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Lack of green has planners seeing red as supply chain continues to grapple with fundamentals

But several studies conducted within the last 12 months by a prominent management consulting firm and a leading group purchasing organization seem to suggest otherwise. They allude to potential deficiencies and inefficiencies among healthcare facilities in caring for patients as well as supporting – and equipping – its own workers.

Despite "increased federal and state funding since 2001" and the number of man-made and natural disasters during the same period, PriceWaterhouse-Coopers Health Research Institute (PWCHRI) declared that "disaster planning in the healthcare arena remains sporadic, disconnected and under-funded" in its latest report, "Closing the seams: Developing an integrated approach to health system disaster preparedness."

In fact, PWCHRI found that "facility and staff resources are limited, public health and private medical sector plans are inadequately coordinated, communications and tracking systems are incompatible and funding is not sufficient to support development of a sustainable infrastructure for an effective response." PWCHRI followed its assessment by indicating that Congress has appropriated nearly $8 billion for disaster preparedness since 2002, but a lack of accountability prevents an accurate assessment of the healthcare industry’s preparedness or progress.

In addition, stringent healthcare facility budgeting and an administratively burdensome application process for funding discourage hospital executives, according to the report. PWCHRI also noted that more money was being spent on stockpiling drugs and supplies than to hire and effectively train healthcare providers to treat victims, including distributing products. "Peak demand usually occurs within the first 24 hours of a disaster, and national stockpiles were designed to supplement local capabilities rather than as a first-response tool," the report stated.

If that weren’t enough, PWCHRI cited a healthcare workforce shortage leaves clinicians and administrators little spare time for disaster response training. A lack of a common definition of preparedness, standard requirements for response and a consensus on training and licensing programs further complicates the process, according to the report.

Meanwhile, last May Novation revealed some alarming statistics culled from a survey of materials managers at its VHA Inc. and University HealthSystem Consortium member hospitals. While more than half were developing comprehensive pandemic-specific disaster plans, including collaborating with other hospitals and distributors and dedicating a separate inventory of products with increased production calls, more than three-quarters of survey respondents said they would run out of supplies within a week, barring external assistance.

Three months later, Novation revealed that pharmacy managers equally were struggling in their pandemic disaster planning efforts. The second survey showed that member hospital pharmacy managers were concerned about which drugs to store in the event of an outbreak, how much to store and how to handle the costs of carrying time-sensitive inventory.

David Parks, Kimberly-Clark Health Care

David Parks, general manager, global business management, Kimberly-Clark Health Care, Roswell, GA, fully understands the complexities and uncertainties hospitals face. "The full range of preparedness exists in the market today," he said, "from facilities and communities who have made heavy investments in preparedness plans, drills and stockpiling to those who have taken very little action. The range is obviously driven by the level of resources at the disposal of these facilities and communities. We are all faced with managing priorities and budgets, and this potential risk is no different. The healthcare community as a whole is taking pandemic preparedness very seriously but has to balance that with the other priorities and available resources they have at their disposal."

Parks contended that at minimum healthcare facilities "should have assessed their level of risk and ability to respond to a pandemic event" by now and are weighing that against the Centers for Disease Control and Prevention’s current phase designation for the risk of Avian Flu, which is at 3 out of 6 phases. They’re looking to the CDC and the World Health Organization for guidance, as well as to their suppliers for support, he added.

"Pandemic preparedness is like buying an insurance policy," Parks noted. "You invest today to protect you against a future risk. It is often difficult to expend significant resources for this type of future event when these resources are critically needed today. However, history tells us that pandemic events will occur and therefore we must convince ourselves that it is a worthwhile investment to make today."

One healthcare industry disaster preparedness expert with civilian and military logistics experience believes that individual healthcare facilities may have improved their disaster preparedness for managing biological and chemical events, compared to where the industry was prior to the Sept. 11, 2001, terrorist attacks, in terms of medical surge bed capacity, personal protection equipment (PPE), decontamination shelters, competency-based disaster preparedness training, redundant communications systems, emergency medical services (EMS), syndromic surveillance systems and volunteer recruitment, according to James M. Rush, president, MEDLOG Inc., Forest Hill, MD. 

"Most hospitals are somewhat better prepared for detecting and treating chemical and biological events where the casualty rates are low and the duration of the event is short," Rush said. He attributed that to federal funding for PPE, decontamination units and antibiotic inventories.

But they lag far behind in other areas, such as coordinating responses between national, regional, state and local authorities and community healthcare providers during a pandemic, a large-scale attack on the food supply or a terrorist attack using a conventional, dirty or nuclear bomb; and transporting, treating and isolating victims and patients.

"The nation that put a man on the moon in 1969 stood helpless and aghast at images of persons in wheelchairs dying outside storefronts, nurses manually resuscitating ventilator patients on the rooftops of hospitals, bodies floating down the streets of New Orleans and old folks drowning in their nursing home beds," said Rush, recalling the aftermath of Hurricane Katrina and the levee breaches in New Orleans in 2005. "Even after a national disgrace of that magnitude, we are still unprepared," he added.

