Anecdotes are rampant about shortages of supplies as a result of the COVID-19 pandemic. We spoke with Kaufman Hall’s supply chain expert Gregg Lambert about hospitals’ ability to access personal protective equipment, ventilators, and blood during the crisis.
Q: What are the main areas of supply concern today?
A: One of the main problems is personal protective equipment, including masks, goggles, and gloves. The main concern is that now there is a substantially larger group of individuals needing this equipment; staff may need to work in the tent in the parking lot doing drive-through testing. There are likely to be more patients who are infected or may be infected, adding to the demand of protection for caregivers. The big question is: Do we have enough?
When a situation like this arises, it’s human nature for people to want to hoard backlogs or stockpile this type of equipment. But that just worsens the situation. In the past, when distributors have seen these kinds of spikes in ordering, they look at hospitals’ historic usage patterns and try to ratchet down the requests and allocate based on the historical level.
However, this situation is far from normal. Hospitals’ usage is going up, and distributors are fully aware of the need. They're not allocating back to original usage, but to some increased level of usage—but a level that they can fulfill. It doesn't do anybody any good if they fill the first four customers’ orders and then all of a sudden the distribution center is empty.
The key is working closely with your med-surg distributors and other partners, and trying to be smart in your ordering patterns.
I applaud the ad hoc efforts we are seeing to deal with shortages—clothing manufacturers sewing masks, liquor distilleries shifting to make hand sanitizer. However, I see more of these used by the local community than by hospitals, and I don’t know that they can produce the volume needed for a large medical center.
The Food and Drug Administration has issued guidelines for conserving surgical masks and gowns, and the Centers for Disease Control has issued guidelines on conserving N95 respirators. I encourage hospitals to follow these guidelines.
Q: What is the situation with ventilators?
A: Ventilators are a more difficult topic, because hospitals only have so many, and there are a limited number of ventilator companies out there that have stock available. All manufacturers are ramping up production as rapidly as possible. We also have some manufacturers that weren't previously producing ventilators that are ramping up to produce them. But all of that takes time.
In the meantime, the FDA has released useful supply mitigation strategies for ventilators.
Q: Are you seeing blood shortages?
A: People are staying home, and they're also afraid to go to a place where they are exposed to the public and needle sticks. So blood donations are way down, and the supply is going to get tighter.
The AABB has excellent guidelines for using blood more efficiently. Tactics included could be something as simple as this: Say the early indications are that a patient will need two units. Start by giving them one. Then wait an appropriate amount of time, reassess, and provide the second unit only if it’s needed.
Q: Can you say anything about how long some of the shortages might persist?
A: It's difficult to say. Believe me, the large manufacturers are doing anything and everything they can do to make every single product that they can possibly push out the door. Obviously, there’s a limit to that. The bigger determinant likely is not manufacturing capacity, because I have faith in our manufacturers and their willingness and ability and reason to ramp up production. I think the bigger determinant is how society behaves in terms of doing all the right things to curb the exponential growth in the numbers of reported cases.
Q: What problems in the supply chain has the coronavirus exposed?
A: Transparency is one big problem. A hospital supply chain director doesn’t have a good way to look into the supply chain, to know where particular products may be. I think individual hospital supply chain directors want to see that information. However, it’s probably more important that this information be available to organizations looking more broadly than an individual hospital—distributors, manufacturers.
The country may also want to consider some form of national stockpile. Health systems in parts of the country that don’t typically have hurricanes or floods or other natural disasters tend to keep a pretty lean inventory, because that’s the most cost-effective way to operate. To a CFO, a product sitting on the shelf represents dollars sitting there and not doing anything. The product is likely to expire. It may be dead stock. Hospitals emphasize being as efficient as possible with inventory. However, that is counterproductive to this pandemic.
I like the national stockpile approach because it’s controlled. You could have personnel being diligent in terms of rotating stock. Personnel who keep up with current trends and refresh with the newest and the latest and greatest as things come out, keeping in touch with CDC and other organizations about what types of supplies make sense based on what those organizations know about what's going on in the world. It would be very difficult for an individual healthcare system to keep up with all that.
Q: How is this situation affecting healthcare supply professionals in hospitals?
A: If you’re in supply chain, you’re now pulled into the command center. You’re in meetings a good portion of the day. You’re touching base with all of your customers, all of your manufacturers, and your distributor. You’re keeping your administration informed. This is a new job right on top of your regular job. It’s hard to fully explain how stressful the situation is right now.
For more information on how your organization can respond to the supply chain difficulties brought on by the COVID-19 pandemic, please reach out to Gregg Lambert.