Can the DIY mindset help transform health care? Last fall, the University of Texas Medical Branch at Galveston opened the nation’s first makerspace in a hospital, giving staff the tools to build their own medical devices. I sat down with David Marshall, UTMB’s chief nursing officer, to hear why he thinks innovation should happen at the patient’s bedside.
Lori: At UTMB you’ve created a space and a culture to allow nurses and others who work in the hospital to make their own solutions to the challenges they encounter with equipment (or lack of equipment) at the bedside. What drove you to bring the DIY spirit and tools of making to your hospital?
David: The University of Texas Medical Branch (UTMB) is a sort of hub of innovation. Our Institute for Translational Science runs an innovation and entrepreneurship course; one of our nurses started a program called Innovation Forerunners which spurs nurses to think about how they could innovate at UTMB, and our executive leadership runs a Shark Tank sort of experience where members of the campus community come and present their innovative ideas and our executive leadership pick the innovations that they want to sponsor. When I heard about MakerNurse, it sounded like a natural fit.
Are you a maker yourself?
I think about making as crafting on steroids. Growing up I took things apart to see how they worked. My dad was a woodworker, and I make electronic things. In my non-work life, I’m a ham radio operator — and if something breaks around the house I’ll fix it. I haven’t made anything in health care, but I call myself a maker because, along with talented colleagues from MakerNurse, I’ve made all this happen at UTMB.
How did you encounter MakerNurse?
I heard about MakerNurse through the Texas coalition of the Future of Nursing Campaign for Action — the national initiative that is working to implement the recommendations in the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. I heard that MakerNurse co-founders José Gomez-Marquez and Anna Young were heading to Texas to meet with hospitals that were interested in exploring the field of making and how it might be applied to health care. I invited them to our campus and set up a meeting with about 30 nursing leaders. We became one of their expedition sites and we participated in the qualitative research that they did to find out what types of things nurses were making in hospitals and that’s where our relationship with making started.
Tell me about the makerspace you’ve created on a floor of your hospital?
Unlike traditional innovation centers where the focus is on generating ideas and methods that will later be produced, a makerspace is equipped with tools, materials, and equipment to bring ideas into a live prototyping environment. The tools include hand tools, a laser cutter, a 3-D printer, a sewing machine, and a variety of connectors and fasteners. The goal is to generate fast prototypes of ideas in an affordable manner. Similar to an open corporate gym, it promotes a culture — an idea generating and prototyping culture. The space itself, called MakerHealth Space, is stocked with all kinds of materials and equipment to support hospital staff in building their own devices — to create prototypes and test them out in the lab. Having the space near the delivery of care is important, because we think that creative ideas are often fleeting, and the MakerHealth Space with its proximity to patient care encourages capturing what may have once been a fleeting ideas.
Can you give me an example of one of the hacks that nurses have designed recently in the makerspace?
When a woman goes into labor, the nurses put a belt around her abdomen as a sensor to measure when the contractions start and end. That belt is not comfortable. So one of our nurses used the makerspace to create a padding to go on that belt so that it makes the patient more comfortable.
How is making different from invention? Do you distinguish between the nurse who has an idea that she wants to turn into a product, from the nurse who is just making for one patient?
Nurses are hacking things on a daily basis to make patients more comfortable and to make the delivery of health care efficient and flow more smoothly in the hospital. Nurses used to use garbage bags and adhesive tape to cover the arm of patients who want to take a shower while they are utilizing an IV. But now, using the MakerHealth Space at UTMB, by welding two pieces of plastic together and adding strings at both ends that they can tie, they’ve developed this plastic arm cover. It’s more user-friendly and easier to use than a garbage bag and adhesive tape. I think these sort of hacks happen every day, and it’s not necessarily something that a nurse is going to take to market and try to sell commercially.
Contrast that with our nurse who developed a board to hold a patient’s arm in position when we insert a catheter to examine the heart. The cath lab had been using a stack of towels to position a patient’s arm and one day the physician laid down a towel and said, hey, how about you make something that would make it more stable and wouldn’t be stacking a set of towels under a patient’s arm? So she went to Home Depot and worked for many nights at her kitchen table with Velcro and articulating arms and developed the arm board. That might be something that could become commercialized and that she could go to market with. She’s taken that device to UTMB’s Office of Technology Transfer and is working to get that process started.