Mintie Corp.’s ECU2 containment system with corridor flange.

Because today’s supply chain is so lean, according to Rush, hospitals at best are minimally prepared to handle anything more than an estimated 20 percent increase in patients for a short duration.

"My belief is that hospitals are in crisis and have been for years relative to beds, staff, supplies and equipment to deal with any very large surge in patients for more than a week or two," Rush noted. "The healthcare supply chain is very lean and is incapable of supporting mega-events of any kind. Healthcare distributors simply cannot invest billions of dollars in inventory for mega-events like a nuclear attack, which will be very supply and equipment intensive, or a pandemic, which will impact the entire worldwide supply chain. Manufacturers will not be able to meet the huge spike in demand. Also, America can’t depend on its worldwide network of raw material suppliers, even if manufacturing could quickly ramp up production."

But Kimberly-Clark Health Care, which weathered demand spikes for masks and respirators during the SARS outbreak in Southeast Asia in 2003, ramping up production and managing to keep supply lines fluid, remains optimistic. "Kimberly-Clark will continue to do everything we can to educate the healthcare community and take our own action internally to ensure our organization is in a position to support the needs of the healthcare community when a pandemic event occurs," Parks noted.

Call it a paradox, Rush said. The more efficient the supply chain becomes, the more limited its ability to sustain unanticipated large spikes in demand for medical products.

"The hospitals just don’t have disaster preparedness dollars," he added. "They are lucky to keep the doors open and the staff paid."

Bill Meins, Mintie Corp.

Bill Meins, clinical administrator, Mintie Corp., Los Angeles, traced much of today’s challenges on how the public health infrastructure was conceived and developed back in the 1950s and 1960s. Fifty years ago, the healthcare delivery system was designed around an individual patient-focused model without the forethought of community impact.

As a result, the system currently is "driven by the cost of individual service rather than a safety net approach," he noted. "The effect is that we have decided legislatively that ‘community care’ translates directly into dollars we don’t have. In a nutshell, this means we have unfortunately adopted risk management as the criteria for spending funds. As a direct result of this mentality we face an uncertain future with respect to how we can best respond to mass illness, which is at this point guaranteed to test our resilience.

"We are ill prepared to deal with a new and challenging worldwide dilemma fraught with drug-resistant infections and diseases we thought long ago eradicated, not to mention the unknown terrorism factor," he added.

Meins estimated that roughly 1,000 of the nation’s 6,000 hospitals are considered "safety-net" capable. Contained within those facilities are fewer than 65,000 airborne infection isolation (AII) rooms available for use during a pandemic, he said, as well as fewer than 30,000 clinical ventilators available for patients. "Who will make the decision regarding who gets appropriate medical care and protection from infection and who does not," he noted, "this clearly is a dilemma."

To put this in perspective, Meins cited CDC estimates that a "simple" 25 percent avian influenza infection rate translates into 75 million people. If only 1 percent required airborne infection isolation hospitalization, that’s 750,000 patients. To convert existing hospital rooms into AII-capable rooms to handle this "extremely conservative" percent of patients is estimated to cost up to $30,000 per room. That amounts to $225 billion – just for room conversions alone – and a far cry from the approximately $10 billion the government has allocated for disaster preparedness as a whole, he noted.

The concept of "cohorting" is one of the key clinical areas getting short shrift in pandemic readiness planning. "The practice of keeping patients with the same disease together during treatment and recovery is important for population isolation during a pandemic event and is mostly very difficult to accomplish given an individual care facility design," Meins said. "Existing airborne infection isolation rooms are often unable to provide the necessary capacity and are also illogically scattered across multiple buildings and floors making treatment more resource-intensive and limits the level of care." As a result, Mintie developed the ECU2 with corridor flange that allows any facility to temporarily isolate a care unit or other suitably designated space easily and quickly without building modifications, he added.

With an aging population base "the likelihood of a sicker patient population entering our healthcare system [is] more the norm rather than the exception," he said.

Rush recalled the 200-bed packaged disaster hospitals of the civil defense days of the 1950s and 1960s. There were 1,900 of them and each was equipped with three operating rooms, a field X-ray unit and a 30-day supply of medical and surgical supplies with pain medications and other pharmaceuticals. Those don’t exist anymore, he added, but would be a good start even if they have to be updated.

He called for the industry and the government to develop requirements for medical materials, air, ground and rail transportation and evacuation systems, food, water, waste treatment, generator power units and other relevant products and services in the event of a disaster or pandemic and the necessary administrative, financial and operational support to make it happen.

"We need to have a statement like, ‘We have 90 percent of all required human, financial and materiel resources on hand to effectively protect the American people for a pandemic. We have requested the funds to bring us to 100 percent readiness within six months of the receipt of the funding,’" he said. "America has just enough available supplies at just the right time to meet only expected demand for anything."