culture of wellness, and supporting personal resilience among healthcare professionals. It suggests that strategic product design, particularly through the implementation of AI, can play a crucial role in achieving these objectives.

Impact & future work
This thesis aims to make a valuable contribution to the healthcare sector by identifying ways to improve the industry from within. It hopes to inspire designers, policymakers, and healthcare professionals to prioritize the wellbeing of healthcare workers, recognizing their essential role in delivering high-quality patient care.

Haptic perception serves as one of our primary interfaces to the physical world. Without it, our ability to understand and respond to a world full of objects and physical beings would be profoundly impaired.
This dissertation addresses how we reconstruct perceptual representations from the mechanical inputs that occur during haptic interactions. It focuses on the behaviorally relevant information that allows the somatosensory system to achieve its goals, such as enabling the exploration and dexterous manipulation of objects.
The dissertation covers fundamental concepts related to the emergence of stable haptic percepts and presents a series of experimental studies spanning topics from contact detection, through texture and material perception, to the perception of time during haptic interactions. The studies reveal several fundamental mechanisms in haptic perception: an intensity metamer in impact detection where duration and amplitude trade off, the role of propagating vibratory waves for roughness perception, and roughness metamers where different combinations of elasticity and surface features produce identical percepts.
Using a novel dual-property stimulus database and local anesthesia techniques, the work further highlights the crucial role of cutaneous information in softness perception and shows how the lack of cutaneous information can influence the perceived timing of haptic interactions.
Together, the studies uncover essential cues and mechanisms used to perceptually reconstruct different haptic interactions.@en

Pulmonary Fibrosis (PF) is a rare and incurable interstitial lung disease, which causes lung scarring, leading to an irreversible decline in patients’ lung function and breathing difficulties. In Europe, Pulmonary fibrosis (PF) affects over 400,000 people, and it claims the lives of about 100,000 people each year (EU-IPFF, 2023). In light of the prevailing medical personnel deficit and the stress on healthcare systems, a collaborative synergy between healthcare practitioners and patients becomes indispensable to facilitate the transition of healthcare services from hospital settings to domiciliary environments and to tailor individualized home care.
This endeavor is spearheaded by Erasmus MC, a preeminent specialist center for PF in the Netherlands. In collaboration with the Convergence program and TU Delft, this initiative embarks on exploring the PF patient journey map while develop innovative design solutions. These solutions are aimed at empowering patients to engage in self-management and to enhance their Health-Related Quality of Life (HRQoL).
The overarching methodology of this project adheres to the Enhanced Data-enabled Design (EDED) approach by Jung (2023), which leverages data collected within the community, user, and design contexts and adopts an iterative design process. Firstly, getting inspired by the online patient community data which contains more than 40,000 of patient stories, the initial problem areas that patients have most struggles are defined.
Subsequently, the insights gained in the community context are further examined in the user context. First, the preliminary patient journey map was validated and refined, and the initial problem areas were scoped down through co-creation and interviews with Healthcare Professionals (HP). Secondly, a user behavior study was conducted to uncover PF patients needs in their self-management process by reusing community data and leveraging the Information-Motivation-Behavioral Skills framework. The result of this study addresses the problem of this project, as the primary needs of PF patients to achieve effective and coherent self-management behavior are to acquire information related to five main aspects:
- Understanding and management of medication;
- Understanding and management of oxygen therapy
- Understanding Treatment and medication options
- Lifestyle adjusting to adapt to changes in life
- Symptom monitoring and management
Therefore, the final design goal of this project is defined as: “ How to provide PF patients with required, reliable, and understandable information to support their self-management behavior in their post-diagnosis stage.”
Accordingly, the user needs in information and the design goal collectively establish the foundation design concept: Vomo, a Product-service systems (PSS) to facilitate PF patient self-management in the post-diagnosis stage. The delivery of Vomo is facilitated through an application that is accessible to its end users. The present PSS has undergone a redesign process, drawing inspiration from the preexisting framework of a PSS known as Erasmus MC's IPF-Online. This project presents a comprehensive analysis of the rationale for the redesign of certain functions and proposes strategies for the future implementation of these revised functions inside the existing product.

