Logistics in the health care industry

Classification of medicines and materials in hospital inventory management: a multi-criteria analysis

BACKGROUND

In the hospital environment, to achieve an optimum level of operations and service, it is necessary to develop adequate inventory management system. Stocks can be managed, amongst other ways, through inputs classification, which is generally carried out based on a single criterion, such as monetary value, demand or criticality, which does not fully address the complexity of a hospital's inventory management system. Thus, the present study proposes a multi-criteria decision support model to help classify the stock of medicines and materials, enabling a more effective inventory management system for hospitals.

METHODS

Methodologically, the study followed 3 stages: (1) preliminary phase; (2) modelling and choice phase; and (3) finalization phase. Each stage had a set of specific steps that were followed. The first stage identified the actors of the process, objectives, criteria and alternatives, establishing 5 criteria and 48 alternatives; the second stage was the choice and execution of the multi-criteria decision method to solve the problem. It was decided to use the Flexible and Interactive Tradeoff method for the sorting problematic. Finally, in the third stage, the sensitivity analysis for the developed model and the validation of the results with decision makers were carried out. In the study, 48 medicines and materials were included to validate the proposed model; however, the model could be used for more items.

RESULTS

From the total of 48 medicines and hospital medical materials selected for the study, the classification of 34 of these alternatives to a single class was obtained through modelling and the other 14 alternatives were destined to two possible classes; moreover, the sensitivity analysis performed showed robust results. The items classified in class W should receive special attention by the stock manager; therefore, they should be monitored weekly. Items classified in class B should be monitored biweekly and finally, items classified in class M, should be monitored monthly.

CONCLUSIONS

The classification of medicines and materials developed according to the inventory demands allowed more efficient purchasing decisions, optimizing the stock of materials and medicines at the hospital while optimizing the inventory manager's activities, saving time. Consequently, the proposed model can support the development of other multicriteria models in different hospital scenarios.

Machine Learning and Lean Six Sigma to Assess How COVID-19 Has Changed the Patient Management of the Complex Operative Unit of Neurology and Stroke Unit: A Single Center Study

Background: In health, it is important to promote the effectiveness, efficiency and adequacy of the services provided; these concepts become even more important in the era of the COVID-19 pandemic, where efforts to manage the disease have absorbed all hospital resources. The COVID-19 emergency led to a profound restructuring-in a very short time-of the Italian hospital system. Some factors that impose higher costs on hospitals are inappropriate hospitalization and length of stay (LOS). The length of stay (LOS) is a very useful parameter for the management of services within the hospital and is an index evaluated for the management of costs. Methods: This study analyzed how COVID-19 changed the activity of the Complex Operative Unit (COU) of the Neurology and Stroke Unit of the San Giovanni di Dio e Ruggi d'Aragona University Hospital of Salerno (Italy). The methodology used in this study was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC roadmap, characterized by five operational phases. To add even more value to the processing, a single clinical case, represented by stroke patients, was investigated to verify the specific impact of the pandemic. Results: The results obtained show a reduction in LOS for stroke patients and an increase in the value of the diagnosis related group relative weight. Conclusions: This work has shown how, thanks to the implementation of protocols for the management of the COU of the Neurology and Stroke Unit, the work of doctors has improved, and this is evident from the values of the parameters taken into consideration.

Benchmarking health-care supply chain by implementing Industry 4.0: a fuzzy-AHP-DEMATEL approach

Purpose

With the rising needs of health-care (HC) services during the health outbreaks, it is essential to upgrade the existing HC delivery infrastructure. The study aims to prioritize and highlight the interrelationships among the key factors of the smart health-care supply chain (HCSC) by implementing the concept of Industry 4.0.

Design/methodology/approach

The key factors of implementing Industry 4.0 in HCSC have been identified through extensive literature review and stakeholders' opinions. To achieve the abovementioned objectives, the present study proposed hybrid multi-criteria decision-making (MCDM) tools, namely, the fuzzy-analytic hierarchy process (AHP) and fuzzy- decision-making trial and evaluation laboratory (DEMATEL). The Fuzzy-AHP prioritized the factors of implementing Industry 4.0 in HCSC, while the cause–effect relationships among the factors have been explored using fuzzy-DEMATEL.

Findings

The results of the study indicated that HC logistics management (HCLM) is the most prioritized factor of implementing Industry 4.0 in HCSC, followed by the integrated HCSC, then sustainable HCSC practices, HCSC innovation and technological aspects, HCSC institutional perspectives, HCSC competitiveness, social aspects and economic factors of HCSC. The cause–effect analysis has highlighted integrated HCSC, HCLM, HCSC competitiveness and social aspects as the cause group factors and they are the critical success parameters for implementing Industry 4.0 in the HCSC.

Practical implications

The results of the study can be useful for policymakers, humanitarian organizations, health administrators and other decision makers considering the smartening of HCSC to enhance the operational performance of health facilities.

Originality/value

This is one of the few studies to have been conducted so far in which the subfactors of HCSC implementing Industry 4.0 have been identified and analyzed using the fuzzy-AHP and fuzzy-DEMATEL hybrid approach.

