Episode 5: Shortages and Recalls Part 1

From unexpected product shortages to critical recalls, healthcare organizations are constantly adapting to supply chain disruptions. In this episode, we introduce the challenges these events create for providers and value analysis teams, why they matter, and set the stage for a conversation on navigating today's ever-changing healthcare landscape. 

Organizations mentioned in this episode:

AHVAP: https://www.ahvap.org/

AHRMM: https://www.ahrmm.org/

FDA: https://www.fda.gov/

Want to learn more about Blue.Point? Contact us today for a free product demo! More information at www.bluepointscs.com or email jdoty@bluepointscs.com.

Data Slayer Podcast

Through this podcast, our subject matter experts will cover in-depth conversations on healthcare data, clinical research, industry trends, real-world stories, and more. 

Blue.Point provides health systems with a specialized data analysis platform designed to optimize clinical product utilization. Our technology identifies savings opportunities and delivers non-bias insights on product best practices, standardization, and utilization-driven impact across hospital systems.

Interested in learning more? Visit www.bluepointscs.com

Transcript

SPEAKER_03 0:04

Hello and welcome to the Data Slayer Podcast, where Insight meets Impact, brought to you by the team at Blue Point Supply Chain Solutions. Blue Point is a data intelligence platform with a focus on clinical product utilization. In today's episode, we are going to discuss the problems around shortages and recalls and the healthcare supply chain. This will be the first part of a two-part series on this topic, as it is very important and a comprehensive issue. Part two will focus on how to manage shortages and recalls successfully. I'm your host, Jennifer Dodi, and joining me from Blue Point are Anne-Marie Orlando, the Vice President of Clinical Services, Keegan Smith, the Senior Manager of Analytics and Product Development, and Sarah Hobbs, the Clinical Program Director. Welcome everyone. Nice of you to join me today. All right. Well, let's just get right into the first question then. So since 2020, there has been a public spotlight on the healthcare supply chain, particularly around shortages and recalls. What was this the first time you were acutely aware of the global impacts? I can start with you, Anne-Marie.

SPEAKER_00 1:15

Um, if not for me. I mean, I was a supply chain director way back when Ebola first came around. And so what was that, 2013, 2014 or so? And that created a significant supply shortage. I think that was the first pandemic that people were very nervous about not having the right protections in place for staff uh, you know, within the our hospitals. And that was the first time that I experienced, I know, at my facility, uh, a lot of the tension around how I was managing my supplies, how I was managing uh the inventory, uh, run rate was became at the tip of everyone's tongue within my facility. And no one had ever cared about what my run rate was. Uh, you know, so when you think about, you know, how often and what your turnover is for some of these products, uh, you know, that wasn't something that anyone really uh paid much mind to. But um, you know, so that was the first time that I actually experienced that. But I want to say, I don't think the general public really understood the impact of recalls or shortages or or they didn't really experience it, wasn't in the news is in terms of shortages. Um, you know, and and it did back then, you know, force me to think outside the box for products, right? You know, you think that um, you know, one route is always uh the same the route you should go. Um, and then you realize, oh wait, there's other places that I can go, other vendors that have this product that may have uh what I need with the same clinical efficacy. But again, it was in that my little world, uh, you know, it within my hospital. Um, I think 2020 changed it to everybody was talking about it. It was on the news every night. Uh so anyway, that was uh that was kind of my my first uh experience.

SPEAKER_03 3:30

Yeah, it seemed to also affect a lot more people that we have, you know, personally our family members, and yeah, you know, um so yeah, that's absolutely once it becomes once it comes into your sphere, that's when you know you definitely start paying attention. Yeah, how about you, Sarah?

SPEAKER_02 3:49

Well, you know, um I wasn't a supply chain director back when Ebola hit, I was actually a nurse on the floor. So the impact hit me different because then it's like, oh my goodness, am I gonna be protected? You know, and you think about that, I think you think about that in general, um, even in supply chain, right? How am I going to be affected? But this was do we have enough product? Is that the thing? And you're right, run rate became the word, right? And shortage became the other word, and everybody was really and donning and doffing.

