Projects blog – Clinical Innovation Fellowships

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Business Modeling and Prototyping: The Final Stage In Our Clinical Innovation Journey

Posted on January 3, 2022 by Mahmoud Tohamy - CIF 2021

Over the years the process of figuring out if the idea will work and become financially stable was an extremely expensive and time-consuming experience.

In our fourth stage of the Clinical Innovation Fellowships program 2021, we went about to discover how to prototype our idea and how to make a valid business model.

Let’s first dive into the Business Model Canvas!

Business Model Canvas is one of the most famous and reliable tools for entrepreneurs transforming their ideas into actionable plans.

The tool enables the entrepreneurs a clear idea about every aspect of their business, starting from the target segment, value proposition, operations to finance. Its efficiency is related to its simplicity; presented as nine simple boxes for each segment.

What really happened in this stage took us about a month and a half. We started with a clear objective: enhancing the blood supply chain in Egypt, putting our main need statement ahead: “A way to improve the efficiency of hospitals to find needed blood products to avoid the delay and cancelation of procedures.”

We started by analyzing the main stakeholders, including public, private, and non-profit hospitals, then we identified three assets:

Stakeholders Map
Stakeholders Persona
User Journey for each stakeholder; what are their pain points, opportunities, and actions

In order to identify the problem further, we made an insightful exercise called Service Blueprint. It is a diagram that visualizes the relationships between different service components: people, props (physical or digital evidence), and processes — that are directly tied to touchpoints in a specific customer journey. This exercise made us understand the problem more clearly and grasp the main touchpoints that we should focus on.

Afterward, our next steps took us to research the globally existing solutions for improving blood supply chains. We explored how the problem is being tackled and recognized our prospecting competitors in the field.

A brainstorming session was also helpful for us to utilize the knowledge we reached into a practical solution. Ultimately, we settled on the solution that we as a team believe it can resolve the problem.

We made a prototype and a structured roadmap to measure and validate our idea; The roadmap we put comprised the following:

· Technical feasibility

· Competition

· Unique value proposition

· Customer feedback

And here was a new phase! We reached out to all the stakeholders we interviewed during our primary research to present our solution and get their feedback. What we encountered was a bit surprising as the market is absolutely competitive. After those interviews, we took a step back to discuss as a team if we will do the pivot.

With the support of our mentor Ahmed Yosry, we reached that we need to focus on one stakeholder that the problem impacts the most, and it was the private hospital sector. This sector can benefit from our solution supplying it with a specific yet rare blood type. From there, we can then have a roadmap to connect the other stakeholders to the solution later on.

We put the prototype and reached private blood banks with our solution. The first verbal deal we got was with one renowned private hospital. We also started a short-termed campaign to validate the interest of the donor. The results were optimistic! We received responses from the rare blood type donors who were ready to donate. So, we put a new roadmap to mark our milestones and see what we need to do to reach them.

This was a key moment for us! Our idea is valid and it can work!

In the end, I want to say it was a fruitful journey for me, with its ups and downs, I learned a lot, in a few months, how the public health sector works; That could have taken years for me to learn on my own, thanks to the educational resources that the program provided through its respectful base of experienced mentors – We can’t be more grateful to them for supporting us in every stage over the course of the program.

The Clinical Innovation Fellowships Program was a life-changing experience for me!

Mahmoud Tohamy, Clinical Innovation Fellow 2021

Paving The Way For Breakthrough Solutions

Posted on December 20, 2021 by Nada Mamdouh - CIF 2021

The iterative process of creating ideas, prototyping, validating, and developing concepts

By the end of the needs screening phase, we landed on five top commercial needs that tackled completely distinct challenging areas within healthcare. In parallel, we attended a session arranged by RISE to introduce the “concept generation” phase to the team. However, after weeks of needs filtration, research, and analysis, I found it the starting point of making each of us back on the same page. The session included practical exercises on practicing brainstorming as individuals to make each one of us able to contribute to the team’s benefit regardless of our backgrounds.

On the other hand, as a team, we were overwhelmed by the number of needs and the urge to make a final decision that would impact the program positively later on. Personally, I was more empathetic to some needs than others. However, I kept this on hold when applying the scoring matrix and group voting and supported my opinion objectively concerning patients and healthcare system benefits. Later during the decision-making session, we found that we had similar viewpoints on the exact needs, which leaped towards the top three. Afterward, we started setting a plan from the concept generation phase, where all our past observations, insights, research, and spark previously thought ideas come into action.

