This is part one of our two-part series, Optimize Your Supply Chain.

Series Introduction

Supply chain management and optimization may not sound like the most riveting topic, but its importance runs deep. An April survey of 138 hospital leaders found that supply chain risk regarding supplies and devices was their second-highest priority—and that PPE, test kits, respirators, and supply sharing were among the top five needs executives wanted met. Even before COVID-19 began, another survey of 100 healthcare C-suite and supply chain leaders found 52% of respondents saw margins increasing by 1 to 3% as a result of improved supply chain management.

While healthcare leaders already knew the importance of a well-managed supply chain, the COVID-19 pandemic has demonstrated how truly critical it is to hospital stability and growth—both in crises and in normal day-to-day operations.

In part one of this blog series, we compile recommendations and considerations for supply chain management during COVID-19 from reputable sources like the CDC, Harvard Business Review, Wexner Medical Center, MedCity News and more. In part two (publishing 9.15.2020) we zoom out and discuss a few best practices for supply chain optimization during times of normal operations.

Let’s jump in.

Supply Chain Management Amid Crisis Situations

Test kit materials, ventilators, and Personal Protective Equipment (PPE) have been at center of the supply chain challenges in the U.S. throughout the COVID-19 pandemic.

Wisely Using Available Resources

The CDC provides recommendations for optimizing the PPE hospitals and health systems have in conventional, contingency, and crisis situations. In all cases, organizations must (1) understand their current inventory, supply chain, and utilization rate (can be calculated via the Burn Calculator Tool) and (2) be in communication with local coalitions, government partners, and other groups to identify and obtain additional supplies as needed.

Here is a sampling of the strategies:

Conventional

• Ensure your workforce is following the correct donning and doffing procedures
• Train workforce on how to appropriately utilize PPE, limit face-to-face patient encounters, and enforce visitor restrictions
• Screen patients prior to healthcare visits and reschedule non-acute visits
• Rely on technology-enabled care, including nurse call lines, telehealth visits, and virtual consultations
• Consider using NIOSH approved N95 respirator alternatives
• Use isolation gown alternatives with same or better protection and eye protection according to product labeling and requirements
• Follow contemporary practices for glove use in patient care settings

Contingency

• Cancel or reschedule elective and non-urgent procedures and appointments where eye protection, gowns, and other PPE is required
• Discharge COVID-19 patients who are medically stable and have a socially and medically appropriate home environment to recover in
• Use N95 respirators beyond their designated shelf life
• Consider the use of coveralls and/or reusable/washable cloth isolation gowns
• Shift eye protection from disposable to re-usable pieces (e.g. goggles, face shields) with appropriate cleaning and disinfection protocols
• Use gloves past shelf life, if applicable, or those gloves that conform to other performance standards

Crisis

• Engage in limited re-use of N95 respirators, and use of respirators approved under NIOSH-similar standards
• Exclude members of your workforce from patient contact who are at increased risk for severe illness from COVID-19
• Consider alternative ventilation measures, including NIOSH’s ventilated headboard
• Extend use of isolation gowns, eye protection devices, and gloves, and prioritize their use to certain care activities
• Allow other pieces of clothing as a replacement for isolation gowns when no gowns are available (disposable lab coats, gowns, etc.)
• Consider non-healthcare glove alternatives

Exploring Alternative Resources

As noted throughout the contingency and crisis scenarios, in many cases hospitals will need to explore alternative resources. It’s important hospitals monitor the FDA’s Emergency Use Authorizations (EUAs) to ensure they are taking advantage of approved substitutions or changes in requirements that could help them keep their doors open and patients/providers protected. In the case of COVID-19, find the full list of PPE EUAs here.

The CDC also provides helpful evaluation items for hospitals to consider when planning to purchase respirators, including:

• Ensure the manufacturer is approved by the National Institute for Occupational Safety and Health (NIOSH) and that the model has achieved filtration efficiency results <95% efficient by NIOSH evaluation.
• Gain as much information as possible about the manufacturer prior to entering into a new agreement: ask for references, review the website, engage in email and phone communications to ensure legitimacy, ask specific questions about the model(s) you’re interested in, request access to tax filings, etc.
• Get samples of the product prior to making a purchase to ensure quality, efficacy, and fit.
• Beware of pricing – too low and it might be suspicious, but too high and you’ll be overpaying. Between $2-$3 per unit is currently the expected reasonable price.
• In contracting, establish protective measures to ensure the seller financially guarantees authenticity and takes financial responsibility for the quality of the product.

Improving Resource Management and Tracking

Harvard Business Review notes a few key lessons that accompany and build on many of the CDC recommendations:

• Do your best not to make in-the-moment decisions that will compromise future care
  • When considering rescheduling treatment or services, stratify patients by the risk of postponement to manage not only their current health but also their future demand for the scarcest health resources
  • When making the decision to discharge, ensure that there is a robust plan in place to continue necessary care—especially with the knowledge that home care and other typical services may be stretched thin as well
• Don’t let perfect be the enemy of good
  • Continue forecasting demand (volume of visits, admissions, and tests) appropriately—you won’t get it exactly right but relying on the data that is available will give you a better chance at managing staffing and supplies
  • Also forecast supply to ensure you are spending time, finances, and efforts in the right places (e.g. getting ahead of PPE shortages, avoiding bottlenecks)
• Embrace a neighborly spirit
  • Work to pool resources with other organizations—even setting up shared inventory and staff across multiple local health systems
  • Set up discussions between leaders of other organizations to discuss innovations, successes, challenges, lessons learned, future planning, and more

MedCity News adds that updating and automating current supply chain management systems has never been more crucial—as it allows for faster responses to shortages and more informed use of the limited available resources. Deloitte agrees, suggesting that digital supply networks are key to breaking down silos, gaining visibility, and driving collaboration throughout the entire supply network.

Lastly, Wexner Medical Center at The Ohio State University mentions a small portion of supplies during crises like COVID-19 may come from previously untapped sources: corporation and personal donations. While the donations are greatly appreciated and are important for positive spirits and strong community relations, they also require a unique sort of evaluation. Wexner notes that they isolate all community donations from their normal supply of PPE until epidemiology experts can examine them, ensure their safety, and direct them to the appropriate place based on their design.

Conclusion

Managing and optimizing hospital supply chain operations at any point in time is no easy task—certainly not during a global pandemic. The good news is, you’re not alone. Though this crisis has caused clear division on many topics, it has also given rise to meaningful new partnerships between hospitals, their vendors, their communities, and even their competitors.

There are also lessons to be learned from this time that can be adapted and applied to periods of “normal” operations as well. Read Part Two of this series (publishing on the blog on 9.15.2020) to go deeper.

If you’re looking for an experienced new partner to help support your operations (during this difficult time and into the future), we’d love to explore how SCP Health can help. Contact us today to start the conversation.