3D printing in hospitals: open innovation during the COVID-19 crisis

When COVID-19 hit, Greater Paris Uni­ver­si­ty Hos­pi­tals (AP‑HP) faced dire short­ages of per­son­al pro­tec­tive equip­ment (PPE) and med­ical sup­plies. In March 2020, an AP-HP sur­geon and the CEO of a 3D print­ing med­ical ser­vices start-up, pro­posed set­ting up a “3D farm” of 60 print­ers inside one of network’s hos­pi­tals. Backed by €1.7m in pri­vate funds, the plat­form was up and run­ning with­in weeks—a tes­ta­ment to what is pos­si­ble when urgency removes bureau­crat­ic fric­tion. Due to the nature of the chal­lenge of sup­ply­ing such an organ­i­sa­tion, the plat­form inno­vat­ed through knowl­edge flows across the estab­lish­ments, mak­ing it an inter­est­ing case study of an “open inno­va­tion” approach.

This organ­i­sa­tion­al par­a­digm dates back to the ear­ly 2000s¹, in the wake of the infor­ma­tion rev­o­lu­tion. Then, Berke­ley Pro­fes­sor Hen­ry Ches­brough posit­ed that infor­ma­tion had become so wide­spread that inno­va­tion could sprout from any­where, and com­pa­nies that want­ed to stay ahead of the curve need­ed to open up to exter­nal ideas. Open inno­va­tion has demon­strat­ed its poten­tial in the health sec­tor, par­tic­u­lar­ly dur­ing the rapid devel­op­ment and test­ing of a new COVID-19 vac­cine². How­ev­er, a hos­pi­tal set­ting is not a blank slate and requires spe­cif­ic knowl­edge flows with­in a dense net­work of pub­lic and pri­vate organ­i­sa­tions. Under­stand­ing the flow of infor­ma­tion and inter­ac­tions with­in such a set­ting could help enhance inno­va­tion with­in this com­plex ecosystem.

The AP-HP ini­tia­tive pro­vides a rare case study to answer this cen­tral ques­tion: can open inno­va­tion work with­in a hospital?

Invest­ment in the 3D print­ing plat­form quick­ly paid off. Over nine months (April to Decem­ber 2020), more than 33,000 units rolled off the print­ers’ banks. The major­i­ty of these (87%) were pro­tec­tive equip­ment, but there were also a sur­pris­ing range of oth­er objects: cus­tomised sur­gi­cal instru­ments, sup­ports for oxy­gen bot­tles, replace­ment parts for clean­ing machines, and even head­rests for intensive‑care patients kept prone for long spells.

In a sys­tem where “inno­va­tion” is often sequestered in spe­cial­ist silos, the plat­form opened the door to all com­ers. Engi­neers were embed­ded on‑site, which meant they could glean ideas from not just doc­tors, but also nurs­es, ther­a­pists, tech­ni­cians, and main­te­nance staff, revers­ing the typ­i­cal hier­ar­chi­cal struc­tures. The close col­lab­o­ra­tion with an exter­nal 3D print­ing start­up, notably its engi­neers, its sup­pli­er, and its aca­d­e­m­ic part­ners (for instance, French engi­neer­ing schools), bol­stered inno­va­tion in a way that would not have been achiev­able through sole­ly in-house inno­va­tion, as con­tract­ing out these engi­neers would have been too expensive.

Prox­im­i­ty allowed for tac­it knowl­edge trans­fer: by walk­ing from a work­bench to a ward, engi­neers could cre­ate pro­to­types in the space of a few hours rather than months, and these could be iter­at­ed rapid­ly. This not only met urgent needs, but often uncov­ered hid­den chal­lenges, and cre­at­ed moments for spillover inno­va­tion, some­times repur­pos­ing devices across departments.

Beyond new prod­ucts, the plat­form brought man­age­r­i­al inno­va­tions (on-site inter­dis­ci­pli­nary col­lab­o­ra­tion) and process inno­va­tions (localised man­u­fac­tur­ing that cut lead times from months to days, reduced costs, and avoid­ed stock­outs). It also seems to have improved work sat­is­fac­tion by empow­er­ing staff to solve prac­ti­cal problems.

A turn­ing point came in Sep­tem­ber 2020. With­out the focus­ing pow­er of the glob­al pan­dem­ic, and away from the press­ing need to pro­vide PPE, it was time to imag­ine how the plat­form could work in the long run. Cham­pi­ons imag­ined sev­er­al ways that it could cre­ate val­ue in the long run, some more finan­cial­ly tan­gi­ble than oth­ers. These ranged from pro­duc­ing reg­u­lat­ed med­ical devices, to licens­ing inno­v­a­tive 3D designs to oth­er hos­pi­tals, to design patent­ing. Per the plan, the mod­els’ licenc­ing fees were also to be shared with the inven­tor, which could act as a mag­net for promis­ing physi­cians that could coun­ter­bal­ance AP-HP’s renown admin­is­tra­tive com­plex­i­ty and lim­it­ed recruit­ment budget.

