English

Healthcare Innovation LAB User-driven health- care innovation via simulation in the fields of construction, product development and services

May 2012 The way to rapid and accurate product development in the healthcare sector, comprising clinicians, the business commu- nity and research scientists

IMPRINT The target audience for this publication is hospi- Title: Healthcare Innovation Lab - User-driven healthcare innovation tal manage­ment, clinicians, research institutions via simulation in the fields of construction, product and services and enterprises involved in innovation in the field Editors: of new products, services, concepts and organi- Susie A. Ruff Eva Jacobsen sational forms within healthcare in Denmark and with contributions from a number of project participants internationally. 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 Denmark The project is co-financed by the Danish Business Authority www.centerforsundhedsinnovation.dk May 2012 under the Programme for User-Driven Innovation PREFACE 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) Healthcare en neutral farve til andre ting farver til de ni faser

involving as many as 26 partners. Innovation

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. L 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 A 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 B 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 3 “The Healthcare Innovation Lab concept is unique for many Organisational structure of the Healthcare Innovation Lab: reasons: we show that simulation can be used as a tool of innovation, as it creates a structured innovation process PROJECT OWNER, OVERALL PROJECT MANAGEMENT with specific output, incorporates the users’ needs and of- AND RESPONSIBILITY: fers the opportunity for rapid testing of ideas and concepts. Healthcare Innovation Centre, the Capital Region of Denmark By virtue of conducting three demonstration projects that MAIN PROJECT GROUP: brought together clinicians, research scientists, the business DI ITEK, DTU management Engineering, Grontmij, University Hospital of Herlev, community, innovation experts and designers, we have the Danish Institute for Medical Simulation, Healthcare Innovation Centre. created dynamic, inter-disciplinary teams with very different skill-sets. The ideas generated are new and different. SUB-PROJECT MANAGEMENT FOR DEMONSTRATION PROJECTS: We use the good ideas, technologies and service concepts The Outpatient Clinic of The Future: Grontmij and Healthcare Innovation Centre from other sectors and bring them into the hospital context. Mobile Blood Test Results: DTU Management and Healthcare Innovation Centre We have created prototypes that can help deal with the Telemedicine – Remote Treatment of Cardiovascular Patients: DI ITEK challenges that will be facing the hospitals of tomorrow. and University Hospital of Herlev We have laid the foundations for establishing an actual lab HEALTHCARE INNOVATION LAB STEERING GROUP: for healthcare innovation in the Capital Region of Denmark Søren Rohde, CEO, University Hospital of Herlev where simulation is used for rapid product development.” 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) Susie A. Ruff Head of Healthtcare Innovation Centre Capital Region of Denmark Chairperson of the Healthcare Inno- vation Lab steering group

4 Healthcare en neutral farve til andre ting farver til de ni faser

Forord...... 3 Innovation Summary ...... 6 Challenges facing the healthcare sector CONTENTS – great need for innovative solutions...... 9 Purpose 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 L Simulation...... 20

From simulation as an educational and training tool in the healthcare sector…...... 20 A …To simulation as user-driven method and innovation tool of the healthcare innovation lab...... 21 B Gathering experience from the demonstration projects...... 22 Patient involvement – an important part of the Healthcare Innovation Lab...... 27 The Outpatient Clinic Of the Future...... 27 Mobile Blood Test Results...... 27 Telemedicine – 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 unique Inter-disciplinary platform...... 37 APPENDIX...... 42 1. Conference papers & abstracts in English...... 42 2. Participants in the Healthcare Innovation Lab project...... 43 3. Simulation...... 48

5 SUMMARY

Summarised below are the key con- ment of specific innovative solutions, cesses in the context, and in an iterative clusions, experience and vision gained have been a central objective in working way. The simulation used in the inter- through the simulation-based and user- with simulation as a user-driven method. disciplinary teams helps to break down driven innovation work in the Health- barriers, boost creativity and identify care Innovation Lab and the three demon- • Innovation in practice in the health- known and unknown needs. Simulation stration projects, The Outpatient Clinic of care sector is a complex task. The helps to qualify the product, concept The Future, Mobile Blood Test Results and prerequisite for success is the iterative/ or service in question. Simulation as a Telemedicine – Remote Treatment of Car- repeated process whereby involvement user-driven method is unique because diovascular Patients. of users, research scientists and busi- simulation visualises processes and nesses (suppliers) ensures that the pro­ makes it possible to review ideas, con- • Healthcare Innovation Lab encompasses cess reaches the target group in the right cepts and prototypes/pilot versions with 26 partners in a Public–Private In- way. It is important that the product, users and system developers, for example novation Partnership (PPIP). This is concept, form of organisation or service during critical usage situation phases. an inter-disciplinary set-up that creates a is developed and adapted to the context dynamic and innovative field of tension and the specific situation in which is it • The lessons learnt from the three demon- between the clinic, the business com- to be used in hospitals. The innovation stration projects, The Outpatient Clinic munity, research scientists and innova- process in the Healthcare Innovation Lab of The Future, Mobile Blood Test Results tors. It takes training and team-building consists of being open to ideas and pos- and Telemedicine – Remote Treatment to get all parties to interact proactively. sibilities, and then “closing” the creative of Cardiovascular Patients have resulted The participants have to be willing to process as well as exercising tight and fo- in the development of a unique metho­ enter into open processes. Tight manage- cused project management. The unique dology for the Healthcare Innova- ment (leadership capacity) is required process that Healthcare Innovation Lab tion Lab. This methodology combines of the project management. In addition, has implemented cannot be brought user observation, idea generation/rapid the project owner has to be able to bring about with classic development methods prototyping and simulation testing. In together relevant players (network, ac- and traditional project management. order to validate the three demonstra- cess) and demonstrate useful results from tion projects, the method has been tried processes that require special innova- • Simulation reinforces work with and tested in a compressed model, tion skills (methods and experience). user-driven methods, as it makes it a 3 x 3 model (three times three hours). Development for the benefit of all PPIP possible to test and try out results of Ten enterprises (five medical technology participants, together with the develop- prior innovation and development pro­ enterprises, four IT enterprises and one

6 Healthcare en neutral farve til andre ting farver til de ni faser Innovation manufacturer of rehabilitation devices) 1) the ability to match-make clinicians, Healthcare as well as nine hospital departments businesses and research scientists, and one psychiatric department served 2) proximity to the clinic and having Innovation LAB as the testing hub. Testing took place ­access to the right specialists, and in autumn 2011 and spring 2012. The 3) being able to set up small-scale or results have been consistently positive large-scale simulation scenarios in or for the departments and the enterprises close to the clinic. The main point that alike. The enterprises have generally ex- has emerged is that there is considerable L perienced faster and important input for potential inherent in bringing together

the product development process, and expert specialists, external consul­ A the departments have been in a position tants and simulation experts in a well-

to directly influence the development established innovation environment. B of the products that they will be work- ing with themselves. The Healthcare • The project has continuously been Innovation Lab’s unique combination communicated to many different play- for the business community. This includes methodology has generated demand. ers. In autumn 2011, for example, the an accelerated development potential Healthcare Innovation Centre invited as well as the opportunity for valuable • The project conducted cost–benefit 250 guests from the hospitals, the re- export potential as a result. The Health- analyses of each of the three de­ gions and the business community to care Innovation Lab project has thus laid monstration projects. Two of the three an innovation conference for a pres- the foundations for and demonstrated demonstration projects can directly entation of the results of the project. the value and usefulness of establish- generate benefits here and now. The ing an actual laboratory that would also third demonstration project will gene­ • There is strong interest from the busi- work across national boundaries in the rate benefits after an investment ness community and at international Öresund Region, for example. Interest in of DKK 4.6 million from ‘Kroniker- level in the process, methods and results the Healthcare Innovation Lab method and programmet’ (Rehabilitation Pro- of the Healthcare Innovation Lab. The partnership model has come from vari- gramme for Chronically Ill Patients). project demonstrates both a rapid and ous quarters including Sweden, Norway an effective development of the health- (Oslo, Stavanger), the European Commis- • Healthcare Innovation Lab demonstrates care sector, but it also demonstrates that sion in Brussels and Kaiser Permanente a number of Unique Selling Points: the method creates useful development healthcare organisation in California.

7 HEALTHCARE INNOVATION CENTRE, THE CAPITAL REGION OF DENMARK: PROJECT OWNER, THE HEALTHCARE INNOVATION LAB

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 PROJECT PARAMETERS

The Danish Business Authority’s

FACTS Programme for User-Driven Innovation KEY NUMBERS FOR THE CAPITAL REGION OF DENMARK and the Growth Forum for the •Far the kargest Region in Denmark Capital Region of Denmark •12 hospitals co-financed the project. •6,500 beds Project period: •More than 3,000,000 treated patients (in and out patients) 1 February 2010 – 30 April 2012. •40,000 employees •1,6 mill. inhabitants

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)

8 CHALLENGES FACING THE HEALTHCARE SECTOR Healthcare en neutral farve til andre ting farver til de ni faser – GREAT NEED FOR INNOVATIVE SOLUTIONS Innovation

Innovation is one of the key tools for tack- products and functionality. Identifying the HEALTHCARE INNOVATION LAB: THE ling the challenges facing the Danish health known and especially the unknown needs LIVING “EXPERIMENTARIUM” FOR service. Today, the health service is under of users is an important prerequisite for PUBLIC–PRIVATE PARTNERSHIPS enormous pressure to deliver quality contributing the necessary knowledge. The Healthcare Innovation Lab includes services­ on time to its users. At the same Simulation as a user-driven method and many collaborative partners from hospi- L time, the number of treatments is increas- hence a tool of innovation can shed impor- tals, the business community, the world of ing, both for emergencies and for chronical- tant new light for enterprises that advise on research, patient associations and innova- A ly ill patients. If prioritisation is not to be or are suppliers for hospital construction of tors. Altogether, there are 26 partners in- the only solution, it is essential to come up the future: interior design, technology, or- volved in the project to a greater or lesser B with new and improved methods for equip- ganisation and arrangement. extent. ping the health service to meet future ex- pectations. New methods that can deal with demands for solutions across sectors. Meth- PARTNERS ods that at the same time create effective so- lutions that can help reduce consumption Business Knowledge Research HOSPITALS of resources in the healthcare sector and in- Communities Institutions Institutions crease focus on the patient. • DI ITEK • CBS Helix • DTU Management • Healthcare The development of the health service re- • Grontmij • Medico Industrien • IT University of Innovation Centre • Care2Wear A/S • Medico Innovation Copenhagen • Herlev Hospital quires new solution models going forward • Pallas Informatik A/S • Danish Patients • Bornholms Hospital for how private enterprise can work innova- • In-JeT ApS • Danish Society for • Bispebjerg Hospital • Bang & Olufsen Patient Safety • Rigshospitalet tively in close collaboration between users, Medicom A/S • Hvidovre Hospital patients, doctors, nurses, research scientists, • CSC Scandihealth • Glostrup Hospital etc. • Max Manus A/S • Danish Institute for • IBM Danmark ApS Medical Simulation Specifically, users – staff and patients • IT-division – are key stakeholders when it comes to • Koncern Regional Udvikling identifying needs and requirements for new physical settings or the design of new

