Intensive care units are technologically advanced environments that are designed to safeguard the patient while their vitals are stabilized for further treatment. Audible and visual alarms are part of the healthcare ecology. However, these alarms are so many that clinicians suffer from a syndrome called ‘alarm fatigue’ and often do not comply with the task alarm is conveying. Measuring compliance with rules in the workspace and determining the success of a system belongs to the field of ergonomics and is based on data collected through task observations and scoring. In this paper, we will explore compliance with critical alarms by not only from their potential success or failure perspective but also from the perspectives of the clinician capacity, needs, and motivations to comply with alarms in critical environments. We will finally, reflect on further possible design strategies to increase compliance in critical care that are beyond following rules per se but through intrinsic motivation.

Continuous subcutaneous insulin infusion using an insulin pump has been documented to have significant clinical benefits as a treatment plan for type 1 diabetes mellitus patients. However, despite this, adoption in resource constrained settings like India is severely limited. This is often attributed to the costs associated with the device.

The usage of such a device is closely associated with a patient's lifestyle and its design demands a more user-centric approach to engineering design. The stakeholder involvement is needed for validation and guiding the product development direction. In this paper, we've outlined a user-in-the-loop approach to engineering design using the design of an insulin pump as a case study.

Underpinned by a contemporary view of automotive systems as cyber-physical systems, characterised by progressively open architectures increasingly defined by their interaction with the users and the smart environment, this paper provides a critical and up-to-date review of automotive Integrated Vehicle Health Management (IVHM) systems. The paper discusses the challenges with prognostics and intelligent health management of automotive systems, and proposes a high-level framework, referred to as the Automotive Healthcare Analytic Factory, to systematically collect and process heterogeneous data from across the product lifecycle, towards actionable insight for personalised healthcare of systems.

Despite advances in pharmacological research providing means for individually customized patient attribute treatments, the 'one-size-fits-all' paradigm remains. Customization is associated with cost increases and the value assessment of customized medicinal products shows upon a narrow economic focus. Inspired by value models, emerging in manufacturing industry research, this study suggests a novel methodology encompassing a full sustainability perspective, including the social, economic and ecological dimension, for design decision support for medicinal products. A concept screening matrix is adapted, using sustainability criteria as value indicators. The focus is to create value for the whole pharmaceutical value chain whilst keeping the core purpose of medicinal products, i.e. to bring societal benefits. An illustrative case study presents an application of the methodology on a commercial product for curing hypertension. The traditional product design for hypertension treatment is compared to a customized product design. Results indicate that a customized product design is preferable if value is to be created from a social or/and an ecological sustainability perspective.

Toys are children's first consumer products and while playing they acquire numerous skills, learn about their environment and socialise with other children and adults. Toys are adapted and used by clinicians as therapeutic devices because they allow them to create bonds and communicate with children. Aesthetical aspects should be considered early in the design process, especially since pre-schoolers’ views are still dominated by the appearance of artefacts, also known as, the perceptual salient characteristics. The study of emotions mediates the understanding of the relationships between a product, user and the process with which consumers set up preferences over products. Decisions taken in each design stage will influence whether therapeutic devices will be enjoyed by children. An experiment was carried out to test out pre-schoolers’ preferences on individual attributes: form, dimension, material (hardness and weight) and surface (appearance and texture). This study exposed dominant characteristic preferences and the fact that some are influenced by gender and age. Employing these findings in therapeutic devices will enable clinicians to better engage the children during therapy.

Driven by networked Electronic Health Record systems, Artificial Intelligence, real-time data from wearable devices with an overlay of invisible user interfaces and improved analytics, Health 4.0 is changing the healthcare industry. The focus on collaboration, coherence, and convergence that will make healthcare more predictive and personalised. Furthermore, Health 4.0 realises the value of data more consistently and effectively. It can pinpoint areas of improvement and enable more informed decisions. What it also does is help move the entire healthcare industry from a system that is reactive and focused on fee-for-service to a system that is value-based, which measures outcomes and ensures proactive prevention.

In this paper, the authors will first explore the realm of the emerging area of Health 4.0 and identify its opportunities and challenges. This includes understanding the relevant base technologies as well as the design principles for the realization of smart healthcare product, systems and product-service-systems of the future. Following on from there, the authors focus on the role of design in the specific context of healthcare.

