ncubeeight: Using VR comfortainment to bring an end to the US blood supply shortage

I conducted my MBA during a fascinating time in our world economy. We’d endured through a pandemic that shut down significant portions of our economy for nearly a year followed by surging interest rates as government response to the pandemic resulted in significant inflation and subsequent layoffs in my region. While this was a dramatic time for the world, it was a fascinating time to return to academia and evaluate the impacts to the global economy of natural and artificial stimuli.

For our masters thesis we were asked to identify an opportunity in the economy that could be addressed by a new business entrant. In discussing with several of my MBA class cohort, we decided to focus on the blood supply shortage that resulted from the end of the pandemic. Why would the US go into blood crisis at the end of the pandemic we wondered. Shouldn’t that have been expected during the peak of the pandemic in 2020 or 2021? But it turns out that during the pandemic surgeries and car crashes dropped at the same time that blood intake to the supply dropped. It was only after the pandemic ended that supply and demand got out of sync. In 2022 people started going to hospitals again (and getting injured at normal rates) while the blood donor pool had significantly shrunk and not recovered its pre-pandemic rate of participation. So hospitals were running out of blood. What's more concerning is that it looks as if the drop in donor participation isn't a short term aberration. Something needs to shift in the post-pandemic world to return the US to a stable blood supply. This was a fascinating subject for study.

As we began our studies we interviewed staff at blood banks and combed through the press to understand what was taking place at this time. There were several key factors in the drop-off of donors. Long-Covid had impacted 6% of the US population, potentially impacting willingness to donate among those individuals who’d participated before. (Even though blood banks accept donations from donors who have recovered from Covid, the feeling that one's health is not at full capacity impacts the sentiment one has about passing on blood to another.) At the same time there was a gradual attrition of baby boomer generation leaving the donor pool while younger donors were not replacing them due to generational cultural differences. Finally, the new hybrid-work model companies adopted post-pandemic meant that blood-mobile drives that took place at companies, schools and large organizations could no longer receive the same turnout for blood drives that had formerly taken place at those locations.

The donation pool we’ve relied on for decades requires several things. So we tried to identify those aspects that were in the control of the blood banks directly:

First, an all-volunteer unpaid donor pool requires a large number of people in the US (~7 million) willing to help due to their own internal motivations and having the ample time to do so. Changing people’s attitudes toward volunteerism and blood donation is hard to do while marketing efforts to achieve this are expensive. In an era when more people are having to work multiple jobs, the flexibility to volunteer extra time is becoming constrained. There is likely going to be an ever worsening trend of time scarcity among would-be donors in contrast to the pre-pandemic times.
Second, there needs to be elasticity in eligible donor pool to substitute for ill would-be donors in times of peak demand. Fortunately, this year FDA has started expanding eligibility criteria in reaction to the blood crisis, permitting people who were previously restricted from donating to participate now. However, this policy matter is is outside the control of blood banks themselves. Blood demand is seasonal, peaking in winter and summer. But donors are consistent and are difficult to entice when need spikes due to their own seasonal illnesses or summer travel plans.
Third, and somewhat within the control of blood banks, is in-clinic engagement and behaviors. Phlebotomists can try to persuade upgrades in donor time during donor admission and pre-screening. This window of time when an existing donor is sitting in clinic is the best time to promote persistent return behaviors. Improving the method of how this is achieved is the best immediate lever to bolstering the donor pool toward a resilient blood supply. But should we saddle our phlebotomists with the task of marketing and up-selling donor engagement?

Considering that there is no near-term solution to the population problem of the donor pool, we need to do something to bolster and expand the engagement of the remaining donors we have. In our studies we came across several interesting references. "If only one more percent of all Americans would give blood, blood shortages would disappear for the foreseeable future." (Source Community Blood Center) This seems small. But currently approximately 6.8 million Americans donate blood, less than 3% of Americans. So it's easy to see how a few million more donors would assuage the problem. But the education and marketing needed to achieve this end would be incredibly expensive, slow and arduous to achieve. It’s hard to change that many minds in a short time frame. Yet this comment from the same source gave us an avenue to progress with optimism: "If all blood donors gave three times a year, blood shortages would be a rare event. The current average is about two." We agreed that this seemed like a much more achievable marketing strategy. In our team calls, Roy Tomizawa commented that we need to find something that makes people want to be in the clinic environment beyond their existing personal motivations for helping others. He suggested the concept of “comfortainment” as a strategy, whereby people could combine their interest in movie or TV content with time they’d sit still in the clinic for blood donation, dialysis or other medical care. If we were to transform the clinic from its bright fluorescent-lit environment into a calm relaxing space, more people may wish to spend more time there.

As a life-long donor, I've heard a lot of promotions to increase the frequency of donation while in clinic. But during intake so many things are happening. 1) FDA screening questions, 2) temperature check, 3) blood pressure measurement, 4) hemoglobin/iron test, 5) verbal confirmation of no smoking or vaping. This battery of activity is an awkward time for phlebotomists to insert promotional campaigns on increasing engagement. One day I noticed some donors were doing something different in the blood bank and I asked about it. Then I was informed how the blood apheresis process differs from whole blood donation. It involves the use of a centrifuge device that can collect more of a specific component of blood product at time of draw from a single donor then returning the rest of the blood to the donor. Not only does this yield multiple individual units of blood per draw, the recovery time between donations is shorter. Whole blood donations require 2 months of time for the donor to replenish their blood naturally before another whole blood donation. Apheresis donors lose less of overall blood and can therefore return more often. The only downside of this is that it requires more time from the donor in-clinic.

