Facingdisruption:Learningfromthehealthcare supplychainresponsesinBritishColumbia duringtheCOVID-19pandemic
HealthcareManagementForum 2022,Vol.35(2)80–85 ©2022TheCanadianCollegeof HealthLeaders.Allrightsreserved.
Articlereuseguidelines: sagepub.com/journals-permissions DOI:10.1177/08404704211058968 journals.sagepub.com/home/hmf
Abstract
ThehealthcaresupplychaincrisissurroundingPersonalProtectiveEquipment(PPE)duringtheonsetoftheCOVID-19pandemic presenteduniqueandcomplexchallengesinachievingtheprimaryaimofsupplychainmanagement,thatis,deliveringtheright amountoftherightsuppliestotherightpeopleattherighttime.Thisarticledescribesthekey findingsfromacasestudyonPPE supplychainresponsestotheCOVID-19pandemicinBritishColumbia(BC).Ithighlightsasetofconstructiveresponse mechanismstopotentialcrisesalonghealthcaresupplychain.Effectiveandtrustedleadership,aunityofpurpose,integratedand robustdigitalinfrastructureandcapabilities,consistentlearning,resiliencebuilding,andenvironmentalsensingforreliable intelligencewerefoundtobeessentialforpreparing,forcontaining,andmitigatingthecrisisasitevolvedacrossvarious phasesofcrisismanagement.
Introduction
TheBritishColombia(BC)healthcaresystemhas fiveregional healthauthorities,oneprovincialservicehealthauthorityaswell asaFirstNationsHealthAuthority,allofwhichreporttothe MinistryofHealth.OnMarch17,2020,BCdeclaredthe COVID-19publichealthemergencyandaprovincialstateof emergency.1,2 Thesedeclarationsacknowledgedthedisruption andchallengesfacedbytheprovinceandenabledtheuseof emergencypowersandaccesstoresourceassetsbythePublic HealthOfficer(PHO),assetoutintheEmergencyProgramAct andPublicHealthAct.AnumberofPHOorderscameinto effectimmediately,includingthesuspensionofin-class learning,socialdistancingrequirementsforrestaurantsand cafes,travelrestrictionsandisolationrequirements,aswellas measuresrelatedtohospitaloperations,LongTermCare(LTC) facilities,casinos,andmassgatherings.3 Theprioritywasto flattenthecurveofinfectionsasquicklyaspossibletoprotect thepopulation,vulnerablecitizens,healthworkers,and healthcarecapacity.
Againstthisbackdrop,apersonalprotectiveequipment supplychaincrisisloomedlarge.4 Buyingonly.2%PPEs fromCanadiansourcesinMarch2020,5 Canadarelied heavilyonotherjurisdictions,whichresultedinsignificant challengesinsupplychainoperationswhenPPEexports werebanned.Personalprotectiveequipmentshortage consumedtheattentionofhealthcareleadersandthepublic.6 Asmoothlyoperatinghealthcaresupplychainisonethatgoes unnoticedandsimplyprovidespeoplewithwhattheyneed whentheyneedit.However,behindthescenes,theprocessis complexandrequiresproperforecasting,sourcing,testing, storage,distribution,trackingandreturnstoworkinunison. Inhealthcare,supplychainmanagementhastheprimary responsibilityoflinkingmajorfunctionsandprocesseswithin thehealthcaresystemandacrossorganizations(eg,suppliers,
intermediaries,thirdpartyserviceproviders,andfrontline workers)intoacohesiveandefficientnetworktodeliver necessaryproductsandservicesreliably.Itincludesthe planningandmanagementofallactivitiesinvolvedin sourcing,procurement,logistics,andinformationtechnology.
InBC,theProvincialHealthServicesAuthority(PHSA) employsapproximately1,000peopleacrosstheprovinceto workinsupplychainsharedservices.ThePHSApartner networkconsistsofsuppliers,warehouseoperators,third partylogisticproviders,supplychainstaffworkingin individualregionalhealthauthorities,andclinicalsafety teamsacrossvarioushealthcareunits.Allpartnerscoordinate withthePHSAsupplychaintoensuresmoothoperations.
ThispaperanalyzestheresponsefromBC’shealthcare supplychainandleadershipduringtheinitialphasesofthe COVID-19crisis.ExamplesfromtheBCpandemicPPEsupply chainareusedtoillustratewhatisatstakeandwhatmorecanbe donetopreventormitigatenegativeimpactsinthefuture.
