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A systematic literature review of healthcare supply chain and implications of future research
Abstract
Purpose
This paper aims to review the healthcare supply chain (HSC) literature along various areas and to find out the gap in it.
Design/methodology/approach
In total, 143 research papers were reviewed during 1996-2017. A critical review was carried out in various dimensions such as research methodologies/data collection method (empirical, case study and literature review) and inquiry mode of research methodology (qualitative, quantitative and mixed), country-specific, targeted area, research aim and year of publication.
Findings
Supply chain (SC) operations, performance measurement, inventory management, lean and agile operation, and use of information technology were well studied and analyzed, however, employee and customer training, tracking and visibility of medicines, cold chain management, human resource practices, risk management and waste management are felt to be important areas but not much attention were made in this direction.
Research limitations/implications
Mainly drug and vaccine SC were considered in current study of HSC while SC along healthcare equipment and machine, hospitality and drug manufacturing related papers were excluded in this study.
Practical implications
This literature review has recognized and analyzed various issues relevant to HSC and shows the direction for future research to develop an efficient and effective HSC.
Originality/value
The insight of various aspects of HSC was explored in general for better and deeper understanding of it for designing of an efficient and competent HSC. The outcomes of the study may form a basis to decide direction of future research.
... Over the past few decades, the healthcare industry has been blooming global-wide and so does the expenditure of healthcare services [1]. According to the work of Shrank and his colleagues, the U.S. spends nearly 18% of the gross domestic product (GDP) in healthcare while approximately 30% of the budget may be considered waste [2]. ...
... While in China, national expenditure on health has been climbing up from 2016 to 2021, reaching over 10.8 trillion dollars in 2021 [3]. How to contain cost and in the meanwhile maintain high quality health service delivery, has been in the spotlight since the 1980s [1,4,5]. Due to the outbreak of COVID-19, economic burden of the disease becomes remarkably high [6] thus such attempt is an increasingly relevant topic. ...
... Nevertheless, leagility as a process improvement methodology addressing work redesign, it accelerates healthcare's transition towards digital technology which tremendously expand the capacity of healthcare organizations [16]. Research and applications have been conducted to transfer the lean concept from manufacturing industry to the field of health care [1,15,17,18], but the discussion of leagility strategy in health care settings arose only more recently [1,4,7,19]. ...
Background
Expenditure of healthcare services has been growing over the past decades. Lean and agile are two popular paradigms that could potentially contain cost and improve proficiency of the healthcare system. However no systematic review was found on leagilty in the healthcare research. This study aims at synthesizing the extant literature of leagility in the healthcare area to consolidate its potential and identify research gaps for future study in the field.
Methods
A systematic literature review is conducted following the PRISMA checklist approach. Studies were searched in multiple databases. The selection of articles was executed by dual-scanning of two researchers to ensure quality of data and relevance to the topic. Scientific articles published between January 1999 and November 2023 concerning leagile healthcare are analysed using Microsoft Excel and VOSviewer (version 1.6.18).
Results
Out of 270 articles identified from the inclusion and exclusion criteria, 24 were included in the review. A total of 11 target areas were identified in leagility applications in healthcare. Success and limiting factors of leagile healthcare were classified into macro and micro aspects and further categorized into six dimensions: policy, organization, human resources, marketing, operation management and technology. Moreover, four research gaps were revealed and suggestions were provided for future study.
Conclusion
Leagility in the healthcare context is still being in its infancy. Few empirical validation was found in leagile healthcare literature. Further exploration into the application of theory in various sectors under the scope of healthcare is appealed for. Standardization and modularization, leadership support, skillfulness of professionals and staff training are the factors most frequently mentioned for a successful implementation of leagility in the healthcare sector.
... Lack of training is one of the reason in implementation of lean supply chain management (Sharma et al. 2015 andDixit et al. 2019). The organization was not only hiring talented people, but also from providing proper training and innovation. ...
... To improve supply chain performance while lowering costs, more attention and work must be paid to a number of important issues, including employee and customer training, tracking and visibility of medicines, waste management, HR practises, risk management, and cold chain management (Dixit et al. 2019). Researchers and consultants have proposed a number of critical success factors to help companies implement lean and avoid costly failures (Netland 2015). ...
The objective of this study is to conduct a systematic literature review to identify the barriers and critical success factor that influence in implementation of Lean Supply Chain Management (LSCM) practices in industry. Through this systematic literature review (SLR), it is expected to identify the main gaps related to LSCM implementation in industry and discuss the relevance of research in this topic for indicating the future research direction. A SLR was developed and determined, which involved the selecting of keyword, developing of research question, searching and evaluation of literature for 53 research articles. The content of present of literature was reviewed, critically analysed and synthesised from the perspective of barrier and critical success factors that influence the implementation of LSCM. This study reveals that relationship with supplier, commitment and support by top management are the key critical success factor in lean implementation. Furthermore, the results showed that lack of management commitment and leadership, lack of training and skills, lack of system view or strategy are the barriers in lean implementation. Based on the extensive systematic review of literature, we found of the consistency data between Barriers and Critical Success Factor. This study extends previous studies on LSCM, strengthens the body of knowledge on the issue and consolidates the key LSCM activities, barriers and critical success factors associated with its implementation. The clear identification of these topics can allow researchers and practitioners to predict occasional problems and to set the right standards for the implementation of LSCM.
... Safeguarding healthy lives and promoting community wellbeing is essential to sustainable development (SDG 2019). All countries are doing their best to ensure the delivery of quality healthcare services with enhanced operational efficiency and reduced costs (Dixit et al., 2019;Nayal et al., 2022). However, due to global climate change patterns and unprecedented human activities, pandemics and epidemics have increased their frequency and intensity, most recently with COVID-19. ...
... Previous studies (Aksin-Sivrikaya and Bhattacharya, 2017; Wamba et al., 2020) find that, to leverage the operational efficiency of the healthcare sector, current healthcare Supply Chain Management (SCM) practices need to be digitalized because of new Information and Communications Technology (ICT) disruptions and increased outsourcing (Dixit et al., 2019;Sapci and Sapci, 2019). There is a tremendous amount of data generated across all phases of healthcare operations due to the advancement in ICTs, driving a need for healthcare organizations to move away from traditional supply chains (SCs) toward Big Data-Driven Pharmaceuticals Supply Chains (BDDPSCs) to handle unexpected situations like COVID-19 (Chakraborty and Paul, 2022). ...
... Applications of HCC in the context of LSCM and models can be seen in recent review papers in a number of studies [6][7][8][9][10]. For example, Dixit et al. [6] conduct a literature review for Healthcare supply chain. ...
... Applications of HCC in the context of LSCM and models can be seen in recent review papers in a number of studies [6][7][8][9][10]. For example, Dixit et al. [6] conduct a literature review for Healthcare supply chain. According to the authors, future research directions are suggested for employee training, tracking and visibility, cold chain management, risk management, and waste management. ...
... Safeguarding healthy lives and promoting community wellbeing is essential to sustainable development (SDG 2019). All countries are doing their best to ensure the delivery of quality healthcare services with enhanced operational efficiency and reduced costs (Dixit et al., 2019;Nayal et al., 2022). However, due to global climate change patterns and unprecedented human activities, pandemics and epidemics have increased their frequency and intensity, most recently with COVID-19. ...
... Previous studies (Aksin-Sivrikaya and Bhattacharya, 2017; Wamba et al., 2020) find that, to leverage the operational efficiency of the healthcare sector, current healthcare Supply Chain Management (SCM) practices need to be digitalized because of new Information and Communications Technology (ICT) disruptions and increased outsourcing (Dixit et al., 2019;Sapci and Sapci, 2019). There is a tremendous amount of data generated across all phases of healthcare operations due to the advancement in ICTs, driving a need for healthcare organizations to move away from traditional supply chains (SCs) toward Big Data-Driven Pharmaceuticals Supply Chains (BDDPSCs) to handle unexpected situations like COVID-19 (Chakraborty and Paul, 2022). ...
During an emergency, there are many activities in a pharmaceutical supply chain (PSC) which are rendered ineffective. This study aims to propose a holistic approach for Big Data Driven Pharmaceuticals Supply Chain (BDDPSC) during medical emergencies. During unprecedented situations, the quality of healthcare services by using traditional supply chain becomes a challenge. The current study aims to generate a model wherein multiple entities will be the part of data entries like hospitals, clinical trials, medical practitioners, and drug manufacturing companies during COVID-19. The study has considered certified medical practitioners as the experts and based their responses for proposing a theoretical framework deploying E-Delphi-Qualitative Data Analysis approach. By critically examining experts' responses and comments, the study formulated four major themes and ten sub-themes for smooth functioning of BDDPSCs during an emergency. The E-Delphi was conducted in two rounds to reach final consensus and to find a balance for PSC in terms of efficiency and quality. This research is novel wherein big data enabled PSC theoretical model has been formulated using a qualitative approach for handling COVID-19. The proposed framework provides an enriched way to capture data from the important link viz. "health officials" of PSCs.
... Dixit & Routroy [8] indicate that supply chain operations, performance measurement, inventory management, lean and agile operation, and application of information technology are thoroughly researched, but employee and customer training, tracking and visibility of medicines, cold chain management, human resource practices, risk management, and waste management demand more extensive investigations. To thoroughly analyze the related former studies, a review has been carried out in the healthcare supply chain, cold chain, and supply chain during epidemic outbreaks. ...
... As shown in Fig. 5, the flow of pharmaceuticals requiring Table 3 The difference in the number of set members with considering clustering or not. (5,8,10,12) CS and CAS is separated to showcase the cold chain flow. This figure depicts the supply chain with four suppliers, a DH, and three hospitals with local pharmacies, as mentioned before, and the flow of pharmaceuticals from day 60-70. ...
As an abrupt epidemic occurs, healthcare systems are shocked by the surge in the number of susceptible patients' demands, and decision-makers mostly rely on their frame of reference for urgent decision-making. Many reports have declared the COVID-19 impediments to trading and global economic growth. This study aims to provide a mathematical model to support pharmaceutical supply chain planning during the COVID-19 epidemic. Additionally, it aims to offer new insights into hospital supply chain problems by unifying cold and non-cold chains and considering a wide range of pharmaceuticals and vaccines. This approach is unprecedented and includes an analysis of various pharmaceutical features such as temperature, shelf life, priority, and clustering. To propose a model for planning the pharmaceutical supply chains, a mixed-integer linear programming (MILP) model is used for a four-echelon supply chain design. This model aims to minimize the costs involved in the pharmaceutical supply chain by maintaining an acceptable service level. Also, this paper considers uncertainty as an intrinsic part of the problem and addresses it through the wait-and-see method. Furthermore, an unexplored unsupervised learning method in the realm of supply chain planning has been used to cluster the pharmaceuticals and the vaccines and its merits and drawbacks are proposed. A case of Tehran hospitals with real data has been used to show the model's capabilities, as well. Based on the obtained results, the proposed approach is able to reach the optimum service level in the COVID conditions while maintaining a reduced cost. The experiment illustrates that the hospitals' adjacency and emergency orders alleviated the service level significantly. The proposed MILP model has proven to be efficient in providing a practical intuition for decision-makers. The clustering technique reduced the size of the problem and the time required to solve the model considerably.
... La gestión de la cadena de suministro hospitalaria (HSCM) se define como como la secuencia de flujos físicos y de información necesarios para entregar un buen servicio a los pacientes al menor costo posible (1). Además, se considera una práctica organizativa para obtener una ventaja competitiva. ...
... 28 | No. Suppl | ISSN 0121-750X | E-ISSN 2344-8393 | e18987 | contribuyan a mejorar la gestión de la cadena de suministro. Sin embargo, la existencia de múltiples actores en la red, la complejidad del servicio y el entorno social, político y económico de estas organizaciones obstaculizan una implementación exitosa de la HSCM (1). ...
