Beyond the Byline:How healthcare supply chain struggles contribute to employee burnout – Transcript

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Alex Kacik: Hey, welcome to Modern Healthcare’s Beyond the Byline, where reporters add context to their stories to help you better understand the news and how it’s reported. My name is Alex Kacik. I’m the hospital operations reporter for Modern Healthcare. I’m joined by safety and quality reporter Maria Castellucci. We’re looking at how the healthcare supply chain has fared during the COVID-19 pandemic and how that’s tied into employee burnout. We’ll try to do more of a free flowing back and forth. Thank you so much, Maria. I appreciate you joining me.

Maria Castellucci: Yes. Happy to be here, Alex.

Alex Kacik: All right. Well, let’s start on the supply chain side. We’ve both been reporting on how hospital administrators have had to turn to non-traditional sources and suppliers for certain protective equipment that has run short. I had one health system executive calling the surgical gown market the wild wild West, telling me about scenarios where hospitals would spend a lot of money to secure products, but have them diverted at customs for not passing quality standards. So what have you seen about the quality of PPE, as providers scrambled to find alternative sources?

Maria Castellucci: Yeah. Alex, I heard similar stories as well from my sources too. So I started reporting on this topic back in April. I initially became interested in it when at the time I was getting press releases in my inbox about tactics that health systems were using to reuse N95 respirator masks for their frontline workers as they treated the COVID-19 patients. This is a respirator mask that is required to be used when you’re interacting one-on-one with a COVID-19 patient.
    And similar to other personal protective equipment like gowns and gloves, N95 masks were designed to be used only one time. But because of severe shortages, health systems were saying that they were forced to have healthcare workers reuse these masks multiple times, and they began using cleaning tactics like ultraviolet light and heat to clean the masks so workers could use them again for their next shift.
    And when I wrote the story, being the safety and quality reporter, I immediately thought, well, how is this going to impact frontline caregivers? Is this safe to do? So I spoke with the patient safety organization, ECRI. They’re a not for profit group. And then physicians too, who had been tweeting about this and doing their own research. And what I heard is that they were really worried about the reuse of N95 masks. One physician that I spoke with actually called putting an N95 mask back on your face that’s already been used bio hazardous waste.
    So fast-forward to September, ECRI, that same patient safety organization had came out with research about the respirator masks, but now these were masks that were being manufactured in China, and they found that between 60% to 70% didn’t meet the US standards of filtering particles in the air. And ECRI was saying they got these got these masks to study from their health system members and so they assumed that some of them actually had their healthcare workers use these masks.
    So really what’s kind of emerged throughout these last nine months of reporting is that there’s definitely a trend forming during this pandemic, that health systems are making decisions about PPE that may not be safe for their workers.

Alex Kacik: What does that cause health system leaders to do when they’re looking to change their practices in terms of how they’re managing their supply chain and how they are going to adapt going forward, knowing that we’ve seen a pretty big wrench thrown in their traditional operations and what’s going to need to change going forward?

Maria Castellucci: Yeah. And I think this is where both of our beats are kind of overlapping, right? You’re typically writing about supply chain too. So, but I did a story a little bit about supply chain when I wrote about what were the biggest lessons learned? And at the time, we were six months into the pandemic. I definitely wanted supply chain to be part of the story. And so I spoke with Premiere and Vizient, who are pretty well-known consultants in the industry, helping health systems manage their supply chain.
  And a theme that definitely came up is that supply chain is never going to be the same after this pandemic. Before COVID-19, it was a pretty common practice between manufacturers and providers to not share a lot of information with each other, like how much supply the manufacturer had on hand, where the supplies were actually being stored and then providers not sharing with the manufacturers what they would need in case of an emergency. Not even just a pandemic, but emergency like a hurricane or a flood. What are the supplies that they need?
    So both Vizient and Premiere talked to me about how they expect going forward that contracts are going to have written in that there needs to be much more transparency from providers and manufacturers about their supply. For providers, what they need, and then manufacturers, what they have and what they can provide should an emergency occur.
    Additionally, something I wrote about was this practice called just-in-time inventory, which is actually something that’s pretty common for health systems that use lean principles, which is a quality management system. And in lean, just-in-time is you only basically have the supplies on your hand that you need. And I spoke with the CEO of Virginia Mason, Dr. Gary Caplin, they’re based in Washington, so they were among the first health system to get hit with COVID patients. He’s been a standing champion of lean. And he said that since COVID, they’re definitely rethinking that just-in-time inventory principle of lean because it didn’t serve them during COVID when they only had a limited amount of ventilators, a limited amount of N95 masks. So those kinds of things going forward, they’re going to think about having more of a supply, more of an excess of supply rather than just-in-time.
    So that’s kind of what I’ve gotten from my reporting. I know, Alex, if you have anything to add about this topic.