9 PURPOSE AND FRAMEWORK OF THE HEALTHCARE INNOVATION LAB

The purpose of the Healthcare Innovation ideas that you cannot simply visualise • To develop and test simulation Lab project is to create a platform for the but that have to be tested in practice.” as a user-driven innovation meth- use of simulation as a user-driven method. od through specific innovation pro­ Simulation has long been used for train- Morten Lebech supports the need for an cesses in three types of demonstration ing and education in the healthcare sector, actual lab close to the clinic: projects involving hospitals, private and user-driven innovation methods have “I recommend that simulation in future enterprise and knowledge institutions. long been used for the development of new Healthcare Innovation Centre projects These must result in specific new pro­ products and services. Combining the two be implemented at full scale, where users ducts, services, work processes and the methods creates a dynamic and results- can test solutions in large-scale physical formation of strategic partnerships. generating platform where the simulation settings located close to the workplace enables relatively rapid development and so as to avoid unnecessary travel time.” • To identify the benefits created by testing of new solutions on site. user-driven healthcare innovation Morten Lebech, Head of Department, As project owner, the task before the – including the potential for commer- Dept. of Gynecology & Obstetrics, Uni- Healthcare Innovation Centre and the cial development created by experi- versity Hospital of Herlev, participated in Capital Region of Denmark is to create the ence gained from the project through The Outpatient Clinic of The Future demon- setting and the prerequisites for a Public– specific interaction of patients, next- stration project. He has this to say about sim- Private Innovation Partnership (PPIP) in- of-kin, health experts and managers of ulation as a tool of innovation: volving stakeholder businesses, hospitals public-sector hospitals, private enter- “The potential for using simulation in and knowledge and research institutions prises and knowledge institutions. Healthcare Innovations Lab is enor- in the Capital Region of Denmark. A part- mous. The method is very useful and has nership model capable of producing so- • To prepare a presentation and great potential for further developing lutions for a number of challenges in the business plan, including preparing ideas and guaranteeing user owners- health service. a proposal for financing and secur- hip. Simulation has amazing potential The project originally had three main pur- ing political ownership of a Health- as a tool for further developing ideas – poses: care Innovation Lab as a ba-

10 Healthcare en neutral farve til andre ting farver til de ni faser Innovation

sis for establishing a future Lab in tofte and Hillerød Hospital subsequent- the Capital Region of Denmark. ly helped trial the method together with five private enterprises. The goal of each L The project has been implemented with demon­stration project is for solutions to three demonstration projects (A, B, C), be scalable and transferable to similar de- A each in its own field/sphere. This shows partments in other hospitals. how user-driven simulation can be used B in very different areas and thus determine Morten Lebech, Head of Department, whether the method has greater potential Dept. of Gynecology & Obstetrics, University Hospital of Herlev 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 Future B. Mobile Blood Test Results C. 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-

11 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.

12 THE OUTPATIENT CLINIC OF THE FUTURE Healthcare en neutral farve til andre ting farver til de ni faser Innovation The tendency towards shorter hospitali- ality inTthe Outpatient Clinics of The Fu- physical setting at Gynaechology Depart- sations and more outpatient checks looks ture. ment G at University Hospital of Herlev. In set to continue in the years ahead. Accord- In order to be able to simulate such a large this specific case, a method was developed ingly, the most effective ways of organising physical space and such complex work pro­ where simulation is used both for deve­ work processes and designing outpatient cesses involving many people, the project lopment and testing of new solutions. The clinics is particularly important going for- group made use of table-top simulations us- method is robust and can be used gener- ward. Now is the time to plan how new ing cardboard and paper models. The simu- ally to resolve challenges that exist in the hospital buildings should be arranged. lation method was used to identify the needs Capital Region of Denmark and nation- L Therefore, this demonstration project has of users – patients and clinicians – for a pa- ally in relation to new hospital construc- a highly relevant focus that may provide tient-centric physical setting that at the same tions. The model focuses on functionality, A valuable insight for the benefit of hospi- time supports staff work processes in the best patient flow, working environment, work tal construction in Denmark and abroad. possible way. New concepts were developed processes and organisation. As we go to B The demonstration project has used simu- and tested in a dynamic collaboration invol­ press, the model and the methodology have lation to develop and test new concepts of ving clinicians at University Hospital of Her- been presented to a wide range of construc- task handling, coordination and function- lev Gynaechology Department G, work study tion managers from a number of hospitals researchers, advisers in the construction in- and psychiatric units in the Capital Region dustry and the Healthcare Innovation Centre. of Denmark as well as the Capital Region’s The essence of the new outpatient clinic Group Construction Management). In addi- concept is a new spatial model. It address- tion, It has been presented to a number of es the problem of long corridors where pa- international stakeholders. 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 IMPLEMENTATION The Star Model can be introduced as an organisational model within the existing

13 MOBILE BLOOD TEST RESULTS

Reports of errors in the transfer of informa- given patient. Similarly, they are dependent FROM IDEA TO IMPLEMENTATION: tion between clinicians and adverse events on the nurses checking whether test results As we go to press, the prototype is in the data show that overlooked test results sent have arrived, also on a stationary PC or fax process of undergoing the final adjust- from the laboratory to the clinic lead to a machine. At the same time, the nurse must ments and will then be ready for clinical reduction in patient safety. Prompt action keep the doctor informed verbally as to the piloting at one of the region’s hospitals. on test results is vital for patient safety and status of test results, which can be an inter- Bispebjerg Endocrinology–Gastroentero­ effective treatment. ruption if it is just to say there is “nothing logy Department is a possibility. The proj- From an examination of the working envi- new”. Altogether, there is a failure to exploit ect group is working with the Capital Re- ronment of clinicians, especially in in-hospi- the possibilities offered by mobile techno­ gion of Denmark’s IT organisation (IMT) tal emergency care and A&E, it is clear that logies to facilitate more effective use of re- to integrate the solution and the know­ the IT aids that would ensure an up-to-date sources, so there is a lot of scope for innova- ledge it represents in an existing project overview of test results in the right place and tion in the handling of test results. to do with the handling and display of at the right time do not exist. With regard to The IT department and Endocrinology– test results such that, within the next few handling test results, the effectiveness of the Gastroenterology Department at Bispebjerg years, all clinicians will be able to take ad- clinicians is impaired because they have to Hospital are the hub of these user studies. vantage of this solution, for the benefit of go to stationary PCs to view test results for a The latter department was selected because patient safety and the clinical working en- it has a large number of patients who have vironment. The next step will be regional blood samples taken. The clinicians play a vi- and national scaling. 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. La­ter, these were firmed up into prototype software on a Microsoft platform and a web-based platform.

14 the hospital management, medical practi- tioners and end-users. This test shows that TELEMEDICINE the basic functionality is satisfactory for the medical practitioner and the end-user. Therefore, the solution can be carried for- – REMOTE TREATMENT OF ward to implementation after operational incubation to ensure that operation of the Healthcare

CARDIOVASCULAR PATIENTS solution is unambiguous and stable in theen neutral farve til andre ting farver til de ni faser Innovation clinic and in the end-user’s home. The Telemedicine solutions are used in a num- developed for how the patient and the medi- demonstration project has succeeded in ber of different countries for Remote cal practitioner can communicate via video obtaining DKK 4.6 m from ‘Kronikerpro- Treatment, which saves time and money, conference and what functionalities need to grammet’ (Programme for Chronically Ill as the patient can typically stay at home be on the screen (user interface). The solu- Patients) to implement a pilot installation without having to travel to the hospital tions are based on existing technology (hard- in departments at University Hospital of or visit their GP. In Denmark, the num- ware, software). The simulations highlighted Herlev, Hvidovre Hospital and Bornholms ber of chronically ill patients for example the specific requirements set for the treat- Hospital. The purpose of CIT is to put the L with cardiovascular disorders is on the in- ment task, quality and process; requirements spotlight on the clinical and organisational crease. Accordingly, based on the case of that cannot be tackled by ordinary dialogue effects of telemedicine, including collabo- A cardiovascular patients, the project group and interview in the same way – quite sim- ration with GPs and municipalities con- focused on developing an innovative solu- ply, things have to be tried out! cerning outpatient care pathways. The B tion for how, in the future, we can use mon- Bornholms Hospital’s Medical Ward and project seeks to demonstrate and docu- itoring and the exchange of information to University Hospital of Herlev’s Cardiology ment that using telemedicine can contri­ treat patients remotely and make these pa- Department have helped to create an excit- bute to a rapid and more flexible treat- tients more self-sufficient. ing case for telemonitoring and remote dia- ment offering at least the same quality as The simulation method was used to iden- logue between healthcare practitioner and ordinary outpatient treatment. tify the needs of the clinics and the patients. heart patient. The lesson from the process Using simulation, technical solutions were 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- FOR FURTHER INFORMATION ON tion was what made all these factors visible THE THREE DEMONSTRATION at the same time – by playing out scenarios. PROJECTS:

FROM IDEA TO IMPLEMENTATION Please contact Healthcare Innovation Centre, Cardiac Insufficiency Telemedicine (CIT) www.centerforsundhedsinnovation.dk. has been tested through simulation with

15 IDEA & CONCEPT TEST AND PRE-STUDY GENERATION IMPLEMENTATION 2 4 6

1 3 5

START NEEDS- DETAIL PROJECT CONCEPT

IDENTIFICATION

16 THE INNOVATION PROCESS IN THE HEALTHCARE INNOVATION LAB Healthcare en neutral farve til andre ting farver til de ni faser Innovation This section sheds light on the innova- to tasks (evidence based, a challenge Specifically, this means the Healthcare In- tion process, including the challenges and to enter into innovation processes novation Lab has to ensure tight manage- methods used in the Healthcare Innova- where the outcome is unknown) ment in order to achieve a successful process tion Lab. • The research scientist with a long time­ and produce results. The project uses an ar- scale from classic research projects ray of specific methods and tools to ensure CULTURAL DIFFERENCES IN PPIP • The enterprise representative with a professionally run innovation project. The The start of the Healthcare Innovation Lab short deadlines, a focus on results following has been implemented in the start- was the beginning of an extensive project. and scarcity of resources, and up phase: L A PPIP project involving 26 partners • Innovation experts with a focus means people come from a number of dif- on ensuring there is scope for in- A kick-off workshop for all PPIP par- A ferent cultures: novative freedom, non-recognised ticipants. There is a need for a com-

needs and unexpected solutions. mon understanding of the project B • The clinic with its day-to-day chal- when so many divergent parties are lenges and with a scientific approach The above challenges are described in more to work together and bring many detail in the PPIP section. different objectives to the table.

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

PRELIMINARY ANALYSIS To 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

Researchers ted national and international sources of 17 u­sers. All of these methods are included

User involvement on the palette of innovation methods and Clinician involvement user-­driven innovation.