SPEAKER_00 4:25

Yes, do you know how to properly don and doff?

SPEAKER_02 4:28

And we would we had a team that did that. How do you get it on? How do you get it off? Yes, and so I was aware of it, but I was aware of it differently, right? And then when COVID came, I was in value analysis, and so that really changed my focus. Like, um, how are we going to find hand sanitizer? Do we have enough? How are we gonna get the the right PPE? I mean, do we have enough masks? Can we reuse them? How are we gonna do that? What's clinically safe? Um, so I was aware of it, but it's funny how your role shifts, right? When you are a nurse on the floor or a patient at that and you're thinking about these things, and then you are in supply chain trying to um trying to get the stuff, the items and the products that are actually short, and you're trying to figure out which way and how you're gonna do it, and what is clinically viable and safe for the patients and for the nurses that are working and taking care of those patients.

SPEAKER_01 5:31

I'd have to say for me, uh 2020 on supply chain and shortages was the first time. Uh, my background in public health, I definitely knew how outbreaks and pandemics can globally affect uh an area in things, but I never really put it into what happened in 2020 and with COVID and seeing, you know, the spend rise for members, seeing suppliers that we hadn't seen in specific categories before, and just how everything was shifting within the data that we were receiving. Um, and then how do we put that out? Like, how do you help uh in tracking that type of stuff for members, for facilities, and you know, how do you gear them to know and arm them with what they need to see and know that financial impact? So it definitely was uh the first time for me in 2020. Um it was very eye-opening, and now I feel like it's talked about all the time, um, which I think is a positive. It's good to have that insight.

SPEAKER_00 6:51

Um yeah, I I think it's a little it's interesting because you know, I remember when I first got into supply chain, it it was I don't know, way back in what is it, seven almost 17 years ago. And you have that mentality of what do you like? I'm always gonna have access to this. Like this is always gonna be there for me and I can stalk as many as I want and I'm never gonna run out. Like that was the mentality you had because on occasion, yeah, you'd have a back order here and there, it was like a random thing. But suddenly it became it became real, you know, and I I think over the years, uh, you know, we've had, yeah, we had, you know, the PPE shortages, but then uh, you know, we had we've had hurricanes, we've had natural disasters, we've had um, you know, endotoxins in a, you know, everyone now is talking about neuropatties or neurosponges, right? Uh, you know, so and finding endotoxins in those. And suddenly it's like, how do we actually um, you know, how have we come to a place where suddenly we actually don't have that product, we don't have that plethora of supplies. It's just uh interesting.

SPEAKER_03 8:10

Yeah, it almost mimics, I mean, not mimics, but it's always a problem that is not just isolated to healthcare. I remember for myself, throughout life you had shortages. A lot of times it was food shortages as some year where there's, you know, no strawberries available. And we kind of, you know, hear in the news about why that is. And then with COVID, um, there was no toilet paper, you know, and everyone figured it was something that was just going to be there always, and they couldn't, you know, always just go down to the store and get. And then all of a sudden, the problems of people hoarding it and you know, trying to um make sure that there was enough on the shelves and then limit the amount of people that could buy it. And it's one of those things is like it sucks that it has to happen when there's a crisis that we weren't necessarily prepared. Um, and the crisis happens and then it resolves. And I've I feel like sometimes it gets forgotten and we don't continue on, like making sure. Um, so that's you know, the the layman's turns. And here obviously it's real important, and that's why I feel like it should be discussed about all the time because this is something I mean, toilet paper is important, but healthcare is a lot more important.

