About Humanitarian innovation:

Santos, A.L.R., Wauben, L.S.G.L., Goossens, R. and Brezet, H. (2015). Systemic barriers and enablers in humanitarian technology transfer, Journal of Humanitarian Logistics and Supply Chain, Vol 6(1).
Purpose – This study has two purposes. First, to collect information about barriers and enablers experienced by international experts when transferring medical equipment to countries affected by humanitarian emergencies. Second, to discuss the suitability of the principles of ‘openness’, ‘interconnections’ and ‘non-linearity’ of systems to understand the nature of the barriers and enablers as described by the international experts.
Design/methodology/approach – In this study, six semi-structured interviews were conducted with experts from humanitarian organizations. The interviews were based on a simplified model of the transfer of medical equipment adapted from supply chain literature. The model ensured that all the process steps undertaken by humanitarian organizations were considered. Afterwards, the interviews were transcribed and structurally analysed to derive barriers and enablers. Finally, the results were described in light of three theoretical principles of systems thinking.
Findings – 14 types of barriers and 12 types of enablers were uncovered that illustrate the complexity of transferring medical equipment in humanitarian emergencies. The paper concludes with a proposal for future research to investigate if, and how, an approach guided by systems thinking could help to create a designated space for the formulation of original, synergetic solutions that address the identified barriers.
Originality/value – This study is the first to explore the specific logistic challenges implicit in the transfer of medical equipment in humanitarian emergencies with a lifecycle perspective. Furthermore, the concept of systems thinking is rather novel in the field of transfer of medical technology.

Nielsen, B.F., Santos, A.L.R (2013). Key Challenges of Product Development for Humanitarian Markets. In: Proceedings of the Global Humanitarian Technology Conference 2013: California, USA.
There is a clear increase in frequency, complexity and length of humanitarian crisis. This trend has driven the attention of donor governments to the private sector when looking for alternatives for more cost efficient solutions for provision of aid. Academics have explored the challenges of bringing these two worlds together in form of a market: the humanitarian market. However little is known about the perspective of enterprises from the private sector and how they address the humanitarian aid context. This study aimed at exploring how context characteristics, specific to the humanitarian aid context affect product development activities. In fact, mismatches between business and humanitarian systems go beyond to logistical systems and extend to product development activities and adjacent servicing. We consider the findings a contribution to defining priorities for future collaborative development of products and services by enterprises and humanitarian aid stakeholders.

Santos, ALR., Capet L.,Diehl, J.C. (2013). The value of collaborative design to address the challenges of the humanitarian sector. In: Proceedings of the International Conference on Integration of Design, Engineering & Management for Innovation: Porto, Portugal.
This paper proposes an innovation approach based on collaboration and design thinking to address the challenges faced by international aid organizations in humanitarian disasters, through the co-development of products and services. The proposed approach was iteratively designed and used in two international workshops. The results show that collaboration and design thinking tools can empower the humanitarian sector to identify opportunities for innovation and create a shared vision for a more sustainable and efficient aid.

About Human Factors and Ergonomics:

A.L.R. Santos, L.S.G.L. Wauben, S. Guilavogui, J.C. Brezet, R. Goossens, P.M.J. Rosseel (2015). Safety challenges of medical equipment in nurse anaesthetist training in Haiti, Applied Ergonomics
Safety challenges related to the use of medical equipment were investigated during the training of nurse anaesthetists in Haiti, using a systems approach to Human Factors and Ergonomics (HFE). The Observable Performance Obstacles tool, based on the Systems Engineering Initiative for Patient Safety (SEIPS) model, was used in combination with exploratory observations during 13 surgical procedures, to identify performance obstacles created by the systemic interrelationships of medical equipment. The identification of performance obstacles is an effective way to study the accumulation of latent factors and risk hazards, and understand its implications in practice and behaviour of healthcare practitioners. In total, 123 performance obstacles were identified, of which the majority was related to environmental and organizational aspects. These findings show how the performance of nurse anaesthetists and their relation to medical equipment is continuously affected by more than user-related aspects. The contribution of systemic performance obstacles and coping strategies to enrich system design interventions and improve healthcare system is highlighted. In addition, methodological challenges of HFE research in low-resource settings related to professional culture and habits, and the potential of community ergonomics as a problem-managing approach are described.

Santos, A.L.R., Systems Design Perspective of Humanitarian Emergency Relief – the Use Context of Medical Devices (working paper)
Humanitarian/international aid organizations face several challenges when providing medical aid in post-disaster settings. Healthcare, and surgery in particular is hindered by the lack of required infrastructure and the need to operate under pressure and uncertain conditions. The use context of medical devices is the focus of this paper. A systemic analysis of the transfer of medical devices in humanitarian emergency response using the descriptive V-Cycle model of system innovation was made using selected literature of response reports as a product service combination. Finally, we discuss the value of Human Factors and Ergonomics in the design of Products-Service Systems to rethink humanitarian practices and the relationship with medical device companies.

Santos, A.L.R., Wauben, L.S.G.L., Dewo, P., Goossens, R. and Brezet, H. (2013) ‘Medical emergency dynamics in disaster-prone countries – implications for medical device design’, Int. J. Human Factors and Ergonomics, Vol. 2, Nos. 2/3, pp.87–115.
Emergency medical services and surgery are an essential part of the local response to natural and humanitarian disasters. The aim of this study is to
identify performance obstacles regarding the use of medical devices in medical emergencies. The case study, conducted in the Dr. Sardjito General Hospital in Indonesia, entails semi-structured interviews with surgeons from the Orthopaedics and Traumatology Department, as well as exploratory
observations in the emergency and operating rooms. A literature-based reporting tool, observable performance obstacles (OPO), was designed and
tested. The results demonstrate that data collection through observation yields rich insights that are relevant to the literature on human factors, and to the applied field of user-centred design. This experience also reveals the inherent difficulty of doing research in the dynamic setting of medical emergencies. As a result, several changes to the OPO are proposed for its application in follow-up projects.

Santos, ALR., Wauben, LSGL., Goossens, R., Brezet, JC. (2011). Extreme Surgical Contexts.. In: Proceedings of the International Association of Societies of Design Research Conference: Delft, The Netherlands
Healthcare has an increasing presence in the agenda of both design practice and design research. In the particular case of surgical care, the specialized products designed to be used in advanced operating rooms (OR), sometimes have specific characteristics that do not allow for proper functioning in poor resourced settings or in contexts of emergencies such as natural disasters. Diverse literature identifies barriers to healthcare and medical device innovation that are relevant for designers and ought to be considered throughout all product development process. In this paper, the reviewed contextual barriers to the use of medical devices are translated into examples of design relevant interventions. From business approaches to technical details, design engineering practice has within its domain the potential to overcome some barriers. Most importantly this research attempts to contribute to the practice of design by 1) enriching existing literature about methodological approaches to design for complex contexts and 2) creating an information platform that supports the stakeholders involved in the development of surgical equipment, designing more context adequate products.