The innovation methods used are: - Participant observation, where

Process planning the users are observed going and definition 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

Feb 2010 Aug 2010 May 2011 - Work process analysis is used among other things to map current work pro­ cesses and identify inappropriate actions inspiration and potential partners. Litera- - Visualisation ture studies were used to obtain up-to-date knowledge of simulation as a user-driven IDEA/CONCEPT GENERATION method. The next step for the Healthcare Innova- tion Lab was to come up with proposed so- IDENTIFICATION OF NEEDS & ANALYSIS lutions for the problems and needs iden- This phase delved deeper into the topics tified in relation to the three groups, The for the three demonstration projects in or- Outpatient Clinic of The Future, Mobile der to gain a better understanding of the Blood Test Results and Remote Treatment challenges through analysis of relation- of Cardiovascular Patients. Ideas and pro- ships, collaboration and patient care path- posals for new solutions (concepts) were ways. This was with a view to identifying developed in ways including the following: the known and unknown needs of the - Different types of brainstorming,

18 Healthcare en neutral farve til andre ting farver til de ni faser Innovation used to generate a number of ideas collaboration with the Danish Institute for in the three demonstration projects Medical Simulation (DIMS). - Concept development to elaborate on the ideas generated. IMPLEMENTATION - Prototyping/trial versions as Here, the Healthcare Innovation Lab fo- models to make the solutions cuses on designing products, concepts and more tangible to the users. services that do not remain in a report left - Rapid prototyping, where lying on the shelf. The focus is on proto- L quick prototypes/trial versions types and on dialogue with the stakehol­

are created, for example using ders in the Capital Region of Denmark A paper, modelling clay, etc. and other stakeholders who can contribute

to scaling and ultimately to implementa- B CONCEPT DETAIL tion (clinicians, IT departments, construc- The recently developed concepts for The tion managers, etc., in the Capital Region). Outpatient Clinic of The Future, Mobile Based on the results from the project, a Blood Test Results and Telemedicine - Re- plan has been drawn up of how to carry mote Treatment of Cardiovascular Patients the recently developed concepts through are prioritised and fleshed out by devising into practice. scenarios and simulations, etc.

TESTING The 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

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

One main purpose of the Healthcare In- projects that seek to apply more standardised care Innovation Lab project groups therefore novation Lab is to develop specific inno- user-driven innovation methods. needed to find a padded cell or laboratory vative solutions. The other main purpose With regard to innovation in the health- where the patient/clinician, enterprises and is to link user-driven innovation meth- care sector, however, various ethical and research scientists were allowed to make mis- ods from private enterprise with simula- safety considerations come into play. These takes together during the innovation process. tion methods used for training and educa- factors can be a barrier to investigative and At the same time, it had to be a laboratory tion in medical contexts. The project thus iterative innovation processes that often in- that approximates so closely to actual prac- sought to develop methodology as well as volve participants making mistakes and then tice that it can indeed be said that the inno- solutions. adapting the solution being worked with. It vation process is user-driven. Such a labora- This distinguishes the Healthcare Innova- is self-evident that not all types of error can tory could, for example, be the places where tion Lab from other user-driven innovation be accepted in actual practice. The Health- simulation training is currently undertaken.

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/

20 …TO SIMULATION AS USER-DRIVEN METHOD AND INNO- VATION TOOL OF THE HEALTHCARE INNOVATION LAB Healthcare en neutral farve til andre ting farver til de ni faser Innovation As already intimated, simulation train- fully clarified. With simulation of future ing is traditionally used for the purpose work processes, development of new medical of training participants and not for deve­ technology or IT products, for example, the loping the equipment to be used, the in- concepts can be rapidly developed, refined terior surroundings or the work processes and tested. being implemented. In the Healthcare In- A functional innovation method is used to novation Lab, development is the actual try out simulation as a functional innovation purpose, so the simulation process and method. Here, specific details of the function L the premises are instead used to imple- are examined to see if they work in different­ ment innovation processes. In the Health- usage scenarios. At this point in the inno- A care Innovation Lab’s three demonstra- vation process, there is no room for radical tion projects, therefore, the focus is not on changes in either concept or solution; for this Funnel simulation model B practising procedures but instead on using reason, the focus is on fine-tuning the simu- From mapping existing models to hypotheses, trialling, scenarios and to prototypes, via simulation simulation at different points in the inno- lation as the need arises. During this phase, vation process, from identifying the needs the simulation will usually be full scale, in of the clinician and patient at the start of order to approximate as closely as possible to FACTS the process, to testing and developing pro­ reality, e.g. simulation in the clinic or other Simulation can be used at different points in the innovation ducts, processes and services at the end of locations where the solution is to be applied. process. For The Outpatient Clinic of The Future, Mobile Blood the process. At this point in the innovation process, there Test Results and Telemedicine – Remote Treatment of Cardiovascular Patients, the project groups have worked Simulation as an exploratory innovation is a need for specific inputs for the solution, with two approaches to the application of simulation as a method can be used, for example, for map- and it is therefore not sufficient to test it by user-driven innovation method: ping existing work processes, simulating means of a table-top simulation, as context these in order to arrive at a common under- is essential for obtaining proper feed-back 1. Exploratory – investigating topics standing among participants. In addition, from the users. 2. Functional – trialling the solution the exploratory approach can be used to generate­ ideas and concepts, with different An exploratory method, where simulation is used early in the innovation process, as part of the analysis phase scenarios being played out. – and a method that can test solutions in the subse- In the early exploratory phase, simula- quent part of the process, where the concept or solu- tion is used to develop different concepts at tion is trialled to assess whether it works as intended. a time when the solutions have not yet been

21 PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST 1 3 5 7 GATHERING EXPERIENCE FROM 2 4 6 THE DEMONSTRATION PROJECTS

Kickoff workshop Projektstyrings- seminar HOW SHOULD THESE METHODS success in the innovation processes of be the most important aspect. Kursus i bruger- BE INCLUDED IN THE FUTURE the demonstration projects. The three At the same time, the project group con- ANALYSE KONCEPT-dreven innovation HEALTHCARE INNOVATION LAB?BEHOVS- activities are: IDÈ-KONCEPT- cludes that, taken in isolation, simulation Tværgående PROJEKT- FORANALYSE workshop To learn lessons from experiences and can work as a user-driven innovation me­thod DETALJERING IDENTIFIKATION GENERERING TEST Innovation resultsOPSTART using these methods, the Health- • User observation with the application if there is a focus on participants being al- Camp I care Innovation Centre has evaluated the of video documentation lowed to develop in between repeated simu­ Healthcare Innovation Lab’s innovation • Idea-generating workshops/rap- lation scenarios, for example distributed over 1 methods across the three3 demonstration id prototyping5 with clinicians, pa- 7several days. If simulation is used as the only projects. Bringing together the lessons tients, experts (or other users), includ- innovation method, however, this might fall learnt across the board makes it possible to ing use of mock-ups and models short partly in relation to the contextual form a methodology that can be used in the • Simulation testing of ideas knowledge obtained from observation stu­ future Healthcare Innovation Lab whatever and solutions (may occur at dif- dies and the knowledge generated by rapid the problem area under scrutiny/requiring ferent points in the process) prototyping at idea-generating workshops a solution for the healthcare sector (hospital with users (e.g. clinicians and patients). department,2 psychiatric unit, disabled unit,4 Combined, the three activities6 com- hospital construction) or the business com- prise the unique methodology of munity (developing/testing a new product the Healthcare Innovation Lab. THE HEALTHCARE INNOVATION LAB’S or service). This has been achieved through METHODOLOGY: EXPERIENCE two Best Practice workshops involving the Other, more general innovation methods 1. Observation using video documentation project participants, as well as through a (such as desk research, brainstorming, etc.) “Because people do not always do what number of subsequent project meetings. do not require any special expertise, but they say they do” The primary purpose has been to evaluate can in most cases be accommodated with- Participant observation, conducted in how the combination ANALYSE of user-driven inno- in the coordinatingKONCEPT- organisation for the in- the practice to which the problem area vation methods and simulation have func- novation process. Accordingly, the Health- relates, provides important emotional FORANALYSEtioned in the innovation processes, as well care Innovation Centre does not see these experience. Using video recordings as as how they can be incorporated as part of as partDETALJERING of the added value that the Health- documentation can enable knowledge the Healthcare Innovation Lab’s core ser­ care Innovation Lab must deliver going sharing and make it possible for others vices going forward. It is evident that the forward. They can be included as part of to analyse the problem area. In the three three activities are the pivotal point of the innovation process, but they will not demonstration projects, video observa-

22 Healthcare en neutral farve til andre ting farver til de ni faser Innovation L

tion contributed to a shared understand- specialisms and disciplines. What the Head of Development at University A ing of the problem area. Especially for sub-projects have in common is that the Hospital of Herlev, Kurt Pedersen, says:

enterprises and other participants with- common problem area became blinding- “Simulation visualises processes and thus B out a clinical understanding, the obser- ly obvious the moment a more concrete contributes to qualification of the dia- vations contributed with insight into approach was taken to what the solu- logue about innovation, for example in clinical practice in general. Video-docu- tion should actually look like (model/ relation to a new work process, develo- mented observation can be implemented mock-up). Another advantage of enga­ ping and testing a new technology within a within a relatively short time, depending ging with physical models of proposed context that closely resembles the context on the problem being observed. Typi- solutions at an early stage is that the in which the innovation is to be used.” cally, 2–3 hours should be sufficient to solution can then be trialled, for exam- identify matters of interest in terms of ple via rapid (table-top) simulations, and subsequent analysis of the problem area. untenable solutions can be rejected.

2. Rapid prototyping 3. Simulation “Not all ideas can be communicated using “In theory, there is no difference between language. theory and practice. In practice, there is” They need to be noticed and felt before we The use of simulation methods as understand what they are about”. an innovation platform has been Kurt Pedersen, Head of Development, University Hospital of Herlev Working physically/materially with ideas particularly enriching in terms facilitates rapid understanding across of the innovation processes.

23

Kurt Pedersen, Head of De- velopment, University Hospitalof Her- PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST 1 3 5 7

2 4 6

Kickoff workshop

Projektstyrings- seminar

Kursus i bruger- ANALYSE KONCEPT-dreven innovation BEHOVS- The lesson from theIDÈ-KONCEPT- three demonstration tant to get table-top simulations under way Tværgående PROJEKT- FORANALYSE workshop projects is that simulation methods can be as quickly as possible, as the description of DETALJERING IDENTIFIKATION GENERERING TEST Innovation OPSTART used very early in an innovation process, on a given work process in connection with the Camp I process, product and organisational devel- preparation of the simulation helps to estab- opment alike. The unique value of simula- lish a shared understanding of what current 1 3 tion is that5 it makes things much more spe- 7practice looks like. cific, as it becomes necessary to carry out the All demonstration projects used scripts. work processes with the solutions that have This is a good tool for facilitating the simu- been thought up. This makes it possible to lations and ensuring that all the details are examine the minutiae of a given work proc- included. The scripts described the scenarios ess. However, it also restricts the amount of that the simulation was intended to address simulation that is achievable in any planned and that the simulators were to perform. The 2 4 simulation. 6 introduction of unforeseen events was also Simulation can be implemented simply on part of the scripts and simulations. These are a table with paper sketches (table-top simula- a good tool for stress-testing the solution un- tion) or it can be implemented at full scale in der examination. the clinic (Dogville simulation). It is impor- FACTS THE UNIQUE METHODOLOGY OF THE HEALTHCARE INNOVATION LAB ANALYSE The KONCEPT-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 FORANALYSE Innovation Centre has called this the 3 x 3 methodology because the three activities can be done in aDETALJERING 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.