As a designer, at this stage, I felt recharged to start developing an optimum solution and put all of our prior efforts to good use.

Practically, we started the concept generation phase by sharing all of our background information regarding the top commercial needs with one another as a team. As understanding, the problem acts as the first milestone in creating concepts. Afterward, in parallel, we started working on the root cause of the needs, researching the established solutions, and brainstorming ideas.

The new learning I acquired during the brainstorming exercises was applying the thinking patterns of other industries to our needs. For instance, applying the “barter” pattern to the shortage blood donation challenge. Honestly, this helped us foster new innovative ideas since it acted as a breakthrough when we started getting stuck in repetitive fragmentary ideas. When we applied this method as a team, each of us came up with an average of 15 ideas. Most of the ideas were new, though.

To make the best use of that excessive brainstorming, we wrote them down in simple words on sticky notes to present each idea solely. We then started clustering them to establish categories and refine the individual ideas by building them on each other to develop a mature concept.

One important key factor that turned this concept generation coaching sessions into productive and successful ones is the “brainstorming session rules,” which are referred to by IDEO in the Biodesign book. They pushed us forward to defer judgments on each other’s ideas, stay focused on one topic at a time and go for the quantities in creating ideas rather than perfecting in being visual. We had to run the same exercise on the remaining new needs since we first applied it to only one need. After that, we finally had to choose the lucky need, which we would pursue working on over the rest of the program. Ultimately, we selected a need that tackles the blood supply chain.

As the Biodesign book goes, we as innovators should experiment with diverse methodologies during the concept generation phase. So, we started doing root cause analysis for our final need, framing questions that we need to figure answers for, converting our need statement and criteria to a series of focused questions. For instance, how might we (HMW) convince eligible donors to donate? Based on those questions, we started running brainstorming sessions, each focusing on a question.

Part of being visual is turning our ideas into quick prototypes to express them to the team and seek feedback.

The concept generation phase was so iterative that we rephrased our need statements more than twice upon new insights that we kept discovering during concept testing and validations.

Practically, we have a need statement that sounds convincing at first. Validated with research, we start ideating and getting quite reasonable solutions; we validated on the ground by covering different healthcare sectors and realized this is not the root yet and so forth. After loops of learnings, iterations and by developing a list of pain points, getting back to our need criteria, and considering the actual market constraints, we ultimately landed on a need statement that we are confident of by many proofs.

So, this brings us steps backward to the creative ideation process, but this time it was more efficient since we had way fewer doubts and neglected market concerns. We turned our top ideas into prototypes and became ready to screen them. The ideas were between service and products, which involves technical and physical solutions. They all sounded promising at first, yet each solution solved the problem at a certain point in the patient journey. So, we decided to consider them as stages rather than ideas that could compete against each other. So, the questions were, where is the most required to intervene and make a difference? Which problem is the most crucial at the moment to start with?

It was crucial not to get biased and try being objective-oriented as much as possible. Through the priority matrix with feasibility, desirability, and viability, we chose our final concept. Nevertheless, we kept developing it along the validation process. We started getting solid validations from healthcare representatives, which pushed us towards planning for our strategy and business model.

It was so engaging that we did a lot of tasks that involved physical interactions, from presenting to prototyping, and validation, seeking more understanding about the blood supply chain. From my perspective, the concept generation phase was the most challenging yet the best enjoyable and rewarding.

Nada Mamdouh, CIF Fellow 2021

Interpreting Needs Through Eliminating Illusions

Posted on October 13, 2021 by Ashraf Hosam Ibrahim - CIF 2021

The process of understanding real needs behind assumptions

During the clinical immersion, I discovered many misconceptions about cardiac patients or cardiac diseases in general, like assuming their needs are only in blood or money; this came from the donation advertisements and campaigns on TVs or social media platforms. Here, the illusion came that cardiac surgeries are like any other surgeries that only need physicians’ interference and treatment plans – but there’s much more than that running the backscenes.

We finished the clinical immersion phase by finalizing our need statements through root cause analysis and following our gut feeling of how real the need is. To benefit from being in a multidisciplinary team, we usually start each phase with a long meeting to share insights and look at the same task through our different backgrounds.

After finishing the need statements, we followed the Biodesign book, which helped us understand the actual value of each need through topics and attributes to search about, which made us go through three stages.

