Hybrid stockless: a case study

Diagnosing patient flow issues in the emergency department: an Australasian hospital case study

PURPOSE

This study investigates how a hospital can increase the flow of patients through its emergency department by using benchmarking and process improvement techniques borrowed from the manufacturing sector.

DESIGN/METHODOLOGY/APPROACH

An in-depth case study of an Australasian public hospital utilises rigorous, multi-method data collection procedures with systems thinking to benchmark an emergency department (ED) value stream and identify the performance inhibitors.

FINDINGS

High levels of value stream uncertainty result from inefficient processes and weak controls. Reduced patient flow arises from senior management's commitment to simplistic government targets, clinical staff that lack basic operations management skills, and fragmented information systems. High junior/senior staff ratios aggravate the lack of inter-functional integration and poor use of time and material resources, increasing the risk of a critical patient incident.

RESEARCH LIMITATIONS/IMPLICATIONS

This research is limited to a single case; hence, further research should assess value stream maturity and associated performance enablers and inhibitors in other emergency departments experiencing patient flow delays.

PRACTICAL IMPLICATIONS

This study illustrates how hospital managers can use systems thinking and a context-free performance benchmarking measure to identify needed interventions and transferable best practices for achieving seamless patient flow.

ORIGINALITY/VALUE

This study is the first to operationalise the theoretical concept of the seamless healthcare system to acute care as defined by Parnaby and Towill (2008). It is also the first to use the uncertainty circle model in an Australasian public healthcare setting to objectively benchmark an emergency department's value stream maturity.

Cost analysis of supply chain management of Da Vinci surgical instruments: A retrospective study

BACKGROUND: Da Vinci surgery is used extensively, but the high costs of the surgical instrument are a serious clinical and management problem. OBJECTIVE: To reduce the cost of the Da Vinci robotic surgical instrument supply chain. METHODS: Patients were selected from the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Control group patients underwent Da Vinci robot-assisted surgery between January 2019 and June 2019 (control group). Patients who were operated with the same robot from July 2019 to December 2019 were selected as the experimental group (SCM group). The cost analysis and comparison were carried out to integrate instrument sets, working hours, workforce expenditure, and direct and indirect expenses. RESULTS: Compared with the control group, the number of instrument packages was lower (4.5 ± 1.4 vs. 11.5 ± 1.6, P< 0.001) and the personnel’s awareness of the instruments was higher (92.3 ± 4.2 vs. 83.4 ± 3.7, P< 0.001) in the SCM group. The SCM group showed lower processing time per device (8.1 ± 1.6 vs. 44.2 ± 5.6 min, P< 0.001) and lower costs per surgical instrument (RMB 11.5 ± 2.3 vs. 60.3 ± 10.2, P< 0.001). CONCLUSION: The application of the supply chain management can reduce the costs of robotic surgery, improve work efficiency and decrease the failure rate of instruments.

Point-of-use hospital inventory management with inaccurate usage capture

Many hospital supply chains in the US follow a “stockless” structure, often implemented with the acquisition of new systems promising improved efficiencies and responsiveness. Despite vendor promises, supply chain gains from new technology are often unfulfilled or result in a reduction of performance. A critical component of achieving promised gains is the hospital’s ability to accurately and consistently capture hospital inventory use. In practice, recording demand with perfect, 100% accuracy is infeasible, so our models condition on the level of accuracy in a particular hospital department, or point-of-use (POU) inventory location. Similar to previous literature, we consider actual net inventory and recorded net inventory in developing the system performance measures. We develop two models, optimizing either cost or service level, and we assume a periodic-review, base-stock (or par-level) inventory policy with full backordering. In addition to choosing the optimal order-up-to level, we seek the optimal frequency of inventory counts to reconcile inaccurate records. Results from both models provide insights for supply chain managers in the hospital setting, as well as hospital administrators considering the adoption of similar technologies or systems.

Opportunities and challenges for contactless healthcare services in the post-COVID-19 Era

This study examines the opportunities and challenges involved with contactless healthcare services in the post-COVID-19 pandemic era. First, we reviewed the literature to analyze contactless or contact-free healthcare services that have been utilized in pre-and during the COVID-19 pandemic periods. Then, we interviewed medical experts and hospital administrators to gain knowledge about how healthcare providers are currently working to mitigate the spread of COVID and preparing for the post-pandemic period. Thus, we analyzed the evolution and utilization of contactless services during the three different time periods: pre-, during-, and post-COVID-19. The results indicated that in the post-COVID-19 era, a new normal of hybrid healthcare services would emerge. While some of the contactless services that have been practiced during the pandemic may revert to the traditional face-to-face services, those innovative contactless healthcare services that have been proven effective during the pandemic would be practiced or even advanced in the post-pandemic period due to the accelerating technological developments. This study suggests many potential opportunities and daunting challenges for healthcare institutions, policymakers, and consumers regarding the implementation of contactless services in the post-COVID-19 era.

