Lessons Learned in Advancing Supply Chain Resilience in Canada’s Health Sector

Dr. Anne Snowdon, BScN, MSc, PhD, FAAN

Where the CoP Started (2022)

Impact of the Pandemic

• 2,632,916 cases of COVID (reported)

• 150,546 cases of COVID case among health workers

• 46 deaths of health workers (9 jurisdictions)

Deaths in LTC were higher in Canada than the OECD average and most other countries.

Impact on Long Term Care

Global Comparison

3% of COVID Cases in Canada were residents of Long-Term Care

43% of COVID Deaths were residents in Long Term Care

Health Workforce Impact

Persistent Global Shortages

• Betrayal of health system leadership

▪ Failure to protect

▪ Compliance focused

▪ Massive shortages of PPE in communities

▪ Primary care – financial hardship

• Moral Distress: loss of autonomy to make decisions; inability to offer “best” care to patients

▪ Are the “cold face” of explaining to patients why care is not available, or ideal due to supply shortages

• Over 50% physicians report symptoms of burnout, 30-40% consider leaving job

• There is not a shortage of workforce, but a shortage of workforce willing to work in these work environments (Aiken et al, 2024)

Supply Chain in Canada’s Health Systems

• Diverse array of supply chain teams, organizations, leadership mandates

• Multiple stakeholders; complex Systems

▪ Federal, provincial/territorial agencies or teams (ex. PHSA; Supply Ontario)

▪ GPO’s: contracting, procurement

▪ Pharmacies, Retail: consumer facing

▪ Health system teams (e.g. hospitals)

• Profoundly limited supply chain capacity in nonhospital settings, and no data

▪ Home care

▪ Community care

▪ Long term care

• Patient and workforce focus unclear

What We are Learning in This Community of Practice

• Deep Knowledge and Expertise within stakeholder groups

▪ Industry

▪ GPO’s

▪ Supply Chain Organizations

▪ Government agencies

▪ Public Health

▪ Health Systems

• Yet, Connectivity between these stakeholders very limited

The “Black Hole” of Silos

• Committees working on shortages

• Academic teams defining critical product lists

• Government agencies define pricing, product approval

• Clinician prescription patterns fuel demand (ex. Ozempic)

• Consumers demanding products, navigating system to access care

• Reactive approach shortages organized by product type

• “Planning for the war we just fought, start planning for the next war which will be different”

• Slipping back to the way we have always done things.

Jurisdictional Culture

Absence of Collaboration and Transparency

Federal/Provincial/Territorial Culture (FPT)

Lack of Trust, Protectionism

Federal agencies

Operate independently of other jurisdictions

Provinces

“We won’t participate if Feds are leading this”

Defensive stance

“We already do that”

Little to no data sharing

Decisions are not data driven

Absence of Person Centred Focus

The endpoint of health supply chain is a person’s life

Impact of Supply shortages on the lives of Canadians is unknown.

ex. shortage of chemotherapy drugs; shortage of imaging contrast dye for diagnostic testing.

Supply Chain Teams prioritize sourcing, procurement, distribution, managing shortages with no access to clinical data on patient outcomes.

Health Workforce has no knowledge of shortages, no communication: Moral Distress, System Betrayal

Phase One: Create the CoP (Y1)

• Significant expertise and depth of knowledge among stakeholders in Canada.

• Limited knowledge sharing or awareness between stakeholder groups.

• Outcome of Year One:

▪ Multi-stakeholder dialogue did not exist.

▪ “Discovery” prevalent

What We are Learning: Year 3 Underway

Phase Two: Co-design of Supply Resilience solutions (Y2-3)

Phase Three: Pilot Test, Validate Solutions (Y4-5)

• Six Workgroups advancing solution strategies.

• Outcomes so far:

• Limitations of jurisdictional cultures and boundaries

• Emerging Solutions for each workgroup

• Feasibility

• Define scalable pathways to adoption of solutions

• Identify current infrastructure, organizations, supply chain systems able to validate and test solutions

• Identify Leadership strategy to advance adoption of supply resilience solutions

multi-jurisdictional collaboration strategy End-to-end digital supply chain mapping. Connecting health workforce and patients.

