Thanking Dr. Khama Ennis for Her Brilliant Guest Lecture in My Humanitarian Logistics Class

 A very important feature of the Humanitarian Logistics and Healthcare class that I teach at the Isenberg School of Management, UMass Amherst is guest lectures from outstanding practitioners. There are truly "heroes" among us. On March 27, 2025 (before I headed to the airport to fly to the University of Louisville to give an invited seminar), the students and I had the incredible honor of hearing Khama Ennis, MD, MPH, FACEP, FAIHM speak on her journey from being born in Jamaica to becoming a leading medical professional, heading the ER department at the Cooley Dickinson Hospital, becoming a documentary maker, and even working at Bellevue Hospital in NYC during 9/11! The messages from students continue as to the impact that her guest lecture made on them. 

Dr. Ennis's intelligence, courage, creativity, and care for her patients and community are truly inspiring. We are incredibly lucky to now have Dr. Ennis with us at the University of Massachusetts Amherst Health Services. A short bio of Dr. Ennis can be found here: https://www.umass.edu/uhs/about/directory/khama-ennis-md-mph. Her first alma mater is also my alma mater - Brown University.  

Dr. Ennis's documentary, Faces of Medicine, "explores the paths of Black female physicians in the United States," of which there are very few: https://www.facesofmedicine.org/.  She kindly allowed us to view the documentary, which I found to be profound, inspiring, and, actually, very elegant. It was wonderful to hear from other female Black doctors, some of whom are in our region of western Massachusetts!

It was poignant to hear from a student in the class, whose family also comes from Jamaica, as to the impact that Dr. Ennis's presentation had on her.

It is such a small world. Dr. Ennis trained at MGH in Boston where our cousin, Dr. Toby Nagurney, was head of the ER and also a faculty member at the Harvard Medical School. I shared photos with him of Dr. Ennis with my students and he was delighted. He said that she has not changed at all.  

And, when, upon the return from speaking at a conference in Buenos Aires 15 years ago, and while taking a walk in our neighborhood, I slipped and fell where a pothole had been recently patched up, and our UMass Health Services, for some reason, could not treat the scar on  my bleeding forehead, I headed to the Cooley Dickinson ER. There, after about 4 hours of a grueling wait, which I blogged about https://annanagurney.blogspot.com/2010/06/operations-and-emergency-room.html , Dr. Ennis came to the rescue and essentially "glued" the wound.

Thank you, Dr. Ennis, for all that you have done and are doing! We are so lucky to now have you at the UMass UHS (Health Services)!

A Big Thank You to the Exceptional Nursing Leadership Team at Cooley Dickinson Hospital for Speaking in My Humanitarian Logistics and Healthcare Class

This past week, the students in my Humanitarian Logistics and Healthcare class had the great honor and privilege of having a panel of 8 nursing leaders from the Cooley Dickinson Hospital in Northampton, Massachusetts, speak virtually via Zoom. The topic of the panel was: Cooley Dickinson Hospital - A Year of COVID: Readiness, Response and Resilience. The presentations from 8 experts provided the class with extraordinary information and insights on this very challenging year and the tremendous response by the healthcare professionals at our local hospital! This was truly a transformative educational experience. We have heroes amongst us and we are so grateful to the Cooley Dickinson Hospital for the incredible care that they have provided over the past year in the pandemic. The panelists were: Angela Belmont, VP, Patient Care Services & Chief Nursing Officer, Lynn M. Grondin, Director of Nursing for Perioperative and CVIR Services, Mike Netta, Director of Operations for Perioperative and CVIR Services, Alexandra Penzias, Director of Nursing and Professional Practice Education, Sara C. McKeown, Nurse Director, Emergency Department, Ann LeBrun, Nursing Director, Critical Care Services, Margaret-Ann Azzaro, Director, Medical Surgical & Childbirth Services, Jacquelyn Ouellette, Director, Behavioral Unit.

