As pandemic makes staples scarce, health systems turn to suppliers near and far

April – May, 2020

May 20, 2020

Way back in January, before the coronavirus pandemic turned the world on its head, Hospital Sisters Health System was buying N95 masks for 50 cents each. These days, when the respirator masks used to protect medical workers from airborne respiratory droplets can be found, Bob Beyer sees them priced as high as $6 apiece.

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Volunteers with Hospital Sisters Mission Outreach collect supply donations from the community at the organization's warehouse facility in Springfield, Illinois, in early April. The charity normally gathers supplies from hospitals and health systems across the country and helps send them to places of need across the globe. During the pandemic, Mission Outreach has worked with the medical organizations in Springfield to collect supplies and then disburse to them as needed.

The story is much the same for the disposable gowns needed by medical workers. Beyer, HSHS's vice president of supply chain services, said the price of the protective garb has gone up tenfold amid the global health emergency.

"The market is driving these costs to an outrageous level," said Beyer, who at the time he was interviewed in early May had a supply of 1,100 mesh bouffant caps in his car that he had bought at a food service store for use at the system's facilities in Illinois and Wisconsin.

In addition to paying dearly for hospital staples, the system is expending many more manhours than it did three months ago tracking down an adequate supply. "We're seeking all these alternative places to buy stuff that we have historically never had any problems getting," Beyer said.

Widespread challenges
HSHS is far from alone in its supply chain challenges. Care providers and governments across the globe have sounded alarms about the critical shortage and spikes in prices of medical goods, including protective gear, medications and devices such as ventilators.

Supply chain leaders and executives at several Catholic health systems and hospitals said they have had to adopt new strategies to meet a demand for supplies that has surged as they treat victims of the COVID-19 pandemic and follow the infectious disease protocols put in place to protect clinicians caring for patients with the virus.

Ed Hisscock, senior vice president of supply chain management for Trinity Health, said his system has been able to keep up with the supply demand "but it's a good bit of work."

He noted that most of the fabric commonly used to make protective gear such as masks, disposable gowns and shoe covers comes from select provinces in China such as the one that includes Wuhan, where the pandemic is believed to have started and where it interrupted production for much of the industry.

Just in time
Trinity Health's hospitals have at least one advantage over many others when it comes to supplies. "We have a distribution network that we own and operate and can use to store product and move it to where it's needed," Hisscock said.

Trinity Health relies on models that use data on the spread of the pandemic to anticipate surges and that match anticipated demand with the location of supplies. Thanks to its distribution network, Trinity can shift supplies to hotspots in the 22 states where it operates rather than stockpiling goods at every facility.

"It's how we designed this to work," Hisscock said. "We didn't want to be amassing excess supply at all of our ministries." That would not serve the common good given the global supply shortages, he said.

"If we have the ability to leverage this capability to buy what we need and not more than we need, we're responsible to do that."

Vetting the offers
Just as finding urgently needed medical supplies has been a challenge, vetting the quality of the goods before purchasing and detecting potential fraud has required exacting diligence from health systems. Beyer said HSHS gets dozens of emails every day offering goods for sale. Many of them are suspect.

"When you start asking deeper questions about the supplies they have and how they can access them, then you start to see weaknesses in their responses and you start to understand that maybe this isn't real or maybe they're a broker to a broker to a broker," Beyer said.

HSHS is getting help from a group purchasing organization it is part of and from its primary supplier, Medline Industries, to vet the offers.

Hisscock said Trinity has engaged outside counsel to help it avoid scams and verify the quality of supplies. "Basically, what we're doing is we're pedigreeing the product all the way back to the manufacturer and verifying that the certificates (of origin) are authentic to FDA-certified labs," he said.

Insatiable appetite for goods
To eliminate waste and stretch its cache of PPE as long as possible, Providence St. Joseph Health, like other systems, has set systemwide standards to conserve protective gear, such as limiting when N95 masks are used, said Dr. Joanne Roberts, the system's chief value officer.

Even so, the system that operates in seven western states has had a voracious need for many staples amid the pandemic. In mid-April the system was using about 100,000 surgical masks, a little over half a million gowns and pairs of gloves, about 80,000 N95 masks and about 25,000 face shields every 10 days.

Providence cast a wide net to find supplies. Some of its protective gear, for example, has shipped from South Africa. But the system has also found suppliers to partner with right in its back yard, some of them nontraditional ones.

One partnership that Roberts takes special pride in is with a furniture company in Everett, Washington. She had struck up a friendship with the firm's owner years earlier. "He called me at about six o'clock one morning and said, 'Hey, I really believe that I need to serve the community and I'm willing to retool my factory making furniture and upholstery to making masks and gowns. Would that be helpful to Providence?"' Roberts recalled.

The system soon began getting thousands of masks and gowns a day from the company, Kaas Tailoring.

New to the biz
Other health systems have gotten similar assistance from companies large and small. Hisscock said Ford and General Motors are among the big names that have sold or donated supplies to Trinity Health.

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Kathy Jostes, an inventory technician at the supply warehouse of HSHS St. John's Hospital in Springfield, shows her gratitude for face shields donated by the Ford Motor Co. The automaker donated 6,000 FDA-approved plastic face shields to St. John's and 4,000 more to the eight other HSHS Illinois hospitals.

Meanwhile, the system has turned its demand for supplies into business for some small concerns. "We're up to five sewing companies now that are making masks and other products for us," Hisscock said. "They haven't made these products before, so we're standing up the capability."