We kicked off the needs screening phase by removing duplicates and merging similar ideas to break down general needs into specific, clear sub-needs. Then, we separated the local needs from commercial ones and identified needs that can work as both local and commercial.
Our local needs screening process was based on research, current running projects in Al Nas hospital, and reference group meetings to discuss, prioritize and select the most critical needs for the entity and offer suggested solutions.

For the commercial needs, it took three stages of research, with a new set of topics in each round:

Stage 1

We examined our gut feeling, researched, validated, and opted into team votes and interest, which emerged from our acceptance criteria. Ultimately, we went from 150+ needs to about 50+ needs.

Stage 2

We spent most of our time and consideration understanding that this is the core of what would come in the following phases. So, we shuffled needs among us to have external eyes in each step.

We also followed the BioDesign book and researched topics like disease state fundamentals to understand the problem and its impact further. That’s besides seeking validation from our mentors during our follow-up meetings. We also looked up the treatment landscape to know more about the available solutions that have already addressed some of the needs and their impact on patients and healthcare providers. Additionally, we conducted thorough market research and inspected the market size. Ultimately, we concluded 20+ valid commercial needs.

Stage 3

We created a metrics-weighing system based on the attributes of Stage 2 to sort and rank needs and compare their numeric values, then we selected our top 3 needs (1 main focus and 2 for backup).

After all the different needs that we identified, screened, and cascaded, we became one step closer to conceptualizing our solution, achieving one of our common goals, which is adding value for patients and enhancing the services provided to them.

Ashraf Hosam, CIF Fellow 2021

Eye-opening Immersion Experience: What’s Behind The Scenes of Saving Children from Heart Diseases

Posted on August 13, 2021 by Hadeer Hegazy - CIF 2021

Since 2016, I’ve been working as a nutritionist at the Children’s Cancer Hospital 57357, one of the world’s largest, most diverse, and dynamic facilities for treating pediatric cancer and the clinical host of the Clinical Innovation Fellowships’ first cohort in Egypt. There, during my work last year, I saw the fellows 2020 at our workplaces, observing and experiencing our daily activities by themselves. Their persistence to spot challenges encouraged me to apply for the program in its second year in Egypt; I was sure that I’d observe and learn about medical perspectives that I’ve never encountered before. And yes, that was true!

Through my participation in the program, I have had my first time dealing differently with patients. It was my first time putting myself in their shoes and feeling their suffering from critical diseases. This was during our six-week immersion experience that took place at Al-Nas Hospital, one of Egypt’s and Africa’s renowned medical centers specializing in Pediatric Cardiology.

As a healthcare professional with experience of more than 12 years, mainly in pediatric oncology, the Clinical Innovation Fellowships Program allowed me to touch the real life of healthcare in Egypt for the first time by witnessing the backscenes of its operations. During the clinical immersion period, I have learned to observe and track the patient through their journey following the Stanford Biodesign methodology. But even more, I saw a significant difference between the healthcare professional perspective and the patient perspective.

We are a transdisciplinary team of four fellows with different educational backgrounds. Being part of such a team has been a value-adding to my whole career path!

At first, we worked in pairs; I had the chance to work closely with Nada our Product Designer, together we explored the hospital’s environment from the Cath-labs to the Outpatient Department. Then I discovered with Ashraf, our Software Engineer, how the hospital’s integrated systems work. With Mahmoud, our Business Development expert, I could see possible solutions for the real challenges we observed.

Together, we interviewed the patients, and each of us saw the patient journey from a different point of view – and this was extremely interesting! After each interview, we had a discussion to show our insights and exchange knowledge. And I was always impressed with the small details my colleagues noticed – which are hard for a medical background person to pay attention to during the daily routine work.

From my side, I was keen to deliver the medical information in a simple way to my teammates, explaining each process, acronym, or medical term mentioned by the hospital staff during our interviews. On the other hand, we had periodic reference meetings with a group of representatives from each of the hospital’s departments to validate our insights. They were more than supportive of us!

All healthcare service aspects are in focus

In fact, following the Stanford Biodesign methodology allowed me to gain hands-on experience in how to effectively keep an eye on patients, their relatives, and healthcare professionals to compile appropriate insights that could be translated to real needs and thereby transformed to tangible solutions.

Especially for the immersion phase, this revealing experience, it’s been a new window for me as a medical person to observe and try to solve the impact of a disease on different parties – the patients, the healthcare professionals, and the whole of the healthcare system.