In this study, the aim is to find out how Erasmus MC can properly prepare for the AI Act. An iterative design approach was utilized to explore what AI project members may experience during this regulatory process. Several factors have emerged during this experimental study, including the allocation of responsibility, the importance of education and the connection of the medical, technical and legal domains. The complexity of the problem necessitates multiple solutions, which resulted in two designs, the concept of a service system and a roadmap. The service system embodies the needs of the target group, while the roadmap offers a pragmatic guide for the organization to prepare for the changes following the legislation for AI.

Colorectal cancer is the third most common cancer disease worldwide with highly fatal. It has accounted for 10% of the global cancer incidence (Bray et al., 2018). In the Netherlands, patients who have undergone treatment and surgery for colorectal cancer typically enter a five-year follow-up phase. During this period, patients often experience long-term health issues. Colorectal cancer not only has physical implications for patients but also significantly affects various aspects of their daily lives, including their social networks and mental health (Arndt et al., 2006). On the other hand, remote patient monitoring (RPM) can enhance efficiency and improve patient care delivery. However, there has been a noticeable lack of research and design focusing on the inclusion of social and mental health monitoring within these systems. According to the World Health Organization, health should include “Physical, Social and Mental” aspects. Therefore it’s important to focus on how to develop remote patient monitoring in these aspects.
The project first used a patient community journey map (Jung, 2023) to summarize the experiences of colorectal cancer patients from a large number of posts on an online communication platform and invited medical experts from the Netherlands to a co-creation session to validate the map and explore research directions.
The final research question was defined as: How to develop a remote patient monitoring system for patients’ social and daily activity and related emotion when they are away from the hospital?
The research question was followed by user research. Patients received diary studies, including finishing a probe based on their activities. Upon completion of the diary studies by the patients, there is a follow-up interview to obtain patients' feedback and sentiments regarding the probe. Subsequently, the insights from the user research act as input during a collaborative designers’ brainstorm session. Finally, these research findings were exported into the initial guidelines for developing the RPM in social, daily activity and related emotions for colorectal cancer patients. After evaluations, the final guidelines for colorectal cancer patients’ RPM and a toolkit summarizing the "develop" and "deliver" phases were presented. This toolkit allows future researchers to develop RPM in social and daily activity and related emotion for patients in other contexts besides colorectal cancer patients, supporting the remote patient monitoring system’s evolution of physical, social and mental health.

People that are recovering from a stroke need frequent and high-intensity training to regain their upper-limb capacity. This will eventually result in better performances and higher quality of their daily life. Robotic devices are often used to assist stroke patients in rehabilitation. The minimally-supervised portable hand trainer, which is currently developed at the Motor Learning and Neurorehabilitation Lab of the TU Delft, specifically focuses on hand and forearm rehabilitation. Haptic feedback is used in a virtual game to train patients' finger flexion and extension and forearm pronosupination.
Prior to this master thesis, a feasibility and usability study has been performed with the second iteration of the hand trainer in collaboration with therapists from Rijndam and healthy participants, showing room for improvement.

In this graduation project, the portable hand trainer is redesigned to develop an improved product design in comparison to the second iteration. Following a human-centered design approach, a modified version of the double diamond method was created to achieve a redesign that enables more functional, ergonomic, and motivating rehabilitation training.

Analysis on strokes, on rehabilitation, on the state-of-the-art, through peer tests, and on the usability study, were performed to create a decision matrix to define a list of potential improvements, distinguishing high-priority, medium-priority and low-priority improvements.
The high-priority improvements have been thoroughly addressed in multiple cycles of ideation-, developing- and validating activities. The results are combined and transformed into a hardware-ready 3D prototype that demonstrates improvement in the pronosupination movement, the donning and doffing of the device and the wrist support. The prototype of the third iteration of the portable hand trainer is evaluated through interviews with experts in the field to reflect on the project goal and propose recommendations on future work.
The medium-priority improvements have been addressed in one cycle of ideation activities of which the results are presented in sketches to advice on further development.
The low-priority improvements have not been addressed in this project.

