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Code blue: Pandemics and hospital surge capacity in a just-in-time world

Code blue: Pandemics and hospital surge capacity in a just-in-time world

We may be about to see the sad fruits of so-called just-in-time (JIT) inventory systems applied to hospitals in the United States and elsewhere. Fourteen years ago I first wrote about the vulnerabilities of such systems across society including health care systems. (Other observers have more recently noted this problem in health care.) If the corona virus spreads rapidly around the world, those hospitals which have adopted such systems will be least able to cope. 

Here’s why:  JIT systems are designed to minimize inventories in order to free up cash for other useful and profitable purposes. If you no longer have to store large inventories, you don’t need to build and maintain substantial rooms and storage areas for that purpose. And, the money actually invested in those inventories, whether for auto parts or for medical supplies, can be deployed elsewhere to make a profit. With JIT, supplies arrive at your door as you need them. The “storage room,” if it can be called that, is a delivery truck on its way to your loading dock.

The trouble is, a wave of corona virus victims showing up at hospitals could quickly exhaust lean inventories of medical supplies. And, the supplier providing those supplies may quickly run out as demand surges. After all, a smart supplier will be practicing JIT as well.

The JIT mentality has also crept into the area of bed capacity in hospitals. The number of hospital beds available in the United States has dropped dramatically in the past 20 years. The reasons are understandable: more outpatient procedures, earlier discharges, and more home care. Why have extra unused beds sitting empty? Get rid of the excess inventory of beds and all the resources needed to maintain them can be used elsewhere.

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