How NYU Langone Weathered a Catastrophic Disruption to Its Supply Chain to Keep Staff & Patients Safe

Patient Care

NYU Langone Health Magazine, NYU Langone Health Magazine Fall 2020

To ensure that PPE—like this N95 respirator worn by Nina Sacks, RN—met quality and safety standards, products are inspected by the Departments of Infection Prevention and Control and Environmental Health and Safety before they were distributed.

Photo: Jonathan Kozowyk

By mid-January 2020, as the world learned that a mysterious virus was starting to overwhelm Wuhan, China, NYU Langone Health’s leadership recognized that the threat was double-barreled. Eventually, the virus might well arrive in New York City, and if it did, sufficient quantities of the personal protective equipment, or PPE, needed to shield patients and frontline workers, might not. With 70 percent of the world’s PPE manufactured in Wuhan, critical shortages resulting from disruptions or delays could prove just as dangerous as the virus itself.

The challenge of managing an inventory of PPE falls to Supply Chain Management, whose staff of more than 400 has been called upon to source, procure, distribute, and replenish ever-more-scarce items at an ever-faster rate. Jacquelyn Marcus, vice president for Supply Chain Management, who joined NYU Langone in 2019, came with extensive experience in consumer-packaged goods, where diversification of sources minimizes service disruptions. She soon learned, however, that for decades hospitals have used a very different model. Rather than stockpiling supplies, they tend to order merchandise through a single distributor for just-in-time deliveries and immediate use.

Coronavirus disease (COVID-19) has turned that model upside down virtually overnight, creating an insatiable global demand for clinical body armor such as N95 respirators, face shields, and isolation gowns. Ordinarily, Supply Chain purchases 99.8 percent of its PPE through 1 medical distributor. But the pandemic has imposed tight restrictions on hospitals based on their historical usage of supplies. With its allocation from the distributor down to 9.25 percent last spring, Supply Chain had to locate other sources. Fast. “There was no roadmap for this,” says Marcus.

Recognizing as early as January that supply disruptions would jeopardize patient and staff safety, Daniel J. Widawsky, executive vice president and vice dean, chief financial officer, had one key question for Mark Pollard, vice president for hospital operations: “What are the top 12 things that will be in highest demand?” Clinical leaders identified such essentials as exam gloves, intravenous (IV) fluids, catheters, and disinfectant wipes. “Without wipes, for instance, clinical spaces can’t function,” notes Marcus. “We looked at about 120 different items, and we made some proactive purchases that put us in a much better position.”

As case counts surged last spring, Marcus and her team had to find suppliers that met not only U.S. Food and Drug Administration (FDA) requirements, but also NYU Langone’s quality specifications, as substandard and counterfeit PPE began to flood the market. “We pulled products from every corner of the Earth,” says Widawsky. “We were always one step ahead, always looking around the corner. It came down to agility, execution, and muscle.” By choosing vendors strategically and spreading out orders, Marcus explains, Supply Chain “didn’t have to put all of its eggs in one basket.” Before products were distributed, they were inspected by Infection Prevention and Control and Environmental Health and Safety. “We weren’t going to compromise safety,” says Marcus.

Many of the lessons learned are guiding Supply Chain’s management team as they reshape their long-term strategy. “We’ve worked really hard to find factories outside of China,” says Marcus, “so our landscape now includes multiple sources.” Partnering with Real Estate Development and Facilities, Supply Chain has tripled its warehouse capacity to 150,000 square feet, enabling 3 to 6 months of critical supplies to be stockpiled. If need be, PPE can be transported to our hospitals the same day it’s needed. All told, Supply Chain received more than 1,500 leads for products, but only 34 made the cut. “We had no fraudulent supplies and zero quality or safety issues,” says Marcus, “which is something we’re all really proud of.”

Deltaplus Respiratory Mask. Before shortages, 3M’s 1860 respirator was one of the standard N95 models provided to NYU Langone clinicians. As of June 2020, it was unavailable as China stopped exporting the raw materials required for its manufacture. Amid fierce worldwide competition, buyers sometimes had only an hour to decide whether to place a million-dollar order. They learned to listen between the lines. “Buying is an art as much as a science,” explains Marcus. “You just get a sense about someone by how they answer your questions.”

Photo: Devon Jarvis

Sensicare Ice Blue Powder-Free Nitrile Exam Gloves. Without extensive warehousing facilities to stockpile PPE and other supplies, NYU Langone has traditionally relied on just-in-time deliveries. Even items used in large quantities, such as disposable nitrile exam gloves (NYU Langone orders 109,154,760 pairs annually) did not pose a storage problem because they were quickly put to use. But with the worldwide pipeline for hospital supplies paralyzed, NYU Langone adopted a new strategy. “The way hospitals acquire supplies hasn’t changed in 30 or 40 years,” says Widawsky. “Going forward, we’re doing things differently.”

Photo: Devon Jarvis

Maxair Controlled Air-Purifying Respirator. By the time COVID-19 reached New York City, even those who still had many questions about the virus knew two things for sure: it was highly contagious and potentially lethal. For high-risk procedures that spray infectious droplets, clinicians would need maximum protection. The helmet-like Maxair respirator—used by some in place of an N95 mask before shaving became mandatory for those with beards—fit the bill. By making facial expressions visible, the device helps clinicians provide much needed comfort to patients and enables translators to communicate more easily. The controlled air-purifying respirator was one of the toughest items to acquire, notes Marcus. “Although we used a small number of these respirators, they proved to be a helpful protective device for certain staff.”