However, I feel optimistic because, together with our different backgrounds and collective efforts, we can innovate a solution that can make a difference in the patient journey and enhance the healthcare systems!

Hadeer Hegazy, CIF Fellow 2021

The Journey to Identify if Patients Really Need this “NEED”

Posted on April 13, 2021 by Amr Yosef Diab - CIF 2020

Our process of validating and shortlisting a myriad of clinical needs for a better healthcare service provision.

After having an intensive one-week workshop to understand the Stanford Biodesign methodology and how to implement it, we started our Clinical Immersion experience, which took six weeks in the Medical Informatics department at 57357 Hospital. It is a cross-cutting department, responsible for the implementation, maintenance, and support of the health informatics system (HIS), Enterprise resource planning (ERP), Patient portals, and other homegrown software that serves patients and other stakeholders.

We were lucky to be immersed in this department; it serves nearly every stakeholder in the hospital which enabled us to go everywhere inside the hospital and talk with everyone to hear more about their needs, pain, and thoughts.

We gathered a lot of observations and needs – to be precise: 985 observations and 234 Needs. Then, we faced a new challenge: We had tons of Data, but we needed to know which of them is desirable, viable, and feasible.

So, it was time to move to a more critical and analytical mindset. We went through a complicated process that was guided with the Biodesign process and we were able to build around it our own tactics to identify the valuable needs, which was a blend of qualitative and quantitative measures.

Working in a multidisciplinary team had a great impact; there was always someone that either has the answer or at least has the basic knowledge that he can with some research build on to find the answer from his perspective. To make use of that and assure that each one of the team gives his opinion about each need, by the end of each stage the ranking was a collective process, each member makes a quick pitch for the needs assigned to him and advocate for his ranking and afterward the rest of the team start building their own ranking.

Our need screening process was divided into 4 stages:

First stage

Our goal was to go from 234 to 120 needs we did so by applying the following.

eliminating replications
merging the needs that can fit together.
and rewriting the needs to make sure they are clear and to the point.

Second Stage

To go from 120 to 80 needs we started by doing a quick high-level research on each one of them to build basic perception and start grading and ranking them according to their feasibility, desirability, and viability.

Third Stage

To go from 80 to 50 needs – the time for digging deeper by doing more in-depth research and identify more specific criteria about them like

identifying the impact on the patient, the caregiver, and the clinical team.
how much each of them is technologically and regulatory globally and locally feasible.
identify how much local and global market size and spending.
not only that but we didn’t forget about adding criteria that reflect how much each one of the team would be excited to work on each of those needs.

Fourth and Final stage

To go from 50 to the top 20 needs and identify the topmost 3 or we call it 1+2) that we should start working on for the next stages. Our approach to making sure that the needs were carefully examined, we did intensive cross research; Each one was doing intensive research for needs that were examined by another member in earlier stages to make sure the results are correct, covered in more depth, and not biased, then reranking took place according to the new inputs.

Now, we know what matters the most and it’s our turn to channel all our power, experience, and knowledge to do something that might relieve some of the pain people are suffering and are willing to do it.

Amr Yousef
Team Bioinformatics, CIF 2020

Sliding through the Journey of Clinical Innovation

Posted on March 2, 2021 by Sherin Helmy - CIF 2020

The immersion in the Children’s Cancer Hospital Egypt 57357 (CCHE) was really eye-opening for me. Coming from a design background with an interest in the medical field from a young age, getting to experience clinical care was such a treat. It allowed me to see firsthand how a hospital works to provide clinical care to its patients. It also allowed me to talk with patients and guardians directly and understand their experience of a vicious disease such as cancer and how they navigate the healthcare system in Egypt.

Design as a discipline taught me how to effectively empathise with the patients and their guardians to be able to collect proper and actionable insights that could be translated into needs, the heart of the Biodesign methodology. I was very pleased to employ this knowledge in a real-life situation and one with that kind of importance.

But what was even more rewarding while sometimes becoming draining, was speaking with the patients’ guardians. Listening to their stories and the difficulties they face was the driving force for our work. One can’t help but feel utter respect for their resilience and strength they continue to show despite the adversity.

Afterward, we moved to the needs screening phase. This phase is when we really started to crunch our on-ground research findings. It’s when we got to apply our critical thinking and collective knowledge as a team to coin our own screening process. We tried to employ both meticulous grading structures with the more organic team discussions and decision rounds to get the best of both worlds and finally reach the top needs that are backed by enough evidence and we are happy with, as a team.

