Friday, June 6, 2025
The question is: how can these so-called ‘prehabilitation’ programs be optimally implemented? What works, what doesn’t, and for whom?
Oncological surgeon Dr. Onno Guicherit works at HMC (Haaglanden Medical Center) and is a consortium member involved in both the Medical Delta Living Lab 'Better in, Better out & Beyond' and the Medical Delta Programma ‘Prehabilitatie als Zorgtransformatievliegwiel (PAZOEV)’. In these initiatives, he contributes to research and the implementation of prehabilitation projects. “Only in daily practice can you truly assess whether something works.”
This interview is the first in a series featuring practical partners from the transdisciplinary Medical Delta programs and living labs.
Could you briefly explain the goals of the living lab ‘Better in, Better out & Beyond’ and the PAZOEV program?
“We want to explore how scientifically and theoretically proven insights about prehabilitation can actually be applied in practice. The main challenge is how to push these proven elements through the often sluggish implementation processes — in other words, how to make them work in everyday healthcare settings.
Patients recover better from surgery or treatment when they are fit, well-nourished, and well-prepared beforehand. Although the benefits are scientifically supported, the Dutch National Health Care Institute is not yet convinced to structurally reimburse prehabilitation measures, such as physiotherapy, for all patients in the preoperative phase. And that presents a major challenge. How do you select the patients for whom it truly adds value? And how do you get patients motivated to start moving in the first place?
What I hope is that we can let go of the traditional approach a bit more.
What I hope—and what we’re still working on at the drawing board—is that we start letting go of the traditional approach a bit more. Up until now, we’ve operated in a rather old-fashioned way. But if you use tools like an app, social media, or influencers—which could even be people from a mosque or community center—you might reach more people. This shifts much more responsibility to the patient and their network. That requires a different approach to drive change.
Students within the living lab are coming up with creative solutions, like a scavenger hunt on the hospital ward or a stationary bike with VR goggles that simulates cycling through a city. Sometimes these interventions work, and sometimes they don’t. Understanding why is something being explored in practice through the living lab.”
What is the role of your organization and your personal role within the living lab and the program?
"I've been working at Haaglanden Medical Center (HMC) for 23 years as a surgical oncologist, combining my clinical work with administrative responsibilities. Within the living lab, we primarily provide space for students—mostly Nursing students, but also those studying Dietetics or Physiotherapy. They need internship placements, and contact with patients is essential for their development as future healthcare professionals.
Day-to-day supervision is handled by the nurses and care staff on the ward. Personally, I’m mainly involved in steering committee meetings and contribute ideas on how to support and advance the projects. I regularly consult with lecturers Lottie Kuijt-Evers and Joke Korevaar, as well as Professor Nico van Meeteren, about the future direction of the living lab.
Following the Medical Delta Living Lab ‘Better In, Better Out’, we are now shaping its successor, the Medical Delta Living Lab ‘Better In, Better Out and Beyond’. I try to implement the ideas that emerge from this initiative within our clinic. That’s not easy—staff shortages make it difficult to create space for student supervision. Still, HMC recognizes the importance of this. Supervision is not an afterthought; it’s a deliberate investment in the future. Only by truly making room for it can we enable quality research and test theory in practice."
In the 2024–2028 Medical Delta programming, transdisciplinary collaboration is a core principle, and practical healthcare settings are explicitly involved. Why is that important?
Do you notice, generally speaking, that there is more attention being paid to practice in research and innovation projects? Where do you still see room for improvement?
“You can see that there is an increasing willingness to listen to practice. For many research grant applications, it’s now mandatory to include input from a patient or patient representative. That serves as an important reality check: does the proposal align with the patient’s perspective? Also, nearly all major studies in the Netherlands are multicenter studies—besides university medical centers, top clinical and general hospitals are involved. This creates an automatic link to practice, and regularly checks whether a study is actually feasible. If it’s not, another reality check follows. In this way, practice remains closely involved in research.
A good example is the ‘5-star experience at home’ project. In this research project, we applied knowledge and expertise from the hospitality industry—specifically from Hotelschool The Hague—to the hospital setting. It was highly inspiring due to the transdisciplinary nature of the collaboration. The hospitality knowledge from the hotel school is quite applicable to hospitals, which also have a hospitality function. But there are important differences. For instance, hotels often use ‘personas’—detailed descriptions or archetypes of guests—to assess which needs align with which types of guests. Together with nursing students, we translated that concept to the hospital to improve the discharge process. After all, someone who is young and fit has very different expectations than an older, lonely patient who sees the hospital as a social place. By categorizing patients into types, you can better tailor the discharge process to their needs and anticipate what’s necessary even before admission.
