BUSI 611 Week 5 Discussion Board Forum 5 Example

Discussion Board Forum 5: Supply Chain Management in Health Care

BUSI 611 Operations Management for Health Organizations, Discussion Board Forum 5

Thread by [Student Name]

The health system, its inventory figures and the classmates are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

In May 2022, our health system's radiology director received a notice that our iodinated contrast supplier would ship only 20% of our usual allocation for the foreseeable future. Contrast is used in roughly half of all CT scans and in nearly every cardiac catheterization, and our hospitals carried about ten days of inventory. A COVID-19 lockdown in Shanghai had closed the plant that made most of the iohexol used in the United States, and because nearly all our contrast came from that one product line, we had no quick alternative, and the other major manufacturer was already overwhelmed by orders. Our materials manager called three distributors and learned that every hospital in the region had received the same notice. Within a week, radiologists were debating which scans could be done without contrast, emergency physicians were asking whether trauma patients would be imaged properly and cardiologists were postponing elective procedures.

Langabeer and Helton (2016) explain that health care supply chains have been redesigned around efficiency, with group purchasing contracts that concentrate volume on a few suppliers and just-in-time delivery that keeps inventory low to free cash and space. Those choices lower cost in normal times but remove the buffers that absorb shocks. The textbook describes safety stock as inventory held to protect against uncertainty in supply or demand, and it notes that the right amount depends on how variable supply is and how long a replacement takes to arrive. Our contrast policy assumed steady supply and short lead times. When a single supplier failed, ten days of stock could not cover a disruption that lasted months.

The most effective response was not finding more contrast but using less. Isabelle et al. (2024) studied a 12-site health system that standardized contrast doses for 13 common CT examinations on May 23, 2022. Mean contrast per examination fell from 89.3 mL to 78.0 mL, a 12.7% decrease, and the reduction largely persisted after the shortage ended, at 80.4 mL, with nine of 12 sites sustaining it. Gertz et al. (2025) used a statewide registry of 19 Michigan hospitals and found that contrast per coronary intervention fell from 149.9 mL to 137.5 mL during the shortage, with no change in acute kidney injury, 7.9% before and 7.4% during, even among high-risk patients. Procedure volumes stayed similar.

Those findings carry an uncomfortable lesson: much of the contrast we used before 2022 was not needed. The shortage forced a demand management program that should have existed all along. Radiologists at our system had used generous contrast doses for years because the cost per bottle was low and no one tracked use by protocol, so the waste was invisible until the supply disappeared.

I recommended three changes for our system. First, make standardized, weight-based contrast doses permanent for all CT protocols and track dose per examination monthly by site. Second, adopt a safety stock policy that sets inventory levels by supplier risk, holding at least 45 days of any critical item that comes from a single manufacturing source, with the added carrying cost approved in the budget. Third, ask our group purchasing organization for a supplier risk review of every single-source item that would stop care if it disappeared, starting with contrast, intravenous fluids and heparin.

After Jesus fed the crowd with five loaves, he told the disciples to gather up the leftover fragments so that nothing would be lost (English Standard Version Bible, 2001/2016, John 6:12). Even in abundance, Jesus would not waste what had been given, and a hospital that wastes contrast in good years has nothing saved for the lean ones. Careful dosing honors the supply and the patients who depend on it.

Reply to Lena

Lena, your thread argued that hospitals should hold six months of every critical imaging supply so that a disruption like 2022 can never stop care again. I agree that our inventory was too thin, and Langabeer and Helton (2016) are clear that safety stock should rise with supply uncertainty. A six-month stock for everything, though, would tie up large amounts of cash, require storage space few hospitals have and risk expiration, since contrast and many drugs have limited shelf lives. Inventory is protection, but it is expensive protection, and the textbook's approach is to match the buffer to the risk rather than buy the maximum for every item.

Evidence from the shortage suggests conservation can carry much of the load. Zakaria et al. (2026) compared trauma patients imaged at a level I trauma center before contrast conservation began in 2022 and after it, 509 and 588 patients respectively. Contrast boluses per patient fell only slightly, from 1.68 to 1.66, and the authors observed no increase in delayed diagnoses, missed injuries or acute kidney injury, though such events were few. The center's careful protocols protected trauma imaging even during the shortage. Waste reduction can also come from equipment. Shakir et al. (2024) described a switch from a traditional manifold system to an automated injector that allows multi-patient dosing from a single container in cardiac catheterization labs during the shortage, which reduced contrast waste and cost while limiting patient exposure.

Those studies suggest a blended policy: moderate safety stock for single-source items, perhaps 45 to 60 days, combined with permanent conservation practices that lower demand and stretch any stock further. A hospital that uses 12% less contrast every day effectively adds weeks to its inventory without buying a single extra bottle. The two strategies reinforce each other, since a smaller daily use rate also means a modest stockpile lasts longer, and the conservation habits built in calm times make the next shortage less frightening for clinicians. Joseph stored grain in good years for the famine he foresaw (English Standard Version Bible, 2001/2016, Genesis 41:35-36), but he also rationed what he stored. A stockpile also needs management after it is bought. Someone must rotate older stock into use before it expires, track lot numbers in case of recalls and decide when the stock may be drawn down, since a reserve that no one is allowed to touch during a moderate shortage does little good. Hospitals in a region could also share a reserve through their coalition or purchasing group, which spreads the carrying cost and reduces the phantom demand that appears when every hospital hoards at once. Has your hospital estimated how many days of inventory a conservation program would add to its current stock?

