Originally a medical doctor and surgeon, I am now assistant professor dedicated to Safety in Healthcare, at the Delft University of Technology.

I studied Medicine at the University of Amsterdam - Academic Medical Centre and graduated as medical doctor (MD) cum laude, in 2000. I was trained as an oncological and abdominal surgeon and additionally as an intensive care specialist between 2004 and 2014.

My academic career started during my medical study, with a variety of smaller projects. The most important one was on complications resulting from the removal of the galbladder through a then new technique, the laparoscopic or key-hole surgical procedure. This research was handed over to a colleague when I started my clinical training as a surgeon in a different region (Groningen) in 2004.

In Groningen my research focused on colorectal cancer (CRC) and - surgery and lasted from 2004 till 2017. My doctorate thesis was finalized in 2011 and was titled 'Searching for metastases in colorectal cancer'. It concerned the clinical challenges in staging the disease (on first occurence and recurrences during follow-up) as the basis for clinical decision-making on treatment. Hereafter I kept working on the successive national follow-up trial (CEAWatch) and further on several studies into complications of abdominal surgery up til 2017. In 2020 I restarted my research career through a project on sustainable professional performance in collaboration with the Erasmus University.

I worked as an abdominal surgeon in the advanced cancer group at the Aarhus University Hospital in Denmark (2014-2018) and as oncological surgeon in the Netherlands (2018-2021). I also did duty as emergency ICU specialist during the COVID pandemic.

In July 2021 I switched to a fulltime academic career in the tenure track position on safety in healthcare, and discontinued my work as an oncological surgeon. To preserve my skills and feeling with the healthcare domain, I work parttime at the emergency care starting March 2023.

Safety in healthcare is my core topic. Harm to patients can occur in many different ways, including unsafe acts, discordance between patient and treatment, organisational failures and many more.

My focus is in the following research areas:

Reducing treatment harm. I study mechanisms of treatment harm that lie hidden in how we practise and do research in medicine in the Western world. The current standard is a predominant reductionist approach that leaves out the dynamics and influences of the system around the health problem. It is also an approach that has a strong focus on disease and tends to forget the diversity in - and values of patients. I believe that a scientific approach from a systems perspective can contribute to safer care, and I work together with others on concrete approaches in two fields:

Mathematical oncology. I contribute to the evolutionary game theory lab that is led by Katerina Stanková. She received a VIDI grant in 2022 from which she established a research project on evolutionary therapy in non-small cell lung cancer (NSCLC). This project is done in collaboration with the ErasmusMC.

Systems science in mental health. From a systems perspective, mental health is an outcome of complex interactions between a person, the environment and significant others in past and present. In current standard of care, mental health issues such as perceived mental pain or behavioural dysfunction, are labelled as a disease. We question the validity of this view and argue that it often are mere physiological patterns in a dysfunctional system. We aim to explore how unjustified disease-labelling can lead to harm. Under the working title ‘According to what order, is this a disorder?’ we established a working group to design alternative scientific approaches to alleviate suffering in mental health. 

Rethinking paradigms. This topic has an overlap with the previous topic, in that it also uses a systems approach to problems, but here the focus is on healthcare organisations and healthcare system structure. I observe that patterns of thinking and reasoning in Western healthcare can have (unintended) adverse effects on safety of care delivery. This for example through failing to understand the real problems underneath a failure scenario or through neglecting essential actors or influences in the complex socio-technical healthcare system, for example in quality improvement cycles or innovation. 

One of the projects I am working on is how to review and address underlying causes of failures that lead to severe harm or death of a patient. The current standard is focused on the sharp-end, the last unsafe act of a healthcare professional to a patient. Whereas in reality, there usually is a multitude of contributing system factors that result in the unsafe act. This phenomenon is well understood in other domains, but not so in healthcare. Which is why we now try to ‘translate’ and educate involved healthcare professionals to think differently. 

I enjoy trying out a variety of existing systems methods, to evaluate the opportunities, obstacles and failures in the context of healthcare. System methods that integrate technical, psychological and social elements, such as problem-structuring methods and system dynamics, can significantly contribute to the understanding of reality and more effectively direct to leverage points for improvement. 

Professional performance. Professional performance, as an individual and in a team, is key to high quality & safe care. I relate performance to group dynamics, communication, learning and culture, thus again as an outcome of a (psychosocial) system. Key words are psychological and social safety, accountability, just culture and non-violent communication. I consider professional responsibility and ownership, as a key value on the way to safe care. We observed that 'structure determines function', thus that the environment and design of working systems can promote but also undermine optimal professional performance and working culture. To improve, adjustments in structures and communication agreements may be the most effective incentive to create a safe working culture. 

Safe care is highly dependent on professional performance, reason to focus on care professionals themselves. A first study was on sustainable professional performance of medical specialists called ‘What’s Up Doc?' A study I conducted in collaboration with colleagues at the Erasmus University. We found that the most significant influences on the ability to perform was group dynamics, and the perceived gap between personal and organisational professional norms and values. Medical specialists actively regulate their environment by influencing group dynamics, and changing work content or place when the norms-gap is too large. Some self-regulations have (unintended) negative effects on patient care, causing moral dilemmas. These findings can help organisations, including specialist partnerships, to create and improve an environment that allows professionals to sustainably perform at a high level that is in alignment with safe care. A second study focused on the motivation of nurses to work at the emergency department, in other words their intention to stay. This study used a quantiattive SD approach revealing different insights and intervention opportunities than mainstream research. I anticipate on more studies to follow with a focus on the people who deliver care.