Contexto: El sector de la salud se ha enfrentado continuamente a los desafíos de disminuir costos y mejorar la calidad asistencial. Las investigaciones de la cadena de suministro en el sector salud han alcanzado un mayor interés en la comunidad científica. Se han publicado varios artículos relacionados con el tema, los cuales se centran en aspectos como el desempeño de la cadena, enfoques de gestión, administración de inventarios, evaluación y selección de proveedores, y algunos otros con áreas de enfoque más amplias.
Método: Este artículo presenta una revisión de literatura y un análisis bibliométrico. El análisis comienza identificando los estudios publicados en los últimos diez años. Luego, se emplean herramientas bibliométricas que permiten identificar temas claves de investigación, sus interrelaciones y patrones de colaboración.
Resultados: Esta investigación ayuda a ilustrar gráficamente las publicaciones sobre gestión de la cadena de suministro hospitalaria (HSCM), presentar la evolución a lo largo del tiempo e identificar áreas de interés de investigación actual y posibles líneas de investigación para el futuro. Los resultados identifican el estado de desarrollo y las principales tendencias en términos de impacto, principales revistas, artículos, temas, autores y países.
Conclusiones: Las futuras investigaciones pueden concentrarse en estudios más innovadores desde múltiples dimensiones: cadena de suministro, gestión y organización, servicios de salud administración de operaciones, sostenibilidad, desempeño, contexto y tendencias.
... Over the last 40 years, the Spanish health system has evolved to the competitive levels of the best European public health systems [4]. However, today the ratio of health investment to gross domestic product (GDP) in Spain continues to be lower than in neighboring countries [5]. The improvement in the health sector has not been accompanied by an evolution in the more efficient management of available resources [6]. ...
... The Farmastock implementation is in line with the development and implementation of health inventory management in national health systems. In healthcare, inventory management is essential because it directly impacts the availability of medicines and the efficiency of the system [5,31]. Moreover, future implementation of our tool should be carried out with guidelines that integrate these procurement and inventory management activities, and medicines use management. ...
IntroductionDue to their impact on healthcare systems, the sustainability and optimization of high-cost drugs is an issue of concern for several countries. Different strategies have been implemented such as centralized purchasing to optimize budgetary resources. However, there is still a need for a mechanism to optimize these drugs further.Methods
We conducted this prospective multicenter intervention study in five hospitals in the Andalusian Public Health System of Cádiz (Spain) between July 2019 and September 2021. We developed an online website (Farmastock) and implemented it to determine the availability of high-cost, low-use, and near-expiry medicines in each hospital. We used a simple analysis using operational variables to assess the project intervention's savings impact on managing these high-cost drugs.ResultsThe implementation of Farmastock in Cádiz resulted in savings of 675,757.52 € for the Andalusian Public Health System, with 238 medicines transferred out of the 373 available. Of these medicines offered, the most considerable percentage were medicines used for pathologies with high clinical instability and accounted for nearly 80% of the medicines optimized by the tool.Conclusions
Farmastock allowed the Andalusian Public Health System to make substantial financial savings by not making new purchases of high-cost drugs available in other centers of this health network that were not being used. Therefore, this tool is a very efficient measure to contribute to the sustainability of the APHS and could be implemented in more hospitals soon.
... In the past few decades, the healthcare field has been grown exponentially because of increasing general awareness and globalization. However, in spite of this, the global healthcare sector is influenced by major hindrance from legislative and regulatory barriers, as well as globalization and expensive costs (Taddesse et al., 2015;Dixit et al., 2019). ...
... Globally, healthcare providers and regulators are striving to continually make improvements in safety and quality across healthcare [1,2]. The emergence of standards, tools and templates has enabled measurable improvement in patient outcomes and service provision [3]. ...
Quality and safety in healthcare have emerged as key factors impacting on both clinical effectiveness and clinical outcomes. While improving the healthcare supply chain has been extensively researched, the impact of the healthcare supply chain on clinical safety has received little attention in the literature, largely due to the complexity of such studies and the involvement of multiple stakeholders. This research proposes an evaluation model using key performance measurements for an electronic procurement system that enables digital transformation of the healthcare supply chain. The model will be tested before and after the introduction of an electronic procurement system in the healthcare supply chain for small and medium sized healthcare providers to provide evidence of both the usefulness of the model itself within industry and to further contribute to the knowledge base. Future use of the model may provide benchmarking and important data and insights to enable enhanced clinical safety in the healthcare supply chain.
... The health industry's supply chain is crucial (Dixit et al., 2019;Leksono et al., 2019). Notably, the cold supply chain (CSC) is gaining adequate attention in the health sector owing to its ability to deliver products with temperature-sensitive and temperature-control mechanisms (Bamakan et al., 2021). ...
Health 4.0 actively focuses on cold supply chains (CSCs) due to digital transformation and technological advancements in refrigeration. With the ill effects of climate change and greenhouse gas emissions, countries globally seek sustainable supply chain management. In this context, integrating sustainability with CSCs becomes crucial. Health sectors actively consider CSC for their activities. In this context, to gain potential suppliers for healthcare management, the present work focuses on grading suppliers from the CSC with sustainability factors. Previous related studies on sustainable cold chain supplier selection (CSSS) (i) have not modeled uncertainty effectively, and (ii) have yet to use any approach under fuzzy Z-numbers information. Therefore, this paper developed an integrated framework, including the Logarithm Methodology of Additive Weights (LMAW) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) methods based on extended fuzzy Z-numbers. The practicality of the framework is exemplified via a case example within the Indian health sector, and results indicate that job creation, value price, and productivity via renewable resources are the most critical factors. Moreover, regarding the findings, the economic dimension is the foremost pillar for effective selection. Sensitivity and comparison analyses are performed to understand the efficacy of the integrated framework as well. The proposed framework could contribute to the relevant literature due to its capacity to cope with complex decision-making problems and find many application areas in engineering.
... Commonly, consumers are not aware of the risks posed by medical devices because errors are not revealed to the public (Makary and Daniel, 2016). Furthermore, the health-care centre trains and practises its ethics and professionalism to uphold the importance of its medical professionals' commitment and self-regulation (Dixit et al., 2019). Patients are also facing knowledge challenges and limitations in dictating the related medical procedures (Boehmer et al., 2016). ...
Purpose
Infection and cross-contamination have been massive concerns in the medical field. This study aims to investigate consumers’ awareness and their choices of endoscopes, which may deter them from the cross-contamination problem.
Design/methodology/approach
A discrete choice experiment survey was administered to 166 respondents in Penang, Malaysia. Participants were asked to make hypothetical choices and estimate their preference for endoscopes. The multinomial logit model was used to estimate the assumptions based on the stated preference data collected.
Findings
Only two-fifths of respondents are aware of their rights regarding endoscope selection. The findings are consistent with utility theory, where choices are made to maximise personal satisfaction. If given the choice, consumers preferred the single-use endoscope over the reusable or the doctor’s preferred endoscope. Price, insurance coverage and personal income are significant determinants of the consumer’s choice of endoscopes.
Research limitations/implications
This study only investigates subjects living in Penang. Other possible important attributes to endoscope choices, such as environmental and device availability may be considered in future study.
Practical implications
The findings may create awareness among consumers about their rights when choosing medical devices. It may also improve health-care institutions’ (users’) and device manufacturers’ (industry players’) understanding of consumer needs and demands from socioeconomic perspectives.
Social implications
The research offers insights into consumer rights and awareness of health-care services. Ultimately leading to better policy to protect consumers’ rights and safety.
Originality/value
This study contributes to the rare literature on consumer rights toward medical devices, in particular, the consumer’s awareness of the choice of endoscopes.
... Hospital drug inventories are difficult to manage as each hospital manages a combination of drugs with different characteristics (demand, shortage frequency, etc.). Drug shortages and criticality level of drugs influence the performance of the system with respect to total cost and number of stock-outs and directly impacts the customer service level (availability of drug) and overall system efficiency (Dixit et al., 2019). In this paper, we propose a mathematical model for the inventory management of the hospitals considering their most important uncertainty, i.e., shortages, and their most important tool against shortage, i.e., substitute drug or supply alternatives. ...
We study the inventory review policy for a healthcare facility to minimize the impact of inevitable drug shortages. Usually, healthcare facilities do not rely on a single source of supply, and alternative mechanisms are present. When the primary supplier is not available, items are produced in-house or supplied through another supplier, albeit with additional cost. Our aim in this study is to determine how optimal inventory parameters are adjusted depending on the availability of the primary supplier. We show that an approximation provides trivial results, yet fails to capture the nuances therein. Our proposed Markov chain model overcomes these issues, and numerical results illustrate the significant economic impact of inventory parameter optimization. Furthermore, we simulate uncertainty scenarios and provide sensitivity analyses concerning fixed ordering cost for the secondary supplier, shortage frequency, shortage duration, and demand rates.
... EHR may strengthen information processing capacity in an increasingly uncertain COVID-19 environment. Consistent with prior supply chain research applying OIPT [31,42,43] we consider OIPT as a critical lens in studying the beneficial effects of EHR in improving the relative COVID-19 and non-COVID-19 capacity allocations [17]. Based on OIPT, EHR allows for horizontal (among hospitals and care providers) and vertical (among labs and pharmacies) relationships through improved contact intensity, greater liaison, and stronger integration necessary to improving COVID-19 related response [44]. ...
Managing flexibility in the relative bed allocation for COVID-19 and non-COVID-19 patients was a key challenge for hospitals during the COVID-19 pandemic. Based on organizational information processing theory (OIPT), we propose that the local electronic health record (EHR) systems could improve patient outcomes through improved bed allocation in the local area. In an empirical analysis of county-level weekly hospital data in the US, relative capacity of beds in hospitals with higher EHR was associated with lower 7-, 14-, and 21-day forward-looking COVID-19 death rate at the county-level. Testing for cross-state variation in non-pharmaceutical interventions along contiguous county border-pair analysis to control for spatial correlation varying between state variations in non-pharmaceutical intervention policies, 2SLS analysis using quality ratings, and using foot-traffic data at the US hospitals our findings are generally supported. The findings have implications for policymakers and stakeholders of the local healthcare supply chains and EHR systems.
... Studies have also shown that people only choose private hospitals when they are dissatisfied with the quality of care they receive from public healthcare providers. They force clients to spend more dollars to receive the required level of service [14]. Paying more on treatment options, clients are becoming more inquisitive & expecting supplemental facilities to receive the quality of services above their anticipations, as well as purely any instance of discontentment manages to pressure them to continue moving towards other competing companies, clients now request accurate and complete data before actually utilizing any type of service by a specific healthcare association [15] As a result, the management of all service organizations places considerable importance on the service quality arrangement, and hospitals should pay particular attention to providing excellent medical care as well as quality support to their customers [16]. ...
... According to reviews in the literature, the healthcare supply chain has not yet been extensively studied. Only a few aspects of this supply chain have been analyzed, such as strategic issues, the functioning of chain processes, and decision-making (Dixit et al., 2019). ...
The healthcare supply chain is a complex and multifaceted entity. A poorly functioning healthcare supply chain can directly affect patient health and facility performance. The task of this paper is to examine the most significant aspects of supply chain risk management in the healthcare industry. The review was carried out by analyzing the literature for keywords in major databases. Based on the authors' literature research, the most important factors related to the supply chain are presented. In addition to supply chain risk assessment, other factors closely related to the supply chain are considered. Since the outbreak of the Covid-19 pandemic, the topic of supply chain risk management has received much more attention from scientists and researchers. Before, the field had not been the subject of much research activity.
... However, multi-echelon inventory management is strongly dependent on the performance of drugs suppliers and distribution centres [24]. Consequently, optimizing the PSC operations while considering inventory levels would be beneficial to achieve higher profit margins as well as higher service levels [25]. ...
In this paper, a global simulation optimization approach is developed to imitate and optimize the performance of the Pharmaceutical Supply Chain (PSC). Firstly, a hierarchical hybrid simulation model is developed in which aggregate and detailed data levels are addressed simultaneously. The model consists of two types of interdependent paradigms: the system dynamics paradigm, which depicts the echelons of pharmacies and wholesalers in the PSC, and the discrete event paradigm, which simulates the manufacturers with their detailed production operations, as well as the echelons of suppliers. Secondly, the "As is" scenario analysis and a screening process are performed to extract significant input parameters as well as sensitive outputs of the model. The final step optimizes the performance of PSC. The proposed approach validity is appraised by being applied to the PSC of a leading pharmaceutical company in Jordan. As a result, the opportunity loss cost has considerably decreased for both the manufacturer and wholesalers’ echelons and the service level has improved throughout the PSC.
