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Unsung heroes: Supply chain team tackles 'unprecedented' challenges

Nicole Hyke with chest tube kits
Nicole Hyke, inventory manager with the Milwaukee VA Medical Center, looks over chest tube kits she assembled in order to meet patient needs when supply-chain issues exhausted the hospital's supplies.

When we think of health care heroes, we typically picture doctors and nurses.

Nicole Hyke isn’t a doctor or nurse. But she and her teammates in Supply Chain Management have been heroic in their efforts behind the scenes of the Milwaukee VA Medical Center.

Hyke is one of about 15 inventory managers for the hospital, and it’s been their work – and the work of the entire supply chain team – that has kept the hospital functioning with critical equipment and supplies despite unprecedented disruptions brought on by the COVID-19 pandemic.

“I’ve never seen anything like this,” Hyke said. “People use the word ‘unprecedented’ a lot, but this really is unprecedented.”

And she should know. She has spent 30 years supplying and equipping not only the hospital but also the National Guard. Her work has included disaster relief efforts after devastating hurricanes.

“Even with the wars we’ve gone through — with soldiers all around the world — I’ve never seen medical supply shortages like this,” she said.

For two years, the supply chain team has been pushed to find creative solutions for vexing problems brought on by supply shortages. At first it was personal protective equipment – masks, face shields, etc.

“But now it’s totally flipped and is hitting the procedural areas — anybody who does emergency or daily procedures,” Hyke said.

In January there was a shortage of vital dialysis supplies. In mid-February it was surgical gloves.

And when the need arose for a specific type of pneumothorax chest tube — that was nowhere to be found — Hyke used her accumulated knowledge to build a substitute kit that filled the void.

The situation came to light when a Veteran had to be sent to another hospital because the chest tube supply at the Milwaukee VA had been exhausted. On top of that, the hospital’s suppliers’ inventory was also empty.

So Hyke took what she learned from working as a purchasing agent with the catheter labs and interventional radiology to figure out a solution. It involved pulling together different items from other chest tube and catheter kits to create suitable substitute kits.

“I was able to figure out a viable solution,” Hyke said, noting that no patients were ever in danger because of the substitution. “It was being creative and using my background and education in order to offer a solution.”

According to Steven Zanotti, chief supply chain officer, this is just one example of the problems facing Supply Chain Management and how his team is responding.

“That’s a day in the life of an IM (inventory manager),” he said. “This is just another instance of these guys going above and beyond.

“And that was just the flavor of the week. I’m not exaggerating; literally every week it’s something different. It’s completely different from the norm a few years ago.”

The new normal

Before the pandemic, it was commonplace to have a 15-day supply of nearly all of the 15,000 items that Supply Chain Management handles.

But now, it’s only a couple of days for some items, and the team can’t depend on anything from manufacturers, suppliers and distributors.

“We’re dealing with these things reactively and situationally to try to bridge the gap,” he said. “We can’t rely on overnight shipping. We can’t rely on base prices; due to inflation, you’re paying three, four times more for the same item. We’re having to reinvent how we stay out in front of these to the best of our ability.”

To keep up with the hospital’s needs, the supply chain team meets weekly with the various clinical teams to identify critical items and set priorities. A dedicated site on the hospital’s intranet SharePoint page provides updates, highlighting items in short supply.

“We’re trying to engage and communicate with our clinical partners and remind them that this isn’t going away,” Zanotti said. “This is the new operational model. … These disruptions are going to last 12 to 24 months. Resources will continue to be constrained.”

Causes for supply shortages range from inflation and lack of raw materials to transportation woes and the bottleneck of ships off the port of Long Beach, Calif., Zanotti said.

Meanwhile, demand for some items spiked during the latest COVID surge, and unforeseen disruptions up and down the worldwide supply chain mean that nothing is immune.

“It’s literally everything we purchase,” he said.

Hyke agreed, saying the PPE shortages seen at the beginning of the pandemic pale in comparisons to shortages being seen now.

“It was only masks and gowns in the pre-pandemic days,” she said. “Now it’s everything — neurological, respiratory, etc. This is difficult.”

Conserve, and stay engaged

Everyone in the hospital needs to be cognizant of the problems, stay engaged with Supply Chain Management and conserve items or make sacrifices if necessary, Zanotti said.

“It’s very challenging,” he said. “The inventory managers are trying to stay out in front of these things … but they’re not the experts. It’s not their job to piecemeal together medical supply kits — it’s to source those things.

“Supply chain has become a dirty word over the last couple of years, especially in health care settings, and we feel that here. Our clinicians get frustrated, and we understand that, but we’re trying to convey the message that we’re doing our part, but we need the medical center to continue to adapt with us as we navigate through these things over the next couple of years.”

Zanotti said the situation mirrors what people see at grocery stores, with empty shelves and sold-out items. It’s no different for medical supplies.

“People don’t see a lot of what we’re going through. They see the disruption on the shelf. … But they don’t see the backstory and what’s going into that. It’s not a pretty picture.

“It’s difficult for some of these folks to come into work without having their heads down because it is a grind. The more this goes on, the more this continues to be absolutely taxing on them. But they’re knocking it out of the park consistently, going above and beyond the call of duty.”

Getting creative

He and Hyke lauded their colleagues, saying their creativity and industriousness have helped to minimize the problems.

“My teammates are extraordinary,” Hyke said. “I would put them up against inventory managers nationwide — civilian and VA. We wouldn’t be able to do this without them.”

“We’ve had to adapt, and I think we’ve done really good as a medical center,” Zanotti said. “We’re doing our best, and we’re going to continue to do our best to stay in front of things proactively and adapt the operation, because that’s what we have to do.”

“We’re here to help Veterans,” Hyke said, noting that many supply chain employees are Veterans. “We’re just as invested in how the providers treat patients. So anything we can do to make their jobs easier, we’re willing to do.”

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