HealthcareLABInnovationUser-driven health-care innovation via simulation in the fields of construction, product development and services

May 2012

English

The way to rapid and accurate product development in the healthcare sector, comprising clinicians, the business commu-nity and research scientists

IMPRINTTitle: Healthcare Innovation Lab - User-driven healthcare innovationvia simulation in the fields of construction, product and services

Editors:Susie A. RuffEva Jacobsenwith contributions from a number of project participants

Layout: Claus Lynggaard / blinkblink.dk, illustrations: Fritz Ahlefeldt

Copyright: Healthcare Innovation Centre, Capital Region

Publisher: Healthcare Innovation Centre, Capital Region of Denmark.

ISBN number: 978-87-995342-1-0

The material can be downloaded in Danish and English at: www.centerforsundhedsinnovation.dk

Project owner: Healthcare Innovation Centre, Capital Region of Denmarkwww.centerforsundhedsinnovation.dkMay 2012

The project is co-financed by the Danish Business Authority under the Programme for User-Driven Innovation

The target audience for this publication is hospi-tal manage ment, clinicians, research institutions and enterprises involved in innovation in the field of new products, services, concepts and organi-sational forms within healthcare in Denmark and internationally.

3

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

PREFAC

E

The challenges facing the healthcare sector are such that we are required to think innovatively and outside

the box in developing the hospitals and healthcare sector services of the future. I therefore take great pleasure

in being able to present this publication outlining the results of the Healthcare Innovation Lab project.

This demonstrates the potential for utilising user-driven simulation as a method of innovation in connection with

the development of new products, concepts and services.

The unique feature is that the project has been conducted from the outset in close collaboration between

hospitals (end-users), businesses and knowledge institutions as a Public–Private Innovation Partnership (PPIP)

involving as many as 26 partners.

During the project, we have worked with three different demonstration projects that reflect different challenges

facing the hospitals of today and tomorrow: The Outpatient Clinic of The Future, Mobile Blood Test Results and

Telemedicine – Remote Treatment of Cardiovascular Patients. All three cases have created prototypes in their

particular sphere. The results from using simulation as a user-driven method are promising and show there is a

tremendous potential in terms of creating added value in the development of new physical hospital settings,

new services, technologies and products.

The real eye-opener was the perception of simulation as an innovation tool by the users taking part in the pro-

cesses, whether clinicians, enterprices or research scientists. The very fact of involving the users, combined with

simulation, as a test and analysis method was ground-breaking in the project and this forms the basis of future

services in the Healthcare Innovation Centre. Breaking down barriers and obstacles is another of the Centre’s

ace cards, and in combination with facilitation processes, this enables solutions to be tested and developed

effectively.

The publication gives the reader a good understanding of how an innovation process can be implemented

and where simulation can usefully be applied, whether the reader is a decision-maker, clinician, business or

knowledge institution. This knowledge emerged as a result of the participants’ strong commitment and positive

teamwork, and I would like to thank you all for your involvement in the project. The project was conducted in a

period of many adjustments and challenges for the Capital Region of Denmark, and yet clinicians stepped up

to the plate and brought to the project immense dedication, interest and the will to develop and change.

The results can be used by private and public-sector healthcare players in Denmark, the Öresund region (Den-

mark-Sweden) and worldwide, and serve as a springboard for future public–private partnerships and strategic

partnerships in the healthcare sector.

Happy reading!

Søren Rohde

CEO, University Hospital of Herlev, Denmark,

Chairman of the Healthcare Innovation Centre steering group

4

“The Healthcare Innovation Lab concept is unique for many reasons: we show that simulation can be used as a tool of innovation, as it creates a structured innovation process with specific output, incorporates the users’ needs and of-fers the opportunity for rapid testing of ideas and concepts. By virtue of conducting three demonstration projects that brought together clinicians, research scientists, the business community, innovation experts and designers, we have created dynamic, inter-disciplinary teams with very different skill-sets. The ideas generated are new and different. We use the good ideas, technologies and service concepts from other sectors and bring them into the hospital context. We have created prototypes that can help deal with the challenges that will be facing the hospitals of tomorrow. We have laid the foundations for establishing an actual lab for healthcare innovation in the Capital Region of Denmark where simulation is used for rapid product development.”

Susie A. RuffHead of Healthtcare Innovation CentreCapital Region of DenmarkChairperson of the Healthcare Inno-vation Lab steering group

Organisational structure of the Healthcare Innovation Lab:

PROJECT OWNER, OVERALL PROJECT MANAGEMENT

AND RESPONSIBILITY:Healthcare Innovation Centre, the Capital Region of Denmark

MAIN PROJECT GROUP: DI ITEK, DTU management Engineering, Grontmij, University Hospital of Herlev,

the Danish Institute for Medical Simulation, Healthcare Innovation Centre.

SUB-PROJECT MANAGEMENT FOR DEMONSTRATION PROJECTS:The Outpatient Clinic of The Future: Grontmij and Healthcare Innovation Centre

Mobile Blood Test Results: DTU Management and Healthcare Innovation Centre

Telemedicine – Remote Treatment of Cardiovascular Patients: DI ITEK

and University Hospital of Herlev

HEALTHCARE INNOVATION LAB STEERING GROUP:Søren Rohde, CEO, University Hospital of Herlev

Torben Ø. Pedersen, Hospital Director, Hvidovre Hospital

Morten Freil, Director, Danish Patients

Christian Graversen, Chief Consultant, DI ITEK

Per Frølund Thomsen, Department Director, Planning, Grontmij

Henning Boje Andersen, Professor DTU Management Engineering, Technical University og Denmark

Jan Kold, former Managing Director, Koncern IT

Kurt Pedersen, Head of Development, University Hospital of Herlev

Jens Kristian Gøtrik, Former CEO in the Medical Technology Industry

Martin Sølvkjær, Head of Innovation & Administrative Systems, IMT, the Capital Region of Denmark

Doris Østergaard, director of the Danish Institute for Medical Simulation

Christian Worm, director of Planning and Development, the Capital Region of Denmark

Susie A. Ruff, Head of Healthcare Innovation Centre, the Capital Region of Denmark (chairman)

5

Forord ................................................................................................................. 3

Summary ........................................................................................................... 6

Challenges facing the healthcare sector

– great need for innovative solutions ............................................................... 9Purpose and framework of the Healthcare Innovation Lab .................................. 10

The Outpatient Clinic Of The Future ................................................................ 13

Mobile Blood Test Results ................................................................................ 14

Telemedicine – Remote Treatment of Cardiovascular Patients ..................... 15

The innovation process In the Healthcare Innovation Lab ............................ 17

Simulation ........................................................................................................ 20From simulation as an educational and training tool in the healthcare sector… ..... 20…To simulation as user-driven method and innovation tool of the healthcare innovation lab ........................................................................... 21

Gathering experience from the demonstration projects .............................. 22

Patient involvement – an important part of

the Healthcare Innovation Lab ....................................................................... 27The Outpatient Clinic Of the Future .................................................................. 27Mobile Blood Test Results ................................................................................ 27Telemedicine – Remote Treatment of Cardiovascular Patients ............................. 27

Validation of the Healthcare Innovation Lab’s methodology: ...................... 29

Specification of requirements for the physical healthcare innovation lab:An actual laboratory for healthcare innovation ............................................ 33

The Healthcare Innovation Lab Public-Private Innovation Partnerships (ppip) contributes to creating the uniqueInter-disciplinary platform ............................................................................... 37

APPENDIX ......................................................................................................... 421. Conference papers & abstracts in English ........................................................ 422. Participants in the Healthcare Innovation Lab project ..................................... 433. Simulation ................................................................................................... 48

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

CONTENTS

6

Summarised below are the key con-clusions, experience and vision gained through the simulation-based and user-driven innovation work in the Health-care Innovation Lab and the three demon-stration projects, The Outpatient Clinic of The Future, Mobile Blood Test Results and Telemedicine – Remote Treatment of Car-diovascular Patients.

• Healthcare Innovation Lab encompasses 26 partners in a Public–Private In-novation Partnership (PPIP). This is an inter-disciplinary set-up that creates a dynamic and innovative field of tension between the clinic, the business com-munity, research scientists and innova-tors. It takes training and team-building to get all parties to interact proactively. The participants have to be willing to enter into open processes. Tight manage-ment (leadership capacity) is required of the project management. In addition, the project owner has to be able to bring together relevant players (network, ac-cess) and demonstrate useful results from processes that require special innova-tion skills (methods and experience). Development for the benefit of all PPIP participants, together with the develop-

ment of specific innovative solutions, have been a central objective in working with simulation as a user-driven method.

• Innovation in practice in the health-care sector is a complex task. The prerequisite for success is the iterative/repeated process whereby involvement of users, research scientists and busi-nesses (suppliers) ensures that the pro-cess reaches the target group in the right way. It is important that the product, concept, form of organisation or service is developed and adapted to the context and the specific situation in which is it to be used in hospitals. The innovation process in the Healthcare Innovation Lab consists of being open to ideas and pos-sibilities, and then “closing” the creative process as well as exercising tight and fo-cused project management. The unique process that Healthcare Innovation Lab has implemented cannot be brought about with classic development methods and traditional project management.

• Simulation reinforces work with user-driven methods, as it makes it possible to test and try out results of prior innovation and development pro-

cesses in the context, and in an iterative way. The simulation used in the inter-disciplinary teams helps to break down barriers, boost creativity and identify known and unknown needs. Simulation helps to qualify the product, concept or service in question. Simulation as a user-driven method is unique because simulation visualises processes and makes it possible to review ideas, con-cepts and prototypes/pilot versions with users and system developers, for example during critical usage situation phases.

• The lessons learnt from the three demon-stration projects, The Outpatient Clinic of The Future, Mobile Blood Test Results and Telemedicine – Remote Treatment of Cardiovascular Patients have resulted in the development of a unique metho-dology for the Healthcare Innova-tion Lab. This methodology combines user observation, idea generation/rapid prototyping and simulation testing. In order to validate the three demonstra-tion projects, the method has been tried and tested in a compressed model, a 3 x 3 model (three times three hours). Ten enterprises (five medical technology enterprises, four IT enterprises and one

SUMMARY

7

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

manufacturer of rehabilitation devices) as well as nine hospital departments and one psychiatric department served as the testing hub. Testing took place in autumn 2011 and spring 2012. The results have been consistently positive for the departments and the enterprises alike. The enterprises have generally ex-perienced faster and important input for the product development process, and the departments have been in a position to directly influence the development of the products that they will be work-ing with themselves. The Healthcare Innovation Lab’s unique combination methodology has generated demand.

• The project conducted cost–benefitanalyses of each of the three de-monstration projects. Two of the three demonstration projects can directly generate benefits here and now. The third demonstration project will gene-rate benefits after an investment of DKK 4.6 million from ‘Kroniker-programmet’ (Rehabilitation Pro-gramme for Chronically Ill Patients).

• Healthcare Innovation Lab demonstrates a number of Unique Selling Points:

1) the ability to match-make clinicians, businesses and research scientists, 2) proximity to the clinic and having access to the right specialists, and 3) being able to set up small-scale or large-scale simulation scenarios in or close to the clinic. The main point that has emerged is that there is considerable potential inherent in bringing together expert specialists, external consul-tants and simulation experts in a well-established innovation environment.

• The project has continuously been communicated to many different play-ers. In autumn 2011, for example, the Healthcare Innovation Centre invited 250 guests from the hospitals, the re-gions and the business community to an innovation conference for a pres-entation of the results of the project.

• There is strong interest from the busi-ness community and at international level in the process, methods and results of the Healthcare Innovation Lab. The project demonstrates both a rapid and an effective development of the health-care sector, but it also demonstrates that the method creates useful development

HealthcareLABInnovation

for the business community. This includes an accelerated development potential as well as the opportunity for valuable export potential as a result. The Health-care Innovation Lab project has thus laid the foundations for and demonstrated the value and usefulness of establish-ing an actual laboratory that would also work across national boundaries in the Öresund Region, for example. Interest in the Healthcare Innovation Lab method and partnership model has come from vari-ous quarters including Sweden, Norway (Oslo, Stavanger), the European Commis-sion in Brussels and Kaiser Permanente healthcare organisation in California.

