Enhancing patient safety and healthcare compliance

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Enhancing patient safety and healthcare compliance: Re-imagining healthworker and carer training in infection prevention and control

London, United KingdomMonrovia, Liberia
Year Founded:
Organization type: 
Project Stage:
$250,000 - $500,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

MiiHealth aims to enhance patient safety principally by transforming infection prevention and control by using interactive and intuitive simulation based training underpinned by powerful analytics, building on insights from the Masanga MENTOR Ebola Initiative (MMEI)

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if the tablet or smart phone could be a guide and mentor to keep health workers and carers safe and improve patient safety
About Project

Problem: What problem is this project trying to address?

As the world becomes ever more interdependent, populations grow and farming practices more intensive ; the threat of infectious diseases grows be it emerging pathogens eg Ebola, MERS & drug resistant TB or Anti Microbial Resistance. Good infection prevention control training keeps carers, patients and communities safe. In an outbreak such as we have seen in West Africa, a single mistake can be deadly for individuals and communities.

Solution: What is the proposed solution? Please be specific!

MMEI have prototyped an interactive, adaptable and potentially adaptive training system providing: ▪ Simulated training in a setting and language familiar to the trainees (a near peer experience) ▪ Safety critical steps highlighted ▪ Risk awareness and mitigation encouraged through role play and gamification ▪ Patient care reinforced through empathetic engagement between care and patient ▪ Copying and behaviour change through simulations ▪ Protocols aligned with international and national guidelines through a peer reviewed ‘compliance control document’ ▪ Analytics enabling adaptive learning and targeted training, and impact measurement ▪ Intuitive tablet and smartphone interface Initial feedback has been very positive.


MMEI were shortlisted for EU Ebola Health Award October 2015 and invited to present at the 2015 Humtech conference hosted by MIT, Cambridge, US
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

ebuddi training modules have been used to improve infection prevention and control capacity / compliance for teams working in the slums of Liberia, and in rural Sierra Leone. Health workers have had their conventional training in IPC augmented by ebuddi– an avatar speaking their own language and demonstrating what they need to do. Critical learning points have been highlighted based on feedback from the frontline teams and lessons learnt across the region as to the most common / critical mistakes made. The frontline teams themselves have been directly involved in the co-creation process building local engagement and ensuring relevance and appropriateness. Knowledge, confidence and competence have all been shown to improve.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

Researchers from Plymouth University Peninsula Schools of Medicine and Dentistry have evaluated the impact of this approach to training in studies that have included Sierra Leone and Liberia. Earlier results have shown ebuddi to have added value compared to traditional workshops and participants’ confidence and skills improve after training with ebuddi. Built-in analytics enable unprecedented insight into learning impact, effectiveness of training programmes and priorities for on-going development, addressing the twin challenges of quality assurance and adaptation to ensure it is faithful to priorities on the ground and health policy. The analytics have highlighted scope for improving training effectiveness and set a new standard for the monitoring and evaluation of training at both the individual and programmatic level. The US Government is currently supporting its use in Liberia.

Spread Strategies: Moving forward, what are the main strategies for scaling impact?

We are continuing with the research work with the aim of being able to demonstrate better health care practice – and ultimately we hope to show reduced infection rates. We will continue to work closely with the WHO, CDC and the Ministries of Health in each country to ensure that ebuddi reinforces national guidelines and responds with any changes in recommendation or policy, and in local language. We are now talking with regional and international agencies to scale the approach across the region affected by Ebola as well as with countries keen to learn the lessons from the Ebola outbreak.

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

We plan to use the company MiiHealth Ltd to market the approach to clients in both the public and private sector. Training modules developed with the support of charity will be freely shared with organisations training front-line health-workers under a copyright commons license, We are aiming to create a mix funding base from grants to invest in new modules and a fee for service model to ensure sustainability and attract investment.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

There are a wide range of e-learning companies, but MiiHealth differs in its IPC focus, the co-creation process and its insights from the unprecedented international response to the Ebola outbreak. We have a network of international experts, from a wide range of disciplines including pedagogy, technology enhanced learning, quality assurance and compliance, media, IT developers & artists, telecoms, public health and finally and critically, front-line teams providing training and supporting care in west Africa. The system for agile development enables rapid adaptation and evolution.