The Way Forward: Transparency > Collaboration > Trust

manufacturing capacity and capability tool

communication strategy to mobilize health workforce expertise in supply management

Health Supply Chain Surveillance System

Health

Workforce

Stakeholder Engagement Strategy to Enable Collaboration

Government

Patients/Citizens

Health System Leaders; Supply Chain Teams, Organizations

Industry (e.g. manufacturers, distributors, pharmacy, retail)

Key Features

• Person Centric Goals: health and safety of people (patients, citizens, workforce)

• Inclusive of All key stakeholder groups

• Builds on Existing Strengths: Integrates (engages) existing teams, strategies, jurisdictions to co-design solutions needed

Leadership and Policy Workgroup

Federal-Provincial-Territorial Committee on Drug and Medical Device Shortages

Provincial/Territorial Emergency Management Committee

Provincial/Territorial Vaccine Management Committee

Multi-Jurisdiction Roundtable:

• Enable knowledge sharing to build transparency

• Mobilize expertise and capacity to manage shortages

• Create Visibility, Transparency of supply management

Effective Communication and collaboration among cross-functional teams

Informed decisions on managing key aspects of supply disruption –proactive, risk mitigation focused

Systems approach to Customization, reporting, real time information and data to inform stakeholder decisions

Data driven

Demand and Supply

Capacity management

Integrated System Approach

Inclusive Stakeholder Engagement

Procurement -

Sourcing Strategies (buffer stock, supplier diversity, policy tools)

Risk management: patients, workforce

External forces:

Geopolitical, Climate

Events

Cybersecurity

Surveillance of alert signals –strong, weak

Production: Capacity, agility, quality, market forces

Domestic Supplier Platform

Goal: Advance supply resilience by strengthening domestic supplier capacity and sustainability

Searchable Supplier Data Platform

• AI driven data platform of domestic suppliers

• Product manufacturing capacity

• Certifications, quality data

• Ownership status

• Location within Canadian borders

Health Workforce Engagement

Communications Strategy for the Clinician Workforce

• Create robust and transparent communication with clinicians.

• Engage clinicians to define alternative products or practices.

• Identify at-risk patient populations

• Advance clinical practice protocols and plans to support a coordinated strategy to manage disruptions.

Supply Chain Security

Proactive Health Supply Chain Surveillance System

• Inventory and demand surveillance system to mitigate risk of supply disruptions or shift in demand.

• Proactive management of early signals of supply disruption (strong and weak)

• Define critical data points and data sharing strategy required to inform decisions and communicate to key stakeholders.

Green Phase

No indication of disruption or demand surge.

Proactive Surveillance System for Supply Capacity

Recovery Phase

Sourcing strategies replenish inventory levels. Monitoring of inventory levels inform transition from Red to Amber and return to Green Phase.

Amber Phase

Inventory levels are low, measures to conserve focus on risk and equity. Alternative products, sources identified.

Red Phase

Urgent or emergent shortage unable to meet demand. Measures prioritizing highest risk populations and equitable management.

Sourcing & Procurement

Supply Sourcing to Support Resilience

• Define emerging models of sourcing and procurement across jurisdictions.

• Identify gaps, risks, opportunities for learning, across jurisdictions to advance sourcing and procurement that offers supply resilience.

• Explore options for reducing variability across jurisdictions, and support collaboration.

Digital Supply Chain

Map End-to-End Digital Supply Chain Features

• Define the critical features of an end-to-end digital health supply chain.

• Inform health system decision makers on where and how to invest in digitally enabled supply chain.

• Enable transparency, and flow to data to support proactive surveillance, inform decisions in patient care settings, manage risk proactively.

Transparency and Visibility

Mobilize and Share knowledge, expertise, capacity, and data to inform decisions.

Engage Clinicians and Patients to inform decisions on alternatives during shortages.

What We Must Achieve

Inclusive Collaboration

Enable Knowledge sharing

Engage all Stakeholder Groups, not just some

Mobilize knowledge sharing, expertise, data to achieve coordination or supply management

Build Trust

Move beyond limitations of jurisdiction culture: “we already do that”; ”we can’t do that if ‘they’ are involved”; “That is not what we do”

Prioritize the health of patients, and safety of the workforce.

Coordinate Proactive management of shortages

“Fate will not create the new normal, our choices will”

(Berwick, 2020)

Advancing supply chain resilience is about people

* the Health of every Canadian

* the Health and sustainability of the health Workforce

What do we need to better understand?

What are we missing?

What would you prioritize to advance first?