8

Innovation is:New ideas put into practice

and implemented, which create value for a large target group including the health-

care sector and the business community.

(Healthcare Innovation Lab’s own definition)

PROJECT PARAMETERS

The Danish Business Authority’s

Programme for User-Driven Innovation

and the Growth Forum for the

Capital Region of Denmark

co-financed the project.

Project period:

1 February 2010 – 30 April 2012.

The Healthcare Innovation Centre is a strategic venture in the Capital Region of Denmark.

The centre works systematically with user-driven innovation and innovation projects at the

region’s 12 hospitals, psychiatric and disabled units. The activities of the centre include:

Implementation of major innovation projects taking as their starting point the needs of

clinicians and departments, gathering new ideas from management and staff for further

processing, facilitation of innovation processes and innovation workshops in the departments.

The centre serves as a link between stakeholders in the public healthcare sector, private

businesses and research institutions. The centre has initiated The National Network for

Healthcare Innovation in Denmark and works continuously to promote an international

network among the world’s most eminent healthcare innovators.

The Healthcare Innovation Centre is financed by The Growth Forum for the Capital Region of

Denmark, and the Capital Region of Denmark’s 12 hospitals, psychiatric and disabled units.

www.centerforsundhedsinnovation.dk

HEALTHCARE INNOVATION CENTRE,

THE CAPITAL REGION OF DENMARK:

PROJECT OWNER, THE HEALTHCARE INNOVATION LAB

KEY NUMBERS FOR THE CAPITAL REGION OF DENMARK•Far the kargest Region in Denmark

•12 hospitals

•6,500 beds

•More than 3,000,000 treated patients (in and out patients)

•40,000 employees

•1,6 mill. inhabitants

FAC

TS

9

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

CHALLENGES FACING THE HEALTHCARE SECTOR – GREAT NEED FOR INNOVATIVE SOLUTIONS

Innovation is one of the key tools for tack-ling the challenges facing the Danish health service. Today, the health service is under enormous pressure to deliver quality services on time to its users. At the same time, the number of treatments is increas-ing, both for emergencies and for chronical-ly ill patients. If prioritisation is not to be the only solution, it is essential to come up with new and improved methods for equip-ping the health service to meet future ex-pectations. New methods that can deal with demands for solutions across sectors. Meth-ods that at the same time create effective so-lutions that can help reduce consumption of resources in the healthcare sector and in-crease focus on the patient.

The development of the health service re-quires new solution models going forward for how private enterprise can work innova-tively in close collaboration between users, patients, doctors, nurses, research scientists, etc.

Specifically, users – staff and patients – are key stakeholders when it comes to identifying needs and requirements for new physical settings or the design of new

products and functionality. Identifying the known and especially the unknown needs of users is an important prerequisite for contributing the necessary knowledge.

Simulation as a user-driven method and hence a tool of innovation can shed impor-tant new light for enterprises that advise on or are suppliers for hospital construction of the future: interior design, technology, or-ganisation and arrangement.

Business Communities

• DI ITEK• Grontmij• Care2Wear A/S• Pallas Informatik A/S• In-JeT ApS• Bang & Olufsen Medicom A/S• CSC Scandihealth• Max Manus A/S• IBM Danmark ApS

Knowledge Institutions

• CBS Helix• Medico Industrien• Medico Innovation• Danish Patients• Danish Society for Patient Safety

Research Institutions

• DTU Management• IT University of Copenhagen

HOSPITALS

• Healthcare Innovation Centre• Herlev Hospital• Bornholms Hospital• Bispebjerg Hospital• Rigshospitalet• Hvidovre Hospital• Glostrup Hospital• Danish Institute for Medical Simulation • IT-division• Koncern Regional Udvikling

PARTNERS

HEALTHCARE INNOVATION LAB: THE LIVING “EXPERIMENTARIUM” FOR PUBLIC–PRIVATE PARTNERSHIPSThe Healthcare Innovation Lab includes many collaborative partners from hospi-tals, the business community, the world of research, patient associations and innova-tors. Altogether, there are 26 partners in-volved in the project to a greater or lesser extent.

10

• To develop and test simulation as a user-driven innovation meth-od through specific innovation pro-cesses in three types of demonstration projects involving hospitals, private enterprise and knowledge institutions. These must result in specific new pro-ducts, services, work processes and the formation of strategic partnerships.

• To identify the benefits created by user-driven healthcare innovation – including the potential for commer-cial development created by experi-ence gained from the project through specific interaction of patients, next-of-kin, health experts and managers of public-sector hospitals, private enter-prises and knowledge institutions.

• To prepare a presentation and business plan, including preparing a proposal for financing and secur-ing political ownership of a Health-care Innovation Lab as a ba-

ideas that you cannot simply visualise but that have to be tested in practice.”

Morten Lebech supports the need for an actual lab close to the clinic:

“I recommend that simulation in future Healthcare Innovation Centre projects be implemented at full scale, where users can test solutions in large-scale physical settings located close to the workplace so as to avoid unnecessary travel time.”

As project owner, the task before the Healthcare Innovation Centre and the Capital Region of Denmark is to create the setting and the prerequisites for a Public–Private Innovation Partnership (PPIP) in-volving stakeholder businesses, hospitals and knowledge and research institutions in the Capital Region of Denmark. A part-nership model capable of producing so-lutions for a number of challenges in the health service.

The project originally had three main pur-poses:

The purpose of the Healthcare Innovation Lab project is to create a platform for the use of simulation as a user-driven method. Simulation has long been used for train-ing and education in the healthcare sector, and user-driven innovation methods have long been used for the development of new products and services. Combining the two methods creates a dynamic and results-generating platform where the simulation enables relatively rapid development and testing of new solutions on site.

Morten Lebech, Head of Department, Dept. of Gynecology & Obstetrics, Uni-versity Hospital of Herlev, participated in The Outpatient Clinic of The Future demon-stration project. He has this to say about sim-ulation as a tool of innovation:

“The potential for using simulation in Healthcare Innovations Lab is enor-mous. The method is very useful and has great potential for further developing ideas and guaranteeing user owners-hip. Simulation has amazing potential as a tool for further developing ideas –

PURPOSE AND FRAMEWORK OF THE HEALTHCARE INNOVATION LAB

11

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

tofte and Hillerød Hospital subsequent-ly helped trial the method together with five private enterprises. The goal of each demon stration project is for solutions to be scalable and transferable to similar de-partments in other hospitals.

sis for establishing a future Lab in the Capital Region of Denmark.

The project has been implemented with three demonstration projects (A, B, C), each in its own field/sphere. This shows how user-driven simulation can be used in very different areas and thus determine whether the method has greater potential in some areas than in others.

The three demonstration projects were created based on specific and current needs for new solutions within each of these fields:

A. The Outpatient Clinic of The FutureB. Mobile Blood Test ResultsC. Telemedicine – Remote Treatment

of Cardiovascular Patients

The point of departure for each demon-stration project is a particular case in the hospital departments of Bispebjerg Hos-pital, University Hospital of Herlev and Bornholms Hospital respectively. In ad-dition, departments from Hvidovre, Gen-

Morten Lebech, Head of Department, Dept. of Gynecology & Obstetrics, University Hospital of Herlev

12

HOW DID THE IDEA OF A HEALTHCARE INNOVATION LAB COME ABOUT?

The idea of a Healthcare Innovation Lab came about in 2009, shortly before the Healthcare Innovation Centre

was established in August 2009. The development department, University Hospital of Herlev, and the Danish

Institute for Medical Simulation (DIMS), the Capital Region of Denmark, had recognised a need for an actual

Lab in the Capital Region where solutions based on the needs of clinicians, for example, could be played with,

tested and developed. Inspiration came inter alia from the Garfield Innovation Center, Kaiser Permanente, USA.

The development department at The University Hospital of Herlev and the Healthcare Innovation Centre fast-

tracked development of the idea and a concept description, and contacted a number of relevant players

from hospitals, the business community, research institutions, patient associations, etc. At the end of August

2009, an application for the present project was submitted to the Danish Business Authority for funding.

13

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

The tendency towards shorter hospitali-sations and more outpatient checks looks set to continue in the years ahead. Accord-ingly, the most effective ways of organising work processes and designing outpatient clinics is particularly important going for-ward. Now is the time to plan how new hospital buildings should be arranged. Therefore, this demonstration project has a highly relevant focus that may provide valuable insight for the benefit of hospi-tal construction in Denmark and abroad. The demonstration project has used simu-lation to develop and test new concepts of task handling, coordination and function-

ality inTthe Outpatient Clinics of The Fu-ture.

In order to be able to simulate such a large physical space and such complex work pro-cesses involving many people, the project group made use of table-top simulations us-ing cardboard and paper models. The simu-lation method was used to identify the needs of users – patients and clinicians – for a pa-tient-centric physical setting that at the same time supports staff work processes in the best possible way. New concepts were developed and tested in a dynamic collaboration invol-ving clinicians at University Hospital of Her-lev Gynaechology Department G, work study researchers, advisers in the construction in-dustry and the Healthcare Innovation Centre.

The essence of the new outpatient clinic concept is a new spatial model. It address-es the problem of long corridors where pa-tients and staff interweave, which inhibits overview and collaboration. The new spatial model is circular and has been dubbed the Star Model; it facilitates more effective utili-sation of personnel resources and provides a much-improved experience for patients.

FROM IDEA TO IMPLEMENTATIONThe Star Model can be introduced as an organisational model within the existing

THE OUTPATIENT CLINIC OF THE FUTURE

physical setting at Gynaechology Depart-ment G at University Hospital of Herlev. In this specific case, a method was developed where simulation is used both for deve-lopment and testing of new solutions. The method is robust and can be used gener-ally to resolve challenges that exist in the Capital Region of Denmark and nation-ally in relation to new hospital construc-tions. The model focuses on functionality, patient flow, working environment, work processes and organisation. As we go to press, the model and the methodology have been presented to a wide range of construc-tion managers from a number of hospitals and psychiatric units in the Capital Region of Denmark as well as the Capital Region’s Group Construction Management). In addi-tion, It has been presented to a number of international stakeholders.

14

Reports of errors in the transfer of informa-tion between clinicians and adverse events data show that overlooked test results sent from the laboratory to the clinic lead to a reduction in patient safety. Prompt action on test results is vital for patient safety and effective treatment.

From an examination of the working envi-ronment of clinicians, especially in in-hospi-tal emergency care and A&E, it is clear that the IT aids that would ensure an up-to-date overview of test results in the right place and at the right time do not exist. With regard to handling test results, the effectiveness of the clinicians is impaired because they have to go to stationary PCs to view test results for a

given patient. Similarly, they are dependent on the nurses checking whether test results have arrived, also on a stationary PC or fax machine. At the same time, the nurse must keep the doctor informed verbally as to the status of test results, which can be an inter-ruption if it is just to say there is “nothing new”. Altogether, there is a failure to exploit the possibilities offered by mobile techno-logies to facilitate more effective use of re-sources, so there is a lot of scope for innova-tion in the handling of test results.

The IT department and Endocrinology–Gastroenterology Department at Bispebjerg Hospital are the hub of these user studies. The latter department was selected because it has a large number of patients who have blood samples taken. The clinicians play a vi-tal part in identifying user needs through ob-servation studies and work process analyses.

The idea-generating workshop and simu-lations are useful tools in the work of deve-loping software capable of giving clinicians the necessary mobile overview of test results received. First, work was done on sketches of different displays of the test results. La ter, these were firmed up into prototype software on a Microsoft platform and a web-based platform.

MOBILE BLOOD TEST RESULTS

FROM IDEA TO IMPLEMENTATION:As we go to press, the prototype is in the process of undergoing the final adjust-ments and will then be ready for clinical piloting at one of the region’s hospitals. Bispebjerg Endocrinology–Gastroentero-logy Department is a possibility. The proj-ect group is working with the Capital Re-gion of Denmark’s IT organisation (IMT) to integrate the solution and the know-ledge it represents in an existing project to do with the handling and display of test results such that, within the next few years, all clinicians will be able to take ad-vantage of this solution, for the benefit of patient safety and the clinical working en-vironment. The next step will be regional and national scaling.

