This master’s thesis presents a comprehensive redesign of the vaginal speculum, an essential yet historically problematic device used in women’s healthcare. The project focuses on addressing three main issues: enhancing patient comfort, fulfilling physician needs, and ensuring environmental sustainability. This work aims to resolve the persistent discomfort and anxiety associated with pelvic exams, which are exacerbated by the current design of the speculum, while also considering the environmental impact of the healthcare sector.

The vaginal speculum has seen little change since its invention in 1845, despite its controversial history and the discomfort it causes to patients. Traditionally, its design prioritized the needs of healthcare providers, often neglecting the experience of the patient. The discomfort caused by the device has been a significant deterrent for women undergoing gynecological examinations, contributing to delays in the diagnosis and treatment of various health conditions. While some modern adjustments have been made—such as the shift from reusable metal speculums to single-use plastic versions—these changes have increased the environmental burden of healthcare, particularly in the context of global greenhouse gas emissions.

The project followed the three diamond design method, encompassing the phases of Discover, Define, Ideate, Conceptualize, Develop, and Deliver, to create a new speculum design. The process began with an in-depth exploration of the needs of three primary stakeholders: patients, healthcare providers, and the environment. This included literature reviews, hands-on explorations, and interviews to understand the diverse perspectives and challenges faced by each group.

The resulting design, named "Lilium," integrates patient-centered features such as improved ergonomics, reduced invasiveness, and enhanced aesthetics to alleviate patient discomfort. For healthcare providers, the design offers a more efficient and user-friendly tool that facilitates better access and visibility during examinations. In terms of sustainability, the Lilium speculum is designed for reusability, with a focus on materials that reduce environmental impact while maintaining high standards of hygiene and safety.

LAYCO Medical Devices BV needs a packaging solution for their new product, vela®, a
reusable vacuum extraction device aimed at replacing single-use devices in Dutch hospitals
by 2025. The challenge was to design packaging that not only meets stringent medical
and logistical requirements in the Netherlands, but also aligns with LAYCO’s commitment
to sustainability, reducing environmental impact while ensuring the device’s safety and
usability.

The proposed packaging solution is a compact box made of corrugated board. The use of
this material has a low environmental impact as it is renewable and easy to recycle. The
corrugated board cutout of the packaging is cunningly designed to fold into a rigid box with
designated placeholders for the product parts. The folding and unfolding of the packaging
is specifically designed to increase the ease of use.

The packaging solution accumulates 0.046 Grams of CO2eq. in its life cycle whilst competitor
packaging solutions are responsible for at least double this number. The design stimulates
correct disposal through its usecues. The solution is seamlessly implementable in the existing
systems in the healthcare ecosystem. The protective capabilities are validated in several
tests with extreme conditions.

The importance of this project lies in the fact that packaging solutions currently are all
designed to be disposed of. While the transition to a world without the need for disposable
packagnig is desired in order to sustain life on earth in the long run, smaller changes right
now can significantly decrease our impact on the environment. In this thesis it is explained
that by redesigning disposable packaging solutions, we can already half our impact today.

This research project explores opportunities for EcoWorld to expand their product portfolio beyond mere recycling. The initial goal was to investigate potential products that could improve the living conditions of local communities in Watamu, Kenya, using collected plastic waste. EcoWorld, a local non-profit organization, aims to ignite the plastic recycling economy in Watamu by creating dynamic value waste streams and empowering women and youth as drivers of this economy. However, they face challenges in moving from recycling to circular design practices and in identifying suitable products for the local communities.

The research begins by defining the local context and identifying key stakeholders. It reveals a significant plastic waste problem in Watamu and inadequate living conditions for the local communities. While there is a growing understanding of the potential of collecting and recycling plastic waste, a knowledge gap hinders progress towards more circular practices. The research clarifies what circular practices mean in the local context, centering on creating products from plastic waste that offer enhanced social benefits to end-users while managing the entire lifecycle of these products. It explores EcoWorld’s potential to build a business around this approach and develops a framework for integrating circular practices into local product production. Integrating local end-users into the design process emerged as a key opportunity to create value, understanding, and awareness, ensuring proper waste management and slowing down the resource loop.
A four-week field research in Watamu engaged these various stakeholders in the design process. Observations and interviews with EcoWorld employees highlighted the potential for new technologies to move beyond recycling and the openness to raising community awareness. Creative sessions with local communities provided insights into their perspectives on plastic pollution and their needs for improving their living conditions. While there was interest in using plastic waste materials, trust in these materials for structural improvements, like bricks for houses, was lacking. However, there was significant interest in improving household cleanliness through storage solutions.

Based on these insights, a cabinet design was developed during the design phase together with the local end users. The design focuses on practicality and simplicity to fit the local market, emphasizing functionality and ease of use. The production process was kept simple with minimal tool requirements to ensure feasibility for local production at EcoWorld. The design aligns with the established circular framework, ensuring proper handling of the product at its end-of-life, thereby slowing down the resource loop.