Casestudyapproach
FromJulytoOctober2020,theresearchteamconducted16 semi-structuredinterviewswith12leadersfromtheMinistryof Health,RegionalHealthAuthoritiesandPublicHealthServices Authorityaswellastwophysicianleadersandtwokeyleaders fromtier1suppliers(ie,vendorsanddistributorsthatwork directlywithPHSA).Theseinformantswereintimately involvedinthepublichealthandsupplychainresponses
1 UniversityofVictoria,Victoria,BritishColumbia,Canada.
2 UniversityofVictoria,Victoria,BritishColumbia,Canada.
Correspondingauthor: JieZhang,UniversityofVictoria,Victoria,BritishColumbia,Canada. E-mail: jiezhang@uvic.ca
duringthepandemic.Althoughthesystemwasunderduress withthepandemic,ourinformantswereverywillingto participantintheinterviewstosupportfuturesupplychain successforhealthcare.TheobjectivewastogainaBCspecificyetcomprehensiveperspectiveofthehealthcare supplychainpolicies,processes,andinfrastructureandto understandhowtheycontributedtothehealthsystem capacityandthecareoutcomesfortheBritishColumbians duringtheearlystagesoftheCOVID-19pandemic,upto November2020.Theinterviewswereaudio-recorded, transcribed,andreviewedbytheresearcherstoidentifykey patternsandthemesfromthecasedata.7 Wealsoconsultedover 1,000pagesofsecondarydata,includingBCgovernment websitesandpublications,pandemic-relatedguidelines, allocationpoliciesandwhitepapers.Inaddition,adigital maturitysurveyattheprovinciallevelusingtheHealthcare InformationandManagementSystemsSociety(HIMSS) ClinicallyIntegratedSupplyOutcomesModel(CISOM)was completedtoinformourstudy.
Giventhebroadimpactofthepandemicandthefactthat multipleentitieswereinvolvedwithleadingtheeffortsin effectingthepandemicresponses,ourapproachfocusedon thefollowingkeyareas:thehealthsystemandorganizational design,supplychainfunctionandprocesses,digital infrastructuretrackingandhealthsystemcapacitytodeliver careandoutcomes.Wealsousedthecrisismanagementphased framework8 depictedin Figure1 tohelptracktheeverevolvingresponsesofthehealthcaresupplychaintothe pandemic.Althoughpresentedsequentially,thesephases oftenfollowanon-lineariterativepattern.Forexample,a secondwaveofcommunityinfectioncoulddisruptthe recoveryphaseafterthe fi rstwaveappearstobecontained andnormalitystartstoreturn,thereforedelayingeffortsin preventionandpreparedness.Thisphasedanalytical frameworkisusefulforcharacterizingdifferentresponses andprovidingatemporalreferenceforunderstandingthe complexinteractionsamongthehealthcaresupplychain actors,thushelpingidentifytheprimaryfocusthrough whichleaderscaninfl uencetheoutcomeacrossphases.9
ThisBC-specificcasestudyapproachallowedustouncover notonlyweaknessesintheresponsesbutalsofactorsthat contributedtotheeffectivecrisisresponsemanagementinBC,
suchasPHSA’sroleinenablingcentralizedPPEinventory managementanddata-drivendecision-making.Applyingthe crisisresponsemanagementframeworktounderstandingthe strengthsandweaknessesintheBCcontextyieldedconcrete examplestohealthleadersregardinghowthesefactorsmaybe integratedtobetterprepareforandmanagefuturecrisis.
Althoughthiscasestudyapproachmetourresearchobjectives byprovidingaholistic,rich,andnuancedaccountoftheBC healthcaresupplychainresponsesregardingPPEshortageand contributingtoknowledgeoncrisismanagement,thereare severallimitations.Theselimitationsinclude,(1)challenges withgeneralizingresultstogeographicareasbeyondBC,(2) subjectivityinherentinqualitativeinterviewing,(3)absenceof hypothesisformationattheoutsetoftheproject,and(4)difficulty inreplicationduetoaccesstoinformants,time,andcost.
AnalysisoftheresponsesoftheBChealthcare supplychain
Thepandemiccausedunprecedentedchallengesacrosstheworld thatthreatenedtheabilityofhealthcaresystemstofunction properly.Healthcaresystemsandleadersworldwidewereforced toprioritizecareorpausenon-emergencyservicesinanticipation ofsurges,andtherelianceofhealthcaresystemsonglobalsupply chainswaspushedtotheforefront.
