"An innovation in the operating room is only successful if its impact on the way of working is taken into account"

The operating room is full of technological innovations. In the development and implementation of these innovations, the influence on the work of operating room staff is not always adequately considered. Anneke Schouten, a Medical Delta PhD candidate from TU Delft (3ME), focuses her research on the effect of technological innovations on the work processes of medical personnel in the operating room. "By measuring these effects on medical personnel, I hope to increase the success rate of innovations."

This interview is the ninth in a series of interviews with PhD candidates and postdoctoral researchers funded by Medical Delta. Anneke's research is funded through the scientific program Medical Delta NIMIT: Novel Instruments for Minimally Invasive Techniques.

What is your research about, and how did you come up with this research topic?

“I studied Biomedical Engineering and Science Communication at TU Delft. In my Science Communication master's program, I learned a lot about co-creation and interdisciplinary collaboration. Over the past years, many technological innovations have been implemented in the operating room. However, the impact of these innovations on the work processes is often insufficiently addressed, and a good collaboration between engineers and medical personnel is not always a given.

My research focuses on mapping the effects of technology on the work processes in the operating room. I do this in two ways. For the first part, I distinguish between open surgeries, minimally invasive surgeries, and robot-assisted surgeries. I consider open surgery as the least technologically supported form of surgery, and robot-assisted surgery as the most technologically supported. During my analyses, I look at the ratio between medical and technical actions and the number of actions within a certain timeframe. Later, I survey and conduct in-depth interviews with the surgical assistants about their work experience.

Human empathy and intuition in decision-making are often not taken into account

Additionally, I focus on human choices in making the operating room schedule. Although much automation has been implemented, it is not often used in practice. This is probably because human empathy and intuition in decision-making are often not taken into account. By mapping these aspects, I hope that operating room scheduling can be more successfully automated in the future.

I am now halfway through my research period, and I hope to dedicate the upcoming year to continuous data collection and analysis of the work processes. I plan to involve not only the LUMC but also multiple university medical centers in the Netherlands to compare them.”

What is your motivation for conducting this research?

“What intrigues me is how to design a product that lands in practice. This is precisely the most challenging step in the design process. What makes a product useful? For me, it's about collaboration and involving all stakeholders.

What I often see happening is that engineers manage to reach the surgeon but not the rest of the operating room staff, even though they are essential for patient care. The surgical assistants are often the ones who come into contact with innovations in the operating room the most. They have a lot of practical experience and knowledge. That's why I specifically focus my research on surgical assistants.

It motivates me tremendously to give a voice to a relatively overlooked group. With my research, I hope to increase the percentage of innovations that successfully land in practice. Having intrinsic motivation is very important when working on a research project for a longer period. I would also like to advise aspiring PhD researchers to find an angle that gives them drive.”

In your research, interdisciplinary collaboration is prominently emphasized. How do you promote that collaboration?

“To be able to fit into the hospital workflows, you need to be highly flexible. Much of what happens in the hospital is 'in the moment,' and you shouldn't try to schedule appointments too far in advance. It's different at the university, where you can't just walk into a place without an appointment. And a lot of coffee breaks! Having a friendly chat is truly part of my research.

Much of what happens in the hospital is 'in the moment'I try to incorporate different perspectives. In terms of workflow, new technologies mustn't increase workload. But how do you precisely measure that? On the one hand, I measure the number of tasks performed within a specific time frame, which allows me to quantify workload with a numerical value. On the other hand, I try to measure workload from a socio-scientific perspective using surveys and interviews. By analyzing these two outcomes for similarities and differences, I hope to gain new insights.”

What new insights have you gained from collaborating with different disciplines?

“My respect for medical personnel has further increased. They are incredibly flexible. Appointments and surgeries are often scheduled or modified last minute. Long days are worked, and they put in a tremendous amount of effort. Despite the workload, the staff remains friendly and professional in their interactions with patients.
I also notice the differences between physicians and engineers. The healthcare focus is primarily on the human aspect, which engineers sometimes overlook as they prioritize automation and optimization. I realize that it's important not to let technology hinder the flexibility of the work. Innovation in the operating room is only successful if its impact on the way of working is considered.”

The previous interviewee, Judy Chen, wants to know: what is the biggest challenge you have encountered in your research?

“The biggest challenge has been integrating into the hospital environment. It's important to learn to speak the 'language of the doctors' and navigate the hospital culture. I still have a lot to learn, but things are heading in the right direction.

The trust between LUMC and TU Delft has been instrumental. I can conduct my research in the operating room, which is not so easy for outsiders. The close connections within Medical Delta ensure that there's always someone who can assist me in my research. Without that strong bond, it would be more challenging to carry out my research.”