Finally, a transition model was created for EcoWorld’s future growth. An implementation plan for the current product includes the necessary tools and machines for successful production. The transition model is based on building trust among end-users as they become familiar with using plastic waste materials for products and actively participate in the emerging economy. This involvement will enable EcoWorld to expand their product portfolio further and focus on proper waste management in the future, creating jobs and income for women and youth in Watamu, igniting the local plastic recycling economy.

This Master's thesis describes the redesign of the HeartEye portable Electrocardiogram (ECG) device to enable home use for patients with coronary artery disease (CAD). The initiative aimed to transition the medical-grade 12-lead ECG from a clinical setting to a user-friendly, home-based application, maintaining the device’s diagnostic integrity while enhancing accessibility for non-expert users.

The project was done in collaboration with HeartEye, TU Delft, and NPK Design, applying the double diamond design framework that works with four key phases: Discover, Define, Develop, and Deliver.

Discover Phase: The redesign began with an examination of the existing HeartEye ECG device, assessing its design and functionality. Following research explored the opportunities in E-Health, highlighting trends and innovations that could inform HeartEye's integration into telemonitoring service centres. In-depth user group research was conducted to understand the specific needs, behaviours, and experiences of CAD patients, guiding the development of user personas. This phase also looked at the regulatory landscape to ensure that the redesigned device would comply with the most important medical device standards and to address potential future regulations related to AI and sustainability in healthcare. A quick dive into machine learning interpretability was completed. Additionally, market strategies were evaluated to discover if they would have an impact on the to be designed device. Gender-specific issues of heart disease and care were addressed as well. Lastly, a qualitative study enriched by direct patient feedback provided deeper insights into the personal impact of CAD.

Define Phase: Using the knowledge from the Discover phase, a start was made to discover potential use scenarios. A well evaluated choice was made to choose for the rehabilitation to rehabilitation period as the use scenario to be designed for. Once this was defined, we scoped down the design space to only encompass the physical design considerations and set up some boundaries to help make design decisions later on in the project. Lastly, we defined four determinants that determine what makes a good measurement based on expert feedback and research.

Develop Phase: Factors influencing measurement quality were developed, allowing for the exploration of a broad range of directions. Ideas were iteratively conceptualized, prototyped, and refined, with three main directions chosen for further development: housing geometry, feedback methods, and electrode material. These were prototyped and tested in a structured user test, consisting of four parts: quantitative evaluation of device geometries, qualitative interviews about user experiences, a card game to discuss feedback needs and methods, and an internal test on electrode material effects on contact resistance. The results informed design guidelines for the redesign.

Deliver Phase: This phase explored the practical implications of the developed design guidelines, by designing, optimizing, and evaluating a concept design. Moreover, some recommendations are given for the future implementation of the insights generated over the course of this project.

The resulting redesigned HeartEye portable ECG device could empower patients to monitor their cardiac health effectively at home, combining clinical-grade monitoring capabilities with an accessible, user-centric design to potentially reduce CAD-related mortality through timely and frequent monitoring.

Cervical cancer is the development of abnormal cell growth on a woman’s cervix. It is a highly preventable and highly curable disease if detected early. Notably, 22.5% of cervical cancer related deaths occur in Africa but, they have the lowest rate of cervical cancer prevention measures worldwide.

This project focuses on increasing women’s participation in cervical cancer screenings through redesigning the C Spec, a product that lowers the patient discomfort barrier associated with cervical cancer screenings.

The C Spec was developed by the startup company GIC Space. Its design utilizes a narrow body and an endoscopic camera to visualize the cervix via a live mobile phone feed, reducing the diameter needed to stretch the vaginal walls to view the cervix.

Although the original C Spec design improves patient comfort, healthcare professional ease of use was limited. This new C Spec design therefore utilizes a speculum style handle attached to the original C Spec main body to allow for intuitive use by healthcare professionals while maintaining patient comfort.

This research, part of the Master Integrated Product Design Engineering at Delft University
of Technology, is a collaboration between Red Cross Kenya, TUDelft, INSPiRED, the
MakerSpaces of I.O.Me 254 and its participating students.

Originating in the 2021 Advanced Embodiment Design course at TUDelft, the Eduscope
project aims to improve microscopy accessibility in Sub-Saharan African countries.
Leveraging accessible manufacturing technologies, such as 3D printing, and collaborating
with local MakerSpaces, it empowers communities by giving them control over the project
and enables the fabrication of low-cost digital microscopes.