Sarcoïdosis is a complex and rare disease, which can affect any part of the body. The disease has symptoms, side effects and treatment plans varying per patient. In the Netherlands, yearly up to 7000 to 8000 people are diagnosed with sarcoidosis, in an acute or chronic form (Sarcoïdose - UMC Utrecht, n.d.). In the Netherlands, there are three sarcoïdosis specialist centres, and Erasmus MC is one of them. The Interstitial Lung Disease department of the Erasmus MC is trying to provide the right care for sarcoïdosis patients. However, together with the Convergence Program, a collaboration between the Delft University of Technology and the Erasmus MC, they analyse how the care at the hospital can be optimised. However, for patient care at home, there is still room for improvement, as expressed by medical experts. In this project, the methods and results lead to a patient journey map that indirectly improves the sarcoïdosis patient journey. The method of Patient Community Journey Mapping from Jung (2023) sets the base for the analysis. This is a data-driven approach to utilising online patient stories for machine learning. Together with a data scientist from Erasmus University, posts of wijhebbensarcoidose.nl are analysed and converged into a patient journey map. Topic listing is applied to the database of 7500 posts, followed by quantification of popular topics, and a sentiment analysis to show the urgency of a topic. The conducted patient journey map consists of 1) a medical journey path and 2) the topics derived from the computational analysis. A co-creation session with pulmonologists and specialist nurses was done to validate the resulting patient journey map. Followed by an interview with a patient to validate this map. These sessions were organised to get an even more realistic patient journey map. Sarcoïdosis is a complex disease, and often multiple topics are discussed in one post. Therefore, an analysis is done to see the co-occurrence between topics. From this resulted that the key value is formed by everything related to finding a balance in life with sarcoidosis. The patient journey map emphasised multiple needs that are mentioned negatively, according to the sentiment analysis. This led to three important patient needs to take into account for this project. Together with the key value, the main four patient needs are the following:

1. Help patients with finding a balance in life after their diagnosis.
2. Give patients a clear overview of their medication intake.
3. Monitor the patients’ quality of life sarcoidosis aspects.
4. Provide patients with information about sarcoidosis-related topics.

These formed the base of the designed system in the form of an application:
Sarcoïdosis voor jou. This application has four main pages where the focus on each page is a different need. The self-management tool can be created with the internal company Digitaal Verbonden. Together with the ILD department, the application can be created with some additional research steps. This project can argue why certain functions should be implemented in the general Digitaal Verbonden application for Erasmus MC patients.

This project focuses on the development of a novel surgical tool designed to facilitate internal tissue closure in minimally invasive surgery, specifically targeting mesenteric defect closures during Gastric Bypass procedures.
The tool incorporates innovative staples and barbed sutures, distinct from conventional methods and existing market tools. The surgical tool features optimized staples made from biocompatible NiTinol, with dimensions of 1.5 x 5.5 x 0.5 millimetres, facilitating tissue penetration while minimizing tissue squishing. The barbed sutures, composed of PBT with dual-cut barbs in alternating tri-radial rows, provide a secure closure mechanism. The applicator, with a diameter of 9 mm and usable length of 35 cm, enables single-handed operation with right- and lefthanded use. The cartridge consists of 80 staples and 30 centimetres of barbed suture, enough to close an entire defect. The tool’s design and functionality aim to enhance the efficiency of internal tissue closure procedures, reducing time, physical exertion, and cognitive load for surgeons.
The project follows a systematic and iterative design approach, best represented by the triple diamond method. A first phase involved extensive literature and market research, exploration and observations in the operation room. In a second phase, various methods such as brainwriting and CAD design are employed to generate ideas and models. Then in a final phase, through comprehensive testing and evaluation, a first version of the device called StapleStitcher, has been established, serving as a solid foundation for future iterations.
The evaluation of the proposed surgical tool has yielded overall positive feedback from bariatric surgeons. This was conducted through a questionnaire. They recognised its innovativeness and some explicitly expressed interest in further development.
Additionally, a risk analysis was conducted to identify potential hazards associated with the use of the surgical tool. The analysis addressed factors such as mechanical failure and user-related issues. Mitigation strategies derived from the analysis and feedback from surgeons informed recommendations for further research, collaboration, and development to optimize the surgical tool for clinical implementation.
In conclusion, the development of the novel surgical tool presents an opportunity to simplify and enhance internal tissue closure procedures in minimally invasive surgery. By incorporating innovative staples and barbed sutures, the tool offers potential improvements in surgeon comfort and efficiency. However, further research, collaboration, and refinement are necessary to fully harness the StapleStitcher’s potential and ensure successful integration into clinical practice.

