Big Buzz recently connected with Mark Wehde, Chair of the Mayo Clinic Division of Engineering. In his role, Wehde is involved in many of the moving parts within the operations of the Mayo Clinic, an ongoing collaborative partnership between its many teams, including clinical and research staff. He also works alongside innovative physicians to help them solve some of their most pressing problems. Rather than a medical technology firm whose primary function is to create a device to move to market, he says his team is more focused on coming up with solutions that can best help treat patients (which may include the creation of a device, but is not its sole mission).
In this time of COVID-19, Big Buzz sought out his expert opinion in learning how the Mayo Clinic is handling this pandemic and how other healthcare entities can follow suit. The Mayo Clinic is an example of a truly agile organization, acting as proactively as possible to overcome foreseeable challenges.
What has the response been at the Mayo Clinic regarding the COVID-19 pandemic?
In the first weeks of the pandemic we first focused on moving staff home. Our concern was limiting the number of people who might be exposed and protecting our patient-facing staff by keeping those with more administrative roles remote. We also eliminated most elective procedures. As an organization, we have a command center ready to stand-up for a variety of emergency situations and certainly, a pandemic was high on our list of possibilities. Of course, a simulation or a scenario is not the real thing. We are finding we need to be flexible and move fast to address issues as they appear.
Our initial concern was based on experiences in China and Italy where we saw healthcare systems being overwhelmed. We were expecting a surge of patients and set out to ensure we had sufficient supplies to manage this possible eventuality. Managing our supply chain was a significant part of our response. Identifying parts, accessories, and supplies that might be needed and making sure we had enough on hand or on order. With all the other healthcare organizations doing exactly the same, the supply chain became a significant problem.
Engineering was asked to look into a variety of supply chain issues and find replacements and alternatives for critical items that weren’t available from the manufacturers. This included face shields, single-use accessories for nebulizers and ventilators, and various covers and shields for devices. We were asked to look into a number of shielding devices – some to protect staff in the various labs processing samples and others for interactions with patients.
Once it became clear that the shelter-at-home order by Governor Walz of Minnesota was working, and when we were more certain that we would be able to handle the peak of the pandemic, our focus shifted to providing elective treatment to patients. It is not possible to indefinitely defer care, nor is it in the patient’s best interest. Our focus now is on devices that provide protection for our staff and for patients. We are looking into ways of limiting the spread of the coronavirus when performing aerosolizing procedures. We are investigating ways to clear and clean a procedure room quickly and safely so we can move patients through in a relatively efficient manner. We are also looking at scheduling changes as we no longer want a reception area full of patients waiting for procedures.
Do you believe this pandemic will change the way we run our healthcare system? If so, how?
Clearly the healthcare systems around the world weren’t ready for this. Almost all countries run their systems with very little extra capacity. It is simply too expensive to do otherwise. But this points out that we need plans in place for doubling or tripling capacity when needed and that will require some serious thought.
Additionally, there was already a strong move to home healthcare, remote monitoring, remote diagnostics, and remote therapy and that move will be even stronger. I think this will provide focused energy to create new systems that don’t require many patients to show up in person. The outdoor drive through testing stations are a good example of a new idea that may have some applications in the future.
How will this pandemic shape how we address emergency responses?
This pandemic, bad as it is, could have been far worse. The mortality is high, but not as high as some of the less transmissible diseases we’ve faced over the last 20 years. I hope we know now how bad it could be and take steps to prepare. Wealthy countries should make use of their central government to stockpile and coordinate the delivery of needed supplies, equipment and personnel. FEMA in the US is designed to respond to a natural disaster. These are generally confined to relatively small areas of the country. What we weren’t prepared for was a natural disaster that impacted the entire nation.
What shifts has the Mayo Clinic made as a whole in regard to messaging, staffing or workflows?
Our first step was sending home those who could work remotely. Our second step was eliminating elective procedures and sending those staff home as well. We are now working to bring staff back as we ramp up elective care. However, for those of us with jobs we can perform remotely, there are no firm plans for our return to work. In fact, I think we will think very hard about what our work models look like in the future. For many of us, the move to remote work has not impacted our productivity. In fact, in some cases, we are dramatically more productive.