InBC,theMinistryofHealthandtheProvincialHealth OfficeledtheCOVID-19responseeffortsinthiscomplexand uncertainenvironment.Earlyhealthoutcomereportswere favourabletoBCwithoutcomesduringthe firstwaveata cumulatedrateof17.5hospitalizations/100,000peopleand5 deaths/100,000peopleasofOctober17,2020.10 Asof November2,2020,BChadexperienced515infectionsand 151deathsamonglong-termcareandassistedlivingresidents.11 Thefollowingthemesemergedfromtheinterviewsregarding BC’shealthcaresupplychainresponses:
1. Governancestructure:Existinggovernancestructures withpriorexperienceinemergencymanagement,suchas emergencyoperationalcentresorcommittees(EOCs)at theprovincialandhealthauthoritylevels,contributedto thequickmobilizationofleadershipandgovernance structuresthroughoutthesystem.
Figure1. Supplychaincrisismanagementphases(illustrationdevelopedbytheauthorsbasedonHollaetal.8).
2. Decision-making :Earlyanddecisiveactions,suchas centralizedpandemicinventorymanagementmandated bythePHSA,collaboratio nbetweenPPEsuppliers, pre-emptivehospitalcapacityplanning,andlong-term carestaf fi ngguidelines,supportedtheresponsetothe fi rstwaveofthepandemicinBC.
3. Digitalization: Digitaldashboardsconsolidated,integrated, anddisseminatedup-to-dateandaccurateinventory informationtointernaldecisionmakersatministries, regionalhealthauthorities,andhealthcaredepartments andprovidedinformationonthedistributionofPPE inventoryasthesituationevolved.
4. Leadershipstability: Thestabilityoftheleadershipand relativelyconsistentpublichealthpoliciesinBCsupported broad-basedandtimelydecision-makingthatisessential duringtimesofcrisis.
Table1 presentsathematicanalysissummaryofthe healthcaresupplychainresponsesbytheBChealthcare systemfromthepandemiconsetuptoNovember2020. Thenextsectionhighlightstheinsightsfrom Table1 by describingtheBChealthcaresupplychaincrisisresponse organizedintofourkeyareas:(i)leadership,governance,and decision-making;(ii)supplychainresponse;(iii)sourcing
Table1. SummaryofBChealthcaresupplychainresponsetotheCOVID-19pandemic.
ResponseofBritishColumbiahealthcaresupplychaintoCOVID-19Pandemic
Leadership,governanceand decision-makingSupplychainresponse
TheintroductionoftheEOC structureinfusedthesystemwith muchneededroleclarityand accountability
Thesystemwasrelianton individualrelationships,rather thanpurposefulstructuresfor trustandcommunication networks
Theinitialdecentralizationof procurementandinventory managementpoliciescaused differentlevelsofinefficiency, ineffectiveness,andpotentialfor PPEshortages
Scenario-baseddecision-making wasnecessarytopreparefor evolvingnovelcrisis
Sourcingandprocurement strategiesDataanddigitalinfrastructure
Sourcingwasfragmentedwith minimalcentralcoordination. PHSAhadseveralestablished contractswithdomesticsuppliers, andhealthauthoritiesmanaged theirseparatecontracts
Existingprocurementpoliciesand practicecreatedbarriersfor suppliersintegrationinto healthcaresystemsupplychains
Datatimelinessanddata transparencyacrossregionswasan initialissue
Centralizationthroughthe preliminarydevelopmentofa provincialdatadashboard, displayinginventory,andotherkey data,didevolveovertime,but transparencycontinuedtobea problem
Rightdataandrighttiming informedtherightdecisionsto supporteffectivecare
Healthcaresupplychainslacked agilitytosupportallparties involvedtobecreativeand innovativeinaddressingever changingcircumstances
Forhistoricalreasons,BCdid notdevelopintegratedand comprehensivehealthcaresupply chaindisruptionscenarios
Anearlywarningsystemwould havebeenusefultodetector predictfuturedisruptionsand supportcollectiveresponses
Anall-outstrategycharacterized thisphaseasfederal,provincial,and localhealthauthoritiescompeted nationallyandinternationallyto securecriticalsuppliesofPPEand otheressentialmaterial
Earlyissueswithdecentralization forinventorymanagementcreated inef ficiencyandineffectiveness relatedtoPPE.Thiswas exacerbatedbyhistoric procurementpoliciesand proceduresthatcreatedbarriers tosolutionbuildingwithsupply chainpartners
Interoperabilityacrossallsystems involvedinsupplychainand connectednessofunderlying supplychainITinfrastructure neededtobeincreased
Needforincreaseddataanalytics andaccurateforecastingto supportdecision-making
Anexpandeddefinitionof collaborationemergedtoinclude morebroad-basedexternaland internalactorstocontainthe crisis,solveunforeseenproblems, andmaintainbusinesscontinuity
Lackofprotocolsandstandardsto supportcrisis-actiondecisionmakingprocess
Crisisraisedthebarforstabilityin structure,policy,andleadership rolesrequiredforhealthcare delivery
Severalstakeholderslackeda sharedawarenessaboutthe healthcaresupplychainasacritical determinantoftheprovisionof care
Awarenessofsupplychainsand theirimportancewaslimitedinthe healthcaresystem.Thiswas evidentbythelackofstockpiles andscenarioplanningandcarly warningsystemstodetector predictsupplychainsensitivity
Datastandardization,dataquality, anddataintegritywereongoing issues
Thecentralizationandaggregation offragmentedaggregationof fragmentedsupplychaindata evolvedovertime
andprocurementstrategies;a nd(iv)dataanddigitalsupply chaininfrastructure.