Alex Kacik: Definitely. The transparency, and I think is a common theme we’re hearing. The supply chain hasn’t been immune to these types of shortages. They’ve been plaguing the healthcare industry for some time now. And some of it’s related to where these supplies come from. A lot of times they’re overseas. A lot of Chinese manufacturers in this space and it’s been a cost efficiency game that’s been driving purchasing patterns there. And in that lean sentiment, minimal overhead has been a priority among health system executives who are trying to find ways to cut costs. And so a lot of times, there’ll be one or two producers overseas, and it’s harder for others to compete when the prices are so low. So you’re left with one or two producers, manufacturers, and then all it takes is one production snafu or quality hiccup to throw off an entire global supply chain.
    So I’m hearing a lot about trying to onshore or near-shore more production. So what that looks like is some health systems, a big one in the Midwest is looking at trying to develop a sustainable source of surgical gowns and they found an idled cheerleading manufacturing facility in Ohio. And they said, look, can we reuse your machines and infrastructure to produce reusable gowns. And they found raw materials, fabric supplier in South Carolina. And so they’re limited in terms of how much they can pump out every day, but they’re trying to expand. And they’re also trying to get buy in from other area health systems to say, look, if you invest in this, you can depend on a certain share of your annual allocation of these goods every year from this source. Granted, the hangup is it usually costs a premium and there’s been some back and forth on whether after this pandemic subsides, if there’ll be willing to pay that premium going forward, or they’ll revert more to that cost cutting mode and try to find the lowest cost supplier.
    So I’m curious, so how health systems, Maria, are factoring this, not only within their supply chain, but then they’re looking at their workforce, right, and understanding how these shortages of PPE impact their day-to-day operations. And a lot of times, this adds anxiety and stress to already stressful jobs. So what are you seeing in terms of that correlation between having adequate amount of supplies on hand and how that interplays with frontline workers, health and mental health specifically?

Maria Castellucci: So burnout and mental health has been a topic that I was interested even before COVID, but definitely during this pandemic, it’s become even more important for us to look at it as an issue. And I haven’t written a story specifically about this, but it’s something that consistently comes up, especially when I’m speaking with nurses and other frontline caregivers. The toll of having to reuse a mask that they’re not, a N95 respirator that they’re not a 100% sure is clean, is really mentally draining.

Alex Kacik: Maria, that makes me think of some health system executives who have downplayed burnout. They’ve told us that it isn’t as much of a deal as it’s made out to be, and that employees should do their jobs, buck up and just get on with it. So I’m curious, do you think the pandemic has changed the tune of some of those naysayers?