... Supply chain management provides a significant impact on better access to health services. 29,30 This is certainly very useful in supporting the performance of doctors in NIDDM chronic disease services, where patients with NIDDM need access to health services for the management of their disease throughout their life. Factor 2 is a safety construct consisting of three theme items, namely confidentiality of medical data and legality, reliability and early warning. ...
Background:
Research on the quality scale of the healthcare supply chain is still limited. This study aimed to assess the information quality of the supply chain model with a focus on construct validity. Studies related to information quality measurement generally focus on measuring the dimensions of the completeness of medical records and consumer perspectives. We intended to assess the scale based on doctors needed as care coordinators on type 2 diabetes mellitus or the Non-Insulin-Dependent-Diabetes-Mellitus (NIDDM) program in primary healthcare.
Methods:
Sixty-four primary healthcare doctors with an age range of 24-51 years were involved in this research. The scale obtained was formed from the assessment of the point of view of a panel of experts through the content validity index (CVI). The exploratory factor analysis (EFA) method was used to explore the scale of information quality in the information supply chain model for the NIDDM chronic disease management program.
Result:
The data analysis results indicated three main factors that affected the quality of the information supply chain model of NIDDM, namely accessibility, safety, and efficiency of information related to NIDDM. The results of the validity and reliability of the data showed that the scale used in this research was valid and reliable with a Cronbach alpha coefficient of 0.861.
Conclusion:
The scale developed in this research could be used to explore the quality of the information supply chain of NIDDM management in primary healthcare. Each item on the scale could explain the variables according to their respective groups.
... 3 Thereby, a well-functioning inventory management operation minimizes shortage and wastage of life-saving TMs 4 and is a basis for supply chain efficiency and effectiveness. 5 This could help the health sector to properly utilize scarce resources and ensures a steady supply of health products to meet the high standard of patient care. Consequently, the public health sector achieves its performance objective by cost reduction while improving customer satisfaction levels. ...
Background:
Inventory management ensures access to tracer medicines (TMs) for priority health-care needs. Factors that impede its performance across primary health-care units (PHCUs) are less explored in Ethiopia. The current study assessed factors affecting the inventory management performance of TMs across PHCUs, Gamo zone.
Methods:
A cross-sectional survey was conducted in 46 PHCUs between April 1 and May 30, 2021. The data were collected using document review and physical observation. A stratified simple random sampling was employed. The data were analyzed by SPSS version 20. The results were summarized as mean and percentage. Pearson's product-moment coefficient and ANOVA were employed at a 95% CI. The correlation test established the relationships between dependent and independent variables. ANOVA test compared the performance between PHCUs.
Results:
The inventory management performance of TMs across PHCUs is below the standard. On average stock according to the plan is 18%, the stock-out rate is 43%, the inventory accuracy rate is 78.5%, and availability across PHCUs is 78%. 72.3% of visited PHCUs fulfill storage condition criteria. Inventory management performance decreases downward the levels of PHCUs. There is a positive correlation between the availability of TMs and supplier order fill rate, r = 0.82, p < 0.01; between the availability of TMs and report accuracy, r = 0.54, p < 0.001; and between TMs stocked according to the plan and supplier order fill rate, r = 0.46, p < 0.01. The inventory accuracy was significantly different between primary hospitals and health posts (p = 0.009, 95% C.I = [7.57, 60.93]); and health centers and health posts (p = 0.016, 95% CI = [2.32, 25.97]).
Conclusion:
The inventory management performance of TMs is below the standard. It is attributable to supplier performance, the quality of the report, and performance variation across PHCUs. These result in the interruption of TMs in PHCUs.
... The era of data-driven technology has enabled it to handle massive amounts of medical data. The healthcare sector has grown tremendously in recent decades because of increased awareness and technological advances (Dixit, Routroy, & Dubey, 2019); other disruptions that health systems have faced include unavailability, inaccessibility, overcrowding, unaffordability, resulting in long wait times, and length of stays (Almeida & Vales, 2020;Supeekit, Somboonwiwat, & Kritchanchai, 2016). ...
The importance of supply chain management to business operations and social growth cannot be overstated. Modern supply chains are considerably dissimilar from those of only a few years ago and are still evolving in a vastly competitive environment. Technology dealing with the rising complexity of dynamic supply chain processes is required. Robotics, machine learning, and rapid information dispensation can be supply chain transformation enablers. Quite a few functional supply chain applications based on Machine Learning (ML) have appeared in recent years; however, there has been minimal research on applications of data-driven techniques in pharmaceutical supply chains. This paper proposes a machine learning-based vendor incoterm (contract) selection model for direct drop-shipping in a global omnichannel pharmaceutical supply chain. The study also highlights the critical factors influencing the decision to select a vendor incoterm during the shipment of pharmaceutical goods. The findings of this study show that the proposed model can accurately predict a vendor incoterm (contract) for given values of input parameters. This comprehensive model will enable researchers and business administrators to undertake innovation initiatives better and redirect the resources regarding the direct drop shipping of pharmaceutical products.
... The value of the global pharmaceutical industry has grown remarkably over the past decade with increased demand for the product's efficacy (Dixit et al., 2019). However, issues such as medicines shortages (Vogler and Fischer, 2020), counterfeiting (de Lima et al., 2018), inaccessibility, antimicrobial resistance (World Health Organisation, 2019) and pharmaceutical fraud (Flynn, 2021) increase its vulnerability. ...
Purpose
This study aims to explore the effect of power-based behaviours on pharmaceutical supply chain (PSC) resilience.
Design/methodology/approach
This study used a mixed-method approach to explore the role of power-based behaviours in PSC resilience. Qualitative interviews from 23 key PSC stakeholders, followed by thematic analysis, revealed the underlying perceptions regarding PSC resilience. Quantitative propositions were then developed based on the themes adopted from PSC resilience literature and the qualitative findings. These were tested via a survey questionnaire administered to 106 key stakeholders across the various levels in the PSC. Structural equation modelling with partial least squares was used to analyse the data.
Findings
The data analysed identified proactive and reactive strategies as resilience strategies in the PSC. However, power-based behaviours represented by quota systems, information and price control influenced these resilience strategies. From a complex adaptive system (CAS) perspective, the authors found that when power-based behaviours were exhibited, the interactions between PSC actors were mixed. There was a negative influence on reactive strategies and a positive influence on proactive strategies. The analysis also showed that PSC complexities measured by stringent regulations, long lead times and complex production moderated the effect of power-based behaviour on reactive strategies. Thus, the negative impact of power-based behaviours on reactive strategies stemmed from PSC complexities.
Research limitations/implications
This research particularly reveals the role of power-based behaviours in building PSC resilience. By evaluating the nexus from a CAS perspective, the analysis considered power-based behaviours and the moderating role of PSC complexities in developing resilience strategies. This study considers the interactions of PSC actors. This study shows that power asymmetry is a relational concept that inhibits the efficacy of reactive strategies. This study thus advocates the importance of power in achieving a more resilient PSC from a holistic perspective by highlighting the importance of the decision-making process among supply chain (SC) partners. The findings are particularly relevant if PSC resilience is viewed as a CAS. All the interactions and decision-making processes affect outcomes because of their inherent complexities. Although this study focused on the PSC, its implications could be extended to other SCs.
Practical implications
The authors identified that power-based behaviours influenced resilience strategies. It was detrimental to reactive strategies because of the complexities of the PSC but beneficial to proactive strategies through resource-sharing. PSC actors are therefore encouraged to pursue proactive strategies as this may aid in mitigating the impact of disruptions. However, power-based behaviours bred partner dissatisfaction. This dissatisfaction may occur even within strategic alliances indicating that power could be detrimental to proactive strategies. Therefore, it is pertinent to identify conditions that lead to dissatisfaction when pursuing strategic partnerships. This study provides insight into actual behaviours influencing resilience and quantifies their effects on the PSC. These insights will be valuable for all SC partners wanting to improve their resilience strategies.
Originality/value
Previous PSC management and resilience studies have not examined the role of power in building resilience in the PSC. This paper thus provides a unique contribution by identifying the role of power in PSC resilience, offers empirical evidence and a novel theoretical perspective for future practice and research in building PSC resilience strategies.
... -implement the vehicle routing system in the supply chain of the medicines during emergency times. 7 Dixit, Routroy, Dubey and Marketing [18] Review the existing literature on healthcare supply chain (HSC) and to find the gap in it. It has recognised and analysed the existing issues that are relevant to HSC and also showing a direction towards future research to develop effective and efficient HSC. ...
Abstract:
Numerous studies in the field of measuring the quality of service in healthcare have been conducted; however, researchers have not reached a consensus on the critical factors that are sufficiently rigorous to link and measure the healthcare service quality based on the supply chain preparedness. This has triggered the need to review the literature pertaining to the impact of supply chain management and preparedness on healthcare service quality to draw lessons from the literature. The studies that have been published between the period of 2015-2020 were reviewed. Two authors independently reviewed the eligibility of the studies, extracted data from the included studies, and appraised the risk of bias and quality of the study. The purpose, methodology, results, and recommendation of all the selected articles have been critically analyzed and synthesized. Based on the evaluation and analysis of the articles, it is evident that there are different factors that play the diverse roles of determinants and barriers of implementing a responsive supply chains in the healthcare system in order to improve and maintain healthcare services. It is examined through the study of different articles that by taking certain crucial factors into consideration. Different studies highlight different aspects that are crucial towards understanding the implications, benefits, as well as barriers and challenges of implementing supply chain management in the healthcare system and how it is the future of lean and agile supply chains in order to amplify and improve the healthcare service quality.
Keywords:
supply chain preparedness, healthcare, service quality, agility, content analysis, literature review
Background: The supply chain of hospital services is a relatively new and highly challenging field, and it is crucial for relevant officials to possess the necessary skills. The success in this domain relies on the characteristics of managers, their management practices, and their leadership style. This study aims to investigate the requirements of management and leadership in hospital services’ supply chain. Methods: This study employed a two-stage mixed-methods approach carried out from 2018 to 2021. In the first stage, a qualitative study was conducted using purposive sampling and semi-structured in-depth interviews with 15 experts in various leadership positions. The data collected in this stage were analyzed using framework approach. Subsequently, the primary themes that emerged from the analysis were presented to 8 experts in the form of a questionnaire. The experts' responses were then analyzed to determine the level of agreement on different topics using Delphi method, Kendall's coefficient of agreement, and the mean was compared through SPSS 21. Results: The experts identified transformationalism, planning capability, crisis management, and creativity as the most crucial factors. Furthermore, there was a high level of agreement regarding the influence of managers (4.62 ± 0.51), maintaining distance from mundane routines (4.50 ± 0.53), and attending to various incidents in hospital services supply chain (4.50 ± 0.53). Considering that Kendall Rank Correlation Coefficient (w) was 0.53 in the first round and 0.72 in the second round and was statistically significant, there was a strong consensus among the expert panel. Conclusion: According to the results of the present study, it is necessary to pay serious attention to the change in management style and hospital services supply chain, there should be a special focus on the possibility of occurrence or impact of sudden accidents. Also, routine and ineffective actions should be eliminated and the managers and employees should be more creative to improve this chain. Transformational leaders should try to manage the hospital services supply chain by forming specialized teams and using the capabilities of employees with the reasonable use of financial resources and appropriate infrastructures, including information technology.