Beyer said that HSHS is also using its buying power to help businesses and communities. The system has contracted to purchase face shields from Prairie Land Design Solutions in Teutopolis, Illinois, and Sun Graphics Media in Sheboygan, Wisconsin. It has bought some supplies from restaurants and school districts that have been forced to close or scale back because of the pandemic.

Also, like other systems, Beyer said HSHS has gotten gear from stockpiles kept by various government agencies. "It hasn't been an overwhelming amount, but they're also splitting that up between hundreds of hospitals," Beyer noted.

'Absolutely unprecedented'
Beyer advised other systems that are struggling to secure necessities to be creative and open-minded about where supplies might be found. "You have to use every resource you can find," he said. "You've got to break down some barriers and talk to people from other health systems, talk to people just down the road from you that, in some cases, maybe historically you have not had a relationship with."

Hisscock said the scramble for goods set off by the current health crisis is unlike anything he has seen in his 35 years in supply chain management. "It's absolutely unprecedented," he said. "We had drilled and we had preparedness exercises for pandemics and other disasters that may occur, but the scale of this is what is so very different. It's a worldwide problem."


Parent systems and governments help shore up supplies for rural hospitals

At the request of a hospital in Florida, commercial cabinet maker Stevens Industries built a clear plastic "intubation box" used to shield clinicians from coronavirus laden aerosols released as they place endotracheal tubes to aid the breathing of the sickest COVID-19 patients.

The manufacturing company is located in the Southern Illinois hamlet of Teutopolis, and it didn't overlook its rural roots once it began making the boxes. It donated product to four hospitals in the Hospital Sisters Health System, including St. Joseph's Hospital Highland, a critical access hospital with 25 beds.

Executives at several rural hospitals, all but one of which was outside a COVID-19 hot zone, credit the generosity and enterprising spirit of local businesses and community groups, the supply chain expertise of parent systems and the support of state and local officials for helping ensure that their facilities aren't running perilously short on supplies during a worldwide shortage.

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HSHS St. Joseph's Hospital Highland staff members demonstrate how an intubation box made by Stevens Industries shields clinicians from contagion during an intubation procedure. Shown left to right are Dr. Neeraj Chimanji, an emergency department physician; Bre Scott, a certified respiratory therapist; Karrie Fink, a nurse and emergency department facilitator; and nurse Renee Richter. Nurse Lyndsey Poettker portrays the patient in the demonstration.

Angie Smith, vice president of nursing at St. Bernards Healthcare of Jonesboro, Arkansas, said the lag time between when they started the planning for a potential patient surge and mid-March, when the first COVID-19 case was diagnosed in the county, allowed time to partner with supply chain organizations and reach out to the state and federal government, to ensure the small system — and its rural facilities — had all the supplies they anticipated they would need, including additional ventilators.

DeAnn Thurmer is president of two critical access hospitals in Wisconsin, the 25-bed Waupun Memorial Hospital in Waupun and the 17-bed Ripon Medical Center in Ripon. The facilities are part of SSM Health, a system that helps to coordinate the supply chains of its 24 hospitals in four states, including the central Wisconsin facilities. The system's expertise has been particularly useful in planning for pharmaceutical inventory, Thurmer said.

Additionally, said Thurmer, "when it comes to supplies, we have been overwhelmed with support from the community." Local residents sewed masks for hospital staff and patients. Schools teamed to provide the hospitals with a van full of personal protective gear from their own supply closets, including gowns, gloves, masks and sanitizer.

Emily McGee, nursing director of intensive care for St. Bernards Healthcare, said at their hospitals, too, there was much local support, with numerous community members and businesses, including nail salons, donating protective gear.

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Workers with Stevens Industries Inc. of Teutopolis, Illinois, pose with packages that hold the four intubation boxes they built and donated to HSHS Illinois hospitals.

Both the Wisconsin and Arkansas executives said their city governments and other local partners have been asking how they can help the hospitals. Thurmer said, "All around us, people want us to feel we're not alone."

Rene Ragas, president of Our Lady of the Angels Hospital in Bogalusa, Louisiana, said the hospital at one point ran out of ventilators and had to divert patients to intensive care units elsewhere, but the state came through with some backups within days. Otherwise, it has had adequate medical supplies, including personal protective equipment, for its workers. The hospital is part of the Franciscan Missionaries of Our Lady Health System.

"We have never gotten to a point where we did not have enough PPE - at any level - to take care of any of our patients, and I think being affiliated with a larger Catholic system has been the reason that we were able to get ahead and stay ahead of our PPE needs," he said in mid-April.

Before the COVID-19 pandemic, Providence Seward Medical & Care Center in Alaska had quite a bit of protective gear on hand, some of it stowed away amid the Ebola scare several years ago, said Administrator Robert Rang. His eight-bed hospital has also gotten medical goods from the health system that manages it, Providence Health & Services Alaska, and from state and local agencies. Providence Health & Services Alaska is part of Providence St. Joseph Health.

Here too, the community has pitched in. A group of quilters has made and donated face masks. Others have made donations that have provided more a spiritual lift, Rang said, such as the anonymous funds that have covered free coffee for hospital workers at a local coffee shop.

"Those little things don't make sense much on their own but collectively it's been a very good morale booster for my team as they've been stressed over this and tried to prepare for it," he said.



Copyright © 2020 by the Catholic Health Association of the United States

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