24 “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.” Healthcare

Kurt Pedersen, Head of Development, en neutral farve til andre ting farver til de ni faser Innovation University Hospital of Herlev.

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). L An inter-disciplinary circle of participants is particularly valuable for innovation pro­ A cesses in general. This has also been the case in the Healthcare Innovation Lab. Especially B 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 Healthcare inter-disciplinary approach is important for Innovation LAB the future of the Healthcare Innovation Lab. The PPIP is one of the ways of establishing an inter-disciplinary circle of participants.

25 PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST 1 3 5 7

2 4 6

A suggestion for The Kickoff Outpatient Clinic of workshop The Future made by Projektstyrings- students from DTU seminar

Kursus i bruger- ANALYSE KONCEPT-dreven innovation BEHOVS- IDÈ-KONCEPT- Tværgående PROJEKT- FORANALYSE workshop DETALJERING IDENTIFIKATION GENERERING TEST Innovation OPSTART Camp I PATIENT INVOLVEMENT – AN IMPORTANT PART 1 OF THE HEALTHCARE3 5INNOVATION7 LAB

The three demonstration projects have and other hospitals, so they are aware of how The Hospital Plan for the Capital Region of used 2a number of different methods of4 in- things are done elsewhere. 6 Denmark (2011) envisages much more collab- volving patients in the project. Working with patient involvement and oration with and inclusion of users, patients But why should patients and next-of-kin be systematic development of one’s department and relatives. This objective could advanta- systematically involved in the development is not without challenges for the staff, how- geously also be applied in innovation work. of new solutions for the healthcare sector? ever. A successful process requires persist- A number of other countries have long Because the direct user feedback in hospi- ence and openness to unexpected insights been working systematically with patient in- tals and psychiatric and disabled units can and realisations and the answers that are volvement and putting the focus on the pa- provide valuable knowledge of areas where forthcoming are not always the answers the tient: individual departmentsANALYSE could do better, and staff hopedKONCEPT- for. Some colleagues might be re- “...the patient must be at the cen- knowledge of where resources can be ap- luctant to support someone’s project because tre of everything the National He- FORANALYSEplied more effectively. Some patients and day-to-day operations take up a lot of atten- alth Services does” (Involving Patients relatives are also creative and innovative, so tion, orDETALJERING perhaps because they are not keen on and the Public in Healthcare. De- they contribute solutions to organisation- change. Nevertheless, working methods us- partment of Health 2001, UK). al challenges facing the department, partly ing patient involvement have been shown to because they visit a number of departments make a difference.

26 Healthcare en neutral farve til andre ting farver til de ni faser Innovation

THE OUTPATIENT CLINIC to ask qualified questions about the selected Concurrently with the innovation process OF THE FUTURE concept. The patient representatives were for mobile blood test results, the project team able to recognise the familiar context and also worked on the possibility that patients L In The Outpatient Clinic of The Future openly reflect on more sensitive issues in a could access their own blood test results at project, the project team has tested various constructive way that could readily be trans- the same time that the results became avail- A approaches to patient involvement – with lated into spatial design and work processes able to the clinicians. In order to research this differing results. in the new physical settings. possibility, the project team interviewed a B Involving patients in connection with an Including patient representatives in the ac- number of patients to investigate how a solu- outpatient visit to the hospital produced tual simulation aspect would also be prefera- tion of this nature could be created. This was scant results for The Outpatient Clinic of The ble. It is evident that the clinical staff on their with a view to identifying new opportunities Future. The patients were very much aware own could not represent all aspects of the pa- for involving patients in their treatment go- of their own treatments and conversations tients’ wishes and requirements in terms of ing forward so that patients get the same in- with different medical practitioners, but treatment. formation at the same time as the medical they were unable to answer questions about practitioner. physical settings, work processes, etc. On the other hand, good results were ob- MOBILE BLOOD TEST RESULTS tained from including patients in workshop TELEMEDICINE focus groups. Here, patients were recruited In the project to do with trialling mobile – REMOTE TREATMENT OF through the relevant patient associations. blood test results, the heart of the matter CARDIOVASCULAR PATIENTS At the workshop, the developed concept as far as user requirements are concerned was presented to the patient representatives, has been to help the clinicians improve In this project, the project team selected pa- and their statements were subsequently used their work processes and their working en- tients for participation in simulation proc- to qualify the concept further. vironment. For this reason, it was not rel- esses with staff at the treatment location in The patients made available their experi- evant to involve patients in this part of the question. Those selected were resourceful ence and knowledge, and they were also able process. patients with a good understanding of the

27 PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST 1 3 5 7

2 4 6

Kickoff workshop Demonstration project manager Projektstyrings- treatment process and the ability to work in special surroundings that are remini- of a testing role, where new solutions and seminarChristian Graversen, DI ITEK, a computer. scent of the patient’s home, as it would concepts are road-tested on ‘real’ patients in Danish Federation of Industries. Kursus i bruger- The project team also entered into dia- be difficult to conduct a test as such with simulation processes. ANALYSE KONCEPT-dreven innovation logue with the Danish Heart FoundationBEHOVS- and the patient in thatIDÈ-KONCEPT- person’s own home,” Tværgående PROJEKT- FORANALYSE workshop its local branch association in Gladsaxe, Den- Morten Freil says. DETALJERING IDENTIFIKATION GENERERING TEST Innovation markOPSTART which gave feedback both on the con- Camp I cept of Cardiac Insufficiency Telemedicine DANISH PATIENTS ASSOCIATION (CIT) and on the prototype developed. – A STRONG ADVOCATE OF USER INVOLVE­- 1 Demonstration project3 manager Christian MENT AND5 PATIENT INVOLVEMENT 7 Graversen, DI ITEK, Danish Federation of In- Morten Freil, director, believes patients dustries: should be included in different phases of “We have benefited greatly from in- the development and testing process. It has cluding patients in a number of pha- been documented that involving patients ses, and it is important to be aware that creates better and more patient-centric so- there can be an advantage in involving lutions, which in turn can result in shorter patients2 with different areas of exper-4 periods of hospitalisation. 6 tise and/or at different locations in the It can be advantageous to include patient process during the individual phases.” representatives nominated from patient as- sociations in steering groups and project According to Morten Freil, director of the teams – for example, in connection with new Danish Patients Association, it is impor- construction, or development of new tech- tant in the case of Telemedicine – Remote nologies. Involving patient representatives Treatment of Cardiovascular Patients to ensures that the project maintains its focus ANALYSE implement the simulation of the treat- on the patientKONCEPT- perspective. Morten Freil, direc- ment process between clinician and pa- Users can also be included in the test- tor ofthe Danish Patients Association FORANALYSEtient in special settings that resemble a ing/trialling of new solutions. According to hospital/home environment: MortenDETALJERING Freil, during the testing/trialling “Due to widespread application of tech- phase, it is best to select user representatives nology and out of consideration for the who have a direct relationship with the spe- patient, it is necessary to set up facilities cialism in question. Here, users take on more

28 Healthcare en neutral farve til andre ting farver til de ni faser VALIDATION OF THE HEALTHCARE INNOVATION Innovation LAB’S METHODOLOGY: TEN INTENSIVE PROCESSES WITH TEN ENTERPRISES AND TEN HOSPITAL AND

PSYCHIATRIC DEPARTMENTS L A Based on experience of the methods the methods as possible, the enterprises and • Ambu A/S and Gentofte Hospital, from the three demonstration projects, a departments selected had not participated in Anaesthesiology Department B methodo­logy has been developed consist- the project. • Trifork A/S and Hillerød Hospital, ing of three compressed activities, which Phase 2 of the test process was scheduled Emergency Department, on the topic are to be used as the core service of the fu- for spring 2012, immediately after the end of mobile emergency journals ture Healthcare Innovation Lab. The meth- of the project, when five enterprises were • Systematic A/S and Gentofte Hospital, odology has been dubbed “3 x 3”, as the matched to relevant departments. Phase 2 Cardiology Department and Medical actual process can be compressed into 3 made it possible to consolidate the first test Department, on the topic of mobile activities allocated over 3 days. Ultimately, processes and to optimise the process. In par- access to patient data though, it will be up to the individual pro­ ticular, efforts were made to professionalise • Radiometer A/S and Hvidovre Hospital, cess to schedule activities, time slots and the process, including developing documen- Pulmonary Department and Intensive use of resources. tation templates and templates for debrie­ Care, on the topic of software for To validate the methodology, a test process fing from the process. This was for the pur- blood gas analysis devices. was undertaken in two phases. pose of ensuring a smoother launch of the • Grontmij A/S and Hillerød Hospital, Phase 1, in September 2011, consisted of concept on commercial terms. As we go to Surgical Out-patient Clinic, on the topic conducting five intensive processes with four press, the final test processes have just been of work process analysis and future enterprises in the fields of medical technolo- concluded, so it was not possible to include patient flow. gy and healthcare IT as well as one engineer- the results here. ing firm and five hospital departments. In The following Danish enterprises and de- order to obtain as objective an assessment of partments took part in Phase 1:

