It began with severe shortages of personal protective equipment (PPE), then ventilators, and now, test supplies and personnel. The never-ending string of crises related to caring for COVID patients has pushed global health care systems to the breaking point. These tips for navigating health care supply shortages may help hospitals and medical practices make it through repeat waves of cases and hospitalizations.
Understand Supply Chain Structure
Under normal circumstances, the health care supply chain can seem invisible. Facilities and practices order supplies from a distributor and the supplies show up on the expected delivery date. Things move smoothly from manufacturers to distributors to health care facilities and medical practices, and finally to the end consumer, either a health care provider (physician, nurse, lab technician, etc.) or patient.
Disruptions in the health care supply chain, when they occurred, happened at isolated points along the chain. An individual manufacturer hit with a strike, a distributor enduring a temporary fuel shortage, or a warehouse that suffered damage in a storm didn’t impact the entire supply chain.
Natural disasters, political upheavals, and fluctuating market conditions all could contribute to temporary supply chain disruptions, but in these circumstances, it was usually possible to identify an alternative manufacturer, distributor, or other health care system that could fill the gap.
The global supply chain disruption that occurred when COVID-19 hit was unprecedented. Manufacturers, distributors, and health care providers all went into crisis mode simultaneously. Surges in demand created shortages of materials, while lockdowns disrupted transportation, labor, and distribution.
Widely adopted supply chain practices like just-in-time delivery also proved exceptionally vulnerable in a global crisis. With an insufficient capacity to manufacture and deliver supplies during periods of surging demand, a cascade effect impacted every point along the health care supply chain.
Providers were caught unprepared when this happened, despite the existence of national stockpiles of supplies, and manufacturer and distributor hazard vulnerability assessment (HVA) plans. Everyone on the health care supply chain learned painful lessons in the first horrible year of the COVID-19 pandemic: preparedness can be the difference between life and death.
These tips for navigating health care supply shortages for providers could help avoid a repeat of shortages as more waves of COVID and additional natural disasters, such as the recent wave of tornadoes, make strain on health care the norm rather than the exception.
These tips were gleaned largely from a much more comprehensive report available from the Department of Health and Human Services’ (HHS) Assistant Secretary for Preparedness and Response (ASPR) Technical Resources Assistance Center and Information Exchanges (TRACIE).
Anticipate Surges in Demand
Providers now know that surges in demand for health care services can happen at any moment. Establish relationships with multiple suppliers and distributors to create redundancy in the event of a disruption. Revise emergency preparedness plans to identify acceptable substitutes for supplies likely to be unavailable, and identify the triggers for implementing the plan.
Maintain Open Communication With Suppliers and Distributors
List critical supplies, anticipate demand, and understand the time needed to produce and deliver supplies. Negotiate supply commitments with guarantees. Identify shelf-stable supplies to cache and keep ready for emergencies. Create lists of always-needed supplies and medications, and work with distributors to develop plans for maintaining inventories they’ll deliver on a “push” basis.
Participate in Health Care Coalitions
In a health care crisis, hospital systems and medical practices benefit from involvement in health care coalitions (HCCs). These coalitions act as bridges to bring together governmental emergency response agencies and public health authorities with private health care providers.
HCC’s can be information hubs and coordinators to share supplies between providers in times of crisis. They can help resolve distribution issues, develop strategies to share information on the availability of supplies, and brokers for requests for resources and supplies between providers.
Establish Memoranda of Understanding
It’s one thing to become a member of a coalition and another to know exactly what to expect when you need to call on the coalition for help. Before a crisis hits, providers should work with HCC’s, manufacturers, distributors, and other providers to define expectations and agree upon what support each will supply to the other when your health care facility activates emergency protocols.
Your Memoranda should also include diversion procedures—which facilities will be capable of treating what kinds of patients with what type of conditions, and when one facility may divert patients to another. Provide first responders with clear information about which facilities will accept what patients.
Review Procedures for Storage, Conservation, and Re-Use
Providers got creative about sterilization and reuse during extreme shortages of PPE. It behooves them now to review their storage capacity, protocols for conserving supplies, and lists of acceptable substitutions for supplies. Providers can order medical supplies online, including basic diagnostic equipment, PPE, and testing equipment that you can stockpile. If you don’t have sufficient storage, negotiate with other, larger local health care facilities to share supplies or storage space.
Plan for Labor Shortages
Early in the pandemic, health care workers were at extremely elevated risk of infection, and many, tragically, gave their lives in the line of duty. Now, while labor shortages persist due to infections among health care, manufacturing, and distribution personnel, health care workers are succumbing to exhaustion and burnout.
Work with medical volunteer organizations to have a plan in place if you need to supplement your staff in times of crisis. HCCs can act as conduits to state and federal agencies if it becomes necessary to ask for help from the national guard or other armed forces personnel.
Communicate Changes in Service Levels to Patients
Many overwhelmed hospitals and providers had to cancel all elective surgeries during waves of COVID admissions. In order to avoid overcrowded emergency departments, have a communication plan in place that will prevent patients you can’t serve from showing up anyway.
Make very clear what medical conditions you will treat during an emergency and which you won’t. Life-threatening conditions that require surgery or other treatment necessary for patient survival will take precedence over treating non-life-threatening conditions. In dire times, this could mean that you will have to turn away patients with injuries that are painful but not life-threatening.
It appears that there will be no break any time soon in the ongoing COVID health care crisis or in the frequency of natural disasters that cause surges in demand for health care services. Between providing care and managing labor shortages, health care systems must find new ways to cooperate and support each other for the benefit of patients and public health.