From idea to patient: the IfM approach to healthcare
The IfM has been working on research in healthcare for over thirty years. When the COVID-19 pandemic hit, this meant the institute could respond to new challenges using past experience. Now, the IfM is building on that work across its research and practice.
By Jason Naselli and Elizabeth Tofaris
Over the past two years, the IfM has been recognised for its work in response to the COVID-19 pandemic — helping local hospitals to make the best use of their resources, streamlining logistics for sourcing and storing vital personal protective equipment (PPE) , informing decision-making on emergency demand, and developing a ventilator sharing system to be used in emergencies.
While these challenges were new, IfM involvement in healthcare was not. The pandemic response built upon three decades of research across healthcare-related areas — work that is, according to Tim Minshall, Dr John C Taylor Professor of Innovation and Head of the Institute for Manufacturing, firmly part of the manufacturing landscape.
‘Healthcare is a manufacturing sector,’ says Tim. ‘We need medicines and medical devices, and they need to be developed, produced, delivered effectively. Healthcare services also need to be supported to operate as efficiently and effectively as possible. Our work on healthcare mirrors our view of what manufacturing really means.’
Today, IfM healthcare research projects range from clinical trial supply chains through to the manufacturing of drugs and medical devices, all the way to developing service models and reconfiguring healthcare supply chains.
‘Some of the early work we did has been around pharmaceutical supply chains, exploring how you ensure that drugs in all forms reach patients in the most effective way,’ Tim explains. ‘Our research started in that field at our Centre for International Manufacturing more than ten years ago.
‘Another key area of work is on medical devices: building things that are needed within the healthcare system. This can be anything from medical robotics, which we were involved in as early as the 1990s (in fact, we even spun out a company called BioRobotics looking at systems designed specifically for using the healthcare sector), to low-cost diagnostics.
‘More recently there has been the idea of applying operations management to different sectors, and this relates to some of the earlier work of Professor Duncan McFarlane, where he took all those principles of operations management and applied them to a hospital setting — looking at a hospital’s inputs, outputs and flows and treating the healthcare system as an operation that needs to be optimised.’
An emerging fourth area is innovation and the role of research in complex systems change; for example, exploring how innovation methods used by industry can address depression in young people. A rather surprising route, at first glance, for industrial engineers.
‘I think it surprises people that the Institute for Manufacturing is involved is in young people’s mental health work,’ says Tim. ‘They ask: How does that fit into this logic? Well, the answer is because we understand how to support successful innovation. We understand how difficult it is to get a complex system to change.
‘Fundamentally, at the Institute for Manufaturing, we are interested in developing processes to enable positive change in complex systems — and healthcare provides a huge range of urgent and important challenges for us to help address’
Manufacturing and medical device development
The regulatory questions that come with medical device development reflect these complex challenges. For Dr Ronan Daly, Head of the Fluids in Advanced Manufacturing research group at the IfM, considering those questions at an early stage of development for emerging technologies is vital — and an area where the IfM is well placed to advise.
‘If you look at healthcare, if you look at medical devices, the regulations that govern the manufacturing of medical devices cover everything from the design through to the instructions for the user,’ says Ronan.
‘What manufacturing really does is cover the complexity of physically making a medical device in the factory and also, then, the design of what is included in that, and how it will be used. The manufacturing readiness levels, and questions that come along the way, depending on the answer, could change entirely how you would design an original device. ‘
The IfM is helping with the fundamental research around the technology and devices, but also working on the effects these will have throughout the manufacturing process.
‘For example: Have you thought about how you’re going to sterilise your medical devices? There is actually a change to the fundamental chemistry as you sterilise them, so the function won’t do what you expect, or the flows of the materials while you’re dispensing them into the body might change the function of the thing you’re putting in there,’ explains Ronan.
‘By co-developing the manufacturing questions at the same times as science, we’re helping get to an optimum design quicker, and therefore getting to patients quicker.’
Manufacturing excellence and expertise
Dr Jag Srai sees the ‘through to patient’ outlook as an essential part of the IfM’s work.