Atopic eczema (AE) is an increasingly prevalent and impactful skin condition that significantly affects the lives of both the patient affected by it and their caregivers. The symptoms of AE, such as persistent itching and discomfort, can have an extensive negative impact on the emotional well-being and overall quality of life of those affected by it, thus making effective management crucial. Several barriers, including child resistance, misconceptions among caregivers, and the time-consuming treatment, contribute to low treatment adherence. To address this challenge and contribute to the enhancement of treatment adherence in (childhood)AE, this project aims to develop supportive tools that enable caregivers to apply treatments in a more efficient, accurate, and enjoyable way.

This project is being conducted in collaboration with Erasmus Medical Center while adhering to the design thinking process. This process involves empathizing with the design problem and target group, as well as (physically) exploring and validating proposed concepts. Throughout these design stages, a range of methodologies was employed, including literature research, field observations, morphological charting, and expert and user interviews. The report details the steps taken in designing two supportive tools aimed at improving the treatment experience and adherence for individuals with atopic eczema (AE).

The initial tool developed in this project is a device aiding a more precise dosing mechanism. It serves as a translation of existing application methodologies. The purpose of this product is to reduce treatment mismatch caused by a lack of understanding of dosing methodologies, thereby addressing non-adherence issues. The dosing mechanism is meant to act as a universal solution, compatible with existing cream and ointment tubes.

Furthermore, the second tool is specifically designed to complement the first tool by providing a visual representation of the appropriate skin surface for each dosed unit. The concept also incorporates various textures to allow for the comparison of healthy skin versus AE-affected skin. By shaping the measurement tool in the form of a stuffed animal, it contributes to heightened relatedness to the child, while also involving them in the treatment process.

Drawing from the comprehensive user and expert research, this report establishes future recommendations for the further development of the concepts. Additionally, a roadmap is provided to bring structure to and help prioritize these recommendations. Both concepts demonstrate promising results, indicating the need for further research and elaboration.

Under the influence of COVID-19, teleconsultation has been applied widely by hospitals and clinics. The value of teleconsultation for the management of chronic diseases is being explored as well. It is widely proved that building a trustworthy relationship between doctors and patients is the key point for long-term care. However, in the new context of teleconsultation, the interaction between patient and doctor has changed dramatically. The expansion of physical distance and the involvement of new technologies have affected the building of trust. Therefore, studying patient trust building in a digital context is crucial to implementing teleconsultation for the long-term management of chronic diseases in the future.

Through a contextual study of the challenges and opportunities in healthcare and technology, a future vision of teleconsultation was generated in the Understand stage (Chapter 2) as the background for implementing the trust design. A literature review was then conducted for an in-depth understanding of patient trust in teleconsultation, identifying the characteristics, consequences, and predictors of trust.

At the end of this chapter, a distinction was made between trust attitudes and trust behaviors. The pathways by which trust attitudes influence the three focused patient behaviors (ITU, Continuity, and Adherence) were demonstrated through a conceptual framework explaining the scenario in which trust attitudes and behaviors are consistent.

The reasons for the inconsistency of trust attitudes and behaviors were explored in the Explore stage (Chapter 3) through qualitative research. Four patient archetypes were first classified according to whether patients' attitudes and behaviors were consistent. The trust-related attitudinal and behavioral characteristics of each archetype and the respective needs were then elucidated through interviews to address the scenario of inconsistency.

In addition, combining the findings of the theoretical study in Chapter 2 and the user interview insights in Chapter 3, five categories of factors that promote patient trust were identified. Considering the design feasibility and value in teleconsultation, the focus scope for the design of this project was positioned.

In the Design stage (Chapter 4), the findings from the research resulted in six design strategies to help designers design for patient trust. The six strategies were further discussed and categorized along three dimensions: the covered influencing factors, the implementation stage corresponded with patient behavior phases, and the value priority for four patient archetypes.