Founding Story

During the civil war in Sierra Leone, Dr. Aniru Conteh kept the Kenema isolation hospital serving patients through his leadership, insight, experience and support for his colleagues until his death caring for a colleague - we set out to capture his guidance in a digital training module. Oil and Gas companies had used immersive training technology to give health and safety training to workers on remote oil and gas rigs. Could we use a similar approach to give frontline health workers the knowledge, confidence and competence that some like Aniru Conteh could have given them - to keep patients and carers safe and serving during the Ebola crisis? What could we learn from other sectors?


Nicholas Mellor, Programme Management and Co-founder of Merlin and MMEI, has been both a social and technology entrepreneur. Nicholas was part of the team that developed and launched the world's first genetically engineered vaccine (for Hepatitis B) when he worked in the pharmaceutical industry on vaccine development. For 5 years was a management consultant specialising in strategy, R&D management and innovation. He was a strategy adviser to the WHO, UNICEF, UNDP, the World Bank and the Rockefeller Foundation on the creation of the Children's Vaccine Initiative - a global R&D effort to create a multivalent children's vaccine for the Expanded Programme for Immunisation (EPI). He was the co-founder of Merlin which became one of the world's leading medical relief agencies and is now part of Save the Children. With the support of the Rockefeller Foundation and working closely with Dr Aniru Conteh in Sierra Leone he established the Lassa Fever Initiative in 2003 following the Civil War in West Africa to establish a centre of excellence in West Africa to build outbreak response in West Africa working closely with Merlin, the Ministry of Health, CDC and the WHO. Although the focus was on Lassa Fever, the threat of an Ebola outbreak was explicitly addressed as well as the importance of infection prevention and control, standard precautions and patient safety. Following the Lassa Fever Initiative he consulted to the Global Outbreak Alert and Response Network and WHO. Nicholas was an adviser to the Rockefeller Foundation on the creation of the Centre for the Management of IP in Health Research and Development (MIHR). He set up the Palliative Care Network building on his insights as a carer, and from the Nairobi hospice and palliative care community outreach in Kerala India. A key aspect of the approach to palliative care training was that it was community centric, and designed in a way as to be as accessible as possible to community health workers in resource poor areas. Nicholas is the co-founder of 20 20 education http://2020education.org/ designed to engage youth people in global challenges, problem solving and entrepreneurship. He became an adviser to Cisco's Global education team looking at the impact of technology and vocational training on employment and employability of workforces in emerging countries and particularly as part of the stabilisation process in countries suffering from violent conflict. He is a co-founder of the Masanga MENTOR Ebola Initiative. A key part of MMEI's model of working is 'Agile development' which allows collaborative development with other partners - in the case of ebuddi, co-creating the product with the frontline health teams in a manner unprecedented in an emergency medical response. MiiHealth builds on the insights of the Masanga MENTOR Ebola Initiative (MMEI) - a partnership between the Masanga hospital in Sierra Leone, the Mentor Initiative a leading international health training NGO operating in Liberia, and the Plymouth University Peninsula Schools of Medicine and Dentistry (“PUPSMD”).
CO-CREATION IDEA: Please offer a brief description of how you imagine a win-win partnership with Boehringer Ingelheim to better serve unmet needs in health. (Hint: Please mention the underlying business model envisioned that would make such a partnership sustainable.)

BI operations cover the health care spectrum from hospitals to community clinics, to patients at home, as well as animal welfare. Infection prevention and control is a challenge in all those sectors, and improving the resilience of health systems means working in all three sectors. The healthcare crisis associated with chronic diseases such as diabetes means that novel ways are needed for empowering the patient and their carers to do more for themselves. IPC is particularly important when patients may be immunocompromised. Ensuring safe care is as important as providing the diagnostics to diagnose and drugs to treat. We have close links with global health policy makers and leaders in global health.

NEEDS: Based on you response above, please specify which of the following resources, operations or expertise by Boehringer Ingelheim you imagine leveraging to actualize the proposed co-creation opportunity. Please check all that apply. (Hint: while financing is often critical to scale, we are also interested in understanding what other assets or expertise could be leveraged).

Distribution Channels, Research and Development, Specific Disease Expertise, Relationships/New Contacts, Marketing/Communications Support, Human Resources, Legal Support, Technology Expertise, Public Policy Knowledge, Access to Capital.

EXPLANATION OF NEEDS: Please explain your choices in more detail.

We are seeking to scale up access to this training system from West Africa building on BI's global reach, to provide access to the ebuddi systems of adaptive learning from healthcare centres to homes. Legal support with licensing arrangements is important to generate revenue as an enterprise, but ensure front line workers in Africa have access to the best possible training.
BI also places great value in building the skills of its workforce and those insights are also relevant
R&D is important as we build the evidence base of our impact on learning outcomes.
We need development capital.

