COVID-19 and Healthcare Security: Challenges and Opportunities for Building Enduring Systems of Safety

PREPARING FOR EMERGENCIES

To prepare for the next threat, healthcare organizations should employ an all-hazards approach to visitor management and aspects of security. (Freidenfelds, 2021; IAHSS, 2020b). Organizations should conduct an All Hazard Risk Vulnerability Assessment (HVA): an objective evaluation of the organization’s key risks, the likelihood of each event, and its effects. The HVA factors in how internal and external preparedness measures mitigate these risks. Organizations should incorporate the HVA into business continuity plans to ensure “continuity of care and adequate security support of altered processes and measures” (IAHSS, 2020b). Health systems should consider bringing in a consultant to audit these policies and practices. It is imperative that communicable disease emergency response plans be informed by a security vulnerability assessment. This assessment should be conducted by an interdisciplinary team including a qualified healthcare security professional as well as leaders in the areas of emergency management, clinical care, infection control, and operations (IAHSS, 2020b). As the COVID-19 pandemic made clear, healthcare security demands a team effort, and so everyone should know the playbook.

SUPPLY CHAIN CHALLENGES

Shortages of PPE and medical supplies exposed the dangers of our existing supply chain systems (U.S. FDA, n.d). In the early weeks of the pandemic, hospitals scrambled to find and restock PPE before it was depleted. Security officers and patient care personnel were forced to reuse masks many times beyond the point of peak effectiveness. At some health systems, the supply dwindled to such a degree that personnel drove from building to building just to recover one mask (Personal Interviews, 2021). Health organizations turned to grey market suppliers who charged exorbitant prices and would not verify the quality or condition of the equipment beforehand. This threatened not only the safety and security of staff and patients but the financial health of organizations. Shortfalls extended beyond critical care equipment and PPE to routine materials such as toilet paper.

Further complicating the crisis was the fact that some healthcare organizations had inadequate real-time understanding of their needs, while other organizations, such as non-acute care hospitals, had little experience sourcing PPE on a regular basis, because they do not use it except for emergencies. They lacked the expertise in supply chains and relationships with suppliers. As a result, these entities relied more on government distribution. These hospitals should consider strategies to address this problem in the future. On a healthcare organization level, a system for tracking real-time supply and demand metrics and the transportation of these materials can be a powerful tool. An up-to-date assessment of the national or global supply of various resources is also important to maintain. 

There is only so much an organization can do, however, if the broader supply systems are inadequate. Supply shortages exposed the dangers of reliance on the global supply chain for critical resources (PPE, medical materials, equipment, etc.). Governments lacked a comprehensive plan for both domestic and foreign manufacturing sources capable of serving as redundant suppliers so that hospitals “are never put in the position of having to forage for PPE or other critical materials in an emergency” (Handfield et al., 2020). On both domestic and global levels, medical supply chains were not set up to handle the surge in demand. Even a large healthcare organization does not have the purchasing power to induce companies to invest in robust medical supply chains. This is where the capacities of national governments can make a big difference.

Another critical deficiency which contributed to the supply crisis was poorly managed national stockpiles. In the United States, the Strategic National Stockpile (SNS) serves as a buffer against medical supply deficits. Despite warnings following the 2009 H1N1 pandemic that reserves were running low, the SNS did not procure the recommended six to eight weeks of supplies. In February 2020, the SNS dwindled and because expiration dates were not easily accessible, personnel could not restock and distribute supplies in a timely manner. The SNS also lacked strategic sourcing, forecasting, and planning capabilities, including market intelligence. Its effectiveness also suffered from inadequate coordination and communication between supply chain managers at SNS and the clinical and emergency managers at CDC, FEMA, and HHS (Handfield et al., 2020). Furthermore, the relatively small budget of the SNS hampered the ability of personnel to remedy the PPE shortage anticipated the month prior.

Handfield et al. (2020) assert that the U.S. should employ a “commons-based strategy” entailing a “network of repositories, fluid inventories, and analytic monitoring governed by the experts.” Their review of scholarly literature concluded that, rather than simply pouring more funds into outdated systems, supply chain plans should be based on the principles of traceability and transparency, persistence and responsiveness, global independence, and equitable access. A National Academies committee formed in 2015 to advise SNS stakeholders came to seven key conclusions, among which are: 1) Inadequate medical supply chains compromise national health security, 2) The SNS had been successful in executing its original purpose, but the scope of its mission has evolved beyond the capacities of its budget, especially amid slimmer supply chains, 3) Insufficient investment in state and local departments of health have impeded last-mile distribution, and 4) The SNS should develop and maintain capacities to facilitate communication and coordination among supply chain stakeholders.

Governments must reimagine their role in supply chain management. If we hope to prepare for the next emergency, this process should start immediately. Preparedness will require a multi-pronged approach: 1) Building robust supply chains on both global and domestic levels and 2) Strengthening stockpiles to meet modern threats. It is essential to target multiple facets because emergencies manifest in unpredictable ways. The first waves of COVID-19 disrupted supply chains throughout the world. Lockdowns, restricted movement, and other safety measures, combined with soaring demand, resulted in a shortage of essential supplies (Chowdhury et al., 2021). Subsequent surges in just one region or country stalled production of PPE on multiple occasions, because the manufacturing of certain products was concentrated in those areas.

Governments have an abundance of tools they can use to promote robust supply chains. A government can guarantee a certain level of purchases so that companies invest in global medical supply chains (Associated Press, 2020). Creating an international stockpile and policies for contributing and dispensing these supplies would help governments fulfill these agreements, while building resilience in every region. Countries can enhance domestic supply chains through multiple policy angles: 1) In the United States, Congress could pass a law requiring manufacturing companies to have capabilities or plans in place to ramp up production upon invocation of the Defense Production Act., 2) Companies that want tax breaks or certain policies in trade deals could be required to manufacture a specified amount of supplies in the U.S., and 3) Financial benefits could be provided in exchange for building and maintaining domestic manufacturing facilities. Eliminating loopholes is crucial to the success of this strategy.

Countries should also maintain a buffer against supply shortages. National supply stockpiles and management systems should be strengthened to meet modern threats. In the United States, officials should build a robust SNS system that has the resources to carry out proper supply chain intelligence and development. Maintaining a well-defined, substantial national stockpile of medical, emergency, and other key supplies helps protect national and healthcare security. The U.S. can strengthen its SNS by enhancing strategic sourcing, forecasting, and planning capabilities, including real-time market intelligence. The country must also improve collaboration between supply chain managers at SNS and the clinical and emergency managers at CDC, FEMA, and HHS (Handfield et al., 2020). Organizations should take proactive steps to create resilience and geographic diversity in their supply chains. Building flexible redundancy into all tiers of the supply chain mitigates the risk of bottlenecks. Companies should invest in real-time intelligence and adaptive responses for inventory, capacity, and shipments (Ivanov & Das, 2020).