SPEAKER_02 9:19

Well, it's the hoarding too. You said that very well because you think people are just the general public, right? You're hoarding the toilet paper, you're hoarding the masks. This is what I can get my hands on, this is what I'm gonna have. And then it shorts someone else. Well, same thing happens in healthcare, right? So, oh, flushes, let me say I have a million of them because I put them in my pocket every day. But really, then you have those that really don't have those that access, and they're trying to come up with a substitute, or how can we make this work? And so it is kind of it's it's hard to imagine, but to talk about it all the time and to keep it on the tip of your tongue because it gives you processes and ways to flow through that. Um, I think that that's super helpful.

SPEAKER_03 10:06

Yeah. All right, let's go a little deeper on how these shortages and recalls increase increase the risk to the patient. Because I know it makes sense that it will, but it's not always obvious. So are there any? Um, I know you already talked a little about the neuropatties, Anne Marie. Um what else?

SPEAKER_00 10:26

Well, I I think you know, any of these shortages or recalls, you know, it creates risk to the patient just from a delay of care, right? You know, patients are now. I know we saw that with uh a few years ago, there was a major IV fluid shortage. And uh despite some const you know, efforts in con conserving uh what current uh product, you know, hospitals had, there still were some delay in care for patients. Uh, you know, the the neuropathies I just mentioned, that is certainly a delay in in in care for uh many patients that we've seen. Um, you know, and that's scary to be able to think, you know, I know Sarah, you mentioned uh reusing masks, right? You know, what how how can we how can we be safe? Uh, you know, and that means, you know, a patient comes in, I if if the worker can't protect themselves, right, against, you know, what uh, you know, what the patient may be coming in with. And, you know, staff have to be safe too. They can't just, you know, uh, as much as they want to run to attend to a patient, you have they have to maintain their safety. They have to also be safe so they can continue to carry on and care for their patients, care for their family when they get home and not bring that, you know, these types of things to their family. And uh, and I think that it's important that we uh understand that it's you know both ways, that it's that delay in care, but it's also the you know, this the safety aspect of it. And it and it gets a little um gets a little scary, you know, when that we you know, when you when you say, Oh, this surgery that you need so badly, uh, you know, we we can't provide that for you. Or the care that you're coming in today to see, we can't see you because we can't protect ourselves to be able to see you. So please don't come in, the doors are closed, you know. Yeah.

SPEAKER_02 12:24

When I think about you can come up with three different ways for this, right? You and it all involves the risk, right? So you either don't have the product available or you're substituting the product, or it's delaying the care. And so, I mean, really, if you don't have the product, then you don't have the product, you can't care for the patient. So it either stops the care or it changes the care. And so then that change comes with the substitution, right? So we we know better, I think as healthcare professionals, that a substitute isn't a flush, isn't a flush. Like sometimes there are variable differences, and so sometimes it makes sense and it's very interchangeable, but other times it's not interchangeable, and you are putting that patient at not at risk. Well, you could be putting that patient at risk, but clinically it's not going to work because you're changing the process of what you're used to doing, and so the delays, I mean, with all the delays, they're not just inconvenient, really. It truly can change that that outcome. If you can't care for a patient because you don't have the supplies or you don't have the proper equipment, um, at the end of the day, it doesn't just impact the supply chain, right? It impacts the patient care, it impacts, it introduces that variability into care, and that's where that uh risk lives, right? Where the variability is. And so if you don't have the product, you can't care for the patient, so you're trying to change it with a substitute, and does that substitute clinically safe? And then are you delaying care even further because you can't find that substitute either? So it does pose some risk, but it also poses some change and and change is hard. That's I always like to say change is hard. You know, we preach it all the time, like it's super easy, but change really is hard across the board in healthcare and your public in within the public um realm, and even in your personal life, change is hard.

SPEAKER_01 14:35

Yeah, it's like a the domino effect, right? Like every you know, action has a reaction and it just keeps going. So it's like something you could think of that is so small, like an exam glove or the mask, like it becomes so important and so critical in these uh times.

