Noora Health

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Noora Health: Training family members to improve patient outcomes and save lives.

Bangalore , IndiaIndia
Year Founded:
2014
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Growth
Budget: 
$250,000 - $500,000
Project Summary
Elevator Pitch

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

Noora Health trains patients and their families with high-impact health skills to improve outcomes and save lives. By training families with simple, low-risk skills, we enable at-risk families to provide high quality care in the hospital and at home.

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

What if the largest untapped potential in healthcare lies with patients and family themselves?
About Project

Problem: What problem is this project trying to address?

Patients & caregivers around the world face a similar need–after a major diagnosis, surgery or health event, they are left to care for a family member but do not have the health information, resources or training they need. This is even more acute in resource poor settings (such as India) where health infrastructure is lacking & families provide the majority of their own care. This can lead to unnecessary complications, readmissions & suffering.

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

We turn hospital hallways and waiting rooms into classrooms. Through our interactive, skill-based learning, we make sure that patient families really have everything they need to succeed after a major diagnosis, surgery or childbirth - replacing anxiety with competency and easing the transition from the hospital to the home. We cut out repetitive, generalized, scattered information from the workflow of doctors and nurses, freeing up more time to have meaningful, patient-specific discussions. We utilize a train the trainer approach to create “nurse educators,” who are experts in teaching these skills in an interactive and engaging manner. The hospital transforms into an educational experience that builds capacity in families.

Awards

Edith: Ashoka India Fellow, Rainer Arnhold Mulago Fellow, PopTech Fellow. Edith & Katy: Echoing Green. Katy: Forbes 30 under 30 Social Entrepreneurs. Noora: Y Combinator, Fast Forward, d.Labs, all 1 of 7 programs- Parliamentary Group on Health in London
Impact: How does it Work

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

Currently, patients and their families are given home-care instructions in a rushed discharge synopsis, often not in their native language. Our core users- family caregivers- are certified in basic skills that will allow their families to better heal. We transform a time of fear and uncertainty into an empowering education experience that helps them improve the health of their family. In addition, our program fundamentally shifts the culture of the patient and family experience, and we have seen patient satisfaction increase by more than 55% after our program is implemented. We offer potential for cost savings, employee efficiency, and have evidence that we decrease length of stay of a patient allowing for higher turnover.

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

A team of researchers from Stanford University recently conducted an independent evaluation of the program. The study revealed a 71% reduction in post-surgical complications, reduction in length of stay of .7 days, sustained behavior change at 30 days of health promoting behaviors, and 6x decrease in caregiver anxiety. The study also demonstrated that every person we train goes on to train between 1-3 additional people in their community or home. Separately, we have measured a 24% reduction in readmission, 40% increase in highly satisfied patients (98% of users would recommend the program to family and friends), and increased knowledge and reported confidence. To date, we have trained over 25,000 family members representing 16,000 patients. We are currently in 20 hospitals. By 2018 we will train over one million patient families and be in 150 hospitals in India.

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

We define success as a global shift in the standard of care, where patient family members are no longer seen as an obstacle, rather as an integral component of high quality in- and out-patient healthcare delivery. Our priorities over the next three years are to validate the impact of family caregiving on health outcomes, test other medical conditions where this model has an impact, pilot in high-need public and mission facilities, and to determine a business and service delivery model that scales effectively. Within three years, we will train over one million family members.
Sustainability

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

We charge private hospitals an initial implementation fee and an ongoing licensing fee for the materials. The fees cover cost of implementation plus margin. It is to be determined whether or not the fee will be high enough to cross subsidize our work in public and mission hospitals. We are also gathering the necessary data to make the case to the government that cost savings from the intervention or substantial enough to warrant a subsidy.

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

Our biggest competitor is the status quo – under qualified medical personnel, rushed discharge, one-off hospital education efforts, difficult to understand instructions delivered to a disoriented patient. There are one-off training programs in very high-end specialty hospitals in the US and UK, but the majority of hospitals across the globe treat patient/family education as an optional check-box for lawsuit mitigation. In addition, you see organizations using tech-only solutions (Bodhi Health, Emmi Solutions) to do patient education - Our focus is one step closer to the frontline of care.
Team

Founding Story

We met as graduate students at Stanford University in a course at the d.school called Design for Extreme Affordability. Half way through the course, we traveled to India and were blown away by what we found - an incredible resource in motivated, compassionate, untapped caregivers; contrasted with a desperate need for higher quality care; and lack of trained personnel/infrastructure. The real ah-ha moment came when we got the data back from our initial pilot and realized that we had developed an intervention that was low cost, high impact, and that was sustaining without our day to day oversight. We quit our jobs and, without funding lined up, we went all in on Noora Health.

Team

Edith Elliott (CEO, Co-Lead) has extensive experience in operational dev, partnership dev, marketing and fundraising with a background in policy (Undergrad at Tufts University, Grad School at Stanford. Worked at The Aspen Institute and Population Services International between undergraduate and graduate studies). Katy Ashe (CDO, Co-Lead) is an engineer, designer, and researcher (Undergrad and Masters at Stanford University in Engineering, has led large research and health campaigns). Edith is responsible for operational strategy, fundraising, partnership and expansion strategy, while Katy oversees all product strategy, methodology and design. Together, we set the vision for the org and work towards meeting the goals with our complimentary skillsets. We value our co-leadership style and always say we have found our “professional soulmates” in each other. The team is rounded out with a Chief Impact Officer - responsible for the Health and Impact Lead who oversees M&E and external research as well as the Director of Operations. Director of Operations oversees our Master Trainer (who does the train the trainer work) and our Program Managers. On the product side we have a Tech Lead as well as a media development group that produce our materials.
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.)