Leadership,governance,anddecision-making
Asalientthemeemergedfromthequalitativedatainvolvedthe well-functioningstructurethroughtheEOCsandclear communicationandescalationinstigatedbytheleadership team.TheBCHealthSystemhaslongstandingsenior leadershipattheMinistryofHealthandacrosstheRegional HealthAuthorities,includingDr.StephenBrown,theDeputy MinisterofHealth,andDr.BonnieHenry,thewell-knownBC PHOwhohasbeenrecognizedprovincially,nationallyand globallyforherleadershipanddecision-making.Thesesenior leadershadextensiveexperiencewithcrisisleadershipandthe competenciesrequiredtoleadduringahealthcarecrisis.12,13 ThisincludedDr.Henry’sexperienceduringthe2003SARS outbreak.Althoughthesystemleadershipstructuressupported system-leveldecision-making,anabsenceoftimelyand accuratedatacreatedearlychallengesineffectivedecisionmakingataclinicalandoperationallevel.BChadsimilar experiencestootherprovinceswiththeneedtomanage misinformationinordertoprotectPPEsupplies,aswellasto manageclinicianconcernsaboutthesupplychain.Contributing totheconfusioninthedisruptionphase,thesystemreliedmore onindividualrelationshipsratherthanpurposefulstructures.As asolution,BCintroducedanEmergencyOperationsCommittee (EOC)atthebeginningofthepandemic,basedontheir extensiveexperienceinusingEOCsduringtheannual provincialwildfires.TheEOCinfusedthehealthcaresystem withmuchneededroleclarity,accountability,andintegrationto crisiscontainment.Overall,anexpandedunderstandingof collaborationemergedtoincludemorebroad-basedexternal andinternalactorstocontainthecrisis,solveunforeseen problems,andmaintainbusinesscontinuity.
Supplychainresponse
TheCOVID-19pandemichighlightedthecriticalroleofthe healthcaresupplychainindeterminingtheprovisionofcare. Ourinformantssharedthatessentialhealthcaresupplychain policiesandprocessessuchasinventorymanagementwere primarilyimplementedattheregionalhealthauthoritylevel priortothedisruption.Forexample,50%ofourinformants explainedhowthepandemicstockpileincludingPPEsshould havebedevelopedandmaintainedbyindividualregionalhealth authoritiesaftertheSARSpandemicin2003,yetonlyoneout ofthe fi veregionalhealthauthoritieshadapandemicstockpile atthestartoftheCOVID-19pandemic.Thisregionalapproach tosupplychainmanagementalsocontributedtothelackof supplychainvisibilityattheprovinciallevel,whichnecessitatedanall-outeffortinannouncingnewmandate,protocols, andstandardsintheearlydaysofthedisruptionphaseto supportdecision-makingacrossalllevelsofthehealthcare system.TheseeffortswerenecessarytoaddresstheanticipatedPPEshortagesbasedonscenarioanalysisofsurges inotherpartsoftheworldincludingItalyandWuhan.The
effectivenessoftheseeffortscouldlargelybeattributedtothe EOCleadershipstructureandpriorexperienceinmanaging crisesduringastateofemergency.Atthesametime,several ofourinformantsacknowledgedtheconfusionandanxiety experiencedbythefrontlineasthePPEguidelinescontinuouslyupdated.Thiscon fi rmedthatleadersmustengagein constantupdatingandleadwithempathyinafast-moving crisisfraughtwithuncertainty. 13 Later,thecontainmentofthe initialdisruptionallowedthes takeholdersoftheBChealthcaresupplychaintore fl ectontheresponsesandrecognize thevitalimportanceofhavinganintegratedhealthcaresupplychain.Ithasbecomeapparentthatongoingeffortsare neededtodeveloptightersupplierintegration,deepercollaborationbetweensupplychainandhealthcareproviders,and theneedforanearlywarningsystemtodefendagainstfuture disruptions.
