When I sat down in early March to write the April edition of Standard Practices on the role of standards to support supply continuity, I knew we were facing serious shortages, but admittedly, I did not yet fully appreciate the enormity of the problem, nor the level of innovation it would generate. The world - and my thinking - have evolved considerably in a month’s time and no doubt will again by the time you read these words in print. With that caveat in mind, here are some thoughts on how “necessity” as the “mother of invention” may have lasting implications for what will become new standard operating procedures in the healthcare supply chain.
As the guidelines for the use of personal protective equipment (PPE) and now ventilators continue to evolve to address ongoing shortages, there is understandable concern among healthcare workers on the frontlines of the fight against COVID-19. They want to know that the new guidelines are based on evidence, and not just shrinking inventories. Changes are particularly challenging for those of us whose mantra has been: reduce variation, in both products and process, to improve both quality and cost.
Faced with a global pandemic that has dramatically and simultaneously increased worldwide demand, while also straining underlying supply chain processes, both procurement and clinical leaders have been forced to look beyond the products, vendors and manufacturers they know well. This is not about switching from Product A to Product B, or from Vendor A to Vendor B; this is more often about finding completely new supply sources, and changing how products are used and even how they are made.
Here are a few lessons learned to date, along with some ideas to take forward after the worst of the crisis is over.
Create clear and constant lines of communication
As hospitals deploy new and often unfamiliar types of PPE to clinicians on the front lines and/or implement guidelines for the extended use or reuse of PPE, constant communication between procurement and clinicians is essential. Such communication is essential in the sourcing process to ensure clinicians have access to evidence about the clinically relevant attributes of products and the rapidly expanding knowledge around effective reprocessing of equipment such as N95 respirators. Clinicians, too, can play an important role in generating evidence from their real-world experience.
Some hospitals are realizing the benefits of having shared scenario-based contingency plans with clinical staff in advance. Others are rapidly deploying a multitude of communications vehicles to keep clinicians apprised of the changes. Whatever the process, standardizing how information is shared can make it easier for clinicians to absorb the information in high stress environments.
Beyond providing physical products for clinicians, supply chain professionals play an important role in delivering information that helps ensure frontline healthcare workers feel confident they have what they need to safely and effectively perform their jobs.
Don’t source non-traditional vendors alone
The one thing that has not been in short supply during this crisis are vendors who claim to have qualifying products for sale. While some of these organizations are well-intentioned and legitimate, many other vendors and their business practices have been called into question. Vetting these potential suppliers is a critical step but also time consuming for overtaxed hospital sourcing and procurement teams to perform on their own. The Association for Healthcare Resource and Materials Management (AHRMM) and the American Hospital Association (AHA) are partnering with GHX, which is voluntarily screening these new players using its Vendormate compliance tools. Vendors passing the initial assessment are then posted on the AHRMM COVID-19 page.
Leverage a worldwide revolution in 3D printing
The COVID-19 pandemic has unleashed a truly global movement of manufacturing, from large automakers retooling production lines to manufacture masks and ventilators to organizations with 3D printing capabilities collaborating to produce testing swabs and cassettes, face shields, safety goggles, quarantine booths and parts to increase ventilator capacity. Even traditional manufacturers are getting involved. Medtronic is providing the plastic material to 3D printing company Stratysys to support its production of more than 15,000 face shields per week.
In addition to rapidly producing products in short supply, 3D printing is fast tracking new product innovations to meet critical needs. A design for a hands-free door opener from Materialise has already been downloaded 50,000 times, while a Saudi Arabian engineer has created a 3D printable wrist clasp that enables a user to dispense antiseptic gel without ever touching the bottle. Providers, too, are playing an important role. Prisma Health, the largest not-for-profit health system in South Carolina, collaborated with engineers at the University of South Carolina to use 3D printing capabilities to create a prototype of a device that will enable two patients to use the same ventilator. Prisma has received emergency use authorization from the FDA for the device, which is being produced by a major manufacturer for distribution to areas likely to exceed their ventilator capacity in the near future.
The COVID-19 pandemic has raised awareness of the importance of a resilient healthcare supply chain, as well as the highly complex nature of global manufacturing and the frailties of a system that has grown to depend upon a limited number of suppliers for both components and finished products. While exactly what will be done to shore up the supply chain by the myriad stakeholders remains to be seen, there is no doubt that the healthcare supply chain will undergo dramatic change. And based on new levels of collaboration and expanded use of technology, I am confident that we have what it takes to make the supply chain better for all involved.
