Caring For The Care Team
Written by Shukti Sarma
No other career is as demanding as that of a health professional. Motivating and maintaining relationships with these professionals is crucial to ensuring effective care and the reputation of the hospital. Like any other field, human resource management in hospitals has to primarily focus on identifying manpower needs and resources, but unlike other fields, the stakes are higher.
Man & Money
In today’s world, no venture, no matter how noble in its intensions, can run without proper cost management. In any field, professionals are the most valued assets, and hence, effective human resource management leads to streamline finances and reduce costs.
There are some key focus areas when considering human resource management in hospitals >>>
- Enhancing productivity of staff, like nurses and doctors
- Designing an incentive-based model for compensation
- Effective revenue cycle management
- Effective patient flow
- Deployment of non-provider staff support, and
- Managing, and trying to reduce the length of stay for individual patients
In hospitals, the most important thing to achieve is reduction of length of stay of individual patients, which ensures an effective patient flow and also enhances productivity of staff. To achieve that, it is important to provide staff with good training, and providing the patient with good care for speedy recovery. And with improved patient flow and more effective care, revenue is increased.
Hence, it is extremely important that the hospital provides good training to its staff, who should be able to provide better care to more patients, and reduce the stay for individual patients. This entails a more coordinated approach between doctors, nurses and other caregivers. Thus, the human resources management should also strive to rouse a sense of camaraderie between its staff and encourage better teamwork.
Challenges & Solutions
Suffice to say that those who work in the human resource department (who are often doctors themselves or handle some additional responsibilities) have to find out the best ways to recruit and retain employees. However, it goes without saying that apart from the management itself, there are various other enabling factors that ensure an efficient caregiving staff; like proper training, role, education and experience.
In 2009, Fadi El-Jardali, Victoria Tchaghchagian and Diana Jamal published a report called “Assessment of human resources management practices in Lebanese hospitals”. While the report is specific to a particular country, the challenges identified have a universal resonance. According to the report, the most frequently reported roadblocks are: poor employee retention, lack of qualified personnel and lack of a system for performance evaluation. Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees, improving salaries and developing retention strategies.
However, the biggest challenge, which becomes evident from the report, is that the solutions and the challenges were mismatched in some cases. The biggest roadblock, perhaps, when talking about human resource management in hospitals, is assigning the perfect salary; which takes into account market values and incentives. Hospitals are people-driven, and hence it is important to manage labor costs effectively without adding further stress, which hampers productivity.
Growing staff shortage, emigration and poor job satisfaction levels are problems which stem from poor work environment. Maintaining a healthy and motivating environment is more important than physical capital in this field. Poor salaries, increasing workload and unsuitable shifts and work hours force health professionals to see opportunities elsewhere.
The key hence, is to identify employee needs and address them, failing which, the high turnover rates will continue. Studies have shown that a stable environment ensures a lower rate of turnover and improved services - and better health services are always linked to improved demographic conditions.
Thus, it is not only important to recruit and retain suitable employees, it is equally important to utilize existing staff better and ensure a healthy working environment. When caregivers are taken care of, more lives are saved.
The challenges to vaccine distribution affecting everyone
While it is comforting to know that vaccines against COVID-19 are showing remarkable efficacy, the world still faces intractable challenges with vaccine distribution. Specifically, the sheer number of vaccines required and the complexity of global supply chains are sure to present problems we have neither experienced nor even imagined.
Current projections estimate that we could need 12-15 billion doses of vaccine, but the largest vaccine manufacturers produce less than half this volume in a year. To understand the scale of the problem, imagine stacking one billion pennies – you would have a stack that is 950 miles high. Now, think of that times ten. This is a massive problem that one nation can’t solve alone.
Even if we have a vaccine – can we make enough? Based on current projections, Pfizer expects to produce up to 1.3 billion doses this year. Moderna is working to expand its capacity to one billion units this year. Serum Institute of India, the world’s largest vaccine producer, is likely to produce 60% of the 3 billion doses committed by AstraZeneca, Johnson & Johnson and Sanofi. This leaves us about 7 billion doses short.