Below, I have posted several of the slides that I captured from the panel that demonstrate the incredible creativity, work ethic, empathy, science-based decision-making, and so much more of these leaders and the staff, in general. They had anticipated the pandemic and had put processes in place ahead of time. It was  fascinating to see the reskilling (I have been publishing a lot on labor and supply chains in the pandemic), as well as the emphasis on the importance of communication and education. It was very interesting to hear about the repurposing of space to make room for more ICU beds and to hear the important role that association with MGH had in terms of provision of much needed PPEs. Amazingly, not a single staff person contracted COVID in the hospital. Plus, the importance of having an incidence command center was emphasized as well as having a single phone number that staff could use for questions. We even got to hear about the impacts of COVID on the behavioral unit and on the birthing unit. Tough for mothers to be separated from their babies. The situation was evolving very dynamically and learning about the new virus was taking place at an incredible pace.

It was also very special to hear how important it is to celebrate both small and big successes, which the staff did. This helps to improve morale. I don't think there was a dry eye among the students - I was shedding tears as well - when the panelists showed us a celebratory video of a patient, who had recovered from COVID, being discharged.

The students had, as an assignment, to writeup highlights and what surprised them from the panel and several wrote that this was the best guest lecture of their college education.

And, on March 25, 2021, I watched a very special remembrance organized by CDH, which was streamed on youtube, and which included Angela Belmont, as the master of ceremonies! 

It was very special, in the remembrance, to see Dr. Brown, the Interim President and CEO of Cooley Dickinson, to whom I wrote a thank you letter acknowledging the fabulous panelists! Our great dean, Dean Anne Massey, also signed Professor for a Day certificates for each panelist, which I emailed to them. In addition, a survivor of COVID, who was treated at the hospital for 30 days, and had been intubated for 2 weeks, spoke very movingly of the great staff and the fabulous care that she had received. Some news coverage of this event can be seen here, along with the link to the video of the remembrance.

Hospital Emergency Preparedness - An Outstanding Lecture by a Security Expert

Today, the students in my Humanitarian Logistics and Healthcare class and I had the true honor and pleasure of hearing Mr. Brian Rust, who is the Manager of Security and Emergency Preparedness at Cooley Dickinson Hospital in Massachusetts, deliver a guest lecture on Hospital Emergency Preparedness at the Isenberg School of Management. Cooley Dickinson Hospital is a 140 bed acute care community hospital, providing primary care 24/7 for Hampshire County residents and neighboring communities. It is part of the Partners Healthcare Network and is now owned by Mass General Hospital in Boston, one of the world's leading hospitals. Cooley Dickinson aims to provide the best healthcare in the most appropriate setting.

Mr. Rust has 11 years of experience at Cooley Dickinson Hospital and previously also worked in the police department and at Smith College.

Mr. Rust's guest lecture was fascinating and provided us with a wealth of information on emergency preparedness in the very important hospital healthcare setting.

At the beginning of his lecture, Mr. Rust told us that hospital emergency preparedness lies somewhere between preparing for emergencies and preparing for disasters since every day a hospital is involved in life or death decisions. He noted that it is important to identify: What are we preparing for? since preparing for anything, anytime, is much too general.

He noted that the hospital prepares for "any incident that has the potential to have a negative effect on normal operations of the hospital." The Joint Commission is the regulatory body that also accredits hospitals and it emphasizes communications, resource and asset management, the importance of the functioning of utilities (he mentioned the huge impact that a water main break would have on hospital operations, for example), as well as patient clinical support. Events, originating with 9/11, and including natural disasters such as Hurricane Katrina, have stimulated the growth in and emphasis of hospital/healthcare emergency preparedness. I was delighted that he mentioned so many issues and events that we had been talking about in the course so far (and even had other guest speakers on) from the Ebola outbreak in western Africa (that Cooley Dickinson even prepared for and learned lessons from) to the Boston Marathon bombing.