The Eduscope project has focused on real-world testing at I.O.Me 254, serving as a crucial
testing ground and incubator. This research builds on this collaboration, starting with an
in-depth exploration of Eduscope V2 and the MakerSpace at I.O.Me 001 in Mombasa,
Kenya. Three categories, featural, structural & sourcing improvements, were identified, but
more essential four missing pieces between the I.O.Me 001 students and the projects’
success were unveiled. Continuing on the four missing pieces, Understanding, Curiosity,
Trial & Error and Independence the research goal of “Empowering the students at I.O.Me
001 to develop digital microscopes targeting low-resource secondary schools in Kenya" was
outlined. With this research goal three deliverables have been developed to ensure a holistic
approach.

The Eduscope Rig is an essential tool in initial recruitment of the students by fostering
curiosity and understanding. Next to the educational function, the Rig functions as an
essential design tool by boosting Trial & Error practices and reducing supply chain
independencies. The Eduscope STEM project is a series of workshops crucial to bringing
the students up to the level where they can make actual improvements to Eduscope
products. Lastly, the Eduscope V3 Prototype serves as tangible and visual presentation for
the three improvement categories, creating an updated reference point for the students and
boosting the development of the Eduscope V3.

In a collaborative effort spanning between the Netherlands and Kenya, this project aimed to enhance the livelihoods of smallholder farmers in the Meru region by designing a manual groundnut thresher. Recognising the importance of cultural context, I embarked on a journey guided by a cultural anthropological research approach, placing a strong emphasis on co-creation and iterative prototyping to ensure the tool’s effectiveness and usability.

Through research, several challenges faced by smallholder farmers in Meru were uncovered. Handpicking groundnuts is labour-intensive and time-consuming, limiting productivity and income generation. Additionally, there is a lack of tools available to aid in the harvest of groundnuts, and the options found in other regions, such as Asia, were prohibitively expensive or unsafe.

This project fostered a collaborative environment where stakeholders from diverse backgrounds actively participated in the design process. Farmers, engineers, and students from a local technical institute worked together to co-create solutions tailored to the specific needs and preferences of the community. This inclusive approach ensured that the final product addressed the real challenges faced by farmers on the ground.

Prototyping played a prominent role in refining the design concepts and iterating towards the final prototype. We experimented with various mechanisms and configurations to optimise the thresher’s performance and usability. Continuous feedback loops enabled us to make iterative improvements, ensuring that the final product met the standards of quality and functionality.

After multiple iterations and rigorous testing, we developed a working final prototype: the Manual Groundnut Harvester. This innovative tool streamlines the harvesting process, reducing the time and labour required to thresh groundnuts. Its design allows for easy operation by farmers of all skill levels, empowering them to increase their productivity and income. Additionally, the thresher’s cultural sensitivity ensures seamless integration into the local farming practices, further enhancing its adoption and impact.

Looking ahead, the project holds promising prospects for the future. The Manual Groundnut Harvester and its redesign have the potential to significantly improve groundnut farming in Meru, offering a sustainable solution to enhance productivity and livelihoods. Moreover, the collaborative approach serves as a model for future design projects, emphasising the importance of co-creation and cultural sensitivity in addressing complex socio-economic challenges.

In conclusion, this journey to design and develop the Manual Groundnut Harvester exemplifies the power of inclusive design and collaborative innovation. By leveraging local knowledge, expertise, and resources, we have created a solution that not only improves agricultural practices but also fosters economic empowerment and community resilience in the Meru region.

This graduation project consists of the journey of developing a context-specific training system for nurses to administer a paracervical block (PCB) using the medical Chloe Syringe Extension Device (SED). This six-month during project is being carried out on behalf of TU Delft and Chloe Company. The aim of the project is to enable nurses in sub-Saharan Africa (SSA) in low-resource settings (LRS) to competently use the Chloe device for pain management during Manual Vacuum Aspiration (MVA). The outcome of this project is a two-component training system: a job aid and a demonstration device designed to enhance the training experience and guidance for use.

The project approach was implemented using a context-driven design approach, consisting of Research & Analysis, Ideation, Conceptualisation and Evaluation. Literature research on the topic and its context is carried out, while further knowledge is gathered through contacts with sixteen Dutch and Kenyan medical professionals. In addition to individual interviews, two studies are conducted in the Dutch and Kenyan contexts. A six-week field trip to Kisumu, Kenya, during which ten medical professionals in three hospitals were visited, made it possible to ensure that the design truly fits its context. These medical professionals provided valuable input to the iterative design process and helped to shape the final concept design of the training system.

Further designing is enabled through prototyping, the use of decision-making methods and continuous iteration. This allowed new ideas to be generated, tested, and therefore new improvements to be made. Ultimately, new requirements could be identified, providing the opportunity to create even more valuable designs.

Future research should focus on further developing these designs, giving them an embodiment, and creating the possibility of actually implementing the training system in its intended context.