Maria Castellucci: So I wrote about this back in May. Like I said, this has always been a topic that I’ve been interested in. So when I wrote about it, it was really easy to get health systems to talk to me about this. This was something that they were really eager to talk about, what they were doing for their frontline workers during this pandemic.
    The American Nurses Association, I spoke with them when I was writing this initial story on it, and they’re worried that they’re going to see an exodus of nurses after this pandemic, depending on how the working conditions were for that nurse. They might say, “I’m done. I want to leave.” And then I think our colleague, Ginger, just recently wrote a really great story about anecdotal reports of healthcare workers leaving jobs in the hospital setting.
    So this is definitely something that has real impact for healthcare CEOs, if they don’t address this problem. And before the pandemic, we were worried about a shortage of nurses and physicians in the next 10 years. So it’s a major concern if we’re going to have early retirement or early exodus of nurses and other frontline caregivers like physicians to the workforce.

Alex Kacik: Well, to that point, staffing costs usually make up the most of hospital expenses in terms of their balance sheets. So recruitment and retention is always a big focus of theirs. And so I imagine, going forward, that they’ll be interested both from a financial and from a cultural standpoint, to try to retain as many folks as they can.

Maria Castellucci: And what I just to want to add, just to kind of bring it back to PPE and this correlation. So the health systems are doing these additional things that maybe they hadn’t done before, like free counseling and meals and support groups. But then there is still the very real fact that we’re in a surge right now, from a survey that I wrote about a couple of weeks ago, most hospitals and healthcare organizations are using this extended and reuse policy. We’re still seeing unions go on strike complaining of staffing problems. So there are efforts by health systems, by the employers, to make it a better workplace, but then there’s still the very real issue of not adequate PPE. And then in some cases, even poor staffing ratios that make working conditions really difficult.
    So I think that’s something that you and I are definitely going to be on the lookout for. What are the longterm implications of some of these policies that we’re seeing from healthcare organizations?

Alex Kacik: Definitely. Well, look forward to researching this more with you, Maria. Thank you so much, in the meantime, for taking the time with me to share your experience and your insight. Appreciate it.

Maria Castellucci: Yes. Thank you, Alex. This was fun.

Alex Kacik: All right. Thank you all for listening. We’ll have links in the show notes that feature Maria’s reporting, as well as links to subscribe to all of Modern Healthcare’s content. Thank you for listening and appreciate your support.

Alex Kacik: Hey, welcome to Modern Healthcare’s Beyond the Byline, where reporters add context to their stories to help you better understand the news and how it’s reported. My name is Alex Kacik. I’m the hospital operations reporter for Modern Healthcare. I’m joined by safety and quality reporter Maria Castellucci. We’re looking at how the healthcare supply chain has fared during the COVID-19 pandemic and how that’s tied into employee burnout. We’ll try to do more of a free flowing back and forth. Thank you so much, Maria. I appreciate you joining me.

Maria Castellucci: Yes. Happy to be here, Alex.

Alex Kacik: All right. Well, let’s start on the supply chain side. We’ve both been reporting on how hospital administrators have had to turn to non-traditional sources and suppliers for certain protective equipment that has run short. I had one health system executive calling the surgical gown market the wild wild West, telling me about scenarios where hospitals would spend a lot of money to secure products, but have them diverted at customs for not passing quality standards. So what have you seen about the quality of PPE, as providers scrambled to find alternative sources?

Maria Castellucci: Yeah. Alex, I heard similar stories as well from my sources too. So I started reporting on this topic back in April. I initially became interested in it when at the time I was getting press releases in my inbox about tactics that health systems were using to reuse N95 respirator masks for their frontline workers as they treated the COVID-19 patients. This is a respirator mask that is required to be used when you’re interacting one-on-one with a COVID-19 patient.
    And similar to other personal protective equipment like gowns and gloves, N95 masks were designed to be used only one time. But because of severe shortages, health systems were saying that they were forced to have healthcare workers reuse these masks multiple times, and they began using cleaning tactics like ultraviolet light and heat to clean the masks so workers could use them again for their next shift.
    And when I wrote the story, being the safety and quality reporter, I immediately thought, well, how is this going to impact frontline caregivers? Is this safe to do? So I spoke with the patient safety organization, ECRI. They’re a not for profit group. And then physicians too, who had been tweeting about this and doing their own research. And what I heard is that they were really worried about the reuse of N95 masks. One physician that I spoke with actually called putting an N95 mask back on your face that’s already been used bio hazardous waste.
    So fast-forward to September, ECRI, that same patient safety organization had came out with research about the respirator masks, but now these were masks that were being manufactured in China, and they found that between 60% to 70% didn’t meet the US standards of filtering particles in the air. And ECRI was saying they got these got these masks to study from their health system members and so they assumed that some of them actually had their healthcare workers use these masks.
    So really what’s kind of emerged throughout these last nine months of reporting is that there’s definitely a trend forming during this pandemic, that health systems are making decisions about PPE that may not be safe for their workers.