Sourcingandprocurementstrategies
Afranticandfragmentedapproachtosourcingandprocurement atthebeginningofthepandemicwasquicklyreplacedwitha coordinatedapproachinBC.Earlyissueswithdecentralization forinventorymanagementcreatedproblemswiththeefficiency andeffectivenessofPPEmanagement.Thiswasexacerbatedby historicprocurementpoliciesandproceduresthatcreated barrierstointegratingandcoordinatingsolutionswithsupply chainpartners.Theawarenessofsupplychainsandtheir importancewaslimitedinthehealthcaresystem,whichwas evidentbythelackofstockpiles,scenarioplanning,and earlywarningsystemstodetectorpredictsupplychain sensitivity.Realizingtheissu es,BChealthcareleaders, EOCs,andPHSAstartedcoord inatingtheirresponseand actions.Measuresweretaken torationavailablesupplies, createcentralizedinventory holdingspacestocontrolthe consumptionratesofthecriticalsupplies,andtocoordinate suppliesandextendedsupplychainservicestoall healthcaresites,includingmostLTCfacilitiesinthe provincethathadnotbeentraditionallypartofthe RegionalHealthAuthorities.TrustintheabilityofPHSAto fulfilordersgrew.Severalkeysuppliershelpedbyprioritizing publichealthandproactivelyprovidingPHSAandother healthcareorganizationswithupdatesonsupplyavailability andupstreamsupplychaindisruptions.Inresponsetothe pandemic,non-traditionalhealthmanufacturersswitchedto PPEproductionandincreasedlocalsupplyofPPEs.
Duringthecontainmentphase,decision-makingevolved frombeingatraditionalfunctionofthebuyingandthe sourcingteamstoafunctionofthesupplychainteamthat involvedPHSAandtheregionalhealthauthoritiestovarying degrees,dependingontheirinternalcapacity.TheBC experiencesuggestedthat,inadditiontoanearlywarning systemandcommitmenttopreparedness,thehealthcare supplychaincouldhavebeenenhancedbydeliberativeand crisis-actiondecision-makingprocessessupportedbyprotocols andstandards.OurinformantsnotedcompetitionforPPE suppliesduringtheearlydaysofthepandemic,which
suggestedopportunitiesforinter-provincialandnational collaborationinsourcingandprocurement.
Dataanddigitalsupplychaininfrastructure
Havinganeffectivedigitalinfrastructureforsupplychain managementwasidentifiedearlyinthepandemicasbeing criticalfordevelopinganeffectiveresponsetoCOVID-19.As canbeenseenin Table1,issuesrelatedtothetimelinessand transparencyofsupplychaindataacrossregionswereinitially encountered.Inresponse,thedigitalinfrastructurefortracking andtraceabilitytosupportsupplychainmanagementevolved considerablyfromtheinitialpreparednessphasethroughtothe disruptionandcontainmentphases.Thisevolutionwas characterizedbyaprogressionfrominformationsilosand isolatedinformationresourcestogreatercentralizationthrough thedevelopmentofaprovincialdatadashboarddesignedto displayinventoryandotherkeydatafromacrossregions.The dashboardwasdesignedtobeusedbydecisionmakersatall levelsandwasseenbystakeholdersasbeinganimportant advance.However,otherissuesremainedandrequired continuedattention,includingtheneedforgreater interoperabilityacrossthemanysystemsintheprovince,and forincreasedconnectednessoftheunderlyingsupplychainIT infrastructure.Inaddition,stakeholdersidentifiedincreaseddata analyticcapabilitiesneededtoenabledecisionmakerstoforecast PPErequirementsmoreaccurately.Additionally,greater standardizationofsupplychaindata,andimprovedintegrity andqualityofdatawerealsoidentifiedasongoingneeds.