Healthcare is a major contributor to the negative effects on the environment, leading to adverse effects on the physical and mental health of people globally (IPCC, AR6). The Dutch healthcare sector alone is responsible for 7-8% of the national carbon footprint, 4,2% of total waste and 13% of raw material extraction (Steenmeijer et al. 2022).
This project was set up in three main parts to identifying opportunities for sustainable interventions in colonoscopy procedures for the EMC gastroenterology department. Throughout the project, a human-centered design approach was maintained. Research was done in literature on sustainability in healthcare and environmental impact of endoscopy, empirical context research and material flow analysis (MFA) in the form of a waste audit.

Based on circular strategies Reduce and Recycle, the research outcomes were synthesized into an intervention that aligns to the EMC's policy statements for sustainability:
- reduce waste with 10%
- increase recycling with 20%

Waste audit data was used as an input for co-creating with endoscopy nurses, where the focus was put on retrieving plastics from GMW because of their significant contribution to total emissions when incinerated (López-Muñoz et al., 2023).

Ideation was done in co-creation sessions to solve the problem of integrating waste segregation inside the complex environment of a colonoscopy treatment room for current system boundaries.
Outcomes
While it is ideal to implement higher R-strategies for designing out waste early on in the process, waste cannot be ruled out completely. Therefore, implementing a waste segregation system in the endoscopy treatment room presents an opportunity to enhance waste management in EMC and align with sustainability goals.
The proposal is a demonstration rather than a product concept, to show small incremental changes within the current system boundaries can help achieve the EMC goals. The intervention was estimated to reduce the weight of incinerated GMW with at least 40% with segregation of plastic products, and additional 16% by disposing of absorbent products in TONTO. Additional research is needed to determine the true recyclability potential of the plastics.
With the foresight of the implementation of new products in the system and a circular model where materials of these products have to be kept in the loop, the endoscopy nurses will be equipped and trained to accomodate these changes, and maintain sustainable practices.

Cataract surgeries using phacoemulsification (phaco) are standard practice, accounting for the large majority of all cataract surgeries. Reliance on sterilization processes has significant environmental implications, giving its energy and resource intensive nature.

This thesis introduces a novel hybrid phaco handpiece design, eliminating the need for sterilization by adding a disposable to facilitate sterile use, combined with a reusable as driver of ultrasound. This product is the first step towards a proposed fully circular system. This project has a focus on reducing impact, while maintaining phaco functionality; it does so by testing for phaco ultrasound characteristics and functioning fluidics while addressing the challenges associated with sterilization. The design emphasizes quick, secure, and sterile assembly in the operating room (OR) while maintaining cost-effectiveness and minimizing environmental impact.

The hybrid phaco handpiece achieves its functional design by carefully managing the components responsible for ultrasound and fluidics. The internal sonotrode, driving ultrasound, is split between the disposable and reusable components, connected securely through a threaded interface. Fluidics are managed by splitting off before reaching the reusable part, employing a simple yet effective O-ring design in the disposable product.

Maintaining sterility in the OR is a critical aspect of the hybrid phaco handpiece design. Mechanical seals in O-rings provide internal sterile barriers, and a blister pack facilitates sterile interaction between non-sterile and sterile components. The contact-free assembly of the disposable into the reusable ensures a tight connection, validated by a torque ridge that breaks at a specified torque, offering a visual cue for successful connection. This usability design, validated with healthcare professionals, adds safety and fits the quick nature of cataract procedures.

The innovative sterile handover method is implemented through the packaging itself, acting as a sterile barrier between different nurses handling the disposable and reusable components. During handover, a pre-attached sterile tube sleeve is unrolled over the non-sterile component. This ensures a seamless and sterile transition during assembly, minimizing the risk of contamination.

A comprehensive functional analysis validates the hybrid design, ensuring it meets specifications. Insights gained from this analysis guide further mechanical tuning, particularly in aspects influencing ultrasound characteristics. Beyond functionality, the hybrid phaco handpiece design has environmental implications. By eliminating the need for energy-intensive sterilization procedures and reducing waste from disposable wraps, the design reduces its climate impact by 67% over the entire life cycle.

This hybrid phaco handpiece design represents a step towards a circular system in the field of cataract surgeries. Balancing functionality, sterility, and environmental impact, this novel approach not only provides new insight into sustainable phacoemulsification procedures, but also shows the potential of hybrid reusable and disposable products in healthcare.

The healthcare sector is one of the major contributors to negative effects on the environment. The healthcare sector is responsible for 7% of the total CO2 emission in the Netherlands (Milieuvoetafdruk rapportage, n.d.), 4% of waste, and 13% of use of resources (Green Deal Duurzame Zorg, n.d.). The emissions produced in, amongst others, the healthcare industry have a negative effect on the public health of the Dutch population. This paradox shows the growing need to make the healthcare sector more environmentally sustainable.