Alex Kacik: What does that cause health system leaders to do when they’re looking to change their practices in terms of how they’re managing their supply chain and how they are going to adapt going forward, knowing that we’ve seen a pretty big wrench thrown in their traditional operations and what’s going to need to change going forward?

Maria Castellucci: Yeah. And I think this is where both of our beats are kind of overlapping, right? You’re typically writing about supply chain too. So, but I did a story a little bit about supply chain when I wrote about what were the biggest lessons learned? And at the time, we were six months into the pandemic. I definitely wanted supply chain to be part of the story. And so I spoke with Premiere and Vizient, who are pretty well-known consultants in the industry, helping health systems manage their supply chain.
  And a theme that definitely came up is that supply chain is never going to be the same after this pandemic. Before COVID-19, it was a pretty common practice between manufacturers and providers to not share a lot of information with each other, like how much supply the manufacturer had on hand, where the supplies were actually being stored and then providers not sharing with the manufacturers what they would need in case of an emergency. Not even just a pandemic, but emergency like a hurricane or a flood. What are the supplies that they need?
    So both Vizient and Premiere talked to me about how they expect going forward that contracts are going to have written in that there needs to be much more transparency from providers and manufacturers about their supply. For providers, what they need, and then manufacturers, what they have and what they can provide should an emergency occur.
    Additionally, something I wrote about was this practice called just-in-time inventory, which is actually something that’s pretty common for health systems that use lean principles, which is a quality management system. And in lean, just-in-time is you only basically have the supplies on your hand that you need. And I spoke with the CEO of Virginia Mason, Dr. Gary Caplin, they’re based in Washington, so they were among the first health system to get hit with COVID patients. He’s been a standing champion of lean. And he said that since COVID, they’re definitely rethinking that just-in-time inventory principle of lean because it didn’t serve them during COVID when they only had a limited amount of ventilators, a limited amount of N95 masks. So those kinds of things going forward, they’re going to think about having more of a supply, more of an excess of supply rather than just-in-time.
    So that’s kind of what I’ve gotten from my reporting. I know, Alex, if you have anything to add about this topic.

Alex Kacik: Definitely. The transparency, and I think is a common theme we’re hearing. The supply chain hasn’t been immune to these types of shortages. They’ve been plaguing the healthcare industry for some time now. And some of it’s related to where these supplies come from. A lot of times they’re overseas. A lot of Chinese manufacturers in this space and it’s been a cost efficiency game that’s been driving purchasing patterns there. And in that lean sentiment, minimal overhead has been a priority among health system executives who are trying to find ways to cut costs. And so a lot of times, there’ll be one or two producers overseas, and it’s harder for others to compete when the prices are so low. So you’re left with one or two producers, manufacturers, and then all it takes is one production snafu or quality hiccup to throw off an entire global supply chain.
    So I’m hearing a lot about trying to onshore or near-shore more production. So what that looks like is some health systems, a big one in the Midwest is looking at trying to develop a sustainable source of surgical gowns and they found an idled cheerleading manufacturing facility in Ohio. And they said, look, can we reuse your machines and infrastructure to produce reusable gowns. And they found raw materials, fabric supplier in South Carolina. And so they’re limited in terms of how much they can pump out every day, but they’re trying to expand. And they’re also trying to get buy in from other area health systems to say, look, if you invest in this, you can depend on a certain share of your annual allocation of these goods every year from this source. Granted, the hangup is it usually costs a premium and there’s been some back and forth on whether after this pandemic subsides, if there’ll be willing to pay that premium going forward, or they’ll revert more to that cost cutting mode and try to find the lowest cost supplier.
    So I’m curious, so how health systems, Maria, are factoring this, not only within their supply chain, but then they’re looking at their workforce, right, and understanding how these shortages of PPE impact their day-to-day operations. And a lot of times, this adds anxiety and stress to already stressful jobs. So what are you seeing in terms of that correlation between having adequate amount of supplies on hand and how that interplays with frontline workers, health and mental health specifically?