15

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

Telemedicine solutions are used in a num-ber of different countries for Remote Treatment, which saves time and money, as the patient can typically stay at home without having to travel to the hospital or visit their GP. In Denmark, the num-ber of chronically ill patients for example with cardiovascular disorders is on the in-crease. Accordingly, based on the case of cardiovascular patients, the project group focused on developing an innovative solu-tion for how, in the future, we can use mon-itoring and the exchange of information to treat patients remotely and make these pa-tients more self-sufficient.

The simulation method was used to iden-tify the needs of the clinics and the patients. Using simulation, technical solutions were

developed for how the patient and the medi-cal practitioner can communicate via video conference and what functionalities need to be on the screen (user interface). The solu-tions are based on existing technology (hard-ware, software). The simulations highlighted the specific requirements set for the treat-ment task, quality and process; requirements that cannot be tackled by ordinary dialogue and interview in the same way – quite sim-ply, things have to be tried out!

Bornholms Hospital’s Medical Ward and University Hospital of Herlev’s Cardiology Department have helped to create an excit-ing case for telemonitoring and remote dia-logue between healthcare practitioner and heart patient. The lesson from the process was not only a matter of the functions re-quired by medical practitioner and patient but also very much a matter of understand-ing the organisational requirements that this type of solution must meet. Again, simula-tion was what made all these factors visible at the same time – by playing out scenarios.

FROM IDEA TO IMPLEMENTATIONCardiac Insufficiency Telemedicine (CIT) has been tested through simulation with

the hospital management, medical practi-tioners and end-users. This test shows that the basic functionality is satisfactory for the medical practitioner and the end-user. Therefore, the solution can be carried for-ward to implementation after operational incubation to ensure that operation of the solution is unambiguous and stable in the clinic and in the end-user’s home. The demonstration project has succeeded in obtaining DKK 4.6 m from ‘Kronikerpro-grammet’ (Programme for Chronically Ill Patients) to implement a pilot installation in departments at University Hospital of Herlev, Hvidovre Hospital and Bornholms Hospital. The purpose of CIT is to put the spotlight on the clinical and organisational effects of telemedicine, including collabo-ration with GPs and municipalities con-cerning outpatient care pathways. The project seeks to demonstrate and docu-ment that using telemedicine can contri-bute to a rapid and more flexible treat-ment offering at least the same quality as ordinary outpatient treatment.

TELEMEDICINE – REMOTE TREATMENT OF CARDIOVASCULAR PATIENTS

FOR FURTHER INFORMATION ON

THE THREE DEMONSTRATION

PROJECTS:

Please contact Healthcare Innovation Centre,

www.centerforsundhedsinnovation.dk.

16

531

642

IDEA

& C

ONCEP

T

GEN

ERAT

ION

PRE-

STUD

Y

NEEDS-

IDEN

TIFIC

ATIO

N

CONCEP

T DET

AIL

PRO

JECT

START

TEST

AND

IMPL

EMEN

TATIO

N

17

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

THE INNOVATION PROCESS IN THE HEALTHCARE INNOVATION LAB

This section sheds light on the innova-tion process, including the challenges and methods used in the Healthcare Innova-tion Lab.

CULTURAL DIFFERENCES IN PPIPThe start of the Healthcare Innovation Lab was the beginning of an extensive project. A PPIP project involving 26 partners means people come from a number of dif-ferent cultures:

• The clinic with its day-to-day chal-lenges and with a scientific approach

to tasks (evidence based, a challenge to enter into innovation processes where the outcome is unknown)

• The research scientist with a long time-scale from classic research projects

• The enterprise representative with short deadlines, a focus on results and scarcity of resources, and

• Innovation experts with a focus on ensuring there is scope for in-novative freedom, non-recognised needs and unexpected solutions.

The above challenges are described in more detail in the PPIP section.

Specifically, this means the Healthcare In-novation Lab has to ensure tight manage-ment in order to achieve a successful process and produce results. The project uses an ar-ray of specific methods and tools to ensure a professionally run innovation project. The following has been implemented in the start-up phase:

A kick-off workshop for all PPIP par-ticipants. There is a need for a com-mon understanding of the project when so many divergent parties are to work together and bring many different objectives to the table.

A course about methods for all par-ticipants. For example, clinicians are frequently unfamiliar with in-novation methods. Enterprise wish-es to expand its expertise in rela-tion to user-driven innovation.

PRELIMINARY ANALYSISTo gain an overview of other existing state-of-the-art activities worldwide as well as knowledge of how other industries apply simulation, the preliminary analysis in-cluded meetings with and visits to selec-ted national and international sources of

Doctors and nurses

Patients

Researchers

Enterprises

18

inspiration and potential partners. Litera-ture studies were used to obtain up-to-date knowledge of simulation as a user-driven method.

IDENTIFICATION OF NEEDS & ANALYSISThis phase delved deeper into the topics for the three demonstration projects in or-der to gain a better understanding of the challenges through analysis of relation-ships, collaboration and patient care path-ways. This was with a view to identifying the known and unknown needs of the

u sers. All of these methods are included on the palette of innovation methods and user- driven innovation.

The innovation methods used are:- Participant observation, where

the users are observed going about their work processes

- Various types of interviews- Video to document the observed

work processes, including iden-tifying problems and needs.

- Design games used here, for example, to map different patient care pathways

- Work process analysis is used among other things to map current work pro-cesses and identify inappropriate actions

- Visualisation

IDEA/CONCEPT GENERATIONThe next step for the Healthcare Innova-tion Lab was to come up with proposed so-lutions for the problems and needs iden-tified in relation to the three groups, The Outpatient Clinic of The Future, Mobile Blood Test Results and Remote Treatment of Cardiovascular Patients. Ideas and pro-posals for new solutions (concepts) were developed in ways including the following: - Different types of brainstorming,

Clinician involvement

Process planning and definition

Feb 2010 Aug 2010 May 2011

User involvement

19

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

used to generate a number of ideas in the three demonstration projects

- Concept development to elaborate on the ideas generated.

- Prototyping/trial versions as models to make the solutions more tangible to the users.

- Rapid prototyping, where quick prototypes/trial versions

are created, for example using paper, modelling clay, etc.

CONCEPT DETAIL The recently developed concepts for The Outpatient Clinic of The Future, Mobile Blood Test Results and Telemedicine - Re-mote Treatment of Cardiovascular Patients are prioritised and fleshed out by devising scenarios and simulations, etc.

TESTINGThe selected concepts for The Outpatient Clinic of The Future, Mobile Blood Test Results and and Telemedicine - Remote Treatment of Cardiovascular Patients re-spectively are tested via simulation in col-laboration with relevant players (users, technology suppliers). This is done within settings that are as close as possible to real-ity by means of selected scenarios and in

collaboration with the Danish Institute for Medical Simulation (DIMS).

IMPLEMENTATIONHere, the Healthcare Innovation Lab fo-cuses on designing products, concepts and services that do not remain in a report left lying on the shelf. The focus is on proto-types and on dialogue with the stakehol-ders in the Capital Region of Denmark and other stakeholders who can contribute to scaling and ultimately to implementa-tion (clinicians, IT departments, construc-tion managers, etc., in the Capital Region). Based on the results from the project, a plan has been drawn up of how to carry the recently developed concepts through into practice.

20

One main purpose of the Healthcare In-novation Lab is to develop specific inno-vative solutions. The other main purpose is to link user-driven innovation meth-ods from private enterprise with simula-tion methods used for training and educa-tion in medical contexts. The project thus sought to develop methodology as well as solutions.

This distinguishes the Healthcare Innova-tion Lab from other user-driven innovation

projects that seek to apply more standardised user-driven innovation methods.

With regard to innovation in the health-care sector, however, various ethical and safety considerations come into play. These factors can be a barrier to investigative and iterative innovation processes that often in-volve participants making mistakes and then adapting the solution being worked with. It is self-evident that not all types of error can be accepted in actual practice. The Health-

SIMULATIONFROM SIMULATION AS AN EDUCATIONAL AND TRAINING TOOL IN THE HEALTHCARE SECTOR…

SIMULATION TRAINING IN THE HEALTHCARE SECTOR – THE DANISH IN-

STITUTE FOR MEDICAL SIMULATION, THE CAPITAL REGION OF DENMARK

Simulation training is a teaching method familiar to many healthcare workers. It is frequently used

when healthcare workers are to be trained in medical procedures that cannot be practised on a

real patient. It is appropriate, for example, in cardiac arrest training, receiving an emergency patient,

or monitoring a patient under full anaesthesia. The training typically does not take place in the clinic,

but in a room reminiscent of a film set with wings. The room is set up with fully functional equipment,

etc.; all that is missing is the patient, who is usually replaced by a high-tech dummy. Accordingly,

simulation training usually takes place at special locations with appropriate rooms and equipment.

The Danish Institute for Medical Simulation (DIMS) on 25th storey of The University Hospital of Herlev is

one of the world’s leading simulation centres, and is a key player in the Healthcare Innovation Lab.

http://www.regionh.dk/dims/menu/

care Innovation Lab project groups therefore needed to find a padded cell or laboratory where the patient/clinician, enterprises and research scientists were allowed to make mis-takes together during the innovation process. At the same time, it had to be a laboratory that approximates so closely to actual prac-tice that it can indeed be said that the inno-vation process is user-driven. Such a labora-tory could, for example, be the places where simulation training is currently undertaken.

21

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

As already intimated, simulation train-ing is traditionally used for the purpose of training participants and not for deve-loping the equipment to be used, the in-terior surroundings or the work processes being implemented. In the Healthcare In-novation Lab, development is the actual purpose, so the simulation process and the premises are instead used to imple-ment innovation processes. In the Health-care Innovation Lab’s three demonstra-tion projects, therefore, the focus is not on practising procedures but instead on using simulation at different points in the inno-vation process, from identifying the needs of the clinician and patient at the start of the process, to testing and developing pro-ducts, processes and services at the end of the process.

Simulation as an exploratory innovation method can be used, for example, for map-ping existing work processes, simulating these in order to arrive at a common under-standing among participants. In addition, the exploratory approach can be used to gene rate ideas and concepts, with different scenarios being played out.

In the early exploratory phase, simula-tion is used to develop different concepts at a time when the solutions have not yet been

fully clarified. With simulation of future work processes, development of new medical technology or IT products, for example, the concepts can be rapidly developed, refined and tested.

A functional innovation method is used to try out simulation as a functional innovation method. Here, specific details of the function are examined to see if they work in diffe rent usage scenarios. At this point in the inno-vation process, there is no room for radical changes in either concept or solution; for this reason, the focus is on fine-tuning the simu-lation as the need arises. During this phase, the simulation will usually be full scale, in order to approximate as closely as possible to reality, e.g. simulation in the clinic or other locations where the solution is to be applied. At this point in the innovation process, there is a need for specific inputs for the solution, and it is therefore not sufficient to test it by means of a table-top simulation, as context is essential for obtaining proper feed-back from the users.

…TO SIMULATION AS USER-DRIVEN METHOD AND INNO-VATION TOOL OF THE HEALTHCARE INNOVATION LAB

Simulation can be used at different points in the innovation

process. For The Outpatient Clinic of The Future, Mobile Blood

Test Results and Telemedicine – Remote Treatment of

Cardiovascular Patients, the project groups have worked

with two approaches to the application of simulation as a user-driven innovation method:

1. Exploratory – investigating topics 2. Functional – trialling the solution

An exploratory method, where simulation is used early

in the innovation process, as part of the analysis phase

– and a method that can test solutions in the subse-

quent part of the process, where the concept or solu-

tion is trialled to assess whether it works as intended.