Presence of numerous competing suppliers along with conflicting evaluation criteria, increased participation and expectations of the stakeholders having varying interest, uncertainty in demand and supply, and lack and vagueness of information make healthcare supplier selection a challenging task which can be effectively solved with the application of multi-criteria decision making (MCDM) methods in fuzzy environment. This paper proposes a two-stage methodology for solving a supplier selection problem in the Indian healthcare scenario. Four efficient suppliers are first shortlisted from a pool of 25 candidate pharmaceutical suppliers using data envelopment analysis based on nine pivotal financial metrics. In the second stage, three MCDM techniques, in the form of weighted aggregated sum product assessment (WASPAS), combinative distance-based assessment (CODAS) and combined compromise solution (CoCoSo) are individually integrated with intuitionistic fuzzy (IF) set to identify the most apposite healthcare supplier on the basis of five qualitative criteria (cost, delivery time, service, quality and flexibility). It is interestingly noticed that all the adopted MCDM techniques behave similarly in selecting the best supplier in IF environment. A sensitivity analysis with respect to changing criteria weights is also carried out to search out the most robust IF-MCDM method.
Understanding the prospective of blockchain technology and its uses in the healthcare sector is essential so that its considerable implementation can support the industry’s much-needed digitization. Furthermore, blockchain can provide answers to the issues in the healthcare industry today. Blockchain’s features like security, traceability, transparency, cost efficiency etc. can help bring supply chain transparency, health record management and prevent drug counterfeiting. Blockchain has emerged as a promising technology with great ability to bring changes to the healthcare sector. Therefore, this study aims to comprehend the current state of blockchain technology research in the healthcare supply chains. Further, it presents potential repercussions and the potential routes it may open for future research initiatives in this area. A systematic literature (SLR) process has been used and conducted in two stages. In the first stage, articles were identified through literature search and were subjected to keyword selection, database search and screening process. Finally, 124 papers were categorized through bibliographic coupling. A detailed investigation of these included papers was performed in the second stage with descriptive and content analysis. The results reveal that research related to blockchain applications or implementation is at a nascent stage. The publications in this area have been rising steadily over the past few years. When it comes to publishing in this field, India is the most productive nation while IEEE Access is the most productive journal. Applications for blockchain technology in healthcare include medical insurance, remote patient monitoring, medication supply chain management, electronic health records (EHRs), and more. The most popular use case is EHR management. The analysis further conveys that findings are less generalizable due to more theoretical or less empirically designed studies published in this domain. This study will help stakeholders, policymakers, researchers, and managers in taking strategic decisions regarding the adoption of the technology in the healthcare industry. This study is done concerning the blockchain’s use in the healthcare sector context, so other emerging technologies and sectors not taken must be considered while generalizing the results. This study is among the few up-to-date consolidated attempts to present a systematic literature review and bibliometric analysis for assessing blockchain technology’s potential in the healthcare sector. It provides an overview of the published work with implications and proposed cluster-wise future research directions.
A distributed and decentralised ledger system shared by a variety of users in a peer-to-peer network is defined as a blockchain. Through its decentralised approach, it makes pharmaceutical products more accessible and secure for vendors, while they can maintain and access their inventories themselves. Between a company and its suppliers, a supply chain is used to produce and distribute a specific product or service, whose efficiency is increased with its integration in the supply chain. For efficient and transparent tracking of products, blockchain will be the right choice. In view of blockchain being incorporated into the supply chain system, it solves many logistical issues that supply chains face, such as appropriate data access, ensuring data quality, and many more. This can increase the traceability of the material supply chain and improve the maintenance of the list when there are several products to be supplied. Therefore, the concept of supply chain was developed in two platforms namely, Hyperledger Fabric and Hyperledger Sawtooth. Finally, Hyperledger Sawtooth was found to be well suited for creating decentralised apps or platforms with respect to resource utilization It enables developers to separate their application domain from the core system so that business rules for apps can exist without requiring knowledge of the primary platform's underlying architecture. The proposed system shows that Hyperledger Sawtooth framework consumes lower CPU than Fabric which helps in increasing the number of transactions.
Background
Effective supply chains for health products require an adequate, skilled workforce for supply chain management (SCM). Rwanda faces challenges in human resources for SCM, including limited capacity for SCM at different levels. Understanding of the factors influencing the supply of and demand for SCM professionals in Rwanda is necessary to ensure the labor market contains an adequate workforce. This study identifies the perspectives of key stakeholders in the supply chain management sector about the factors influencing the supply of and demand for SCM professionals.
Methods
Data were collected in semi-structured group and one-on-one interviews with 39 key stakeholders involved in the supply chain management labor market between March and April 2019. Interviewees were categorized according to their role in the labor market as system actors, functional actors involved in the supply of SCM workers, and functional actors involved in the demand for SCM workers. Interviewees were asked open-ended questions about factors influencing the demand for and the supply of SCM workers, and recommendations for improvement. Interviews were analyzed thematically. One validation focus group was held and the results were also reviewed by the Ministry of Health in Rwanda.
Results
Stakeholders agreed that skills mismatch between SCM workers’ skills and the competencies jobs require impacts the supply of workers. A lack of career structure for SCM, lack of professional definitions for health supply chain management, and SCM curricula that do not match the needs of the workplace contribute to this gap. The demand for SCM professionals is poorly defined in terms of the numbers of professionals needed and the skills workers require. Financial limitations hinder demand for health SCM professionals.
Conclusions
This study adds to the understanding of factors influencing the SCM labor market in Rwanda by documenting perspectives from government ministries, professional organizations, universities, and employers from SCM organizations. Improving the SCM labor market in Rwanda and the availability of the skilled cadres required for the effective management of health supply chains in Rwanda requires a coordinated effort by the Ministry of Health in Rwanda, private SCM companies, professional associations, education sector, and policy makers.
Purpose
The purpose of this study is to learn how the incorporation and use of leanness, agility and innovation in Indian manufacturing micro, small and medium enterprises (MSMEs) affect their bottom lines and how much these factors contribute to the MSMEs’ ability to meet their long-term sustainability goals.
Design/methodology/approach
The suggested model was subjected to data validation and additional empirical validation using a sample of 411 Indian manufacturing MSMEs. The analysis of construct measures is conducted through the utilization of confirmatory factor analysis, a statistical technique that is grounded in the theoretical framework of structural equation modeling (SEM). In addition, path model analysis was applied for the purpose to validate the assumptions that were included in the structural models.
Findings
Consistent with the proposed model, the findings of this study demonstrate that leanness, agility and innovation have a substantial favorable impact on the sustainability of a company’s performance. These findings may be helpful in gaining professionals, academics and policymakers to acknowledge the significance of leanness, agility and innovation in enhancing the long-term sustainability of MSMEs and enhancing the overall performance of a particular company. This research excluded the service industries-based research papers.
Research limitations/implications
Many research in the field of manufacturing industries that have adopted leanness, agility, innovativeness and sustainability as individual approaches or as a collective methodology of two or more were considered in the current study. This research excluded the service industries-based research papers.
Practical implications
This literature review has recognized and analyzed various dimensions and roles of leanness, agility, innovativeness and sustainability that are prevalent in manufacturing industries that include the positive and negative effects on the performance of the industries. The research enlightens the path and shows future directions for research to develop efficient, effective and sustainable manufacturing industries.
Social implications
By promoting the concept of focusing on the “human factor”, namely, stakeholder perspectives, the MSME sector is propagating a strategy that moves away from an excessive focus on technology and toward a more humane one. Through the application of the three key concepts of leanness, agility and innovation, this work aims to create a framework for measuring the sustainability performance of micro-, small- and medium-sized enterprises (MSMEs), with the ultimate goal of assisting the country in achieving the Sustainable Development Goals in the fields of industry, innovation and infrastructure by supporting environmentally friendly and resource-conserving businesses that give back to society and the natural environment.
Originality/value
The objective of this research is to assess the importance and effectiveness of integrating various approaches such as leanness, agility, innovativeness and sustainability within the framework of manufacturing micro, small, and medium enterprises (MSMEs). The authors hope that by going further into these concepts, they will be able to broaden their understanding and get a more comprehensive insight into the role that these concepts play and how they might be successfully used within this environment.
The objective of this study is to conduct a systematic literature review (SLR) to identify the barriers and critical success factors that influence in the implementation of Lean Supply Chain Management (LSCM) practices in the industry. Through the analysis systematic literature review, it is hoped to identify the main gaps related to LSCM implementation in literature and industry and also discusses the relevance of research in this topic for indicating the future research direction. A SLR method was used, developed and determined. It is about 48 research articles were analyzed. The content of the present literature was reviewed, critically analyzed and synthesized from the perspective of barrier and critical success factors that influence the implementation of LSCM. Based on the extensive systematic review of the literature, we discovered the consistency data between Barriers and Critical Success Factors. This study strengthens the body of knowledge on the issue and consolidates the key LSCM activities, extending previous studies on LSCM barriers and critical success factors associated with its implementation. The clear identification of these topics can allow researchers and practitioners to predict occasional problems and to set the right standards for the implementation of the LSCM.
This research focuses on developing a fuzzy sustainable model for drug supply chain networks during a pandemic. The outbreak of a pandemic introduces unprecedented uncertainties and complexities to the drug supply chain, necessitating the integration of sustainability considerations and fuzzy logic techniques into decision-making processes. The proposed model aims to optimize decision variables, such as inventory levels, production capacities, transportation routes, and allocation strategies, while balancing conflicting objectives and addressing sustainability criteria. The model incorporates fuzzy logic to handle imprecise and uncertain inputs, allowing decision-makers to capture qualitative information and expert knowledge. The research emphasizes the importance of sustainability in drug supply chains, encompassing environmental impact, social welfare, and economic viability. Through the use of an optimization framework and a decision support system, stakeholders can make informed decisions considering sustainability criteria and dynamic pandemic conditions. The research contributes to enhancing the resilience, efficiency, and sustainability of drug supply chains during pandemics, facilitating better patient care and community well-being.
Last-mile logistics in the healthcare supply chain is becoming increasingly important, especially in pharmacies where medication delivery to patients' homes is becoming prevalent. Therefore, this paper proposes a mathematical model for the last-mile logistics of the pharmaceutical supply chain and optimizes a pharmacy's logistical financial outcome while considering medication synchronization, different delivery modes, and temperature requirements. In this research, we create a Mixed Integer Linear Programming (MILP) model to find optimal solutions regarding the number of order batches, the composition of these batches, and the number of staff related to the preparation of the order batches. We create a case study by gathering, preparing, processing, and analyzing the data associated with an outpatient pharmacy of a Dutch hospital. Our results show that our optimal solution increases the pharmacy's logistical financial outcome by 34 percent. Besides, we propose other model variations and perform extensive scenario analysis to provide managerial insights useful for various pharmacies and distributors in the last step of cold supply chains. In particular, our scenario analysis of these results suggests that improving medication synchronization can significantly enhance the pharmacy's logistical financial outcome. Furthermore, the model proves to be a tool for assessing multiple sets of scenarios relevant to the pharmacy.
Purpose
Ineffective management inventory of medical products such as blood and vaccines can create severe repercussions for hospitals, clinics or medical enterprises, such as surgery delays and postponements. Inventory sharing is a form of horizontal collaboration that can provide solutions to key actors of the healthcare supply chain (HSC), yet no prior study reviewed this topic.
Design/methodology/approach
This study conducts a systematic literature review of thirty-nine inventory-sharing studies in the context of HSCs published from 2012 until early 2022. The descriptive and thematic analyses include chronological distribution, geographical location, comparison between developed/developing regions, stakeholder and incident analysis.
Findings
Thematic analysis classified inventory sharing among five product supply chains (blood, medical supplies, medicines, vaccines and generic medical products). Benefits include shortage reduction, cost minimisation, and wastage mitigation. Barriers include (1) IT infrastructure, (2) social systems, (3) cost and (4) supply chain operations. Perishable inventory policies include Fresher-First (FF), Last-Expire-First-Out (LEFO), First-In-First-Out (FIFO) and First-Expire-First-Out (FEFO). The analysis also showed differences between developed and developing countries. The study identifies several future research opportunities that include (1) product utilisation rate, (2) cost reductions, (3) shortage mitigation and (4) waste reduction.
Originality/value
No prior study has systematically reviewed inventory sharing in HSCs to reveal benefits, barriers, patterns and gaps in the current literature. It makes five propositions and develops a research model to guide future research. The study concludes with theoretical and managerial implications.