Those two types of things are very distinct, but the MakerHealth Space supports both — it’s a starting place to help these kinds of ideas flourish.
Another use we’ve seen for the space: we had some nursing students come in and make some activity aprons for patients with dementia. These patients pick at their clothes or pick at their IV lines, so the activity apron has different things on it, like a zipper and some buttons that you can button and unbutton, to keep them occupied. They said these aprons were commercially available for about $75 apiece, but they were able to make them for about $15 in the makerspace.
Did nurses who identify as “makernurses” find their way to the space? Or was outreach needed to find and attract nurses that had been making at the bedside, but didn’t necessarily recognize that what they were doing was anything special?
Well it’s been a bit of both, I think. We held an open house when we opened the space. We had about 110 people who came just to tour it and see what was available. We’ve publicized the space campus-wide and that’s drawn in visitors. And word of mouth has brought more nurses in. But we’ve also held a series of events to get nurses involved. Around the holidays, we hosted an ornament making session in the space over four or five days, just to get people interested in coming by the space, seeing a 3D printer in action, testing out the laser cutter, and talking to people about what making was, and how making could be used in health care. And we had a maker-in-residence who spent several weeks here working with staff. I made rounds on the units with him and did a little show and tell, trying to get people interested.
We’ve had the team from MakerNurse come to the space at least once a month to host making sessions. When we have one of these experts in the space, there’s probably 10 to 15 people a day who come through, wanting to make something, but when they’re not here, that number goes down. The MakerNurse team are always available by Skype, so you may see one or two people a day in this space using Skype to talk to José or Anna about their ideas, or how to use the equipment in the space. We’ve hired a space manager, who will start in a few weeks, and will help get people in the space but more importantly be a resource for people who come into the space and maybe have a problem they are trying to solve or have an idea but want to know how to use the equipment and what materials might be best to build a prototype. He’ll do some of the same things that we’ve done with the MakerNurse team to spread the word and get people to come and visit.
Do you think it’s important to have an expert on hand, either virtually or in-person?
It has been important — both to get those people who frequently visit the space comfortable with the equipment and also to help those people who are first-time visitors get familiar with what’s going on in the space.
Among the nurses and other staff who come in, do you get the sense that they’re coming to tinker, or do they generally come with a problem that they’re trying to solve?
I’ve seen the whole gamut. We had one guy that showed up with a device that he had already gotten a patent on. He had the paperwork from his lawyer’s office. It was an endotracheal intubation handle and blade, and he was trying to put a light source on it. José was in the space and helped him explore the LED lights that were available. So that was a fully developed idea, it just needed a little more stuff to make it work. I’ve seen people come in and say, “you know, I really don’t know what to do about this but this is the issue that we’re facing and can you think of ways that we might solve this problem?” And usually there are some good ideas that come up. So it’s been a little bit of everything.
At Robert Wood Johnson Foundation, we began exploring making and how it might support nurses’ efforts to lead quality improvement at the bedside, but we’ve always been eager to see all kinds of health professionals — and others working in the health care system — engage in making. Who is using your space?
We really wanted to open up the makerspace to our campus wide community. On our campus we have a medical school and a nursing school, and almost 1,200 nurses and 800 physicians in practice. And then we have our School of Health Professions that has physical therapy, occupational therapy, respiratory therapy, lab technology, and physician assistant studies. So we really wanted to open the space up to all those areas.
We had a surgeon and anesthesiologist come in who were developing an oral suctioning device. They came to the makerspace to prototype their idea — to make it using the 3-D printer so they had something they could hold it in their hands and see what it would look like and whether it was something they could commercialize. They already had some 3-D printing files and they were going to get an off campus firm to print them for them, but it was going to be pretty expensive. So they were excited about the possibility of using the 3-D printer in the hospital and that we were able to assist them in doing that.
Why, of all possible hospitals in all possible US cities, do you think Galveston has the first hospital makerspace?
Part of it, I think had to do with what José and Anna found in their multi-site research study, is that organizations who had experienced a shock to the system had more making going on. UTMB had been through Hurricane Ike in 2008 which brought the organization to its knees. About a million square feet of the first floor of the hospital was flooded by seawater and we had to close the hospital for 30 days. We got almost a billion dollars in FEMA recovery funds. So I think that “shock to the system” may be why we have so many nurses making and innovating, and it’s because of that creativity and innovative spirit that we opened the maker space — to give nurses and others a place to go and make their ideas.
