Institute of Global Health Innovation

The majority of people who die every year would prefer to die at home, yet only about half achieve this.

This is often due to not being able to manage symptoms at the end of life. People often have to wait longer than what feels acceptable to them for district nurses to come and administer injections. When this happens, symptoms can escalate, carers and patients can become distressed and families lose control of the situation. (more…)

Read Palliate, a digital tool to support community end-of-life care in full

It’s been almost a month since Imperial PhD student Sam Tukra won IGHI’s Student Challenges Competition (SCC).

His healthcare innovation, Third Eye Intelligence, an artificial intelligence (AI) driven platform that predicts a patient’s risk of organ failure impressed the competition judges. Sam’s pitch earnt him the top prize of £10,000. But behind every start-up, there is a journey full of twists and turns.

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Read Third Eye Intelligence: Buying time for people with organ failure in full

By Laura Braun, co-founder of Capta, 2018/19 winners of IGHI’s Student Challenges Competition

Parasitic worms affect more than one sixth of the world’s population (WHO). They target the most marginalised communities that lack safe water, sanitation, and health care. These worms, including hookworm and the flatworms that cause schistosomiasis, are contracted through contaminated water, soil or food.

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Read How IGHI’s Student Challenges Competition helped us in the fight against parasitic worms in full

Nobody should have their quality of life limited by hearing loss. But if your hearing started to deteriorate, would you know?

Hearing loss can remain undetected and untreated for a long time. But if identified early and treated effectively, those with hearing loss can continue to communicate with the world around them and have meaningful experiences in all aspects of their life. This is one of the major messages that this year’s World Hearing Day is focused on, under the theme “hearing for life”. (more…)

Read How birdsong is helping raise awareness of hearing health in full

It was Christmas time three years ago when Amy experienced a stroke. Amy was enjoying her retirement, having spent her career working in publishing. But the stroke took away her independence, paralysing her left arm such that she needed full-time care. This isn’t an uncommon outcome: some 80% of people experience difficulty using their arms after a stroke.

Amy spent the next four months in hospital, the beginning of a long road to recovery.

“The rehabilitation I received in hospital mainly focused on walking, but it was my hand that I really needed help with,” she says.

“And I wasn’t told that if I didn’t use my hand that I would lose function of it.”

When Amy returned home she needed full-time care and regular rehabilitation sessions. But with an overstretched health system burdened by an ageing population, Amy wasn’t able to access the recovery support she required at home.

“I was glad to get out of hospital, but I couldn’t get the help I needed and felt very hard done by,” she says. “I had to take charge of my own recovery.”

Spotting gaps in stroke services

Amy joined a local network called LEGS (Local Exercise Groups for Stroke), a charity that offers physiotherapy-led rehabilitation for stroke survivors. It was here that she met Ella Gibbs and Gianpaolo Fusari from our Helix Centre, who were working on a solution to help people like Amy.

“Stroke is the leading cause of disability in the UK, so we were really motivated to work in this area and find out where we could use design to make a difference to people’s lives,” says Gianpaolo, senior designer at Helix, an innovation lab for healthcare.

“We wanted to learn more about what happens both in the hospital and in the community, so we shadowed teams of therapists on wards, linked up with various charities and also observed rehabilitation sessions in the home environment.”

It was the latter scenario where Gianpaolo realised there was a major gap to be filled.

“We followed early-support discharge teams, the therapists who go to people’s homes five days a week for 45 minutes to do intensive therapy,” he says.

“It’s a really great service, but only about 20-30% of eligible people receive it because there aren’t enough therapists to go around.”

A numbers game

The team ran workshops with patients and healthcare professionals to further flesh out people’s needs after stroke and better understand their feelings. It became clear that the lack of help at home was a real roadblock in people’s recovery.

“People felt unsupported after their formal rehabilitation programmes ended,” says Ella, physiotherapist and clinical researcher. “They were afraid to do some exercises at home for fear of injuring themselves. And they didn’t have any way of monitoring their own progress. The same goes for the therapists, who couldn’t see whether their patients were sticking to their exercises between sessions.”

Evidence suggests that stroke survivors need to perform hundreds of exercise repetitions every day to recover the function of their affected limbs. But even for those fortunate to be eligible for support at home, typical therapy sessions simply aren’t long enough to achieve those kinds of numbers. So rather than looking for an unlikely solution in these narrow windows, the Helix team began to focus on life outside of therapy. They wanted to help people help themselves – empowering them to take charge of their own recovery.