Healthcare supply chain management: Application in the Maltese Healthcare System

Introduction

Hospital supply chains are complex systems ensuring flow of products/services to satisfy patients. The aim of this exploratory study is to improve the Maltese health care system’s efficiency using supply chain management principles in three hospital settings. The theoretical basis underlying the study is the supply chain decision-making framework.

Methods

Using observation and focus groups, the following steps were undertaken: (i) mapping healthcare supply chain processes and identifying challenges; (ii) understanding competitive strategy through implied demand uncertainty; (iii) deriving supply chain strategies through supply chain drivers; (iv) optimizing healthcare supply chain (right balance between cost and responsiveness); (v) identifying critical success factors for healthcare supply chains.

Results

In line with their competitive and supply chain strategies, the three settings have well-defined primary goals, stakeholders’ needs/demands/expectations, as well as clear-cut, albeit some similar, criteria and sub-criteria for improving the quality and quantity of their services. The trade-offs between efficiency and responsiveness for the supply chain drivers are distinctive and in line with their competitive strategies, hence achieving the desired fit with the healthcare supply chain strategies.

Conclusions

By adopting healthcare supply chain principles, there should be improved services in each setting, which in turn should lead to system-wide results.

A systematic literature review of healthcare supply chain and implications of future research

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.

Sustainable Supply Chain Management Practices and Sustainable Performance in Hospitals: A Systematic Review and Integrative Framework

Hospital supply chains are responsible for several economic inefficiencies, negative environmental impacts, and social concerns. However, a lack of research on sustainable supply chain management specific to this sector is identified. Existing studies do not analyze supply chain management practices in an integrated and detailed manner, and do not consider all sustainable performance dimensions. To address these gaps, this paper presents a systematic literature review and develops a framework for identifying the supply chain management practices that may contribute to sustainable performance in hospitals. The proposed framework is composed of 12 categories of management practices, which include strategic management and leadership, supplier management, purchasing, warehousing and inventory, transportation and distribution, information and technology, energy, water, food, hospital design, waste, and customer relationship management. On the other side, performance categories include economic, environmental, and social factors. Moreover, illustrative effects of practices on performance are discussed. The novelty of this document lies in its focus on hospital settings, as well as on its comprehensiveness regarding the operationalization of practices and performance dimensions. In addition, a future research agenda is provided, which emphasizes the need for improved research generalizability, empirical validation, integrative addressing, and deeper analysis of relationships between practices and performance.

Adoption of practices for organizational effectiveness in healthcare supply chains

Purpose

The purpose of this paper is to explore the adoption of practices and investigating of commonalities/intensities between the factors for measuring organizational effectiveness (OE) across healthcare supply chains in the United Arab Emirates (UAE).

Design/methodology/approach

System theory coupled with the Supplier-Input-Process-Output-Customer tool was applied to facilitate the linkage between different nodes of the healthcare chain. An exploratory approach was used to explore and measure the importance of various OE factors across various nodes of the healthcare supply chain. Data were collected using a two-stage questionnaire process addressed at personnel in the UAE’s healthcare sector.

Findings

The study identified that 62 OE factors in the health are supply chain. Of these, 15 are related to suppliers, 14 to the healthcare process, 12 to employees, 8 to patients and the community, 6 to government directives and 7 to branding. In total, 21 common factors were identified and clustered into groups based on commonalities and intensities.

Research limitations/implications

The study identifies the most important factors for healthcare organizations to achieve OE for different dimensions of operations or performance. These factors will provide valuable insights for decision makers in the sector; it will provide valuable insights to healthcare professionals and academia to investigate more on these factors.

Originality/value

While there is an increasing research interest in healthcare supply chains, this is the first study to investigate OE across the entire chain while also evaluating the importance of and commonalities in OE-enabling factors.

Lean implementation in healthcare supply chain: a scoping review

PURPOSE

The purpose of this paper is to identify the lean production (LP) practices applied in healthcare supply chain and the existing barriers related to their implementation.

DESIGN/METHODOLOGY/APPROACH

To achieve that, a scoping review was carried out in order to consolidate the main practices and barriers, and also to evidence research gaps and directions according to different theoretical lenses.

FINDINGS

The findings show that there is a consensus on the potential of LP practices implementation in healthcare supply chain, but most studies still report such implementation restricted to specific unit or value stream within a hospital.