SPEAKER_00 14:59

So it's important, you know, from a value analysis perspective that you know that's why we always talk about um inviting people to the table and making sure that we have interprofessional collaboration because it's not just us putting a substitute product on a shelf and hoping all goes well fairly well. I hope you figure out how to use it. Right. And so it's it's working with uh, you know, not only you know your industry partners, but working with a a team of professionals who are very adept at using the original product and having them check out what is this new product, what are the differences, how can we educate the staff to use that and how can we ensure that we're conveying uh conveying that. So conveying that whether it's uh in in-depth education or even sometimes it could be used the same way, but just hey, here's a heads up, it's a new product because even the packaging sometimes can just throw a nurse off, right? You're you're so used to looking for that blue bin or that blue package, right? And then all of a sudden one day it's red and there's none and you can't find it. Right. And you know, nurses, right? It it we're so driven to that, uh, you know, we're always used to grabbing that same one and suddenly we don't see the one that that blue one anymore. Now we're gonna try and find our own work around because you know we're gonna get that done, right? And we're very creative at times, uh sometimes to our detriment. And you know, so so it's it's all about that communication too.

SPEAKER_03 16:33

Yeah, I can see once again, all of this is happening in crisis mode too. So, you know, um, and that's kind of leads almost into the next question because um staying on top of these disruptions. It's something that I feel we can't really predict, like the weather. Like you might know it could happen, like we could have this, but at the same time, I feel some of these products are not like they have expiration dates too. So, how do we how do we stay on top of these?

SPEAKER_02 17:04

You know, I think to stay on top of it, it really comes down to communicating, right? So being proactive, connecting with the end users that do use it, like Anne-Marie said, and really been truly just being transparent, like you're really working hard on this, um, and we really need to work together, and so let's collaborate and do it together. Um, I think part of it is we obviously can't do it alone, and so that scale matters. And so those people that you are inviting to the table, is it the right people? Um, are they the ones that are using the product? Are they the ones that can help gather the product? So your GPOs are the are they helping um in these shortages as well? Um, and then to have that that strong relationship with the vendors and those relationships to where they can help you out as well, I think it's pretty important. Um, you know, I just think that really bringing the same, like Anne-Marie has said it a couple of times, but bringing those people to the table and just having those discussions and being open and honest and saying, we need your help, so let's rely together. And I will figure this out if you can figure this out and distribute that workload, because you can't take it on alone.

SPEAKER_00 18:26

Right. I think the other part to that is also identifying at your facilities what are those critical items. You know, I I think that there's an art to that, right? Because, you know, ne we never would have thought that certain items uh like N95s was going to be a critical item, but we found out, yes, it could very well be. Uh and so identifying those areas, maybe it's a maybe it's a a high volume item, right? That's um, but maybe there's not a lot of substitutions behind it, right? So how at your facility, I know there's uh some third-party um items, there's uh less sophisticated ways, you know, just going through the going through your bins and saying, okay, is this a critical? Would you would we deem this a critical item? And what are those, what's that criteria to deem criticality of the item, right? Are there a lot of substitutions available? Do I have a lot of relationships? Are there a lot of people, uh vendors who are manufacturing this? Does is there diversity of the manufacturing? Right now we even have to know where these things are being produced and where is the raw material being harvested from, right? You have to know everything down the supply chain because you know, when you sit at those tables and you have those discussions, you sometimes you need to have that insight on um, you know, do I have repetitive options in this in this product? And and how can I get that? And how can I identify those items where if I'm running low and I can't get a sub, I have a big problem on my hands and and I need to be very reactive or proactive actually.

SPEAKER_01 20:13

Yeah.

SPEAKER_00 20:13

Yeah.

unknown 20:14

Yeah. Yep.

