As medical product developers, we observe design every day in what we see and interact with, learning from the problems of the past and using those insights to fuel our ideas for new products. So what can we, as designers, engineers, and creators learn as COVID-19 spreads across the globe? Is there insight to gain from this tragedy about good design, especially in times of great need?

Demand for medical equipment has created shortages in the world’s supply of disposables, such as gloves and masks, as well as essential equipment, such as ventilators. All of these products have been designed and produced in a certain way. A huge part of their design inputs are dependent on the predictive demand of these products and how they are expected to be used. So what happened when the entire world began to self-isolate, the demand for these products skyrocketed, and the supply chain went haywire? With a shortage of essential equipment, people have resorted to reusing masks, foregoing them all together, or calling on the public to create DIY and hacked solutions to shortages.

Healthcare workers on the front lines in medical facilities still have to go to work every day despite a dwindling supply of personal protective equipment (PPE) for clinicians. Not to mention the lack of essential life-supporting equipment, such as dialysis machines and ventilators, for patients battling this disease. The design of these products is critical to the clinicians’ ability to help patients and stay healthy.

So what can we learn about the design elements of these products that can be applied to all medical product design?

Design for Single Use: PPE and Disposables

Social media has been a great tool for people to connect during this time. Online platforms such as Instagram and Twitter have been a place for people battling this virus every day to share their stories. Recently, many nurses and doctors have been posting images of themselves, and, interestingly, their PPE. The images show battle scars of clinicians with bruised lines on their cheeks from tight-fitting masks and goggles. In order to fully protect themselves, those in direct contact with COVID-19 patients must wear multiple layers of protection, especially around their faces. The layers begin with a gown, often covering their heads, then goggles to protect their eyes, and close-fitting N95 ventilated masks, of which many places are in short supply, followed by a face shield to protect the rest of their face. One doctor described her experience on PBS Newshour saying that, “I couldn’t smile too big or it would compromise my safety” and that the layers of protection “take away the humanity…those visual cues of reassurance” for patients who are sick.

Wearing this much equipment limits clinicians performance of their everyday tasks. Their vision is limited because they have to look through multiple layers of reflective plastic. They must wear tight-fitting, single-use masks for much longer than recommended (sometimes up to 12 hours); this has caused many to bruise and blister.

The public has been addressing the disposable shortages with their own unique designs. Companies and individuals are coming together to create open source designs for masks, face shields, and other essential equipment so that others may work with them to build or 3D print these components. However, these are all temporary solutions to a much larger problem: the design of the PPE.

So why is PPE designed this way? Masks and face shields are designed to be cheap and disposable as a trade-off for the cost of sterilizing and cleaning longer lasting equipment. Additionally, some items, such as filters, are designed to absorb harmful molecules from sicknesses, so reusing them only works for a short time. However, a problem arises with this system when the need for disposable masks is as high as it has been. The supply chains in place to produce and distribute disposables is limited or at an altogether standstill.

The CDC even put information for clinicians to disregard the usual “best practice” to conserve these supplies. They advised using one mask for multiple patients during their “crisis capacity strategies.”

How do we apply this learning to a design solution?

As designers, we could look at this problem another way, and see it as an opportunity to address some issues with the design of the disposable. In what ways could designers of PPE improve their ideas based on this “extreme” use case?

Start by asking important product design questions:

1. What is the primary purpose of this product?

2. Should this product be reusable or single use, and what are the trade-offs of both?

3. What is required in the design for this to allow the users to perform their duties?

4. What do your users actually do with the product? How do they use it?  If you observe your users in action, you might find out that they use the product in a way you wouldn’t expect.

Humans will always be human. In the case of masks, they will always want to touch them, adjust them, or take them off for a drink of water – rendering them ineffective. What can be done in the design of protective equipment to provide maximum comfort for the people who use the product every day, while still allowing them to avoid contamination? Can masks get a redesign so that they are reusable ventilating masks, combining the effectiveness of goggles, face shields, and a mask together?

Design for Reuse: Sterilization

After masks, the most talked about piece of equipment throughout this outbreak has been ventilators. This piece of machinery is part of life support in the intensive care unit (ICU) for people who are no longer able to breathe for themselves. So what can be learned about the design of ventilators to improve the design of ventilators tomorrow or inspire innovation for other life-saving products?

Ventilators are complex pieces of equipment that require specialized training to use. Most of the time, ventilators are used in the ICU as a part of life-supporting equipment. Since this outbreak, the need for ventilators has skyrocketed far past the number of ventilators actually available. Especially when you consider that using this complicated equipment requires special training, it becomes even more difficult to meet the need for ventilating equipment.