Reply to Ibrahim

Ibrahim, your thread argued that the real lesson of 2022 is that hospitals and their purchasing groups should never rely on a single manufacturer for a critical product, and that contracts should require at least two qualified suppliers. I agree, and Langabeer and Helton (2016) describe supplier diversification as a basic tool of supply chain risk management. The difficulty is that the same efficiency logic that created the fragility works against the cure, since splitting volume between suppliers raises unit prices.

Recent analyses make this trade-off explicit. Del Prete et al. (2026) argue that intensive care units depend on supply chains in which active ingredients are produced in a few places and some products come from a single site worldwide, so a disruption at one node spreads quickly to the bedside. They describe how just-in-time buffers are depleted and how phantom demand, as every hospital orders extra at once, worsens shortages, and they contend that decades of efficiency-driven reform removed the slack, in inventory, capacity and workforce, that lets systems adapt. Hussain et al. (2025) studied the University of Pittsburgh Medical Center after Hurricane Maria disrupted saline production in Puerto Rico, which supplied about half of the nation's saline, and found that hospitals relying on just-in-time delivery were exposed, prompting the system to build adaptive models of fluid use and conservation in anesthesia practice.

Those studies support your proposal, but they also suggest that dual sourcing alone is not enough if both suppliers depend on the same raw material or region. Two brands of contrast made from the same imported ingredient can fail together, just as two saline brands assembled in the same storm-prone region did. A useful contract clause would require suppliers to disclose where active ingredients and finished products are made, so purchasing groups can see hidden single points of failure. Hospitals should also be ready to pay somewhat more for that resilience. Paul told the Corinthians that it is required of stewards that they be found faithful (English Standard Version Bible, 2001/2016, 1 Corinthians 4:2), and faithful stewardship of a supply chain sometimes means paying for protection that looks wasteful until the day it is needed. Visibility is the other half of the answer. During the 2022 shortage, many hospitals learned their allocation only when a shipment failed to arrive. A purchasing group that tracks supplier production sites and receives early warnings could give members weeks of notice, time enough to begin dose standardization before stocks run low. Building that monitoring into the contract would cost little compared with the disruption it prevents, and it would turn the next shortage from a surprise into a managed event. Would your purchasing group accept a small price increase in exchange for a guaranteed second source?

References

Del Prete, C., Carenzo, L., & Caviglia, M. (2026). When supply chains fail: Rethinking resilience in intensive care. Critical Care, 30(1). https://doi.org/10.1186/s13054-026-06257-6

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Gertz, Z., Mitchell, B. K., Kontos, M. C., Teman, N. R., Norman, A., Ahmad, R., Strobel, R. J., Damluji, A. A., Shor, R. A., Spier, A., & Qauder, M. A. (2025). Percutaneous coronary intervention during the shortage of iodinated contrast. Journal of Invasive Cardiology, 37(5). https://doi.org/10.25270/jic/24.00242

Hussain, R., Pickle, E., Lonjin, T., Then, J., Rivosecchi, R., Cassavaugh, J., Fichman, M., & Kaynar, A. M. (2025). Disruption of normal saline supply chain due to a disaster: An analysis of the impact of normal saline shortage on anesthesia practice in a large hospital system and models toward resiliency. Frontiers in Medicine, 12, 1671978. https://doi.org/10.3389/fmed.2025.1671978

Isabelle, M., Lacson, R., Johnston, H., Pianykh, O., Sharma, A., Gervais, D. A., Saini, S., Khorasani, R., & Glazer, D. I. (2024). Reducing intravenous contrast utilization for CT: A health system-wide intervention with sustained impact. Journal of the American College of Radiology, 21(11), 1746-1754. https://doi.org/10.1016/j.jacr.2024.07.025

Langabeer, J. R., II, & Helton, J. (2016). Health care operations management: A systems perspective (2nd ed.). Jones & Bartlett Learning.

Shakir, M. A., Garratt, K. N., & Wimmer, N. J. (2024). Impact of ACIST CVi contrast delivery system on iodinated contrast media administration and waste. Journal of Invasive Cardiology, 36(10). https://doi.org/10.25270/jic/24.00150

Zakaria, H., Johansen, C., Waldrop, C., Wan, B., Graham, C., Fetzer, D., Minei, J., Bruns, B., Ananthakrishnan, L., Pepin, E., & Park, C. (2026). A global contrast shortage: A descriptive study exploring IV contrast utilization and outcomes in trauma patients at a level I trauma center. European Journal of Trauma and Emergency Surgery, 52(1). https://doi.org/10.1007/s00068-026-03277-3