Over email @Enrico raised a number of constructive considerations that led to various responses. A lot of these will need to be put in action as we progress, so I’ve organized our long email thread into clear topics.
(To reply, highlight text and use the [quote] button. I will moderate and keep replies organised in threads to save everyone time.)
Feedback loop and improvement
- Order is too large
- Difficult to track use and receive back-data from
- A “moral “- contract with one source at the hospital
- One point of reference to receive feed-back
- Less masks ( max 30 pcs, better if 10-20) per hospital
- We should disperse the amount of masks we have as widely as possible, even if this means that some hospitals will get less than 5 pcs. The wider we spread the more empirical info we collect. ( avoid all eggs in a basket)
Alexadnrovska - 24 medics in the ER / 30+ in ICU / + 15 for the non-medics, who are cleaning, sanitizing etc. The total in the meeting with Dr. Aleksandrov was 70 masks. They wanted to also try the CPAP application, since in relity its a HELM. They have 9 CPAPs + are taking delivery of 6 more, but have no true helms for them. We accounted 30 more for contingency. Poli was with me in the meeting, she can confirm the numbers.
We dont have to deliver the full 115, but my desire is to deliver at least the 70 + 15. We can keep the rest and deliver on-demand. Dr Aleksandrov is the CEO of the hospital and demonstrated commitment to use them. Furthermore, I have been in contact with Dr. Hubanov from the Aleksandrovska ER and he has also demonstrated willingness to have this PPE method for his whole team.
I am in the other end of the spectrum. The 230 masks we are currently working on is not enough. I would really like to push this, once we have proof of case (total implementation in Aleksandrovska), and secure the further 880 masks trough the Ministry of Health. I have been in contact with the Czech technincal university team, who last week have supplied 2000 masks as PPE and were preparing 10 000 more. Population of Czech Republic is 10.65 million.
I understand that it will be optimal to get proof of concept on a small scale first and then expand. However, this could take months. There is risk, but I believe that the risk/reward is very favourable.
I would like to add:
With small batches, we can both increase our production speed, our rate of improvement, and lower our exposure to errors.
We will much likely be faster if we deliver in smaller batches. This is a very typical phenomenon in new production lines if you study Lean production Larger batches tend to get held up. Plus, smaller batches speed up the feedback loop. If we deliver 20 masks quickly, we will have feedback on those that could improve or avoid rework by the time we deliver the next 20, meaning we have just saved rework on the the remaining 75 masks in the order. Plus, overall the product will improve much more quickly over time, as there are more iterations.
I think it makes sense to have a single point of contact in the hospital who takes responsibility for the mask allocation and maintenance, and another who is responsible for organizing feedback to us. That said, feedback to will be much clearer if collected directly from the source.
Our batch size may increase as we scale up, but for the next few weeks, financing and mask deliveries will be the constraining factor for us to grow. So small batches are even more useful as we can get more feedback and more iterations in early, and be more prepared with a better design and production capability when the funding unlocks larger volumes.
Care and accountability
- Who is in charge of the masks at the hospital, all 115 people separately
- How are they stored and where
- When things are for free they do not receive the proper respect and treatment -> barking, misusing, stealing , etc.
- How do we make sure the masks are stored and properly treated – they are not meant to be disposed of after the epidemic.
- We need a type of contract to ensure the masks are not used privately and will be always at the hospital
- The masks will be a donation. They will be delivered without the snorkels, so they cant be used in water.
- We are preparing a document - user manual which will include cleaning, desinfection, storage etc.
Enrico makes some valid points. We discussed with Momchil and he will start drafting this Instructions Doc for the medical staff. Once it is started, he can share the file and we can all contribute.
I’m less concerned that people will steal them, but am aware that they could be easily “forgotten”.
My suggestion is that we have a contract where we specify that we’re providing the masks free of charge for an unlimited amount of time. However, if the masks are not in use we keep a door open to collect them and provide them to another hospital. From a legal perspective if we don’t donate them, then they will have to be responsible for keeping them safe for us.
Of course the wording is important as I’d like the agreements to be seen as an act of cooperation and that we collectively provide support where it’s most needed.
I think we should consider this concern, and keep an eye on it in the early stages. We don’t need to make a policy decision now, but loan or recall rights might be something effective for us to ensure hospitals implement appropriate care.
- How do we make sure that the masks are not being used for its original purpose during summer vacation
- Who disperses the masks at the hospital ? how do we make sure they actually get dispersed ?
We are organizing another batch of 115 masks, that will be used to distribute to individual medics and smaller hospitals around the country. We want to see requests/letters for this and all this will be well accounted and tracked.
I don’t have answers to all your questions and some things we have no control of. I believe in the honest concern of the medics and their desire for adequate PPE.
I wonder if this addresses @enrico’s concerns?
- What happens to the masks after the epidemic, who checks on this? What leverage do we have
- Are masks a gift or a “loan” to be returned ….to whom ( suppose the epidemic returns in fall full force and we need masks again ;
- How do make sure the masks are still available at the hospital
Here, I would like to suggest we talk to the Ministry Of Health, and see if we can collect all the masks and rely on them with the responsiblity for long-term storage and care. They can then re-issue them if need be.
Credit for our contributions
- Personnel does not understand we is involved in creating theses masks.
This is something that bothers me too. As these types of projects scale up, more people get involved, and more intermediaries and inevitably others try to take credit. I can suggest two low-effort tactics:
- We make sure everyone’s names, contributions and even locations are on the main website.
- We make some kind of logo sticker for each mask, and put our stamp on it
This sounds a little silly, but it’s serious: when this is all over, we throw a mask party and meet the people who used this equipment.
I know that nobody here is doing this for fame or notoriety, but I also know the feeling of not getting credit for your hard work. It hurts our motivation in some way, so worth considering seriously.