He also spoke about the ASPR (Assistant Secretary for Preparedness and Response) and that hospitals have realized that one needs a system-wide perspective, even if hospitals, which are non-profits, compete with one another for patients, since although they are non-profits, they are still businesses. Means of cooperation include: fatality management, information sharing, dealing with medical surges, and even volunteer management, along with emergency operations coordination. Cooley Dickinson Hospital is part of a health and medical coordinating coalition. Members include hospitals, public health facilities, long-term care facilities, community health centers, and EMSs. He also emphasized - as several of the guest lecturers this semester have - that relationships between these various entities have to be built before emergencies and disasters occur. Despite numerous documents and plans, when an emergency happens, the training and experience kick in, and no time should be wasted in response.

Mr. Rust also reinforced the importance of practice drills and mentioned a recent exercise that his hospital was involved in which simulated a norovirus outbreak post a wedding with twenty patents arriving in the emergency room in twenty minutes. He also spoke on the scheduling of hospital staff, and the replenishment of supplies and medicines, and the fact that older hospitals do not have much (if any) space for warehousing. He talked about the maximization of existing resources (great reference to operations research) and the strengthening of community health resources and emphasized that it is humans that play the most important roles.

In speaking about the different regulations (and associated organizations) he mentioned CMS (Center for Medical Services) and how it identified such key essentials in hospital emergency preparedness as: safeguarding human resources, maintaining business continuity, and protecting physical resources. A hospital is supposed to be operational and self-sufficient for 72 hours following a disaster. Towards that end, he noted how Cooley Dickinson has alternative fuel sources and also mentioned how generators on low levels of healthcare institutions flooded both during Hurricane Katrina as well as Superstorm Sandy (something I had also mentioned to the class).

One of my favorite takeaways and quotes from today's fabulous lecture, during which I took copious notes, was that "hospitals are a team sport."

He spoke about the hospital incident command center and how incident command centers evolved from battling fires (I had shown the students a video of the response to San Diego's fires of a while ago which illustrated precisely such an incident response system, so the analogy, although not perfect, was great for the students to hear).

More precisely, what are the challenges for hospital emergency preparedness (EP)? Mr. Rust identified the following challenges, reminding us, again, that hospitals are non-profits:

• hospitals compete with other hospitals
• EP can be complex and confusing
• it is costly to stock supplies and equipment that may be needed in emergencies
• it is labor-intensive to prepare 
• there is a low probability of high-impact large events
• "apathy" - it won't happen here
• defining triggers - when does it become an emergency, given that hospitals are involved in life or death decisions each and every day
• "storm of century" media hype.

And what have hospitals learned from the various events and experiences? They now have procedures and policies and understand the value of working in concert plus "in a disaster, we all have to be together as one."

After the class and so many very interesting questions from the students, we took the group photo below.

We are truly grateful to Mr. Brian Rust for taking the time out of his very busy professional schedule to share his very valuable insights and expertise on hospital emergency preparedness with us. This is a guest lecture that we will never forget. He was an amazing Professor for a Day at the Isenberg School!

Emergency Management in Healthcare

I am thoroughly enjoying teaching my Humanitarian Logistics and Healthcare class this semester at the Isenberg School of Management. The students are always willing to discuss and share their experiences and the time goes by much too quickly.

A very important feature of this class is the guest speakers that I bring in who are expert practitioners.

Mr. Thomas Lynch spoke on Emergency Management in Healthcare to my recently. (Since February 9 was a snow day at UMass and the university was closed, we are grateful that he was able to reschedule his talk for February 16.) He spent about two decades working in security and emergency management at Baystate Health in Springfield, Massachusetts, and, before that,  about 10 years working in security at Mount Sinai in Manhattan. He was a terrific Professor for a Day! He even brought multiple handouts for the student.

Baystate Health is a major trauma center in Massachusetts and Mr. Lynch shared with the students the importance of drilling, drilling, and drilling. When there was smoke next to an operating room, where a surgery was taking place, the medical team was prepared and had practiced and moved the patient (who was opened up) to another surgical unit where the surgery was successfully completed.

He provided the class with information on a hazard and vulnerability assessment tool for events that a hospital such as Baystate must be concerned about from hurricanes to snowfalls and now even tornadoes, since we had one in June 2011, as well as floods and droughts, along with the estimated probabilities and risk measurement.