The paper presents a systematic, comprehensive literature review of Sub-Saharan African public health supply chain studies. It shall involve both formal academic studies and consulting studies where available in the public domain. The key focus of the literature review shall be: to create a themed catalog of African public health supply chain studies that have been done in academia and by non–academic institutions. The specific objectives of the study shall revolve around Conducting a systematic literature review of public health supply chain studies in sub-Saharan Africa; Conducting a systematic literature review of nonacademic publications in public health supply chain studies in sub-Saharan Africa; Categorising the current
publications according to supply chain functions; Determining a database of contributors to public health supply chain studies for academic and non-academic knowledge; and proposing an approach to develop a database of research in public health supply with both academic and non-academic literature and develop a
way forward. The research philosophy adopted for the study was exploratory through a desk research of Public health supply chain studies conducted within the last 15 years(2007 – 2022) and themed based on the supply chain functions of the Supply Chain Operations Reference (SCOR) model. The output for the study shall entail catalogs/documentation of Africa's public health supply chain, contribution to an easily searchable body of knowledge that informs public health supply chains in sub-Saharan Africa, dissemination through publications in peer-reviewed academic journals ( at least five articles); and dissemination Through International Conferences And Symposiums.
Transgender medicine is a vital facade of health care. The
transgender population forms a significant minority in South
Asian countries, including India,Pakistan, Nepal and Bangladesh.
The government of India estimates that around 4.8 million people
identify as transgender.This chapter gives the reader a clear overview about the related terms and concepts.
Sustainability is attracting the concerns from governments, individuals and communities. To respond to the interests from these stakeholders, many companies are paying more attention and efforts in the sustainability areas, attempting to set up a sustainable supply chain. As one of the most important roles in the supply chain, suppliers play an influential role in sustainability for companies. In order to develop a more sustainable supply chain, companies want to utilize sustainability metrics to evaluate and control the sustainable performance of their suppliers. Many companies that are currently in the initial stage of its sustainability work are interested in this area, however they do not know how to proceed. Therefore, the purpose of this report is to aid Wellspect HealthCare to design its sustainability metrics for suppliers and also provide guidance in how to successfully implement these metrics through an in-depth analysis of factors that could influence an implementation of change. This research utilized qualitative methodologies to collect data, which consisted of 17 interviews, including 8 internal stakeholders, 2 external suppliers, literature review and documents. With the support of this information, this research designed and analyzed sustainability metrics that are suitable for Wellspect HealthCare and its suppliers. Additionally, the result of this research identified various factors that could impact the implementation of sustainability metrics and concluded how to utilize these factors in a successful way. The findings from this research could help Wellspect HealthCare to enrich its sustainability work through an implementation of metrics for suppliers in an effective way. Lastly, since the research was based on a real case company, it has also contributed to valuable insights and knowledge for other companies about implementing new changes in the sustainability area.
The rapid spread of the COVID-19 virus and the massive influx of patients exceeded the intensive care units capacity limit. Hospitals have engaged community partners to request resources or transfer patients to facilities with available resources. This setting fosters the need for rationing decisions to allocate scarce resources consistently, rather than basing decisions on clinicians’ intuition in the heat of the moment. In this paper, we identify the inter-hospital COVID-19 patients’ transfer criteria, and we apply a multi-criteria decision-making methodology to classify and rank these criteria in order to determine the transfer priority scores between hospitals. We then develop an optimisation model for patient systematic referral from saturated to recipient hospitals with contingency capacity expansion and a ventilator donation scheme. To deal with the uncertainty related to the number of ill patients requesting beds in hospitals, a two-stage stochastic model is presented and solved using the sample average approximation. A case with real data related to the COVID-19 French context is presented, which allows us to assess the resilience of the hospital network under the proposed solutions. The results show how local and regional coalitions can avert the saturation of the hospital system and reduce the number of rejected patients.
Supply Chain Management (SCM) has grown in the last years due to the changing and evolutionary environment. The SCM has become fundamental for gaining financial and social, among others, benefits. Currently, the traditional SCM mechanisms have some areas of improvement, such as the transparency and lack of information, long waiting times for information retrieval and data fidelity. The past months our daily lives have been changing in a drastic way due to COVID-19 and some industries were affected but with this change there has been some opportunities to improve. In this article we describe the main concepts about the blockchain technology, the smart contracts, and their main use. We talk about different areas that these technologies could help to improve in different ways of their internal and external processes. Our main discussion is the description and improvement in the performance inside a supply chain, how it could be possible to speed up the information sharing, how a smart contract could be applied to a consumer-supplier relationship in the healthcare supply chain and the benefits that it would bring to it due to the quick times that this area demands because of the nature of their transactions and operations that are critical to maintain the needs of the industry.
Cardiovascular disease is the common cause of morbidity and mortality
worldwide. It is more prevalent in recent days due to life style modifications,
change in diet and environmental pollution. Use of herbal plants for the
treatment is gradually increasing due to cost effective and low risk of
adverse effects. Picrosides is the major compound present in the medicinal
plant, Picrorhiza kurroa royle ex benth which accounts for its medicinal
properties. It is one of the most important endangered plants which have
been reported to exhibit potential cardiovascular activities. Plants with
protective effect on heart, contains a variety of bioactive compounds,
including diosgenin, isoflavones, sulforaphane, carotinized, catechin, and
quercetin. These have been proved to enhance cardioprotection and hence
reducing the risk of cardiac abnormalities.
The aim of this review is to highlight the scientific evidence of the
rhizome Picrorhiza kurroa and describing the biological mechanisms of
cardioprotection.
In recent years, healthcare systems have faced problems procuring medicines, and medical materials, cooperation with suppliers, rising costs, and disposal of medical waste. One of the health system's goals is optimization without reducing the quality of service for the patient. Supply chain and logistics, a scientific and economic activity that optimizes supply, storage, inventory management, transportation, demand forecasting, and distribution, have played a significant role in optimizing the health system in the last few years. Motivated by the recent pandemic of COVID 19 and resulting supply, storage, and inventory problems, a review of selected scientific literature available on scientific databases ScienceDirect of Elsevier and Web of Science of Clarivate Analytics was conducted. Scientific literature dealing with medical waste and connected logistic activities were included in the review. A growing trend of research in this field has been perceived in the last three years, thus proving that the real healthcare sector is becoming aware of logistics problems and their importance.
The healthcare supply chain involves the manufacturing and delivery of medicines at the right time, at the right place, and in the correct quantity. In the world of uncertainties, especially deadly pandemics, the digitalization of the healthcare supply chain has emerged as one of the urgent phenomena to implement, for which organizations are focussing on the omnichannel healthcare approach. This paper explores (a) the antecedents of big data analytics and artificial intelligence (BDA-AI) technology-based collaborative platform for empowering absorptive capacity in omnichannel health care processes; (b) the effect of BDA-AI collaborative platform powered absorptive capacity in omnichannel health care processes and organization performance. The data is collected using a structured questionnaire from healthcare supply chain executives working in South Africa. The findings indicate that the involvement of managerial factors will improve the capacity of health care organizations to develop a BDA-AI technology-driven collaborative platform to assimilate, transfer and exploit critical information from large data sets. It will capacitate healthcare supply chains to deliver innovative performance to healthcare businesses. This work is the first of its kind to examine big data-based knowledge gained in the context of the omnichannel supply chain.
The purpose of the paper is to contribute to the knowledge in the field of marketing of medical devices in the public sector. The research problem is based on verifying the correlations between the elements of the 4P marketing mix, after-sales activities and their influence on the preparation of tender documentation in the marketing of medical devices to social welfare institutions. In the process of marketing products through public procurement, the same attention is devoted to the after-sales activities as marketing mix elements (4P). We created a marketing mix model for the marketing of medical devices through public procurement.
The rapid development of Internet medical and advanced information technology has allowed patients to effortlessly search for their preferred healthcare services before making medical decisions. However, such strategic search behavior from patients will challenge the efforts of healthcare service providers to enhance their services and create marketing strategies. We investigate a healthcare service provider’s optimal service enhancement strategy with the consideration of patient search. Our primary objective is to figure out how the patient search cost affects the optimal healthcare service level and also the healthcare provider’s corresponding selling strategy. We find that if the fraction of patients who like the service is low, the optimal service level is increasing in the search cost. Whereas, if there are more patients who like the service, with a decrease in search cost, the healthcare provider may increase the service level to attract patients to search their preferences. In addition, by comparing with the scenario wherein patient search behavior is prohibited, we find that the patient search will counter-intuitively dampen the healthcare provider’s incentive on service enhancement. Thus, the underlying patient search would be detrimental to the provider’s profitability. We further find that, even if patients initially perceive their preferences over the healthcare service, such elimination of preference uncertainty (i.e., patient search, in this case, is needless) will not always benefit the healthcare provider, which highly hinges on the fraction of patients who like the healthcare service and the magnitude of search cost.
Competitive pressures and severe cuts in public healthcare spending force healthcare organizations to reconsider their business strategies and management practices. In this important industry, managers need not only lower costs but maintain at the same time a level of quality services. Supply chain management is currently regarded as having an important impact on reducing costs and improving performance in healthcare organizations. Supply chain management is greatly enabled by information technology and enterprise resource planning systems and specially developed supply chain management systems. In addition, a series of related factors, such as regulation, globalization, and health insurance legislation is of the utmost importance for the healthcare sector. This paper provides a literature review of the impact of supply chain management on the healthcare organizations and proposes a research agenda for supply chain management in the private and public regulated healthcare sectors.
Supply Chain Management (SCM) in the healthcare industry has been neglected in least developed countries like Bangladesh. The proper supply chain management in hospitals is extremely important as it affects the cost and accessibility to healthcare of the patients and community. A SCM study was conducted at Square Hospitals Ltd., a representative of high-end 425-bed tertiary level hospital in Dhaka, Bangladesh. From the case study it is revealed that the supply chain management system of Square Hospitals Ltd is controlled by means of an integrated computerized system. It analyzed various types of data like consumption patterns of medicine, diseases patterns, patient turnover, their length of stay etc. to ensure competitive advantages in procurement and inventory management. Consequently, the hospital is not only able to ensure availability of drugs for the patients, but also can minimize the inventory cost and gains economic advantages in every step of SCM through proper drug use management. It is observed that the Square hospital supply chain system is more responsive than effective. Finally, it can be concluded that there are areas in the supply chain where changes may bring about through improvement in the quality of the service provided by the hospital.
Purpose
The complexity and criticality of healthcare services highlight the importance of maintenance management function in healthcare facilities. The purpose of this paper is to review the literature on maintenance management of healthcare facilities and hospital buildings to provide an organized literature review and identify gaps from the perspective of research and practice.
Design/methodology/approach
The paper categorizes the literature and adopts a review hierarchy according to maintenance management functions in hospital buildings. It explores the impact of those functions on the performance of maintenance activities in hospitals. Furthermore, it examines the role of information technology and automated decision support systems in facilitating hospital maintenance management functions and performance.
Findings
Literature on maintenance management in healthcare facilities and hospital buildings has so far been very limited. Recently published literature focusing on healthcare facilities management and its maintenance management functions is classified into various areas and sub-areas. The paper highlights gaps in the literature and suggests avenues for future research and improvements.
Originality/value
The paper contains a comprehensive listing of publications and their classifications according to various attributes. It will be useful for researchers, maintenance managers, practitioners and stakeholders concerned with facility management of hospital buildings.
