In December 2019, the Assistant Secretary for Preparedness and Response told a House committee that “supply chain issues were among the most significant challenges to preparing for an influenza pandemic as well as other infectious diseases.” A few months later, healthcare systems across the country and around the world are face-to-face with that harsh reality, as many of the largest healthcare suppliers are unable to fully meet the growing global demand for personal protective equipment (PPE) for healthcare workers and ventilators and other supplies needed to care for patients.
Supply chain professionals are collaborating and innovating with clinicians and communities in ways that are not only addressing the immediate crisis but also will likely reshape the future of the healthcare supply chain. As the COVID-19 pandemic progresses, with some communities at or near the apex, the lessons learned to date can be shared in real-time with those still in its path.
The work being done by Yale New Haven Health, as well as Mercy, BJC Healthcare, and SSM Health in the St. Louis area, serve as examples other health systems can follow as organizations work diligently to establish best practices to help serve their communities in the days and weeks ahead.
Collaborate and Communicate with Clinicians
Supply chain professionals emphasize the importance of making sure healthcare workers feel safe in order to perform at the level demanded by the disease. This is challenging when the supplies they are accustomed to are no longer available and short supplies of alternatives warrant protocol changes, such as wearing the same mask for longer periods of time or even re-using equipment. Implementing these changes must be done in close collaboration with clinical leadership and constant communication with front line staff, so that they not only understand the changes but also the supporting evidence.
Patrick Kenney, MD, medical director for supply chain at Yale New Haven Health, says it is especially disruptive for systems and clinicians who routinely seek to reduce variation to improve quality. When changes are a necessity, not an option, Dr. Kenney stresses “communication is essential, along with close interaction between supply chain, medical staff and nursing leadership.” Yale New Haven Health employs a multitude of communication channels, including videos, websites, and town halls, among others, to help clinicians with the transitions.
Dr. Kenney says the guidance from the Centers for Disease Control (CDC) has been vital in providing as many alternative strategies as possible. He and his colleagues have conducted research on the reprocessing of N95 respirators and are implementing the practice to help minimize shortages of the higher filtration devices. The research (currently undergoing peer review) is available on a pre-print service (https://www.medrxiv.org/content/10.1101/2020.03.24.20041087v1) to accelerate knowledge sharing. The 1,000+ COVID-19 related articles already on the site are a testament to the wealth of knowledge that is being generated by researchers around the world.
In his daily briefings, New York Governor Andrew Cuomo has called on hospitals in the hard-hit New York City area and now the entire state to plan and function as if they were one system, to help ensure, among other things, that supplies are where they are needed most. Without such coordination, Governor Cuomo says individual hospitals and governments can create unnecessary competition leading to higher prices when they each seek to secure supplies from the same sources.
In St. Louis, three major health systems, Mercy, BJC Healthcare, and SSM Health, are collaborating at the CEO level on testing, patient surge projections, and capacity planning. BJC Chief Supply Chain Officer Tom Harvieux says it has been “a real community effort.”
Link the Patient and Supply Demand Planning
Yale New Haven Health has also created a dashboard of patients with confirmed or suspected cases to visualize where patients are coming from and to plan for upcoming demand. The System’s Corporate Supply Chain Lead Vin Matozzo says his team can predict with 70 percent accuracy the associated supply needs for those patients, helping ensure the product is where it is needed and to model the financial impact on a daily basis.
Securing and Strengthening the Supply Chain
With the COVID-19 pandemic expected to last into the summer, and traditional suppliers likely unable to meet the full demand, the Association for Healthcare Resource and Materials Management (AHRMM), part of the American Hospital Association, has led an effort to identify and vet non-traditional suppliers to help broaden the supply base, while also minimizing the introduction of unscrupulous players. The vendors cleared through the process are listed on the AHRMM COVID-19 page. Matozzo says the FBI and US FDA have also provided guidelines for how to recognize counterfeit products.
Going forward, Yale New Haven Health’s Matozzo says it will be important for hospitals and healthcare systems to have better visibility into upstream supply risks, be it from natural disasters like Hurricane Maria, trade sanctions, labor strikes, or another pandemic that puts unprecedented demand on the global supply chain. With a deeper understanding of how their supply partners are managing risk, providers can make sourcing and contracting decisions to minimize potential supply chain disruptions.
Across the country, supply chain leaders credit relationships with trusted partners as foundational to meeting critical needs, beginning with the clinical, financial and operational leaders inside their own systems, and extending out into the community. This includes government, emergency responders, and public health agencies, as well as neighborhood resources.
With many schools with medical training programs closing their on-campus operations, they can be a great source for supplies, Instead of sourcing product from suppliers only, hospitals are calling on organizations that typically purchase those supplies, such as schools, construction companies, and hardware stores. In other cases, those with 3D printing capabilities are downloading open-source designs for products ranging from face shields to respirator parts and setting up production lines in their living rooms. As one hospital supply chain leader put it: “In healthcare, we get used to things working with certain players; in times of crisis your next-door neighbor might be your best supply chain.”
About Karen Conway
Karen Conway is Vice President, Healthcare Value with Global Healthcare Exchange (GHX). GHX is a healthcare business and data automation company that works with 4,100+ North American healthcare providers, and 600 manufacturers and distributors in North America to automate their business processes.