Project goal
This project aims to have a positive impact on the sustainability of the Interventional Cardiology department at Erasmus Medical Centre. The goal of the project is to:

“ Design a co-creation tool that provides a general approach for making medical products or protheses used at the Interventional Cardiology at Erasmus MC more environmentally sustainable. ”


Based on literature research and context research, multiple barriers and opportunties for co-creation of sustainable initiatives were found. These barriers were translated into opportunties for the design of the co-creation tool.
In the ideation phase, brainstorming sessies were held, and how-to questions were answered to find concepts for elements of the co-creation tool. The concepts were evaluated in multiple test sessions with people that work in the medical field and stakeholders from the Interventional Cardiology department. Iterations were made based on the insights from these test sessions.

Outcomes
A co-creation tool was designed for healthcare workers at the Interventional Cardiology department.
The tool consist of two different elements: The Sustainability Space, and the Co-creation toolkit.

The Sustainability Space serves as a basis for sustainability by raising awarenes and increasing the motivation for environmental sustainability amongst stakeholder at the Interventional Cardiology department. The Project Board provides a physical space for sustainabilty that attract attention, hereby raising awareness about the sustainability initiatives. The transparent presentation of the planned, active, and completed sustainability projects might help reduce the resistance to change, as this might be a consequence of unawareness of the need for sustainable improvements.

The co-creation toolkit provides a general approach for the initiation of sustainability projects. The steps in the proces help to establish or strengthen the relationships between stakeholders by creating mutual understanding. The collaborative goal setting activity helps to create goals that aim to align with the values and requirements of all stakeholders. This can create the feeling of a shared responsibility and ownership of the sustainability projects. Defining the goal (with a time-bound element) will improve the change of a succesful completion of the project.

Limited access to surgical care in low- and middle-income countries has resulted in the loss of approximately 16.9 million lives annually, accounting for 32% of global deaths. This is more than tuberculosis, malaria and HIV combined.

Several factors contribute to this disparity, including the scarcity of surgical equipment. Despite the limited availability of equipment, a staggering 40% of donated equipment in sub-Saharan Africa is ultimately discarded in landfills due to its short lifecycle.

This is attributed to the lack of consideration for the local use context in the design of medical devices. For example, medical devices are not robust enough, can not be repaired locally due to lack of access to spare parts and might not function because of the harsh working environment. (i.e. fluctuations in the electricity grid).

Laparoscopy offers much shorter recovery times and reduces risks of infection, thus improving clinical outcomes and allowing individuals to return quickly, thus enhancing the livelihoods of families that might rely on a single source of income.

Recognising that equipment availability is an issue in hospitals, I designed EasyTower - a practical and cost effective design. EasyTower integrates an outer casing to securely store the devices required for laparoscopy, such as the diathermy, ENT drill, and insufflator. Seamless connectivity to an uninterruptible power supply ensures continuous operation through power outages.

The tower includes a laptop holder and a drawer for accessories. Instead of using the typical laparoscopic stack, costs are drastically reduced by using a laptop to replace the light source, screen and image processing, thus eliminating the need for expensive equipment, by connecting to a scope that works with a standard laptop or tablet.

EasyTower is designed to be mobile, thus ensuring equipment can be moved and utilised in various hospital settings as needed. It can easily be opened up and used directly. To reduce the risk of damaging the medical equipment, Easy tower folds into a safe, lockable storage space (like a flightcase), protecting equipment from frequent impacts with e.g. patient beds, thus ensuring a longer life span.

Produced from off-the-shelf components which can be easily procured in Africa, EasyTower can be produced locally and spare parts can be easily sourced, making it easy to repair locally. Easy tower reduces equipment needs and protects equipment from breaking, either due to impacts or due to electrical problems. In this way equipment can have a longer lifespan, thus preventing the equipment from ending-up in the landfill, contributing to a more accessible and sustainable healthcare system.

The Ocean Cleanup faces a lot of different challenges during new deployments aimed to prevent riverine waste from entering the sea and harming surrounding ecosystems. These challenges are particularly evident when addressing entire river systems rather than individual rivers. An example of a currently challenging site The Ocean Cleanup faces in their efforts to clean up Kingston Harbor is Shoemaker Gully, which is obstructed by mangrove forests preventing the Interceptor Tender to reach the waste. A smaller scale extraction tool that can be deployed in tight spaces would open up several possibilities for efficient extraction. Beyond The Ocean Cleanup, local initiatives operate in areas where commercial solutions prove inadequate, resorting to manual extraction or building their own tools due to worker health concerns. The introduction of new designs capable of benefiting both local cleanup organizations and The Ocean Cleanup can have a substantial impact on combating riverine plastic pollution.

This project aims to achieve that by introducing a new addition to the current solution portfolio. The objective of this thesis is to develop a modular extraction tool designed to efficiently remove contained waste from rivers directly to the shore. This innovation will expand The Ocean Cleanup's deployment options and empower other organizations to amplify their impact. By creating a cost-effective and adaptable proof-of-principle prototype, a foundation will be established for further development of extraction tools tailored to selected use cases.