Next, was the concept generation phase, the phase when the fun really begins. It’s when we get to work on the top needs and try to come up with the best solutions. It’s when I get to have the most fun! Definitely the most enjoyable part for me. I get to be playful, focus on using creative methods, mention all kinds of ideas, even the stupid ones. How I see it is this is when you move from the research and giving form to those findings. I get to sketch, use all kinds of design tools while having some childish fun!

Throughout the fellowship, we, as teammates, got to know each other better as individuals on both the professional and personal levels. And as it’s always the case, it had its ups and downs. Having so many discussions, many of them on the heated side was bound to create conflict, but that also shows the great passion that each member has. And once we sat together and talked, we were able to resolve matters and understand each other better, making the communication process better and better moving forward. Having said that, those discussions are among my favorite parts of the process. It’s those discussions that allow us to come up with the best concepts by building on each other’s ideas. Moreover, it’s important to have teammates to rely on in an unstable process such as the innovation process. It’s a road filled with uncertainties and obstacles, hard to go through alone. I’m grateful I found that kind of support in my team.

I must say, I’m utterly grateful for this experience as a whole. I got to follow my passions, learn new things, meet amazing people, and these are invaluable things, really hard to come by.

©Media Team of the Children’s Cancer Hospital in Egypt 57357

Sherin Helmy
Team Bioinformatics, CIF 2020

In the Footsteps of Thomas Edison

Posted on February 16, 2021 by Dina ElDisouki - CIF 2020

A lot has happened since our clinical immersion at the Children’s Cancer Hospital Egypt (CCHE 57357). During our 6 weeks at CCHE, we witnessed 678 observations, which helped us identify 314 unmet needs. After pinpointing all these needs, we faced a perplexing conundrum: how can we choose only ONE need to try to solve when each need presented an opportunity for us to innovate and improve? Also, how can we prevent ourselves from falling in love with one of the needs and remaining attached to it prior to fully understanding each of them? And, most importantly, how can we validate whether that need truly is THE most important one to tackle?

Where the Needs Screening stage falls on our timeline.

And so we embarked on a journey to choose just one need through a rigorous, objective process of screening to identify opportunities and challenges…

We studied the disease state fundamentals of the needs…

We analyzed existing solutions…

We mapped the influence and interest of the stakeholders involved…

We evaluated the market…

And we challenged ourselves repeatedly…

We challenged ourselves to not be biased towards a need…

We challenged ourselves to not jump into coming up with solutions…

We challenged ourselves to postpone inventing…

We challenged ourselves to reject the misconception that innovation depends on magic…

In order to complete this journey though, first and foremost, we had to accept and appreciate our difference in opinions and points of view that stemmed from our different backgrounds; as our team is composed of a diving medicine specialist and technology guru (Amir), a clinical pharmacist turned business developer (Shadi), a product designer with an interest in healthcare (Mayar), and me, a dermatology consultant and a healthcare management specialist (Dina); united together by a common passion for improving healthcare services in Egypt. Stepping into the intersection of our disciplines allowed us as a team to examine each need from multiple perspectives.

As a physician who has been working in the healthcare sector for more than 10 years, it was a unique opportunity and an eye opening experience to see how those from other disciplines view how things are done in healthcare. Despite working in healthcare for so long and witnessing and trying out new technologies and treatments as they entered the market, it was my first time to be in the “inventor’s seat”. This presented as a personal challenge as I had to disassociate from my preformed ideas about the status quo and to accept that I can influence the way things are done. In order to do so, I tapped into my innate curiosity and allowed myself to ask my favorite question more frequently (namely “why?”); and I intentionally became a more active listener as I wanted to hear and learn from the opinion and experience of my team members.

From right to left: Amir, Shadi, Mayar, and Dina.

Through an intense process, we progressively dived deeper into the needs that have the most potential. We narrowed down our 314 needs to 120 needs, then to 50 needs, then to 20 needs. We relied on different methodologies to do so; namely our intuition at times and detailed research at other times. Eventually, we arrived at the five most promising needs which—if we can solve—will have a major impact on healthcare.

