Are hospital supply chains defenceless?

With borders closed and exports banned, how do hospitals secure a sufficient supply of the necessary medical equipment as they battle COVID-19?

COVID-19 not only disrupted our healthcare ecosystems but also our supply chains. Globalisation was put on hold as countries closed their borders. When China, dubbed as “the world’s factory,” went into lockdown, the impact was felt across the world.

Supply chains were disrupted. Countries banned exports to secure their own local supply. Hospitals clambered for more personal protective equipment (PPE) products. 

Effectively controlling the spread of infection, according to the World Health Organisation, requires providing 89 million masks, 30 million gowns, 1.59 million goggles, 76 million gloves, and 2.9 million litres of hand sanitizer to front-liners around the world. But with soaring demand and limited supply, hospitals struggled with securing enough PPE to protect their staff and patients.

Nadiah Wan, CEO, Thomson Hospital Kota Damansara

Hospital Insights Asia had the privilege to discuss with Ms Nadiah Wan, CEO of Thomson Hospital Kota Damansara, about the most effective strategies to build a resilient supply chain for the healthcare industry especially in time of a pandemic.

We have to be ingenious and quick

Malaysia went into lockdown in March. Thomson Hospital wasn’t spared from the shortage of PPE products, but they couldn’t let this jeopardise their operations. “A speedy and ingenious response was needed,” Wan said. Because domestic and international policies were rapidly changing, they had to roll out pre-emptive measures to prevent further issues.

Thomson Hospital, similar to other hospitals in Southeast Asia, opted to stop elective surgeries to control their inventory. Patient flow and interaction were limited. Telemedicine was swiftly put in place. The hospital also implemented a series of “new normal” services, like drive-thru for COVID-19 testing, medication, blood drawing, and vaccination.

The industry’s resourcefulness was likewise assessed. “As the virus hit different parts of the world at different times, we were able to leverage on learnings from our colleagues in other countries to quickly implement stop-gap measures,” shared Wan.

Hospitals in Asia largely benefitted from research on 3D printing plans for modified scuba mask and mask holders, instructions to make face shields, designs for isolation gowns or SOPs for disinfecting N95 masks in ovens which were all being shared online.

Thomson Hospital, for instance, worked with 3D printers to provide mask holders and design acrylic barriers for intubation. They also modified scuba masks for doctors and produced their own face shields.

Collaboration is crucial

Wan believed that “the virus crosses all borders”, effectively blurring the line between public and private as well as national and local. “At the end of the day, it is in everyone’s interest to survive this pandemic that affects all of humanity.” Thus, collaboration is key for everyone to stage a successful response.

In Malaysia, a centralised approach to the pandemic was implemented. Public hospitals were assigned to admit all COVID-19 cases while private hospitals assisted by loaning them ventilators. Even the other sectors played their part and worked together to produce more PPE, acrylic barriers and swabbing booths, mask holders, and other substitutes for needed medical supplies.

Hospitals also received donations of face shields from the community. Thomson Hospital, specifically, received offers of goods and services from partners like Tesco, which provided large Styrofoam boxes to store COVID-19 swab samples and app designers, who helped to design the app to book and manage payments for COVID-19 tests. “This is why building good partnerships is helpful,” Wan emphasised.

Time for domestic production

Dependence on international suppliers had long been a predicament in supply chain management, with the trade wars and changing political priorities. During the pandemic, we’ve seen countries impose export bans to protect their local interests and this considerably impacted countries without domestic manufacturing.

The United States, for example, had forced 3M to divert its stock of N95 respirators back to the country. Malaysia still imposes an export ban and implements ceiling price on face masks. With stricter border controls across the world, delays in delivery, installation, and commissioning of medical equipment were posing a serious problem for the industry.

Further, when a vaccine becomes available, we’re expecting countries, which developed the vaccine, to restrict its distribution and export, making sure that its manufacturing is localised for their own populations.

Investing in technology

“The most important resource, whenever supply chain disruptions occur, is the ingenuity of the people, but we cannot ignore that accurate data is also important for us to have a real view of the situation on the ground and help us plan strategies,” said Wan. This is where technology comes in.

Shortages in PPE were reported during the early months of the pandemic. To address this concern, the Ministry of Health in Malaysia started to track and publish its daily PPE stock so the public is aware and the entire healthcare sector can better plan strategies. This accurate monitoring also allowed the public to help in the national effort of securing the supply by donating and coordinating with relevant personnel. 

The same daily monitoring likewise benefitted Thomson Hospital. They engaged with consultants and staff to update them on the status of supplies and advise on appropriate usage to avoid wastage and conserve stocks.

Moreover, Wan acknowledged the importance of analytics in building resilience and in better supply chain management. As of writing, Thomson Hospital is in the midst of implementing a new HIS-EMR-ERP system aimed to help them better manage, monitor, and analyse its supply chain in more detail.

The pandemic surely made us look at supply chain resilience in a more serious manner. We might be unprepared today, but the healthcare industry will definitely be in a much better position with regard to the supply chain should another pandemic occur.

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