FAC

TSFunnel simulation modelFrom mapping existing models to hypotheses, trialling, scenarios and to prototypes, via simulation

22

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

HOW SHOULD THESE METHODS BE INCLUDED IN THE FUTUREHEALTHCARE INNOVATION LAB?To learn lessons from experiences and results using these methods, the Health-care Innovation Centre has evaluated the Healthcare Innovation Lab’s innovation methods across the three demonstration projects. Bringing together the lessons learnt across the board makes it possible to form a methodology that can be used in the future Healthcare Innovation Lab whatever the problem area under scrutiny/requiring a solution for the healthcare sector (hospital department, psychiatric unit, disabled unit, hospital construction) or the business com-munity (developing/testing a new product or service). This has been achieved through two Best Practice workshops involving the project participants, as well as through a number of subsequent project meetings. The primary purpose has been to evaluate how the combination of user-driven inno-vation methods and simulation have func-tioned in the innovation processes, as well as how they can be incorporated as part of the Healthcare Innovation Lab’s core ser-vices going forward. It is evident that the three activities are the pivotal point of

success in the innovation processes of the demonstration projects. The three activities are:

• User observation with the application of video documentation• Idea-generating workshops/rap-

id prototyping with clinicians, pa-tients, experts (or other users), includ-ing use of mock-ups and models

• Simulation testing of ideas and solutions (may occur at dif-ferent points in the process)

Combined, the three activities com-prise the unique methodology of the Healthcare Innovation Lab.

Other, more general innovation methods (such as desk research, brainstorming, etc.) do not require any special expertise, but can in most cases be accommodated with-in the coordinating organisation for the in-novation process. Accordingly, the Health-care Innovation Centre does not see these as part of the added value that the Health-care Innovation Lab must deliver going forward. They can be included as part of the innovation process, but they will not

be the most important aspect. At the same time, the project group con-

cludes that, taken in isolation, simulation can work as a user-driven innovation me thod if there is a focus on participants being al-lowed to develop in between repeated simu-lation scenarios, for example distributed over several days. If simulation is used as the only innovation method, however, this might fall short partly in relation to the contextual knowledge obtained from observation stu-dies and the knowledge generated by rapid prototyping at idea-generating workshops with users (e.g. clinicians and patients).

THE HEALTHCARE INNOVATION LAB’S METHODOLOGY: EXPERIENCE1. Observation using video documentation“Because people do not always do what they say they do” Participant observation, conducted in

the practice to which the problem area relates, provides important emotional experience. Using video recordings as documentation can enable knowledge sharing and make it possible for others to analyse the problem area. In the three demonstration projects, video observa-

GATHERING EXPERIENCE FROM THE DEMONSTRATION PROJECTS

23

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

tion contributed to a shared understand-ing of the problem area. Especially for enterprises and other participants with-out a clinical understanding, the obser-vations contributed with insight into clinical practice in general. Video-docu-mented observation can be implemented within a relatively short time, depending on the problem being observed. Typi-cally, 2–3 hours should be sufficient to identify matters of interest in terms of subsequent analysis of the problem area.

2. Rapid prototyping“Not all ideas can be communicated using language. They need to be noticed and felt before we understand what they are about”. Working physically/materially with ideas

facilitates rapid understanding across

specialisms and disciplines. What the sub-projects have in common is that the common problem area became blinding-ly obvious the moment a more concrete approach was taken to what the solu-tion should actually look like (model/mock-up). Another advantage of enga-ging with physical models of proposed solutions at an early stage is that the solution can then be trialled, for exam-ple via rapid (table-top) simulations, and untenable solutions can be rejected.

3. Simulation“In theory, there is no difference between theory and practice. In practice, there is” The use of simulation methods as

an innovation platform has been particularly enriching in terms of the innovation processes.

Kurt Pedersen, Head of Development, University Hospital of Herlev

Head of Development at University Hospital of Herlev, Kurt Pedersen, says:

“Simulation visualises processes and thus contributes to qualification of the dia-logue about innovation, for example in relation to a new work process, develo-ping and testing a new technology within a context that closely resembles the context in which the innovation is to be used.”

Kurt Pedersen, Head of De-velopment,

University Hospitalof Her-

24

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

THE UNIQUE METHODOLOGY OF THE HEALTHCARE INNOVATION LABThe combination of the three methods brings together experience from innovation in the world of

design, medical training and industrial design in a unique methodology developed in the

Healthcare Innovation Lab and constitutes the core competency of the Lab. The Healthcare

Innovation Centre has called this the 3 x 3 methodology because the three activities can be done

in a minimum of approximately 3 hours allocated on 3 days. Healthcare Innovation Centre set itself

the task of validating this concept with selected external enterprises and departments.

Further details are given in the section on method validation.

FAC

TS

The lesson from the three demonstration projects is that simulation methods can be used very early in an innovation process, on process, product and organisational devel-opment alike. The unique value of simula-tion is that it makes things much more spe-cific, as it becomes necessary to carry out the work processes with the solutions that have been thought up. This makes it possible to examine the minutiae of a given work proc-ess. However, it also restricts the amount of simulation that is achievable in any planned simulation.

Simulation can be implemented simply on a table with paper sketches (table-top simula-tion) or it can be implemented at full scale in the clinic (Dogville simulation). It is impor-

tant to get table-top simulations under way as quickly as possible, as the description of a given work process in connection with the preparation of the simulation helps to estab-lish a shared understanding of what current practice looks like.

All demonstration projects used scripts. This is a good tool for facilitating the simu-lations and ensuring that all the details are included. The scripts described the scenarios that the simulation was intended to address and that the simulators were to perform. The introduction of unforeseen events was also part of the scripts and simulations. These are a good tool for stress-testing the solution un-der examination.

25

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

The more realistic the simulations are, the better. It is partly a matter of involving the individuals the simulation deals with (e.g. if it requires patients, they should be included as much as possible).

An inter-disciplinary circle of participants is particularly valuable for innovation pro-cesses in general. This has also been the case in the Healthcare Innovation Lab. Especially in simulation sessions, there is scope for dif-ferent professional groups to participate and contribute detailed input for the products or services being developed. Maintaining this inter-disciplinary approach is important for the future of the Healthcare Innovation Lab. The PPIP is one of the ways of establishing an inter-disciplinary circle of participants.

“Simulation as a development tool is useful in many contexts, but makes a particular contribution to qualify-ing and testing innovation in complex processes where the players have differing skill-sets and/or come from different organisational units. Here, simulation contri-butes to qualification of the dialogue about innovation, taking as its point of departure a ”simulated common understanding” among the future users involved.”Kurt Pedersen, Head of Development, University Hospital of Herlev.

HealthcareLABInnovation

26

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

The three demonstration projects have used a number of different methods of in-volving patients in the project.

But why should patients and next-of-kin be systematically involved in the development of new solutions for the healthcare sector? Because the direct user feedback in hospi-tals and psychiatric and disabled units can provide valuable knowledge of areas where individual departments could do better, and knowledge of where resources can be ap-plied more effectively. Some patients and relatives are also creative and innovative, so they contribute solutions to organisation-al challenges facing the department, partly because they visit a number of departments

The Hospital Plan for the Capital Region of Denmark (2011) envisages much more collab-oration with and inclusion of users, patients and relatives. This objective could advanta-geously also be applied in innovation work.

A number of other countries have long been working systematically with patient in-volvement and putting the focus on the pa-tient:

“...the patient must be at the cen-tre of everything the National He-alth Services does” (Involving Patients and the Public in Healthcare. De-partment of Health 2001, UK).

A suggestion for The Outpatient Clinic of The Future made by students from DTU

PATIENT INVOLVEMENT – AN IMPORTANT PART OF THE HEALTHCARE INNOVATION LAB

and other hospitals, so they are aware of how things are done elsewhere.

Working with patient involvement and systematic development of one’s department is not without challenges for the staff, how-ever. A successful process requires persist-ence and openness to unexpected insights and realisations and the answers that are forthcoming are not always the answers the staff hoped for. Some colleagues might be re-luctant to support someone’s project because day-to-day operations take up a lot of atten-tion, or perhaps because they are not keen on change. Nevertheless, working methods us-ing patient involvement have been shown to make a difference.

27

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

THE OUTPATIENT CLINIC OF THE FUTURE

In The Outpatient Clinic of The Future project, the project team has tested various approaches to patient involvement – with differing results.

Involving patients in connection with an outpatient visit to the hospital produced scant results for The Outpatient Clinic of The Future. The patients were very much aware of their own treatments and conversations with different medical practitioners, but they were unable to answer questions about physical settings, work processes, etc.

On the other hand, good results were ob-tained from including patients in workshop focus groups. Here, patients were recruited through the relevant patient associations.

At the workshop, the developed concept was presented to the patient representatives, and their statements were subsequently used to qualify the concept further.

The patients made available their experi-ence and knowledge, and they were also able

to ask qualified questions about the selected concept. The patient representatives were able to recognise the familiar context and openly reflect on more sensitive issues in a constructive way that could readily be trans-lated into spatial design and work processes in the new physical settings.

Including patient representatives in the ac-tual simulation aspect would also be prefera-ble. It is evident that the clinical staff on their own could not represent all aspects of the pa-tients’ wishes and requirements in terms of treatment.

MOBILE BLOOD TEST RESULTS

In the project to do with trialling mobile blood test results, the heart of the matter as far as user requirements are concerned has been to help the clinicians improve their work processes and their working en-vironment. For this reason, it was not rel-evant to involve patients in this part of the process.

Concurrently with the innovation process for mobile blood test results, the project team also worked on the possibility that patients could access their own blood test results at the same time that the results became avail-able to the clinicians. In order to research this possibility, the project team interviewed a number of patients to investigate how a solu-tion of this nature could be created. This was with a view to identifying new opportunities for involving patients in their treatment go-ing forward so that patients get the same in-formation at the same time as the medical practitioner.

TELEMEDICINE – REMOTE TREATMENT OF CARDIOVASCULAR PATIENTS

In this project, the project team selected pa-tients for participation in simulation proc-esses with staff at the treatment location in question. Those selected were resourceful patients with a good understanding of the

28

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

treatment process and the ability to work a computer.

The project team also entered into dia-logue with the Danish Heart Foundation and its local branch association in Gladsaxe, Den-mark which gave feedback both on the con-cept of Cardiac Insufficiency Telemedicine (CIT) and on the prototype developed.

Demonstration project manager Christian Graversen, DI ITEK, Danish Federation of In-dustries:

“We have benefited greatly from in-cluding patients in a number of pha-ses, and it is important to be aware that there can be an advantage in involving patients with different areas of exper-tise and/or at different locations in the process during the individual phases.”

According to Morten Freil, director of the Danish Patients Association, it is impor-tant in the case of Telemedicine – Remote Treatment of Cardiovascular Patients to implement the simulation of the treat-ment process between clinician and pa-tient in special settings that resemble a hospital/home environment:

“Due to widespread application of tech-nology and out of consideration for the patient, it is necessary to set up facilities

in special surroundings that are remini-scent of the patient’s home, as it would be difficult to conduct a test as such with the patient in that person’s own home,” Morten Freil says.

DANISH PATIENTS ASSOCIATION – A STRONG ADVOCATE OF USER INVOLVE -MENT AND PATIENT INVOLVEMENTMorten Freil, director, believes patients should be included in different phases of the development and testing process. It has been documented that involving patients creates better and more patient-centric so-lutions, which in turn can result in shorter periods of hospitalisation.

It can be advantageous to include patient representatives nominated from patient as-sociations in steering groups and project teams – for example, in connection with new construction, or development of new tech-nologies. Involving patient representatives ensures that the project maintains its focus on the patient perspective.

Users can also be included in the test-ing/trialling of new solutions. According to Morten Freil, during the testing/trialling phase, it is best to select user representatives who have a direct relationship with the spe-cialism in question. Here, users take on more

Demonstration project managerChristian Graversen, DI ITEK, Danish Federation of Industries.

Morten Freil, direc-tor ofthe Danish Patients Association

of a testing role, where new solutions and concepts are road-tested on ‘real’ patients in simulation processes.