Our top five needs were: a way to prevent chemotherapy induced hair loss to improve the quality of life of those receiving chemotherapy, a way to minimize the unutilized drug in the vial to decrease drug waste and save millions of pounds, a way to decrease the patients’ reliance on memory to decrease errors and improve health outcomes, a way to ease peripheral venous cannulation to improve the patients’ experience, and a way to deliver services remotely to traveling patients to increase access to care. We did not expect that choosing one need out of these top five would be the most challenging part of our journey in the needs screening stage.

Now that we have clearly identified the clinical need (the problem, the affected population, and the desired outcome) that we will work on solving, I look forward to starting Phase 2 of the Biodesign innovation process… It is now time to INVENT!

“I find out what the world needs, then I proceed to invent it” – Thomas Edison

Dina ElDisouki
Team Clinical Pharmacy, CIF 2020

From Curiosity to Empathy: Discovering People and Processes in the Children’s Cancer Hospital 57357

Posted on February 5, 2021 by Mayar Morsy - CIF 2020

Just a few months ago I was watching the donation ads for the Children’s Cancer Hospital Egypt (CCHE 57357) on TV unaware that one day I would be standing under its big glass dome and surrounded by its people moving like bees in a hive. And as much as I loved presentations and enjoyed being on stage, the realization of me being there got my hands to be a bit shaky while presenting.

“What does that mean?” was probably the most frequent thing I said throughout the first couple of weeks during our orientation lectures and tours. One of the most important tools that a designer should have is curiosity; to ask and not take things for granted. I once heard that a baby’s brain collecting data is like a sponge absorbing water. And so, it was time to think like one!

I am thankful for my team, Amir, Dina, and Shadi, who constantly educated me and sometimes explained to me medical terms and procedures even before I had the chance to ask about them. At first, it wasn’t easy and there were times when I felt overwhelmed by the amount of knowledge I had to acquire to be able to keep up with my team. Nevertheless, step by step, everything started to make more sense like combining puzzle pieces together to get a meaningful image.

Our immersion started in what initially felt like a marathon to fulfill a certain target. We couldn’t believe we would record so many observations in such a short time. Gradually, we realized it was possible and started to be more focused on certain areas in the hospital such as the Day Care Unit (DCU) where patients receive their IV infusions and chemotherapy, the Clinical Pharmacy where life-saving medications are prepared and checked before their delivery to the patients’ rooms, DCU, or the dispensing pharmacy.

At first, we quietly observed both different procedures and various interactions between the healthcare team members, the patients, and their caregivers. Then, we transitioned from being a fly on the wall to getting a first-hand experience in the complex fabric of the hospital’s operations. One memorable experience for us was entering the IV Mix, where drug compounding takes place, in our caps, gowns, overshoes, and masks.

Although we couldn’t try out the compounding process ourselves, having such a close look into the journey of the drug -from being just a label to being created in the glovebox and finally handed over to be checked and packaged with other drugs before reaching the patient- was simply inspirational. Not only because of its moral value but because the complexity of operations in this department acts as the nucleus to every success in this hospital.

During the last two weeks of the immersion, we focused more on the DCU and its patients. Based on a collection of observations and hypotheses, we felt that it needed a closer look on how things worked -specifically- from a patient’s perspective. I headed to the DCU reception to say hello to Mr. Ahmed and ask for help. He greeted me with the same smile he shows to everyone and that I have witnessed since day one at the hospital. With his guidance and better judgment, I was introduced to a mother whose daughter was to receive chemotherapy that day.

The mother, Arwa (the patient), an older sibling and me -shadowing them- started our journey from that reception desk, passing by several checkpoints such as Radiotherapy, Radiology, DCU and different assessment points in these departments. The 6-hour long journey involved a lot of challenges such as miscommunication between departments, long queues, waiting periods, keeping the children entertained… etc. I strongly believe that the hospital is offering all its best to its patients and their caregivers. However, it is almost certain that an over-populated hospital will have a hard time to pay full attention to and address the patient and the caregiver’s experience and feelings.

Empathy, in many design thinking approaches, is considered the first stage to understanding the patient and accurately identifying problems. And this experience required all the empathy I could generate. I was lucky that Arwa and her family were open about expressing their emotions and did not alter their attitude with me around them and soon enough, I myself was in sync with their mood levels. I was no longer a shadow and was trying to help them navigate obstacles as much as possible. And my notebook became a sketchbook for Arwa during long waiting periods when there was no other option for entertainment.