OFFER: What are the main assets you may contribute in a co-creation partnership with Boehringer Ingelheim that would better serve unmet needs in health?

Deep understanding of an unmet need in a specific market/context, Access to and established trust with customers/beneficiaries, Insights into behavior change.

FOCUS AREAS: Which of the following best describes the main focus of your project? (select all that apply)

Holistic solutions that work across the entire care continuum (including education, prevention, detection, treatment, management, follow-up), Remote care solutions for health management, treatment, and diagnosis.

Please share what your organisation and Boehringer Ingelheim will Co-Create together

Enhancing Patient Safety through better infection prevention and control capacity building and healthcare compliance.

The digital platform for building competencies as well as improving healthcare compliance can also be used to explore the link between competency, health practice and health outcomes underpinned by GIS data. Building on the potential of such analytics would be a key outcome for the collaboration.

This is one of the key opportunities opened up by the 'digital healthcare' opportunity.

Initiatives such as mPESA (in mobile banking) in East Africa show how digital opportunities can be as significant in emerging markets as they are in more mature, developed markets.

Please specify what your Co-Creation will result in:

a new service, other (please explain below).

If you selected "other" above, please explain:

Insights into digital health.

Please provide a 1-2 sentence summary of your Co-Creation idea

Improve infection prevention and control as well as patient safety by further development of, and scaling the ebuddi model - an interactive and intuitive simulation based training underpinned by powerful analytics, that has been developed to train community health workers in response to the Ebola crisis in West Africa.

How does this project link to the core mission of your organisation?

MiiHealth Ltd was created to catalyse a transformation in IPC training, through applying technology enhanced learning to improve knowledge retention, confidence and ultimately competence – and to make quality assured training accessible worldwide.
This project would mark a move beyond Ebola related training and West Africa to show how the platform developed and insights gained have a relevance to healthcare across the globe. The massive investment in pharmaceuticals and other healthcare technologies will only lead to improved health outcomes if there is an associated advance in the competencies of healthcare workers and carers to be able able to use them properly and minimise the risk of opportunistic infections. We will use this project to mark a new phase of development and application of the ebuddi system.

Beyond social impact, how does this project link to Boehringer Ingelheim’s core business?

Patient welfare and safety is at the heart of BI's human health business, and infection prevention and control is a theme that underpins both human and veterinary care.

However we think there are broader, more strategic reasons why the MiiHealth Initiative could be of strategic importance to BI.