ORIGINALITY/VALUE

Healthcare organizations are under constant pressure to reduce costs and wastes, while improving services and patient safety. Further, its supply chain usually presents great opportunities for improvement, both in terms of cost reduction and quality of care increase. In this sense, the adaptation of LP practices and principles has been widely accepted in healthcare. However, studies show that most implementations fall far short from their goals because they are done in a fragmented way, and not from a system-wide perspective.

An innovative procedure for introducing the lean concept into the internal drug supply chain of a hospital

Purpose

In a hospital, the management of different materials (i.e. waste, drugs, equipment, etc.) is fundamental from an economical point of view and also when considering its impact on patient treatment. The purpose of this paper is to introduce by an innovative approach lean principles in the management of this supply chain.

Design/methodology/approach

After the contextualization of the importance of the drug management in hospitals, authors analyze the literature in particular discussing the points of weakness. They propose an innovative methodology to implement a lean principle in this particular supply chain. After a general discussion authors discuss the application of the proposed methodology in the largest Italian hospital, the Policlinico Sant’Orsola – Malpighi in Bologna.

Findings

The results are very encouraging, confirm the value of the methods and motivate the authors to do further research. The proposed methodology takes into account both a technical approach and the real behavior of a hospital including logistics knowledge and motivation for material management in ward personnel. Real results are interesting both in term of economic impact and in term of effect on patient care.

Originality/value

Maximizing patient care is the mission of the healthcare system; however, poor management of drugs and materials can have serious effects on the quality of service. In the last years, several excellent technological solutions have been developed, but often their application in the field was limited and ineffective due to the gap in knowledge and commitment required and available in the ward’s personnel. The new methodology developed is focused to solve this gap and was tested in an important case study.

Inventory management of surgical supplies and sterile instruments in hospitals: a literature review

Operating rooms are considered a significant revenue source, as well as the main source of waste and cost, among the hospital's departments. Any cost savings in operating rooms will have a broad financial impact. Over the last decades, many researchers and practitioners have conducted studies to deal with the issue of managing surgical supplies and instruments, which are highly affected by surgeons' preferences. The purpose of this article is to present an up-to-date review of research in the field of inventory management of surgical supplies and instruments. We have analysed the literature in a systematic manner and organised the identified papers into two groups: the papers that were published by scientific researchers and developed optimisation techniques and the papers that were published by practitioners and reported their observations of the current issues in the operating room. We also identify the future research directions leading to operating room inventory cost reduction.

The adoption of vendor managed inventory for hospital pharmaceutical supply

Purpose

The purpose of this paper is to investigate vendor managed inventory (VMI) for the supply of medicines between distributors and hospitals to identify factors that may affect VMI adoption.

Design/methodology/approach

Two contrasting VMI initiatives involving five organizations (three hospitals, one distributor and one manufacturer/supplier) are studied. A case study method with semi-structured interviews is used with triangulation in data collection, site visits and document analysis to enhance reliability and validity. The cases are analyzed and compared with respect to hospital, supplier, product and supply chain integration characteristics.

Findings

A successful public sector VMI initiative and an unsuccessful private sector VMI initiative are identified. The public sector supplier focuses on improving service level while the private sector supplier seeks to strengthen relationships with a key customer. Hospital characteristics, including type of hospital, top management perspectives and the hospital’s willingness to share information, are critical in decisions on VMI initiation or termination. Relatively stable demand products are preferred for a VMI approach. Hospitals may perceive risks in VMI adoption for medicines as it involves relinquishing control of critical supplies and may result in “lock-in” with a particular supplier.

Research limitations/implications

The cases have been conducted in one country, which may affect generalization of the findings. Wider empirical evidence from other countries in both developed and less developed regions will be beneficial.

Practical implications

VMI is advocated as being beneficial in many supply contexts. However, it is challenging to implement. The study identifies factors that affect the adoption of VMI for hospital pharmaceuticals and provides guidance on initiating VMI in a hospital context.

Social implications

The potential for VMI in public health projects to enable greater access to critical medicines is highlighted.

Originality/value

The paper provides supply side and demand side perspectives on VMI adoption in an important sector. It highlights the need for greater understanding of the perceived and actual risks in VMI from the perspective of both the hospital and the supplier and for much clearer advice on which pharmaceutical products are appropriate for VMI control in a hospital context.

The drug logistics process: an innovative experience

Purpose

– The purpose of this paper is to present the latest innovations in the drug distribution processes of hospital companies, which are currently dealing with high inventory and storage costs and fragmented organizational responsibilities.

Design/methodology/approach

– The literature review and the in-depth analysis of a case study support the understanding of the unit dose drug distribution system and the subsequent definition of the practical implications for hospital companies.

Findings

– Starting from the insights offered by the case study, the analysis shows that the unit dose system allows hospitals to improve the patient care quality and reduce costs.

