This article was written by Lisa Miller.

Leadership & Experience in Difficult Times

I. Introduction
In late December of 2019, Wuhan, China reported a cluster of pneumonia infections to the WHO (World Health Organization). In early January 2020, the virus was identified as a novel coronavirus that appeared to be highly contagious. The virus spread rapidly globally and later that month, the US reported its first case in Washington State. On January 30, 2020, the WHO declared a global public health emergency. [1]
The virus continued to spread worldwide with spikes in South Korea, Italy and Iran. On March 11, 2020, the WHO declared that the novel coronavirus (COVID-19) outbreak was a global pandemic.
The virus has overburdened the healthcare system, and medical providers worldwide are seeking solutions to deal with the crisis.
II. US healthcare status
In the US, the CDC has issued guidance to the public in hopes of reducing the spread of the virus. These recommendations include social distancing, handwashing, respiratory etiquette, and frequent cleaning of surfaces.
On March 13, 2020, President Trump declared a national emergency due to the new coronavirus. This set into motion emergency preparedness plans in all US hospitals. [2] Multiple states have issued orders to residents that they must stay home, and non-essential businesses have been closed.
Americans are becoming more anxious regarding their health and the economic fallout from COVID-19. Multiple federal agencies, including the CDC, FDA, CMS, FEMA, OCR and others have issued guidance to healthcare providers and are focused on “flattening the curve” (i.e, slowing the number of infections and critical admissions to the healthcare system). Hospitals are faced with a critical shortage of personal protective equipment (PPEs) and respiratory care equipment (ventilators). Providers have been scrambling to meet the increasing demands, necessary bed capacity, and at the same time protect their patients and healthcare workers.
The federal, state and local governments have responded to the crisis and realize the need to intervene. The current state of US healthcare crisis with the outbreak of SARS-CoV-2 (AKA: COVID-19, coronavirus) is an evolving story. Change is a constant as new statistics, new guidance/rulings and the “status quo” remains a fluid situation.
At the time of writing (4/1/2020), Johns Hopkins Coronavirus Tracking map [3] lists almost 190,000 confirmed cases of SARS-CoV-2 in the US, with a global death total of over 40,000.
Time is of the essence, challenges are many and the US healthcare system is in desperate need of supplies, equipment and healthcare workers to protect the people of this country. Although recent crises such as the terrorist attack on 9/11/2001 and multiple hurricanes (including Hurricane Katrina in 2005, Superstorm Sandy in 2012, Maria in 2017) have served as learning experiences to healthcare entities in preparing for disasters, this global pandemic is an unprecedented challenge.
III. Hospital challenges to be met

There are multiple challenges to be met by hospitals, including:

1. The surge of critical patients, lack of capacity and a shortage of ICU beds and ventilators, among others.
2. Infection control, patient safety concerns, for both patients and healthcare staff.
3. Shortage of equipment, supplies and drugs.
4. Workforce disruption, staff burnout and stress; increase in contract labor costs, change to remote workforce, productivity decline.
5. IT needs, such as, telehealth capacity, online communication, and mobile response process change.
6. Reporting criteria, compliance, alternate payment models, reimbursement, changes to legislation affecting the healthcare sector (Medicare/Medicaid, HIPAA, EMTALA)
7. Increases in LOS, changes in CMI, severity of illness, changes in place of service.
8. Financial instability, for example, an increase in operating costs, loss of revenue due to cancellation of elective procedures and surgeries, payroll concerns.

The healthcare supply chain has been impacted immensely by SARS-CoV-2.
As China began to slow the global supply chain, businesses throughout the world felt the impact of the strain. The healthcare sector relies heavily on factories in China for medical products, component parts, pharmaceuticals and ingredients necessary to produce them.
As infected patients began to stream into US hospitals, supply shortages emerged.
The current climate finds hospitals in dire need of PPEs, ventilators and other necessary supplies. Inventories of these items have rapidly dwindled. Furthermore,  infection control mechanisms to protect the healthcare workforce and provide life-saving equipment for patients has reached crisis point.
IV. Crisis management – Best strategies for supply chain
As hospitals implement emergency/disaster plans, their priority is to save lives and ensure the safety of their workforce. In addition to the knowledge and endurance of the clinical team, the hospital supply chain (which has undergone a huge transformation over the last few years), is at the forefront of the challenges to be met.
In a crisis, it “takes a village” to brainstorm, research and redesign processes to succeed. Collaborative efforts between the clinical, financial and operational leadership is underway. The hospital workforce is strained and strong leadership is needed to “steady the ship during the storm.”
Healthcare leaders are looking for solutions now!
In a crisis it ‘’takes a village’’ to brainstorm, research and redesign processes to succeed. The hospital workforce requires strong leadership. Click To Tweet
A best strategy to handle the huge supply chain task at hand begins with a revised “strategic actionable plan” with defined priorities. As change is happening, a partnership with a trusted advisor will strengthen the healthcare team and provide expertise crucial to maintain financial stability for healthcare providers. An advisor can quickly add “teeth” to the team, supplement strained team resources, source vendors for needed inventory and provide expert suggestions.
This partner should have the expertise, proven success rate and ability to quickly assess, coordinate and help to utilize novel approaches to constantly changing problems.
Data utilization, strong communication skills and a willingness to do whatever it takes to find solutions are the qualities necessary for success in times like these.