29 TEST OG IMPLEMENTERING PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST 1 3 5 7

2 4 6

Kickoff workshop

Projektstyrings- seminar For reasons of discretion in connection 3. Simulation test and re-design: the pro- Kursus i bruger- with commercial development activities, totype is tested by means of simulation ANALYSE KONCEPT-dreven innovation BEHOVS- the description of IDÈ-KONCEPT- processes given below in-situ or at other locations. Purpose: Tværgående PROJEKT- FORANALYSE workshop will not give details of product-specific in- to identify input for re-design. All but DETALJERING IDENTIFIKATION GENERERING TEST Innovation OPSTART formation. one of the simulations are implemen­ Camp I ted in the clinic. Duration: 3–6 hours. TEST PROCESS ACTIVITIES – “3 X 3” 1 The following Danish3 enterprises and de- The methodology5 comprised three core 7The Healthcare Innovation Centre’s con- partments took part in Phase 2, in March– activities that the demonstration projects sultants facilitated the entire process, April 2012: underwent, described previously in the starting with planning and booking of section on processes. However, this valida- participants, documenting user needs, • Pressalit A/S and Jonstrupvang, Pleje­ tion process is a compressed process im- editing video observations and through center Rosenhaven Skovlunde & plemented over 3 weeks in all five cases. to results reporting. Dagtilbuddet Søndre Fasanvej, on the topic2 of developing care facility 4 1. Identifying needs and contextual6 RESULTS AND EVALUATION OF THE METHOD • Novo Nordisk A/S and Hvidovre Hospi- research: observation studies (vid- 1. Identifying needs and contextual research tal, Endocrinology Department, on the eo recording) at a relevant location For the majority of processes, user obser- topic of new systems for injecting insulin (in the ward, in the patient’s home, vation was arranged with one participant • Daybuilder and Affective Disorders Inten- etc.) Duration: 3 hours to 1 day. from the enterprise observing together sive Care Unit - Copenhagen psychiatric with one consultant from the Healthcare centre, on the topic of a mobile platform 2. Idea-generating with rapid prototyping Innovation Centre. The team followed a to support people with depression. and table-top simulation: concept ideas doctor or nurse on duty for a period of be- • CSC Scandihealth, MaxANALYSE Manus and for solutionsKONCEPT- are generated; physical tween 3 hours and one day. Relevant situ- Frederiksberg Hospital, Cardiology mock-ups are developed and tested via ations and work processes were videoed; FORANALYSEDepartment, on the topic of speech table-top simulation in a future sce- the videos were later analysed and used recognition on a mobile device narioDETALJERING (first simple simulation). Work- for idea-generating and rapid prototyping. • Pirutech Aps, and Glostrup Hospital & shops take place in the hospital out of Clinicians gave positive feedback: Gentofte Hospital on the topic of fur- consideration to their opening times “it is usefull that someone has taken the ther development of pill dispensers (after 3 pm). Duration: approx. 3 hours. time to see what actually happens in

30 Video recording of a future scenario with a mobile emergency journal instead of today’s bundle of papers, Hillerød Hospital, Emergency Department Healthcare en neutral farve til andre ting farver til de ni faser Innovation

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 the clinic before developing solutions!” specialist field ask ‘silly’ questions in a number of possibilities for further devel- Thomas Høi Hansen, cardiology a professional way. This cuts right opment. L 1. Relief Doctor, Cardiology Department, through our familiar paradigms.” Getting the clinicians to design the proto-

Gentofte Hospital. Frank Samsøe Jensen, Superin- types was one of the great “eureka” moments A tendent Medical Officer, for many of the enterprises. The input that

“It was really good that the Healthcare Gentofte Hospital comes from allowing the clinicians them- B Innovation Centre videoed our work. We selves to make a decision about the design usually find with process consultants 2. Idea-generation with rapid prototyping and for them to produce prototypes in their that we have to spend a lot of time at and table-top simulation: own language is something that cannot be seminars explaining to them what our Idea-generating workshops were successful done using the enterprise’s own employees. work is actually all about. So it’s great for all five processes. Between two and se­ that we can take a look at our own work ven clinicians participated, and they had 3. Simulation test and re-design through your video clips to arrive at the the opportunity to discuss the findings that The time lapses between the idea-gener- ideal patient flow. Better still, we are the resulted from user observations as well as ating workshop and the simulation test ones who get to define what the surgi- the opportunity to formulate their ver- varied – from one day to one week. It is cal outpatient clinic of fhe future should sions of prototypes. Obviously, some clini- appropriate to have at least one week (de- be all about. After all, that’s what user- cians had more of an aptitude than others pending on the prototype) because there driven innovation is all about, isn’t it?” when it came to drawing and expressing needs to be sufficient time to incorporate Lisbeth Dammegaard, superintendent themselves creatively in this process. So it is the best ideas from the workshop as well medical officer, Surgical Out-patient valuable to have consultants on hand who as observation findings. Clinic, Hillerød Hospital are able to contribute to the design and can Simulation tests were planned on the ba- serve as the clinicians’ ‘mouthpiece’ if they sis of DIMS simulation scripts (referred to “Another very useful thing here is that get stuck trying to produce something. Pro- previously). These were prepared to a lesser people who are not familiar with our fessional designers/illustrators participated extent, as the scenarios to be played out co­

31 TEST OG IMPLEMENTERING PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST EXPERIENCE 1 3 5 7 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 2 4 6 time it also ensures acceleration and an understanding of what actually happens.

Kickoff workshop

Projektstyrings- vered short work processes. structured interviews, for example. like our customers, who are not engineers­, seminar Simulations in the clinic are very valuable • It is motivating for the clinicians to par- to see what they regard as intuitive. It’s Kursus i bruger- because it is possible on the one hand to in- ticipate in innovation processes that very different, and it’s important to de- ANALYSE KONCEPT-dreven innovation clude more participants and, on theBEHOVS- other, to broaden the perspectiveIDÈ-KONCEPT- and help to de- termine that very early on so you don’t Tværgående PROJEKT- FORANALYSE workshop reflect the specific clinical context in as rea­ velop their skills to think more innova- run up a lot of costs pursuing some idea DETALJERING IDENTIFIKATION GENERERING TEST Innovation listicOPSTART a way as possible. It was only necessary tively and with an understanding of what or other that could have been scrapped Camp I in the case of one enterprise to use DIMS it takes to make innovation “happen”. upfront. So it’s extremely beneficial.” premises and a dummy. In the other cases, Thus, they also gain an appreciation of Henning Hjortskov, Software Developer, 1 there were no ethical dilemmas3 with patients how engineers5 and developers think. 7 Radiometer at stake and no danger to patient safety, so “It would have taken us six months to ar- it was possible to conduct the simulation in rive at what was accomplished in 3 x 3 ”... The process was very useful, we have in the clinic. hours. And we would still have disagreed a very short time developed a product to The 3 x 3 process model produced ex- about whether it would work in the mar- clinicians which seems to work in reality” tremely positive results and knowledge for ket. Here, the clinicians might simply make Lasse Benn Norregaard and Philip the enterprises and departments that would the decision we wouldn’t dare make” Kaare Løventoft, Daybuilder Solutions have 2 taken a very long time to acquire4 by Erik Øllgaard Vilhelmsen,6 Process other means. Development Manager, Ambu A/S Simulation of future work processes at • There was tremendous enthusiasm for Hillerød Hospital, Surgical Out-patient Clinic participation in the process (on the part “It is very beneficial for us to be involved EXPERIENCE of enterprises and clinicians alike). very early on in the process. So, instead It is very important to maintain the • The process provided good insight into of spending two years developing so- simulation procedure whereby the the everyday work of the clinicians and mething we think is a good idea, we can simulator (test subject) is allowed to the challenges facing them, which fu- determine very early on whether users complete an entire simulation sce- nario before the person is interrupted ture products shouldANALYSE help to solve. see thingsKONCEPT- the same way we do. Because, and debriefed (by the interviewer). • The selected methods outlined above when you’ve been working on some func- If this simulation procedure is not FORANALYSEhelp provide very detailed insight tion or other for 2–3 days as a software maintained, valuable behavioural into the work processes carried out in developerDETALJERING […], it seems incredibly intuitive. input from the simulator is lost. hospitals. This sort of insight could But it’s very healthy to get out and meet not be obtained by means of ordinary people who are not software developers,

32 SPECIFICATION OF REQUIREMENTS FOR THE PHYSICAL HEALTHCARE INNOVATION LAB: AN ACTUAL LABORATORY FOR HEALTHCARE INNOVATION Healthcare en neutral farve til andre ting farver til de ni faser Innovation The vision of this project is to use the various scenarios in terms of an actual lab. methodology work from the three demon- The main target group/stakeholders are stration projects – to lay the foundations of hospitals/hospital departments and the an actual, physical Healthcare Innovation business community. Lab. Obviously, new processes and meth- How should the lab be organised? Should ods will have to be developed in order to be it be incorporated into the respective hospi- able to offer the services to the healthcare tals with a local lab where clinicians and en- sector that will be needed for many years terprises can experiment, innovate and test L to come. Simulation as a tool of innova- as required (and in close proximity to the

tion has proved its worth. This recently de- clinic)? Or should it be housed in a building A veloped methodology framework should away from the hospital? Should there be a

make the use of an actual Healthcare Inno- Mobile Innovation Team arrangement? We B vation Lab attractive. In the project, in the have been working on financing models for course of preparing the specification of re- the lab. Below are the highlights of our work quirements and the preliminary work for and current proposals for an actual lab. the business plan, we have gone through EXPERIENCE 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.

33 TEST OG IMPLEMENTERING PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST 1 3 5 7

2 4 6 Jan Kold, Former Director, Capital Region of Denmark and member of Healthcare Innovation Lab steering group.

Kickoff workshop

Projektstyrings- INSPIRATION FOR THE ACTUAL LAB of an innovation project – the Healthcare and better healthcare services can be ob- seminar – TRIPLE HELIX Innovation Lab works in Triple Helix. In tained within the available means. With this Kursus i bruger- The Garfield Innovation Centre at Kaiser developing the methodology, the impor- in mind, we have worked in an inter-disci- ANALYSE KONCEPT-dreven innovation Permanente works mainly on productBEHOVS- de- tance of involving IDÈ-KONCEPT- designers and anthro- plinary way involving clinicians, enterprises Tværgående PROJEKT- FORANALYSE workshop velopment and testing for its own hospi- pologists has also become apparent; they and researchers to define what makes the DETALJERING IDENTIFIKATION GENERERING TEST Innovation talsOPSTART and with patients. Business has not are able to contribute specific experience Healthcare Innovation Lab special – what are Camp I yet been brought in, except in cases where of user involvement in product develop- our Unique Selling Points? equipment needs to be tested. In purely ment processes. During the Healthcare Innovation Lab 1 physical terms, the Garfield3 Innovation In an actual5 innovation laboratory, it is 7process, Jan Kold – former Director of Centre is housed in an industrial building possible to test and adapt services and tech- Capi­tal Region of Denmark and member some distance from Kaiser Permanente’s nologies thoroughly prior to implementa- of the Healthcare Innovation Lab steer- hospitals. The Healthcare Innovation Lab tion. In other words, both the healthcare sec- ing group – used the Healthcare Innovation has a broader model of collaboration, as tor and the business community are able to Centre to produce a three-month innovation the business community and research in- eliminate costs of untried and unsuitable process in relation to The Clinical IT Device stitutions2 are included at the earlier stage4 products and processes. In a6 nutshell, more of The Future. Methods and experience FACTS 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, ANALYSE KONCEPT- patient hotel services, etc.) FORANALYSE Also: DETALJERING • Research institutions • Patients/patient associations and relatives (services, cohesive patient care pathways)

34 FACTS 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) Healthcare en neutral farve til andre ting farver til de ni faser Innovation gained from the Healthcare Innovation Lab meeting users’ requirements. Unlike with create innovation within your own enter- were applied to implement the process that ordinary development methods, where prise, but the real excitement starts when included clinicians from a number of hospi- the faults/inappropriate aspects are not you are working with other partners. tals in the Capital Region of Denmark, as discovered until a late stage of the pro- This project has been about develo- well as enterprises that develop health- cess – when faults would have to be very ping a methodology, which has thus related­ IT products. The process included a serious indeed in order to justify rectifying made it possible to create new fra- Trend Seminar for a number of national ex- them. The fact that multiple participants, meworks for user-driven innovation. perts in technology as well as an Innovation players, research scientists, suppliers and A unique new method has been developed

