Safety First

For health care organizations, especially those in aging services, the supply chain is indicative of how we steward our resources, how prepared we are for emergencies, and our ability to keep patients, residents, and staff as safe as possible.

Before the COVID-19 pandemic took root, supply chain had challenges, but the pandemic put the supply chain under a microscope, exposing existing vulnerabilities that were amplified by the pandemic. These amplified vulnerabilities resulted from increased demands for multiple product lines; lack of transparency about sourcing of raw materials; a dependence on a variety of foreign sources; and lean inventory models that depended on just-in-time delivery.

The shift called attention to a care-critical truth: the supply chain is intrinsically tied to, and supportive of, patient, resident, and staff safety.

Case in point regarding safety: a George Washington University Milken Institute School of Public Health study of 1,200 health care workers asked about challenges faced during the COVID-19 pandemic, and found a wide-ranging list of concerns including infection control, employee and patient safety, and high stress. Some 87 percent of nurses reported needing to reuse single-use PPE multiple times, while 53 percent reported feeling unsafe due to being forced to reuse and decontaminate single-use PPE.

This study helped to demonstrate the direct connection of supply chain to patient and staff safety, and highlighted our challenge: to do better by our patients, residents, and our staff on the frontline of care. Additionally, even prior to COVID, staff burnout was a significant concern, and increased cases of burnout are considered pandemic collateral damage. The pandemic has now forced a reckoning with health care workers’ mental health needs. In fact, ECRI named international supply chain disruptions number eight on its list of 2022 Top Ten Patient Safety concerns.

Supply Chain Resiliency

Supply chain resilience, a term we now hear frequently, includes creating an unfiltered view into the many moving parts of your supply chain. Health care organizations must develop a robust program to address daily operational supply chain needs, integrated with the ability to anticipate and prepare for the next big emergency, be it a health care crisis, a global manufacturing slowdown, a strained budget, or other challenge that can ultimately impact care and safety.

Creating an unfiltered supply chain view helps your organization to diversify your field of suppliers to increase purchasing flexibility; decrease potential and impact of disruptions, and identify possible vulnerabilities in a supplier’s supply chain. These steps will allow you to have greater input and engagement when trying to compensate for unavailable products and strengthen your negotiating power.

Operations and Stewardship

Economic pressures on skilled nursing facility provider organizations are great, with key drivers creating operating margin challenges. Slow post-pandemic recovery has resulted in occupancy rates ranging from 76 percent to 81 percent, and operating margins from -3 percent to -8 percent. Stewardship of resources plays an important role in provider survival. Strengthening of procurement functions and supply chain resilience can help provider organizations improve operating margins and use savings for other care-critical functions, such as workforce challenges.

Functional Equivalents

Shortages of health care supplies such as drugs, PPE, intravenous fluids, as well as durable medical equipment, including wheelchairs and beds, can disrupt routine resident care—threatening care quality and patient safety. A key strategy that helped many organizations survive the worst of the pandemic was learning to identify and procure functionally equivalent products. By vetting and documenting suppliers, and the quality and availability of supplies during the height of the pandemic, ECRI served as a resource and trusted source for health care organizations seeking to procure functional equivalents.

Action Recommendations to Promote Supply Chain Resilience

With manufacturers still having difficulty accessing raw materials needed to produce health care products and ongoing delivery disruptions and logistical challenges, it is vital that health care organizations reach beyond their usual partners and identify collaborators among peer institutions, suppliers, government agencies, manufacturers, and others to promote a resilient supply chain. ECRI recommends that such preparation be twofold: prepare to address current supply chain issues, and prepare for future emergencies.

ECRI recommends seven areas where health care organizations can take steps to prepare for supply chain issues that can impact patient and staff safety as well as care. With planning, preparation, communication, flexibility, and cooperation with outside collaborators, your organization can improve its ability to safely navigating supply chain disruptions.
1.    Identify supplies and drugs critical to your organization and identify domestic and international alternatives for each.
2.    Monitor drug shortages using information from the American Society of Health-System Pharmacists, the U.S. Food and Drug Administration (FDA), wholesalers, manufacturers, and other health care organizations.
3.    Demand transparency from distributors and manufacturers regarding minimum inventory levels, product and raw materials country of origin, and surge capacity plans.
4.    Maintain communication with local, state, and federal government agencies to determine available stockpiles.
5.    Re-examine sole-source, dual-source, and multisource agreements. If there are supply disruption related to these agreements, reassess the partnership, insist on specific improvements, and terminate relationships, if necessary.
6.    Follow the recommendations in Self-Assessment: Vetting Nontraditional Suppliers.
7.    Establish initial and routine quality control protocols for products from nontraditional suppliers.

Health care organizations also need to support clinician resilience and be available to staff; use transparent, two-way communication channels; and support practitioner wellness effectively. These recommendations can be read in full detail by accessing ECRI’s 2022 Top 10 Safety Concerns at

Collaborating to Improve Safety Across the Care Continuum

Approximately 3,000 U.S. hospitals and health systems are members of ECRI’s strategic sourcing and supply chain programs. ECRI has analyzed nearly $50 billion in supply and capital spend and has provided guidance on COVID-19-related personal protective equipment.

ECRI invites your organization to get to know the depth and breadth of our experts, our medical technology databases that enable us to benchmark pricing on nearly 2 million supplies and more than 100,000 capital equipment items, our exclusive content, membership resources, and tailored-to-you consulting services.  ECRI's experts are ready to help you protect safety with a better supply chain and are reachable at clientservices@ecri.og.