Nigeria is the most populous country in Africa and in 2012 was suffering some of the lowest vaccination rates in the World. A combination of factors had resulted in a dysfunctional immunization cold chain and supply chain. Recognizing that the number of unimmunized children contributed to high levels of under-5-mortality, and that health MDGs would not be attained, Minister of State for Health Mohammed Pate launched a vaccines transformation project in 2013. In partnership with BMGF, GAVI, UNICEF, WHO, other donors and implementing partners the transformation journey has so far taken three years and achieved impressive results. It has though faced challenges along the way and with the financial burden of GAVI graduation facing Nigeria, the economic downturn and the decentralized funding of health services, the results are far from sustained. This paper documents the work undertaken at the Federal level and then highlights specific work undertaken in partnership with Lagos State Government. It identifies the importance of taking an end to end approach and looking at the root causes of weak system performance. The strategy combined simple innovations in how data was captured, recorded and used to drive decision making. It included a comprehensive and systematic approach to cold chain procurement, installation and maintenance with a shift to a culture of active cold chain maintenance that is performing with higher levels of uptime. It also included supply chain redesign at both the Federal and State level. Finally, it involved an institutional transformation at the National Primary Health Care Development Agency (NPHCDA) to establish a data driven Department of Logistics and Health Commodities (DLHC) to manage the many challenges in immunizing 7.5 million children annually. While results have been impressive, there have been many challenges and lessons learned on the way. As Nigeria gets ready for its graduation from GAVI, a robust agile performing cold chain and supply chain will be essential for the good health of Nigeria’s children and its economy. The necessary transformation journey has only just begun.
Purpose
The purpose of this paper is to propose and test a healthcare framework of service quality, perceived value, and satisfaction in Ghana. More specifically, this study investigates the role and effect of service quality on patient satisfaction and perceived value in Ghana’s healthcare delivery.
Design/methodology/approach
Data were gathered through surveys administered to 113 healthcare patients in Ghana. partial least square-structural equation modeling analysis was used to empirically test the research model.
Findings
Results show healthcare quality significantly influences satisfaction and perceived value of healthcare delivery. Additionally, perceived value’s impact on satisfaction and behavioral intention shows that increasing perceived benefits while reducing perceived costs leads to repeat behavior and paves the way for retention strategy for healthcare management.
Research limitations/implications
This study yields a series of limitations in its results and conclusions. These limitations and future research are discussed in Section 7 of the study.
Originality/value
This study contributes to the literature by examining the effects of healthcare service quality on patient satisfaction and perceived value, determining the effect of healthcare service quality on patients’ behavioral intention, and testing the proposed framework in Ghana, a fast growing and economically liberalized emerging country in Sub-Saharan Africa.
With the widespread use of healthcare information systems commonly known as electronic health records, there is significant scope for improving the way healthcare is delivered by resorting to the power of big data. This has made data mining and predictive analytics an important tool for healthcare decision making. The literature has reported attempts for knowledge discovery from the big data to improve the delivery of healthcare services, however, there appears no attempt for assessing and synthesizing the available information on how the big data phenomenon has contributed to better outcomes for the delivery of healthcare services. This paper aims to achieve this by systematically reviewing the existing body of knowledge to categorize and evaluate the reported studies on healthcare operations and data mining frameworks. The outcome of this study is useful as a reference for the practitioners and as a research platform for the academia.
This paper aims to show how lean six-sigma
philosophy can be integrated to improve productivity of the
patient care supply chains. Case study approach was used
and three main hospitals in Sri Lanka were studied where
the results can be generalized as applicable to other contexts.
The main outcome of the research, lean six sigma process
improvement framework was developed to address cost
effectiveness, waste reduction and quality improvements in
terms facilities, input resources and processes through
blending lean six sigma best practices. Efforts to apply lean
healthcare concept into different aspects of healthcare
supply chain is rare in existing literature thus the paper fills
the gap in the literature through addressing wide range of
supply chain components.
Some Lean improvement projects have been successful while others have not. According to the literature on Lean management principles, a potential explanation for this equivocal state is a paradox that can develop depending on the focus of the project. If the focus is on improving the efficiency of individual resources and not on the interconnections between them, then paradoxically, the worse the efficiency of this resource will become. To overcome this paradox and achieve the expected outcome of Lean projects, the aim for Lean improvement projects should be to achieve “flow efficiency” rather than "resource efficiency". By conducting a detailed study of four case studies of Lean improvement projects from two large acute-care hospitals, we examine how organizations can systematically focus on flow efficiency by considering the role and value of redundancy in Lean improvement projects. We found that redundancy plays a vital role in enabling the goals of Lean improvement projects to be achieved. Our findings extend the discussions on the Lean practices in healthcare context by incorporating the nature of the redundancy concept in explaining how Lean practices are being adapted in variant operations settings.
Purpose
In the present context of a health-concious society, management of pharmaceutical supply chains has become more complex because it involves the life-saving interest of human being and requires the participation of different stakeholders such as pharmaceutical manufacturers, wholesalers, distributors, customers, information service providers and regulatory agencies. Limited research is available in the area of pharmaceutical supply chains. This paper aims to find the gaps in the literature by reviewing research papers on different strategic issues of supply chain management in the pharmaceutical sector.
Design/methodology/approach
In total, 136 research papers, mainly from refereed international journals, were reviewed to identify the issues of supply chain management (SCM) in the pharmaceutical supply chain. On the basis of a review, gaps are identified and research agenda is proposed.
Findings
It is observed from review that the pharmaceutical sector is not widely researched in developing countries because of many complexities in this supply chain. The share of pharmaceutical firms in the global market is also not very significant. Based on an extensive review of pharmaceutical supply chains, research gaps are identified in different areas such as inventory management, new product development, process development, capacity planning, network design, plant design, pipeline and development management, outsourcing logistics activities, reverse logistics, Lean manufacturing, green SCM and implementation of E-business processes and performance management. These strategic issues have been further classified into three broad categories, i.e. resources, processes and performance.
Originality/value
This paper explores major strategic areas of pharmaceutical supply chains for research. Findings of the paper will be highly useful for researchers to decide direction of future research.
Purpose: The paper aim is to present a new outsourcing model for materials management related to the operating theatre of hospitals. Two distinguishing features characterize the model: the long-term collaborative network established among the supplying companies (the ‘Network factor’), and the implementation of the RFID technology along the supply chain (the ‘RFID factor’). The Network factor allows sharing transportation costs, while the RFID factor allows implementing a Continuous Review policy, instead of the Periodic Review policy normally utilized in hospitals. In the paper the effect of this two factors on the minimization of total materials management costs is investigated.
Methodology: An analytical model, validated through a simulation study, is proposed to calculate total management costs of materials, depending on the presence of the Network and the RFID factors. Throughout the model it is possible to perform a scenario analysis and individuate the inventory management policy that allows minimizing total costs. The procedure has been applied to a real case study of a long-term collaborative network of supplying companies in the health care sector that operates in central Italy.
Findings: The optimal inventory management policy strongly depends on the mutual distances of supplying companies and the hospital. The two factors have both an impact on the reduction of total annual costs. The analysis of scenario shows that a positive interactions effect exists between the two factors, so that higher savings are obtained when both factors are present.
Originality/value: The outsourcing model presented in the paper is new, and the managerial insights that can be drawn from the application of the model to the healthcare sector can be extended to many other industries.
The purpose of this study was to determine the impact of Information Technology (IT) to the Jordanian hospitals in terms of patient care and financial aspects management. This study established that various Jordanian hospitals have different levels and standards of IT within their supply chain. The research motivated by lack of latest data and information on IT in performing various functions in hospital supply chain. Under the theoretical framework of the study, these include administrative costs management, tracking bills to patients and payment of staffs and suppliers of materials and equipment, managing quality of change process, disaster management and coordination of activities during operational disruptions on the supply chain and management of reimbursement from the medical insurance schemes. Consequently, the researcher adopted a survey method to collect data for testing various IT impact hypotheses among the public, private, military and university hospitals in Jordan. Using ANOVA approach, the research found higher alpha significance than the standard α =0.05 of level of determination for IT impact in all the five hypotheses related to patience care and financial aspects management where implementation has succeeded. This study made further recommendations on how the Jordanian hospitals can improve the IT impacts in the areas captured in the study for implementation and future research.
Healthcare and disaster supply chain have becoming a more important and popular research issues recently. However, only a few of paper is known about the current issues both healthcare and disaster supply chain especially in natural disaster case. This paper is a preliminary report of a research on healthcare and disaster supply chain. The paper intends to review and analyse several papers on above topic published during the last ten years. Published papers on healthcare and disaster supply chain research from 2005 and 2014 were classified into three main themes: (1) healthcare supply chain, (2) disaster supply chain and (3) healthcare supply chain in natural disaster. The topic issues in each main themes include operational management, information technology, inventory and control management, strategic management, and service management. Besides, the type of research methods contain empirical study, case study, modelling and simulation, literature review, and conceptual theory. Result of the review will provide the basis for the direction of future research in these three themes.
Background:
The Analytic Hierarchy Process (AHP), developed by Saaty in the late 1970s, is one of the methods for multi-criteria decision making. The AHP disaggregates a complex decision problem into different hierarchical levels. The weight for each criterion and alternative are judged in pairwise comparisons and priorities are calculated by the Eigenvector method. The slowly increasing application of the AHP was the motivation for this study to explore the current state of its methodology in the healthcare context.
Methods:
A systematic literature review was conducted by searching the Pubmed and Web of Science databases for articles with the following keywords in their titles or abstracts: "Analytic Hierarchy Process," "Analytical Hierarchy Process," "multi-criteria decision analysis," "multiple criteria decision," "stated preference," and "pairwise comparison." In addition, we developed reporting criteria to indicate whether the authors reported important aspects and evaluated the resulting studies' reporting.
Results:
The systematic review resulted in 121 articles. The number of studies applying AHP has increased since 2005. Most studies were from Asia (almost 30 %), followed by the US (25.6 %). On average, the studies used 19.64 criteria throughout their hierarchical levels. Furthermore, we restricted a detailed analysis to those articles published within the last 5 years (n = 69). The mean of participants in these studies were 109, whereas we identified major differences in how the surveys were conducted. The evaluation of reporting showed that the mean of reported elements was about 6.75 out of 10. Thus, 12 out of 69 studies reported less than half of the criteria.
Conclusion:
The AHP has been applied inconsistently in healthcare research. A minority of studies described all the relevant aspects. Thus, the statements in this review may be biased, as they are restricted to the information available in the papers. Hence, further research is required to discover who should be interviewed and how, how inconsistent answers should be dealt with, and how the outcome and stability of the results should be presented. In addition, we need new insights to determine which target group can best handle the challenges of the AHP.
Background:
Access to free essential medicines is a critical component of universal health coverage. However availability of essential medicines is poor in India with more than two-third of the people having limited or no access. This has pushed up private out-of-pocket expenditure due to medicines. The states of Punjab and Haryana are in the process of institutionalizing drug procurement models to provide uninterrupted access to essential medicines free of cost in all public hospitals and health centres. We undertook this study to assess the availability of medicines in public sector health facilities in the 2 states. Secondly, we also ascertained the quality of storage and inventory management systems in health facilities.
Methods:
The present study was carried out in 80 public health facilities across 12 districts in Haryana and Punjab states. Overall, within each state 1 MC, 6 DHs, 11 CHCs and 22 PHCs were selected for the study. Drug procurement mechanisms in both the states were studied through document reviews and in-depth interviews with key stakeholders. Stock registers were reviewed to collect data on availability of a basket of essential medicines -92 at Primary Health Centre (PHC) level, 132 at Community Health Centre (CHC) level and 160 at tertiary care (District Hospital/Medical College) level. These essential medicines were selected based on the Essential Medicine List (EML) of the Department of Health (DOH).
Results:
Overall availability of medicines was 45.2 % and 51.1 % in Punjab and Haryana respectively. Availability of anti-hypertensives was around 60 % in both the states whereas for anti-diabetics it was 44 % and 47 % in Punjab and Haryana respectively. Atleast one drug in each of the categories including analgesic/antipyretic, anti-helminthic, anti-spasmodic, anti-emetic, anti-hypertensive and uterotonics were nearly universally available in public sector facilities. On the contrary, medicines such as thrombolytics, anti-cancer and endocrine medicines were available in less than 30 % in public sector facilities. Among the medicines which were not available at the time of survey in Haryana, nearly 60 % of them were out of stock for 3-6 months whereas 8 % of them were out of stock for more than 6 months.