29TEST OG IMPLEMENTERING

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

VALIDATION OF THE HEALTHCARE INNOVATION LAB’S METHODOLOGY: TEN INTENSIVE PROCESSES WITH TEN ENTERPRISES AND TEN HOSPITAL AND PSYCHIATRIC DEPARTMENTSBased on experience of the methods from the three demonstration projects, a methodo logy has been developed consist-ing of three compressed activities, which are to be used as the core service of the fu-ture Healthcare Innovation Lab. The meth-odology has been dubbed “3 x 3”, as the actual process can be compressed into 3 activities allocated over 3 days. Ultimately, though, it will be up to the individual pro-cess to schedule activities, time slots and use of resources.

To validate the methodology, a test process was undertaken in two phases.

Phase 1, in September 2011, consisted of conducting five intensive processes with four enterprises in the fields of medical technolo-gy and healthcare IT as well as one engineer-ing firm and five hospital departments. In order to obtain as objective an assessment of

the methods as possible, the enterprises and departments selected had not participated in the project.

Phase 2 of the test process was scheduled for spring 2012, immediately after the end of the project, when five enterprises were matched to relevant departments. Phase 2 made it possible to consolidate the first test processes and to optimise the process. In par-ticular, efforts were made to professionalise the process, including developing documen-tation templates and templates for debrie-fing from the process. This was for the pur-pose of ensuring a smoother launch of the concept on commercial terms. As we go to press, the final test processes have just been concluded, so it was not possible to include the results here.

The following Danish enterprises and de-partments took part in Phase 1:

• Ambu A/S and Gentofte Hospital, Anaesthesiology Department • Trifork A/S and Hillerød Hospital, Emergency Department, on the topic

of mobile emergency journals• Systematic A/S and Gentofte Hospital, Cardiology Department and Medical

Department, on the topic of mobile access to patient data

• Radiometer A/S and Hvidovre Hospital, Pulmonary Department and Intensive

Care, on the topic of software for blood gas analysis devices.

• Grontmij A/S and Hillerød Hospital, Surgical Out-patient Clinic, on the topic of work process analysis and future patient flow.

30

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

For reasons of discretion in connection with commercial development activities, the description of processes given below will not give details of product-specific in-formation.

TEST PROCESS ACTIVITIES – “3 X 3”The methodology comprised three core activities that the demonstration projects underwent, described previously in the section on processes. However, this valida-tion process is a compressed process im-plemented over 3 weeks in all five cases.

1. Identifying needs and contextual research: observation studies (vid-eo recording) at a relevant location (in the ward, in the patient’s home, etc.) Duration: 3 hours to 1 day.

2. Idea-generating with rapid prototyping and table-top simulation: concept ideas for solutions are generated; physical mock-ups are developed and tested via table-top simulation in a future sce-nario (first simple simulation). Work-shops take place in the hospital out of consideration to their opening times (after 3 pm). Duration: approx. 3 hours.

3. Simulation test and re-design: the pro-totype is tested by means of simulation in-situ or at other locations. Purpose: to identify input for re-design. All but one of the simulations are implemen-ted in the clinic. Duration: 3–6 hours.

The Healthcare Innovation Centre’s con-sultants facilitated the entire process, starting with planning and booking of participants, documenting user needs, editing video observations and through to results reporting.

RESULTS AND EVALUATION OF THE METHOD1. Identifying needs and contextual researchFor the majority of processes, user obser-vation was arranged with one participant from the enterprise observing together with one consultant from the Healthcare Innovation Centre. The team followed a doctor or nurse on duty for a period of be-tween 3 hours and one day. Relevant situ-ations and work processes were videoed; the videos were later analysed and used for idea-generating and rapid prototyping.

Clinicians gave positive feedback: “it is usefull that someone has taken the time to see what actually happens in

The following Danish enterprises and de-partments took part in Phase 2, in March–April 2012:

• Pressalit A/S and Jonstrupvang, Pleje-center Rosenhaven Skovlunde & Dagtilbuddet Søndre Fasanvej, on the topic of developing care facility

• Novo Nordisk A/S and Hvidovre Hospi-tal, Endocrinology Department, on the topic of new systems for injecting insulin

• Daybuilder and Affective Disorders Inten-sive Care Unit - Copenhagen psychiatric centre, on the topic of a mobile platform to support people with depression.

• CSC Scandihealth, Max Manus and Frederiksberg Hospital, Cardiology Department, on the topic of speech recognition on a mobile device

• Pirutech Aps, and Glostrup Hospital & Gentofte Hospital on the topic of fur-ther development of pill dispensers

31TEST OG IMPLEMENTERING

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

the clinic before developing solutions!” Thomas Høi Hansen, cardiology 1. Relief Doctor, Cardiology Department, Gentofte Hospital.

“It was really good that the Healthcare Innovation Centre videoed our work. We usually find with process consultants that we have to spend a lot of time at seminars explaining to them what our work is actually all about. So it’s great that we can take a look at our own work through your video clips to arrive at the ideal patient flow. Better still, we are the ones who get to define what the surgi-cal outpatient clinic of fhe future should be all about. After all, that’s what user-driven innovation is all about, isn’t it?”Lisbeth Dammegaard, superintendent medical officer, Surgical Out-patient Clinic, Hillerød Hospital

“Another very useful thing here is that people who are not familiar with our

specialist field ask ‘silly’ questions in a professional way. This cuts right through our familiar paradigms.”Frank Samsøe Jensen, Superin-tendent Medical Officer, Gentofte Hospital

2. Idea-generation with rapid prototyping and table-top simulation: Idea-generating workshops were successful for all five processes. Between two and se-ven clinicians participated, and they had the opportunity to discuss the findings that resulted from user observations as well as the opportunity to formulate their ver-sions of prototypes. Obviously, some clini-cians had more of an aptitude than others when it came to drawing and expressing themselves creatively in this process. So it is valuable to have consultants on hand who are able to contribute to the design and can serve as the clinicians’ ‘mouthpiece’ if they get stuck trying to produce something. Pro-fessional designers/illustrators participated

in one of the processes, and they were able to translate the clinicians’ ideas into physi-cal form, which was very good for the re-sult. The enterprises said the output has been valuable knowledge that gives rise to a number of possibilities for further devel-opment.

Getting the clinicians to design the proto-types was one of the great “eureka” moments for many of the enterprises. The input that comes from allowing the clinicians them-selves to make a decision about the design and for them to produce prototypes in their own language is something that cannot be done using the enterprise’s own employees.

3. Simulation test and re-designThe time lapses between the idea-gener-ating workshop and the simulation test varied – from one day to one week. It is appropriate to have at least one week (de-pending on the prototype) because there needs to be sufficient time to incorporate the best ideas from the workshop as well as observation findings.

Simulation tests were planned on the ba-sis of DIMS simulation scripts (referred to previously). These were prepared to a lesser extent, as the scenarios to be played out co-

Video recording of a future scenario with a mobile emergency journal instead of today’s bundle of papers, Hillerød Hospital, Emergency Department

32

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

vered short work processes. Simulations in the clinic are very valuable

because it is possible on the one hand to in-clude more participants and, on the other, to reflect the specific clinical context in as rea-listic a way as possible. It was only necessary in the case of one enterprise to use DIMS premises and a dummy. In the other cases, there were no ethical dilemmas with patients at stake and no danger to patient safety, so it was possible to conduct the simulation in the clinic.

The 3 x 3 process model produced ex-tremely positive results and knowledge for the enterprises and departments that would have taken a very long time to acquire by other means.• There was tremendous enthusiasm for

participation in the process (on the part of enterprises and clinicians alike).

• The process provided good insight into the everyday work of the clinicians and the challenges facing them, which fu-ture products should help to solve.

• The selected methods outlined above help provide very detailed insight into the work processes carried out in hospitals. This sort of insight could not be obtained by means of ordinary

structured interviews, for example. • It is motivating for the clinicians to par-

ticipate in innovation processes that broaden the perspective and help to de-velop their skills to think more innova-tively and with an understanding of what it takes to make innovation “happen”. Thus, they also gain an appreciation of how engineers and developers think. “It would have taken us six months to ar-rive at what was accomplished in 3 x 3 hours. And we would still have disagreed about whether it would work in the mar-ket. Here, the clinicians might simply make the decision we wouldn’t dare make”

Erik Øllgaard Vilhelmsen, Process Development Manager, Ambu A/S

“It is very beneficial for us to be involved very early on in the process. So, instead of spending two years developing so-mething we think is a good idea, we can determine very early on whether users see things the same way we do. Because, when you’ve been working on some func-tion or other for 2–3 days as a software developer […], it seems incredibly intuitive. But it’s very healthy to get out and meet people who are not software developers,

like our customers, who are not engineers , to see what they regard as intuitive. It’s very different, and it’s important to de-termine that very early on so you don’t run up a lot of costs pursuing some idea or other that could have been scrapped upfront. So it’s extremely beneficial.”

Henning Hjortskov, Software Developer, Radiometer

”... The process was very useful, we have in a very short time developed a product to clinicians which seems to work in reality” Lasse Benn Norregaard and Philip Kaare Løventoft, Daybuilder Solutions

Simulation of future work processes at Hillerød Hospital, Surgical Out-patient Clinic

It is very important to maintain the

simulation procedure whereby the

simulator (test subject) is allowed to

complete an entire simulation sce-

nario before the person is interrupted

and debriefed (by the interviewer).

If this simulation procedure is not

maintained, valuable behavioural

input from the simulator is lost.

EXP

ERIEN

CE

As a point of departure, using video documentation is very valuable, as it gives you the op-

portunity to share the knowledge you have gained with others in the enterprise or depart-

ment. At the same time, it provides documentation that can be analysed from very objec-

tive perspectives instead of a more individual reproduction of reality. However, recording

a lot of video is quite resource-intensive. It slows the pace of the process, but at the same

time it also ensures acceleration and an understanding of what actually happens.

EXP

ERIEN

CE

33TEST OG IMPLEMENTERING

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

various scenarios in terms of an actual lab. The main target group/stakeholders are hospitals/hospital departments and the business community.

How should the lab be organised? Should it be incorporated into the respective hospi-tals with a local lab where clinicians and en-terprises can experiment, innovate and test as required (and in close proximity to the clinic)? Or should it be housed in a building away from the hospital? Should there be a Mobile Innovation Team arrangement? We have been working on financing models for the lab. Below are the highlights of our work and current proposals for an actual lab.

The vision of this project is to use the methodology work from the three demon-stration projects – to lay the foundations of an actual, physical Healthcare Innovation Lab. Obviously, new processes and meth-ods will have to be developed in order to be able to offer the services to the healthcare sector that will be needed for many years to come. Simulation as a tool of innova-tion has proved its worth. This recently de-veloped methodology framework should make the use of an actual Healthcare Inno-vation Lab attractive. In the project, in the course of preparing the specification of re-quirements and the preliminary work for the business plan, we have gone through

The Capital Region of Denmark alone covers 12 hospitals as well as psychiatric and disabled

units, with a staff of 40,000, and represents some of the major hospital construction pro -

grammes already underway. In order to be able to incorporate new solutions that are future-

proof, effective and sustainable, it is necessary to build innovation processes into the actual

planning of the hospital buildings. Hospitals, enterprises and innovation experts need to work

closely together to produce value-creating solutions.

There is a need for innovation and testing facilities to be in close proximity to those hospitals in

the region that are to be built from scratch, converted or extended. There is also a great need to

be able to innovate and test in direct proximity to the everyday lives of the users – the clinicians

– as they have to find time in their busy schedules to participate in the innovation processes.

EXP

ERIEN

CE

SPECIFICATION OF REQUIREMENTS FOR THE PHYSICAL HEALTHCARE INNOVATION LAB: AN ACTUAL LABORATORY FOR HEALTHCARE INNOVATION

34

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

and better healthcare services can be ob-tained within the available means. With this in mind, we have worked in an inter-disci-plinary way involving clinicians, enterprises and researchers to define what makes the Healthcare Innovation Lab special – what are our Unique Selling Points?