Despite the long day, the fatigue and occasional incidents of frustration, all went well. I went back home and even though I was quite tired and emotionally burnt out, I was content with the outcome and was looking forward to the next phase.

Mayar Morsy
Team Clinical Pharmacy, CIF 2020

Understanding cancer through empathy

Posted on February 4, 2021 by Hesham Shaltout - CIF 2020

The Clinical innovation fellowship landed in Egypt with an exciting collaboration between RISE, enpact, and EIT Health. On a personal level, this piece of news was very exciting to me. I knew about Stanford’s Biodesign process and I was interested in the fellowship’s implementation of the process through taking a transdisciplinary team from a need in healthcare to business creation.

Our team is a composite of diverse competencies representing the tech industry, design and the medical field. I felt right in place to complement these competencies with my skillset in health research, innovation, and business.

After an intensive bootcamp to get the teams up and running about the Biodesign process, the teams were ready to begin their six weeks clinical immersion in the Children Cancer hospital in Egypt 57357 (CCHE).

Beforehand, our team sat down and discussed our strategic focus. It was fulfilling to see how we all collectively strive to provide value and to innovate for health equity and accessibility.

All the fellows were looking forward to the clinical immersion, we started sharpening our research toolkit and we tried to open our minds to that new realm. We knew that being immersed in an advanced cancer hospital to observe how this giant being function is going to be a novel experience for us.

Our team was hosted by the medical informatics department in the hospital. After receiving a very warm welcome from the hospital’s staff and listening to the hospital’s story by the Chairman himself, the medical informatics team took us in a comprehensive introduction to get a good grasp of the role and responsibilities of the department.

The medical Informatics system in any hospital generally provides electronic health recording (EHR) of its patients and clinical decision support for its healthcare staff. The department is responsible for the implementation, maintenance, and support of the health informatics system (HIS) in the hospital. The informatics system includes Cerner HIS system, Oracle platform, and in-house developed software.

Our team was impressed by the advancements inside the system and the extent of complexity of different hospital functions and how all the pieces of the puzzle fall into place to provide clinical care for cancer patients.

We knew from our first week, that if we want to innovate for the patient, we must empathize not only with the patient but also with all stakeholders around the cancer patient (including guardians, relatives, doctors, nurses, management, and the hospital’s staff). This took shape in several forms, talking deeply with them, walking their walk sometimes and observing like a fly on the wall the other times.

Personally, I spent the first part of the immersion trying to understand the HIS itself. I realized that it is the most sophisticated implementation of modern age technology in clinical care. Moreover, it is a land of opportunities for the future of clinical care.

On the other hand, empathizing with the healthcare staff led us to understand their day-to-day work, the challenges they face, the emotional low points of the workday, and the most fulfilling parts of their job in their noble mission to treat cancer and relieve pain.

The second part of the immersion for me was all about the patient, the core of the system that everything revolves around. I spent time with in the team deliberately observing and interviewing patients receiving the clinical care and caretakers accompanying them, we tried to capture every single detail that affects their experience and emotions.

During our interviews, we met with the psychology team and they welcomed us into one of the group therapy sessions they did for their patients.

In the session, every patient took the chance to talk freely about their experience with cancer, the struggles, and the social and cultural challenges they face. We learned a lot through their words and their detailed description of how illness shaped their lives. For example, they described the havoc that the chemotherapy caused on their well-being and how difficult it was for them to get back to society after years spent in treatment at the hospital.

Moreover, they all mentioned feeling hopeless and lonely at some point and how this tightly knitted group of friends from the hospital kept them going.

For us, that was an eye-opener and caused a storm of strong emotions. It inspired us to try to make a positive difference for cancer patients in our approach to the rest of the innovation process.

We concluded our clinical immersion with a mind full of learnings and insights, we had the chance to capture the whole health system represented in the hospital and more importantly the human as the core of that system who deserves human-centered innovations to attain the best quality of life possible.

Hesham Shaltout
Team Bioinformatics, CIF 2020

Concerning Urinary Catheters.

Posted on September 26, 2019 by Marcus Bilgec - CIF 2017-2018

TEAM GOTHENBURG

A lot has happened since clinical immersion at Alingsås hospital and Lerum commune.

One of our identified needs from the clinical immersion have been on our mind for a while to solve. It causes a lot of suffering for people and expenses for the healthcare organisations around the globe.

Today, let’s talk about urinary catheters.

