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Designing Interventions in a Complex Health Care Setting Learnings from 2 case studies Tanja Enninga, MSc. [email protected] September 1st

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Designing Interventions in aComplex Health Care SettingLearnings from 2 case studiesTanja Enninga, [email protected] 1st

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

Research Group Co-Design

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffCo-design, applied & participatory research - Industrial designersMe, health experiences, PhD title2 cases one recent, one 15 years, no solutions, share assumptions and thoughts 2

Source: http://thecicc.com/thecicc/aboutus.htmlIn Jones (2013) Design for Care Innovation Pyramid (CICC Toronto)

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffThoughts and assumptions focus on the upscaling and dissemination, having others use these concepts, outside the projects that originated these ideasAs change is necessary in the system. To improve quality, to lower costs, to make the utterly complex system less complex3

Two case studies

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Source: http://thecicc.com/thecicc/aboutus.htmlIn Jones (2013) Design for Care Innovation Pyramid (CICC Toronto)How do patiens and relatives, as well as health care professionals evaluate the intervention for implementation in their daily practice?

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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First Case: POKO

Designing interventions to improve exercising and nutritional status in children with cancer (UMCG)

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

Nutritional intake - Exercise

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffIn the beginning often to underweightedIn the end overweighted and too much fat tissueNutrition: sometimes eating more sometimes lessExercising to keep or to gain muscle tissue7

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffSick, mouth feeling, taste, smell, tired, parents feel pity, starting point message be aware no more weight loss8

Stakeholder map

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffParticipating as many stakeholders as possibleResearch design also student teams guided by design firms9

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffResearch In hospital and at home10

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffParticipating health care professionals in various steps of the design process11

Patient journey extended

Needs/ GoalsParents / FamilyHospitalEnergy levelTreatment / outpatients

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffWe learned from this research that we had to look different at exercisingFirst conotation13

Research in hospital environment

Photo Roos Tigchelaar, 2014

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Levels of energy in children with cancer

walking about the hospital walking about the ward sitting up in bedill in bedsitting on the edge of the bedstanding next to the bedsitting in a chair in the roomwalking in the roomAdapted from Thesis Roos Tigchelaar, 2014

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Student project: Race mat (prototype)

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffThis insight lead to 16

Food game: a Journey of Fivefrom prototype to start-up

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffSame for food intake: information enough, more a matter of awareness and small steps forward17

Source: http://thecicc.com/thecicc/aboutus.htmlIn Jones (2013) Design for Care Innovation Pyramid (CICC Toronto)How do patiens and relatives, as well as health care professionals evaluate the intervention for implementation in their daily practice?

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffResearch other hospitals to investigate criteria for implementation

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Two main responsesWow, nice! Very interesting indeed!However, Actually not very new at all. We are already focusing on these issues.

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffSecond Case: Hogewey

A nursing home designed to improve quality of life for people with severe dementia

Hogewey, Weesp, NL

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffReminded me of the second case20

Hogewey 1992:

Residents in controlLiving a normal life in a normal household

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffResidents in control, contradictory with severe dementia?Normal life as in daily activities21

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffNot all people are created equalStunning results in terms of quality of life, family satisfaction, emloyee satisfaction, less medication, within governmental budgets22

For years Hogewey received the same main responses from the professional fieldWow, nice! Very interesting indeed!However, Actually not very new at all. We are already focusing on these issues.

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffShowing their case to fellow workers in workshops23

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffUntil recently with building new premisses24

Hogewey 2012: may have the answers, according to the Guardian

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Source: http://thecicc.com/thecicc/aboutus.htmlIn Jones (2013) Design for Care Innovation Pyramid (CICC Toronto)How do patiens and relatives, as well as health care professionals evaluate the intervention for implementation in their daily practice?

What did we learn from those two cases?

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Patients and relativesProfessionals

Level of involvementin development processPatients and relatives who participated in the co-design projectParticipants of the co-design projectOrganizational colleagues of the participants of the co-design project (various professionals, same organization and same patient group)Patients and relatives in similar health seeking situationsFunctional colleagues of the participants of the co-design project (same profession, different organization)Different lenses

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Patients and relatives

POKO):recognise the problem framing enthusiastic about the idea of the interventionswilling to cooperate in testing of prototypes

Hogewey during development care takers were volunteering immediately to have their loved ones placed in the prototype ward

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Patients and relatives

Interventions POKO (children and their parents):recognise the problem framing enthusiastic about the idea of the interventionswilling to cooperate in testing of prototypes

Hogeweyduring development care takers were volunteering immediately to have their loved ones placed in the prototype wardPOKO: children and their parents recognise the problem framing and designed solutions and are enthusiastic and willing to cooperate in testing of prototypes.

Hogewey: patients with severe dementia do recognise the created environment and their relatives/ care takers recognise the benefits of the concept for their loved ones

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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POKO inspired others in same hospital: some change happens besides project activities

POKO professionals (UMCG)Enthusiastic about process participatory designWilling to cooperate, although time is an issue

Hogewey (1992)Process design with whole organization (n=200)Some professionals were skeptical.A few left the organization (concept didnt match professional beliefs of good care); some other critics gave it a try (now the best ambassadors)

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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POKO inspired others in same hospital: some change happens besides project activitiesPOKO professionals (UMCG)Enthusiastic about process participatory designWilling to cooperate, although time is an issueHogewey (1992)Process design with whole organization (n=200)Some professionals were skeptical.A few left the organization (concept didnt match professional beliefs of good care); some other critics gave it a try (now the best ambassadors)POKO:Recognise problemNo active questions from other hospitals about the interventions

Hogewey:Recognise problem;Often positive about how they experience solution in situ; ask frequently about the evidence-base of the concept; some have difficulty to see the integrality of the concept

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Creating empathy and understanding needs, problems, experiences

personas

relationshipsjourney in time

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Patients and relativesProfessionals

Patients and relatives

Recognise and acknowledge problem (re)framing

Accept / understand/ like the idea or concept; are willing to try or useHealth care professionals:

Recognise and acknowledge problem (re)framing

However, acceptance of the concept and/or willingness to try differs and seems to decrease outside the project and even more outside the organization

Empathy and understanding needs, problems and experiences, should lead to desirable solutions

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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context

childfamily systemvarious family systemshealth care profshealth care mgt

one health organization

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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one health organization

context

childfamily systemvarious family systemshealth care profshealth care mgt

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Discussion

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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BoundaryAdapted from http://thecicc.com/thecicc/aboutus.htmlInnovation Pyramid (CICC Toronto)

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffWe cannot cross this boundary with more research, better maps, extensive implementation plans37

Content and process

The intervention and the project experiences are like the destination and the journey towardsIllustration from: Van de Ven etal (2008)The Innovation Journey

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, BanffThe interventions and innovative concepts are the contentProject experiences are vital part

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Armchair Travellingcrossing boundaries with narratives

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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Q & A

Tanja Enninga, MSc.Research Centre Technology & Innovation, Research Group Co-Designwww.onderzoek.hu.nl1 September 2015, Systemic Design, Banff

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