Lessons for emergency healthcare logistics
IfM PhD student Rob Glew, supervised by Professor Duncan McFarlane, reflects on the lessons learned from two years of working on emergency healthcare logistics during the COVID-19 pandemic. A new research project with ETH Zurich is applying these lessons to the Ugandan healthcare system to build resilience for future emergencies.
Logistics formed an important part of our COVID-19 response at the IfM. An IfM team ran an emergency PPE warehouse for Cambridge University Hospitals early in the pandemic, and later we coordinated the pooled PCR testing programme for the whole of the University of Cambridge.
We’re now taking the lessons learned from two years of work and research in emergency healthcare and delivering them to a new location. In collaboration with the team at ETH Zurich, led by Professor Stephen Wagner, we’re working with the Ugandan Ministry of Health to improve their logistics preparations for medical emergencies.
Infectious disease outbreaks are frustratingly common in Uganda, particularly in its remote and rural regions. The Ugandan government is working with the IfM and ETH Zurich to create a new strategy for logistics preparedness by placing medical supplies in key locations and planning emergency transport to rural areas.
Our experience with COVID-19 testing in Cambridge is directly informing the plans to create temporary healthcare logistics in emergencies in Uganda. Drawing on what we’ve seen during COVID-19 and bringing it to a new environment, we have identified three critical lessons for emergency healthcare logistics.
Complexity kills, so kill the complexity
When healthcare logistics are planned in a high-pressure, emergency situation, it is easy to overlook the complexity of the system that’s being created. For example, distributing PPE in the early stages of the pandemic became very complicated very quickly, with the military, the NHS, local authorities, and many others all involved in different roles.
Complexity makes adapting to changes more difficult, because it is hard to understand the effect of changes through the logistics network. The first step in killing complexity is to map out the emergency network, then to start to remove the links between organisations that aren’t required for the network to function.
Standardise to prepare for unknown changes
Working in a state of flux has been the norm rather than the exception for emergency healthcare logistics during the COVID-19 pandemic. It’s especially difficult to manage changes when they arise suddenly with little or no time to prepare. Yet, one way to get ready for possible but unknown future changes is to ‘standardise the interfaces’ in the logistics network.
In the University’s COVID-19 testing programme, this meant delivering all test kits to colleges in identical transport boxes. The standard interfaces allow internal changes to be made to the logistics operations without affecting those on the outside.
Look for the tipping point
Scale is particularly important for healthcare operations, especially during infectious disease outbreaks. As demand increases, the experience will not be the same across the network. Some regions, for example, may experience more intense disease outbreaks than others. At the same time, the spare capacity for scaling up will also be different across the network.
These two effects combine to lead to a tipping point at one node in the network, where the combination of demand and available capacity will first reduce the ability of the logistics operations to scale up. Preparing for emergencies requires scenario planning to identify these ‘tipping points’ and evaluating the options for expanding them if required.
There have been a great many specific challenges related to COVID-19 over the past two years. But in identifying these broader lessons that can be learned, we’re now preparing to use the experience to inform new healthcare and humanitarian logistics solutions.