Physician Leadership in Supply Chain

Now more important than ever

By Stacy A. Brethauer; Patrick A. Kenney, MD; Molly K. Zmuda, MHA3; Sidney M. Fletcher, MD4; Bruce L. Hall, MD, PhD, MBA5; Jimmy Chung, MD, MBA6

When COVID-19 began spreading across the United States in 2020, the role of physician leaders in supply chain at the nation’s hospitals accelerated in importance.

Physician leadership in supply chain helps bridge the gap to clinical staff through a model known as a clinically integrated supply chain. Clinical integration (CI) brings together two previously siloed (but equally important) entities within health care provider organizations: clinical care and resource management. A clinically-integrated supply chain helps establish a common vision and strategy for advancing quality through resource utilization, clarifying cost-effectiveness and justifications of new technology for clinical needs.

As the pandemic surged, providers quickly encountered supply constraints for routine commodities such as masks and gowns, forcing clinicians and managers to think differently and aggressively incorporate CI principles into practice.

To evaluate the roles of physician leaders in supply chain management and personal protective equipment use, in May 2020, Vizient, along with its Large IDN Supply Network (LISN) and its subgroup the Supply Chain Physician Collaboration (SCPC) reviewed daily pre/post COVID-19 PPE usage as well as conservation strategies, policies and protocols employed by 24 of the nation’s largest health systems represented in LISN. The 24 IDNs in the Vizient LISN represent more than 500 acute care facilities across the country.

Noting variation in quantitative survey results detailing policies, conservation strategies and daily PPE usage per COVID-19 patient, in June of 2020, a COVID-19 Workgroup of LISN SCPC designed and administered a qualitative survey of senior, system-level supply chain leaders across LISN on “COVID-19: Supply Chain Physician Collaboration.” Completed survey responses were compiled and analyzed regarding the culture and perceived importance of CI and physician leadership in supply chain.

The LISN SCPC methodology involved evaluating supply chain physician leaders’ roles, PPE use and related policies from March 28, 2020 to May 11, 2020, when COVID-19 cases began surging in the U.S.

Critical PPE use surges dramatically during crisis

Results from LISN’s first survey provide a perspective on the PPE resources that needed to be managed and leveraged during COVID-19’s first surge. The inquiry about PPE-related policies drew responses from 63% of the IDNs in LISN.

As expected, responses indicated a crisis was at hand. The average daily use for critical PPE items surged dramatically with the greatest increases in use of N95 masks (870%), face shields (1,055%) and goggles (1,168%) at these organizations. Among the health systems, the average number of COVID-19 positive patients who were inpatients at the time of our survey ranged from 55 to 1,700 with a median of 114 patients. A smaller number of COVID-19 persons under investigation (PUI) were admitted to these health systems with a median number of 34, a range of 2 to 100. The percentage of COVID-19 positive inpatients who were admitted to the intensive care unit ranged from 15% to 35% with an average of 28%.

At the time of LISN’s initial survey, the system with the largest number of patients was in the New York area where PPE availability was at critical levels at many facilities. Hospital systems with the lowest numbers of COVID patients were in the South and the Midwest, which had not seen an initial surge of patients yet experienced large increases in PPE use.

Repeating surveys in later months would likely have demonstrated a different distribution of PPE use by region based on the pattern of the pandemic’s spread. Also, some conservation policies were universally applied, while other policies were put in place only at some of the health systems, factors likely dependent on PPE inventory, the availability of re-sterilization systems for N95 masks, and the degree to which COVID-19 had affected health systems at the time of the survey.

Positives were gleaned from the survey results. We found that the pandemic has strengthened the CI culture in hospital systems and established a precedent for multidisciplinary teams working together for delivering high-value health care. Leveraging the experience of physician leadership will be crucial to CI’s success at these provider organizations as they continue to manage COVID-19 surges in their region.

Executive leadership: supply chain physicians very or extremely valuable during COVID

Results from the second survey focused on site culture of CI and physician leadership in the supply chain. Feedback from the survey, which drew responses from 71% of the IDNs, was also intended to understand roles. Sites were asked to describe the scope of the role as well as the title, tenure and background of the physician leader in the health system’s supply chain.

The responses indicate that these leaders’ activities were primarily focused on communication with supply chain, health system faculty, and executive leadership. As supplies of PPE and the nature of the crisis were changing daily, supply chain involvement was critical to ensure alignment of PPE inventory and rapidly changing policies. Supply chain physician leaders were expected to address policy development, COVID-19 projections, average daily PPE use, current PPE inventory, changes in practice, extended use or reuse of PPE (contingency or crisis standards), and applicability and safety of using substitutes. These responsibilities placed supply chain physician leaders in a unique position to add value and contribute by communicating critical information to key health system stakeholders.

During the pandemic, physician supply chain leaders were mostly seen as a valuable resource for clinical issues related to COVID-19 (77%) and for disseminating supply chain information to the faculty and clinical leadership (59%).

LISN member organizations highly valued the role of their supply chain physicians. Eighty-eight percent of the supply chain leaders reported that physician leadership was a very valuable or extremely valuable resource during COVID-19. Among the health system executive leadership, 82% saw the supply chain physician leader as a very valuable or extremely valuable asset during COVID-19.

The survey also asked about the role of the supply chain physician leader during the health system’s eventual emergence from the pandemic. Again, the roles of communication and clinical decision-making were felt to be most relevant.

Roughly a third of survey respondents had assigned a role of Medical Director of Supply Chain and 52.9% of the respondents have a physician with another administrative title who is responsible for supply chain activities. Physicians in these roles have a wide variety of medical and surgical specialties and clinical backgrounds and 64.7% have held their supply chain role for over three years while 65% have received salary support for their work in the supply chain.

Physician supply chain leaders were also perceived to be accessible: 71% of facilities utilized the physician leader 12 or more times per month.

The survey’s conclusion was that hospital support for a physician leader in the supply chain is “critical to developing a culture of clinical integration and resource stewardship in times of crisis.” The COVID-19 crisis has strengthened the clinical integration culture in these hospital systems and established a precedent for multidisciplinary teams working together to deliver high-value health care. 

How the role of supply chain physicians shifted during the crisis

In normal times, supply chain physician leaders focus on pricing, sourcing, utilization and variation at both the physical and enterprise level. But the pandemic rapidly altered the role of the supply chain physician leader, gaining in importance in the health systems.

In times of crisis such as COVID-19, the role of supply chain physician leaders shifted from leading culture change to communicating the urgent needs and limitations of supply chain resources to the faculty and health system leadership, and helping to solve related problems. LISN SCPC findings demonstrate that health systems can benefit from having a clinical leader in supply chain. To facilitate and manage changes in costs, utilization, sourcing, and variation, strong clinical leadership is required. An effective leader in this role can drive value in the system by balancing costs with outcomes, innovation, and the clinical mission.

Supply chain physicians poised to lead through post-pandemic recovery

As health systems emerge from the acute phase of COVID-19, the financial impact will continue well into 2021. The supply chain physician leader will take on an important role in these financial recovery efforts and their prominence during the crisis will have positioned them well to lead the process.

This initial study into the role of physician leaders in clinical supply integration revealed broad variations in title, specific responsibilities, and impact on organizations during a pandemic. As such, the optimal description of the supply chain physician leadership role, including whether ad hoc or permanent, advisory or executive, and operational or strategic, has not been well-established, unlike other traditional physician leadership positions.

In terms of studying the long-term value of standardizing physician leadership roles in supply chain, the skillsets and training required for these positions, and where they would fit in the organization’s leadership structure, further research is warranted.