Except for some isolated trouble spots, healthcare hardly missed a beat during the first week of the United Parcel Service strike.
Still the prevailing calm could turn to panic if the familiar brown trucks remain parked for weeks.
Many hospitals have adopted just-in-time systems in which supplies show up at the loading dock within days or hours of their use. That reduces costly inventories but also makes hospitals more vulnerable to supply disruptions.
Shortages in medical-surgical and laboratory supplies could occur this week as stockpiles run low and alternative distribution systems, such as long-haul truckers, take time to kick in, said Larry Dooley, vice president for distribution services at VHA, an Irving, Texas-based healthcare alliance.
"I think it's too early in the strike to predict whether we're going to get through this thing unscathed," Dooley said.
But last week, many hospitals around the country were upbeat. They reported business as usual as UPS prioritized its remaining medical deliveries and other carriers picked up the slack. Many alert hospital administrators had stockpiled goods in anticipation of a strike.
In Philadelphia, strikers allowed about 20 UPS trucks carrying medical supplies to leave a distribution center.
Add to that the serendipity that demand for healthcare dwindles in August, when people tend to be healthier and elective procedures are postponed until after summer vacation.
"It's not affecting us at all," said John Clough, M.D., director of health affairs at Cleveland Clinic, which has been hoarding supplies since early July.
Yet there was some scrambling.
On the first day of the strike, a distributor for VHA's critical blood plasma program, which ships refrigerated plasma for surgeries on an expedited basis, found itself without a carrier. Federal Express, which has a contract with VHA, stepped in and agreed to take the business.
Even though UPS put a priority on delivering medical supplies already in its system by using managers, nonunion workers and subcontractors to make deliveries, some supplies didn't arrive on time.
At Waukesha (Wis.) Hospital System, two surgeries were postponed by a day and another proceeded with an orthopedic surgeon using tools he was "not as familiar with," said John Macisac, a vice president in charge of materials management and transportation.
"It's unbelievable to me that other areas of the country are faring much better than us," Macisac said.
Some 50% to 60% of hospital supplies arrive outside controlled distribution channels-that is, through independent shippers like UPS, Dooley said. There's every indication that healthcare shares the rest of the nation's disproportionate reliance on UPS.
"I can't think of a hospital in the United States that doesn't get a major delivery from UPS every day, sometimes twice a day," said Jamie Kowalski of Kowalski-Dickow Associates, a materials management consulting firm in Milwaukee.