Research limitations/implications

– The limitations of the research are those related to the theoretical and exploratory nature of the study, but from a practical point of view, the work provides important indications to the management of healthcare companies, which have to innovate their drug distribution systems.

Originality/value

– This paper analyzes a new and highly topical issue and provides several insights for the competitive development of a fundamental sector.

Collaborative purchasing of complex technologies in healthcare

Purpose

– The purpose of this paper is to investigate how buyers and the vendors pursue alignment in collaborative purchasing (CP) of complex medical technologies.

Design/methodology/approach

– Through a literature review in CP, the paper identify factors for shareholder alignment (i.e. aligning the needs of the buyers within the purchasing group) and customer alignment (i.e. aligning buyers’ needs with the vendors offering strategies) and investigate how they manifest in the case of CP of complex technology in the Danish National Healthcare System.

Findings

– Shareholder alignment requires appropriate management of the relationships, expertise and guidance in simplifying procedures and effective management of the purchasing group. Customer alignment is facilitated by buyers’ understating of the vendor’s design options, which are moderated by the vendor’s design strategies.

Research limitations/implications

– The findings and generalizations from a single case study are limited to the complexity of the purchased technology and the specific cultural context. However the paper represents the first explorative study that poses the attention on the relevance of shareholder and customer alignment in CP.

Practical implications

– The study can offer hospitals, vendors, governmental and regional institutions a better understanding about the alignment mechanisms for successful implementation of CP and how to avoid pitfalls.

Originality/value

– Literature on CP is scarce as there are virtually no contributions that debate the key elements and tradeoffs that need to be considered for strategic alignment. The study addresses this gap.

Outsourcing of facilities management (FM) services in public hospitals

Purpose

– The purpose of this paper is to extend the body of knowledge on health care facilities management (FM) by investigating the extent to which public hospitals in Nigeria have fared in terms of outsourced FM services.

Design/methodology/approach

– The paper relied on two strands of methodology common with pragmatic research. Questionnaire survey (QS) used data from 74 respondents representing 74 hospitals, while 3 of the 74 hospitals involved in the QS were selected based on their willingness to enter the case study interview. Data collected were analysed using descriptive statistics (QS) and using narrative techniques by discussing themes, sub-themes and interconnecting themes through a chronology of events, as in grounded theory.

Findings

– Findings revealed that most public hospitals do not have a policy framework for outsourcing in general and FM services in particular, giving room for duplication of functions and non-establishment of functional FM units to handle FM activities, while six FM services are outsourced in all the hospitals. Cleaning, security and catering services received the highest satisfaction ratings, while plant maintenance services, however, received the least satisfaction rating.

Originality/value

– The paper provides the first ever survey based on empirical evidence about the state of FM services outsourced in Nigeria’s public hospitals. The survey suggests a relatively low level of usage of outsourcing for its services, as only a handful of FM services are outsourced in most of the hospitals.

AUTOMATION IN HEALTHCARE INTERNAL LOGISTICS: A CASE STUDY ON PRACTICE AND POTENTIAL

The current demographic development puts even greater demands on the healthcare sector which is already struggling with scarce resources and constant pressure of cost reductions. This paper, through multiple case studies, aims to describe how automation of hospital internal logistics can be a tool in improving efficiency. The results include several potential implementations for patient transports, waste handling and small goods transports. However, organizational issues as lack of ownership and a strategic view render difficulties and need to be dealt with. The authors conclude that transfer of knowledge and technology used in the manufacturing industry would be beneficial.

Outsourcing in public hospitals: a Greek perspective

PURPOSE

The purpose of this research is to investigate the extent of outsourcing, the decision-making process, the impact of outsourcing, and the future trend of outsourcing in public hospitals in Greece.

DESIGN/METHODOLOGY/APPROACH

A survey instrument was designed and mailed to a random sample of 100 public hospitals in Greece and 43 usable questionnaires were received, representing a response rate of 43 percent. The survey instrument focused on the extent to which public hospitals outsource services, the decision-making process for choosing an external service provider, the impact of outsourcing, and the future trend of outsourcing in public healthcare organisations.

FINDINGS

Public hospitals in Greece outsource a variety of activities. Cost savings and customer satisfaction are the main factors affecting the outsourcing decision. The cooperation with a contract service provider has led to significant improvement in service quality levels. Most users are satisfied with the performance of these companies and believe that there will be an increase in the usage of these services in the future.

PRACTICAL IMPLICATIONS

It provides a decision-making framework regarding outsourcing in public healthcare organisations.

ORIGINALITY/VALUE

This research fills the gap in the area of outsourcing in public hospitals in Greece.