A catheter is a flexible tube that is inserted into a body cavity or channel to remove or add a fluid. A urinary catheter is a tube with one end in the urinary bladder, and is used for draining urine. One of the most commonly used type of catheters are “foley catheters”, or indwelling catheters. Please see the illustrative figure below. A catheter is inserted into the urethra, and kept in place in the bladder with a 10 ml balloon (a) inflated via a port (d). The two holes in the crossectional picture of the tube in figure b are fluid channels for the balloon and the urine. The catheter is connected via a junction (c) to a drainage bag (f) which is strapped to the wearer’s leg. Urine is collected in the bag, and emptied from a drainage port (g) several times per day into a bottle or directly into the toilet.

And no. They are not comfortable to wear.

Why are urinary catheters so important? 15-25% of all hospitalized patients get an indwelling catheter during their stay at the hospital [7]. Some need it because their natural ability to urinate is temporary not functioning properly because of neurological dysfunction (e.g. after a stroke), anesthesia after surgery or because of obstructing scar tissue or tumors, etc. Assuring a proper flow of urine and thus a proper kidney function is vital [8]. From a palliative care perspective, a catheter gives terminally ill people and frail elders a better quality of life through a higher sense of integrity and dignity, when the alternative is to wear an adult diaper or having to struggle going to the bathroom several times per day and night [9].

The biggest issue with urinary catheters are that they get dirty (big surprise!). As time pass, skin and bowel bacteria start to grow a biofilm on the surface of the catheter, spread and cause urinary tract infections (UTI).

[4]

So, what is biofilm? Remember the last time you went to the dentist? And the dentist said: “You should floss. Flossing is good.” And then you said “Yeah , okay. I’ll floss.” And then you went home and flossed your teeth and removed a bunch of white goo from between your teeth. That’s biofilm! Biofilm is basically a shelter made out of secretory products which are released by bacteria to protect them from bactericidal substances like antibiotics and the immune system. It also protects bacteria from naturally being flushed away by urine. Biofilm is a supervillain in a hospital setting, next to multiresistant bacteria. Biofilm grows and spreads on the surface, “ascending” up the catheter to the bladder or urethra and infects the mucous membrane [10].

The risk of getting a urinary tract infection increases with 3% – 7% for each day when you have an indwelling catheter [2][1]. Catheter-associated urinary tract infections (CAUTI) are inevitable after a month of use! CAUTI’s make up more than 30% of all hospital acquired infections [1].

Not only does the infection cause patient suffering with symptoms like fever, chills, abdominal pain and smelly urine, but it takes time and effort to treat for the hospital [11]. What if we could save time from the nurses, doctors, the hospital lab? What if we could shorten the hospital stay with a day or two? [12] What if we could prevent a few of the 13000 annual deaths related to complications of UTI? [2]

Another issue with CAUTI is that the treatment requires antibiotics, which contribute to the global problem of antibiotic resistance [4]. In some countries where use of antibiotics is less regulated, patients with catheter are given antibiotics preventively [5].

Are you convinced yet that CAUTI is worth trying to fix?

Our mission in the past weeks have been looking into ways to prevent bacteria from traveling inside the catheter from the drainage bag to the bladder and cause a symptomatic infection.

We are far from the first to learn that this is a problem, catheter manufacturers and innovators are developing antibacterial catheters. With that in mind, any innovator in this field need to find an edge. You need a specific piece of insight and resource that no one have had before.

There are many different catheters that might reduce incidence of CAUTI. In recent years, antimicrobial technologies have been tested [6]. Why are they not being used instead of the catheters that contribute to CAUTI? You might ask. One problem is the higher cost compared to a non-coated, regular silicone catheter. Another reason is that the doctors and the people who make financial decisions at the hospitals are skeptical about new technologies. There just isn’t enough valid data on the long term effect of the new tech. A third reason might be rigid purchase agreements that hospitals have. Not all hospitals in Sweden have the opportunity to buy silver alloy coated catheters, even though silver coating have shown significant efficacy to reduce formation of biofilm [13].

So, how do we find a solution that meet the needs of all stakeholders around this device? Not only does it have to be simple enough for care staff to actually want to use compared to the benchmark product, but cheap enough to manufacture and bring to the market for hospitals to purchase. It has to be safe enough for the patient to use.

Just like the airplane, the current design of catheters haven’t changed much since the 1930s. It might be a dogma issue. The current solution is well proven. It simply works.

Marcus Bilgec

References

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