One Market, One Product: How Baxter Developed a Truly Global Hemodialysis Machine
What is Hemodialysis?
Hemodialysis is a life-sustaining, chronic therapy used to treat patients with chronic or acute kidney failure. As part
of the body’s waste-removal system, healthy kidneys work to clean the blood of wastes produced through food intake and
metabolic function. For patients with end-stage renal disease, or kidney
failure, this process has stopped working, and patients must either undergo kidney transplant or some form of dialysis.
For a typical patient, hemodialysis is a life-changing process, requiring three four-hour treatments per week at a
dialysis clinic, during which the blood is filtered ex-corporally (i.e. outside the body). Dialysis is a complex therapy
involving a considerable amount of risk – approximately 20% of treatments include a morbid or life-threatening event.
And the machines are often running six days a week, 20 hours per day.
Facing the Challenge
The product development process for Baxter’s hemodialysis division was unscientific at best, and very much driven by
internal brainstorming among the engineers. The time had come to introduce a more robust process. But Baxter’s development
team faced a daunting challenge. Traditionally, separate machines, significantly different from one another, had been
dedicated to each of the three major hemodialysis markets – the U.S., Europe, and Asia – because of important variations
in many aspects of hemodialysis treatment and delivery. For example, in the U.S., there may be 20-40 patients per clinic,
while in Taiwan, there may be 120. And in the U.S., the sickest patients tend to receive kidney transplants, while in Japan, these same patients
are still receiving hemodialysis for years. Perhaps most important, the magnitude
and process for obtaining reimbursement was vastly different from one country to the next.
Could the Baxter team develop a
single machine that would overcome these differences, enabling it not only to save on development and marketing costs, but
also to win new customers worldwide and capture precious market share? And even more daunting, was it possible to conduct
this research, synthesize results, and introduce a new machine in the 30-month time frame allotted to the development team?
Getting Started
The company hired Applied Marketing Science to help explore these issues, and embarked on an extensive Voice of the Customer
study to develop a truly global hemodialysis machine. Their approach was a “no-holds barred” reexamination of the entire
machine from the ground up, based on the results of the Voice of the Customer. We first conducted face-to-face qualitative
interviews with 54 physicians (nephrologists), nurses, technicians, and dialysis clinic administrators in the U.S., Canada,
Germany, and France, and were able to observe many of their clinics in action.
The resulting needs statements
were then used in a second quantitative phase of research in which the needs were affinitized and prioritized by 158 respondents
fitting the same profile as in the earlier phase, but now adding Italy and the U.K. to the sample. The result of this research
was a detailed needs structure consisting of 110 unique needs statements, which were then aggregated into 25 tactical needs,
and then further aggregated into 5 overarching strategic needs categories. And since the prioritization was surprisingly
consistent from country to country, Baxter was able to proceed with its original strategy of trying to develop a truly global
solution.
Answering the Need
Below is a brief overview of some of the needs that were uncovered through the Voice of the Customer process, along with a
description of how the Baxter team answered these needs with smart, functional product design:
- Dependability. Because the threat of morbid events is so great during hemodialysis, and the need for patient
treatments at specified intervals is dire, dependability is key. This was clearly identified as the foremost need
among the nurses and physicians interviewed. While many clinics keep an extra machine available in case of breakdowns,
this is clearly an expensive proposition. Baxter answered this need with testing, testing and more testing – spread
over nine countries in 11 different hospitals – including shock testing, vibration testing, and long-term trials,
sometimes lasting 25,000 hours or more. In fact, the testing performed was orders of magnitude beyond what was
required by the FDA, and resulted in a number of further improvements to the product design.
- Easy to use. Hemodialysis machines are notoriously intimidating and difficult to use, with innumerable buttons
and dials, tubing, bags of saline, filters, injectible medicines, information displays, and more. Not only did the need
emerge for a clean and easy-to-understand interface, but also for keeping as much of the basic design and layout the
same wherever possible, in order to minimize the need for retraining.
- Ability to quickly perceive patient status. Getting clear patient status information quickly emerged as a very
high-level need. Nurses have to be able to see at a glance the condition and vital statistics of each patient. Baxter
answered this need with a large 15-inch swivel display that was simplified and easy-to-read for top-level information,
and included additional more detailed patient information at levels deeper inside the system.
- Ability to distinguish between serious and minor alarms. In a typical hemodialysis clinic, there are multiple
alarms going off at all times – some serious and needing immediate attention, but others merely indicating that a patient
is starting or terminating some phase of the process. The key question that emerged from our research was “how do you
know what to worry about?” The solution they developed was a system of color-coded lights for the various alarms that
was highly intuitive and easy to see from all angles and from almost any distance. This “traffic light” type system
employed green, yellow, and red lights mounted on a pole on top of the machine that indicated the seriousness of each
alarm.
- Conservation of nursing resources. With nursing resources so scarce in the U.S. and elsewhere, it was critical
to automate tasks typically performed by nurses wherever possible. In dialysis, a critical event can occur when the
patient’s blood pressure drops suddenly and he or she becomes unconscious or “crashes”. The typical treatment for this
event was an injection into the line through a special portal that took a nurse approximately 10 minutes to administer.
One of the innovations Baxter developed was to enable the patient – who is highly attuned to the “crashing” sensation –
to self-administer the injections, thereby reducing that patient’s reliance on an extremely valuable nursing resource.
And of course, the machine will still alarm if the intervention is not successful.
- Ability to capture and input patient information. Another important need was to more easily be able to track
information for insurance companies, government agencies and other third parties. For each patient, there is typically
a patient flow sheet, which captures seemingly endless amounts of information, including patient history, billing
instructions, hemodialysis procedures, and medication information. In addition, the patient’s prescription information
can consist of five or ten different parameters, many of which include specific caveats. By developing a technology to
encode this information electronically on a memory card, the Baxter team was able to capture, input, and output this
data automatically, rather than manually.
- Neater work area during treatment. Hemodialysis treatments require a myriad of accessories, including saline
bags, syringes, gloves, charts, blood pressure cuffs, bottle holders, and so on. Most prior machines didn’t have any
place to keep these items, and as a result, they seemed to be scattered everywhere, creating some risk of mix-ups in
patient treatment. The Baxter team was able to greatly reduce the clutter and enhance patient safety simply by building
a flat storage shelf on top of the new machine.
- A place to write. Even with additional automation, nurses still need to be able to write things down on occasion, and through observation, the team realized that they were either writing vertically on the side of the machine or going elsewhere to find a flat, horizontal surface. This problem was solved with a small flat panel on top of the machine – a ridiculously simple, but highly appreciated feature!
The Final Result
The finished product met with enthusiastic reviews. Nurses and physicians loved the automatic features, the enhanced
technical aspects, and the improved design. The initial showing was at a major medical conference in Berlin and the “doctors
absolutely couldn’t wait to get their hands on it,” according to Baxter product development manager Bob West. European sales
as a fraction of the total began to grow and by converting to a more global machine, the company succeeded in achieving
considerable economies in marketing and manufacturing. The goal of a consistent product and a consistent message had been met.
One hidden benefit of the project was the role it was able to play in the company’s strategic planning processes. The data
ended up driving many of their product portfolio decisions, helping the company to zero in on the most promising development
projects.
According to West, the key lesson learned was “research, research, and more research. . . In the various product development
projects the company had conducted previously,” said West, “so much of our decision-making was driven by intuition. I found
that if I could share a customer quote with the engineers, it had so much more validity – much different than in the past,
when all we had to go on were our own opinions. Once we had real customer information, decision-making became easier and
less contentious. Data was simply a better way of making decisions than intuition.”
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