Healthcaresupplychaincrisismanagement framework
TheBCcasestudydemonstratesthathealthcaresupplychains arecomplex,especiallywhenessentialsuppliesmustbe distributedrapidlyandequitably.Complexityisincreasedby:
1.Thecomposition,characteristics,andbehaviouralnorms ofresponseteams.Themorecomplextheorganizational relationships,themorecomplextheresponse.
2.Thenumberoflevelsinanorganizationasbranchingincreases andasanorganizationdevelopsmultiplechainsofreporting.
3.Changesinorganizationalstructure.Responseprocedures oftenrequirediversegroupsofpeopletomakedecisions, anddifferentpartieswillrotaterolesandresponsibilitiesas theresponsetoaneventevolves.
4.Organizationalproceduresbecomingmorecomplicated. Passinginformationupanddownahierarchy,andwaiting foraninformedresponse,canincreasecomplexity,especially whenthistakesplacewithincomplexorganizational structures.
5.Thenumberofcommunicationchannels.Duringa fast-evolvingandhighlyuncertaincrisis,channelsof communicationmustincreasesignificantlytoaccommodate constantdemandfornewinformationandfrequentupdates followingdecision-making.
Increasesincomplexitycreatedifficultiesinhealthcare supplychainmanagementandthereforehaveanegative impactonhealthcareorganizations,suppliers,frontline workers,patients,communities,andothernationaland internationalstakeholders(eg,thefederalgovernment).The difficultiescausedbycomplexitycanbeaddressedby leveragingenablers,implementingmechanisms,andby anticipatingandadaptingtothetrajectoryofacrisis. Collaborationoutsideoftheprovincealsobecomesessential andtherewasnoevidencethatactivecoordinationoccurred eitherinter-provinciallyorfederally.
BasedontheBCexperience,webuildonthecrisis managementphasedapproachtodevelopageneral frameworkforhealthcaresupplychainleaderstopreparefor andmanagecrises.Thisframeworkproposesmechanismsor enablersforhealthsystemleadersandsupplychain stakeholderstoquicklystabilizethehealthcaresupplychain andimproveitsresiliencebyproactivelymanagingthephases ofthecrisismanagementprocess(preparedness,disruption, containment,recovery,andprevention).Asshownin Figure2, asuccessfulresponsetoacrisisrequires fi vemechanisms: (1)effectiveandtrustedleadership,(2)aunityofpurpose,(3) integratedandrobustdigitalinfrastructureandcapabilities, (4)consistentlearning,and(5)resiliencebuildingand environmentalsensingforreliableintelligence workingin concertatallstagesofthecrisis.Tocutthroughthecomplexity
Figure2. Proactivelymanagesupplychaincrisisbyshiftingtheprimaryfocusofresponsesacrossthephases.
ofafast-movingandhighlyuncertaincrisis,leaderscouldlean onakeyresponseatanindividualstage.Thatis,focussingon effectiveandtrustedleadershiptocontaindisruption;unityof purposetoinitiaterecovery;consistentandcontinuallearning topreventthecrisisfromreoccurring;resiliencetogetbetter preparedforunforeseencrises;andreliableintelligence supportedbyup-to-dateandreliabledataandinfrastructure toinformleadershipanddecision-making.
Conclusion
ItisevidentfromtheworkdescribedinthisarticlethatBC’s publichealthdependsonglobalsupplynetworks,andthatpublic healthandtheprovisionofcaredependsonthehealthcaresupply chain.Asweemergefromthispandemic,BCmustrecognizethat supplychainsareanintegralcomponentofsocio-economic resilienceandthereforearealsoapotentialvulnerability.
Healthcaresupplychainsareincreasinglycomplex.The heighteneduncertaintyandcomplexityduringtheCOVID-19 pandemic,coupledwiththeneedtodistributesuppliesrapidly andequitablyonamassivescale,haspresentedarareopportunity toobservehowleadership,supplychainstructures,anddigital capabilitiesoperateduringcrises.Withpotentialcrisesahead, enhancinghealthcaresupplychaincrisismanagementisessential, andBChealthleadersmustplannow.Whileformulationsof effectivecrisismanagementcanundoubtedlyvary,insightsfrom theBCcasestudysuggestthatpreparednessandresiliencearise fromcollaborationsacrossorganizational,professional,and geographicalboundariesledbyanticipatoryandadaptive decisionmakersatmanylevelsoftheBChealthcaresystem.
Funding
ThisresearchwasfundedbyCanadianInstitutesofHealthResearch grant#Ref.VR5172669.
ORCIDiD
JieZhang https://orcid.org/0000-0002-0681-5820
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