SPEAKER_01 20:15

Yeah, those are great points, but you can also look at your data points too, right? Like we rely on the nurses to give us like what products are, you know, going to be interchangeable or the critical ones in the future, but looking at your data and tracking your data points and seeing, is there a change or is there is it you know staying the same? Because maybe a slight change can trigger, you know, some questions that then say, okay, we might be going into a shortage, like we're going into the winter months. So is are we gonna see an influx in this and let's start preparing, right? I think one of the takeaways is that it's what happened in 2020 taught us to be a little more prepared um in different ways. Um, so really utilizing your data and internally, you know, AI is a big thing now. So let's use AI, let's use those machine learning tools that you know we have at our hand to be able to track historic usage and when it's changing, um, I think is equally as important as identifying uh the critical items.

SPEAKER_00 21:30

I think um that was the first time I have to say in 2020, where I got a lot of emails from customers and they would say, we don't have any more of this. What other companies are buying that same item that I can look at? What other what other companies are out there? Can you help me? And I got a plethora of those messages, and so um which then I was thinking, this is great the way we. group our products together because I could just select in the database. Oh, I want this product and this grouping. And oh, here's all the other alternatives that are in that are out there that we haven't categorized. And you know, I could I could quickly send that off. So um so it's really nice to you know whether you use a third party solution or build your own right. So as you're as you're moving through and and you're finding subs, it you know, make sure you're capturing that data so that you can then refer to it because you know next time it's not typically a one and done right. I think we've seen now this is going to be cyclical. Right now we're 11 years later from you know 11 or 12 years later from the first Ebola crisis. Now we're kind of heading into there throw a Hantavirus in there too and you know and suddenly you know people are looking at uh you know fit testing N95s again in in you know making sure again how how can we um build that resiliency and that's I think you know capturing that data is important. Yeah.

SPEAKER_03 23:05

Yeah absolutely it's another way of being able to actually get evidence you know rather than just saying oh I think this makes sense that we're going to run out of this because of that but actually having the evidence sometimes it's it's not exactly what you thought. Yeah.

SPEAKER_02 23:22

Yeah those trends are nice to look at through the data right like you can see the trends if you can see the ups and downs and you know what to expect and when to expect it. And so you were totally spot on Keegan when you're talking about using the data for that because it is super helpful because even us we're reviewing the data and looking at it you don't see those slight nuances sometimes and it and looking at those small things may actually impact later on down the road something something big. And so to be able to see it visually and to be able to look at it and analyze it is super helpful to see. And to figure out where that where you're going to land um coming up or anticipating that. So you are proactive and not reactive.

SPEAKER_03 24:15

Exactly I know we mentioned a few times about bringing like the right people to the table do you have a little bit more who specifically like should be part of these conversations?

SPEAKER_00 24:28

A few that you always have to have you would always want to have risk involved right because anything that you're going to do is going to uh change uh whether it's change when you change your products you may have to change your practice right so risk is always or quality sometimes they're bundled together uh infection uh control or prevention is always going to be at the table obviously you need you know you know supply chain is and value analysis right those those two are going to be working hand in hand um and then you know the products are you know mainly where you know whether it's OR specific or you know whatever that department that lead department or maybe it's the nursing council you need to have at the table right um because it touches everywhere in the facility I don't know if anyone else has you know if you're lucky enough to have an analytics person on your staff I think you know to talk about some of run some of those data uh points and and keep track of that I think that is helpful to have them as part of that conversation.

SPEAKER_02 25:35

I don't know Sarah Keegan if am I missing any I'm sure I am but if you have a good relationship with certain suppliers in that area bring them to the table right like yeah um yeah I think that's a good or a distributor someone on the other side it might be worth it bringing them to I think you hit the non-negotiables right and so um that's the people that have to be there and so it's not necessarily about having more people at the table but it's having those right perspectives right because you think about that every shortage makes a is a clinical decision is an operational decision has a financial decision and it's all happening at the same time so if you miss one of those non-negotiables it's going to impact it down the road or it's going to impact it immediately and I think it really just depends on the timing and how long the shortage is going to be.

