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How University Hospitals found a way to clean up to 30K masks per day—with NASA's help

By Eric Fontana

October 8, 2020

    University Hospitals' (UH) Kipum "Kip" Lee, managing director of the Innovation Center within UH Ventures, and Dr. Shine Raju recently spoke with Advisory Board's Eric Fontana about the health system's collaboration with NASA Glenn Research Center. In response to Covid-19, the two organizations partnered to develop—and test—technology to decontaminate personal protective equipment (PPE)—and solve one of the top challenges of the Covid-19 pandemic: How do we protect our health care providers?

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    Question: Thank you both for making the time to talk. I'd like to start at the beginning—how soon into the Covid-19 crisis did the idea for the sterilization technology occur?  

    Kip Lee: At the beginning of Covid-19, we activated our unified command structure, and one of our senior leaders, Dr. Eric Beck, COO, had the vision and foresight to say we needed an alternative PPE strategy in our back pocket.

    We were not at a PPE crisis point yet, but we anticipated that might be coming, so Dr. Beck asked the UH innovation team to come up with creative ideas about sourcing, reusing, creating, and building PPE. We plugged into the logistics arm of the unified command structure and began a quick deep dive into PPE opportunities. We had a weekly meeting with clinical infectious disease experts who connected us with experts like my colleague Dr. Shine Raju and his wife Dr. Amrita John.

    Shine Raju: Both Dr. John and I have a background in intensive care medicine, and Dr. John has added expertise in infectious disease and an extensive research background with PPE. We were primarily tasked with caring for critically ill patients with Covid-19 in the ICUs. As we planned for the pandemic, we discussed innovations that would ensure we and our colleagues were protected so that we could return home safely to our families every night.

    Ultimately, we reached out to leadership about developing a solution, and that's how we connected with Kip and the innovations team. It was the right time and the right group of people. From that point on, we worked together.

    Q: Excellent. Now, when most health systems think about NASA, they aren't thinking about partnership. So tell me, how did you get from the initial team to a partnership with NASA?

    Lee: The UH Ventures team thinks about partnerships in the largest possible sense, including, but not limited to, traditional health care organizations. We recognize that some of the most disruptive, exciting innovations out there are not coming from the health care industry. So, we actively look for non-traditional opportunities, like what we've done with NASA around Covid-19, as part of our surveillance and programming efforts.

    For example, last year we recognized a growing interest in biomimicry—essentially, nature-inspired innovation—in the greater Cleveland area. In turn, we teamed up with the University of Akron, which has a biomimicry department, and Great Lakes Biomimicry, a big player in biomimicry headquartered in the greater Cleveland area, to host a Biomimicry Innovation in Health Care event at the Natural History Museum to inspire our providers and the public at large.

    So, as you can see, we seek out partnerships and programming events that will introduce ourselves and our staff to alternative ways of thinking, not just innovation from a caregiver context. We've always operated this way as a platform, so when the NASA opportunity came, it didn't seem that unusual because we already have such a broad approach to innovation at UH.

    Q: How did the idea to reach out to NASA come up—and why was the organization receptive?

    Lee: We had already started the work to partner with Dr. Raju and others around what we've dubbed the "Alternatives Task Force." In hindsight, we like to think of this effort as organized around three workstreams:

    1. Creatively sourcing existing PPE during a nationwide scarcity by looking beyond the obvious "medical" product categories;

    2. Designing and building PPE in partnership with Cleveland manufacturers; and

    3. Finding methods to decontaminate and reuse PPE.

    As we started this work, we found out that the president of our UH Rainbow Babies & Children's Hospital has a connection with NASA, and she facilitated the introduction between NASA and our innovation team. And when we spoke with NASA, we shared some of the issues we were having at the time—that is our philosophy, to not think about solutions first, but instead start with the problem we're trying to solve. We found that there was some overlap between our top five challenges and some of the technology work NASA has been doing over the last few years.