The final design is a mobile and modular extraction tool, equipped to handle waste extraction from a diverse range of sites that is currently challenging to access. A full-scale prototype has been made to accurately assess its feasibility, with a potential deployment in Jamaica. It features well-thought-out features like adjustable and extendable legs for diverse riverbanks, a robust overall design, and an intuitive user interaction.

This project aims to reduce the environmental impact of an endoscopic product, the Polyp trap. The polyp trap is a single use device, that is used during endoscopy to catch removed polyps. Endoscopy is a department that has a relatively high reliance on single-use devices. This is one of the reasons why endoscopy has a high carbon footprint. Through observations in hospitals, literature and product research, the context of endoscopy, the polyp trap and other single-use devices are analysed. Additionally, circular frameworks and strategies specific to the medical context were explored, to identify circular opportunities for the polyp trap. A fast-track LCA of the current polyp trap is used to estimate its current environmental impact and analyse how interventions in design, function or material could influence its carbon footprint.

The insights from this research are used to generate ideas aimed at decreasing the polyp traps environmental impact. The resulting idea directions are presented to various healthcare professionals, such as nurses and infection prevention specialists during interviews. During these interviews, opportunities and risks for the redesign are discussed. Insights from the interviews are used to further develop the idea direction into the final design.

The final design consists of two concepts: The first concept is more conceptual, and reduces its impact by using some components for a longer amount of time; one day rather than per patient. The second concept is more traditional, and decreases its CF through minimising the required amount of material, leading to a smaller design that uses lower-impact materials. The environmental footprint of the final concepts is evaluated with a fast-track LCA.

The client of this graduation project, Dune Innovation, aims to facilitate and execute a structured design process for medical device development. This is a complex task most notably during the early ‘discover’ phase, or fuzzy front end. In medical device development, the first stages of the design process are crucial in ensuring the adoption chances of a new product. During the discover phase, the focus is to gather design inputs or requirements to reduce the uncertainty and risk in future project development. By logic, Dune Innovation does not have sufficient knowledge on all design criteria to solve these uncertainties. Therefore, the company seeks interaction with stakeholders to find unknown design inputs that can help to make progress. To do so, the intention is to organize meetings or interviews with these stakeholders. Unfortunately, this is no easy task. Stakeholders in the medical field often are short on time and don’t prioritize collaboration with Dune Innovation. Even if they manage to make time, standard interview methods are suboptimal for creativity and exploration. This struggle leads to ongoing uncertainties and longer lead times in projects.

This thesis project delivers a new approach to interview settings during the discover phase of medical device development for Dune Innovation. This is achieved by developing a tool which embraces co-design strategies during stakeholder interview settings. By providing transparency on the clients’ design process towards the interviewee, the desired effect is to increase engagement, improve the quality of discussion and outputs. The goal of the session is to generate new design inputs together with the interviewee that are relevant for the projects design process. The concept of the co-design tool is based on these issues and aims to enable a structured co-design session between a facilitator and a stakeholder in a physical interview setting. The tool offers a functionality that should help in reaching a shared understanding between both parties, as a foundation for the following co-design sessions. The tool should engage participants to actively contribute their expertise, insights, and ideas during a 90-minute interview session, with the goal to generate new inputs for the project. The printable design of the tool encourages the use of pens and post-it’s to spark design thinking and creativity.

Validation rounds showed a great potential of the tool. All participants shared their enthusiasm after concluding a session. It showed that during use of the tool participants were engaged for the entire length of the session. Both the facilitators and interviewees had enjoyable experiences. The validation rounds proved that shared understanding could be reached within 15 minutes. Validation also showed that the tool encourages sketching, writing, and unexpected discussion, which led to new design inputs for the client. Although more testing Is necessary, the concept shows great value for future implementation.

Single-use auto-injectors have been around for more than 40 years, serving as a safe and comfortable way of self-injecting drugs through the intramuscular route. But, as much as their design has improved the injection experience, their existence poses a threat to the environment. Like many other single-use medical devices, their production and disposal generate a great amount of waste and carbon emissions (Benedettini, 2022). This Master Thesis represents the joint effort of both Alliance to Zero and Delft University of Technology to transition current single-use auto-injectors into a circular model. The approach involves exploring one of the Circular Economy strategies - Reprocessing - and adapting it to the life cycle of the YpsoMate 2.25 ml auto-injector. By proving if the YpsoMate 2.25 ml can be reprocessed, a possibility for reusing other single-use auto-injectors opens up.

-What-

Medicines are used for all types of surgeries in the operating room (OR). They are needed to provide safe and effective care. However, the use of medicines also results in waste. Research conducted by Barbariol et al. (2021) highlighted that a substantial proportion, ranging from 20% to 50%, of medications prepared in the OR ultimately remain unused and are consequently discarded. The Leiden University Medical Centre (LUMC) and ‘Nationaal Netwerk de Groene OK’ aim to minimize the waste of medicines at the OR.