In the Deliver stage of the project (Chapter 5), patients and designers were invited to evaluate both the research outcomes and the design strategies. Ultimately, all research outcomes and final design strategies on trust were presented on an online website to provide design guidance and inspiration for future trust designers.

In healthcare, the doctor-patient interaction is most commonly held in the Consultation Room, which hasn't changed much over the last few decades. However, new technologies such as virtual reality, artificial intelligence, speech-to-speech translation, and so on are available now. These developments provide new opportunities to support all processes in the consultation room, of which communication between doctor and patient will be revolutionized. During the pandemic, the benefits and broad prospects of teleconsultation gradually entered the public consciousness and gained acceptance. However, for patients, going to the doctor is about more than just convenience and efficiency. Patients who are ill frequently experience significant anxiety, feeling lost and uncertain about their condition and future plans. According to Tyrer (2013), 10% to 20% of general hospital patients have abnormal health anxiety. As a result, the future of teleconsultation should consider patients' vulnerability and emotional needs.

This project aims to explore how to alleviate patient anxiety in teleconsultation contexts in 2030. The following sub-questions are proposed to structure the final RQ:
SQ-1: What are the key influencing factors of patients’ anxiety?
SQ-2: How can technologies be used to alleviate anxiety? / Where do the design opportunities lie?
SQ-3: How to align the technologies/ideas with the desired future vision?

The project is divided into five stages to answer these questions:

Understand: A literature review and expert interviews will be conducted to fully comprehend the research context. An opportunity map will be presented as the outcome of the first stage of research.

Explore: Future possibilities will be identified through Strategic Trend Research, Technology Scouting, and Future Visioning. At the end of this stage, a desirable future vision will be defined.

Empathy: To gain a deeper understanding of patients, thematic analysis and generative design research methods will be used to both understand current teleconsultation users' experiences and to profile different traits, thereby facilitating concept development.

Develop: At this stage, eight strategy proposals and a design roadmap are created. The roadmap and proposals are spirally iterated through evaluation.

Deliver: An online design guidance toolkit incorporating key project outcomes is being developed to guide designers interested in future teleconsultation experiences through the methods derived from this project step by step. In addition, a final roadmap is provided as the answer to the RQ.

To summarize, this project began by looking for ways to alleviate patient anxiety. However, the developed roadmap and strategy proposals are not only applicable to anxious patients, but also point the way forward for future teleconsultation evolution. That could be because considering any individual's vulnerability is a must-have feature of future healthcare.

Supportive care, regardless of its diversity or who provides it, aims to enhance and preserve the quality of life and independence and to empower and optimize well-being (Fitch, 2008). We can see that digital health can benefit supportive care by empowering users, providing more accessible support, and encouraging self-management. However, the impact of digital health interventions on existing organizations and systems is not always positive and effective.

We could conclude that even with the rapid development of DHIs, physical or traditional interventions cannot be replaced entirely. That is to say, digital health intervention remains a viable option rather than a necessity, its purpose being to be a supplement and complement to the current medical system. (Yildiz & Oksuzoglu, 2020)

This project explores how to connect digital and traditional care to create a seamless experience that fully embraces patients in cancer care when and where they need it. However, it is unclear how this hybrid model fits in the context of the supportive care plan.

To understand how to build such a hybrid patient journey, we decided to research the types of problems in SCP and think about what role the DHIs could play.

To gain a more systematic understanding, we researched three groups of people: patients, health professionals, and medical experts. The result of the research led to a picture of the current patient journey, which helped us identify opportunities for intervention. We believe the DHIs can help alleviate the current pressure on the system and provide patients with timely, adequate and effective supportive care. However, it must be based on providing patients with digital care that fits their situation.
Based on this, we designed the future patient journey. It shows how digital care can be combined with traditional care. Also, it includes 1) the opportunities to involve more DHIs in SCP;
2) the concept of the AI support system to help the HCPs decide the care plan.

In addition to this, an extensive validation study has proven that the new patient journey has the potential to help the patients access care and increase their well-being. Also, the AI support system could help HCPs make decisions and reduce their workload.

The whole project started with women with breast cancer. However, in the interviews, we found that this could apply to other cancer care where the patient can use the digital tool.