Conclusion:
Health system needs to be strengthened by making essential medicines available for patients. Ensuring access to free medicines is likely to reduce private expenditure on medicines, which is a long-term, sustainable way to towards universal health coverage in India.
Despite the importance and value of the pharmaceutical market, a significant portion of procurement spending including pharmaceuticals are lost. Coupling poor and reactive management practices with the inevitable national drug shortages, leads to lack of medicines causing patient suffering and direct life or death consequences. In this paper, we propose a stochastic model to find the optimal inventory policy for a healthcare facility to proactively minimize the effect of drug shortages in the presence of uncertain disruptions and demand. © 2015 Elsevier B.V. and Association of European Operational Research Societies (EURO) within the International Federation of Operational Research Societies (IFORS).
This study investigates the means by which hospitals can improve the reliability of their medical supply value streams. Field research involving pharmacy supplies in eight Australasian public sector hospitals utilised a rigorous, multi-method data collection procedure based around the uncertainty circle model. Value stream maturity, performance inhibitors and pathways to effective improvement are explored. The high levels of value stream uncertainty detected are commonly the result of process immaturity and poor inter-functional integration. Chief among the common root causes is failure by the executive to acknowledge the strategic value of medical supplies management, which ultimately leads to higher materials cost and increased risk of a medical mishap. The study demonstrates how managers can use systems thinking and a context-free performance benchmark to identify effective interventions and potentially transferable best practices.
Healthcare organisations all over the world are looking for ways to improve operational efficiencies at reduced costs without affecting their services. This study was undertaken to first and foremost examine the supply chain practices at KATH Pharmacy, and secondly to assess those practices in the light of industrially accepted best practices. Primary data was obtained from fifty-five (55) respondents and the data were analysed using SPSS, and queuing model. Interesting findings emerged from the study, including patients spending an average of 12 minutes within the system of drug dispensing unit. However, this time can be reduced if the numbers of servers within the facility is increased by way of opening more dispensing outlets.
Hospitals worldwide are giving a growing emphasis to the application of 'lean concepts' in the healthcare sector, commonly known as lean healthcare. A fundamental tool that allows such implementations is the value stream mapping (VSM). The problem is that VSM models used in implementations of lean healthcare are simple adaptations of the original VSM model, which was initially directed towards manufacturing and may not always represent important support activities for the patient flow that directly impact treatment time. Within this context, this paper presents a new VSM approach for healthcare environments. This new VSM model, specifically designed for healthcare environments, contemplates all activities that directly affect the treatment time. In addition, the present paper also presents an action research in a Brazilian hospital where the proposed VSM model is compared to other VSM models found in the literature. The results shown that the proposed VSM model was able to identify some operational bottlenecks and wastes that interfere in the patients treatment that could not be identified by other mapping models studied.
The paper explores the implementation of the kanban system, which is a Lean technique, within the Pharmaceutical Supply Chain (PSC). The case study provides insight to the benefits and challenges arising from the application of this technique, within a group of cooperative pharmacists, in Greece. The research questions developed from the review of the literature were tested using evidence from field-based, action research within a pharmaceutical organisation. The reported case study contributes to the longer term debate on assessing the Lean maturity level within the healthcare sector. There are two primary findings: i) that the adoption of kanban system provides a strategic benefit and improves the quality of services. ii) it also provides a basis for a strategy of operational change; it gives the opportunity to the organisation to move away from the current push delivery and logistics systems toward improved logistics strategy models.
When the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported Supply Chain Management System (SCMS) programme began working in Ethiopia in 2006, the estimated population of people living with HIV exceeded one million, while only 24,000 were on treatment and only 50 treatment sites were in operation. SCMS and other key partners entered into this context to support the Ethiopian government in significantly strengthening the public health supply chain system, with the aim of increasing the availability and accessibility of pharmaceutical products. The country now has 1,047 treatment sites and is nearing complete treatment coverage. This article discusses how priorities were set among many competing challenges from 2006 until 2014, and how the four-step strategy of build, operate, transfer, and optimise has resulted in a successful partnership.
Purpose
The purpose of this paper is to review the Agriculture Supply Chain (ASC) literature along many dimensions those include but not restricted to scope, objective, wastages, driver, obstacle, outcome etc.
Design/methodology/approach
Two hundred three relevant and scholarly articles of various researchers and practitioners during 2000-2016 were reviewed. The information related to definition, research methodology, global research spread, supply chain strategy, various types of produce, author profile and year of publication of ASC were collected and analyzed.
Findings
The information related to empirical research and viewpoint of various ASC drivers were captured, studied and analyzed in detail. Although inventory policy, demand forecasting and ASC integration were found to be important areas of ASC, but they were less focused, studied and researched.
Research limitations/implications
Mainly post-harvest ASC of different agricultural produces were considered whereas products like dairy, fishery and meat supply chain were not included in the study.
Originality/value
The paper provides an insight into various aspects of ASC in general and one can get a deeper and richer knowledge on it which will help in formulating effective strategies to design of an effective and efficient ASC. It uncovers the research gaps for the new future research paths. This systemic review is strongly felt to fill the gap in the ASC literature.
This study attempts to model the enablers of agility of healthcare organizations and interprets the interrelationship among them using total interpretive structural modelling (TISM). Its contribution to the knowledge base is twofold. First, it provides a hierarchical structure portraying the driving enablers and the dependent enablers. Second, it ranks the enablers based on their influence on organization agility. To accomplish the above objectives, ten enablers of organization agility have been identified through an extensive literature review followed by an expert interview to comprehend the interactions and transitivity between the enablers and finally an analysis of the interrelationship using TISM. The results suggest that organizational structure is the most crucial enabler of agile performance in healthcare organization. Apart from that, a motivated and flexible workforce, cooperation between management and employees, availability of training and implementation of employee and patient’s suggestion play a significant role in healthcare organization agility. Eventually, limitations and future research avenues have been outlined to extend the current study.
This study proposes a new multi-objective mathematical model in pharmaceutical supply chain for natural disaster response considering quality, green concepts. The proposed model includes three objective functions. The first minimizes total manufacturing costs including production costs, purchasing costs, opening manufacturing plant costs, opening distribution centers costs, transportation costs and cost of poor quality (appraisal and prevention costs). The second minimizes environmental effects of products and transportations. The third maximizes humanitarian forces. Before disaster occurrence, to efficiently predict the objective functions values, we apply the back propagation (BP)—neural network, hybrid genetic algorithm (GA)—artificial neural network and particle swarm optimization (PSO). Finally, the effectiveness of the proposed solution shows the proposed multi objective optimization technique and its feasibility to be adopted as suitable methodology. The obtained results illustrate that the BP had high performance, which its R² was 0.99. Managerial implications of this research focus on improving the efficiency and effectiveness of the healthcare supply chain for natural disaster response: saving time, minimizing costs, minimizing environmental impact, utilizing resources more effectively (e.g. financial, human, technical, assets, transportation), showing social responsibility for communities affected by the disaster and continuously improving healthcare supply chain management.
While the focus of many in the vaccine world has been on developing new vaccines and measuring their effects on humans, failure to understand and properly address vaccine supply chain issues can greatly reduce the impact of any vaccine. Therefore, everyone involved in vaccine decision-making may want to take into account supply chains when making key decisions. In fact, considering supply chain issues long before a vaccine reaches the market can help design vaccines and vaccine programs that better match the system. We detail how vaccine supply chains may affect the work and decision making of ten examples of different members of the vaccine community: preclinical vaccinologists, vaccine clinical trialists, vaccine package designers, health care workers, epidemiologists and disease surveillance experts, policy makers, storage equipment manufacturers, other technology developers, information system specialists, and funders. We offer ten recommendations to help decision makers better understand and address supply chains.
Managing independent members who share common goals is a frequent concern in any supply chain. More specifically, due to the critical role of the pharmaceutical industry in producing and delivering the right product to the right people at the right time, coordination of pharmaceutical supply chain (PSC) members is a critical factor. Therefore, the purpose of this study (PSC) is to identify and prioritise factors affecting coordination of a PSC. The analytic hierarchy process (AHP) is used to prioritise six strategic criteria, with 26 sub-criteria, for coordinating PSC operations. To run AHP, 44 interviews were performed to collect data for deep analysis. In this study 26 factors affecting coordination in a PSC were grouped to the six strategic factors. The results showed that, of these factors, organisational structure is perceived as the most important factor, followed by information technology, relationship and decision making, mutual understanding, management commitment, and regulatory affairs.
Healthcare providers currently operate in an environment of complex supply chains and increasing costs where approximately one-third of hospital operating expenses are related to supplies. It is pertinent that healthcare providers have a clear understanding of their supply chain process costs. Knowing how these costs are driven and where opportunities for cost reduction exist can support healthcare provider supply chain (HPSC) efficiency. In this paper, we present a Time-Driven Activity-Based Costing (TDABC) supply chain cost methodology for healthcare providers. A TDABC management system can provide healthcare providers with valuable product and process supply chain cost information by investigating logistics activities, resource consumption, and time drivers. Our HPSC TDABC methodology is demonstrated in a case study conducted for the supply chain department of a 200-bed, not-for-profit hospital.
In services, which require significant customer participation to create value, customers who lack the knowledge, skills and motivation necessary to participate effectively can negatively impact service quality and cost outcomes. This paper develops a conceptual model to investigate the effectiveness of utilizing customer training and education (CTE) to improve customer readiness to provide effective behaviors in a professional service. The model was tested using survey data from patients diagnosed with diabetes who received CTE as part of their healthcare service. We found that customers who are taught why they have to perform the tasks, have higher levels of motivation to perform these tasks effectively. Further, as proposed by the customer readiness model, when their task performance is higher, they have improved health and lower healthcare costs.
Purpose
This work analyzes a pharmaceutical supply chain (PSC) in terms of supply chain visibility (SCV). The current good distribution practice (GDP) guideline demands increased visibility from firms. The purpose of this paper is to propose a solution for SCV enhancements based on automatic identification (Auto-ID) technologies.
Design/methodology/approach
The authors qualitatively analyze data from ten case studies of actors in a PSC. A review of Auto-ID technologies supports the derivation of solutions to enhance SCV.
Findings
This work shows that the functionalities of Auto-ID technologies offered by current practical monitoring solutions and challenges created by the GDP guideline necessitate further SCV enhancements. To enhance SCV, the authors propose three solutions: securPharm with passive radio frequency identification tags, transport containers with sensor nodes, and an SCV dashboard.
Research limitations/implications
This study is limited to a PSC in Germany and is therefore not intended to be exhaustive. Thus, the results serve as a foundation for further analyses.
Practical implications
This study provides an overview of the functionality of Auto-ID technologies. In juxtaposition with the influence of the GDP guideline, the use of our Auto-ID-based solutions can help to enhance SCV.
Originality/value
This work analyzes a PSC in Germany, with consideration given to the influence of current legislation. Based on a multiple-case-study design, the authors derive three Auto-ID-based solutions for enhancing SCV.
This paper provides an overview of the current state of the art in the field of healthcare quality, with a special focus on technological and managerial innovation. It also serves as an introduction to the special issue of healthcare quality and innovation. We synthesize the results of selected studies, emphasizing the themes of healthcare quality and innovation in terms of diversity of continental localities, study purpose, study methods, and topics discussed in each individual paper. Our review provides valuable information and strategic insights for healthcare policy makers and managerial decision makers in both the private and public sectors to use in planning and controlling healthcare quality, activities, and services.
Purpose
The aim of this paper is to contribute to the services marketing literature by developing a scale based on Parasuraman’s SERVQUAL scale for the measurement of distributor perceived service quality at the distributor–manufacturer interface of the pharmaceutical supply chain.
Design/methodology/approach
Based on a literature review and discussions with experts, a questionnaire was designed basing on the widely used service quality measurement scale (SERVQUAL). Personal survey was conducted among selected distributors spread over three major cities of the Indian pharmaceutical market. The study used the exploratory factor analysis to identify the critical factors of service quality followed by the confirmatory factor analysis (AMOS 20).
