Safety in healthcare is my core topic. Harm to patients can occur in many different ways, including unsafe acts, discordance between patient and treatment, organisational failures and many more.

My focus is in the following research areas:

Reducing treatment harm. I study mechanisms of treatment harm that lie hidden in how we practise and do research in medicine in the Western world. The current standard is a predominant reductionist approach that leaves out the dynamics and influences of the system around the health problem. It is also an approach that has a strong focus on disease and tends to forget the diversity in - and values of patients. I believe that a scientific approach from a systems perspective can contribute to safer care, and I work together with others on concrete approaches in two fields:

Mathematical oncology. I contribute to the evolutionary game theory lab that is led by Katerina Stanková. She received a VIDI grant in 2022 from which she established a research project on adaptive therapy in non-small cell lung cancer (NSCLC). Simultaneously we started exploring the opportunities for adaptive therapies in the context of colorectal cancer liver metastases (CRLM). Both projects are in collaboration with the ErasmusMC.

Systems science in mental health. From a systems perspective, mental health is an outcome of complex interactions between a person, the environment and significant others in past and present. In current standard of care, mental health issues such as perceived mental pain or behavioural dysfunction, are labelled as a disease. We question the validity of this view and argue that it often are mere physiological patterns in a dysfunctional system. We further explore how unjustified disease-labelling can lead to harm. An example is ‘shift-work disorder’ that in reality is a normal bodily response to abnormal circumstances (credits for this example go to prof. Trudy deHue). Under the working title ‘According to what order, is this a disorder?’ we establish a working group to design an alternative scientific approach for mental health. 

Rethinking paradigms. This topic has an overlap with the previous area, in that it also uses a systems approach to problems, but here the focus is on healthcare organisations. I observe that patterns of thinking and reasoning in Western healthcare can have (unintended) adverse effects on safety of care delivery. This for example through failing to understand the real problems underneath a failure scenario or through neglecting essential actors or influences in the complex socio-technical healthcare system, for example in quality improvement cycles or innovation. 

One of the projects I am working on is how to review and address underlying causes of failures that lead to severe harm or death of a patient. The current standard is focused on the sharp-end, the last unsafe act of a healthcare professional to a patient. Whereas in reality, there usually is a multitude of contributing factors that result in the unsafe act. This phenomenon is well understood in other domains, but not so in healthcare. Which is why we now try to ‘translate’ and educate involved healthcare professionals to think differently. 

Another related topic is thinking about risk and failure in healthcare. For a multitude of reasons, risks are not always perceived as the threat they are and successively, largely ignored or poorly controlled. I am interested in finding out the underlying reasons for this risk-blind culture, to be able to address them. 

Thirdly I enjoy trying out a variety of existing systems modeling techniques, to evaluate the opportunities, obstacles and failures in the context of healthcare. I believe various existing methods including qualitative research methods that contain both technical, psychological and social elements can significantly contribute to continuous quality improvement (QI). 

Professional performance. Professional performance, as an individual and in a team, is key to high quality & safe care. I relate performance to group dynamics, communication, learning and culture, thus again as an outcome of a (psychosocial) system. Key words are psychological and social safety, accountability, just culture and non-violent communication. I consider professional responsibility and ownership, as a key value on the way to safe care. I study approaches how to improve the professional culture in healthcare.

Recently we concluded the first study on sustainable professional performance of medical specialists called ‘What’s Up Doc?' A study I conducted in collaboration with colleagues at the Erasmus University. We found that the most significant influences on the ability to perform was group dynamics, and the perceived gap between personal and organisational professional norms and values. Medical specialists actively regulate their environment by influencing group dynamics, and changing work content or place when the norms-gap is too large. Some self-regulations have (unintended) negative effects on patient care, causing moral dilemmas. These findings can help organisations, including specialist partnerships, to create and improve an environment that allows professionals to sustainably perform at a high level that is in alignment with safe care. 

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