The healthcare sector has reached a turning point in which the patient stands central during the continuum of care. Erasmus MC is a leading hospital in health care innovation and thrives on pioneering this shift towards value-based care. Value-based care is a philosophy of delivering optimal care for the patient while reducing costs.

To reach this, Erasmus MC has implemented a five-year strategy focused on dedication and technology. Dedication emphasizes the importance of providing a patient with the right treatments and supporting them in the process. Technology is seen as an enabler in both the procedures as well as improving patient experience. The question now is how to create the perfect balance between dedication and technology to optimize the patient experience while streamlining the journey for Erasmus MC staff. This project focuses on the specific case of the Transcatheter aortic valve implantation (TAVI) procedure. This procedure involves the implantation of valve prostheses in the native aortic valve of the patient’s heart by percutaneous puncture via their transfemoral artery. It is a minimally invasive procedure under local anesthesia, meaning they are vividly awake during the procedure. TAVI patients are, on average, 80 years old.

This project evolved from a problem identified by an interventional cardiologist at the Erasmus MC. He noticed that technological advancements were improving the procedure; however, the patient experience was not progressing.
The majority of the patients were anxious and uninformed prior to the procedure. This is a problem because pre-operative anxiety affects the interaction between cardiologist and patient, it hinders the person from processing information (Cammen, 2021), affects the post-operative recovery process (Yuzkat et al., 2020), and decreases overall patient satisfaction (Herrera et al.,2009). Therefore, the challenge was: Design a tool to improve the patient experience by reducing pre-operative anxiety of patients who undergo a TAVI.

To tackle this, extensive user research was conducted on the journey of TAVI patients. This led to a reliable patient experience curve identifying the pain and success points as well as the reasons for these peaks. Concurrently, the enablers of positive patient experience are defined through a literature review. This led to the concept proposal, an improved TAVI patient journey. The new patient journey consists of (1) several new touchpoints throughout the continuum of care that ensures the patient feels recognized and improves the continuity, (2) a physical care package (Zorgpakket) delivered to the patient's doorstep, supporting the patient by providing them with the right tools to prepare themselves for the procedure, and (3) a 3D animation of the TAVI procedure, creating an accessible manner for elderly patients to use technology which has an added value for the patient journey.
An extensive validation study has proven that the new patient journey, specifically the Zorgpakket, helps the patient feel at ease by providing the tools to form the right expectations and increase trust through empathy and professionalism. The aimed long-term effect is to eliminate the pain points in the experience curve.
The proposal is a desirable solution that fits the patient's needs while streamlining the workflow of the healthcare professionals. The different aspects of the project are applicable in other areas within the healthcare sector and will serve as inspiration within Erasmus MC to reach the goal of value-based care.

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.

Philips is the global leader in Image-Guided Therapy (IGT). This medical specialization provides integrated solutions that allow for minimally invasive medical procedures. A specialized medical team consisting of multiple stakeholders works closely with Philips's newest technological devices and systems during these interventions. These complex procedures are followed and guided via real-time, on-screen imaging modalities. This way, technology-enabled, optimal care can be provided for many different interventions. Clinical demands, challenges and complexities can be very specific and patient-dependent. Often bottlenecks in IGT procedures come down to limitations like sterility and hands-busy situations. However, touchless interaction technologies provide solutions in many ways. Technologies like eye-gaze, voice control and gesture sensing are expected to minimize the number of mistakes made and time lost because of inefficiencies. The future context of IGT is explored by doing creative trend research to get an idea of the technologies, trends, and developments in the future healthcare landscape. A future vision of IGT is established to give an expression of a desired future. It provides a strategic reference point for actionable innovations. Through qualitative research, ideation and conceptualization, several design implications are provided. Synthesizing these concepts into an implementation strategy that aligns with the future vision is essential. Since the result of this thesis will be a roadmap, a division is made into three separate horizons leading towards the future vision. These horizons address a particular aim, alignment with the developing healthcare landscape and related implementation of the concepts into the roadmap. Through validation and assessment, the roadmap is optimized and aligned with the business. An estimated improvement target is established as a reference point. Additionally, the expected value of the clinical and operational performance of the concept propositions are estimated and substantiated. This results in a strategic roadmap that can deliver concrete insights and provide guidance in the implementation possibilities of these touchless UI innovations in this healthcare domain.