Findings
A valid scale with four dimensions – (reliability, assurance, responsiveness and communication) and 13 items for measuring the distributor perceived service quality was developed which also satisfied all the reliability and validity tests. The findings of the present study indicate that distributor perceived service quality has an effect on satisfaction.
Practical implications
The proposed scale is an attempt to explore the less researched area. This study will give further insights to researchers to measure service quality at different phases of the pharmaceutical supply chain. The study is limited to three cities; it can be extended to other regions of the country. This study will be helpful to the practicing managers to measure the service quality and improve the performance in the pharmaceutical supply chain.
Social implications
Service quality in pharmaceutical supply chain is very important, as it directly effects the health of the people, so the proposed scale can be used to control the quality of service.
Originality/value
The scale developed in this study can also be used for measuring distributor perceived service quality in other manufacturing sectors. This research provides direction and scope for further research to develop new concepts and models in measuring service quality in the supply chain.
The objective of this study is to investigate the perceptions of practitioners/experts about the prioritisation of healthcare performance measures and their relationship with lean supply chain management (LSCM) practices. The study will also prioritise the drivers and resources required to implement LSCM in a healthcare operations context. The prioritisation is based on the relative weights of various initiatives on a range of performance measures. Twenty-four LSCM initiatives were identified using a comprehensive literature review. Q-sort method was used to divide those initiatives into four categories. Fuzzy AHP was then used to prioritise the four categories based on relative weight of importance of each category on three different performance dimensions. The result shows that continuous improvement is a dominating LSCM initiative in increasing operational and financial performance, while enterprise alignment/integration is a dominating initiative in enhancing organisational image and operational performance. However, lack of homogeneity among LSCM initiatives suggests that there is a need for careful consideration when implementing them in healthcare organisations. Furthermore, customer needs and the influence of competitor’s actions are the most important drivers to encourage hospitals to adopt an LSCM strategy. This is one of the first studies to examine the prioritisation and ranking of LSCM constructs on performance within the context of the healthcare industry.
Several factors such as the raise in healthcare expenditures impose growing pressures to improve efficiency in healthcare industry Industrial engineering and operations research can be effectively used at this aim. This paper examines the optimization of a hospital’s inventory costs where the central pharmacy of the hospital assumes a role of central decision maker for drugs’ purchasing and their distribution to internal wards. Inventory control strategies integrating combinatorial based mechanisms and classical inventory control has been developed in order to optimize inventory costs of drugs logistics. The developed work includes into the decisional model also a partial decisional independence of wards and the special requirements of drugs delivery. Results and tests of the model’s implementation on real data are reported to evaluate the goodness of offered tool and to discuss of potential real application.
Healthcare supply chain has recently attracted attention by scholars, researchers, government officials and providers as one of the main tools in their effort to manage healthcare cost and improve quality at the same time (Elmuti, et al., 2013). It is reported that healthcare costs in the United States represent a sizeable portion of the gross domestic product and it is expected to increase at a much higher rate than other sectors in the economy. Nevertheless maturity of healthcare supply chain is said behind the commercial supply chain leaving room for improvement (de Vries and Huijsman, 2011). This paper explores strategic areas where healthcare supply chain may enhance efficiency in terms of cost per patient discharge of healthcare operations while improving the quality of care in terms of reducing re-admission rate. This paper argues that fundamentals of supply chain principles should be deployed to create “supply chain community surplus” where resources can be tapped to improve quality of care. Three strategic areas were explored to maximize the provider's revenue; understanding of supply chain principles (perception change), process improvement and deployment of logistics tools.
Previous measurement of hospital supply chain performance independently measure the performance groups of patient safety and hospital supply chain efficiency which include clinical care and supporting process efficiency. In fact, these three performance groups relate to one another. The interdependencies among performance groups should be investigated. Moreover, it is necessary to examine which performance aspects included in each group is the most important for improvement. The importance of performance aspects can be determined by designated weights. The weights of performance aspects can help manager select which aspect needs improvement. The interdependencies inform hospital executives how to improve performance properly. This study employs DEMATEL-modified ANP to investigate the relationships among performance groups, and calculate weights for performance aspects. DEMATEL is used to examine the causal relationships among performance groups and among performance aspects within each group. The causal relationships are then used to determine weights of performance aspects applying modified ANP. The result of the study shows that the most important aspects of hospital supply chain performance are completeness of treatment, no delay in treatment and clinical care process time. The causal relationships from DEMATEL can also inform the hospital executives that improving no delay in treatment performance can be achieved by improving itself, while to ease an improvement in completeness of treatment and clinical care process time must consider improving other performance aspects relating to them as well.
This study examines the effects of innovation leadership and supply chain (SC) innovation on SC efficiency in the healthcare organization. Specifically, this study attempts to investigate the moderating effect of hospital size (more than 500 and < 500 beds) on the relationships. The data used in this study were collected from relatively large hospitals with more than 100 beds. The structural equation modeling (SEM) technique with AMOS 17.0 was used to test hypotheses in the research model. The results show that innovation leadership positively affects SC innovation which in turn increases SC efficiency.
In this paper, we focus on the development of a methodology for the performance of hospital supply chain via the three dimensions of cost, quality and safety. The first part of the article shows the interest of the hospital logistics in a hospital as well as the review of the literature on the assessment of performancer. The second part describes the implementation stages of our methodology. Nous finish our work by applying the decision support system in a hospital in Morocco.
This study presents a literature review of 107 papers on lean healthcare to evaluate its evolution by updating previous literature reviews and to propose a classification and analysis of the papers reviewed. The literature classification was performed based on six parameters: research method, country, healthcare area, implementation, lean tools and methods and results. From the analysis performed, this paper presents a quantitative analysis of the state of the art concerning lean healthcare and indicates current research trends, based on the stage of evolution of the area, that may guide further studies on the subject. An example is lean healthcare expansion to other countries, such as Brazil and the Netherlands. Another aspect is the application of lean healthcare in hospital as a whole, not limited to a specific setting. Finally, a few studies detail the lean implementation process and use infrequently applied tools, present the barriers and main critical factors found in the lean implementation.
This paper lays a foundation for the better understanding of the application and acceptance of Actual Usage Inventory Management within the health care supply chain. Actual Usage Inventory Management consist advanced inventory control practices driven by actual usage data. To determine the possible savings from using Actual Usage Inventory Management, a case study was performed on pharmaceutical products in a large healthcare system in the mid-west. The case study used the (r, Q) inventory policy to model the current inventory system and to propose a more cost-effective inventory control system at each echelon. A multi-echelon inventory control system is also proposed and the cost benefits are measured. Demand forecasting algorithms were applied to forecast demand for inventory control procedures. The results indicate that there is great potential for significant cost savings within the healthcare provider network. It is likely that if other providers adopt such practices that they will be able to better control material supply costs.
This study presents an integrated approach for analyzing the impact of macro-ergonomics factors in healthcare supply chain (HCSC) by data envelopment analysis (DEA). The case of this study is the supply chain (SC) of a real hospital. Thus, healthcare standards and macro-ergonomics factors are considered to be modeled by the mathematical programming approach. Over 28 subsidiary SC divisions with parallel missions and objectives are evaluated by analyzing inputs and outputs through DEA. Each division in this HCSC is considered as decision making unit (DMU). This approach can analyze the impact of macro-ergonomics factors on supply chain management (SCM) in healthcare sector. Also, this method ranks the relevant performance efficiencies of each HCSC. In this study by using proposed method, the most effective macro-ergonomics factor on HCSC is identified as “teamwork” issue. Also, this study would help managers to identify the areas of weaknesses in their SCM system and set improvement target plan for the related SCM system in healthcare industry. To the best of our knowledge, this is the first study for macro-ergonomics optimization of HCSC.
This paper is based on secondary data, therefore, the authors constructed conceptual framework after thorough analysis of a numerous research papers. Due to scarcity studies on Service Industry Supply Chain Management (SCM), this paper would create a noble approach for the current health care managers of hospitals to review and apprise their operational and strategical objectives. This study highlight Supply Chain Management (SCM) concept for the hospital which representing a service industry. In addition, this study reveals the limited application of SCM in hospital. Consequently the authors describe recommendation and propose a model on valued supply chain management which could be applicable in integrated hospital management. Though this paper highlights in intensive analysis however, it unlocks further frontiers for the prospective researchers as well as practitioners in order to develop SCM model for hospital.
This paper attempts to gain a better understanding on the main issues affecting the management of medicines in hospitals by defining and analyzing the main logistics inefficiencies executed by the hospital pharmacy. This field research was conducted in a North American hospital which represents the main research site. Three other hospitals and other healthcare organizations have been involved in order to validate empirical evidence. We relied on multiple sources such as observations, process mapping and semi-structured interviews in order to allow triangulation and strengthen the validity of results. From the reception of medicines at hospital docks to their distribution to the hospital pharmacy, we identified an important number of inefficiencies, namely incorrect inventory management, medicine shrinkage, intensive manual labor, long procurement cycles, time-consuming product recalls and improper use of technology.
This article explores the issue of demand for health care and medicines in India where household share of total health expenditure is one of the highest among high- and low-income countries. Previous work found that important determinants include health status, socio-demographics, income and demand for care was inelastic. Compared with previous studies, this article uses large household data sets including data on medicine expenditure to explore health-seeking behaviour. Count models find that determinants include health status, socio-demographic information, health insurance, household expenditure and government regulation. Elasticities range from −0.13 to 0.03 and are generally consistent with literature findings. For inpatient care, conditional on having at least one hospitalization, the expected number of hospitalizations increases with being male and household expenditure. Medicine expenditure accounts for a large share of household health expenditure. Low-income individuals could experience problems and raises important policy implications on the demand and supply side to improve access to health care and medicines for patients in India.
Research on the adoption of fuzzy logic in healthcare diagnostic system to oversee the process performance and recognize certain predefined patterns has been conducted for associating the well-known problems using the rule-based approach technique. Even though a couple of medical applications such as those described above had shown generally proven results, the literature regarding applying fuzzy logic in healthcare delivery remains modest and the application of fuzzy logic to healthcare services had been rare. Applying fuzzy logic in healthcare services is still a mostly untapped region, especially collecting the voice of customer. Coupled fuzzy logic with QFD in healthcare services enables medical practitioners to understand customer requirements and include them for continuous improvement during the health service delivery. A fuzzy QFD approach for analyzing healthcare service requirement is proposed and realized through a case study. It is realized that the proposed approach can adjust service quality toward customer requirements.
Healthcare waste management has become a major issue of concern for solid waste managers due the treatment of healthcare waste being generated and the potential environmental risks and public health risks to those who come in contact with it. Special attention must be paid when dealing with healthcare waste because of infectious and non-infectious waste as well as general waste it contains. If managed through inappropriate healthcare waste management systems, it can adversely affect the environment and public health. In Botswana, the Waste Management Act was introduced in 1998 not only for healthcare waste handling, but also to promote sustainable treatment and disposal; the document currently applies to the management of all the healthcare waste, including liquid and chemical waste. The paper presents an overview of the current healthcare waste management in Botswana. A mixed methods study incorporating an exploratory survey was used. A range of data gathering techniques including observations, informal dialogues, published and grey literature and semi-structured interviews of selected participants and operatives dealing with waste were used to identify key policies, composition, storage, treatment, disposal, challenges and best practices. Specifically, sorting and storage, collection, treatment and disposal systems and the recent regulation of healthcare waste were discussed. Current storage facilities and collection services in the healthcare facilities (HCFs) were not operating effectively and efficiently. The composition was almost the same in the HCFs, with mean values in the following decreasing order: general waste (48.84) >medical waste (39.39 %) >sharps (13.13 %). Therefore, more attention should be paid on segregation of infectious and non-infectious from general waste, pollution prevention and recovery of valuable materials from HCFs. Several suggestions were made to deal with healthcare waste management problems efficiently and to prevent the potential impacts. These included development of a legislation to allow for a more defined roles and responsibilities for healthcare personnel responsible for the handling and disposal of the waste streams at the point of generation in the HCFs. Therefore, there is an urgent need to formulate a more sustainable healthcare waste management system.