Per Frølund Thomsen, Department L Camp, where clinicians helped to develop users work together makes it easier to steer which, unlike conventional simulations, is Director, Grontmij. and create their own prototype devices. things in the right direction, and it is pos- not based exclusively on testing; this me­ A Jan Kold has this to say about the advan- sible to arrive at the right product sooner.” thod also makes room for new innovation tages of the Healthcare Innovation Lab me­ to arise – and this is something we specifi- B thod and process: Using simulation as a tool of innovation, cally experienced during this process. The “Involving users early on in the process, as the lab should seek to develop commercial- method is flexible, cost-effective and easy we have done in this project, means the ly realisable ideas that shorten the time to work with, so it is an excellent alterna- product and solutions are more capable of to market, reduce development costs and tive way of supporting that users’ wishes, ensure that product development hits the needs and ideas are reflected in the con- Clinicians help to create prototypes for future clinical devic- spot. We have developed a number of ex- struction project. At the same time, the es based on the Healthcare Innovation Lab method (Innova- amples of services to be offered by the lab. method is an activity that, from the point tion Camp, Healthcare Innovation Centre, January 2011) Some services will be in demand from the of view of innovation, supports the change business community (medical technology processes that the hospital as an organi- enterprises, healthcare IT enterprises, sup- sation undergoes concurrent with the de- pliers of building materials, etc.). velopment of the construction project.” 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

35 Innovate new products and services

ENT RA EM PI The company uses Health- LV D O PR care Innovation Lab and V O N T I O makes the innovation R T E Y project in co-operation A company from the S P U I with clinicians, patients The company uses Health- N

medical Device In- G and research institutions

care Innovation Lab and

dustry wishes to de-

makes the innovation

velop and test a new

project in co-operation with

product idea in the

clinicians, patients and

The hospital gets a new

early part of the inno- E

S research institutions

product where they have

vation process A S

C

I

M participated in the devel- S

U S

L

E

A opment of the product

N

I T

I

S

O

U

N

B and therefore it fits into

their daily work.

3 months

Innovate functional and organizational planning EXPERIENCE perts need to work closely together to pro- when designing new hospital buildings The Capital Region of Denmark alone cov- duce value-creating solutions.

ENT RA ers 12 hospitals as well as psychiatric and There is a need for innovation and test- EM PI LV D O PR V O disabled units, with a staff of 40,000, and ing facilities to be in close proximity to those N T I O R T E Researchers and two Y S P represents some of the major hospital con- hospitals in the region that are to be built U companies as well as patients I N

are involved in the innovation G Three departments A new way of working

struction programmes already underway. from scratch, converted or extended. There is process to provide input to and (outpatient) wishes with value creation for

be co-developers of the future

to develop new work- both the hospital and

clinic. For example a designer In order to be able to incorporate new solu- also a great need to be able to innovate and

flows that fits the the companies.

and an anthropologist are

future clinic. E

S

involved and contributes tions that are future-proof, effective and su­ test in direct proximity to the everyday lives

A

S

C

I

with knowledge about M

S

U

S

L

E user involvement stainable, it is necessary to build innovation of the users – the clinicians – as they have to

A

N

I T

I

S

O

U

N

B

processes into the actual planning of the hos- find time in their busy schedules to partici- pital buildings. pate in the innovation processes.

3 months Hospitals, enterprises and innovation ex- FACTS 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

36 THE HEALTHCARE INNOVATION LAB PUBLIC- PRIVATE INNOVATION PARTNERSHIP (PPIP) CONTRIBUTES TO CREATING THE UNIQUE Healthcare en neutral farve til andre ting farver til de ni faser INTER-DISCIPLINARY PLATFORM Innovation

The Healthcare Innovation Lab is a liv- PPIP and set up Best Practice in this field, FACTS THE MOBILE INNOVATION TEAM ing example of how PPIP works. The the PPIP participants in question are: project – the largest of its kind in Den- “development partners who jointly in- The idea is for the lab to include a flexible and mobile organi- mark so far in the healthcare sector – vestigate innovative new solutions to L sation – a kind of Mobile Innovation Team. This could comprise comprises 26 inter-disciplinary part- problems that they have jointly defined

three permanent employees (manager, consultant, administra- ners covering hospitals, the business (not a purchaser–supplier relationship)”. A tor) as well as five freelance workers covering inter-disciplinary community, research scientists, patient skill-sets centred on simulation, user-driven innovation and associations and innovation experts. The EBST study also showed that 1) B business acumen (business developer, designer, anthropolo- The conclusion of the project is that the Awareness of PPIP in Denmark and gist, engineer, architect). In addition, 10–15 clinicians would be attached, trained in the Healthcare Innovation Lab methodo­ fact that the project was implemented abroad remains limited, 2) there is no sin- logy model. The team could to good advantage be anchored in with inter-disciplinary participation gle way of organising a PPIP, and 3) the the existing Healthcare Innovation Centre, which has hospitals, contributed greatly to the degree of in- PPIP is characterised by a high degree of psychiatric and disabled units as its target group, and which has novation in the Healthcare Innovation user involvement (direct involvement of innovation tasks and projects currently in the works. In light of the Lab. When an inter-disciplinary group users in the innovation process – citizens, new construction of hospitals and other units in the Capital Re- is put together, a creative field of ten- gion of Denmark Quality fund Construction, it is important for the sion is created that cannot exist when FAKTA mobile team among other things to contribute to new solutions BEST PRACTICE FOR WORKING enterprises carry out development work for the Capital Region of Denmark’s construction managers, WITH PPIP PROJECTS: as well as other units/clinical departments with urgent require- with other enterprises, or research sci- ments, including the IT and Medical Technology Enterprise IMT. In entists carry out development work • Mutual trust and willingness to take risks addition to the specific innovation tasks, the team is also tasked with other research scientists. • Passionate people across sector divides, with being out in the field and maintaining close dialogue and with the authority to make decisions contact with heads of construction, clerks of works and clinical GENERAL INFORMATION ABOUT PPIP • Open dialogue and communication departments. Next, the team must be in close dialogue with the According to the Danish Business Au- • Separation between innova- business community in order to meet the need for involving rel- thority (EBST 2009), which conducted tion and operation evant enterprises, including construction firms, in PPIP projects. • Management back-up a survey to uncover experiences with across the sector divides.

37 PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST 1 3 5 7

- PATIENTS RELATIVES FACTS HOW IS THE PRESENT HEALTHCARE IN- HEALTH PROFES NOVATION LAB PROJECT FUNDED? 2 4 6 SIONAL EMPLOYEES The present PPIP project has a combined project sum of Healthcare DKK 8.4 million, towards which the Danish Business Author- Kickoff workshop Innovation LAB ity has granted a subsidy of DKK 6.0 million from the Pro- HOSPITALS gramme for User-Driven Innovatio. The rest of the funding Projektstyrings- DESIGNERS, NEW INNOVATIVE SOLUTIONS FOR seminar ARCHITECTS, THE HEALTHCARE SECTOR comes respectively from Healthcare Innovation Centre ETC. ANALYSE Kursus i bruger- ANTHROPOLOGISTS monies (25% self-funding via monies from the Growth KONCEPT-dreven innovation Forum for the Capital Region of Denmark), hospitals and Tværgående BEHOVS- IDÈ-KONCEPT-DIMS (25% self-funding), both research institutions (25% self- PROJEKT- ENTERPRISES FORANALYSE workshop DETALJERING OPSTART IDENTIFIKATION GENERERINGfunding), as well as the participatingTEST private enterprises, Innovation organisations and patient associations (50% self-funding). Camp I RESEARCH 1 3INSTITUTIONS 5 7

patients, etc.) or by involvement of public- Trust and willingness to take risks (includ- credit crunch, which meant devoting time sector employees (“ambassadors”). The fact ing open dialogue and communication) were and costs to development projects in gener- box below brings together some initial, obviously prerequisites for the project teams al got lower priority. Even though the spot- general2 experiences of PPIP in Denmark.4 of The Outpatient Clinic of 6The Future, Mo- light has been on operations for clinics and bile Blood Test Results and Remote Treat- enterprises alike, the Healthcare Innovation REFLECTIONS ON PPIP COLLABORATION ment of Cardiovascular Patients to be able to Lab largely succeeded in making room for IN THE HEALTHCARE INNOVATION LAB arrive at actual solutions. In identifying hos- and prioritising time and personnel to as- In the Healthcare Innovation Lab, a defi- pital departments with the resources, time sist with workshops, simulation scenarios nite challenge and a major task was get- and energy to participate in the Healthcare and meetings to consolidate the experience ting so many different parties, each with Innovation Lab as case studies, it was depart- gained. One prerequisite for involving the their own cultures, to work together. This ment managers with a willingness to change clinic is for the project set-up to facilitate was very demanding inANALYSE terms of resources (peopleKONCEPT- with a passion) who ultimately buy-out for the clinicians who would and required among other things a focus saw the value of playing their part. As pre- take part. The Healthcare Innovation Lab FORANALYSEon team-building in order to kick-start viously mentioned, the project began at a was able to do that. The Healthcare Innova- collaboration when the clinic, the re- time whenDETALJERING a number of hospitals in the Capi­ tion Lab described issues of copyright and search scientist, the enterprise repre- tal Region of Denmark faced major savings other legal matters in a collaboration agree- sentative and the innovation expert drives/cut-backs. At the same time, the busi- ment. met. ness community had been impacted by the

38 Healthcare en neutral farve til andre ting farver til de ni faser Innovation A. Why is PPIP relevant to enterprise a number of statements about the respective care Innovation Lab – a collaborative representatives working within enterprises’ participation in the Healthcare In- venture and a network that the en- the healthcare sector? novation Lab. Below is a brief summary. terprises regard as very valuable • Direct involvement of clinicians: This PROJEKT- BEHOVS- IDÈ-KONCEPT- PPIP is regarded as one of the new forms WHY DID THE ENTERPRISES CHOOSE was a great plus for the project. The sup- IDENTIFIKATION GENERERING TEST of collaboration capable of helping to cre- TO PARTICIPATE IN THE HEALTH- pliers gain greater insight into needs OPSTART ate the platform for new, specific solutions CARE INNOVATION LAB? and development opportunities. in the health service, for example. But how • New or enhanced expertise: The project • Insight into working methods and con- L do you create a PPIP project, and what mo- encompasses an area in which the en- ditions in the Danish health service

1 A 3 5 7 tivates the parties to participate? Many terprise wishes to strengthen its ex- • New product/new solution enterprises are reticent, as they may fear pertise. The Healthcare Innovation for several enterprises that participating in a PPIP project requir- Lab made it possible to gain new ex- B ing investment of time, where the expect- perience and to be involved with the HAS ANYTHING NEW BEEN ACCOM- ed outcome is the development of a new latest developments in the field. PLISHED BY THE ENTERPRISE’S PARTICI- product, could exclude them from involve- • New business area: The opportunity PATION IN THE HEALTHCARE INNOVA- ment in a subsequent procurement. One for the enterprise to develop a new TION LAB THAT COULD NOT HAVE BEEN 2 4 6 way of handling this is by ensuring open- business area ACHIEVED BY ANY OTHER PROCESS? ness in the process from the inception of • The opportunity to make contact with • Close collaboration has made it pos- the project until a prototype of the product Danish healthcare sector operators. sible to develop a unique methodo­ has been developed (Legal Advisor to the logy. Close collaboration with players Danish Government, 2011). HOW HAS THE ENTERPRISE ALREADY in the demonstration project, inclu­ In the Healthcare Innovation Lab’s process, BENEFITED? ding the department, made it possible some experience was gained in how to mo- • Development of methods for work- to develop a unique methodology for tivate the business community to parti­ ing with user-driven innovation, which simulation as a user-driven method. ANALYSE KONCEPT- cipate and to invest in development time. proved to be such a good tool that the • Simulation was a new feature. The en- The enterprises must finance half the costs enterprise sees a lot of scope for using terprises are keen to use this again; it FORANALYSE of their involvement with the Healthcare In- it in its own business in the future resulted in a greater understanding of DETALJERING novation Lab themselves. Do the enterprises • Networking: Very close collabora- the everyday work of clinicians and derive any benefit from this, and if so, what? tion with the institutions, associa- hence, it is to be hoped, better chances Via a round of interviews, the project collected tions and hospitals in the Health- of being able to achieve common goals.

