When hospitals are rocked, Supply Chain must roll
By Barlow, Rick Dana | |
Proquest LLC |
Crisis management, disaster prep hinges on resiliency
When crises hit or disasters strike, the Supply Chain needs to bend but not break.
Generally, healthcare organizations face two types of crises and disasters that can be classified in two ways: One involves a massinjury/casualty occurrence or epidemic/ pandemic that means a rapid influx of patients in a relatively short period of time; the other involves a weather-related event in which the facility is damaged and that more frequently requires a rapid evacuation of patients in a relatively short period of time.
For Supply Chain executives, however, the delineation is immaterial. Either way, clinicians and other caregivers need relatively quick and easy access to devices and products. Failure is not an option; delay is unacceptable but understandable; routine may be no longer, at least in the short term.
Whether hurricanes, tornados or galeforce winds completely destroy a facility; torrential rainfall swells river banks, overloads subterranean sewer systems and submerges the lower floors of a facility; or extreme cold and excessive snowfall buries transit routes, grinding daily activity to a halt, Supply Chain must be stocked and coded.
This year is no exception. HPN reached out to a small group of sources with firsthand and front-line knowledge about how crises and disasters impact supply chain performance. They include
HPN: In prepping your supply chain for a crisis/disaster what are some of the specific pain points you need to identify and address?
O'CONNOR: First, the "three Cs" - cooperation, collaboration, and communication - are critical for healthcare facilities before, during and after an emergency. Every healthcare organization should have an Emergency Command Center (ECC)/Protocol (if you don't have one, you should develop one) and a staffing plan to man the ECC 24/7 as soon as it is activated. Supply chain emergency preparedness needs to be part of that institution-wide preparedness plan. In a crisis/disaster setting, it's all hands on deck, and all hospital departments should be fully aware of their organization's disaster protocol and their role in it (And those facility emergency plans should be reviewed on a regular basis - at least quarterly - to ensure that). Moreover, the facility emergency plan should reflect input from critical departments - like the supply chain.
The goal of any healthcare facility during severe weather is to avoid evacuating unless absolutely necessary. A supply chain best practice is to ensure at least 96 hours' worth of all critical items is in stock within the facility during a crisis. Essential items include pharmaceuticals, communication devices, food (non-perishable), laundry items, fuel, cots/mattresses (for staff staying at the facility), dry ice, and when possible, refrigerated trucks and/or generators (in case of power failure). And supply chain management must assess and balance the need for these types of essentials against "overstock" concerns.
DIFUCCI: Prepping for crisis/disaster must occur long before a crisis or disaster is seen coming. High-volume suppliers and supply lanes must be analyzed for alternate routes and or modes. DC contingency plans consisting of alternate order flow, staffing and power must be finalized and communicated. Finally, all outbound lanes are analyzed and alternate routes or final destination sorts must be planned.
ZAMSKY: It is imperative as a supply chain professional that you disburse your inventory. Keeping all your medications and life-saving equipment in one location could prove to be a major problem. Should something happen to the on-site storage or distribution location, the well-being of individuals who depend upon those medications could be in jeopardy. This is why it is important to consider multiple distribution centers and diversify the risk.
For example, consider the recent tornadoes that struck
Along with secondary distribution centers, supply chain professionals should consider how they receive supplies. The pharmaceutical suppliers from which healthcare organizations receive their medications are increasingly turning to thirdparty logistics (3PL) providers to stock and transport critical supplies. Thus, healthcare supply chain professionals must consider the full scope of the supply chain and think beyond their own operations - selecting the right suppliers and 3PLs. My advice is to look at one which owns and operates its own assets, such as vehicles, planes, trucks, etc., and demonstrates a resilient supply chain infrastructure of its own.
What eye-opening lessons did you learn from your organization's reaction to the crisis/disaster you faced that you recommend to facilities?
O'CONNOR: Superstorm Sandy confirmed our long-standing position that GPOs are integral partners for hospitals and healthcare organizations before, during, and after a crisis. When Sandy hit the
DIFUCCI: Communication with local authorities and knowledge of road closures, area quarantines, customer openings and closings is important. Often times, medical supplies are able to get to areas where other goods are not allowed.
ZAMSKY: Disasters have a domino effect, so it is critical that the preparations occur at many different levels within the business. This includes ensuring that the business think beyond the disaster and understand the impact of this crisis/ disaster to its bottom line.
The reality is that businesses may not be fully prepared for the financial impact of a "what-if" disaster. This is because the implications are so broad and many are unforeseen. But having a formally documented process in place and leveraging risk management specialists, such as an insurance company that understands the multiple levels of risk within the supply chain, can prove to be beneficial. Insurance companies have a vested interest in minimizing losses so they can be key partners in working with a business to minimize losses when a crisis situation occurs.
Here's a brief example: If the crisis required that a temperature-sensitive drug reach the disaster within a certain time frame and it did not, many insurance policies would not cover the loss of this drug. The business would be out-of-pocket for the cost. Today, however, there are specialty insurance programs that can protect perishable goods that are timeand temperaturesensitive and, if the delivery is not made, the company is covered for the loss. This is why the widespread implications of properly planning for a disaster are so critical; and that these types of risk-mitigation details be built into disaster recovery plans.
Given that floods can engulf basements and ground floors, and hurricanes and tornadoes can destroy them in higher elevations where do you recommend housing portable or stationary backup generators? Is protective shielding even possible?
O'CONNOR: There is no perfect answer to this question - the ideal location of generators depends on the weather risks most prevalent in your area, as well as your physical plant. Depending on the type of risk you face, the building's basement or the very top level may not necessarily be the best options. If feasible, you should consider the possibility of storing multiple generators in different locations.
