Why industrial methods do not work in healthcare: an analytical approach.

Healthcare professionals and managers in hospitals are frequently suggested to learn from industry and business to improve quality and efficiency. However, evidence that the implementation of industrial techniques and business methods has a meaningful effect on patient outcomes is often lacking. An explanation for this phenomenon is thought to be the complexity of the hospital organisation and the diversity of patients. In this article, we use the practice approach to discuss the application of industrial techniques and business methods in healthcare. We employ a practice model that offers three perspectives to understand professional practices: Identity and intrinsic values, Interests of stakeholders, and Ideals and basic beliefs (Triple I). This model demonstrates that the nature of healthcare practices differs strongly from the nature of industrial and business practices. Healthcare has a moral nature that does not let itself be easily organised along technological or business categories. This may provide a fundamental explanation of why industrial techniques and business methods in general will be less successful in healthcare. At the same time, this model invites hospitals to develop innovative approaches that do justice to the identity and intrinsic values of healthcare. In this process, insights from industry and business cannot be copied but have to be used as sources of inspiration.

Understanding User Practices When Drawing up Requirements-The Case of Designing Assistive Devices for Mobility.

Patients with orthopedic problems often use assistive devices, e.g., ankle-foot orthoses and therapeutic footwear, to support their mobility. However, many users are not satisfied with their devices or do not use them at all, resulting in a decrease of quality of life. It has been shown that a main cause for dissatisfaction and non-use lies in the process of drawing up requirements. It appears that orthopedic engineers have too little insight in the different areas of life of patients leading to deficient design requirements. In this article a general approach-the so-called Triple I model-is presented to understand the different areas of life of patients. This model offers, in line with and directed by the intention of the International Classification of Functioning, Disability and Health (ICF) model three perspectives or 'pairs of lenses' to analyze these areas of life: the identity, the interests of key stakeholders or social actors, and the underlying societal ideals. The Triple I model is elaborated for assistive devices and offers an associated methodology to orthopedic engineers to systematically map the different areas of life of patients, to understand the requirements for every area, and to explore the conditions. In case of assistive devices five different areas of life have to be investigated: daily living at home, work, transport, social and spiritual activities, sport and leisure.