The drug logistics process: an innovative experience

A structural equation modeling of supply chain strategies for artemisinin-based combination therapies in Uganda

Introduction:

Malaria is a killer disease in the tropical environment; artemisinin-based combination therapies (ACTs) play a central role in treating malaria. Thus, the supply and presence of ACT drugs in hospitals are a key feature in the fight against malaria. Supply chain management literature has focused on the private sector, and less attention has been paid to the public sector, especially hospitals.

Aim:

This study uses an interdisciplinary lens in investigating how to boost the supply and distribution of ACTs to save lives in low-income countries, specifically in Uganda.

Methodology:

The study adopted a quantitative research design using a questionnaire as the data collection instrument. Of the 440-population size, 304 of the sample population participated in the study. The model was estimated using structural equation modeling (SEM) to establish the causal relationship among the variables.

Results:

From the SEM analysis, all the hypotheses were significant at p < 0.05. The availability of ACTs is strongly affected by strategic dimensions (0.612), followed by operation dimensions (0.257); strategic determinants significantly affect operational determinants by a magnitude of 0.599. The indirect influence of the strategic determinants via operational determinants on the availability of ACTs is not significant. Overall, the factors explained 63.9% of the observed variance in the availability of ACTs, and the ACT availability can be predicted as follows: ACT availability = 0.612 × strategic determinants + 0.256 × operation determinants. Top management commitment and organizational responsiveness are among the items that positively affect the availability of ACTs.

Conclusion:

Strategically, hospital management should invest in cheap technology and software to minimize the unavailability of medicines. Our research suggests that strategic and operational determinants should be integrated into the hospitals’ core business and implemented by the top management. The article contributes to theoretical and policy direction in the public sector medicine supply chain, specifically in public hospitals.

Factors influencing procurement behaviour and decision-making: an exploratory qualitative study in a UK healthcare provider

Background

In 2016 the UK Department of Health and Social Care published the results of a comprehensive review of efficiency in hospitals, identifying “unwarranted variation” in procurement (or purchasing) practices for materials, supplies and devices. Addressing this variation in materials and supplies procurement practice has been identified as particularly important for creating efficiencies in health service delivery. However, little is known about the behaviour and experiences of front-line individuals who make these procurement decisions, which has implications for the development of strategies to improve efficiency. The objective of this study is to improve understanding of the factors influencing procurement behaviour and decisions among requisitioners who use an internal electronic procurement portal for medical supplies and equipment, and identify areas where efficiency could be improved.

Methods

Qualitative semi-structured individual interview study, following approximately 70 h of exploratory observations on site. The study context was a large London National Health Service (NHS) healthcare provider (the Trust), where we focussed primarily on purchases managed by a large hospital. Participants were drawn from requisitioners from multiple directorates across the Trust (n = 15; of these n = 2 clinical staff members, n = 13 non-clinical).

Results

Four factors stood out in our analysis as directly affecting procurement decisions: (1) a high level of variation in electronic purchasing and inventory management procedures throughout the Trust, (ii) an inaccurate and cumbersome search facility on the internal electronic procurement platform, exacerbated by poor IT skills training and support (iii) an inefficient purchase approvals system and (iv) multiple working sites and cluttered environments. We observed that these factors led requisitioners to employ a variety of strategies or so-called ‘workarounds’ to overcome the challenges they encountered, including stockpiling, relying on internal and supplier relationships, by-passing procedures to save time, purchasing outside existing agreements to save cost, and (re) delegating purchasing responsibilities among requisitioner staff - which both addressed and created difficulties.

Conclusions

Working with the assumption that staff ‘workarounds’ indicate where main issues lie, we offer four possible explanations to why they occur: (a) to maintain services and prepare for future care requirements, (b) to save on costs for the organisation, (c) to develop skills and development in purchasing and (d) to break silos and work collaboratively. These four explanations help provide initial starting points for improving efficiencies in health supplies’ procurement processes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07065-0.

An apple a day - how the platform economy impacts value creation in the healthcare market

The healthcare industry has been slow to adopt new technologies and practices. However, digital and data-enabled innovations diffuse the market, and the COVID-19 pandemic has recently emphasized the necessity of a fundamental digital transformation. Available research indicates the relevance of digital platforms in this process but has not studied their economic impact to date. In view of this research gap and the social and economic relevance of healthcare, we explore how digital platforms might affect value creation in this market with a particular focus on Google, Apple, Facebook, Amazon, and Microsoft (GAFAM). We rely on value network analyses to examine how GAFAM platforms introduce new value-creating roles and mechanisms in healthcare through their manifold products and services. Hereupon, we examine the GAFAM-impact on healthcare by scrutinizing the facilitators, activities, and effects. Our analyses show how GAFAM platforms multifacetedly untie conventional relationships and transform value creation structures in the healthcare market.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12525-021-00467-2.

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.

Service Quality and Customer Satisfaction in Pharmaceutical Logistics: An Analysis Based on Kano Model and Importance-Satisfaction Model

The implementation of National Health Insurance in Taiwan has affected the medical industry by significantly depleting the supply chain’s profits. Service providers in the medical industry must meet the dual-service expectation of serving as medical manufacturers with upper reaches and as suppliers in the downstream marketing channel. As a result, service providers must anticipate customer requirements, offer new service items that align with customer demands and improve the quality of existing services. This study aims to examine consumer perspectives about service satisfaction in the domestic medical industry using Kano’s two-dimensional model. In addition, it employs the importance-satisfaction model to determine service items that need improvement. The empirical findings show that consumer perceptions about service quality attributes vary and thus, service items may be categorized differently in Kano’s model. Further, the reliability of service quality significantly affects customer satisfaction. Thus, service providers can gain a competitive edge and maintain their market position by offering high value added and critical quality attributes. Finally, analyzing customer attitudes toward new service items for indifference quality will help service providers determine effective tactics in a competitive market. In general, service providers should assign higher priority to items that customers consider in need of improvement.

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.