Design Of Healthcare Technology Research Articles

Enabling nurses’ engagement in the design of healthcare technology – Core competencies and requirements: A qualitative study

BackgroundDue to the globally increasing demand for care, innovation is important to maintain quality, safety, effectiveness, patient sensitivity, and outcome orientation. Health care technologies could be a solution to innovate, maintain, or improve the quality of care and simultaneously decrease nurses’ workload. Currently, nurses are rarely involved in the design of health care technologies, mostly due to time constraints with clinical nursing responsibilities and limited exposure to technology and design disciplines. To ensure that health care technologies fit into nurses’ core and routine practice, nurses should be actively involved in the design process. ObjectiveThe aim of the present study was to explore the main requirements for nurses’ active participation in the design of health care technologies. DesignAn exploratory descriptive qualitative design was used which helps to both understand and describe a phenomenon. ParticipantsTwelve nurses from three academic hospitals in the Netherlands participated in this study. MethodData were collected from semistructured interviews with hospital nurses experienced in design programs and thematically analysed. ResultsFour themes were identified concerning the main requirements for nurses to participate in the design of health care technologies: (1) nurses’ motivations to participate, (2) the process of technology development, (3) required competence to participate (such as assertiveness, creative thinking, problem solving skills), and (4) facilitating and organizing nurses’ participation. ConclusionNurses experience their involvement in the design process as essential, distinctive, and meaningful but experience few possibilities to combine this work with their current workload, flows, routines, and requirements. To participate in the design of health care technologies nurses need motivation and specific competencies. Organizations should facilitate time for nurses to acquire the required competencies and to be intentionally involved in technology design and development activities.

Warm Solutions: Centering Nurse Contributions in Medical Making

Making medical devices in healthcare settings engages practitioners in organizational innovation. Nurses improvise physical workarounds at the bedside in response to patient needs. Yet nurse-led problem-solving is rarely centralized in an emerging innovation ecosystem through medical making. We interviewed medical makers in six healthcare makerspaces to understand factors for nurse inclusion in the medical making ecosystem. Findings from 16 multi-stakeholder interviews with 6 facilitators and 10 nurses in the USA, reveal insights into nurse-led problem-solving with and without the use of physical prototyping (making) in formal innovation spaces with maker technologies. We report how a nurse's capacity for making is practice-driven to address in-patient discomfort, repair their own practice, and update standardized workflows. Most nurses iterate on low-tech solutions facing barriers to formal collaboration when they attempt to scale up. Their technical capabilities extend from innovation-centered resources (e.g., lab spaces, technologies), often with complete reliance on facilitators who have limited authority in the medical system. We contribute to themes around practice-based innovation, participation in technology design, and articulation work for collaborative innovation. From nurse makers' experiences, we discuss how nurse participation can be supported in healthcare technology design.

The Lean and Agile Multi-dimensional Process (LAMP) – a new framework for rapid and iterative evidence generation to support health-care technology design and development

ABSTRACT Introduction: Health technology assessments (HTA) are tools for policymaking and resource allocation. Early HTAs are increasingly used in design and development of new technologies. Conducting early HTAs is challenging, due to a lack of evidence and significant uncertainties in the technology and the market. A multi-disciplinary approach is considered essential. However, an operational framework that can enable the integration of multi-dimensional evidence into commercialization remains lacking. Areas covered: We developed the Lean and Agile Multi-dimensional Process (LAMP), an early HTA framework, for embedding commercial decision-making in structured evidence generation activities, divided into phases. Diverse evidence in unmet needs, user acceptance, cost-effectiveness, and market competitiveness are being generated in increasing depth. This supports the emergence of design and value propositions that align technology capabilities and clinical and user needs. Expert opinion: We have been applying LAMP to working with medical device and diagnostic industry in the UK. The framework can be adapted to suit different technologies, decision needs, time scales, and resources. LAMP offers a practical solution to the multi-disciplinary approach. Methodologists drive the process by performing evidence generation and synthesis as and by enabling interactions between manufacturers, designers, clinicians, and other key stakeholders.

