I know many of you have heard it said that securing personal protective equipment (PPE) in wave one of the COVID-19 pandemic was like the Wild West. As someone who was in the thick of it, I can confirm it really was. I have worked in health care for more than 30 years and seen the system go through many evolutions, but I have never seen the kind of panic around supplies that occurred last spring.
I was new to UHN. I had been here just a matter of weeks when it all began. Each day, we would look at the Johns Hopkins University world map of COVID cases and see them spreading across the planet. “I wonder if it will come here?” I asked.
Looking back more than a year, that seems like an odd question. But, at the time, a pandemic seemed inconceivable. We had been through West Nile, H1N1, Zika and Ebola. Each time, we were able to prepare and protect against the newest viral threat.
On March 9 of last year at UHN, we adopted an incident management system structure, a standardized approach to emergency management in Ontario. I was in the role of chief of logistics. I did not even know where Stores, the place where we keep all of our excess medical supplies, was located.
Reviewing our organizational chart, I found the pair who knew everything about our supplies. Within a week, we had assembled a team, gathered data, assigned new roles to people and started understanding our PPE situation. I was overwhelmed by how creative, talented and committed the team was to do whatever we needed to do to keep our people safe. What drove all of us was the safety of our staff and patients.
After the outbreak of SARS in 2003, Ontario hospitals were encouraged to have pandemic stocks of equipment and supplies. But it was not mandated, and some hospitals chose not to carry those costs in inventory because the stockpiles were never used.
Over the previous decades, Ontario – and Canadian – hospitals matured their supply chain. Internal Stores Department and specific purchasing specialists gave way to shared services and common warehousing. Sophisticated procurement and evaluation teams spanned multiple hospitals, heavily involved clinical providers and drove to lowest price, standard quality and just-in-time delivery. We evaluated the use of reusables versus disposables in many of our supplies. Products were sourced internationally, especially Europe, the United States and China.
Everything was produced offshore and shipped to Canada. Little to no manufacturing was done here. Ontario hospitals became very LEAN.
When Canada became aware of the looming pandemic, much of the world was already in the throes of the clinical consequences of COVID-19. Not only did our supply chain dry up, our knowledge and capacity to source product was strained. We had not done this work in years and we quickly needed to once again become experts in masks, gowns, face shields and hand sanitizer.
My office was covered in mask samples because the quality being sold was well below what we were used to. We literally scoured the world for supplies that would meet our quality standards, and brought up testing teams to review each and every product. For most of 2020, we did this seven days a week and at all hours of the day. I recall Easter weekend having a call with suppliers in the Netherlands; Victoria Day it was Turkey; Labour Day the U.S. If you did not buy product when you found it, it would be gone – just like that.
Sorting through what were legitimate orders and what were fake orders became our team strength. We never did land the big order for 3M N95 masks we were chasing. We also never purchased supplies we could not use.
It was all about teams. Teams were built to follow every lead we received, which numbered hundreds every week. It was intense.
We recreated warehouse space and developed dashboards showing daily usage across all UHN sites and programs. Each week, teams manually counted supplies on the units and had coveted resources under lock and key. I recall one Sunday afternoon, an array of masks was spread out on the floor of my home office as I studied the various options, usage and possible substitutions. We started refilling disposable hand sanitizer containers using bulk product we secured from local suppliers. Creative teams figured out how to build small production lines on site. It was a free-for-all. No options were overlooked, no ideas discounted as we did everything we could to keep our staff and patients safe.
Here we are a year later, and much has changed. Our supply of PPE is stable. Global production levels have increased to meet the new demand and quality standards are returning to the marketplace with more choices for buyers. We now have an off-site warehouse for our “just-in-case” inventory, carrying up to a year’s worth of PPE on site.
Also key is increased domestic supply. The Ontario and federal governments announced in August an agreement that will see 3M produce up to 100 million N95 masks a year at its plant in Brockville, Ont., helping secure Canadian PPE self-sufficiency. Other homegrown production of such things as nasal swab kits, gowns and face shields are happening in Canada. These measures should help us avoid another Wild West scenario as we saw early in the pandemic.
Personally, I got to know many people across the organization very quickly. Out of necessity, our PPE teams connected across UHN sites and across the province. We were fast. We were always just slightly ahead of the pack. We managed to avoid any critical shortages in PPE. It felt like we were part of the Amazing Race, moving swiftly from one task to another, the clock always ticking, constantly on the lookout for the competition.
What the past year has taught me is that there really is nothing teams cannot accomplish when we put our collective minds together and focus on what really matters.
Rebecca Repa is the executive vice-president clinical support and performance at the University Health Network.