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During the VCU Business Graduate Kickoff on Thursday, August 18, incoming graduate students had the unique opportunity to see firsthand how recent global supply chain crises have had a direct impact on patient care locally at VCU Health.

Dr. Casey Cable, pulmonologist and critical care physician with VCU Health, and Dr. Jeff Smith, chair of supply chain management and analytics at the VCU School of Business, discussed the relationships between supply chain management and healthcare, demonstrating how a disruption to either can have a massive ripple effect in their respective industries. Though experts in completely different fields, the two share a special interest in one another’s work given their own personal relationship as husband and wife.

“Very frequently, I take my problems at work home and discuss with Jeff,” says Cable. “I was fascinated to understand why we were having these problems, to understand where they were coming from.”

Global supply chains have suffered a number of devastating blows in recent years, most notably due to the Covid-19 pandemic and now the Russia-Ukraine conflict. Each has led to shifts in demand, facility limitations, and labor shortages. “Everything is broken in the supply chain right now,” says Smith. “This directly impacts both of us.”

Cable highlighted examples of two medical products that have recently seen critical shortages at VCU Health: intravenous (IV) contrast dyes for computerized tomography (CT) scans, and clear, plastic lock boxes that hold continuous ambulatory delivery devices (CADD). 

“Certain things happening in the supply chain world may seem innocuous, but they significantly impact [Dr. Cable’s] ability to deliver care,” says Smith. “These two instances have implications in her world, and they come from my world.”

IV contrast dyes are used to help physicians highlight differences in soft tissue during scans that might otherwise look entirely the same. The dye greatly improves the accuracy of a scan and assists in the identification of life-threatening diseases, including cancer. 

“When we hit a critical shortage of IV contrast dyes at VCU Health, it took us off guard,” says Cable. “We use it for so many purposes. The first thing we needed to address was how to prioritize IV contrast and reduce unnecessary scans.” 

To understand where the IV contrast dye shortage was coming from, Smith mapped out three major pieces of the puzzle: the product itself, the big industry players producing the most widely used dyes, and the production locations. 

GE Healthcare is the big player in contrast dye production with about 70-80 percent of the market share. The organization has three production facilities, though over 80 percent of their production comes from just one location in Shanghai. 

“One location, one main compound, one big player,” says Smith. “That’s a heavy concentration of a total industry. If you look at the complexity and total time it takes to produce this product, even when they’re back up to full production and capacity, it’s a significant amount of time needed to get this dye back in [Dr. Cable’s] hands.”

“It isn’t comforting having to tell my patients I can’t get them a CT scan to see if cancer is there or not,” says Cable.

Cable’s second example—the clear, plastic lock boxes that hold CADDs—are seemingly more mundane. And yet this plastic box is vital: they allow physicians to safely administer medication like fentanyl and morphine to patients.

“These opiates are controlled substances,” says Cable. “Without the plastic cassettes, I’m not able to administer these medications from a security standpoint. We have to completely change our practice and use other medications that maybe I don’t want to use, things that are maybe not superior to what we typically use for a variety of pharmalogic reasons.”

A petroleum shortage and the complexity of plastics production are at play here, says Smith. 

“We run into a situation where supply chain decisions create concepts of bad patient care. This is just a plastic box with a lock on it, but it has massive implications in [Dr. Cable’s] ability to treat patients the way they need to be treated. She has the fentanyl. She doesn’t have the box to hold it in.”

Unfortunately, the shortages don’t stop there, says Smith, and there are more to come. 

What can be done to alleviate the shortages and help those on the frontlines of patient care? Aside from things like contingency planning, alternating supplies, and building a more domestic supply, Cable and Smith tout the need for creative problem solving. 

“Thinking of different ways to solve the problem: that’s what you guys are for,” says Smith of the new VCU Business students. “That’s your future. You’re the next group to face these problems, and we’re relying on you.”

“This isn’t just a supply chain issue,” adds Cable. “This impacts all areas of business.”

Cable and Smith paused during their presentation to welcome Dr. Naomi Boyd, dean of the VCU School of Business, who joined the kickoff event to welcome the new graduate students. Boyd spoke of her own personal time in graduate school and the opportunities that await the incoming Rams.

“In graduate school, you get to define who you are and really figure out what you want to be, where you want to go,” said Boyd. “Make connections. Find mentors: in the building, outside of the building, with one another and beyond. This time will transform your life.”

For more information about VCU Business or the Supply Chain Management and Analytics programs at VCU, visit the School of Business website.

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