Teaching cross-cultural design thinking for healthcare

ObjectivesArtificial intelligence (AI) is poised to transform breast cancer care. However, most scientists, engineers, and clinicians are not prepared to contribute to the AI revolution in healthcare. In this paper, we describe our experiences teaching a new undergraduate course for American students that aims to prepare the next generation for cross-cultural designthinking, which we believe is crucial for AI to achieve its full potential in breast cancer care. Materials and methodsThe key course activities are planning, conducting, and interpreting interviews of healthcare professionals from both Portugal and the United States. Since the course is offered as a short-term faculty-led study abroad program in Portugal, students are able to explore the impact of culture on healthcare delivery and the design of healthcare technologies. ResultsThe learning assessments demonstrated student growth in several areas pertinent for future development of AI for breast cancer care. With respect to understanding breast cancer care, prior to taking this course, most students had underestimated the impact of cancer and its treatment on women’s quality of life and most were unaware of the importance of multidisciplinary care teams. Regarding AI in medicine, students became more mindful of data privacy issues and the need to consider the effect of AI on healthcare professionals. ConclusionThis course illustrates the potential benefits for AI in medicine of introducing future scientists, engineers, and clinicians to cross cultural design-thinking early in their educational experiences.

Studying Design and Use of Healthcare Technologies in Interaction: The Social Learning Perspective in a Dutch Quality Improvement Collaborative Program

Designing technologies is a process that relies on multiple interactions between design and use contexts. These interactions are essential to the development and establishment of technologies. This article seeks to understand the attempts of healthcare organisations to integrate use contexts into the design of healthcare technologies following insights of the theoretical approaches of social learning and user representations. We present a multiple case study of three healthcare technologies involved in improving elderly care practice. These cases were part of a Dutch quality improvement collaborative program, which urged that development of these technologies was not “just” development, but should occur in close collaboration with other parts of the collaborative program, which were more focused on implementation. These cases illustrate different ways to develop technologies in interaction with use contexts and users. Despite the infrastructure of the collaborative program, interactions were not without problems. We conclude by arguing that interactions between design and use are not naturally occurring phenomena, but must be actively organised in order to create effects.

Evaluating methods for engaging children in healthcare technology design

Examples of user involvement can be found throughout healthcare literature. This extends to the design and development of healthcare technology where the involvement of users has been found to positively impact the quality and safety of products. However, there is currently little known about which methods are the most appropriate for involving children in technology development. The research applied and developed a framework to guide the use of methods in the design and development of healthcare technology for upper limb rehabilitation in children with cerebral palsy. Utilising an assessment framework to explore the suitability of four interview methods for involving children in the design and development of healthcare technology, research was carried out in primary schools in the United Kingdom. The research team i) used the assessment framework to guide the collection of information for comparing methods for involving children; ii) considered additional criteria for inclusion in the framework; and iii) gathered observations and data to comment on the criteria in relation to the four interview methods. Children were able to participate in all four interview methods, although further consideration is needed to identify how children with disabilities can be involved in design activities forming part of interview methods. Differences were found between the methods relating to their robustness, reliability, validity, efficiency, enjoyment and cost. The involvement of participants with a disability highlighted the need to develop new methods that support their inclusion in healthcare technology design work. The assessment framework applied in this research was useful to inform the comparison of methods and represents a step towards a more unified approach to understanding how best to capture the perspectives of children to develop technology that meets their needs.