There have been plans made that are derived from the hazards and vulnerability assessment for such incidents as: mass casualty, fire, weather events, hazmat (internal and external), bioterror, infant abduction (which worried him the most), evacuation, active shooter, a civil disturbance, and an IT outage.

He also shared with us that, after Hurricane Katrina, the costliest natural disaster in US history,  each hospital must prepare an emergency sustainability plan for 96 hours. This means that a hospital should be reliable/functional for 96 hours post a disaster without outside support. Hence, Baystate has a five day supply of food on hand. There is also a warehouse filled with pandemic supplies of 30 days. Since communications are essential to emergency preparedness and disaster relief, there is a backup phone system, cellphones for redistribution, and even 100 radios that can be put on a single frequency and a mobile satellite phone. The facility has 30,000 gallons on campus of fuel capacity which should be sufficient to sustain operations for 96 hours.

Mr. Lynch emphasized that it is important in an emergency to take care of yourself first and that is what the medical professionals are also trained to do. They also must take care of their families since otherwise they would be distracted about their welfare to do work. Only then does one worry about property.

It was very impressive to hear how the regional hospitals meet regularly to exchange best practices and also work with firemen and police departments. Relationships are critical and are built over time and they must be in place when an emergency or disaster strikes.

Mr. Lynch shared with us his varied experiences as to the responses various scenarios from barricades (which required rerouting of staff and ambulances) to shootings to a major explosion with 8 burn victims that were not readily identifiable. He also stated that when the Ebola crisis in western Africa peaked a few years ago that Baystate Health was one of a handful of centers in Massachusetts selected to be a treatment unit and it took them 18 months to prepare for this.

Mr. Lynch's presentation can be downloaded here.
 
Bay State Health (and we) are very lucky to have such a consummate emergency and security professional in our midst as Mr. Thomas Lynch and we thank him for all that he has done for our major hospital and its community!

Security and Emergency Management in a Major Hospital

Today, we had the great pleasure of hosting Mr. Thomas, Lynch, the Director of Security and Emergency Management at Baystate Health in Springfield, Massachusetts. This is a big level 1 trauma hospital, which, on some days, as happened last week with 397 patients, is the busiest hospital in terms of emergency room visits in Massachusetts. He has been the Director of Security at Baystate Health since 1995 and the Chair of the Emergency Management Committee for the Baystate Medical Center since 1997.  Prior to his arrival at Baystate, he served for 11 years as the Assistant Director of Security at Mt Sinai Medical Center in Manhattan and also served for 10 years as an officer in the Army Military Police Corps.

The title of Mr. Lynch's  presentation to my Humanitarian Logistics and Healthcare class was: Healthcare Emergency Management. 

Mr. Lynch emphasized the very dynamic, integrated process that is used in the hospital setting with an all hazards approach to emergency management. The challenges in such a setting are immense and his team, the hospital staff, and, of course, the medical professionals are constantly drilling and continuously improving their processes. He noted the importance of table top exercises and real drills.

He shared with us the following scenario: how an evacuation was handled from an Operating Room during surgery because there was smoke. Practicing fire drills had helped and the patient that was being operated on was moved safely to another room and the surgery completed. Think of the associated issues of sterility, for example.  

Mr. Lynch shared with us his wealth of experiences including the handling of VIP patients while he worked at Mt. Sinai Hospital in Manhattan. The VIPs, patients at separate times, included  a close relative of the Saudi king and a renowned Orthodox rabbi, whose supporters created surges. It was interesting to see, given that it was July, that there were men in raincoats around the hospital for the former (clearly with armaments beneath).

He emphasized all phases of disaster management, which we have been covering in class, and especially risk mitigation and the lessening of exposure to risk, with preparation and planning so that you can adequately respond. He said that more efforts should be spent on recovery. He noted how hospitals are accredited and the accrediting body shows up unannounced every three years (a bit different from the forthcoming AACSB team visit for the accreditation of our business school later this month). He also noted that Baystate Health in Springfield is one of three designated Ebola treatment units in Massachusetts and that unit is now complete after 1 1/2 years of planning and work.