‘We see in our work with both hospitals and on drug development how that complex system goes all the way through to the patient,’ says Jag, who heads the Centre for International Manufacturing at the IfM and leads on the IfM’s healthcare theme.
‘Active ingredient production, product formulation, packaging, and then the packing involves multiple manufacturers in multiple geographic locations. This front-end of the supply chain then leads into a very complex distribution system eventually reaching through to the patient and all the service models around that — these are all things the IfM has expertise in, that we can apply to the healthcare space.’
Jag also believes the IfM’s work in this field is important for the wider Cambridge ecosystem and the UK economy as well.
‘The UK invests significant funds in drug discovery and is widely recognised for its leading position in this area, but the location of manufacturing is often influenced by local incentives leading to a very complex global manufacturing footprint,’ says Jag.
‘So, whilst the UK has a leading position in the discovery space — and is home to two of the largest multinationals in GSK and in Astra Zeneca — and a thriving healthcare innovation cluster, most essential medicines, or off-patent generics are imported from distant contract manufacturing organisations. This introduces significant risks to security of supply.
‘We therefore have this legacy, that product discoveries are often UK-based, but then we typically don’t make the product here, due to scale economies, incentives, or infrastructure provision. New production technologies and supply security considerations are driving a rethink on manufacturing location decisions of the past decades and providing new opportunities for value capture.
‘So I think it’s important that Cambridge especially is known for not just discovery, but also manufacturing excellence and supply chain expertise.’
COVID-19 mobilisation
It was this strong foundation in healthcare work — together with the institute’s culture of collaboration — that meant the IfM was able to react quickly and effectively to the COVID-19 crisis, mobilising students, staff and healthcare contacts across the city to ensure a swift and targeted response.
‘We were able to respond so quickly to COVID-19 partly because of our open culture, but also the expertise we were able to access,’ Tim Minshall explains. ‘Addenbrooke’s Hospital reached out to us in the middle of a crisis, and we wanted to respond as positively as we could. The engagement with the hospital was helped by a sense of a common cultural approach, a similar sense of purpose, and a shared context of our local community: we all had, at some point, made some personal link with the work of our local hospital. This helped ensure a ready level of engagement at the institute, as well as the individual level.’
With many hospitals across the UK needing rapidly accessible and innovative solutions to operational challenges arising in the COVID-19 crisis, the IfM team addressed the areas of hospital logistics, PPE delivery and intensive care unit (ICU) equipment development.
‘The hospital said our engineers brought diversity of perspective to addressing multiple challenges. As a result of the success of this work, a joint Cambridge University Hospitals Trust (CUH)–IfM panel has been initiated so that the local hospitals and the IfM can continue working together for mutual benefit after the pandemic,’ says Tim.
The future of healthcare at the IfM
Devastating though it has been, COVID-19 has shone a light onto the workings and failings of the healthcare-related parts of the manufacturing world:
‘Numerous cracks in our healthcare systems had been appearing way before the pandemic,’ says Tim. ‘COVID-19 hammered a wedge into those cracks and revealed how alarmingly fragile these systems are. But it also showed us that things could be done differently, and it accelerated the development of exciting ideas that had been lurking in corners for years.’
The IfM is now spinning out lessons from COVID-19 across its healthcare activities. Experiences during the pandemic have led to research in knowledge-sharing across the NHS and how to apply logistics of testing programmes to other healthcare and humanitarian contexts, among other work.
Meanwhile, researchers across the institute are building on that established healthcare foundation, for example, examining service models for new wearable devices to treat cancer in children, improving targeted drug delivery, and developing new low-cost medical sensors.
‘In some cases, healthcare can be a unique challenge, with additional concerns about things like regulation and patient safety. But often the common principles from our work in a range of manufacturing sectors that the IfM works in, apply in a very similar way. This is especially true when we are looking at solutions that work not just in the UK but in many different healthcare contexts across the world — we need simple, efficient and effective solutions. That’s what COVID-19 really highlighted, and what we are continuing to pursue in our healthcare work.’