-Why -

The environmental impact of medicines

Research conducted last year by RIVM presented that the contribution of chemical products, including medicines in particular, is responsible for 41.2% of healthcare CO2

Medicine scarcity

The ‘Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie’ (KNMP), presened that last year in 2022 the highest number of medicine shortage ever occurred. They predict that these kind of issues will only grow more in the further, so it is important to stay mindful about medication prescription, use and disposal.

Ethical obligation

Medication waste raises ethical concerns within the healthcare context. The waste of medications contradicts the principles of equity and justice, as resources that could have been allocated to patients in need are wasted.

-How?-

DrugWise

Consequently, a final concept called ‘DrugWise’ was devised. This sustainable approach targets medicine waste prevention in the OR through a holistic approach. DrugWise consists of five critical steps:
1. Measure the waste to gain an understanding of the current situation.
2. Prioritize areas for action based on the measurements.
3. Raise awareness amongst OR staff regarding the extent and implications of medicine waste.
4. Initiate action in four key areas: medicine use, prescribing practices, stock management, and disposal.
5. Evaluate the effectiveness of the interventions implemented.

The target audience of the approach is the Anaesthesia Green Team. The DrugWise approach was developed in collaboration with the primary stakeholders involved in medication use - anesthesiologists and anaesthetic nurses. This collaboration ensured that the solution was rooted in their practical experience and professional knowledge.

-Future steps-

Looking ahead, LUMC will serve as the pilot hospital for the DrugWise approach. Upon successful implementation and review, the intention is to broaden the reach to other hospitals, advocating for a nationwide effort in reducing medicine wastage in the OR.

Healthcare is an essential part of our lives, promoting and preserving the health of individuals and society. The industry has been evolving at a high pace over the last few decades, driven by technology and growing care demands. This progress is currently having an opposite effect on the overarching objective of serving healthy living due to the increasing environmental footprint and social toll of the industry. Today, healthcare accounts for nearly 4.4% of global CO2 net emissions worldwide, while in the Netherlands, the sector accounts for about 7% of the national footprint. In particular, Radiology represents a clinical area of great concern, being a major contributor to the healthcare carbon footprint due to its high energy consumption and hazardous waste generation. Furthermore, Radiology professionals face heavy workloads due to rising demands for imaging exams, driven by patient expectations on the one hand, and the convenience of leading doctors, as well as existing differences in protocols across hospitals, on the other hand. These complex Environmental, Social, and Governance (ESG) challenges must be approached in an integrated way, to effectively enable the embedding of sustainable practices at the core of healthcare, accelerating in this way the transition towards a circular economy across the industry. This research aims to provide broad and deep insights into the Radiology ecosystem in the Netherlands, ESG definition guidance, and an end-to-end ESG strategic design toolkit that aims to simplify, measure, and integrate ESG efforts across healthcare. An integrated department-, hospital-, national-, and global approach is being proposed to streamline efforts towards 2030 ESG goals and beyond.

A systemic design approach is proposed for this study, combining mixed methodologies of qualitative, quantitative, and co-creation efforts with cross-disciplinary experts from six university hospitals, as well as the national Radiology association in the Netherlands. The steps towards framing, prioritizing, and embedding ESG into the Radiology workflow are consistently captured as research findings, concluding contextual insights on the ESG impact across the different levels of the system. These are represented as an ESG pyramid in this study. Identifying key ESG healthcare challenges and influential entities in the system offers a foundation for strategic dialogues on ESG goals definition. Additionally, an ESG healthcare ecosystem map has been developed to further understand the dynamics among key system stakeholders, on three main dimensions: financial, clinical compliance, and ESG. The perspective of embedding ESG in Radiology, within the Netherlands, is taken as a representative industry case study. Consolidation of clinical workflow data, operational insights, and current ESG context resulted in a cross-hospital view of Radiology ESG hotspots, dependencies, and opportunities. Interventions on ESG hotspots are then addressed and positioned, at corresponding decision power levels, within the larger system. Furthermore, a solution for integrated ESG value-impact measurement and continuous monitoring is proposed. Such a simplified and transparent way of working has the potential to increase awareness, drive collaboration, significantly reduce ESG spending and identify new circular value opportunities.

The outcomes of this research indicate that embedding ESG hotspots into the Radiology workflow should be approached in a holistic and systemic way. The ESG strategic design toolkit can facilitate relevant dialogues on the value and impact of ESG interventions across levels in the healthcare ecosystem, enabling hospitals and departments to effectively define ESG goals and programs. This simplifies complexity and provides consistency across the broader system hierarchy.

This master's thesis collaborates with the Netherlands Red Cross (NLRC) and their Water and Innovation team. The aim of the team is to foster greater engagement with local communities and establish a power balance that empowers the partnering country, rather than being centralized in the NLRC's headquarters in The Hague.

