Written by John Ferrari | Photographed by Vincent Rios
Think of everything you use at Torrance Memorial. Everything, every day,
from scalpels to swabs, caps to booties. All that stuff is made somewhere—often
thousands of miles away—and makes it into your hands, at your fingertips,
when and where you need it. That’s the magic of Torrance Memorial’s
supply chain … but it’s not magic. It’s the work of
purchasing agents, warehouse managers and teams of people delivering and
stocking everything, every day.
“That’s our mission statement,” explains director of
supply chain operations Phil Cutler. “To ensure we have the right
goods at the right time, for the right cost, through the right channel.”
For someone looking at the supply chain process from the end user’s
perspective, it seems seamless. “That’s the view, I think,
people understand of supply chains, but it’s so much more complex
than that,” Cutler explains.
It involves anticipating the hospital’s needs weeks or months in
advance, sourcing supplies—fully approved for medical use and at
the best price—and coordinating their delivery, storage and finally
repackaging for delivery and use by individual units at the medical center.
That includes everything the hospital uses, apart from blood, radionuclides,
food, pharmacy stock and some materials used by Environmental Services.
Now think of that chain breaking: every link—from the factories where
items are made through sea, air, rail and truck transport, right to the
hospital warehouse’s receiving docks—is impacted. Think of
every hospital in the U.S. and around the world clamoring for the same
PPE, as much as they can get, all at once. And think of what happens if
those supplies don’t make it to the hospital—because it’s
a matter of life and death.
Think of February 2020. From their computer screens, Cutler and the hospital’s
purchasing agents look out over Torrance Memorial’s supply chain
as it stretches from the hospital to wholesalers and distributors, and
ultimately to manufacturers that may be in the next state or across the
Pacific. It’s their job to ensure supplies are ordered and scheduled
for delivery. When the COVID-19 pandemic reached Southern California,
they saw the hospital’s supply chain tighten until no slack was
left. They saw links starting to weaken, but they knew they had to keep
the hospital supplied.
“We’re sitting in planning meetings, anticipating what we’re
going to need,” Cutler remembers. “Thousands of things. We’re
in the same boat as every other hospital, every other business, every
other country, every other person.”
Torrance Memorial’s supply chain often begins in China, which was
grappling with the pandemic. Not only Torrance Memorial but every other
hospital and the wholesalers from which they purchase supplies suddenly
had to confront unprecedented issues moving supplies out of China. Everyone
involved in the supply chain worked to overcome problems and keep hospitals
throughout the United States equipped to care for patients.
For example, Cutler shares, “Surgical-grade N95 masks were one of
the most quickly disrupted items. But only 10% of the global N95 mask
production are manufactured for medical use; 90% are industrial grade.
An FDA emergency use authorization allowed us to use industrial N95 masks
in nonprocedural situations.”
Evaluating and approving items that could be used in place of regular supplies
(known as substitute items) became one of the key methods that kept Torrance
Memorial stocked throughout the pandemic. Cutler explains the process:
“Typically, we evaluate the supplier, and once we’ve determined
this might be a viable product, we request medical-grade samples. We put
those in front of a medical analysis team of practitioners, clinical education
folks and others. Normally a process like this for a new product takes
a month or two at least, but during the pandemic a decision may have to
be made in 24 hours or the opportunity would be gone. In many cases we
couldn’t even get a sample. We might have to determine an initial
trial buy by looking at photos, and substandard items were a huge problem.
These decisions needed to be made quickly.”
Cutler marvels that sometimes they were competing with other countries,
when the entire country would buy items in massive quantities from a manufacturer.
Thinking small—and very outside the box—gave Cutler an advantage.
Case in point: protective goggles. Essential PPE, they were hard to source.
One evening after another long day—and every day was a long day,
Cutler says—he noticed his son using goggles from a children’s
science set and realized the manufacturer probably manufactured adult
goggles too. Contacting a family connection in educational materials,
he was able to get several hundred pairs of goggles air-freighted from China.
Those goggles—and just about everything else—arrive at Torrance
Memorial’s warehouse, overseen by warehouse and receiving manager
Tony Bonilla. “Receiving supplies and planning to deliver—that’s
a normal day for us,” he says. “We get regular deliveries
for every single department. The amount is big, but we can handle it.”
Every day Torrance Memorial’s warehouse personnel deliver orders
by the pallet-load and by the individual box to every single department
at the hospital. And even on a normal day, there are special orders and
emergency requests to handle.
The pandemic changed everything at the warehouse, Bonilla says. In addition
to receiving deliveries, he and warehouse personnel drove throughout Southern
California to collect and bring back lifesaving supplies and equipment—like
ventilators—Cutler had sourced for the hospital. It was a challenge,
he says, to stay on top of everything and keep organized. Today the entire
warehouse, including Bonilla’s office, is full to the roofline with
supplies and donations.
Some supplies are delivered directly to hospital units. Others arrive at
Central Services, where manager Chance Krutsinger and his team package
and prep them for final delivery. “We supply all of the nursing
floors with supplies,” he explains. “We’re the face
of where their supplies are coming from. We check each nursing unit and
restock up to par level. That is our main focus during the day: restocking
their supply from our supply in the basement. We work with the managers
of the departments to adjust, taking their requests and adjusting par
levels accordingly.”
When the pandemic hit, demand spiked for PPE immediately. “People
wanted to be protected from head to toe,” Krutsinger recalls, from
face shields to shoe covers. At the same time, the normal sources of those
supplies were disrupted and overwhelmed. “That was our biggest challenge
when it came to our day-to-day ops: A lot of supplies weren’t coming
in. We weren’t able to restock units to their normal levels.”
Deciding where to deliver items was one of the big challenges for Krutsinger.
“Everyone felt they needed supplies the most. We were trying to
get the point across we had a limited supply, and we were trying to get
supplies to the areas where they were needed most—to the areas at
highest risk. We worked a lot with Infection Prevention and administration
to determine that. We can’t make that determination in Central Supply
because we’re not clinical. Based on what we had available and what
the department normally uses, we rationed what we had. We needed to stretch
our supply.”
While some of the shortages were predictable, others were surprising—certain
IV sets, for example. “Nurses got creative running IV lines farther
than usual so they didn’t have to enter a COVID-19 patient’s
room for normal adjustments,” Krutsinger explains. “That minimized
the number of times they needed to enter rooms, which saved PPE by reducing
the use of gowns and masks.”
Over the course of the last year, Krutsinger, Bonilla, Cutler—everyone
in Torrance Memorial’s supply chain—became so good at keeping
the hospital stocked that by the last surge in cases, “We had everything
we needed in far greater quantities than normal,” Cutler says. “By
that time, we weren’t dealing with PPE but with items needed for
next the stage: vaccinations.”
“I’m proud of our staff,” Krutsinger says. “They
work hard day in and day out.” There’s a good reason for that,
during the pandemic and every day. “These things are important,”
Bonilla explains. “They’re what keeps the hospital going.
Having a box in my hand—it’s like a life.”