Logistics and procurement outsourcing in the healthcare sector: A comparative analysis

As outsourcing ventures become more complex, opportunities for synergies and efficiencies increase, but also create longer and more fragmented supply chains which could have disastrous consequences, particularly in a healthcare context. This study investigates the implications of outsourcing on healthcare supply chains by comparing two alternatives: outsourcing from public-to-private and outsourcing from public-to-public. A conceptual framework, adapted from previous literature, has been employed to provide a comprehensive overview of the phenomenon and consider the implications of logistics and procurement outsourcing on the healthcare supply chain structure and performance. The study presents a European cross-country comparison, analysing both the National Health Service (NHS) outsourcing in England (public-to-private outsourcing) and the Regional Health Service (RHS) outsourcing in the Tuscany region (Italy) (public-to-public outsourcing). Specificities and commonalities of the two outsourcing experiences provide suggestions for managers and policy-makers and enhance the current knowledge of outsourcing in the public healthcare sector.

Service modularity in managing healthcare logistics

Purpose

The purpose of this paper is to examine how modularity is used for enabling value creation in managing healthcare logistics services.

Design/methodology/approach

Material logistics of four different kinds of hospitals is examined through a qualitative case study. The theoretical framework builds on the literature on healthcare logistics, service modularity and value creation.

Findings

The case hospitals have developed their material logistics independently from others when looking at the modularity of offerings, processes and organisations. Services, such as assortment management, shelving and developing an information platform, have been performed in-house partly by the care personnel, but steps towards modularised and standardised solutions are now being taken in the case hospitals, including ideas about outsourcing some of the services.

Research limitations/implications

This paper proposes seven modularity components for healthcare logistics management: segmentation, categorisation and unitisation of offerings, differentiation and decoupling of processes, and centralisation and specialisation of organisations. Thus, this study clarifies the three-dimensional concept of modularity as a cognitive frame for managing logistics services with heterogeneous customer needs in a rapidly changing healthcare environment.

Practical implications

Modularity offers a tool for developing logistics services inside the hospital and increases possibilities to consider also external logistics service providers.

Social implications

Managing healthcare logistics services through modularity has potential social implications in developing healthcare processes and changing the usage of health services. On a wider scale, modularity is helping healthcare systems reaching their goals in terms of service quality and cost.

Originality/value

This paper shows the context-specific antecedents of service modularity and the usage of modular thinking in managing healthcare logistics.

Factors impacting technology adoption in hospital bed logistics

Purpose

The purpose of this paper is to refine and expand technology adoption theory for a healthcare logistics setting by combining the technology–organization–environment framework with a business process management (BPM) perspective. The paper identifies and ranks factors impacting the decision to implement instances of technologies in healthcare logistics processes.

Design/methodology/approach

A multiple case study is carried out at five Danish hospitals to investigate the bed logistics process. A combined technology adoption and BPM lens is applied to gain an understanding of the reasoning behind technology adoption.

Findings

A set of 17 factors impacting the adoption of technologies within healthcare logistics was identified. The impact factors perceived as most important to the adoption of technologies in healthcare logistics processes relate to quality, employee work conditions and employee engagement.

Research limitations/implications

This paper seeks to understand how managers can use knowledge about impact factors to improve processes through technology adoption. The findings of this study provide insights about the factors impacting the adoption of technologies in healthcare logistics processes. Differences in perceived importance of factors enable ranking of impact factors, and prioritization of changes to be implemented. The study is limited to five hospitals, but is expected to be representative of public hospitals in developed countries and applicable to similar processes.

Originality/value

The study contributes to the empirical research within the field of BPM and technology adoption in healthcare. Furthermore, the findings of this study enable managers to make an informed decision about technology adoption within a healthcare logistics setting.

Healthcare supply chain management: literature review and some issues

Purpose

The purpose of this paper is to examine the causal linkages among supply chain practices, effectiveness of supply chain performance (SCP) and organizational performance (OP) in Indian healthcare industries.

Design/methodology/approach

This paper is helpful in developing a framework for linking a healthcare supply chain practice to its OP, and thus identifies how such a linkage can be connected to the effectiveness of SCP. Such effort also enables the authors to derive a set of recommended supply chain practices for SC performance.

Findings

From the literature review, this paper finds that, in the context of Indian healthcare industries, efficient SC performance may play a critical role for overall OP improvement, as there is a close interrelationship between supply chain management (SCM) practices and SCP that may have a more significant effect on OP improvement.

Research limitations/implications

The principle limitation of the paper is that it is performed only in a particular industry and with a questionnaire survey which could be extended in future for other industries also. Another limitation of the paper is that it is focused only on the SCP of medical device and equipment supply chain which is a small portion of the whole healthcare supply chain, and therefore requires further research covering various other domains of healthcare supply chain. Another limitation of the study is that the sample survey has been taken from only one respondent per company at one point of time which may create biasness in the results. Thus, future research should collect data through multiple members from the organization.

