Pool Economies and Pandemic Management

The situation we are currently facing with the COVID-19 epidemic is about getting to grips with the shortage of equipment, goods and products. That is organizing the resources to distribute those, using these and rotating these as the apex of the epidemy moves from country to country and city to city. While most military logistics departments are accustomed to managing their stocks and supplies in times of crisis and so are international relief organisations, each of those entities are used to do so with regard to the materials and tools they own and for the circumstances they prepared themselves to face such as wars, natural disasters but not necessarily national and international unpredictable health pandemics. Although the situations these entities face widely vary, they are by nature temporary and in their broad spectrum anticipated, therefore encompass an element of planning. For example, the United Nations has ready-for-use vehicles available in central locations for deployment in the field, Oxfam has water tanks and sanitation equipment at hand, the armies have tents and other survival kits in stock. With a pandemic such as this one, there are few necessities which are known in advance such as: the way the virus transmits e.g. the PPE needed, the type of ICU equipment needed, the fact that nurses and doctors are needed to operate ventilators as opposed to defibrillators etc…

The private and public sectors too have experience with pool economics, which apply mostly in the transportation area with airlines, railways managing their pool of assets and their staff to tend to peaks and lows. However, again, they are prepared for high probability events such as storms, vacation peaks, mass exoduses due to natural or men made disasters in natural disasters prone and volatile countries. They have detailed business continuity and emergency plans tailored to the type of event. They are not prepared however, to events of this magnitude, amplitude and randomness.
The state of the technologies today can help to assist a centralised control of pool echo-systems. First, the cost to keep track of any type of equipment or supply has been drastically reduced both in time and in cost. Assets and goods can be tagged and RFI registered as soon as produced and followed throughout the course of their useful lives. These assets and goods are inventoried but can also be equipped with sensors which monitor their location, usage and maintenance requirements with regard to consumable spare parts, cleaning and physical checks. The information regarding their existence, their location, their usage and their status can be relayed to a central monitoring system in real time.

Today’s technologies also permit to incorporate manufacturers, suppliers, vendors and hauliers of these assets and goods onto the same technology platform into the echo-system. Not only does this technology allow to inform suppliers of the replenishment needs, the maintenance needs and the general status of the pool of assets and the inventory of goods, but it allows to trigger in automated fashion the replenishment, refurbishment and maintenance of these stocks and inventories. The cost of maintaining the stocks and inventories in ready-to-deploy state becomes comparatively cheap while the quality of the maintenance can be stellar.

Today’s technology in a pool economy also dispense from keeping a centralised stock in a central location except for an initial ramp-up in deployment, when an epidemic hotspot appears. The technology not only allows to monitor through sensors, how the equipment is used and the outcome of its usage, (allowing to improve the equipment further down the line), it allows to monitor a distributed stock that is in multiple locations, in fact in all locations. In the case of ventilators, all ventilators available on earth and in which state these are, which make they are, how often they are used, if they are in use or if they are defect or requiring maintenance can be captured. Databases and other tools allow, to model the time to deploy to any particular location on earth and to identify the carriers which can get them there the quickest and mobilise these in an automated and real-time fashion. These models can be input the supply chains. True globalisation and micro-data analysis mobilised for a good cause.

Not only, do today technologies help to maintain, track, monitor and optimise the stock and inventories, they also have the ability to keep track of the needs with regard to their deployment to the right location, at the right time, in the right quantity, in the right quality and with the right staff. Modelling is widely available at the start of a pandemic as COVID-19, within the first days, the case curve is assessed and mortality estimates are projected, usually Pareto applies (80% is probably right and 20% probably off). If hospitals, clinics, test centres and other medical centres log in their cases as they do daily in most open societies, the technology would be able to direct the assets and inventories where they are most needed with a minimum number of days anticipation. That is send the equipment where it will be most needed, mobilise suppliers to produce future replenishment quantities, mobilise transport companies to deliver to medical facilities and pick-up from manufacturers and plan for pick-up of the same, when the model predicts the next apex somewhere else and the flattening of the curve in the previous location. The system could even mobilise refurbishment and cleaning squads for the redeployed equipment, which could even happen in transit to avoid time loss.

Pushing this model to the extreme could mean, without a need to break privacy rules to assign one or more operating mobile staff member to each equipment unit identified and deploy these to travel along with the equipment when the equipment is deployed. One could even, make it a one-leg deployment, e.g. the equipment is deployed to New York from Oklahoma, the operating staff member flies to New York. When the equipment is moved to Seattle, after that, it is New York equipment which is moved to Seattle along with the staff members which operate it, while the staff from Oklahoma returns home.

A legitimate question is, what happens to the Oklahoma owned equipment? In a pool economy, the principle is that all equipment and inventory is equivalent, that equivalence is established with regard to a purpose, that is to its functionality. So, in our case, a ventilator is a ventilator. Granted, these might have been purchased by different entities at a different price, staff has been trained to use a particular model as opposed to another…In a multiple stakeholder economy, which is the pendant of a pool economy, each stakeholder has a stake in the game and while that stake might not be equivalent at the outset, it should be in the end. There should however be compensatory means to reward, punish and most of all incentives to participating in a pool economy.

Here some ideas of incentives:
1. Staff operating equipment from different makes could benefit from multi-certifications for being able to operate different equipment, this could lead to higher remuneration while further reinforcing deployment capabilities. This additional remuneration should be carried by the pool.
2. Medical institutions could be compensated financially for making their equipment available to the pool but accepting another make in return to avoid return cost of the original equipment. This compensation could be financial, but also in training or in a standing compensation for each different make of equipment their staff can operate.

Quid of equipment standardisation? There are benefits to standardisation beyond staff expertise at operating a certain type/make of equipment, such as spare part inventories, maintenance costs for different makes are higher than in case of a standard make.

This means that only designated critical equipment should qualify for pool economics to limit economic inefficiencies in other supplies. An indirect virtuous corollary will be that maintenance and repair providers will also need to become multi-make skilled which will further reduce dependency on a certain type of ventilators or other equipment, as in our example case.

Here some ideas of penalties:
1. Not participating in the pool, would entail a fee to join it, in the case of need to be calculated and applied after-the-fact.
2. There should be a flat fee for a requirement to return the borrowed equipment which medical institutions would factor into their original buying decision. However, to limit standardizing suppliers, the highest number of homologations in terms of equipment should be maintained by the pool.

Here some ideas for rewards:
1. Medical institutions contributing most equipment (albeit not putting their situation in jeopardy) should be rewarded by additional means to purchase stocks and equipment
2. Medical staff who made themselves available for redeployment to out of city, state, country, region should receive a premium and adequate recognition within their own career path.

There is no need to reinvent the wheel:
– Companies like airlines, railway companies, relief organisations have the IT solutions to manage pools efficiently. These need adjustments but not an overhaul. It is about reconfiguring redeployment logics to sudden emergency situations in a multi-stakeholder environment as opposed to a unique stakeholder environment.