All the ventilators are in use right now because of high demand and most are working well, but what about the ones that aren’t? Machines that are old, dated, and poorly designed are running at the same levels as newer equipment backed with R&D. So what makes a bad design for this type of equipment? Why is it as important for the design of the product to be high quality as it is for the equipment to function?

How do we apply this learning to a design solution?

When creating a piece of medical equipment such as a ventilator, it is important to ask the same design questions mentioned earlier: questions about the user and how they will interact with the product, but also how it is engineered? What type of materials are appropriate for this type of product? How will the design of medical equipment affect its ease of use, storage, cleanability, and longevity in a tough environment like an ICU?

• Since this type of equipment is reused between patients, it is important to consider material selection for sterilization. Certain materials do not hold up well against the chemical cleaners that are often used in these types of environments. These poorly selected materials could significantly shorten a product’s usable life.

• A significant portion of a medical product’s life is spent waiting to be used in a storage closet. What is the footprint of the device, and is it easy to clean then put away?

• Cracks, crevices, wheels, and buttons. In any other environment, the sky is the limit on designing the form and function of your product, but in an environment with sickness and contamination, the design choices for every element has to be considered for cleanability.  Any small corners are a place for bacteria to hide.

• Design for Longevity. Stockpiles were made in advance of this pandemic as part of emergency protocol. Disposables, unlike reusable equipment, are not designed to last. So  when clinicians opened boxes up in their time of need, they found that their life-saving equipment had disintegrated! As designers, how do we plan for this unintended or unplanned use case? Do we include this as an additional primary requirements driver? Or does a new face-mask product get developed whose primary use case is longevity and stockpile?

In healthcare products, there is a lot to consider: the needs of the clinicians using the device, its ability to stay sterile, how the device will fare in a hospital environment, etc. Since this virus has spread, good design choices have meant the difference between life and death for some people. All because of a product that goes beyond simply working, and actually works well for those who need it most.

Is there a design solution out there?

In times of great need, innovation and creativity are used as tools to solve problems as they arise. Many cross-disciplinary teams have formed in order to address shortages of masks and ventilators. One piece of scuba diving equipment has been used to solve the need for clinicians to have protection against airborne virus molecules. Interestingly, the same scuba mask has also been adapted for use as a non-invasive ventilator for patients. This kind of design innovation, brought together around the world and across specialties, is the kind of innovation that pushes technology into the future.

So what makes the design of this scuba mask transferable to a medical device for both clinicians and patients?

1. These masks are made to be durable as a piece of sports equipment, so they can withstand cleaning, scratching, and being stored in the cycles of everyday use.

2. They are designed to be comfortable for someone to wear for long periods of time. Of course, people snorkeling may only wear a mask for three hours, whereas a nurse may wear a ventilating mask for their whole shift without taking it off.

3. These snorkeling masks completely seal the face of the wearer from their environment. They have a tube running around the perimeter of the face which connects to a sealed area around the mouth and nose allowing the wearer to breath from a nozzle at the top of their head which would poke out of the water. Or, in the case of the adapters, this is where oxygen or a filter could be attached.

Although snorkeling masks are far from usual medical equipment, the designers of this mask were motivated to create something for a user in a way that would make the mask comfortable. This way, wearers could focus on the task of looking at beautiful ocean wildlife, rather than concentrating on if the comfort and usability of the mask. The innovation expressed by the creators of these two scuba mask adaptations in order to transform this commercial mask into a medical product is just one example of how the design process can be applied to a problem to create a truly unique solution.

Cross-disciplinary teams, such as those that created these scuba mask alterations, exemplify the importance of asking the questions about their product, their users, and the overall lifespan of their product. If medical mask designers wanted to create a mask that was comfortable and long lasting for users, they could have applied design methodology to create a product similar to the scuba mask from the beginning. This way, the design ultimately solves problems instead of creating them.

So what did we learn about medical product development from COVID-19?

• • Ask questions: Asking important product design questions from the beginning sets the right foundation for your product. One that can be built on throughout its development.

  • Material selection for sterilization: Look at  all the options. Consider reuse rather than single use as the only option and know what materials will hold up under chemical sterilization. Think about the design of the device and how the design will effect its ability to be cleaned and sterilized during reuse.

  • Product footprint: Consider the whole life cycle of the product, where it will be used the most, how people will get it from place to place, and where it will be stored.

  • Make it durable, comfortable, and usable: Look to other products from different industries to see how design elements from their products could solve the same problems for your users.

  • Design for longevity: Sometimes the least likely scenario brings out the most creative solutions for the day to day.

Designs for masks and ventilators are meant to be a solution to medical needs, but lately they have been the cause of many problems. The need for good design has been highlighted by this global tragedy; a silver lining may be that this will be the fuel for new technology and innovation in the near future. This will continue to happen as long as we can learn from the design flaws of the past and present, and design the best products possible for the future.

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