Do you think all hospitals should create makerspaces? Or do you think it’s more appropriate for some settings than others?
I do think everyone should try it. Some hospitals have mobile making carts and that’s sort of the first level of entry — to get the tools and equipment on a cart and either set it up in a room or take it to different places so that people can see the types of tools that are available and explore what’s already being made in an organization. Because I can guarantee you that those daily hacks are going on in every hospital in the United States; that nurses are putting tape on devices to make them more comfortable for people, or covering people’s arms with materials that are at-hand so they can shower. Those things are going on. So you just have to shine the light on them and say hey, you’re making and here’s some assistance that could show you how to use different materials, or to make your device more easily reproducible. Clayton Christensen, the guy who coined the term “disruptive innovation,” really talked about simplicity and convenience and accessibility and affordability when he talked about disruptive innovation. And that’s what we’ve tried to do with the makerspace at UTMB: to put it near where care happens so that it’s accessible and convenient and simple.
As health care moves out of hospitals and into the community, pharmacies, and homes, do you think the maker movement should continue to expand into those areas? Do you have any visions related to that?
Yes, I think there’s a role for making anywhere that care happens. I think that anywhere care is delivered there is an idea to make it more efficient or safer for the recipient. For example, we recently hosted a roundtable discussion with NASA and the US Department of Health and Human Services to talk about how to take care of people in constrained environments, whether it’s a medical mission to South Sudan, or the mission to Mars. We looked at the common problems with innovating when there are resource constraints and how making might be part of the solution.
Has there been any talk about engaging patients and letting them come into the space?
We have pretty active patient family advisory committees in our organization. We worked with them as we designed and built the makerspace, and we have taken some of our patient and family advisory committee members to the space. We had conversations with them about their ideas for devices and how we can get patients and their families into the maker space, but haven’t had a patient actually in there doing anything yet.
When we started working with José and Anna on MakerNurse, we were very skeptical that we would find a hospital willing to put in a makerspace due to regulations, intellectual property, and other legal concerns. But Galveston did it! You got permission, space and some funding from your system. How hard was that? What did you think was going to be harder than it was, or what did you think was going to be easier than it was?
We really didn’t know what to expect for sure, so part of it was a leap of faith, but knowing that we had nurses who were making things anyway, we all agreed: why not bring it out into the open? We already had many of the necessary pieces in place. We had the legal mechanisms to support staff who create something that they want to take to market and commercialize. We had the Technology Transfer Office which works with staff when they’ve devised something new or experimental that’s actually going to be used on a patient. And then we already had folks trained in quality improvement looking at ways that processes could be improved. What has surprised me is that so many people have ideas and want to put those build on those ideas in the space.
Is there any other advice you would give to CNOs or hospitals who want to bring making to their health care organization?
Yes, I think those considering bringing making to their organization should start by introducing the concept of making. Simply introducing the concept will stimulate thinking about what could be, and you may find out about things that your staff are already making. I think for anybody who’s considering having a makerspace or a maker cart, it’s a good idea to get together a guiding coalition of people who can stimulate interest, capture ideas, and commit to maintaining the space or the cart. Then, get on the phone with MakerNurse and UTMB to learn about what you need to consider as you set this up and keeping it running.
I would be remiss if I didn’t ask you this: what does a Culture of Health mean to you?
In a Culture of Health, we are using everything at our disposal to give people the opportunity to be as healthy as they can be. That means we encourage and support people on their personal journeys towards health. That we educate them and we help them become literate about issues impacting their health, and the steps they can take to protect and improve their health and the health of their loved ones.
Thank you David. We look forward to observing your continued efforts to improve health and health care and can’t wait to see what you guys make next!
At Robert Wood Johnson Foundation, we actively explore emerging trends — like making — and learn how they might be applied to improve health and health care, and build a Culture of Health.
Through MakerNurse we uncovered an underground movement of nurses who were making solutions to health care problems right there at the patient’s bedside. Now, armed with the tools and resources of the maker movement, institutions across the country are harnessing nurses’ creativity and ingenuity, providing them with the right support to bring their ideas into realization and spread front-line innovations for better care throughout the health care system.
Tune in to our Pioneering Ideas podcast to hear more about MakerNurse. And check out our other podcast episodes to hear from visionary thinkers from many fields who are working with us to build a Culture of Health.