Maria Castellucci: So burnout and mental health has been a topic that I was interested even before COVID, but definitely during this pandemic, it’s become even more important for us to look at it as an issue. And I haven’t written a story specifically about this, but it’s something that consistently comes up, especially when I’m speaking with nurses and other frontline caregivers. The toll of having to reuse a mask that they’re not, a N95 respirator that they’re not a 100% sure is clean, is really mentally draining.

Alex Kacik: Maria, that makes me think of some health system executives who have downplayed burnout. They’ve told us that it isn’t as much of a deal as it’s made out to be, and that employees should do their jobs, buck up and just get on with it. So I’m curious, do you think the pandemic has changed the tune of some of those naysayers?

Maria Castellucci: So I wrote about this back in May. Like I said, this has always been a topic that I’ve been interested in. So when I wrote about it, it was really easy to get health systems to talk to me about this. This was something that they were really eager to talk about, what they were doing for their frontline workers during this pandemic.
    The American Nurses Association, I spoke with them when I was writing this initial story on it, and they’re worried that they’re going to see an exodus of nurses after this pandemic, depending on how the working conditions were for that nurse. They might say, “I’m done. I want to leave.” And then I think our colleague, Ginger, just recently wrote a really great story about anecdotal reports of healthcare workers leaving jobs in the hospital setting.
    So this is definitely something that has real impact for healthcare CEOs, if they don’t address this problem. And before the pandemic, we were worried about a shortage of nurses and physicians in the next 10 years. So it’s a major concern if we’re going to have early retirement or early exodus of nurses and other frontline caregivers like physicians to the workforce.

Alex Kacik: Well, to that point, staffing costs usually make up the most of hospital expenses in terms of their balance sheets. So recruitment and retention is always a big focus of theirs. And so I imagine, going forward, that they’ll be interested both from a financial and from a cultural standpoint, to try to retain as many folks as they can.

Maria Castellucci: And what I just to want to add, just to kind of bring it back to PPE and this correlation. So the health systems are doing these additional things that maybe they hadn’t done before, like free counseling and meals and support groups. But then there is still the very real fact that we’re in a surge right now, from a survey that I wrote about a couple of weeks ago, most hospitals and healthcare organizations are using this extended and reuse policy. We’re still seeing unions go on strike complaining of staffing problems. So there are efforts by health systems, by the employers, to make it a better workplace, but then there’s still the very real issue of not adequate PPE. And then in some cases, even poor staffing ratios that make working conditions really difficult.
    So I think that’s something that you and I are definitely going to be on the lookout for. What are the longterm implications of some of these policies that we’re seeing from healthcare organizations?

Alex Kacik: Definitely. Well, look forward to researching this more with you, Maria. Thank you so much, in the meantime, for taking the time with me to share your experience and your insight. Appreciate it.

Maria Castellucci: Yes. Thank you, Alex. This was fun.

Alex Kacik: All right. Thank you all for listening. We’ll have links in the show notes that feature Maria’s reporting, as well as links to subscribe to all of Modern Healthcare’s content. Thank you for listening and appreciate your support.

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