The core of the research project is the design of a storytelling book that adopts a fairytale tone to facilitate ease of reading, engagement, and inspiration. The book incorporates captivating visualizations to narrate the stories of Akila, a Mozambican girl living in Beira, and the Red Cross volunteers during disaster relief efforts.

This design is created through extensive research. The study identifies significant challenges within the NLRC, highlighting the need for substantial transformations in work methodologies. Specifically, the structure of projects must be reoriented to prioritize the active involvement of local communities. The challenges analyzed in this thesis include organizational alignment, global knowledge transfer, and local engagement.

To address these challenges, the project adopts a comprehensive five-phase approach. The initial phase involves a digital visit to Mozambique, conducting extensive research across five domains to gain a deep understanding of the context. The second phase focuses on developing an academic foundation by exploring topics such as climate injustice and climate change. The third phase encompasses in-depth interviews with a multitude of organizations both within and outside the field. Subsequently, it reconvenes to synthesize the gathered information into an engaging design specifically tailored for the NLRC. The fourth phase involves defining and refining the design concept, including testing the book and formulating an implementation strategy.

The book's target audience includes experienced and new Red Cross employees, direct project partners of the NLRC (e.g., Deltares), indirect partners (e.g., the Ministry of Foreign Affairs), and organizations encountering similar challenges (e.g., Doctors Without Borders). Furthermore, with adaptations in text, language, and visualization, the book holds the potential for integration into the NLRC's existing school packages.

Currently, theWater and Innovation Unit aims to expand the organization's expertise across various phases of the disaster risk management cycle. While historically focused on the response and recovery phases, the NLRC's project in Beira signifies a transition toward involvement in the mitigation and preparation phases as well.

The extensive network of organizations and companies affiliated with the NLRC offers a significant opportunity for sustained expansion. To promote a shift of control to the partnering countries, it becomes essential to establish a network that incorporates local organizations. This necessitates the acquisition of localized knowledge to effectively engage with the NLRC, thus fostering a comprehensive understanding of the specific contexts. The primary future role of the NLRC encompasses not only financial support but also the refinement of programs, enhanced program impact, and facilitation of network expansion. Consequently, the NLRC assumes the role of a facilitator in the realm of disaster risk management, where decisions are governed by the partnering country. Acknowledging the existing power imbalance, the transition to this stage will undoubtedly demand a substantial investment of time and effort.

This design report focuses on exploring the opportunities for technology-driven interventions to address health inequalities in children during their first 1000 days of life in Lamu, Kenya. Children’s health during the first 1000 days of life is crucial for their future development and overall health. Interventions that focus on improving health inequalities in the first 1000 days are cost-effective and help to reduce inequalities. In Lamu, Kenya, there is a young demographic and children’s health is worse than the national average, due to financial, geographical, and cultural constraints which make it difficult for communities to access quality healthcare. Technologies and innovation could help bridge the gap between communities and healthcare facilities to improve children’s health. The main research question that this report aims to answer is “How can we improve the healthy start to life in Lamu using available technologies within the local current context?”.

First, a focus for a health challenge for this project is found, which had to be a relevant burden in Lamu in the first 1000 days, be culturally relevant, and present opportunities for technology. After mapping and eliminating health risks and problems in the first 1000 days based on these criteria, two health challenges stood out as relevant and offering opportunities: stunted growth and pneumonia. Experts from the KRCS recommended reframing stunted growth and focusing on (un)healthy nutrition, as it had not been focused on much in the region, was culturally relevant, and had the potential to make a significant impact.
Next, fieldwork interviews, observations and generative sessions were used to understand the context of (un)healthy nutrition in Lamu, as well as the local opportunities for technologies. Lamu is a diverse region with strong informal networks and social cohesion, but food insecurity, lack of awareness on the importance of healthy diets, and healthcare accessibility concerns are challenges. Community Health Volunteers are central in a wider approach to improve community health. Opportunities for technological enablers were found in the widespread adoption of phones, as well as the potential for anthropometric measurement tools as they are available and affordable.

The opportunities that were found from the context research were used to ideate and describe six different intervention scenarios, in which Community Health Volunteers use anthropometric measurement tools to enable various basic nutrition-based health services for children in the first stages of life at the community level. The basics of these scenarios were evaluated and co-created with Community Health Volunteers during the fieldwork. The scenarios vary mainly on the purpose of doing the measurements, how the technological enablers are used, and the impact that is generated. Two scenarios, the community-based growth monitoring scenario and the remote follow-ups scenario, were selected as the most promising after evaluation with local experts from KRCS. Further evaluation on the desirability, feasibility, and viability of these two scenarios resulted in the community-based growth monitoring scenario being identified as the most promising. One of the main barriers to implementing these interventions is the compensation of CHVs, and ways to overcome this issue are suggested. Finally, recommendations are given for further design and implementation