Photo: Devon Jarvis

3M Particulate Respirator 9210. When the FDA cleared industrial respirators like the 3M Particulate Respirator 9210 for healthcare use on March 2, 2020, it expanded the number of N95s that became available. But other masks that were subpar or downright fraudulent had already started to populate the international market. “We had a lot of offers that didn’t work,” explains Widawsky. “We canceled a ton of orders.” To screen out unacceptable products, Supply Chain established a rigorous vetting process, working closely with the departments of Infection Prevention and Control and Environmental Health and Safety. “They were amazing,” says Marcus. “We never distributed anything that wasn’t 100 percent inspected.”

Photo: Devon Jarvis

3M Particulate Respirator 8210. The more intense worldwide competition for PPE became, the more nimble Supply Chain had to become. For example, when the raw materials from China used in many N95 respirators became unavailable, NYU Langone turned to 3M’s 8210, an industrial respirator approved by the FDA for use in healthcare that could be manufactured quickly in America. “Things were tight and flying off the shelf,” says Marcus. “We were making decisions minute by minute, around the clock.” Action was swift, to be sure, but never hasty.

Photo: Devon Jarvis

DIY Face Shields. At the height of the crisis, clinicians caring for patients with COVID-19 used between 20,000 and 30,000 face shields each day, so Supply Chain had to rely on multiple manufacturers worldwide. Even with such aggressive efforts, “we weren’t getting face shields in fast enough,” recalls Marcus. “So we thought, ‘Wouldn’t it be great if we started making them ourselves?’” Many members of the NYU Langone community stepped forward, fashioning homemade shields. Students from NYU Grossman School of Medicine, for example, turned out some 30,000 shields, assembled from off-the-shelf parts. This do-it-yourself spirit also sprang up as volunteers improvised other items in critically short supply, notably hand sanitizer and COVID-19 testing media.

Photo: Devon Jarvis

Halyard Fluidshield Particulate Respirator 46867. In January 2020, Supply Chain wasted no time ascertaining the hospitals’ supply needs as the outbreak in Wuhan began to hinder the city’s PPE factories. “We said to our clinical leaders, ‘What would be the top things you would need to do your job?’” recalls Marcus. They identified such essentials as exam gloves, IV fluids, catheters, and disinfectant wipes. Michael S. Phillips, MD, chief hospital epidemiologist, added N95 respirators to the list because, as an infectious disease specialist, he knew they would play a vital role in keeping clinicians safe should the virus hit New York City. When Supply Chain ordered a large shipment before allocations were restricted, Richard Kraft, director of logistics, inventory, and distribution, thought to himself, “We’re more than set.” But in the coming weeks, usage of N95s increased to 26 times the norm.

Photo: Devon Jarvis

Isolation Gown. Supply Chain was integral to NYU Langone’s strategy for preparing for COVID-19, explains Fritz François, MD, chief medical officer and patient safety officer. “We met with the team every day to assess our workflows, our current level of PPE, and our anticipated burn rate,” he says. “Burn” is an apt word. At the peak of the outbreak, between 20,000 and 25,000 isolation gowns were distributed to NYU Langone’s hospitals on a daily basis. “People were truly thinking outside the box, trying to anticipate the next need so that we didn’t skip a beat,” recalls Kraft. The result, says Widawsky, was that “decisions were being made in hours and days, not weeks or months. Everybody was reachable 24/7.”

Photo: Devon Jarvis

3M Earloop Procedure Face Mask 1820. Several weeks into the outbreak Supply Chain ran critically short of earloop isolation masks, as they were being distributed to all employees throughout the hospitals who did not provide direct patient care. The shortage didn’t last long, however, because Jacob Navarro, director of freight management, expedited domestic and international shipments of the masks to NYU Langone. Navarro is one of several staff with experience outside the healthcare industry whom Marcus had recently hired to build a best-in-class supply chain operation. Navarro’s expertise in international transportation logistics was particularly valuable when overseas transportation routes were disrupted. He coordinated third-party vendors to facilitate shipments of PPE on chartered flights from Shanghai, China. “The combination of staff with healthcare expertise and those with experience in other industries really enabled us to navigate this crisis,” says Marcus.

Photo: Devon Jarvis

Omni Face Shield. For clinicians who provide direct care to patients with COVID-19, a face shield is as vital a piece of equipment as an N95 respirator because it protects the eyes from droplet spray. But face shields provide an additional benefit in that they also guard N95 masks against contamination. By serving as one item of PPE that protects another, face shields came to play a key role in Supply Chain’s conservation efforts. Though face shields are designed to be disposable, they were carefully preserved. Wiped with a disinfectant after each use, they could be worn multiple times before their plastic shields became cloudy. “As a society, we’ve gotten very used to disposing of things,” says Tommy Psoras, product manager for Supply Chain Management, “but in reality you don’t always need to.”

Photo: Devon Jarvis

3M Particulate Respirator 1860. Before shortages, 3M’s 1860 respirator was one of the standard N95 models provided to NYU Langone clinicians. As of June 2020, it was unavailable as China stopped exporting the raw materials required for its manufacture. Amid fierce worldwide competition, buyers sometimes had only an hour to decide whether to place a million-dollar order. They learned to listen between the lines. “Buying is an art as much as a science,” explains Marcus. “You just get a sense about someone by how they answer your questions.”

Photo: Devon Jarvis

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