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.