SPEAKER_03 26:33

I think Sarah you also mentioned earlier um the buzzword of transparency because I think that's a real important one and making sure that um that there is cooperation and everyone is working together um because this is not an isolated uh when once these shortages and recalls happen it's not just isolated to one facility you know right um so I know for for me when I've been able to go to um conferences and able to hear everyone working together and sharing their solutions, you know, I I feel like that is also this is a a global issue. You know, we all have to work together and not make it a competitive thing. So didn't know if there's any specific professional networks we want to um discuss that could help if anyone needs to reach out.

SPEAKER_00 27:24

Yeah I mean I think we mentioned our you know your GPO is a great one to to rely on um you know your professional networks you're going to want to also uh you know as a you know value analysis you know you're not going to be there alone uh there are going to be like you said other hospitals so uh AVAP is going to be uh you know another place you can go to and say hey what are you doing about this uh what are other products you're reaching out to what are some caveats to implementation so that I can do this safely right you know uh hopefully uh someone else has that experience and and hopefully they'll they're willing to share uh same thing you know for supply chain arm right uh you know we want to look at again uh those you know what are some possible substitutions or um you know anywhere that you can build that network and um and have these discussions I think it's really important you know if you have a you know a collaborative that maybe your hospital that's local to you that uh you you belong to or um your local chapter the um you know your state chapter the uh hospital association or ACHE is an is another one um that you would want you know American College of Healthcare executives you know that you know that's another one where um you'd be able to find that network of hospitals that are going through uh exactly what you're describing.

SPEAKER_02 28:50

Yeah and I think the other thing um sometimes subscribing to those alerts and within the governmental and regulatory agencies can really help because it will if it's something that's coming up it should notify you ahead of time. And then really and truly honestly to me and we name all of the professional networks right but that peer-to-peer sharing not just the vendors but peer-to-peer across you all of the networks that you have is super helpful because sometimes the best solutions come from just the neighbor next door right and you're thinking what was I why wasn't I thinking about that what what where did that come from but two heads are better than one and I mean again it comes down to inviting those people to the table and whether that's via a text or a simple email or something like that just to say hey we're really struggling with this what have you done um using using that peer-to-peer group really helps and then knowing those shortages that are coming up so the FDA website and things like that and governmental agencies that really help um so you get those alerts.

SPEAKER_03 29:59

All right do we have any final words on part one part two will go more into now how to manage you know these shortages successfully but any final thoughts for today's episode?

SPEAKER_00 30:11

I'm just thinking you know I think preparation is key and I know we'll talk about some of that in the next episode. Today we talked a little bit about uh you know the awareness around it and and all I can think of is the quote is never let a good crisis go to waste right and sometimes it's like you know it's like you go through it don't waste that opportunity uh you know in moving forward you know make sure you you kind of do an after action report and really look at it and say you know when I went through you know maybe Ebola the first time or COVID the first time and then second time and third third time in the IV fluids and this you know you know each time you should be learning and building and restructuring and and making you a little bit more resilient building those networks and and really um you know again learn something from it right don't just uh go through it.

SPEAKER_03 31:11

That's a great ending absolutely such a good spot like spot on so with that in mind I think that's a wrap. So thank you all for joining me today and for everyone out there listening and watching um make sure to like and subscribe wherever you are enjoying this episode so that you'll be informed when part two airs and other episodes. For information for more information you can visit our website at bluepoints.com or any links in the podcast or video description I will include some of those um organizations that we mentioned and websites as well. And remember best practice doesn't have to cost more when you slay your data with Bluepoint. Until next time all right well I don't think we have any bloopers today guys.

SPEAKER_02 32:03

All right well that's Anne Marie disappearing trying to plug her thing in and I kinda realize oh yeah besides that it's like vanishing me like I know you fell out of your chair or something.