During the Healthcare Innovation Lab process, Jan Kold – former Director of Capi tal Region of Denmark and member of the Healthcare Innovation Lab steer-ing group – used the Healthcare Innovation Centre to produce a three-month innovation process in relation to The Clinical IT Device of The Future. Methods and experience

of an innovation project – the Healthcare Innovation Lab works in Triple Helix. In developing the methodology, the impor-tance of involving designers and anthro-pologists has also become apparent; they are able to contribute specific experience of user involvement in product develop-ment processes.

In an actual innovation laboratory, it is possible to test and adapt services and tech-nologies thoroughly prior to implementa-tion. In other words, both the healthcare sec-tor and the business community are able to eliminate costs of untried and unsuitable products and processes. In a nutshell, more

INSPIRATION FOR THE ACTUAL LAB – TRIPLE HELIXThe Garfield Innovation Centre at Kaiser Permanente works mainly on product de-velopment and testing for its own hospi-tals and with patients. Business has not yet been brought in, except in cases where equipment needs to be tested. In purely physical terms, the Garfield Innovation Centre is housed in an industrial building some distance from Kaiser Permanente’s hospitals. The Healthcare Innovation Lab has a broader model of collaboration, as the business community and research in-stitutions are included at the earlier stage

Main stakeholders who would use an actual lab:

• Clinicians/Hospitals as well as primary sector

• Producers

(medical technology, IT, construction,

interior design, logistics, etc.)

• Service enterprises

(facility services, citizen services,

patient hotel services, etc.)

Also:

• Research institutions

• Patients/patient associations and relatives

(services, cohesive patient care pathways)

FAC

TS

Jan Kold, Former Director, Capital Region of Denmark and member of Healthcare Innovation Lab steering group.

35

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

create innovation within your own enter-prise, but the real excitement starts when you are working with other partners.This project has been about develo-ping a methodology, which has thus made it possible to create new fra-meworks for user-driven innovation.A unique new method has been developed which, unlike conventional simulations, is not based exclusively on testing; this me-thod also makes room for new innovation to arise – and this is something we specifi-cally experienced during this process. The method is flexible, cost-effective and easy to work with, so it is an excellent alterna-tive way of supporting that users’ wishes, needs and ideas are reflected in the con-struction project. At the same time, the method is an activity that, from the point of view of innovation, supports the change processes that the hospital as an organi-sation undergoes concurrent with the de-velopment of the construction project.”

meeting users’ requirements. Unlike with ordinary development methods, where the faults/inappropriate aspects are not discovered until a late stage of the pro-cess – when faults would have to be very serious indeed in order to justify rectifying them. The fact that multiple participants, players, research scientists, suppliers and users work together makes it easier to steer things in the right direction, and it is pos-sible to arrive at the right product sooner.”

Using simulation as a tool of innovation, the lab should seek to develop commercial-ly realisable ideas that shorten the time to market, reduce development costs and ensure that product development hits the spot. We have developed a number of ex-amples of services to be offered by the lab. Some services will be in demand from the business community (medical technology enterprises, healthcare IT enterprises, sup-pliers of building materials, etc.).

Per Frølund Thomsen, Department Di-rector, Planning, Grontmij, talks about the positive difference the lab method has made from the enterprise’s point of view:

“Innovation is created at the interface of multiple corporate skills and collabo-rative efforts. It is certainly possible to

gained from the Healthcare Innovation Lab were applied to implement the process that included clinicians from a number of hospi-tals in the Capital Region of Denmark, as well as enterprises that develop health-related IT products. The process included a Trend Seminar for a number of national ex-perts in technology as well as an Innovation Camp, where clinicians helped to develop and create their own prototype devices.

Jan Kold has this to say about the advan-tages of the Healthcare Innovation Lab me-thod and process:

“Involving users early on in the process, as we have done in this project, means the product and solutions are more capable of

WHY A PHYSICAL AND VIRTUAL HEALTHCARE INNOVATION LAB

IS ESSENTIAL UNIQUE SELLING POINTS:

• serves as a matchmaker between private enterprises and hospital departments

• serves as advisor to the hospitals and enterprises in relation to (all) aspects of user-driven PPIPs

• increases the suitability of products for the market

• is “wireless” – has its own address and space, but works on-site at the enterprises’ premises

(public or private sector), or virtually

• is a development laboratory of internationally acclaimed calibre

• delivers rapid prototype development at the interface of the parties to the PPIP

• creates synergy via simulation for the Danish Institute for Medical Simulation (DIMS)

Clinicians help to create prototypes for future clinical devic-es based on the Healthcare Innovation Lab method (Innova-tion Camp, Healthcare Innovation Centre, January 2011)

FAC

TS

Per Frølund Thomsen, Department Director, Grontmij.

36

EXPERIENCEThe Capital Region of Denmark alone cov-ers 12 hospitals as well as psychiatric and disabled units, with a staff of 40,000, and represents some of the major hospital con-struction programmes already underway.

In order to be able to incorporate new solu-tions that are future-proof, effective and su-stainable, it is necessary to build innovation processes into the actual planning of the hos-pital buildings.

Hospitals, enterprises and innovation ex-

perts need to work closely together to pro-duce value-creating solutions.

There is a need for innovation and test-ing facilities to be in close proximity to those hospitals in the region that are to be built from scratch, converted or extended. There is also a great need to be able to innovate and test in direct proximity to the everyday lives of the users – the clinicians – as they have to find time in their busy schedules to partici-pate in the innovation processes.

The company uses Health-care Innovation Lab and makes the innovation project in co-operation with clinicians, patients and research institutions

The hospital gets a new product where they have participated in the devel-opment of the product and therefore it fits into their daily work.

3 months

Innovate new products and services

RAPID PROTOTYPING

SIMULATION BUSINES

S CA

SE

U

SER

INVO

LVEMENT

The company uses Health-care Innovation Lab and

makes the innovation project in co-operation with

clinicians, patients and research institutions

A company from the medical Device In-dustry wishes to de-velop and test a new product idea in the early part of the inno-vation process

WHAT DOES THE HEALTHCARE INNOVATION LAB OFFER?

• Simulation as a user-driven method/tool of innovation (small-scale and large-scale)

• Rapid innovation processes (from 7 days up to 3 months)

– from brainstorming to prototype/mock-up, including development and testing

• within the following areas:

- new products (medical technology, IT, construction, interior design, etc.)

- new services (facility services, patient-oriented services, etc.)

- new work processes and forms of organisation

- cohesive patient care pathways that also involve the primary sector

- other problem areas

- always close to the clinic

FAC

TS

A new way of working with value creation for both the hospital and the companies.

3 months

Innovate functional and organizational planning when designing new hospital buildings

RAPID PROTOTYPING

SIMULATION BUSINES

S CA

SE

U

SER

INVO

LVEMENT

Researchers and two companies as well as patients are involved in the innovation

process to provide input to and be co-developers of the future clinic. For example a designer

and an anthropologist are involved and contributes with knowledge about

user involvement

Three departments (outpatient) wishes to develop new work-flows that fits the future clinic.

37

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

THE MOBILE INNOVATION TEAM

The idea is for the lab to include a flexible and mobile organi-

sation – a kind of Mobile Innovation Team. This could comprise

three permanent employees (manager, consultant, administra-

tor) as well as five freelance workers covering inter-disciplinary

skill-sets centred on simulation, user-driven innovation and

business acumen (business developer, designer, anthropolo-

gist, engineer, architect). In addition, 10–15 clinicians would be

attached, trained in the Healthcare Innovation Lab methodo-

logy model. The team could to good advantage be anchored in

the existing Healthcare Innovation Centre, which has hospitals,

psychiatric and disabled units as its target group, and which has

innovation tasks and projects currently in the works. In light of the

new construction of hospitals and other units in the Capital Re-

gion of Denmark Quality fund Construction, it is important for the

mobile team among other things to contribute to new solutions

for the Capital Region of Denmark’s construction managers,

as well as other units/clinical departments with urgent require-

ments, including the IT and Medical Technology Enterprise IMT. In

addition to the specific innovation tasks, the team is also tasked

with being out in the field and maintaining close dialogue and

contact with heads of construction, clerks of works and clinical

departments. Next, the team must be in close dialogue with the

business community in order to meet the need for involving rel-

evant enterprises, including construction firms, in PPIP projects.

FAC

TS

The Healthcare Innovation Lab is a liv-ing example of how PPIP works. The project – the largest of its kind in Den-mark so far in the healthcare sector – comprises 26 inter-disciplinary part-ners covering hospitals, the business community, research scientists, patient associations and innovation experts. The conclusion of the project is that the fact that the project was implemented with inter-disciplinary participation contributed greatly to the degree of in-novation in the Healthcare Innovation Lab. When an inter-disciplinary group is put together, a creative field of ten-sion is created that cannot exist when enterprises carry out development work with other enterprises, or research sci-entists carry out development work with other research scientists.

GENERAL INFORMATION ABOUT PPIPAccording to the Danish Business Au-thority (EBST 2009), which conducted a survey to uncover experiences with

PPIP and set up Best Practice in this field, the PPIP participants in question are:

“development partners who jointly in-vestigate innovative new solutions to problems that they have jointly defined (not a purchaser–supplier relationship)”.

The EBST study also showed that 1) Awareness of PPIP in Denmark and abroad remains limited, 2) there is no sin-gle way of organising a PPIP, and 3) the PPIP is characterised by a high degree of user involvement (direct involvement of users in the innovation process – citizens,

BEST PRACTICE FOR WORKING

WITH PPIP PROJECTS:

• Mutual trust and willingness to take risks

• Passionate people across sector divides,

with the authority to make decisions

• Open dialogue and communication

• Separation between innova-

tion and operation

• Management back-up

across the sector divides.

FAK

TA

THE HEALTHCARE INNOVATION LAB PUBLIC-PRIVATE INNOVATION PARTNERSHIP (PPIP) CONTRIBUTES TO CREATING THE UNIQUE INTER-DISCIPLINARY PLATFORM

38

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

patients, etc.) or by involvement of public-sector employees (“ambassadors”). The fact box below brings together some initial, general experiences of PPIP in Denmark.

REFLECTIONS ON PPIP COLLABORATION IN THE HEALTHCARE INNOVATION LABIn the Healthcare Innovation Lab, a defi-nite challenge and a major task was get-ting so many different parties, each with their own cultures, to work together. This was very demanding in terms of resources and required among other things a focus on team-building in order to kick-start collaboration when the clinic, the re-search scientist, the enterprise repre-sentative and the innovation expert met.

credit crunch, which meant devoting time and costs to development projects in gener-al got lower priority. Even though the spot-light has been on operations for clinics and enterprises alike, the Healthcare Innovation Lab largely succeeded in making room for and prioritising time and personnel to as-sist with workshops, simulation scenarios and meetings to consolidate the experience gained. One prerequisite for involving the clinic is for the project set-up to facilitate buy-out for the clinicians who would take part. The Healthcare Innovation Lab was able to do that. The Healthcare Innova-tion Lab described issues of copyright and other legal matters in a collaboration agree-ment.

Trust and willingness to take risks (includ-ing open dialogue and communication) were obviously prerequisites for the project teams of The Outpatient Clinic of The Future, Mo-bile Blood Test Results and Remote Treat-ment of Cardiovascular Patients to be able to arrive at actual solutions. In identifying hos-pital departments with the resources, time and energy to participate in the Healthcare Innovation Lab as case studies, it was depart-ment managers with a willingness to change (people with a passion) who ultimately saw the value of playing their part. As pre-viously mentioned, the project began at a time when a number of hospitals in the Capi-tal Region of Denmark faced major savings drives/cut-backs. At the same time, the busi-ness community had been impacted by the

HOW IS THE PRESENT HEALTHCARE IN-

NOVATION LAB PROJECT FUNDED?

The present PPIP project has a combined project sum of

DKK 8.4 million, towards which the Danish Business Author-

ity has granted a subsidy of DKK 6.0 million from the Pro-

gramme for User-Driven Innovatio. The rest of the funding

comes respectively from Healthcare Innovation Centre

monies (25% self-funding via monies from the Growth

Forum for the Capital Region of Denmark), hospitals and

DIMS (25% self-funding), both research institutions (25% self-

funding), as well as the participating private enterprises,

organisations and patient associations (50% self-funding).