39 • Users’ needs come first: completely B. What does the clinic get out of a PPIP? department’s functional and organi- different results are produced sational planning going forward by looking at the users’ The project interviewed four departments • A LEAN project has been initiated on needs first instead of by focusing on that participated in the three demonstra- the basis of the results from the the technology first. tion projects about the value of the PPIP Healthcare Innovation Lab to the clinic/hospital department and their • Working methods have inspired other SPIN-OFFS/EFFECTS DERIVED experiences of PPIP. innovation processes in the department FROM PARTICIPATING IN THE HEALTH- • The management and intermediate man- CARE INNOVATION LAB? WHAT MADE THE CLINICS PARTICIPATE IN agement of the department regard partici- • Branding value: There is branding value THE HEALTHCARE INNOVATION LAB? pation in the Healthcare Innovation Lab in participating in innovation projects – • The Healthcare Innovation Lab pro- as a major course in innovation methods important to the enterprise to show the vided a way of exploring new hori- • An extended network and new col- market that the enterprise is at the fore- zons and new solutions in relation laborative partners across pub- front of important areas of development. to the challenges facing clinics in a lic sector and private enterprises • Close contact with relevant players situation in which the health service ­ • A prototype has been produced for fur- in the healthcare sector: The Health- is under a great deal of pressure ther inspiration and development care Innovation Centre, the Danish • Opportunity to explore new angles­ • Opportunity to test other innovation Institute for Medical Simulation, hos- of public-sector innovation, and projects under regional auspices. pitals and hospital departments. how the methods can be applied more specifically in the clinics THE CLINICS’ EXPERIENCES FROM THE ENTERPRISES’ EXPERIENC- PARTICIPATING IN THE HEALTH- ES FROM PARTICIPATING IN THE HOW HAVE THE CLINICS ALREADY BENEFITED? CARE INNOVATION LAB: HEALTHCARE INNOVATION LAB: • The group of staff from the de- • It is important for workshops and other • Meeting culture: Cancellations on the partment who were involved have activities involving clinicians to be part of the clinic shortly before meet- become­ innovative and inspired planned and diarised well in ad- ings/simulations puts the brakes on • Learning about the innovation­ vance due to shift rotas, etc. knowledge sharing and the process. pro­cess has increased interest in • Buy-out is essential in deciding wheth- • Influence from the outset: it is im- future­ innovation projects er a department can participate in a portant for private enterprises to • Initiatives for change have constantly major, long-term innovation project have a decisive influence from the been noted in relation to the future of • Important to define the roles in- outset. They should not just be in- the department, and the results will volved – whether they are consult- vited along for financial reasons. be incorporated into the design of the ants or actual project participants.

40 PHYSICAL HEADQUARTERS IN THE CAPITAL RE- Healthcare

GION OF DENMARK – AND COLLABORATIONen neutral farve til andre ting farver til de ni faser Innovation THROUGHOUT DENMARK AND WORLDWIDE As previously stated, the lab must be located in direct proximity to clinicians or hospitals earmarked for new construction, i.e. district • It is vital to the project for project set- Would you like to read more about hospital(s) in relevant locations. There could up and planning to take account of the specifics of establishing a PPIP preferably be satellites at all major hospitals the challenges by setting aside re- and the experiences of others so that there are facilities available for use sources from day-to-day operation at from this type of partnership? close to the clinicians. The headquarters com- L the clinics. Management and employ- The Capital Region of Denmark has plex must include a showroom where suc-

ees alike should be ensured full op- produced a guide in Danish to PPIP. cessful cases can be displayed. In addition, it A portunity to participate in projects For further information, see is important for a large room to be available

• Important to ensure user and em- http://www.regionh.dk/NR/rdonlyres/ (in the hospital) in which the simulation can B ployee ownership of the project D301AC93-CD98-493D-93C67121769B- take place. Some aspects of this could also • There must be full disclosure to all 42CA/0/OPIguide.pdf take place elsewhere at existing simulation project participants as regards where, The Ministry of Business and Growth/ facilities, such as DIMS. when and why the user is involved. MindLab has launched a PPIP guide via the The lab must collaborate with other similar following website: http://opiguide.dk/ 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- FACTS WHO SHOULD FUND AN ACTUAL LAB? ternational forums (Sweden, Norway, the EU, the US) and will be collaborating at the highest Due to changing circumstances in the healthcare sector/the Capital Region of Denmark level internationally. Interest in the lab model (cut-backs and efficiency drives in hospitals, psychiatric and disabled units) as well as the credit has been expressed from Sweden (Skåne) and crunch and its impact on the business community, it has been most appropriate to look at Norway (Stavanger). A dialogue has been initiat- a number of possible finance models for the lab: ed and opportunities are being explored for col- • A 100% public-sector funded lab that kick-starts rapid innovation processes laboration with Kaiser Permanente. Other in- with clinicians and enterprises alike • A public–private funded lab where the private-sector business community (including business ternational profiling will be investigated on an organisations, industry associations, etc.) supports the lab with start-up financing of processes ongoing basis with regard to other parts of the • A 100% private-sector funded lab where funds and organisations donate resources to the lab. world (the Middle East, Asia, South America).

41 - - Jointly Organized by ESRA and IAPSAM ESRA by Organized Jointly www.psam11.org Marina Congress Center, Scandic Helsinki, Finland 25–29 June 2012 of University Boje, Henning, Technical Reliability and Human Denmark, Safety, Alexandre , DENMARK; Alapetite, Factors of Denmark, Safety, University , Technical , DENMARK; Reliability and Human Factors Nielsen, Jacob , Dansk Institut for Medicinsk Simulation, DEN MARK; Frederiksen, Mads Stampe, Center for Sund hedsinnovation, DENMARK; Andersen, Informatik A/S, Pallas Vitting, Svend DENMARK of Denmark, Management, DENMARK; of Denmark, Management, of University Broberg, Ole, Technical DENMARK Denmark, Management, Overview of Test Results” “Clinical Probabilistic Safety 11th International Assessment and Management Conference European & The Annual Safety and Reliability Conference - of Denmark, Safety, Reliability of Denmark, Safety, , DENMARK, 1 and Human Factors of an “User-driven innovation outpatient department” Congress from 18th World Proceedings 2012) on Ergonomics (IEA University Technical Edwards, Kasper, & European Safety and The Annual Reliability Conference and IAPSAM ESRA by Organized Jointly www.psam11.org Center, Marina Congress Scandic Helsinki, Finland 25–29 June 2012 University Technical Edwards, Kasper, of Denmark, Management, DENMARK (Presenting); Broberg, Ole, Technical of Denmark, Management, University DENMARK, 1; Nielsen, Jacob , Dansk Institut for Medicinsk Simulation, DENMARK, , Technical Alexandre 1; Alapetite, of Denmark, Safety, University Reliability and Human Fac tors , DENMARK, University 1; Boje, Henning, Technical

- - 11th International Probabilistic Safety Assessment and Management Conference DENMARK; Hartmann Schou, Tanja, DENMARK; Hartmann Schou, Grontmij A/S, DENMARK; Momme, Else, Grontmij A/S, DENMARK and Hansen Graa, Marianne, Uni Hospital of Herlev, versity DENMARK. Afdelingen, Nybyg Using Explorative “Abstract: Simulation to Drive User-Centered Design and IT-Development in Healthcare” 5th NOVO Symposium 3 5th NOVO Symposium 2011 & 4 November Hospital Landspitali University Reykjavik, Sustainable Nordic Health Care Systems & Sustainable Hospital Design of University Technical Edwards, Kasper, Denmark, Management, DEN MARK; Broberg, of Denmark, University Ole, Technical , Management, DENMARK; Nielsen, Jacob Dansk Institut for Medicinsk Simulation, Appendix 1 Appendix & PAPERS CONFERENCE IN ENGLISH ABSTRACTS for dev- “Simulation as a method processes in an eloping new work – Conference Paper outpatient unit”

APPENDIX Appendix 2 PARTICIPANTS IN THE HEALTHCARE INNOVATION LAB PROJECT Healthcare en neutral farve til andre ting farver til de ni faser Innovation

THE OVERARCHING PROJECT

Organisations/centres of excellence L

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

Eva Jacobsen, Assistant Project Manager, Project management, business plan/specification of requirements B Healthcare Innovation Centre and PPIP, facilitation of workshops, seminars and test processes Lise Engell Hartwell, Assistant Project Manager, Project management, business plan/specification of requirements Healthcare Innovation Centre 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, Facilitation of workshops, seminars and test processes Healthcare Innovation Centre Mads Stampe Frederiksen, Innovation Consultant, Facilitation of workshops, seminars and test processes Healthcare Innovation Centre until May 2012 Stephanie Eloisa Pitarch, Project Worker, Facilitation of workshops, seminars and test processes Healthcare Innovation Centre Lea Graversen, Project Worker, Healthcare Innovation Centre Communication and documentation of project results Doris Østergaard, Director of The Danish Institute for Business plan/specification of requirements and PPIP Medical Simulation Klinikere/hospitaler Kurt Pedersen, Head of Development, University Hospital of Herlev Business plan/specification of requirements and PPIP

43 PROJEKT- BEHOVS- IDÈ-KONCEPT- OPSTART IDENTIFIKATION GENERERING TEST 1 3 APPENDIX 5 7

2 4 6

Kickoff workshop THE OUTPATIENT CLINIC OF THE FUTURE Projektstyrings- seminar

Kursus i bruger- Clinicians/hospitals ANALYSE KONCEPT-dreven innovation Marianne Graae Hansen, Consultant,BEHOVS- University Hospital of Herlev,IDÈ-KONCEPT- Activities manager (technical project manager, project description, Tværgående PROJEKT- FORANALYSE workshop Development department arranging meetings, knowledge sharing) DETALJERING OPSTART IDENTIFIKATION GENERERING TEST Innovation Morten Lebech, , Head of Department, Dept. of Gynecology Clinician involvement, clinical staff at Gynaecology Camp I & Obstetrics, University Hospital of Herlev, Outpatient Clinic, implementation Anette Madsen, Architect, University Hospital of Herlev, Programming of construction processes 1 New Construction Department3 5 7 The business community Tanja Schou Hartmann, Consultant, Grontmij Assistant project manager/project manager Else Momme, Senior Consultant, Grontmij User involvement, patient perspectives Research institutions Ole2 Broberg, Associate Professor – Technology,4 organisation 6 Processes involving users, Workspace Design and work, Technical University of Denmark Kasper Edwards, Associate Professor – Technology, Identifying needs, functional planning organisation and work, Technical University of Denmark Per Anker Nielsen, Professor – Technology, organisation Facility management & logistics, guide for sub-project and work, Technical University of Denmark participant Aneta Frontcek, Ph.D. student Organisations/centres of excellence ANALYSE Elisabeth Brøgger Jensen, Project Manager, KONCEPT- Patient safety The Danish Society for Patient Safety (DSFP) FORANALYSEWerner Sperschneider, Innovation Consultant, DETALJERINGInnovation, user-driven innovation methods Healthcare Innovation Center Jacob Nielsen, Superintendent Medical Officer, Danish Facilitator of simulation activities and an overall Institute for Medical Simulation (DIMS) view of clinical perspectives in the solution.