Federal law requires that patients are treated according to the EMT law and the medical center has to prepare for surges of patients, as well. Sometimes, police assist in stopping influxes at the perimeter because there are only so many patients that can be handled. He spoke of surges, post 9/11, due to fears about anthrax.  At times, when there are casualties family members and friends can also cause congestion in the emergency rooms.

He emphasized "serving the most people that you can save" when it comes to a hospital evacuation and, ideally, one hopes just for a horizontal evacuation - to another part of the building, for example, rather than a vertical one (down stars). He mentioned a flood in Houston a few years back during which it took 8 staff members to carry patients down 6 flights of stairs.  We've learned from Superstorm Sandy that generators should not be in basements, which can flood.

He emphasized 3 things that are very important to remember and respond to in the order below:

1. Take care of yourself (this is hard sometimes for medical professionals who are always trying to save lives),

2. Take care of other people, and only then

3. Take care of property.

One has to manage the disaster and keep the hospital running, too. By federal law, a hospital is required to be self-sufficient, post a disaster, for 96 hours.

Mr. Lynch also noted the criticality of Medicare and Medicaid for the financial survival of a hospital and that immediately after an incident, the team gets together and identifies what can be done better. The focus on continuous improvement, I am sure, resonated with the Operations and Information Management and Industrial Engineering students in the class. He noted that similar incidents continue to happen so one must learn and improve and that could include getting a badge maker on site so that you can identify people promptly.

He also told the class that relationships matter with your partners and it makes matters so much easier and more seamless if you have good working relationships with the police and fire departments, the Department of Public Health, and also Homeland Security. He also emphasized that the Public Affairs department is crucial in dealing with the media since a hospital's reputation is very important.

The incidents that one worries about are so different from issues in the commercial space: mass casualties, which the hospital deals with on a regular basis, infant abductions, and, of course, surges, cases of violence, etc. I was also impressed that the incident commander can change from incident to incident depending on the situation and even time of day. The Chief Operation Officer, who is a female, would be in charge of many emergencies but the VP of Facilities would be in charge of those having to do with his responsibilities. At night, an administrator would be on call.

Mr. Lynch's presentation was very informative and fascinating and I am so grateful that such a professional would take tie out of his very busy schedule to share his experiences with my students. Having such guest speakers is invaluable for education.

His lecture can be downloaded here.

Operations Research and Healthcare with Dr. Hari Balasubramanian

As I mentioned in my previous post, with the new academic year upon us there are also many great events, including talks by speakers!

A wonderful colleague of ours, Professor Hari Balasubramanian, who was recently awarded an NSF CAREER Award, and with whom I had the pleasure of helping to organize the first Northeast Regional INFORMS Conference, which took place at UMass Amherst, will be giving what is sure to be a fascinating talk next week.

More information is on the flier below.

I hope that you can join us -- there is so much exciting research going on at the frontiers of Operations Research  (O.R.) and healthcare and this is an application where we Do Good with Great O.R.!

Blood Supply Chains, Risk Minimization, and Healthcare Operations

Blood is a life-saving "product" and, at the same time, it is highly perishable. Its delivery is also time-sensitive. In addition, since blood is not manufactured, there is risk associated with the supply side of the blood supply chains; that is, the blood drive sites.

Blood service operations are a key component of the healthcare system all over the world. According to the American Red Cross, over 39,000 donations are needed everyday in the United States, alone, and the blood supply is frequently reported to be just 2 days away from running out. Of 1,700 hospitals participating in a survey in 2007, a total of 492 reported cancellations of elective surgeries on one or more days due to blood shortages. While for many hospitals, the reported number of blood-related delays was not significant, hospitals with as many days of surgical delays as 50 or even 120 have been observed. Furthermore, in 2006, the national estimate for the number of units of whole blood and all components outdated by blood centers and hospitals was 1,276,000 out of 15,688,000 units.