The one universal truth about generators is to create a response plan around them. Testing backup generators on a regular basis and in the immediate days before a storm is predicted to hit is critical. Sandy taught the
DIFUCCI: We believe generators are key to keeping the supply chain operating smoothly, especially the technology and data flow aspect. Housing the main IT facility with a generator above ground four feet higher we deem is sufficient, especially if the facility is not in the primary flood zone. Finally, a redundant facility in a different [area] is ideal for any disaster planning if the company has enough capital for the investment.
During a crisis/disaster that extends community-wide, how do you keep supply lines flowing if traditional vehicular traffic is blocked and fuel runs low?
O'CONNOR: Sandy brought such destruction to certain neighborhoods that vehicle access was challenging, if not impossible. Closed ports of entry temporarily stopped the delivery of desperately needed fuel See PRODUCTS & SERVICES on page 56 and pharmaceutical supplies. And when travel restrictions were imposed to ease congestion as mass transit slowly came back online, it was extremely difficult for delivery vehicles and healthcare workers to get in and out of
DIFUCCI : Communication with local and state authorities as well as end customers is essential in knowing what can move over the roads and where. Alternate modes are also analyzed, such as rail and air for extended travel. Many times in flood zones, the area is cordoned off and evacuated, so the supply need is not there.
ZAMSKY: Caring for critically ill and injured patients is the primary focus during a disaster, as it should be. However, keeping supply lines open and flowing can be a critical component of caring for those in need.
A classic example of this occurred during the Boston Marathon bombing last April. The city shut down, and no deliveries were being made. This is where planning in advance is so important. In this situation, a medical supplier of a critically temperaturesensitive drug utilized UPS Proactive Response Secure. Through a sophisticated monitoring system, proprietary to UPS, the dedicated logistics experts of the UPS Proactive Response team continuously observed this critical shipment. They quickly identified that the delivery was in jeopardy and needed to be expedited to ensure the scheduled delivery was met. UPS Proactive Response Secure enables the highest level of service by early detection, and if a shipment can't be delivered as scheduled, then UPS executes service recoveries - like rerouting the packages - based on a client's pre-defined protocols.
In the case of the Boston Marathon, the shipment made it to its destination. But in the event arrangements could not have been made, the shipper's risk would have been mitigated through the service's insurance provided through
How do you access electronic health/medical, financial and operational records housed onsite, in a secure off-site location or in the cloud if computers and cellular/online communications are down or the power is out? Rely on generators first, if possible and then resort to pen and paper until the power is restored?
O'CONNOR: During the worst of Sandy and for days after, cell phone service throughout the
Records are another area where your GPO might be able to help; speaking for GNYHA Services, we offer contracts for data backup and recovery solutions that can protect important information offsite.
DIFUCCI: We have generators at our IT facilities. We also have a redundant facility in another geographic area that can replace our current facility.
What are some of the demands and expectations that providers have of their suppliers in crisis/disaster mode that you believe are unreasonable and why?
O'CONNOR: A GPO's mission should be to deliver the right products to the right patients at the right time - and that means coordinating with essential suppliers to overcome transportation, delivery, and availability issues, particularly during emergencies. But in order for suppliers to rise to the challenges of supporting facilities in compromised locales, your organization needs a clear emergency response plan that integrates your GPOs and supplier resources. Fortunately, what transpired before, during, and after Sandy was a remarkable display of solidarity and generosity from the healthcare community, local first responders, and numerous city, state, and federal agencies who came together to ensure the safe continuity of care for
Z AM SKY: Maintaining normal supply lines and schedules may be an unreasonable expectation during a crisis/disaster, and having inventories established for emergency purposes may not be economically feasible for many businesses. This is why it is important for your business to have the appropriate contingency plans in place that allow for multiple sources and processes for obtaining the required supplies. Eliminating the threat of supply disruption may not be possible, but limiting the impact is possible with the right risk management plans in place.
With the understanding that no one can anticipate all crisis/disaster scenarios, which is easier to solve - planning for a crisis/disaster yet to happen or reacting to a crisis/disaster that already happened - and why?
O'CONNOR: There is nothing "easy" about a crisis/disaster situation. Unpredictability is the common denominator of all crisis situations. And Superstorm Sandy was no different. The Category 2 storm threw significant curveballs into what were, in some cases, the most well-prepared plans. At GNYHA headquarters, we began monitoring initial weather forecasts five days in advance of the predicted storm arrival. We connected with our internal staff, as well as contacts at the
Despite pre-storm preparations, no one could have predicted Sandy's ultimate strength and the severe consequences. While facilities in the
DIFUCCI: I like to refer to a quote by
ZAMSKY: Risk cannot be eliminated completely, but having a plan is a better option than reacting to a crisis or disaster. Plus, having a plan in front of a crisis or disaster can be a competitive advantage. Preventing as many disruptions as possible through proactive planning can dramatically impact an organization's overall financial health. One way to plan for a crisis/disaster is to leverage the experience of a supply chain logistics provider and a supply chain insurance company with the right solutions. Taking advantage of services that have already been developed, such as using a shipping company that through proactive monitoring and proprietary software can make critical deliveries, eases the burden of this issue from the business' crisis/disaster plan.
It is incumbent upon supply chain professionals to always plan around the "what-ifs" because of the broad repercussions. However, supply _chain professionals can, through anticipation and proper planning, provide the required coverage to defend against supply chain disruptions. This can include protection programs, such as, time-in-transit insurance, or flexible parcel insurance, which complements the delivery of goods and insures them for the full sales value (up to the stated value in the customer's agreement), and other types of coverage designed to mitigate supply chain risks - including those that come during crises. HPN
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