44 Healthcare Innovation LAB

farver til de ni faser 45

en neutral farve til andre ting

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jeret indblik i klinikkens IT systemer og behovene set fra IT systemer og behovene jeret indblik i klinikkens project management solution Development of the web-based software for use on smartphones. methods, project management user-driven innovation Innovation, view of Facilitator of simulation activities and an overall perspectives in the solution. clinical Overlæger og yngre læger har deltaget med den kliniske vinkel læger har deltaget med den kliniske vinkel Overlæger og yngre løsningen. og test af samt deltaget i udvikling på behovene har deltaget og bidraget til et IT chefen og en medarbejder detal­ brugerperspektiv samt et driftsynspunkt. et overordnet For the project: Supplies software solutions and IT integrations. software responsible for developing the first prototype for the device. sector Supplies software solutions to the healthcare in the Capital Region of – including the laboratory IT system used Denmark: Labka. technology. Supplier of speech the project. This technology was not applied during Insight into the human factorssafety, and patient Contributed the clinical angle on needs and participated and participated angle on needs Contributed the clinical and testing of the solution. in the development - and participa angle on needs Contributed the clinical and testing of the solution. ted in the development to a detailed insight into Participated and contributed user per from an overall and needs the clinic’s IT systems point of view. as from an operational spective as well Contributed the clinical angle on needs and participated angle on needs the clinical Contributed and testing of the solution. in the development

Jacob Nielsen, Patient Safety Manager, MD, Unit for Patient Safety, MD, Unit for Patient Safety, Jacob Nielsen, Patient Safety Manager, Capital Region of Denmark Mads Stampe Frederiksen, Innovation Consultant, Mads Stampe Frederiksen, Innovation Centre Innovation Healthcare Ph. D., IT engineer Alexandre Alapetite, DTU Management, Alexandre Ph. D., IT engineer of Denmark University Technical Healthcare, of excellence Organisations/centres Henning Boje Andersen, Professor, DTU Management Engineering, DTU Management Engineering, Henning Boje Andersen, Professor, of Denmark University Technical Healthcare, – Frank Petersen, Managing Director – Lars W. Thomsen, Sales Director institutions Research MaxManus A/S Hans K. Pallesen, Solution Architect, CSC Scandihealth Solution Architect, CSC Scandihealth Hans K. Pallesen, The business community A/S Informatik Pallas Svend Vitting, Managing Director, Bispebjerg H, IT afdeling Bispebjerg H, endokrinologisk afdeling Bispebjerg H, endokrinologisk Klinikere/hospitaler Martin Sølvkjær, Head of Innovation & Head of Innovation Martin Sølvkjær, the Capital Region of Denmark IMT, Administrative Systems, Tomas Møller Christensen, Doctor, Bispebjerg Hospital, Christensen, Doctor, Tomas Møller Department I Endocrinology–Gastroenterology Endocrinology–Gastroenterology Department I (now in a new Department I (now Endocrinology–Gastroenterology Hospital) Officer at Helsingør Medical position as Superintendent Christian Homann, Superintendent Medical Officer, Bispebjerg Officer, Medical Superintendent Christian Homann, Department I Hospital, Endocrinology–Gastroenterology Bispebjerg Hospital, Relief Doctor, Nøjgaard, Camilla Clinicians/hospitals MOBILE BLOODTEST RESULTS - -

- - Assistant project manager June 11) Assistant project manager (March 11 to and device development. Specialist in user involvement Sparring in relation to patient solutions. departments. User obser- ICT solutions for cardiac/cardiology Has participated actively of needs. and identification vations in simulations and user involvement. Project sponsor staff, treat clinical Clinician involvement, in simulation ment process, active Project sponsor imple staff, treatment process, clinical Clinician involvement, of requirements, active in simulation mentation, specification staff, treatment process, imple clinical Clinician involvement, of requirements, active in simulation mentation, specification in simulation Treatment process, implementation, active staff, treat clinical Clinician involvement, ment process, implementation Treatment process (until Feb 11) Coordination with KIT strategy Sparring på strategi og klinikerinvolvering

Department, University Hospital of Herlev Department, University Care2Wear A/S Director – Birgitte Lønvig, Nielsen, Director – Peter Søby Jonas Engberg Lind, Development Consultant Jonas Engberg Lind, Development Consultant of Herlev Cardiology Department, University Hospital Koncern IT Judith Lørup Rindum, Project Manager, Hospital of Herlev Kurt Pedersen, Head of Development, University Consultant, Niels Blinkenberg Federspiel, Development University Hospital of Herlev Herlev of Hospital University Consultant, Development Frejbæk, Ulla The business community Manager, Bjørn Knud Andersen, Senior Business Development Bang & Olufsen Medicom A/S Knud Skagen, Lead Superintendent Medical Officer, Cardiology Officer, Medical Knud Skagen, Lead Superintendent ­­ Officer, Medical Superintendent Helena Dominguez Vall-Lamora, of Herlev Cardiology Department, University Hospital Department, Jimi Clausen, Department Nurse, Cardiology University Hospital of Herlev Department, Birthe Møgelhøj, Senior Nurse, Cardiology University Hospital of Herlev Officer, Merete Vaage-Nielsen, Superintendent Medical of Herlev Cardiology Department, University Hospital Clinicians/hospitals Hospital Bornholms Director, Kurt Espersen, Hospital Bornholms Hospital Peter Juul, Senior Nurse, TELEMEDICIN – REMOTETREATMENT OF CARDIOVASCULAR PATIENTS

APPENDIX Klinikere/hospitaler

- IBM Danmark ApS Healthcare en neutral farve til andre ting farver til de ni faser - Project Executive Jerke Smed Christensen Innovation - Project Executive Peter Mortensen Leverer software løsninger og IT integrationer. - Project Executive Christian Kalsen Har i projektet ansvaret for udviklingen af den administrative - Key Account Manager Torben Lyng Madsen software løsning. Har deltaget aktivt i simulationer og - IT Specialist Christina Møller brugerinvolvering. - Senior IT Architect Jesper Vejs - Consultant Niels Agersnap - Business Manager Birgitte Wulf

Supplies software for collecting data from the patient and transmit- L

In-JeT ApS ting it to the IBM system. In addition, In-JeT facilitated the loan of A Jesper Thestrup, Director Continua Health Alliance-certified scales and pulse and blood- pressure monitor. Has participated actively in simulations and B user involvement.

Supplies software solutions to the healthcare sector – including Per Monberg, Director, Pallas Informatik 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 Activity management (technical project management, project Christian Graversen, , Danish Federation of Industries (DI ITEK) description, arranging meetings, knowledge sharing) Jacob Nielsen, former Superintendent Medical Officer, Facilitator of simulation activities and an overall Danish Institute for Medical Simulation (DIMS) view of clinical perspectives in the solution.

47 47 ------tients, as it was essential to see how the us the how see to essential was it as tients, 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 Outpatient The in role-play use to difficult of Clinic The as Future, this requires more extensive preparations and physical loca scale. full at solution the showcase to tions For this reason, a simulation of the physi cal set-up is more difficult to work with than a simulation of medical technology etc. devices, TABLETOP SIMULATION This type of simulation does not need to take place in a simulation room. these for used be can etc., mock-ups, types, Proto simulations. user Typically, scenarios are utilised, and they are reviewed verbally, but without a specific simulator. ROLE-PLAY Role-play (acting) is used in full-scale sim (actor(s)) simulator(s) more or One ulation. scenar The scenarios. more or one out acts 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 Pa – Remote Treatment of Cardiovascular ------reflect, facilitate, etc. Design games vary in form and substance depending on the problem area. Design games of types were used various in The Outpatient Clinic of The Future among other things to de fine the users’ dream outpatient clinic. PROTOTYPE A prototype is a model of a solution that is ready to be tested. The requirements, therefore, are that it must work – so all as considered. contexts, In IT been pects have this means it must be possible to “switch it on”. VISUALISATION3-D A 3-D drawing that is typically created us ing special 3-D programs. This is a read ily-understandable way of complex products. The Outpatient illustrating Clinic ofThe Future demonstration project uses these types of 3-D visualisations to show one of the concepts to the users. DESIGN GAME understand shared a create can that tool A ing in a large project team. It is typically par the whereby game board a as designed ticipants use the game to develop, learn,

- - - duct. A duct. Appendix 3 Appendix METHODS: SIMULATION a mobile overview of test results. mock-ups were then included in the These IT de signers’ first prototype. boxes, boxes, Lego figures and cardboard and pa per, which were used for rapidly testing different models. MOCK-UP A mock-up is a model of a solution can be made from cardboard that and paper or pro­ physical a is it if materials other the mock-up product is of typically a rapid­ prototyping process. In project B, mock-ups were developed of the demonstration screen images envisaged to give clinicians – in order to something have physical that can be used to simulate Cardboard and user paper, full-scale models or scenarios. 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 conceptualisation more specific phase. The Outpatient project demonstration Future The of Clinic used rapid prototyping to the develop spa tial model by using objects including shoe RAPID PROTOTYPING In 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

APPENDIX Healthcare en neutral farve til andre ting farver til de ni faser For further information on Healthcare Innovation Lab Innovation please contact:

Healthcare Innovation Centre Capital Region of Denmark Head of Centre, Susie A. Ruff susie.ruff @ regionh.dk L A B

49 Samarbejdspartnere i HealthcarePartners inInnovation Healthcare Lab Innovation Lab

Dansk Institut for Koncern Regional Medicinsk Simulation Koncern IT Udvikling