In-house pro­duc­tion was also fore­cast­ed to be cost-cut­ting, as there were ear­ly signs that it could help reduce some pro­cure­ment costs, improve care, retain con­trol of valu­able patient data tied to cus­tomised devices and enhance teach­ing and research. Train­ing could also be offered to oth­er hos­pi­tals to roll out a sim­i­lar plat­form. One of the most advanced plans was the 3D Print for Africa project, which imag­ined train­ing staff and help­ing in the imple­men­ta­tion of 3D print­ing hos­pi­tals in five west African hospitals.

Buoyed by its ver­sa­til­i­ty, per­ma­nent ambi­tions were sketched out to increase the platform’s role, while improv­ing its val­ue cap­ture. In the­o­ry, these plans met the three­fold mis­sion of a teach­ing hos­pi­tal: patient care, research, and edu­ca­tion. In prac­tice, how­ev­er, sev­er­al organ­i­sa­tion­al and finan­cial bar­ri­ers hin­dered progress. Phase‑two invest­ment was esti­mat­ed to require €1.4m, with annu­al run­ning costs val­ued at €1.2m. While senior lead­ers acknowl­edged the patient‑care ben­e­fits of the pro­posed phase 2 plans, it was dif­fi­cult to sup­port a clear revenue‑or‑savings mod­el. The hospital’s pro­cure­ment agency, also clashed with the project team over med­ical device reg­u­la­tion, notably fear­ing that pro­to­types pro­duced by the plat­form would fail to meet com­pli­ance stan­dards linked to med­ical equip­ment. There was lit­tle vis­i­bil­i­ty on the facility’s scal­ing up, as the plat­forms’ ini­tial small size, which had proven cat­alyt­ic to inno­va­tion, would also lim­it development.

Three essen­tial con­di­tions have been iden­ti­fied to make such inno­va­tion sus­tain­able: a cul­ture of inno­va­tion, align­ment of inter­ests, and clar­i­ty of expect­ed rewards.

His­tor­i­cal in-fight­ing also proved to be an issue — in prac­tice, dur­ing the first phase of the platform’s life, hos­pi­tals clos­est to the 3D farm were most like­ly to use the ser­vice. As the sec­ond phase was being exam­ined, stake­hold­ers expressed fears that AP-HP’s rep­u­ta­tion for inter­nal com­pe­ti­tion, referred to by one inter­vie­wee as “turf wars”, could lim­it access of some of the net­works’ par­tic­i­pants to the machines. With no con­sen­sus on objec­tives and reg­u­la­to­ry doors closed, the con­tract with the exter­nal part­ner was end­ed ear­ly in 2021.

Despite its limitations—including the excep­tion­al nature of the COVID-19 pan­dem­ic, the study’s small sam­ple size (a case study), and the speci­fici­ty of this organisation’s culture—this research sheds light on the poten­tial of open inno­va­tion in a hos­pi­tal set­ting. It also demon­strates how a project can be quick­ly aban­doned if the val­ue cap­ture is not quick­ly and clear­ly defined.

Our research iso­lates three vital con­di­tions for mak­ing such inno­va­tion sus­tain­able. First is an inno­va­tion cul­ture. Bureau­crat­ic rigid­i­ty, hier­ar­chi­cal deci­sion-mak­ing, and finan­cial con­straints arrest­ed momen­tum until lead­er­ship appoint­ed a ded­i­cat­ed direc­tor and project lead. With­out com­mit­ted struc­tures and cham­pi­ons, exter­nal knowl­edge flows strug­gle to take root. Sec­ond is align­ment of inter­ests. All inter­nal stake­hold­ers — not just clin­i­cians, but also admin­is­tra­tors and sup­port ser­vices — should be able to see their roles and rewards clear­ly. In AP‑HP’s case, mis­aligned com­pe­ten­cies and per­ceived turf threats under­mined progress. Third is clar­i­ty on expect­ed rewards. The project’s ori­gin as an emer­gency PPE fac­to­ry blurred its poten­tial long-term impact. Man­age­ment sought finan­cial returns; cham­pi­ons also val­ued harder‑to‑measure gains such as effi­cien­cy, morale, and data sov­er­eign­ty. Absent con­sen­sus, the ini­tia­tive lost polit­i­cal and fis­cal support.

The orig­i­nal “3D farm” did leave a lega­cy. In 2024, AP‑HP launched a new addi­tive man­u­fac­tur­ing plat­form. The project learned from its ear­li­er cau­tion­ary tale — this time it has for­mal gov­er­nance, a net­work of thir­teen oth­er pub­lic research hos­pi­tals, and a clear mis­sion to pro­duce both med­ical and main­te­nance equip­ment inside the health system.