Unsung Heroes: Supply Chain Team Tackles ‘Unprecedented’ Challenges | VA Health Care Milwaukee

Nicole Hyke is neither a doctor nor a nurse. But she and her Supply Chain Management teammates have been heroic in their efforts behind the scenes at Milwaukee VA Medical Center.

Hyke is one of about 15 inventory managers at the hospital, and it’s their work – and the work of the entire supply chain team – that has kept the hospital running with critical equipment and supplies despite the unprecedented disruption caused by the COVID-19 pandemic.

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

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

“Even with the wars we’ve been through – with soldiers all over the world – I’ve never seen such shortages of medical supplies,” she said.

For two years, the supply chain team was driven to find creative solutions to vexing problems caused by supply shortages. At first it was personal protective equipment – masks, face shields, etc.

“But now it’s totally reversed and hits the procedural areas – anyone doing emergency or daily procedures,” Hyke said.

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

And when the need arose for a specific type of chest tube for pneumothorax – which was nowhere to be found – Hyke used his accumulated knowledge to create a replacement kit that filled the void.

The situation came to light when a veteran had to be sent to another hospital because the Milwaukee VA’s chest tube supply ran out. On top of that, the hospital vendor inventory was also empty.

So Hyke took what she learned working as a purchasing agent with catheter labs and interventional radiology to find a solution. This was to bring together different elements from other chest tube and catheter kits to create suitable replacement kits.

“I was able to find a workable solution,” Hyke said, noting that no patient has ever been in danger from the substitution. “It was about being creative and using my background and education to come up with a solution.”

According to Steven Zanotti, director of supply chain, this is just one example of the issues facing supply chain management and how his team is responding to them.

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

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

The new normal

Before the pandemic, it was common to have a 15-day supply for almost all of the 15,000 items that supply chain management manages.

But now it is only a few days for some items, and the team can no longer depend on anything from manufacturers, suppliers and distributors.

“We deal with these things in a reactive and situational way to try to close the gap,” he said. “We cannot rely on overnight shipping. We cannot rely on base prices; because of inflation, you pay three, four times more for the same item. We need to reinvent how we stay ahead of them to the best of our abilities. »

In order to meet the needs of the hospital, the supply chain team meets weekly with the various clinical teams to identify critical elements and establish priorities. A dedicated site on the hospital’s intranet SharePoint page provides updates, highlighting items that are 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. “It’s the new operating model. … These disturbances will last 12 to 24 months. Resources will continue to be limited.

The causes of the supply shortages range from inflation and lack of raw materials to transportation problems and bottlenecked vessels off the port of Long Beach, California, Zanotti said.

Meanwhile, demand for some items has increased during the latest COVID surge and unforeseen disruptions in the global supply chain mean nothing is immune.

“That’s literally all we buy,” he said.

Hyke agreed, saying the PPE shortages seen early in the pandemic pale in comparison to the shortages seen now.

“It was just masks and gowns in the pre-pandemic era,” she said. “Now that’s it – neurological, respiratory, etc. It’s difficult.”

Retain and stay engaged

Everyone in the hospital needs to be aware of the issues, stay engaged with supply chain management, and keep items or make sacrifices if necessary, Zanotti said.

“It’s very difficult,” he said. “Inventory managers try to steer clear of these things…but they’re not experts. It’s not their job to piece together medical supply kits piecemeal – it’s to procure those things.

“Supply chain has become a dirty word over the past couple of years, especially in healthcare settings, and we’re feeling it here. Our clinicians are frustrated, and we understand that, but we’re trying to send the message that we’re doing our part, but we need the medical center to continue to adapt with us as we navigate these things over the two coming years. years.”

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

“People don’t see much of what we’re going through. They see the disturbance on the shelf. … But they don’t see the backstory and what’s going on in there. It’s not a pretty picture.

“It’s hard for some of these people to come to work without having their heads down because it’s a chore. The longer this continues, the more absolutely taxing it continues to be for them. But they constantly knock it out of the park, going beyond the call of duty.

To show creativity

He and Hyke praised their colleagues, saying their creativity and zeal helped minimize the problems.

“My teammates are amazing,” Hyke said. “I would pit them against inventory managers nationwide – civilians and VA. We wouldn’t be able to do this without them. »

“We had to adapt, and I think we did really well as a medical centre,” Zanotti said. “We’re doing our best, and we’re going to continue to do our best to proactively stay ahead of the game and adapt the operation, because that’s what we need to do.”

“We’re here to help veterans,” Hyke said, noting that many supply chain employees are veterans. “We are equally invested in how providers treat patients. So anything we can do to make their job easier, we’re ready to do.

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