FAC

TSPA

TIEN

TS

HEALT

H PROFE

S-

SIONAL E

MPLOYEE

S

ENTERPRISES

DESIGNERS,

ARCHITECTS,

ANTHROPOLOGISTS

ETC.

RESE

ARC

H

INST

ITU

TIO

NS

RELATIVES

HOSPITALS

HealthcareLABInnovation

NEW INNOVATIVE SOLUTIONS FOR THE HEALTHCARE SECTOR

39

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

A. Why is PPIP relevant to enterprise representatives working within the healthcare sector?

PPIP is regarded as one of the new forms of collaboration capable of helping to cre-ate the platform for new, specific solutions in the health service, for example. But how do you create a PPIP project, and what mo-tivates the parties to participate? Many enterprises are reticent, as they may fear that participating in a PPIP project requir-ing investment of time, where the expect-ed outcome is the development of a new product, could exclude them from involve-ment in a subsequent procurement. One way of handling this is by ensuring open-ness in the process from the inception of the project until a prototype of the product has been developed (Legal Advisor to the Danish Government, 2011).

In the Healthcare Innovation Lab’s process, some experience was gained in how to mo-tivate the business community to parti-cipate and to invest in development time. The enterprises must finance half the costs of their involvement with the Healthcare In-novation Lab themselves. Do the enterprises derive any benefit from this, and if so, what? Via a round of interviews, the project collected

a number of statements about the respective enterprises’ participation in the Healthcare In-novation Lab. Below is a brief summary.

WHY DID THE ENTERPRISES CHOOSE TO PARTICIPATE IN THE HEALTH-CARE INNOVATION LAB?• New or enhanced expertise: The project

encompasses an area in which the en-terprise wishes to strengthen its ex-pertise. The Healthcare Innovation Lab made it possible to gain new ex-perience and to be involved with the latest developments in the field.

• New business area: The opportunity for the enterprise to develop a new

business area• The opportunity to make contact with

Danish healthcare sector operators.

HOW HAS THE ENTERPRISE ALREADY BENEFITED?• Development of methods for work-

ing with user-driven innovation, which proved to be such a good tool that the enterprise sees a lot of scope for using it in its own business in the future

• Networking: Very close collabora-tion with the institutions, associa-tions and hospitals in the Health-

care Innovation Lab – a collaborative venture and a network that the en-terprises regard as very valuable

• Direct involvement of clinicians: This was a great plus for the project. The sup-pliers gain greater insight into needs and development opportunities.

• Insight into working methods and con-ditions in the Danish health service

• New product/new solution for several enterprises

HAS ANYTHING NEW BEEN ACCOM-PLISHED BY THE ENTERPRISE’S PARTICI-PATION IN THE HEALTHCARE INNOVA-TION LAB THAT COULD NOT HAVE BEEN ACHIEVED BY ANY OTHER PROCESS?• Close collaboration has made it pos-

sible to develop a unique methodo-logy. Close collaboration with players in the demonstration project, inclu-ding the department, made it possible to develop a unique methodology for simulation as a user-driven method.

• Simulation was a new feature. The en-terprises are keen to use this again; it resulted in a greater understanding of the everyday work of clinicians and hence, it is to be hoped, better chances of being able to achieve common goals.

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

40

• Users’ needs come first: completely different results are produced

by looking at the users’ needs first instead of by focusing on the technology first.

SPIN-OFFS/EFFECTS DERIVED FROM PARTICIPATING IN THE HEALTH-CARE INNOVATION LAB?• Branding value: There is branding value

in participating in innovation projects – important to the enterprise to show the market that the enterprise is at the fore-front of important areas of development.

• Close contact with relevant players in the healthcare sector: The Health-care Innovation Centre, the Danish Institute for Medical Simulation, hos-pitals and hospital departments.

THE ENTERPRISES’ EXPERIENC-ES FROM PARTICIPATING IN THE HEALTHCARE INNOVATION LAB:• Meeting culture: Cancellations on the

part of the clinic shortly before meet-ings/simulations puts the brakes on knowledge sharing and the process.

• Influence from the outset: it is im-portant for private enterprises to have a decisive influence from the outset. They should not just be in-vited along for financial reasons.

B. What does the clinic get out of a PPIP?

The project interviewed four departments that participated in the three demonstra-tion projects about the value of the PPIP to the clinic/hospital department and their experiences of PPIP.

WHAT MADE THE CLINICS PARTICIPATE IN THE HEALTHCARE INNOVATION LAB?• The Healthcare Innovation Lab pro-

vided a way of exploring new hori-zons and new solutions in relation to the challenges facing clinics in a situation in which the health service is under a great deal of pressure

• Opportunity to explore new angles of public-sector innovation, and how the methods can be applied more specifically in the clinics

HOW HAVE THE CLINICS ALREADY BENEFITED?• The group of staff from the de-

partment who were involved have become innovative and inspired

• Learning about the innovation pro cess has increased interest in future innovation projects

• Initiatives for change have constantly been noted in relation to the future of the department, and the results will be incorporated into the design of the

department’s functional and organi-sational planning going forward

• A LEAN project has been initiated on the basis of the results from the Healthcare Innovation Lab

• Working methods have inspired other innovation processes in the department

• The management and intermediate man-agement of the department regard partici-pation in the Healthcare Innovation Lab as a major course in innovation methods

• An extended network and new col-laborative partners across pub-lic sector and private enterprises

• A prototype has been produced for fur-ther inspiration and development

• Opportunity to test other innovation projects under regional auspices.

THE CLINICS’ EXPERIENCES FROM PARTICIPATING IN THE HEALTH-CARE INNOVATION LAB:• It is important for workshops and other activities involving clinicians to be

planned and diarised well in ad-vance due to shift rotas, etc.

• Buy-out is essential in deciding wheth-er a department can participate in a major, long-term innovation project

• Important to define the roles in-volved – whether they are consult-ants or actual project participants.

41

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

• It is vital to the project for project set-up and planning to take account of the challenges by setting aside re-sources from day-to-day operation at the clinics. Management and employ-ees alike should be ensured full op-portunity to participate in projects

• Important to ensure user and em-ployee ownership of the project

• There must be full disclosure to all project participants as regards where, when and why the user is involved.

Would you like to read more about the specifics of establishing a PPIP and the experiences of others from this type of partnership? The Capital Region of Denmark has produced a guide in Danish to PPIP. For further information, see

http://www.regionh.dk/NR/rdonlyres/ D301AC93-CD98-493D-93C67121769B-42CA/0/OPIguide.pdf

The Ministry of Business and Growth/MindLab has launched a PPIP guide via the following website: http://opiguide.dk/

WHO SHOULD FUND AN ACTUAL LAB?

Due to changing circumstances in the healthcare sector/the Capital Region of Denmark

(cut-backs and efficiency drives in hospitals, psychiatric and disabled units) as well as the credit

crunch and its impact on the business community, it has been most appropriate to look at

a number of possible finance models for the lab:

• A 100% public-sector funded lab that kick-starts rapid innovation processes

with clinicians and enterprises alike

• A public–private funded lab where the private-sector business community (including business

organisations, industry associations, etc.) supports the lab with start-up financing of processes

• A 100% private-sector funded lab where funds and organisations donate resources to the lab.

FAC

TS

PHYSICAL HEADQUARTERS IN THE CAPITAL RE-GION OF DENMARK – AND COLLABORATION THROUGHOUT DENMARK AND WORLDWIDEAs previously stated, the lab must be located in direct proximity to clinicians or hospitals earmarked for new construction, i.e. district hospital(s) in relevant locations. There could preferably be satellites at all major hospitals so that there are facilities available for use close to the clinicians. The headquarters com-plex must include a showroom where suc-cessful cases can be displayed. In addition, it is important for a large room to be available (in the hospital) in which the simulation can take place. Some aspects of this could also take place elsewhere at existing simulation facilities, such as DIMS.

The lab must collaborate with other similar centres/labs in Denmark and the Öresund Re-gion to harness synergies. The project and the lab idea have been presented in a number of in-ternational forums (Sweden, Norway, the EU, the US) and will be collaborating at the highest level internationally. Interest in the lab model has been expressed from Sweden (Skåne) and Norway (Stavanger). A dialogue has been initiat-ed and opportunities are being explored for col-laboration with Kaiser Permanente. Other in-ternational profiling will be investigated on an ongoing basis with regard to other parts of the world (the Middle East, Asia, South America).

APPEN

DIX

“Simulation as a method for dev- eloping new work processes in an outpatient unit” – Conference Paper5th NOVO Symposium 3 & 4 November 2011Reykjavik, Landspitali University HospitalSustainable Nordic Health Care Systems& Sustainable Hospital Design

Edwards, Kasper, Technical University ofDenmark, Management, DEN-MARK; Broberg,Ole, Technical University of Denmark,Management, DENMARK; Nielsen, Jacob ,Dansk Institut for Medicinsk Simulation,

DENMARK; Hartmann Schou, Tanja,Grontmij A/S, DENMARK; Momme,Else, Grontmij A/S, DENMARK andHansen Graa, Marianne, Uni-versity Hospital of Herlev,Nybyg Afdelingen, DENMARK.

“Abstract: Using Explorative Simulation to Drive User-Centered Design and IT-Development in Healthcare”11th International Probabilistic SafetyAssessment and Management Conference

&The Annual European Safety andReliability ConferenceJointly Organized by ESRA and IAPSAMwww.psam11.orgScandic Marina Congress Center,Helsinki, Finland25–29 June 2012

Edwards, Kasper, Technical Universityof Denmark, Management, DENMARK(Presenting); Broberg, Ole, TechnicalUniversity of Denmark, Management,DENMARK, 1; Nielsen, Jacob , Dansk Institutfor Medicinsk Simulation, DENMARK,1; Alapetite, Alexandre , TechnicalUniversity of Denmark, Safety,Reliability and Human Fac-tors , DENMARK,1; Boje, Henning, Technical Universityof Denmark, Safety, Reliabilityand Human Factors , DENMARK, 1

“User-driven innovation of anoutpatient department”Proceedings from 18th World Congresson Ergonomics (IEA 2012)Edwards, Kasper, Technical University

of Denmark, Management, DENMARK;Broberg, Ole, Technical University ofDenmark, Management, DENMARK

“Clinical Overview of Test Results”11th International Probabilistic SafetyAssessment and Management Conference& The Annual EuropeanSafety and Reliability ConferenceJointly Organized by ESRA and IAPSAMwww.psam11.orgScandic Marina Congress Center,Helsinki, Finland25–29 June 2012

Boje, Henning, Technical University ofDenmark, Safety, Reliability and HumanFactors , DENMARK; Alapetite, Alexandre, Technical University of Denmark, Safety,Reliability and Human Factors , DENMARK;Nielsen, Jacob , Dansk Institut forMedicinsk Simulation, DEN-MARK; Frederiksen,Mads Stampe, Center for Sund-hedsinnovation,DENMARK; Andersen,Svend Vitting, Pallas Informatik A/S,DENMARK

Appendix 1

CONFERENCE PAPERS & ABSTRACTS IN ENGLISH

43

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

Appendix 2

PARTICIPANTS IN THE HEALTHCARE INNOVATION LAB PROJECT

THE OVERARCHING PROJECT

Organisations/centres of excellence

Susie A. Ruff, Head of Centre, Healthcare Innovation CentreProject owner/overarching project management, responsibi-lity for business plan/specification of requirements and PPIP,

Eva Jacobsen, Assistant Project Manager, Healthcare Innovation Centre

Project management, business plan/specification of requirements and PPIP, facilitation of workshops, seminars and test processes

Lise Engell Hartwell, Assistant Project Manager, Healthcare Innovation Centre

Project management, business plan/specification of requirements and PPIP, facilitation of workshops, seminars and test processes

Mads H. Odgaard, Project Manager, Healthcare Innovation Centre Project management from 1 February 2010 – 1 February 2011