A neurointerventional training model called HANNES (Hamburg ANatomical NEurointerventional Simulator) has been developed to replace animal models in catheter-based aneurysm treatment training. A methodical approach to design for mass adaptation is applied so that patient-specific aneurysm models can be designed recurrently based on real patient data to be integrated into the training system.

HANNES’ modular product structure designed for mass adaptation consists of predefined and individualized modules that can be combined for various training scenarios. Additively manufactured, individualized aneurysm models enable high reproducibility of real patient anatomies. Due to the implementation of a standardized individualization process, order-related adaptation can be realized for each new patient anatomy with modest effort. The paper proves how the application of design for mass adaptation leads to a well-designed modular product structure of the neurointerventional training model HANNES, which supports quality treatment and provides an animal-free and patient-specific training environment.

It is essential to graduate students to contribute researching in their academic field. Although it leads to the success of academic career path, the students are more at high risk of mental health problems. Thus, this study attempted to reveal underlying causes of the problems, figure out coping techniques and explore design interventions that can improve of graduate students’ mental health quality. We conducted interviews with one health professional expert and twenty-five graduate students. Design Sheet was created to elicit design solution ideas and distributed to ten professional designers. From the research, we have found out that graduate students are suffering from multiple reasons however there are unmet mental health needs among graduate students. By the end of the paper, we propose five design guidelines for designers to make products or services to promote mental health of graduate students.

High stiffness fracture fixation devices inducing absolute stability, activate inefficient primary healing and stress shielding. Taking High Tibial Osteotomy as a representative example, review of the clinical literature and mapping the fracture healing process revealed two physically contradicting requirements, which are only partially met by current techniques. Stiffness of the fixation is required immediately after fracture, however in the remodelling phase this can cause stress shielding. Stability is required immediately after fracture, however in the ossification phase less stability is required to stimulate secondary (and more efficient) healing. This study evaluates the use of the TRIZ Inventive Design Principles to overcome these physical contradictions. Six designs concepts were evaluated, of which the Macro-Geometry stiffness modulated design was ranked the highest. This was achieved through spatial decomposition of the problem utilising the Inventive Principles of Asymmetry, Extraction and Local Quality. This study offer perspectives on how to increase the patient specificity of fixation utilising the increased topology freedom of design for additive manufacture (AM).

Given that we live in a time within a growing competitive healthcare market, the customer experience and healing opportunities are on top of the priority list. However, little attention has been dedicated on how to merge the disciplines of architecture, healthcare and management to create healthcare environments to enhance the customer experience and the healing process. The goal of this paper is to explore how design can foster customer-perceived intimacy within a healthcare context to achieve enhanced customer outcomes, such as customer well-being. Understanding the importance of customer- perceived intimacy is paramount, as customers are constantly exposed to intimate situations. The study suggest that there is potential for such situations to be wrought with problems involving complexities associated with human cognition, emotions, physiological responses, and behaviors. A literature review is undertaken to highlight the antecedents and the short-term and long-term outcomes of customer- perceived intimacy. As a result, the paper provides a conceptual framework that raises many questions that need to be answered. In doing so, a solid foundation for future inquiry has been laid.

An ageing population leading to more chronic disease is straining healthcare systems. This paper makes two core contributions to healthcare systems design research: Firstly, a systemic techno-behavioural approach is presented to support intervention design with value-effective health outcomes. The systemic techno-behavioural perspective takes into consideration the interaction between three angles: The current healthcare system in place, the technological opportunities for addressing an issue and a broader and deeper understanding of the behaviour of those involved. The purpose of considering these three angels is to create interventions that are more robust. This will help inform healthcare systems design researchers and other stakeholders. Secondly, it is proposed that interventions should be grounded in behavioural theory, a collection of theories are presented to be incorporated in the design process of interventions. The systemic techno-behavioural approach is applied to dementia care highlighting the need to understand the dynamic relationship between the context of the current healthcare delivery system, technology, and behaviour to improve quality of care during the progression of the disease.

Current healthcare delivery challenges are multi-faceted, requiring multiple perspectives to be addressed using a systems approach. However, a significant amount of healthcare systems design research work is carried out within single disciplines or at best a few disciplines working together. There appears to be little deliberate attempt to draw together a wide range of disciplines committed to working together to overcome differences and tackle some of the complex challenges in healthcare delivery. In this paper, we report on the initial outcomes of such an international initiative that, in the form of a workshop held at the University of Cambridge, brought together researchers and practitioners from a wide range of disciplines to explore the foundations of a community for Healthcare Systems Design Research and Practice.

