How NYU Langone Weathered a Catastrophic Disruption to Its Supply Chain to Keep

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.”

Conservation: We Made the Most of What We Had

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

Warehousing: We Supplemented Just-in-Time Deliveries with Just-in-Case Reserves

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

Functionality: We Found the Right Gear for the Right Job

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

Exacting: We Kept Fraudulent Products Out of Our Inventory

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

Agility: When One Door Closed, We Found Another to Open

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

Resourcefulness: If We Couldn’t Find It, We…

Read More:How NYU Langone Weathered a Catastrophic Disruption to Its Supply Chain to Keep