Expanding vaccine production for most regions in the world is complicated and time-consuming. Unlike many traditional manufacturing operations that can expand relatively quickly and with limited regulation, pharmaceutical production must meet current good manufacturing practice (CGMP) guidelines. So, not only does it take time to transition from R&D to commercial manufacturing, but it could also take an additional six months to achieve CGMP certification.
The problem becomes even more complex when considering the co-products required. Glass vials and syringes are just two of the most essential co-products needed to produce a vaccine. Last year, before COVID-19, global demand for glass vials was 12 billion. Even if it is safe to dispense ten doses per vial, there is certain to be significant pressure on world supply of the materials needed to package and distribute a vaccine.
It is imperative drug manufacturers and their raw material suppliers have clear visibility of production plans and raw material availability if there is any hope of optimizing scarce resources and maximising production yield.
It is widely known by now that temperature is a critical factor for the COVID-19 vaccine. Even the regions with the most developed logistics infrastructures and resources needed to support a cold-chain network are sure to struggle with distribution.
For the United States alone, State and local health agencies have determined distribution costs will exceed $8.4 billion, including $3 billion for workforce recruitment and training; $1.2 billion for cold-chain, $1 billion vaccination sites and $0.5 billion IT upgrades.
The complexity of the problem increases further when considering countries such as India that do not have cold-chain logistics networks that meet vaccine requirements. Despite India’s network of 28,000 cold-chain units, none are capable of transporting vaccines below -25°Celsius. While India’s Serum Institute has licensed to manufacture AstraZeneca’s vaccine, which can reportedly be stored in standard refrigerated environments, even a regular vaccine cold chain poses major challenges.
Furthermore, security will undoubtedly become a significant concern that global authorities must address with a coordinated solution. According to the Pharmaceutical Security Institute, theft and counterfeiting of pharmaceutical products rose nearly 70% over the past five years. As with any valuable and scarce product, counterfeits will emerge. Suppliers and producers are actively working on innovative approaches to limit black-market interference. Corning, for example, is equipping vials with black-light verification to curb counterfeiting.
Clearly, this is a global problem that will require an unprecedented level of collaboration and coordination.
Disconnected information systems
While it is unreasonable to expect every country around the world will suddenly adopt a standard technology that would provide immediate, accurate and available information for everyone, it is not unreasonable to think that we can align on a standard taxonomy that can serve as a Rosetta Stone for collaboration.
A shared view of the situation (inventory, raw materials, delivery, defects) will provide every nation with the necessary information to make life-saving decisions, such as resource pooling, stock allocations and population coverage.
By allowing one central authority, such as the World Health Organization, to organize and align global leaders to a single collaboration standard, such as GS1, and a standard sharing protocol, such as DSCSA, then every supply chain participant will have the ability to predict, plan and execute in a way that maximises global health.
Political influence and social equality
As if we don’t have enough stress and churn in today’s geopolitical environment, we must now include the challenge of “vaccine nationalism.” While this might not appear to be a supply chain problem, per se, it is a critical challenge that will hinge on supply chain capabilities.
In response to the critical supply issues the world experienced with SARS-CoV-2, the World Health Organization, Gavi, the Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations (CEPI) formed Covax: a coalition dedicated to equitable distribution of 2 billion doses of approved vaccines to its 172 member countries. Covax is currently facilitating a purchasing pool and has made commitments to buy massive quantities of approved vaccines when they become available.
However, several political powerhouse countries, such as the United States and Russia, are not participating. Instead, they are striking bilateral deals with drug manufacturers – essentially, competing with the rest of the world to secure a national supply. Allocating scarce resources is never easy, but when availability could mean the difference between life and death, it becomes almost impossible.
Global production, distribution and social equality present dependent yet conflicting realities that will demand global supply chains provide complete transparency and an immutable chain of custody imperative to vaccine distribution.
The technology is available today – we just need to use it. We have the ability to track every batch, pallet, box, vile and dose along the supply chain. We have the ability to know with absolute certainty that the vaccine is approved, where and when it was manufactured, how it was handled and whether it was compromised at any point in the supply chain. Modern blockchain technologies should be applied so that every nation, institution, regulator, doctor and patient can have confidence in knowing that they are making an impact in eradicating COVID-19.