Considering also the ever-increasing hospital cost of a unit of red blood cells with a 6.4% increase from 2005 to 2007 further highlights the criticality of this perishable, life-saving product. The New York Times reported in 2010 that this criticality has become more of an issue in the Northeastern and Southwestern states in the United States since this cost is meaningfully higher compared to that of the Southeastern and Central states. Moreover, hospitals were responsible for approximately 90% of the outdates, with this volume of medical waste imposing discarding costs to the already financially-stressed hospitals.

In the paper, "Supply Chain Network Operations Management of a Blood Banking System with Cost and Risk Minimization," my doctoral students, Amir Masoumi, and Min Yu, and I, developed a network optimization model for the complex supply chain of human blood. In particular, we considered a regionalized blood banking system consisting of collection sites, testing and processing facilities, storage facilities, distribution centers, as well as points of demand, which, typically, include hospitals.

Our multicriteria system-optimization approach on generalized networks with arc multipliers captures many of the critical issues associated with blood supply chains such as the determination of the optimal allocations, and the induced supply-side risk, as well as the induced cost of discarding the waste, while satisfying the uncertain demands as closely as possible. Indeed, since it may be difficult to predict the demand, it is essential to capture the uncertainty associated with the demand in an appropriate modeling and computational framework.

This research we will be presenting at the POMS Conference in Reno, Nevada, as well as at the Northeast Regional INFORMS Conference at UMass Amherst.

The supply chain network model for the optimization of blood supply chains is part of our growing body of research on healthcare-oriented supply chains with applications even in disasters. For example, results in the study, "Supply Chain Network Design for Critical Needs with Outsourcing," co-authored with Min Yu and Dr. Patrick Qiang, can also be applied in disaster relief.

It is especially gratifying to see students so engaged in research that can have a positive societal impact!

The Greening of the O.R. and Hospitals and Corporate Social Responsibility

Although we are living in a world of "throwaways" we are seeing an exciting convergence of corporate social responsibility, green logistics, healthcare, and even humanitarian operations through the recycling, redesign, and reprocessing of medical products and associated medical waste, so there is HOPE!

Interestingly, as The New York Times is reporting, in the article, "In a World of Throwaways, Making a Dent in Medical Waste," by Ingfei Chen, the biggest source of medical refuse is the operating room (O.R.), with 20-30% of a hospital's waste.

A nonprofit group in VA, Practice Greenhealth, is now working on reducing the environmental footprint of health care institutions with its Greening of the O.R. initiative, which is focusing on identifying the best sustainable practices for reducing operating room garbage, energy consumption, and indoor air quality problems, while lowering expenses and improving safety -- all fantastic goals! Reducing the waste associated with medical supplies and equipment,which can be achieved through recycling and reprocessing, for example, can save on new purchases and can also reduce landfill fees and incineration costs.

For example, according to the article, the Hospital Corporation of America, which owns 163 hospitals, eliminated 94 tons of waste last year through the reprocessing of medical supplies!

I am reminded of the similarity between medical waste and recycling and reprocessing issues to that of electronic recycling, or e-cycling, a topic that I have written about in the past, with Dr. Fuminori Toyasaki. Our paper, "Reverse Supply Chain Management and Electronic Waste Recycling: A Multitiered Network Equilibrium Framework for E-Cycling," remains as one of the top cited papers in Transportation Research E.

Dr. Ralph Pennino, the chief of plastic surgery at Rochester General Hospital in upstate New York, notes that surgeons have agreed to use standardized supply kits selected to cover most of their needs while leaving little unused, so that they can “work systems out so we don’t have anything to reprocess." This is said beautifully and speaks to the importance of designing health care supply chains and medical products accordingly, a topic that we have also been writing about, and where we specifically allow decision-makers to assign costs associated with oversupply/waste.

Dr. Pennino notes that leftover items are donated to InterVol, a nonprofit organization started in 1989 by him. Each week, its volunteers gather about 8,000 pounds of unused supplies and reusable equipment from regional health care facilities, then ship the stock to clinics in more than two dozen countries, including Somalia and Haiti. This is an example of the best in green logistics, healthcare, and humanitarian operations!