“There’s increasing emphasis on this self-management aspect of treatment for people with longer-term conditions,” says Jennifer Crow, an occupational therapist at Charing Cross Hospital who has been working with Helix on the project.

“Because people aren’t going to get a therapist’s help every time they need to do something. There simply aren’t enough of us. I believe self-management has to be the way of the future.”

A recipe for rehabilitation

Working with some 200 patients and healthcare professionals like Amy and Jennifer, the Helix team created a digital tool – OnTrack Rehab – that enables self-management of stroke recovery.

This platform couples a smartwatch app with tailored coaching to help people own their rehabilitation journey at home. The app works like a step counter. It tracks minutes of arm activity through an algorithm developed specifically for stroke survivors, whose arm movement differs from healthy individuals’.

“That’s the ‘secret sauce’ of our innovation,” says Gianpaolo.

The device displays these minutes to the user, alongside a daily goal and what they achieved the previous day. The app also sends the user tailored messages – depending on how active they are – to motivate and encourage them.

“It’s great – it reminds you to use your hand,” Amy says. “I think you need constant reminding that it’s there and needs to be used. I think it’s helped me to be more aware of that.”

Earlier versions of OnTrack showed users much more information. But testing sessions showed that people found it overwhelming and difficult to make sense of.

“What really struck me was how the Helix team really listened. Not just to us, the therapists, but to the patients as well,” Jennifer says. “Throughout this project they’ve always taken on board our suggestions, so that the next time we see them, they’ve made appropriate iterations. So much other research is done without any prior consideration of patients’ actual needs, which is so important.”

No single silver bullet

OnTrack shares the activity data it gathers not only with the users themselves, but also with their therapists. This offers a window into what happens between therapy sessions. The OnTrack team also uses this information to provide regular, tailored coaching sessions, which the therapists consult on.

By motivating people to better engage with their rehabilitation at home, OnTrack hopes to complement therapists. And ultimately, reduce the need for therapy sessions, which are in scarce supply.

Results from a pilot study in 2018 with 10 people showed an average increase in activity of 20%, which equates to roughly an extra hour of arm activity per day. While promising, the team can’t be sure that this improvement was due specifically to OnTrack. That’s why they’re now carrying out a more robust feasibility study with a larger number of patients and an independent evaluation.

The road ahead

Despite the years of research and development so far, it’s still early days for OnTrack. The team has more to do to refine the product and its features. They also need to demonstrate its impact on rehabilitation outcomes at scale. But if trials support its use, Gianpaolo has high hopes for the platform.

“In the short term, we want to see how it can integrate with NHS practice, becoming part of the services offered to stroke survivors here and hopefully in other countries in the future,” he says. “We also want to explore whether we can adapt OnTrack for rehabilitation in other areas. For example people living with Parkinson’s disease.”

The OnTrack team is excited for the road ahead and to helping many more people like Amy recover from stroke.

This work has received funding from the NIHR Imperial Biomedical Research Centre. Read about other Helix work here. 

Read Empowering stroke survivors in their own recovery in full

People complain for a variety of reasons. But international evidence consistently finds that most people complain to prevent incidents from happening to others – they want to see change as a result, when they feel something isn’t right. Making a complaint can therefore be an empowering process, if people know – or feel – that their actions could make a difference.

Dealing with complaints is an important learning process for those that the complaint is directed against, but also the institution more widely. They can highlight problems that may have otherwise slipped through the net, prompting action that can prevent the same mistakes happening again and affecting more people.

That’s why complaints are such a valuable resource for health systems. They’re a gold mine of information that represents people’s unfettered thoughts, feelings and real experiences with health care, representing an important opportunity to reflect, learn and improve.

But they can also be messy.

People’s unstructured feedback is difficult to navigate and laborious to extract meaningful insights from, particularly since the NHS receives some 570 written complaints every single day. Arguably, though, this is part of what makes the feedback so valuable.

“The unstructured nature of feedback is what provides the complexity,” says Pip Batey, designer at our Helix Centre. “But this complexity is also the value. Written feedback, especially complaints, are a rich narrative of personal experiences across multiple touchpoints within the system; hospitals, GP surgeries, community services, etc.”

So how do healthcare professionals begin to make sense of this melting pot of data?

“One solution is to categorise or ‘code’ this data to make it structured, so that it can be analysed more efficiently and, in turn, fed back to hospital wards in a meaningful way that can prompt change,” says Jackie van Dael, PhD student at IGHI’s NIHR Imperial Patient Safety Translational Research Centre.

