Is COVID A Turning Point For Sustainability In Hospital Supply Chains?

Scarcity has, in many ways, defined the COVID-19 experience in the U.S., from shortages in personal protective equipment to ICU ventilators and hospital capacity, to COVID test kits, to drugs like Remdesivir in hard-hit states. These shortages have added impetus and new dimensions to existing conversations around health care supply chains, some of which had originally stemmed from a climate-conscious, sustainability lens. As suggestions are put forth to re-evaluate hospital supply chain design, from procurement to waste disposal, this momentum can be harnessed to achieve the dual aims of bolstering pandemic preparedness and improving sustainability in the health care sector.

COVID-19 illustrates the need for greater resiliency within health care’s supply chain. Dependence on expansive global networks for raw materials, manufacture, and distribution of critical health care supplies created a pathway prone to breakdown during a worldwide pandemic. Of note, this pathway is similarly vulnerable to the climate crisis, as worsening natural disasters can disrupt critical junctures of the U.S. supply chain.

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In the context of COVID, some experts have advocated for strengthening supply chain resiliency by increasing local sourcing, manufacture, & distribution. Ohio State’s medical center, for example, reduced susceptibility to supply chain disruption by manufacturing virus liquid test kits in-house. The appeal of onshoring or reshoring also includes the potential to reduce health care’s contribution to climate change. An analysis by Healthcare Without Harm found that 64 percent of greenhouse gas emissions from the U.S. health care sector are from the “supply chain, through the production, transport, and disposal of goods and services;” consolidating this process to remove transportation steps and improve environmental standards could make a significant impact on health care’s carbon footprint. Critics of onshoring as a cure-all point to practical considerations around the associated timeframe and costs, and instead propose “stress testing” to evaluate weak points along existing chains.

An effective solution to increase resilience will likely include a combination of approaches. This is exemplified by various health care systems’ pandemic responses; NYU Langone Health expanded to utilize multiple suppliers with diverse raw material sources while also building up its own in-house safety stock. New York’s governor called on state-wide hospitals to function as a single supply-sharing system, and Penn Medicine practiced similar system-wide resource pooling. Moving still farther beyond these regional collaborations by incentivizing local manufacture can play a role in both mitigating supply chain disruption and reducing health care’s contribution to climate change.

In line with reducing emissions to improve public health, hospitals should opt for low-carbon procurement strategies when reassessing suppliers. Procurement offices may be guided by resources from the World Bank and the UN’s “Greening the Blue” program, which include recommendations to promote more sustainable practices by existing suppliers and to identify sustainable suppliers to support. Practice Greenhealth has compiled the Sustainable Procurement Digest, a directory of hundreds of approved vendors for products and services relevant to health care systems. Although scoring vendors by sustainability criteria is not the norm for most U.S. hospitals, success stories like Kaiser Permanente’s Environmentally Preferable Purchasing Standard reveal the potential for fiscal and environmental savings.

Health care systems can also prepare for future crises and become more sustainable by prioritizing resource conservation and waste reduction. Third-party single-use device reprocessors represent an underutilized opportunity to conserve supplies by safely, through FDA-approved processes, disinfecting medical instruments originally designated for single use and disposal. In times of unexpectedly high resource utilization, domestic commercial or in-house reprocessing can circumvent the time it would take to replenish medical stocks anew along global supply chains. In more stable times, commercial reprocessors can still accommodate “just in time” inventory strategies for certain items and provide cost-savings for hospitals. Particularly for more complex devices requiring significant energy to manufacture, reprocessing can make a positive impact on health care landfill waste and associated emissions.

Automation, both in terms of hospital inventory tracking and demand forecasting, is an additional avenue with unrealized potential—a recent survey found that low uptake of inventory technology and limited end-to-end supply chain visualization are roadblocks to improved resource management. Industry experts have recommended increased automation as an important step post-COVID to better respond to shifting trends in resource utilization. Yale New Haven Health, for example, implemented a patient dashboard tracking confirmed or suspected COVID cases to anticipate needs across the health system. These technologies can not only help prepare for outbreak-fueled resource demand, but they can assist hospitals in reducing the substantial amount of needless waste comprised of inappropriate product sizing and expired hospital inventory, again improving environmental sustainability.

The COVID pandemic has accelerated conversations and trends around health care resource management that have positive implications for decreasing health care’s outsized carbon footprint. Looking to the future means more than just demand forecasting—it requires the foresight to make intentional changes to hospital supply chain and procurement practices that mitigate the threats of both future disease and escalating climate change.

Genevieve Silva is a medical student. Cassandra Thiel is an assistant professor, NYU Langone Health’s Departments of Population Health and Ophthalmology. The opinions expressed herein do not reflect those of their affiliated academic institutions or hospital systems.

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