Werner Sperschneider, Innovation Consultant, Healthcare Innovation Centre

Facilitation of workshops, seminars and test processes

Mads Stampe Frederiksen, Innovation Consultant, Healthcare Innovation Centre until May 2012

Facilitation of workshops, seminars and test processes

Stephanie Eloisa Pitarch, Project Worker, Healthcare Innovation Centre

Facilitation of workshops, seminars and test processes

Lea Graversen, Project Worker, Healthcare Innovation Centre Communication and documentation of project results

Doris Østergaard, Director of The Danish Institute for Medical Simulation

Business plan/specification of requirements and PPIP

Klinikere/hospitaler

Kurt Pedersen, Head of Development, University Hospital of Herlev Business plan/specification of requirements and PPIP

44

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

642

7531

TESTID

È-KO

NCEPT-

GEN

ERER

ING

BEHO

VS-

IDEN

TIFIK

ATIO

N

PRO

JEKT

-

OPS

TART

FORA

NALYSE

ANALYSE

KONCEP

T-

DETALJ

ERIN

G

Kickoff workshop

Projektstyrings-seminar

Kursus i bruger-dreven innovation

Tværgående workshop

Innovation Camp I

THE OUTPATIENT CLINIC OF THE FUTURE

Clinicians/hospitals

Marianne Graae Hansen, Consultant, University Hospital of Herlev, Development department

Activities manager (technical project manager, project description, arranging meetings, knowledge sharing)

Morten Lebech, , Head of Department, Dept. of Gynecology & Obstetrics, University Hospital of Herlev,

Clinician involvement, clinical staff at Gynaecology Outpatient Clinic, implementation

Anette Madsen, Architect, University Hospital of Herlev, New Construction Department

Programming of construction processes

The business community

Tanja Schou Hartmann, Consultant, Grontmij Assistant project manager/project manager

Else Momme, Senior Consultant, Grontmij User involvement, patient perspectives

Research institutions

Ole Broberg, Associate Professor – Technology, organisation and work, Technical University of Denmark

Processes involving users, Workspace Design

Kasper Edwards, Associate Professor – Technology, organisation and work, Technical University of Denmark

Identifying needs, functional planning

Per Anker Nielsen, Professor – Technology, organisation and work, Technical University of Denmark

Facility management & logistics, guide for sub-project participant Aneta Frontcek, Ph.D. student

Organisations/centres of excellence

Elisabeth Brøgger Jensen, Project Manager,The Danish Society for Patient Safety (DSFP)

Patient safety

Werner Sperschneider, Innovation Consultant, Healthcare Innovation Center

Innovation, user-driven innovation methods

Jacob Nielsen, Superintendent Medical Officer, Danish Institute for Medical Simulation (DIMS)

Facilitator of simulation activities and an overall view of clinical perspectives in the solution.

APPEN

DIX

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

45

Klinikere/hospitaler

Bispebjerg H, endokrinologisk afdelingOverlæger og yngre læger har deltaget med den kliniske vinkel på behovene samt deltaget i udvikling og test af løsningen.

Bispebjerg H, IT afdeling

IT chefen og en medarbejder har deltaget og bidraget til et detal jeret indblik i klinikkens IT systemer og behovene set fra et overordnet brugerperspektiv samt et driftsynspunkt.

The business community

Svend Vitting, Managing Director, Pallas Informatik A/SSupplies software solutions and IT integrations. For the project: responsible for developing the first prototype software for the device.

Hans K. Pallesen, Solution Architect, CSC Scandihealth Supplies software solutions to the healthcare sector – including the laboratory IT system used in the Capital Region of Denmark: Labka.

MaxManus A/S– Frank Petersen, Managing Director– Lars W. Thomsen, Sales Director

Supplier of speech technology. This technology was not applied during the project.

Research institutions

Henning Boje Andersen, Professor, DTU Management Engineering, Healthcare, Technical University of Denmark

Insight into the human factors and patient safety, project management

Ph. D., IT engineer Alexandre Alapetite, DTU Management, Healthcare, Technical University of Denmark

Development of the web-based software solution for use on smartphones.

Organisations/centres of excellence

Mads Stampe Frederiksen, Innovation Consultant, Healthcare Innovation Centre

Innovation, user-driven innovation methods, project management

Jacob Nielsen, Patient Safety Manager, MD, Unit for Patient Safety, Capital Region of Denmark

Facilitator of simulation activities and an overall view of clinical perspectives in the solution.

MOBILE BLOOD TEST RESULTS

Clinicians/hospitals

Christian Homann, Superintendent Medical Officer, Bispebjerg Hospital, Endocrinology–Gastroenterology Department I

Contributed the clinical angle on needs and participated in the development and testing of the solution.

Camilla Nøjgaard, Relief Doctor, Bispebjerg Hospital, Endocrinology–Gastroenterology Department I (now in a new position as Superintendent Medical Officer at Helsingør Hospital)

Contributed the clinical angle on needs and participated in the development and testing of the solution.

Tomas Møller Christensen, Doctor, Bispebjerg Hospital, Endocrinology–Gastroenterology Department I

Contributed the clinical angle on needs and participa-ted in the development and testing of the solution.

Martin Sølvkjær, Head of Innovation & Administrative Systems, IMT, the Capital Region of Denmark

Participated and contributed to a detailed insight into the clinic’s IT systems and needs from an overall user per-spective as well as from an operational point of view.

APPEN

DIX

TELEMEDICIN – REMOTE TREATMENT OF CARDIOVASCULAR PATIENTS

Clinicians/hospitals

Kurt Espersen, Hospital Director, Bornholms Hospital Project sponsor

Peter Juul, Senior Nurse, Bornholms HospitalClinician involvement, clinical staff, treat-ment process, active in simulation

Knud Skagen, Lead Superintendent Medical Officer, Cardiology Department, University Hospital of Herlev

Project sponsor

Helena Dominguez Vall-Lamora, Superintendent Medical Officer, Cardiology Department, University Hospital of Herlev

Clinician involvement, clinical staff, treatment process, imple-mentation, specification of requirements, active in simulation

Jimi Clausen, Department Nurse, Cardiology Department, University Hospital of Herlev

Clinician involvement, clinical staff, treatment process, imple-mentation, specification of requirements, active in simulation

Birthe Møgelhøj, Senior Nurse, Cardiology Department, University Hospital of Herlev

Treatment process, implementation, active in simulation

Merete Vaage-Nielsen, Superintendent Medical Officer, Cardiology Department, University Hospital of Herlev

Clinician involvement, clinical staff, treat-ment process, implementation

Jonas Engberg Lind, Development Consultant Cardiology Department, University Hospital of Herlev

Treatment process (until Feb 11)

Judith Lørup Rindum, Project Manager, Koncern IT Coordination with KIT strategy

Kurt Pedersen, Head of Development, University Hospital of Herlev Sparring på strategi og klinikerinvolvering

Niels Blinkenberg Federspiel, Development Consultant, University Hospital of Herlev

Assistant project manager

Ulla Frejbæk, Development Consultant, University Hospital of Herlev Assistant project manager (March 11 to June 11)

The business community

Bjørn Knud Andersen, Senior Business Development Manager, Bang & Olufsen Medicom A/S

Specialist in user involvement and device development. Sparring in relation to patient solutions.

Care2Wear A/S – Birgitte Lønvig, Director– Peter Søby Nielsen, Director

ICT solutions for cardiac/cardiology departments. User obser- vations and identification of needs. Has participated actively in simulations and user involvement.

47

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

47

Klinikere/hospitaler

IBM Danmark ApS - Project Executive Jerke Smed Christensen - Project Executive Peter Mortensen - Project Executive Christian Kalsen - Key Account Manager Torben Lyng Madsen - IT Specialist Christina Møller - Senior IT Architect Jesper Vejs - Consultant Niels Agersnap - Business Manager Birgitte Wulf

Leverer software løsninger og IT integrationer. Har i projektet ansvaret for udviklingen af den administrative software løsning. Har deltaget aktivt i simulationer og brugerinvolvering.

In-JeT ApSJesper Thestrup, Director

Supplies software for collecting data from the patient and transmit-ting it to the IBM system. In addition, In-JeT facilitated the loan of Continua Health Alliance-certified scales and pulse and blood- pressure monitor. Has participated actively in simulations and user involvement.

Per Monberg, Director, Pallas InformatikSupplies software solutions to the healthcare sector – including the laboratory IT system used in the Capital Region of Denmark: Labka.

Research institutions

Ulrik Falktoft, Director, HELIX – Copenhagen Business School Contributed a frame of reference in the early part of the project

Organisations/centres of excellence

Christian Graversen, , Danish Federation of Industries (DI ITEK)Activity management (technical project management, project description, arranging meetings, knowledge sharing)

Jacob Nielsen, former Superintendent Medical Officer, Danish Institute for Medical Simulation (DIMS)

Facilitator of simulation activities and an overall view of clinical perspectives in the solution.

47

-

APPEN

DIX

RAPID PROTOTYPINGIn rapid prototyping, a sketch or model of the solution is developed in a short space of time – a matter of hours or a few days – in order to have something physical that can be used to simulate user scenarios. Cardboard and paper, full-scale models or scaled-down models can be used, depen-ding on the concept or solution. The idea of rapid prototyping is to give the solution physical form so that ideas can rapidly be rejected or passed on to a more specific conceptualisation phase. The Outpatient Clinic of The Future demonstration project used rapid prototyping to develop the spa-tial model by using objects including shoe boxes, Lego figures and cardboard and pa-per, which were used for rapidly testing different models.

MOCK-UPA mock-up is a model of a solution that can be made from cardboard and paper or other materials if it is a physical pro duct. A mock-up is typically the product of a rapid prototyping process. In demonstration project B, mock-ups were developed of the screen images envisaged to give clinicians a mobile overview of test results. These mock-ups were then included in the IT de-signers’ first prototype.

PROTOTYPEA prototype is a model of a solution that is ready to be tested. The requirements, therefore, are that it must work – so all as-pects have been considered. In IT contexts, this means it must be possible to “switch it on”.

3-D VISUALISATIONA 3-D drawing that is typically created us-ing special 3-D programs. This is a read-ily-understandable way of illustrating complex products. The Outpatient Clinic ofThe Future demonstration project uses these types of 3-D visualisations to show one of the concepts to the users.

DESIGN GAMEA tool that can create a shared understand-ing in a large project team. It is typically designed as a board game whereby the par-ticipants use the game to develop, learn, reflect, facilitate, etc. Design games vary in form and substance depending on the problem area. Design games of various types were used in The Outpatient Clinic of The Future among other things to de-fine the users’ dream outpatient clinic.

ROLE-PLAYRole-play (acting) is used in full-scale sim-ulation. One or more simulator(s) (actor(s)) acts out one or more scenarios. The scenar-ios are very important in order to be able to test the specific problem/challenge, as they help to put the spotlight on the ac-tual challenge. Role-play was used in Mo-bile Blood Test Results and Telemedicine – Remote Treatment of Cardiovascular Pa-tients, as it was essential to see how the us-ers handled the IT solutions. “You have to try it” before it is possible to assess whe-ther the solution works. It was much more difficult to use role-play in The Outpatient Clinic of The Future, as this requires more extensive preparations and physical loca-tions to showcase the solution at full scale. For this reason, a simulation of the physi-cal set-up is more difficult to work with than a simulation of medical technology devices, etc.

TABLETOP SIMULATIONThis type of simulation does not need to take place in a simulation room. Proto-types, mock-ups, etc., can be used for these simulations. Typically, user scenarios are utilised, and they are reviewed verbally, but without a specific simulator.

Appendix 3

SIMULATION METHODS:

49

He

alth

ca

reLAB

Inn

ova

tion

farve

r til de

ni fa

ser

en

ne

utra

l farve

til an

dre

ting

For further information on Healthcare Innovation Labplease contact:

Healthcare Innovation CentreCapital Region of DenmarkHead of Centre, Susie A. Ruffsusie.ruff @ regionh.dk

Partners in Healthcare Innovation LabSamarbejdspartnere i Healthcare Innovation Lab

Dansk Institut for Medicinsk Simulation Koncern IT

Koncern Regional Udvikling