In theory, this works well, and students were enthusiastic. But in practice, it proved difficult. Nurses who had worked on the ward for years found it hard to classify patients into personas and adjust their workflow accordingly.
Another example involves interventions to encourage movement, such as stationary bikes or physiotherapy groups. These work well during project periods, especially when they’re free of charge. But once the reimbursement from the health insurer ends, many people drop out. This shows that even a good idea can falter in practice due to financial or organizational barriers—an important consideration when implementing innovations.”
Are there specific methods, cases, or practical examples from other sectors that the Medical Delta community can learn from?
“I find the principles of so-called ‘value-based healthcare’ very interesting. This concept comes from Michael Porter, a professor at Harvard and one of the key thinkers behind the reforms of Obamacare. His philosophy is that if healthcare focuses solely on cost, it results in poorer care. But if you focus on quality, more affordable care will ultimately follow. High-quality care—with fewer complications and, above all, high patient satisfaction—leads to less healthcare consumption, fewer unnecessary treatments, and therefore lower costs.
A key aspect of this approach is that you don’t just focus on organizing processes and structures, but instead look at healthcare outcomes—specifically, the outcomes that truly matter to the patient. A good example I often use is knee or hip replacement. For years, orthopedic surgeons focused on technical precision: does the angle of the new prosthesis exactly match that of the original joint? But in reality, we should be asking much more: how much pain does the patient still have? How far can someone walk again without getting tired or experiencing pain? In practice, that turns out to be far more important—especially for the patient—and it doesn’t always align with how perfectly the anatomy has been reconstructed.
If you organize care in such a way that procedures and treatments are chosen based on what leads to the greatest satisfaction and best recovery for the patient, you end up with the most valuable—and often the most cost-effective—care. Ultimately, healthcare should revolve around the question: what is best for the patient?”
What do you ultimately hope to achieve through the Medical Delta collaboration?
“That we contribute together to better and more sustainable healthcare. We have a mission and vision aimed at providing care that truly helps patients and allows healthcare professionals to work in a healthy, sustainable way. That’s urgently needed—especially in light of the double ageing of the population and the large number of students we’re currently training and will desperately need in the near future. If we deploy them the same way we always have, they risk becoming overworked or burning out. That’s why we must now find new approaches—or test and adapt existing ones to fit real-world practice.”
We need to learn to trust in technology and innovation, redesign processes, and automate actions wherever possible.
The biggest challenge is not just coming up with or testing something new, but actually implementing it. In practice, nurses and paramedics often cling to familiar routines. They tend to think that changes are mainly economically driven and come at the expense of their work. Of course, we need to use staff more efficiently, but in a positive way that supports healthcare professionals. We need to learn to trust in technology and innovation, redesign processes, and automate tasks wherever possible.
For example, you could also have change management students research how to adopt new knowledge and how to prevent change from being blocked by people who are resistant to innovation. I believe this aspect still receives too little attention."
Which other consortium member have you learned something from or been inspired by?
“In general, I think we’re a fun and constructive group, precisely because we come from different disciplines. We also collaborate well with TU Delft. Last year, we had an inspiring conference there, and it’s wonderful to see so many young people from diverse backgrounds coming together.
I also work a lot with Nico van Meeteren. We often strongly disagree, but that keeps us sharp. He believes hospitals are still working too traditionally, while I think we’re already applying much of what his peers are developing. I learn a lot from him — hopefully, that works both ways.”
What call to action would you like to make to the Medical Delta community?
“Keep giving students the space to test theoretical frameworks in practice, and make sure they feel welcome. We really need to give the future a chance now, or we’ll inevitably hit a wall at some point. That’s why it’s important that everyone makes room for this. Involve students in internships, let them do research, and be open to their ideas.
At the same time, we need to be careful that this doesn’t result in a pile of isolated studies that ultimately go nowhere. Lecturer Joke Korevaar rightly says that if you bundle all the data and insights, someone else — for instance, a PhD student — can turn it into something valuable. In the end, they’re all puzzle pieces that together form a bigger picture and can truly make a difference in practice.”
