AABB23: Supply Chain Shortages Analyzed

Three speakers in Saturday’s session on “Lean Is the Enemy of Preparedness: Analysis of Contribution of Supply Chain Shortages Affecting Blood Supply for Transfusion Medicine,” considered whether Lean manufacturing principles work against the principles of preparedness. Recent supply chain failures have included the availability of collection bags for whole blood, collection kits for apheresis components, saline and calcium solutions, testing supplies and personal protective equipment.

Looking at Lean

Jed Gorlin, MD, MBA, vice president and medical director of Memorial Blood Centers in Minneapolis, opened the session with a recap of Lean manufacturing, the goals of which are highest quality, lowest cost and shortest lead times. The most relevant Lean principle in terms of supply chain shortages is that no action is taken by the manufacturer until the customer signals a need. In such a system, inventories are deliberately reduced.

Gorlin continued by describing the results of these market forces. Suppliers that are pushed to offer the lowest pricing will reduce their own costs by minimizing inventory, limiting the development of product improvements and cutting labor costs (via offshore manufacturing). These actions, in turn, set the stage for a magnified impact anytime the supply chain suffers a setback, such as bad weather, natural disaster, labor or civil unrest, regulatory limitations or a host of other occurrences.

So, what can be done about this problem? In his closing remarks, Gorlin offered several suggestions for action:

• Develop an infrastructure to track and record specific shortages.
• Use a shared-risk model to create a buffer inventory.
• Support alternative products or manufacturing techniques.
• Develop public/private partnerships to ensure progress.

  His final plea was to create an economic model that at least provides several months of stored inventory to cover temporary disruptions to supply.

Tools for Preparedness

John Hick, MD, medical director, Emergency Preparedness, Hennepin County Medical Center, Minneapolis, and lead editor for the ASPR TRACIE preparedness website discussed a strategic approach to disaster preparedness. Although no specific local incident has overwhelmed the blood supply, temporary logistic challenges have occurred with blood usage higher in the mass shooting events. In addition, mass shooting events have diverted patients to hospitals not usually caring for this level of trauma.

Hick has assisted both locally and nationally in helping to establish preparedness guides to various kinds of medical emergencies, from pandemics to terrorist events. He shared the blood product conservation table developed by experts with the Minnesota Department of Health (MDH Scarce Resource Cardset) as well as the DASH (disaster available supplies in hospitals) tool that helps hospitals plan what supplies to have in place for disasters. He estimates that many hospitals may not have enough blood on hand for mass shooting events and that regional plans are needed.

Making Progress

William Block, chief executive officer of Blood Centers of America (BCA), reported changing demographics in donor age groups. From 2012 to 2022, BCA’s robust data (almost 100 million records) showed a decline of -47% in donors under the age of 30 years. However, in 2022, the year-over-year change for this donor age group soared to +17.3%. BCA is expecting to build on this gain for 2023 totals.

The analysis of BCA’s data also showed a hopeful trend in donation growth. Specifically, for plateletpheresis and automated red cell procedures, a decline (-10% and -7%, respectively) in 2017 to 2020 was offset by an increase (18% and 10%, respectively) from 2020 to 2022. These data point to a mixed reality at present with the potential for improvement.

Block also shared progress on mitigation of supply chain risks. Using examples from BCA operations, he detailed several initiatives:

• Partnerships with multiple vendors. BCA worked with three companies to create a 30-day contingency supply of medical plastics used in blood collection (approximately 600 pallets of collection sets, kits, solutions, etc). This supply is available in addition to whatever individual BCA blood centers may stock at their own locations.
• Priority product guarantees with individual vendors. BCA made arrangements with individual vendors to ensure priority allocation for selected high-volume or hard-to-obtain items (eg, gloves, test tubes).
• Contracts specifically for emergency services. BCA has a contract for emergency fueling services anywhere in the nation during times of crisis.

Perhaps the most memorable image in his presentation was an image and quote from Dwight D. Eisenhower, “Planning is everything. The plan is nothing.”