Our work is rooted in Human Centered Design (HCD), and we use this methodology to get to know our users and to deeply understand how they make decisions concerning health and well being. Our experience in HCD would allow us to work with BI to develop a strategy that predicts the decision making process for patient families when prescribing and purchasing medications and therapies. BI would benefit from gaining a deeper understanding that can be used to mitigate current barriers to medication adherence etc. Noora would win by learning from BIs experience and expertise working across a multitude of clinical areas, through a variety of illness care institutions, and with new distribution channels we have not considered.

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, Relationships/New Contacts, Human Resources, Legal Support, Public Policy Knowledge, Access to Capital.

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

Distribution Channels - it would be tremendously beneficial to learn from BI's expertise in this area. Our primary distribution channel is in the hospital, however it would be interesting to explore additional options.
Public Policy Knowledge - our long-term goal is to have a state or national level campaign. In order to do this, we need to make sure we are forming the right relationships, fully understanding the ecosystem and measuring the appropriate indicators.

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)

Increasing physical access to healthcare to people with restricted mobility or restricted access (senior people, people with disability, remote or difficult areas, etc.), 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.

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

After several conversations with a key stakeholder at BI, it is clear that there is room for significant co-creation.

In particular, we have identified the need for more comprehensive patient and family education tools for Chronic Obstructive Pulmonary Disease (COPD). What if upon diagnosis of COPD, patients were able to have access to critical information pertaining to the disease, how to manage their health and a good understanding of the medication they are prescribed with in a language that they are most comfortable with?

COPD is one of the main drivers of mortality in India, where rates are estimated to be among the highest in the world. Similarly, in Canada, COPD is a leading cause of mortality and morbidity, with prevalence rates of roughly 4%. Unlike other chronic disease states (such as diabetes, heart disease), patient-facing information on COPD is incredibly limited. Noora Health would work with BI to develop comprehensive family caregiver and patient-facing tools to be used among non-English speaking patients in both Canada and India to help families understand and manage their condition.

Please specify what your Co-Creation will result in:

a new product, a new service, a new distribution channel.

If you selected "other" above, please explain:

Reaching a new market of COPD patients in rural India (2/3 of 1.25 billion people reside in rural areas). See prevalence below.

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

Together with BI, Noora Health will develop family caregiver and patient-facing education tools that will better equip healthcare providers and patients with the information and tools they need to properly diagnosis and manage COPD. BI has access to best-in-class medical information and tools that, when repackaged by Noora Health for the patient and family caregiver audience can significantly help with the long-term management of this chronic disease.

BI in partnership with Noora Health (and possibly ViperMed) will develop patient education tools that can be accessible to patients at the time of diagnosis in their language of choice. Tools that are relevant to educating patient and their families in rural India will be taken and used by Noora Health to bring awareness to these communities.

The prevalence of COPD reported in studies varied from 2%-22% in males and from 1.2%-19% in females. The prevalence of COPD is not completely understood due to the fact that this disease is often not properly distinguished from asthma and in some cases these patients are diagnosed separately for chronic bronchitis or emphysema.

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

Noora Health's mission is to train family members how to care for their loved ones. With COPD on the rise in India, it is critical that we develop these materials. Working with BI would allow us to fast-track the creation of this content and reach thousands of low-resource patients in desperate need of high quality medical tools.

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

BI has a mandate to be more patient-centric - this project would directly feed into this mission by providing patients and their families the opportunity to better manage their condition, reduce the need for unnecessary medical attention, and alleviate the burden on healthcare professionals for non-trivial matters. BI has a wealth of knowledge and resources in the area of respiratory health and, because they manufacture drugs for COPD, have an incentive to ensure that their patients are able to manage and adhere to their drug regime.

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:

Deep expertise and knowledge in Human Centered Design: we have been successful in effectively assessing patient needs and developing tools to train patients and their families how to manage their health with indisputable results of reducing return visits to the hospital and empowering people with medical knowledge so they can then apply
this at home without medical experts.

Expertise in developing tools that get behavior change to stick: we have shown sustained behavior change at 30 days around health promoting behaviors, we have shown a 70%+ reduction in preventable post-surgical complications as a result of our training program.

Boehringer Ingelheim will contribute:
Has a wealth of medical knowledge (both internally and via affiliations with external members of the medical community) worldwide

Has the capital means to roll out projects that align directly with BI corporate strategy

Patient- focused initiatives are high on BI's company mandate both in Canada and globally

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

Through the co-creation challenge winning awards, initial funds would be invested in the development of initial patient education tools in the languages identified by those most prevalent of having COPD in Canada and India. The materials will likely be made available online for doctors and pharmacists and/or delivered through in-person trainings (however the delivery mechanism will be set upon further user testing) as well as to those prescribed with a BI drug. Revenue generated from new prescriptions with immediate access to education tools would be evaluated and could possibly become BI’s new product (drug + patient information, revenues from which would be shared w/ Noora Health).

In India, patient education materials could be licensed for a fee to medical practitioners (or materials provided for free in those settings that do not have the resources to pay a licensing fee but can pay for operating costs, following Noora Health's current business model for highly resource-constrained hospital sites).

What possible risks or challenges do you foresee?

Potentially significant differences in the "needs" of patients in Canada and India. It will be interesting to see how much of the information is applicable in these two very different settings. For Noora Health, it has been remarkable to see how similar the family member and patient needs are between India and the US. We anticipate the same being the case for marginalized patients in Canada and India, but we will see. Noora Health uses different teaching methodologies and where there are differences, we can adjust and adapt accordingly as we teach the materials live to the patients and their families in India.

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

Partnering with INSPIRE clinics (COPD outreach programs) and Respirologists in order to develop the most effective patient education tool and content.