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How F1 tech saves lives - a personal story

by Carley Bowman

Filed under Coronavirus

The headlines seem extraordinary - Formula One has come to rescue of the NHS by delivering a prototype breathing machine in under a week to treat critically ill Covid-19 patients. I wasn’t in the least bit surprised. Healthcare in the UK has learned much from high performance racing teams. My son has benefitted directly.

Composite image of an F1 pitstop from above and a high level diagram of a baby transfer
F1 pitstop compared to a baby transfer

In 2009, when Ben was just two-years-old, he was diagnosed with Long Segment Congenital Tracheal Stenosis. A bit of a mouthful. He had been in and out of hospital repeatedly - often in HDU - with breathing difficulties. Several times we had to resuscitate him while waiting for the ambulance.

It was a relief, in some part, when we discovered the reason why he had struggled with any minor respiratory infection. His airway wasn’t growing and was slowly suffocating him as his body grew bigger.

The prognosis wasn’t good. Without pioneering surgery he was unlikely to survive the next infection, let alone the next winter.

That’s when Professor Martin Elliott walked into our lives - The Prof, as he was affectionately known among staff and patients at Great Ormond Street Hospital (GOSH) in London. Head of tracheal services and a paediatric cardiac surgeon, even back then he was a maverick thinker. Always challenging the status quo.

Professor Martin Elliott in an F1 race suite delivering his Gresham Lecture
Professor Martin Elliott
A leader who believed passionately in sharing - rather than protecting - his skills and knowledge. He often spoke of being frustrated by the limitations of service delivery. One particular bugbear was the inability to conduct virtual outpatient appointments.

In his view, they would be less disruptive for children and families, no less effective in terms of clinical judgement, and far, far cheaper for the NHS. Surely data protection concerns could have been easily overcome? If they had ten years ago, our health service would certainly have been in a different position now to identify and advise those with suspected Coronavirus.

Ben’s surgery was a success. The weeks we spent in intensive care, then HDU and finally the cardiac ward at GOSH were a big learning curve for us as parents. Ben was ventilated for 10 days on PICU (paediatric intensive care unit). We witnessed many babies and young children receiving CPAP - Continuous Positive Airway Pressure - to help them breathe.

These are the devices that the Mercedes F1 team, along with engineers from University College London and clinicians from University Hospital London have developed rapidly to roll out to hospitals struggling to cope under pressure from Covid-19 admissions.

The Prof was ahead of the game. In 2001 the public inquiry into the Bristol Baby scandal identified the transfer from the operating theatre to the intensive care unit as one of the ‘most difficult stages in the care of a child’.

He already knew first-hand how challenging it was to disconnect a baby from a ‘very safe, highly structured’ environment in the operating theatre and transfer it to a trolley for the move to ICU. With all the associated risks of ventilating by hand, damaging the ‘plumbing’ connecting baby to the other life saving equipment and poor, unstructured communication between exhausted members of staff.

It was between two complicated procedures, when the surgical team was watching a Formula One race on television, that Prof Elliott and a colleague, Allan Goldman, first made the connection between the F1 pitstop and cardiac operations.

They observed the F1 crew refuel the car, change its tyres and transfer all the relevant information in 6.8 seconds. They had one thought. If they can do that, why can’t we?

It began a process of intense work for the GOS group with F1 team McLaren and later Ferrari to improve outcomes after paediatric surgery.

The initial solution from McLaren was to ‘engineer’ their way out of it. To build an operating table which was the same as a trolley and the same as an intensive care bed.

Clinicians operate on a child
A 'highly structured' operating theatre
But this kind of maverick thinking soon hit a brick wall. No manufacturer was willing to make it because no NHS hospital would replace all their equipment at the same time.

Taking a different approach, this time with Ferrari, the team mapped what made a successful pit stop and quickly identified gaps in their clinical approach.

The key failing? Leadership. No one was clear who was in charge. Critically, in F1, that’s not necessarily the most senior person on the scene.

Predicting and planning was another key area to address. Identifying the critical risks, including those that are undetectable - or unthinkable - to prioritise tasks.

And one of the most important findings, in my view, that junior staff were ‘frightened of speaking out’. In Formula One, juniors are positively encouraged to speak up. This was a key learning for the cardiac team. A decade later this was also highlighted by Sir Robert Francis after the problems at Mid-Staffs Hospital. Freedom to Speak Up Guardians are now in every hospital Trust.

And now the clinical handovers developed by Prof Elliott and his team are international standard practice.

Rapid prototyping - of the kind we are seeing with the production of CPAP machines by Mercedes - is standard practice in F1. Using data to inform engineering to give drivers the edge on the track.

How inspiring it is to see this collaboration in action - with the potential to save lives. But how disappointing that it takes a global pandemic to make it happen.

It shows the huge impact for innovation and transformation that mavericks can achieve. They are too often dismissed as irritations. In reality, they are visionaries who deserve a place at the table.

In my work with Nik Gowing and Chris Langdon on the Thinking the Unthinkable project, we make this precise point. Mavericks need to be nurtured, valued and encouraged by their leaders, not marginalised for not conforming.

My great hope post-Coronavirus, when we emerge into a ‘new normal’, is that we will learn from collaborations like these. That a new leadership will form, removing the conformist barriers that prevent some maverick thinkers, like The Prof, from fulfilling their potential for the benefit of us all.

You can watch Professor Elliott’s full Gresham Lecture, Formula 1 and its Contribution to Healthcare here.

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