Experience and proven success in strategic supply chain management, process improvement, cost analysis/savings, data analytics and operational efficiency is essential.  Strategies that your organization and expert partner should employ include:

1. Review of all current spend to uncover hidden areas of potential cost savings. SARS-CoV-2 has created a surge in supply chain needs and costs. The plan must include all efforts to cut waste and identify cost saving opportunities quickly and efficiently.
2. Data analysis, integrity and the ability to harness the power of data analytics for continuous monitoring, quantifying real-time supply demand, utilization, new vendor streams, benchmarking and the tracking of costs and contract adherence. The ability to utilize business intelligence analytics to map costs to line item details will uncover pricing errors. [4]
3. Supply chain/procurement
   1. The ability to implement new procurement strategies, for example:
      1. Construction: Hospitals are constructing triage tents for testing, building ad hoc hospital rooms. Management and negotiation skills are necessary, in addition to the ability to collaborate and coordinate with community partners for alternate facility utilization.
      2. PPEs and SARS-CoV-2EVS testing kits: New sources of inventory, and intervention with local and government agencies for quick retrieval
      3. Ventilators and maintenance supplies for other critical equipment which requires continuous communication and triage skills.
      4. Cleaning supplies and equipment for infection control. Constant monitoring and evaluation of new supply avenues.
      5. Physician Preference Items (PPIs): Analysis and prioritizing of critical areas, change in protocols, new vendors.
      6. Purchased services: Supplementing the workforce, IT support, telehealth, billing/coding, security, compliance, and other new contracted services.
      7. IT/Telecommunication needs: Review of utilization, costs, areas for improvement, and capabilities with increased utilization of telehealth, remote workforce, cybersecurity, HIPAA regulations and upsurge of online communication processes.
   2. The disruption in the healthcare supply chain creates havoc with shipping channels and impedes the flow of goods. Management of shipping and freight logistics is also vital to inventory replenishment.
4. Utilization of expert negotiation skills: with the swell of new vendors, new contract development, evaluation and negotiation will require expertise. In particular, the surge of new and current vendors for purchased services (including workforce supplemental needs), PPE supplies, life saving equipment, and critical Physician Preference Items (PPIs) for emergency cardiac, neuro, cancer, and ortho/trauma cases.
5. Improvement of operational efficiency, while maintaining productivity.
6. Strong communication skills to build business relationships in both the private and government sectors (federal, state and local).

V. Conclusion: “It Takes a Village”… this is a race against time!
In a Gartner research report [5] listing the top 25 leaders in the healthcare supply chain realm, a description of the supply chain as one with an uncertain future is given.
Little could they imagine that a global pandemic would strike in 2020 and cause a major disruption in the United States healthcare system and economy?
In the report, analysts describe the term “agility” as a necessary quality for healthcare supply chain viability. Agility is defined as the ability to be resourceful, adaptable and respond to change.
Utilizing a partner with experience in leadership, strategy, on-time deliverables and proven solutions will be invaluable in this changing environment.

• The use of a strong, successful business partner in times of deep disruption can identify immediate problems, supplement existing staff and skill gaps, provide objectivity – a “fresh perspective” – and assist the workforce to free up time and resources.
• A strong data analytics platform enables quick turnaround to gain clarity and optimize efficiency.
• A team player with creativity, realistic goals, attention to cost savings, and the ability to collaborate and build new vendor relationships can help a supply chain weather the storm.

Utilizing a partner with experience in leadership, strategy, on-time deliverables and proven solutions will be invaluable in this changing environment. Click To Tweet
Change has been thrust upon us by a novel coronavirus, #SARS-CoV-2. The health and wellbeing of our patients and workforce are depending upon us to stay the course.
Healthcare leaders, federal, state and local government, private industry and expert advisors are in this together to find solutions, remain vigilant and keep our patients healthy and our hospitals financially stable.
This is a race against time and it will “take a village” in the spirit of community to survive this crisis.
[1] https://www.businessinsider.com/coronavirus-pandemic-timeline-history-major-events-2020-3
[2] https://www.hfma.org/topics/news/2020/03/national-emergency-declared–with-hospital-provisions-included–.html
[3] https://coronavirus.jhu.edu/map.html
[4] https://viehealthcare.com/purchased-services-consulting/
[5] https://www.gartner.com/en/documents/3975188/the-healthcare-supply-chain-top-25-for-2019
[6] http://www.cidrap.umn.edu/covid-19/supply-chain-issues
[7] https://www.npr.org/2020/03/25/818881845/senate-reaches-historic-deal-on-2t-coronavirus-economic-rescue-package
[8] https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0080
[9] Advisory Board- 3-24 https://www.advisory.com/daily-briefing/2020/03/24/sick-workers
[10] WHO- Emergency Response Checklist https://www.who.int/docs/default-source/documents/publications/hospital-emergency-response-checklist.pdf
[11] COVID-19 Healthcare Planning checklist https://www.phe.gov/Preparedness/COVID19/Documents/COVID-19%20Healthcare%20Planning%20Checklist.pdf
[12] Strategies for Optimizing the Supply of PPE https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
[13] CDC: NIOSH-Approved N95 Particulate Filtering Facepiece Respirators -List of Manufacturers: https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/N95list1.html
[14] Health Industry Distributors Association-https://www.hida.org/hida/govt-affairs/issues/Coronavirus_Resource_Center/distribution/advocacy/industry-issues/Coronavirus-resource-center.aspx?hkey=00951aa2-b69d-4618-a43b-c11d1e23ca08
[15] Association for the Healthcare Environment- https://www.ahe.org/novel-coronavirus-evs-advisory
[16] FDA- 3-24-2020 FAQs on Diagnostic Testing for SARS-CoV-2 https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2
[17] AHRMM-Association for Health Care Resource & Materials Management of the American Hospital Association https://www.ahrmm.org/ahrmm-covid-19
[18] https://www.businessnewsdaily.com/4610-business-consultant.html