When he took the role of chief innovation officer of LifeBridge Health in Baltimore, Daniel Durand, MD, never imagined less than two years later the system's executives would ask him to rapidly develop a mask factory.
The health system's leadership realized early on that although Baltimore wasn't at the apex of COVID-19, they would eventually face a shortage of key supplies when the surge did come to LifeBridge. The conventional supply chains nationwide were overwhelmed by requests for personal protective equipment, and health systems that relied on middle men to purchase the materials faced inflated prices.
"Supply chain leaders who spent their entire careers dealing with group purchasing organizations now have to go outside the box to procure supplies and that is difficult," said Dr. Durand. "In addition, we are facing new needs that we didn’t have a month ago. Every single employee, clinical or not, has to wear a protective mask while in the hospital in order to protect the hospital environment from the spread of virus by asymptomatic carriers. We didn't want everyone to wear N95 masks because that would have been wasteful frontline workers need them most. Instead, we needed a new kind of mask that could cover our employees mouths and noses in a safe and cost-effective fashion."
The procurement, sterilization and supply chain specialists are typically very guideline oriented to follow The Joint Commission's prescribed guidelines exactly. However, in an emergency, the system needed to find a way to develop a mask factory quickly.
"They brought in the innovation team to ignite a nimble mindset," said Dr. Durand. "We were thinking about how to meet these new needs and we looked around the country to see what other systems were doing. We decided to develop a mask factory and received the approval of senior leadership on a Thursday, asking us to move in the direction of developing our own protective masks by the end of the following week.”
"We were given the approval to obtain the hundreds of thousands of square yards of non-woven textile material, 90 sewing machines, textile cutting tools, etc. We selected a location from the system’s real estate portfolio across the street from our largest community hospital which was an unfinished space at the time," said Dr. Durand. "Five days later, we had a fully functioning factory with about 40 people producing around 2,000 completed masks. Over the next three days we pushed daily output from 2,000 to 13,000 protective masks per day. The following week we started making surgical gowns."
How did Dr. Durand and his team do it? He started with a simple request to Neil Meltzer, president and CEO of the system.
"I contacted Neil and told him we are aware of what we don't know. We are a bunch of doctors, including one radiation oncologist who has a sewing shop in her house and was able to do prototyping, but we aren't professionals," said Dr. Durand. "I have broad healthcare management experience, but I've never run a factory before. I asked him to put us in touch with people that know things we don't know; people who have experience running a factory and taking a design from idea to prototype."
Mr. Meltzer connected Dr. Durand with several textile manufacturing leaders, including Randy Harward, senior vice president of advanced material and manufacturing innovation at Under Armour. Mr. Harward said the company had already connected with other health systems about developing masks and already had a prototype in the works. He sent it to the LifeBridge team, who were initially skeptical. They tried on the mask and thought it wasn't as good as their own prototype, but after a series of video calls, the team realized they put it on upside down; the mask prototype was superior when worn correctly.
"When I sent the email to our CEO asking to talk to someone that understands the garment industry, some people thought that wasn't the right response in the middle of the crisis; that we should take action as quickly as possible," said Dr. Durand. "But if I hadn't sent that email, I wouldn't have known that Under Armour was already going through the same process and we wouldn't have collaborated. That email might be the most important thing I've done as a human being."
Under Armour was prepared to produce 500,000 masks over the first few weeks of production, but had to supply others as well and they didn't have a sewing facility in Maryland. The company could cut the fabrics and send them to the LifeBridge mask factory for sewing and assembly. LifeBridge sent a physician to Under Armour as well to work with their engineering team to think though the proper manufacturing conditions to ensure the masks would be manufactured under semi-sterile conditions and would be able to keep clinical workers safe.
"It was a back and forth exchange of ideas, and each of us was helpful to the other," said Dr. Durand. "We landed on an arrangement where they procured and cut the material with their machines that were much more accurate than what we could do. Then they would send it to us for assembly. We also worked together on making disposable gowns, which quickly emerged as our No. 1 focus at all levels of the supply chain. We recruited volunteers from across the organization to help fold the masks and string them together."
At the same time, Dr. Durand also led the project to ensure the empty health system space was prepared for manufacturing masks and gowns. It needed new drywall, electricity and climate control. A team of experts were able to finish the space and convert it into a manufacturing factory within a few days, ready for the volunteers.
One of the volunteers on the assembly line had a background in mechanical engineering and created a simple machine that was able to assemble the masks more efficiently than human hands. He built seven of them for the factory and sent one to Under Armour for feedback on how to make it more efficient and ergonomic going forward. The team named the device the "Victorinator" in honor of its investor, Victor Filatiov.
"Every time I go there, I get more blown away," said Dr. Durand. "The people working in the mask factory aren't necessarily people who are renowned for their engineering expertise, but after interacting with professionals they started making inspiring things happen. They’ve exceeded everyone’s expectations for quality and productivity."
Beyond the mask and gown factory, Dr. Durand and his team are working with other local businesses to ensure the system has enough PPE. In one case, the system worked with an existing partner named "VSP" — a LifeBridge subsidiary that normally producing things like printed fliers and banners — to convert their production line to make face shields. In a parallel initiative LifeBridge combined multiple 3D printer donations from local area private schools into a single space to create a 3D printing "farm" capable of producing hundreds of face shields each week. These efforts are part of the reason there is no longer a faceshield shortage at LifeBridge.
"We are now experimenting with the 3D printers in our orthopedics institute to make parts for PAPRs," said Dr. Durand. "The innovation team helps out wherever we are needed. But Innovation isn't solving the problem; we are solving the process. We are figuring out who knows more about the process than we do and then we work with them on a solution. We don't want perfect to be the enemy of good. In healthcare, we are conservative and want things to be perfect from day one, but when we find ourselves in an emergency situation, this isn't always possible. We have to do the best we can and know when we are in a good enough spot to move on to the next need, because there are a ton of needs."