Prototypes have the potential to provoke discussion and to encourage stakeholders to play an active role during design engagements in the front-end phases of a design process. However, detailed descriptions of stakeholder engagement strategies in front-end design are lacking. The aim of this research study was to understand how design practitioners prepare and manage stakeholders for engagements involving prototypes in the front-end phases of a medical device design process. Design practitioners at companies developing mechanical and electromechanical medical devices for use in low- and middle-income countries were interviewed following a semi-structured interview guide. Interview transcripts were analysed, and inductive codes were developed. The findings suggest that design practitioners manage the group composition of stakeholders, review the project and prototype(s) with stakeholders at the start of the engagement, and show the progress of prototypes to stakeholders over multiple engagements. These strategies shed light on the importance of handling interpersonal relationships during stakeholder engagement with prototypes.

Among 75-90% of residents in Danish nursing homes are diagnosed with dementia. This article explore how a team of five 3rd semester bachelor's design students sought to improve quality of life for elderly people with dementia in a nursing home through a co-design process of a new sensory stimulation technology. Participatory Design researchers agree that it is important to involve diverse actors in the design process such as elderly with dementia, nursing home management, nursing staff etc. But when involving many different actors in designing new products, services and systems the challenge is to navigate the many perspectives and concerns of these actors, which is often conflicting and hence needs negotiating. ‘We draw upon the ANT framework to analyse how ‘matters of concern’ (MoCs) are negotiated and to discuss how designers navigate by staging and facilitating design interactions to support negotiation of MoCs among numerous actors during the design process.

A low cost robotic-assisted prototype for finger and hand rehabilitation of people affected by a stroke is presented. The system was developed by a team of undergraduate students led by a Design lecturer in collaboration with the Rehabilitation Unit of the Peñablanca Public Hospital in Chile.

The system consists of a flexion sensor equipped glove, a hand exoskeleton and an Arduino control unit. The patient wears the glove in his healthy hand. When s/he performs movements with the healthy hand, the sensors register the flexion of the fingers and send this information to the servo motors installed in an exoskeleton attached to the affected hand. In this way, the affected hand reproduces the movement of the healthy hand. The system uses a combination of the mirror therapy (the patient sees his/her affected hand moving in the same way that the healthy hand does) and passive exercising (as the exoskeleton produces the movement of the hand affected by the stroke). The combination of two types of therapy in a single low cost system makes the present work unique. In the near future, the developed prototype will be used to validate the effectiveness of the new proposed robotic therapy.

More and more attention is paid nowadays to the human health concerns, associated with environmental problems arising from the fossil fuel use. The world scientific community offers new alternatives that, despite being more environmentally friendly, require an analysis of their potential environmental impacts. For example, biorefineries are becoming increasingly widespread nowadays offering a large gamma of bio-based products. However, it is necessary to take into account what potential effects such facility may have on the human health, depending on its geographical location since different territories may be more or less sensitive to its installation. Our study describes a new bioprocess implementation in terms of impact on human health through three countries: France, Belgium or China. In order to understand what territory can be more appropriate to the industrial process installation in terms of its effects on the human health, we propose to use the spatialized life-cycle analysis methodology.

With increasing level of advancement and complexity in medical devices, there is a need for methodology, tools and techniques in practice to integrate Human Factors and Usability (HF/U) elements in design due to its increasing diversity of users and rapidly changing interface types. This paper proposes a methodology to develop a tailor-made HF/U design guidelines for medical device development with various sources and to develop heuristics for evaluation and score the product usability throughout the development process.

This paper proposes a categorization of existing approaches to healthcare-related engineering design based on systems thinking principles. Three existing approaches to healthcare-related engineering design are isolated which contribute differently to health systems fundamental purposes and interconnections. The three approaches are labeled as 'silent', 'overt', and 'convergent' health design. Each approach is defined and illustrated through an example. Following, practical advantages and disadvantages of each approach are discussed. A reflection is offered on the expected relevance of the convergent health design approach for present and future societal challenges in the health domain, and specifically on the recently growing field of e-health. Finally, open methodological challenges related to convergent health design are outlined and characterized as opportunities for future research.