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

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

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

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

Using these points the following future vision was set up:

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

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

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

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.

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

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

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

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

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

Problem definition

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

Research outcomes

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

Design goals

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

Recommendations

As a recommendation, the game should be implemented in an interdisciplinary manner, involving physicians, assistants, IT personnel, organizational staff, and policymakers. This approach aims to connect perspectives and foster collaboration. Ultimately, the game serves as a tool to bridge the gap between policymakers and healthcare practitioners by providing insights into each other’s perspectives, fostering a collective and collaborative approach towards successful BgZ implementation.

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

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

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

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

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

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

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

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

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

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

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

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

The following design goal was created:

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

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

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

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

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

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

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