    Specifically, it turns out that NASA has been using atomic oxygen or ozone technology to clean spaceships for a long time, and it's even shared that technology with the Cleveland Museum of Art to clean artwork at one point. So, we thought, if we can use this to clean spaceships and delicate art, why couldn't we use it to clean N95 masks and other types of PPE? We're now in the process of testing and refining this technology for N95 and other PPE decontamination.

    Raju: Dr. John and I are also working with NASA on a multi-institutional study to test the efficacy and viability of peracetic acid for PPE decontamination. Peracetic acid is an established method for decontamination of non-porous surfaces in hospital settings, but the important question is does it work for porous surfaces like N95s?

    So far, we have proven convincingly that we can use this technology to decontaminate N95 masks for up to five times with no degradation in form, fit, or filtration. Large-scale adaptation of this technology will be dependent on FDA emergency use authorization.

    Q: As you think about the partnership more broadly, what are the lessons learned—and has this changed your approach for future partnerships?

    Lee: In technical terms, according to management literature, our partnership approach would be called "emergent strategy," in contrast to the deliberate and formally planned strategy we're used to. I think emergent strategy is a powerful way to describe our collaborative actions because often what we end up doing in the real world is indirect, serendipitous, and we don't always know what the final state is.

    In our case, we're thinking more about how we might craft an expansive informal network to help source non-traditional partnerships. We know that people's interests often fall outside of their formal role at UH, and instead of thinking of who people are outside of work as peripheral to their job, we want to think of the "extracurricular" as a core piece of who they are. It's recognizing our colleagues as whole individuals. I recently read an article in Harvard Business Review about the importance of dual roles as a part of career development—how might we be doctors and researchers or administrators and innovators? The community emphasis is championed at UH. For example, everyone in leadership is encouraged to be on a board or involved in a meaningful way with causes outside of the organization.

    This particular crisis was not something we could have planned for, but we did leverage the social relationships and networks many of our associates already have to tackle our top challenges. My big takeaway is that the social and relationship development we tapped into during the pandemic should be a cultivated resource in a post-Covid environment.

    Q: Any unanticipated benefits of such a relationship? Has this partnership opened doors to other things?

    Lee: One of the things we didn't anticipate is the idea of "the gift that keeps on giving." The management guru Jim Collins calls this the "Flywheel Effect" or strategic compounding. The success of the immediate opportunity in front of you can lead to additional small wins that can gradually build momentum for change and innovation. Even the NASA opportunity came up because of the earlier successes that were realized on the Covid-19 front, and the success of the work with NASA has led to other opportunities.

    One (qualitative) lesson in all of this: At the beginning, you really have to try to get things going, but once you get to a critical mass or series of good creative actions and positive engagements, it becomes almost an automated process. We now have other non-health care partners proactively reaching out to us. That was not something that was planned from the get-go.

    Q: Have you done any financial analysis of the potential impact of the decontamination technology?

    Lee: We've done some back of the napkin work and initiated some due diligence that we use to vet any new technology—we're in the early stages of this analysis. During the crisis, for obvious reasons, we had to accelerate action and could not fully activate our usual disciplined approach to business modeling and crafting the business case. But as of now, I can say there are real benefits to the atomic oxygen and peracetic acid approaches: They're in-house, cheaper per-mask, and clinically superior in many ways.

    Q: How far off from prime time is this technology? Is this something that we could expect other organizations to replicate soon?

    Raju: We are testing three different methods of decontaminating N95s right now: peracetic acid, atomic oxygen, and humidified heat. Peracetic acid and humidified heat methods have been submitted for regulatory approval to FDA. Then second in line is atomic oxygen decontamination—we are still finessing the prototypes but are close to a final working model.

    That said, even without approval for use across the industry, at full capacity, we can decontaminate 25,000-30,000 masks per day for our organization using peracetic acid. This would be adequate to meet the PPE needs for a large tertiary care hospital.

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