Because apheresis was the most flexible variable that blood banks could impact as demand and supply waxed and waned, our study zeroed in on optimizing this particular lever of supply to address the blood shortage. In a single blood draw via apheresis, a donor can provide 3 units of platelets, compared to whole blood draws. This allows the blood bank to supply three units immediately after draw to hospitals instead of having to use a centrifuge on post-donation pooled units of whole blood from multiple donors. Platelets are uniquely needed for certain hospital patients in the case of cancer patients or among those with blood clotting disorders. Regarding other blood components, an apheresis blood draw can provide 2 times more red blood cells than what would otherwise be donated as whole blood. At the same time that a donor is providing platelets, they may also provide plasma in the same draw, which provides leukocytes which can help patients with weakened immune systems by providing natural antibodies from healthy donors.

Hearing all this you might think that everybody should be donating via apheresis. But the problem with it is the extra time needed, an additional hour of donor time at least. A donor planning to donate for just a 15 minute blood draw may be reluctant to remain in apheresis for one to two hours, even if it triples or quadruples the benefit of their donation. Though this is one factor that can be immediately augmented based on the local hospital demand, asking donors to make the trade off for the increased benefit can be a hard sell.

When I first tried apheresis, I didn’t enjoy it very much. But that’s because I don’t like lying down and staring at fluorescent lights for long periods of time. Lying on the gurney for 15 minutes is easy and bearable. Having phlebotomists try to persuade hundreds of people to change their donations to something much more inconvenient is a difficult challenge. Some blood banks offer post-donation coupons for movies or discounts on food and shopping to promote apheresis donations. My team wondered if we could we bring the movies into the clinic the way that airlines had introduced movies to assuage the hours of impatience people feel sitting on flights. Having people earn two hours of cinema time after donation by sitting still for two hours in clinic begs the question of why you couldn't combine the two together. Donors could watch IMAX films at the clinic when they'd plan to be immobile anyway!

We interviewed other companies which had launched VR content businesses to help people manage stress, chronic pain or to discover places they may want to travel to while they're at home. We then proceeded to scope what it would take to create a device and media distribution company for blood banks to entice donors to come to the clinic more often and for longer stays with VR movies and puzzle games as the enticement. Introducing VR to apheresis draws doesn't create more work for phlebotomist staff. In fact one phlebotomist can draw several apheresis donations at once because the process provides an hour between needle placement and removal as idle time. So while we increase yield per donor, we also reduce the busywork of the phlebotomy team, introducing new cost efficiencies into the clinic processing time overall.

Consumer grade VR headsets have now decreased in price to the level that it would be easy to give every donor an IMAX-like experience of a movie or TV show for every 2 hour donation. To test the potential for our proposed service, we conducted two surveys. We started with a survey of existing donors to see if they would be more inclined to attend a clinic that offered VR as an option. (We were cautious not to introduce an element that would make people visit the clinic less.) We found that most existing donors wouldn’t be more-compelled to donate just because of the VR offering. They already have their own convictions to donate. Yet one quarter of respondents claimed they’d be more inclined to donate at a clinic where the option existed rather than a clinic that did not offer VR. The second survey was for people who hadn't donated yet. There we heard significant interest in the VR enticement, specifically among a younger audience.

Fortunately, we were able to identify several other existing potential collaborators which could make our media strategy easy to implement for blood clinics. Specifically, we needed to find a way to address sanitation of devices between use, for which we demoed the ultra-violet disinfection chambers manufactured by Cleanbox Technologies. If donors were to wear a head mounted display, they would need to make sure that any device that was introduced to a clinical setting had been cleaned between uses. Cleanbox is able to meet the 99.99% device sterilization standard required for use in hospitals, making them the best solution for a blood clinic introducing VR to their comfortainment strategies.

Second, in order for the headsets to have regular updates and telemetry software checks, we talked to ArborXR which would allow a fleet of deployed headsets to be updated overnight through a secure update. This would take device maintenance concerns away from the medical staff onsite as well. Devices being sterilized, charged and updated overnight while they weren’t in use could facilitate a simple deployment alongside the apheresis devices already supplied to hospitals and blood banks through medical device distributors, or as a subsequent add-on.

Using the Viture AR glasses at an apheresis donation

While we hope that our study persuades some blood banks to introduce comfortainment strategies to reward their donors for their time spent in clinic, I’ve firmly convinced myself that this is the way to go. I now donate multiple times a year because I have something enjoyable to partake in while I’m sharing my health with others.

I’d like to thank my collaborators on this project, Roy Tomizawa, Chris Ceresini, Abigail Sporer, Venu Vadlamudi and Daniel Sapkaroski for their insights and work to explore this investment case and business model together. If you are interested in hearing about options for implementing VR comfortainment or VR education projects in your clinic or hospital, please let us know.

For our service promotion video we created the following pitch which focuses on benefits the media services approach brings to blood clinics, dialysis clinics and chemotherapy infusion services.