Practical implications

This study contributes to know the effect of SCM practices on healthcare SCP and provides a practical and useful tool to evaluate the extent of effectiveness of SCP and finally their impact on the healthcare OP. Finally, this study provides conceptual and descriptive literature regarding SCM practices that leads to improvement in healthcare performance.

Social implications

This study adds to the knowledge on healthcare SCM performance by exploring the relationship between supply chain practices, healthcare SCP and healthcare OP and by developing and testing a research framework thus help in improving patient satisfaction.

Originality/value

This study attempts to show how the potential benefits of supply chain practices can no longer be ignored in healthcare supply chain.

Strategic issues in pharmaceutical supply chains: a review

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.

RFID-enabled process reengineering of closed-loop supply chains in the healthcare industry of Singapore

Due to an increasing global awareness of the need for sustainable development in academia and business, closed-loop supply chains in hospitals have become an important area of focus. Process reengineering in purchasing, materials management, work practices, and waste management can reduce environmental hazards and contain costs at the healthcare facilities. This paper demonstrates an application of the RFID-enabled process reengineering in sustainable healthcare system design, and presents a case study in the linens division of central sterilization services department at a Singaporean hospital using ARENA simulation.

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.

[Lean logistics management in healthcare: a case study]

OBJECTIVE

To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs.

METHODS

This study is based on a case study.

STUDY PERIOD

2005-10.

SCOPE

Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments.

RESULTS

The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics.

CONCLUSIONS

The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise.

Improving decision making in healthcare services through the use of existing simulation modelling tools and new technologies

Purpose

The purpose of this paper is to investigate the viability of using distributed simulation to execute large and complex healthcare simulation models which help government take informed decisions.

Design/methodology/approach

The paper compares the execution time of a standalone healthcare supply chain simulation with its distributed counterpart. Both the standalone and the distributed models are built using a commercial simulation package (CSP).

Findings

The results show that the execution time of the standalone healthcare supply chain simulation increases exponentially as the size and complexity of the system being modelled increases. On the other hand, using distributed simulation approach decreases the run time for large and complex models.

Research limitations/implications

The distributed approach of executing different parts of a single simulation model over different computers is only viable when the model: can be divided into logical parts and the exchange of information between these parts occurs at constant simulated time intervals; is sufficiently large and complicated, such that executing the model over a single processor is very time consuming.

Practical implications

Based on a feasibility study of the UK National Blood Service we demonstrate the effectiveness of distributed simulation and argue that it is a vital technique in healthcare informatics with respect to supporting decision making in large healthcare systems.

Originality/value

To the best of the knowledge, this is the first feasibility study in healthcare which shows the outcome of modelling and executing a distributed simulation using unmodified CSPs and a software/middleware for distributed simulation.

Measuring supply chain performance among public hospital laboratories

Purpose

The purpose of this paper is to investigate the efficiency levels of the decision‐making units within the public hospital laboratories in using their supply chain towards meeting the satisfaction of doctors.

Design/methodology/approach

Data were collected from two senior laboratory administrators and 30 doctors of two hospital laboratories in Malaysia using two sets of structured questionnaires, which comprised of two dimensions, i.e. doctor satisfaction dimension (DSD) and supply chain inputs (SCI). The dimensions of DSD and SCI were developed and that SCI has been relabeled as hospital laboratory inputs (HLI) to suit the nature of current study. The resulting data were positioned on an importance‐performance matrix. By using the data envelopment analysis software, the efficient frontier for both hospital laboratories was calculated under different scenarios.

Findings

Results reveal that one of the laboratories satisfies doctors efficiently using the present levels of HLI for each scenario while the other failed.

Research limitations/implications

The paper focuses only on two hospital laboratories.

Practical implications

The findings offer insights on the important dimensions of DSD and HLI that the hospital laboratories should concentrate on when measuring doctor satisfaction through the utilization of resources they possess. This will undoubtedly lead to better hospital‐doctor‐patient relationships.

Originality/value

Many prior supply chain studies have focused on patient satisfaction. This paper is probably one of the first attempts that comprehensively examines satisfaction from the perspective of doctors.

An analysis of international health care logistics

PURPOSE

The primary purpose of this study is to undertake a diagnostic investigation of the international health care logistical environment and determine whether regulatory policies or industry procedures have hindered the implementation of just-in-time (JIT) systems and then to recommend operational improvements to be achieved by implementing JIT Systems.

DESIGN/METHODOLOGY/APPROACH

The analysis was conducted in a systematic manner and compared the anticipated benefits with benefits validated in other industries from the implementation of JIT. An extensive literature review was conducted.

FINDINGS

In this particular study the cost and benefit outcomes achieved from a health care JIT implementation were compared with those achieved by the manufacturing, service, and retail industries. Chiefly, it was found that the health service market must be restructured to encourage greater price competition among priorities. A new standardization process should eliminate duplication of products and realize substantial savings.

ORIGINALITY/VALUE

The analysis was conducted in a systematic manner and compared the anticipated benefits with benefits validated in other industries from the implementation of JIT.