‘We are looking for a sweet spot between reality and what's workable in healthcare’
Unfortunately, it can be a regular occurrence in the medical world: a perfectly successful operation, but a patient who is still not completely satisfied with the treatment process. Healthcare professionals are eager to improve the situation, but often have no clear image of what exactly is wrong. IDE designer Bob Groeneveld and psychologist Tessa Dekkers are working together to investigate how patient satisfaction can be improved by tailoring the care as far as possible to suit the individual patient.
Is your collaboration in this area something that happened by chance or does your research project really require it?
Tessa: “The latter! Although Bob and I are both writing our own theses, we share the same aim. We have identified two issues: on the one hand, there is the question of how we can make care more personal and especially what contribution a designer can make to it. In addition, the quality of medical care is currently largely safeguarded by means of protocols – general agreements between healthcare professionals on the nature of treatment. Because these are the same for everyone, they offer little opportunity for personalisation. If you want to achieve personalisation and ensure that care providers are also on board, you need to create a framework in which personalisation works. We are therefore investigating how, by means of personalised care, we can ensure that patients will be more satisfied about the treatment they have received.”
What psychological component and what design component does it involve?
Tessa: ‘As a psychologist, I develop instruments to identify patients' psychological characteristics. Is someone perhaps scared of pain? That can be an indication that they will be unlikely to start exercising properly during rehabilitation. This person might need additional motivation to reach a good final result. I also create clusters of patients. Are there patients who share similar factors in the treatment process who we can then categorise into groups and base the design of their treatment on these shared factors?’
Bob: ‘For my design work, I am partially dependent on Tessa's findings. But I have also started to collect data myself. At the moment, we have two parallel processes. Tessa is working with large groups of people, identifying profiles in them. With part of those groups, I collect more in-depth data about individual patients, about their experience of care and rehabilitation and what they would like to see improved. I look to see what patterns we can identify and we then consult to see how we can match these.’
Tessa: ‘At the start, it seemed that Bob could do very little because my psychological profiles were not yet ready. But the design approach of observing and conducting research actually ended up enriching my dry psychological questionnaires. In any case, personalisation naturally involves variations in design. But first of all, you need to have a basic design and then, by engaging in discussions with patients and looking for a common denominator, we can get to work on it. From that basis, we can start some really targeted tweaking.’
Bob: ‘That's right, we are now looking for the things that patient groups have in common, and the minor differences where we can prove useful as designers.’
The design approach of observing and conducting research actually ended up enriching my dry psychological questionnaires.
What groups have in common? But surely it is all about personalisation?
Tessa: ‘It would be a fallacy to think that everyone enters into a completely unique care process. If that were the case, today's care would result in dissatisfied patients only, because the process is not personalised for anyone! But in our case, dealing with hip and knee replacements in the Reinier de Graaf Hospital in Delft, we have a lot of satisfied patients. So we need to find out what makes the difference for those small portion dissatisfied patients. Is it possible to identify a pattern in that group?
Bob: ‘You can imagine it to be like this: if you have no patient profiles at all, everyone is the same and is treated in the same way. That's what currently happens, but it obviously does not do justice to the reality in which each person is unique and has unique characteristics. The more you can identify psychological groups of patients, the more you can do justice to reality. But it also makes it less workable. Reinventing the wheel for every patient is unrealistic. We are trying therefore to identify some kind of optimum, a sweet spot between reality and what is workable. This is why we make the profiles comparatively general. We need to be able to say something about different groups with some level of certainty, which is primarily Tessa's field, but it also needs to result in something that designers can use and which is of benefit to patients and care providers.’
Tessa: ‘Being able to sort patients into psychological profiles is also useful for integrated care. A patient is seen by many different care providers. These include the GP, the specialist, a physical therapist and a district nurse. The patient has to repeatedly explain the problem, as well as their medical background. If we have workable profiles, we can say something useful about the type of patient and how best he or she can be approached by care providers. That should make interaction much more pleasant for everyone involved, patients as well as care providers.’
You have been working on the project for 18 months now. Are the patient profiles now beginning to emerge?
Tessa: 'It has taken much longer than was initially thought. I had to read up on design and we still have regular discussions about what designing is and what exactly constitutes good research. But we have now started the first major study into patient groups which we will be able to use as basis for ‘patient profile 1.0’. For this, we have approached everyone who underwent hip surgery at the Reinier de Graaf hospital in the last year. We asked questions like: how would you have preferred to communicate with your doctor, who made the decisions and who would you like to have made the decisions, how uncertain where you about your symptoms? So far, this has resulted in a risk group that is uncertain and relatively anxious and a 'good group' where this is much less the case. But I anticipate that additional data will help us attain a greater level of nuance within these patient profiles.’
Bob: ‘As a designer, I then attempt to go from the abstract to the concrete. When we have properly identified the profiles, we can look at what will benefit them and at the interactions that these patients have with healthcare professionals. Once we know this, we can explore what impact this has on the information healthcare professionals need and what form any designed product should take. If there are indeed different groups, I would like to be able to demonstrate that a specific product or specific adaptation to the healthcare process actually works for one group and does not work for the other. That will enable us to demonstrate that our approach works and that designers can really make a difference for people. That helps to ensure that healthcare professionals are also on board.’
Tessa: ‘Exactly! And ultimately, of course we also want to know whether our patient profiles and the guidance and knowledge they result in for designers can be applied universally, for example in treating cancer or in more chronic healthcare situations. That is how you create true added value in the longer term.’
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"A well thought-out medical product reflects the daily experiences of the medical practitioner."
Tessa Dekkers, MSc. PhD candidate Tailored Healthcare: Patient Profiles for Medical Consumers
prof.dr. Huib de Ridder
dr.ir. Marijke Melles
Bob Groeneveld, MSc. PhD candidate Tailored Healthcare: Design with Patient Profiles
prof.dr.ir. Richard Goossens
dr.ir. Marijke Melles
dr.ir. Marijke Melles, Project leader research programme: Tailored Healthcare through Customer Profiling
Consortium partners: TU Delft, Zimmer Biomet, Reinier de Graaf Group, VanBerlo, Panton
Financed by Zimmer Biomet Inc. & the Netherlands Organisation for Scientific Research NWO (project 314-99-118)