In the McKinsey article ‘How pharma can win in a digital world’ McKinsey consultants spoke to 20 leading executives to find out how they cope—and what they do to stay ahead. The backdrop to this research was that in 2014, digital health investments topped $6.5 billion, compared with $2.9 billion a year earlier.
The sheer scale of this investment raises the question for pharmaceutical companies as to how to ensure their investments leverage existing insights and open up new opportunities for adding value to their health solutions.
The article highlighted the fact that there is a consensus that: ‘as healthcare continues to digitize, pharma companies must transform themselves in basic ways to stay competitive. Successful ones will rethink their business and operating models, transform their cultures and capabilities, and adopt a new, longer-term mind-set that fosters innovation and bold strategic moves.
The article concluded that winning will involve ‘developing a collaborative culture and challenging barriers to sharing, and reinventing companies by building capabilities beyond traditional healthcare and updating the operating model.’
A co-creation project with MiiHealth could be of strategic value in 3 main ways:
1) Adding value to the service proposition and improving health outcomes
Dr. Krishna Yeshwant of Google Ventures pinpoints the challenge in this potential future: “For pharma, there comes the question of whether they can tie digital to the assets they have. There is an interesting broader conversation to have with pharmacos about moving from a products-and-pills company to a solutions company.”
The associate director of US medical affairs of a global pharma company commented “One of the most exciting values of digital to the pharmaceutical industry is how technology may be able to supplement or support pharmacological therapies to more effectively address the problem of suboptimal outcomes.”
This latter point is exactly where MiiHealth could help, tying in data on competence and compliance to health outcomes. Because the training can be provided on tablets, there is the potential to link competence with GIS data which can then be linked through to health outcomes. This opportunity to link health outcomes to GIS data through to compliance and competence could be as significant as the use of health economics data to improve the cost effectiveness of clinical practice.
This is based on almost 30 years of insights involving health economics which started in 1987 when I led a collaboration with Prof Alan Maynard at York University for Smith Kline to look at the cost effectiveness of different vaccine strategies. This became one of the pioneering studies within the pharmaceutical industry on health economics.
2) As a tool for empowering the carer within health and social care
This recognises that where healthcare takes place is changing. As BI UK pointed out in their White paper ‘Empowering the carer within health and social care’ what the NHS needs to deliver to survive as a 21st century institution, includes taking care out of the hospital and back into the community, wherever possible. This will require giving the families and carers the knowledge, confidence and competence to care effectively and keep their patient, themselves and the rest of the family safe. This is true for most markets – not just in the UK.
3) Emerging markets – drivers of growth
The McKinsey Insight article ‘Africa: A continent of opportunity for pharma and patients’ concludes: ‘In a world of slowing and stagnating markets, Africa represents the last geographic frontier where high growth is still achievable. As ever, the key to success lies in understanding individual markets in granular detail. Early movers with the right approach should be able to capture competitive advantage. Africa will continue to grow for the foreseeable future. Now is the time for drug companies to decide whether they want to be part of that growth and, more important, play an active role in improving public health.’
A key driver of growth has been Healthcare capacity. ‘Between 2005 and 2012, Africa added 70,000 new hospital beds, 16,000 doctors, and 60,000 nurses. Healthcare provision is becoming more efficient through initiatives such as Mozambique’s switch to specialist nurse anaesthetists and South Africa’s use of nurses to initiate antiretroviral drug therapy. The introduction of innovative delivery models is increasing capacity still further.’
Building local capacity and ensuring compliance in the use of pharmaceuticals is key to growing, sustaining market development and market leadership in these fiercely competitive emerging markets.
The 2014 McKinsey article Healthcare’s digital future concluded:
‘Digitally enabled healthcare is here, and most pharmaceutical companies aren’t ready. Despite access to unprecedented data and technologies that can be used to drive better health outcomes by influencing customer behavior, few are truly exploring digital-engagement models. The opportunity to learn more about consumers and develop better, more targeted products and services far outweighs the threat digitization presents companies—for now. Unless incumbent pharmaceutical companies move quickly, innovative competitors may grab a greater share of benefits and stronger customer loyalty.’

What are the specific inputs and actions that each side will contribute to this Co-Creation idea based on each of your unique competencies and experiences?

My organization will contribute:
Prototype platform / product which has been developed for West Africa for training and assessing compliance.
Global health network with International organisations and policy makers
Potential insight into the learning journey through the ebuddi analytics, as well as broader insights into innovation and digital health

Boehringer Ingelheim may be able to contribute:
Its own insights into healthcare compliance and patient / carer centric care
Investment in the service
lessons learnt from virtual veterinary academy and its other digital health initiatives.
Support with competency evaluation and building evidence base around improved patient safety outcomes

Please describe the potential revenue model for this Co-Creation idea.

Fee for service based on use of the training module as well as 'contextualised performance support' .
Insights into the training programme can be derived from analysis of the data profile from the individual learner as well as training programme.

As the data set grows with time and scale, the analytics will provide ever greater insight and scope for adding value to the customer (be they in the public or private sector).

What possible risks or challenges do you foresee?

Ensuring appropriate contextualisation of the learning material
Ensuring an appropriate balance between maximising access to ebuddi as a training tool for frontline workers in low income countries as well as generating revenue from wealthier countries - not unlike the challenge around anti retroviral therapy.
Responding to the need to enable the training to be accessible on a specified tablet to a 'Bring your own device model'

Is there anything else you would like to share about your Co-Creation idea?

We have interest in our approach from health agencies in:
- the US (agencies addressing the challenge of health security and outbreak response
- Europe (EU DG Sante and the European CDC), as well as expressions of interest from a number of healthcare Ministers,
- Africa
- Asia
Our specific is global and the team has already been involved in initiatives which have sought to reshape the global health agenda

How much input do you hope to receive from Boehringer Ingelheim?

I’d like to implement together.

If you selected "other" above, please explain:
Besides Boehringer Ingelheim, what other types of partners might be valuable to carrying out your Co-Creation idea, and why?

Agencies involved in global health policy and practice - with a particular concern about infection prevention and patient safety. These include:
Public Health England
Department of Health
WHO Patient Safety Group
ECDC (European Centre for Disease Control)
EU DG Sante