“This is exactly what the Healthcare Complaints Analysis Tool does. The issue is, it’s a well-kept secret among the complaints community. We want to drive greater engagement with this tool so that patients and families can have a greater impact on health systems, and we hope our new platform, Feedback First, will help towards that goal.”

A catalyst for change

Developed at the London School of Economics, the Healthcare Complaints Analysis Tool (HCAT) is a coding method that allows organisations to standardise the way they analyse patient complaints, and thus turn them into an effective springboard for improvement. It’s a powerful tool with great potential, yet this has yet to be realised across much of the healthcare community.

Many professionals aren’t aware of HCAT, which is in part due to the fragmented nature of the complaints community.

Professionals therefore have little opportunity to come together to share best practices, meaning few people know what works well and what doesn’t. Added to this is the fact that patient experience data exists in siloes across the NHS, taking many different forms such as complaints, PALS, social media comments, the Friends and Family Test, among others.
Cognisant of these issues, Jackie’s and Pip’s teams came together to find a solution that could help leverage HCAT and increase its potential as a driver of quality improvement.

The researchers interviewed and shadowed a range of people, from HCAT users to patient complaints teams, and coalesced all of this information to identify emerging themes and pain points.

“We then ran a number of workshops with different users and stakeholders – clinicians, members of complaints teams, patients and the public – to try to figure out people’s priorities and needs,” says Pip.

“We started off just looking at patient complaints, but then we realised these are part of a much wider world of patient feedback.”
One major finding, Jackie says, was that staff didn’t feel empowered to give feedback to their colleagues because there was a lack of consistency and clear policies on doing so.

“This work highlighted the need for a common language that can align the feedback process and profession, and a way to highlight existing evidence on best practices to give them credibility,” she adds. “This will, in turn, provide patients and families reassurance that their concerns are listened to, and learned from.”

A spotlight on patient complaints

The team’s solution is simple. They’ve created a web-based platform for the feedback community – a toolbox for Trusts, researchers, and patient experience organisations to unite, share and learn. The idea is that this website, Feedback First, is a one-stop-shop for users to discover best practice tools, like HCAT; explore evidence that demonstrates the value of these tools, and connect with others who are seeking to make the most of patient feedback.

“By including a community section on the website, we hope to encourage people to take ownership of feedback, recognising that it’s everyone’s responsibility,” Pip says. “We’re also aiming to be a collaborative hub so that partners can join and bring in their analytical tools, enabling people to make sense of lots of different types of feedback data.”

No longer is the task of crunching thousands of comments seemingly impossible. But the end goal goes further than analysis. Ultimately, the team wants to use this data to trigger positive change in hospitals.

“In addition to traditional case-by-case complaint resolution, we want to help Trusts to systematically monitor trends in complaints data so that they can identify, for example, recurring or high severity complaints across the board,” Jackie says. “A tool like HCAT can help hospitals to visualise patient complaints data they get from using these tools. We call this ‘spotlight’ analysis.”

Scan, zoom, dissect

Spotlight analysis allows researchers to scan the high-level trends to spot areas that should be probed in finer detail. By performing further in-depth analyses of patients’ journeys through care, teams can then pick out lessons that Trusts can learn from and act on to prevent similar situations from happening in the future.

“It’s an antidote to the often fragmented and clinically-focused quality and safety data that is used in healthcare,” says Jackie, “which can be somewhat limited in providing a comprehensive picture of incidents or negligence.”

Our researchers hope these tools and techniques can enable Trusts to tangibly show how they’re responding to patients’ voices, and track the impact that resulting changes are having. It’s about listening, learning and improving.

It’s still early days for Feedback First, but the team hopes that growing this community is one important step towards safer, better quality healthcare.

If you’re interested in partnering with Feedback First, please contact Jackie (j.van-dael18@imperial.ac.uk) or Pip (pip@helixcentre.com) to find out more about this opportunity.

Read Feedback First – making patient complaints easier to digest in full

This week we’re opening applications for IGHI’s annual Student Challenges Competition. We’re inviting aspiring global health innovators to submit their project in a bid to win £10,000.

To help budding student innovators get started, IGHI Visiting Professor and former BMJ editor Dr Richard Smith reveals his most essential pieces of advice.

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Read Words of advice to student innovators, by Dr Richard Smith in full

Every Christmas, researchers from IGHI’s Hamlyn Centre gather to show off their latest innovations in robotics and healthcare technology.

We caught up with some of the team to find out more about their research, and how they hope it could make a difference to people’s lives.

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Read 5 innovative pieces of healthcare tech we learned about this Christmas in full