Table 5 Theme 4 PPE supply and demand

4. PPE supply and demand

The crisis stage

Q1 “We’re faced with this crisis, that are we going to have enough set of gloves for a day in our ED are we going to be able to do this” (P4)

Q2 “You know masks were scarce at one point, they do chop and change the supply as well” [….] “And there were a few laughs along the way, trying on boiler suits you know” (P5)

Q3 “I think we've been reasonably okay with supply most of the time, but certainly in the beginning, obviously it was a little bit scary. I don't think we ever got to a point where we had to say to people, you know you can't have anything” (P5)

Q4 “I think the organisation was probably a little bit behind the eight ball, in the sense that a lot of other health services forecast potential shortfalls and accessed PPE prior to a centralized stockpile mechanism” (P3)

Q5 “I think the only time, on no it might have been twice, that I thought what on earth am I doing here, when I didn't I didn't think I had enough PPE to send my junior staff into ICU to look after COVID positive patients, but that was when what was coming out of Italy at that time was a lot of doctors dying” (P8)

Q6 “In the early days we were worried about supply, we had to really be careful about how we used our supply and be responsible, but again being responsible when people needed it they needed it, so there was no point where we were not able to have our staff in the PPE that they needed to be in” (P6)

Q7 “So, going from say whether it's a hand sanitizer or PPE we really struggled in the early stage to work out what our requirements are going to be and how we are going to cater that requirement” [….] “We just couldn't visualize demand because in the traditional days we work out what we need based on historical usage, so we can work out the numbers, but in the early stage we really struggled” (P7)

Q8 “My team in purchasing, we really struggled in the early days, because you know what the requirement is and you know you're not going to get that requirement. But some of the time you have to put a smile on your face, and face the business and say oh we're working on it we're going to get it, but in the back of your mind you know that there is nothing there that you can do it, so that first five to six months was a real struggle” (P7)

Q9 “At one stage we were looking at N95’s, within 6 or 12 months we used 25 years’ worth of N95. That’s the scale we were looking at on a normal day” (P7)

Q10 “And we were concerned partly about sort of our supply of N95 and at times gowns, but we never got to the stage where people were never supplied with the appropriate PPE” [….] “We got to a stage about discussing options for recycling N95s and gowns, and we get I think a fairly regular view of the stock take during that time” [….]“Although we had times where we thought okay we've only got 100 (gowns) left for the week what are we going to do” [….] “I think at the end we never really got to the situation where we couldn't get any PPE supplies, but there were certainly anxieties” (P10)

Q11 “We initially had people such as the OR nurse manager, ward managers, ringing up their usual suppliers as private phone calls and attempting to get products, so we could end up with a situation where different ward areas and different theatre areas had a diversity of equipment available” (P12)

Q12 “It left the leaders in a difficult position, because we had to explain why we weren't getting more (PPE), why we were making the decisions we were, trying to provide reassurance that that the information we were providing was based on best practice, based on trying to balance demand was in agreeance with guidance coming out of the department, so that that period was very challenging because obviously from an individual staff member perspective, there was a lot of differences of opinion from individual staff as to why some of the decisions were being made. That was a very challenging time because we're obviously trying to make what we thought were the most guideline concordant decisions that we thought were in the best interests of staff, but obviously when you're dealing with a crisis and demand is outstripping supply and you have to make difficult choices and yeah it was a very challenging time” (P3)

Q13 “The supply of the P2 masks that we were getting really early on didn't fit that brilliantly, they were built for an Anglo-Saxon male in a manufacturing environment, and we are an 85% female organisation from 150 different countries, so we had some real challenges in getting masks that fit and masks that were comfortable” [….] “And everybody saw you know the (news) footage of people will big bruising around their face” (P4)

Q14 “Early on I was monitoring incident reports about what people are reporting for their masks and there would be five to 10 a month about the issues people were experiencing, I'm not getting anything now, having said that, I know that you put a P2 mask on and someone says you're going to wear that for your 8, 10 or 12 h shift, exhausting” (P4)

Logistics

Q15 “Okay we need a whole lot of masks, right where do we get them from, where do we store them, who distributes them, who monitors stock levels. It's very easy in your original plan to say we would just get PPE and we would store it here, and you haven't necessarily thought through the volumes, or that supply and logistics element of it” (P3)

Q16 “We managed to get some space for the back-up stock, but we never anticipated that we will be needing to hold about 40,000 gowns as an emergency backup” [….] “But again, the human nature when the pandemic is over everyone will get on with life and forget about it until the next one, but this is something we need to work really closely with the business and see how we can cater for such an emergency situation” (P7)

Q17 “You see it was all pretty chaotic at that beginning period because of the supply chain issues generally, and a lack of overall supply” (P3)

Q18 “I actually think that there was actually good support between the sites, and I think there was understanding that one site was undergoing a lot more activity than the other at that time, and you know they could redeploy PPE as required” (P10)

Centralised supply

Q19 “The DHHS jumped on that wagon at the right time, as with any transition we struggled and they struggled, but they took control of the entire supply so there was no health service that can go outside of that network, and buy from the supplier, so they cut down that supply and brought it into a central supply chain” (P7)

Q20 “A N95 is the classic example, so we had three—four different brands and sizes of N95 available across the board, but when we go into that centralized supply chain network, only few products were available, and staff want to continue to use that product that they used to use, and we couldn’t cater that product” [….] “So in any transition it doesn't go perfect, but I’m really, really happy with the way the State Government responded, and the way they set up the network quickly and put a system in place and I’m confidently saying that they never let us down in any given day. We asked for say 10,000 gowns, and they probably gave us half of it, that's the case in the early days, but they never let a single day that they didn't give us anything” (P7)

Q21 “The DHHS are looking at the Health Share Victoria model, I think it is in place in NSW, so that every public hospital has to buy from that network, they centralise the product, they centralise and consolidate the brand etc., So I think down the track Victoria will adopt that model, that means you only get what they supply. Now they've got Health Share Victoria, but in the beginning everyone was scrambling for procurement and consumables and New South Wales was as well, but it got centralized a lot quicker And then that gave the organisation's confidence that that wasn't going to be an ongoing issue” (P7)

Q22 “with the lack of a centralised supply system the organisation was used to purchasing all of its own supplies often from private suppliers rather than a state supply centre, and one of the significant changes has been the centralisation of state supply, and notification of supply levels and supply chain reinforcement, which in the early days at least 6–9 months, was not very sound” (P2)

Q23 “I can remember, so the State supply chain they supply for free, but towards the end of the year they give us a report on what they suppled and how much its worth, and the report went to the CFO and he fell off the chair. We are talking about some $2.4 million dollars’ worth of PPE consumed across both hospital in that 12-month period. Which we never accounted for, and never predicted for, and it's just the way it is. And it is like the $2.4 million is just gone, you can get the physical stock but you can’t just articulate back to the business and say we've got that 40 or 50 pellets of gowns, but they were just gone within two days across both hospitals and aged care” (P7)