Emergency department patient-tracking system evaluation

Information technology is rapidly being developed and implemented for health care environments, often as a replacement for paper based or other manual tools. One example of this transition is the replacement of large dry-erase boards, used in emergency departments (ED) for tracking patient locations and clinical care, with computerized patient-tracking systems. The design of such systems has important implications for aspects of ED work, including changes to workload and situation awareness of ED staff. In this study, we used a newly developed electronic patient-tracking system simulator which combined a realistic model of ED and patient events with a configurable patient-tracking system display. Situation awareness regarding patient data, workload, responses to system failures, and performance on secondary tasks was measured for two groups of experienced ED staff (nurses, and clerks) across two display conditions and two patient volume conditions. We found that nurses had higher situation awareness than clerks, and that increased patient volume increased some aspects of workload. Additionally there were some indications that color coding information made it easier for participants to remember information in the event of system failures and that the choice of display size may depend on users’ primary tasks. As demonstrated by these important findings, the simulator was considered to be viable in adequately representing emergency department processes in a controlled lab setting for helping assess situation awareness and workload. Relevance to industry Healthcare technology design industry and healthcare systems planning to implement new information technologies would significantly benefit from the methodology and findings.

Engaging children in healthcare technology design: developing rehabilitation technology for children with cerebral palsy

This paper presents a case study of users’ involvement in the design and evaluation of two devices for upper limb rehabilitation for children with cerebral palsy to use in their homes. The devices comprise a computer game and a force feedback interface, designed to stimulate children with cerebral palsy to undertake fun arm exercises that are beneficial in terms of improving overall functional use of their impaired arm. This device was developed for children using a combination of informal and formal user-centred design methods. The methods used include standard questionnaires, interviews, a modified peer tutoring process and a comparative method, and have been applied to the iterative design of both the hardware and software components of the rehabilitation systems. Thirty-seven non-disabled children and 15 children with cerebral palsy in the 5–12-year-old age group were involved in the evaluation, held at six local primary schools. Prototypes of the final design were used by 18 patients with cerebral palsy for approximately 4 weeks as a therapeutic intervention. To evaluate the designs, qualitative and questionnaire-based opinion was sought from these children, and their parents, at the end of the intervention. An evaluation of the methodologies employed is presented.

Design of Health Care Technologies for the Developing World

Approximately 20 years ago, the international community embarked on a project to bring health care to everyone by the year 2000 featuring, among other things, technologies that were known to be effective and economical. It was largely a failure. In fact, health care deteriorated in many of the target nations. Problems such as public mistrust, lack of spare parts, lack of required consumables, lack of reliable power and water, lack of public infrastructure such as roads, lack of technical expertise, and other problems plague health care technology in the developing world. Biomedical engineers are just beginning to quantify and address the barriers to technology unique to the developing world. This article reviews the barriers, both real and perceived, to the introduction of health care technology with a main focus on health care technology in hospitals.

The Role of Learning-by-Using in the Design of Health Care Technologies: A Case Study

New technologies typically go through significant improvements during their early diffusion. Literature suggests that these modifications follow from learning-by-using. However, the micro-level processes by which learning-by-using is actually achieved remain understudied. This article examines these processes through an in-depth case study of the design and use of a new health-care device. It identifies several learning processes and preconditions for learning that constituted learning-by-using. The results question the dominant image of learning-by-using as a harmonious flow of user feedback.

Molecular/cell engineering approach to autocrine ligand control of cell function.

Tissue engineering, along with other modern cell- and tissue-based health care technologies, depends on successful regulation of cell function by molecular means, including pharmacological agents, materials, and genetics. This regulation is generally mediated by cell receptor/ligand interactions providing primary targets for molecular intervention. While regulatory ligands may often be exogenous in nature, in the categories of endocrine and paracrine hormone systems, they are being increasingly appreciated as crucial in local control of cell and tissue function. Improvements in design of health care technologies involving autocrine ligand interactions with cell receptors should benefit from increased qualitative and quantitative understanding of the kinetic and transport processes governing these interactions. In this symposium paper we offer a concise overview of our recent efforts combining molecular cell biology and engineering approaches to increase the understanding of how molecular and cellular parameters may be manipulated for improved control of cell and tissue function regulated by autocrine ligands.