What shifts has your department made in reaction to this, if any?
At the beginning, we thought our challenge was figuring out how to keep doing our work while having reduced access to our tools and equipment. We sent staff home with tools and computers. For those who had to come to the office, by moving most workers home, we dramatically limited the number of staff on campus at any one time. We split shifts in our machine shop to ensure that at least one shift would remain functional if someone on the alternate shift got sick.
Then we started getting requests. It started in the labs, one of our regular customers. Mayo Clinic has a large lab testing group that does tests for countries all over the world. These labs were seeing dramatically increased volumes of certain types of tests related to the coronavirus and we were asked to develop various shielding devices to minimize the exposure of our staff to aerosols. Next, we started getting requests for parts that our suppliers could no longer supply. Then we started getting requests for PPE (personal protective equipment) such as n95 respirators, face shields, intubation shields, laminar flow hoods, PAPRs (powered air purifying respirators) and other types of equipment. We now have over 20 active projects that are focused on helping our patients return to Mayo for care.
Do you see this having a lasting impact on the healthcare industry?
I don’t know how a lot of organizations are going to survive this. Our healthcare system is incredibly low-margin and most healthcare systems are now losing a lot more money than they can afford. I suspect most will take years to recover. There is a lot of inefficiency in healthcare. Some estimates put it at 20-25% of costs.
I think there are also positives. Healthcare organizations will be focused on driving out waste. They will also find new ways of saving money, such as remote work, saving all the costs associated with an office. But the biggest positive is going to be the acceleration of the development of alternatives to hospitalization. When you need expensive equipment, a hospital at a major center will be appropriate. But for many conditions, your community hospital and even your home will be perfectly acceptable alternatives. The infrastructure is in place to allow for remote monitoring of patients. There are some enhancements needed, and there is some equipment that needs to be redesigned for a different type of care. But it is doable. It may be time for the house call to come back.
How does this affect product development? Has it pushed any technology or processes to the front lines?
We’ve been so busy that I haven’t paid attention to the medical device community. I know that within healthcare systems, development has definitely taken a back seat to cutting costs. The analogy I use is that if you are in the ocean and your boat is sinking, you want everybody bailing water, not working on the navigation system. You will eventually need the navigation system to get back to shore, but not if your boat sinks.
This short-term focus will have some negative long-term consequences, but that is unavoidable until we can contain the negative cash flow. Things we have prioritized are those that will help us bring patients back safely. We are also prioritizing projects that have a near-term significant positive impact on our care for patients. Projects with a much longer timeline to the bedside can afford a pause of a few months.
What is the overall “feel” of your team members and those you are around? Are people confused, optimistic, worried, etc.?
Many of our staff have taken significant pay cuts. Many have had to take a partial furlough for the next few months. They are scared. They don’t know what the future holds. They are dealing with homeschooling. They are worried about their families. They don’t know if they can pay their bills. They don’t know if they should wait or look for another job. They don’t know if there are other jobs out there. I would say that our staff is in shock, though most seem glad that it wasn’t worse.
That said, there is an underlying confidence that Mayo Clinic will come back from this. Mayo has always leveraged opportunities to become stronger and I have no doubt we will this time as well. We will change, we will adapt, and we will accelerate the disruption of the very industry that we excel in.
What are some of the challenges people are rising up to tackle?
We are used to working on long-term, highly complex engineering projects. All of a sudden, the projects are simpler, but the schedule is incredibly compressed. I have been amazed at how well our staff have adapted. It has been the most incredible thing I’ve seen in my time at Mayo Clinic. There is nothing like an emergency to bring focus to an activity. We’ve cut unnecessary complexity and bureaucracy from our processes. Our sense of urgency is especially heightened because everything matters, and time, even a single day, can make a difference.
What is the best thing we can do to support those on the front lines right now?