1

Assignment 5

Conclusion and recommendations

Anthony John Gargiulo

Whatsapp Number: +1 (954) 213-3494

Dr. Tuly Badillo

SCM4191: SCM Capstone Online

Broward College
Date: 10-12-2023
Running Head: HEALTHCARE SUPPLY CHAIN MANAGEMENT

Contents
1. Background and Research Questions.................................................................................3

1.1 Problem statement.......................................................................................................3

1.2 Background..................................................................................................................4

1.3 Research questions......................................................................................................5

2. Review of literature............................................................................................................7

2.1 Co-creation theory and complexity theory..................................................................7

2.2 Lean theory..................................................................................................................8

2.3 Simulation based lean theory.......................................................................................9

2.4 Transaction cost economics.........................................................................................9

2.5 Theory of constraints.................................................................................................10

3. Research method...............................................................................................................11

4. Research finding...............................................................................................................14

5. Conclusion and recommendations....................................................................................16

6. References.........................................................................................................................20
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1. Background and Research Questions

1.1 Problem statement

Despite the existence of extensively documented evidence highlighting the substantial

competitive advantage and cost savings associated with the execution of supply chain

management (SCM), the healthcare sector has exhibited a notable reluctance in adopting

these practices. According to a study conducted by the Centre for Studying Health System, it

was reported that hospital expenditures were 47% of the total 7.2 % rise in healthcare costs in

2017 (Ridao-López, Comendeiro-Maaløe et al. 2018). Likewise, according to Essila (2022), it

has been asserted that the operational expenses associated with running a typical hospital

account for 40% of the overall cost of the supply chain. As per Ahmadi, Mosadegh, and

colleagues (2022) studies, existing evaluations indicate that the prospective worth of a well-

managed healthcare supply chain varies between 2% and 8 % of hospital operating cost.

According to a study conducted by Cap Gemini, 70% of the 1,000 companies surveyed

experienced a recovery period of three months or longer for their supply networks in response

to the impact of the COVID-19 pandemic in 2020. Furthermore, the findings of the study

indicate that a significant proportion of the healthcare providers examined, specifically 40%,

had a restoration period exceeding three months in order to regain functionality in their

supply chains. (Supply Chain Challenges in the Global Healthcare Sector, n.d.). Based on the

analysis conducted by (Monroe, Teets et al. 2014), a prominent medical equipment provider,

hospitals allocate a significant portion of their expenditures, almost 30%, towards supply

chains. This amounts to a substantial annual sum of $25.4 billion.

The findings of a survey done by Sage Growth Partners, commissioned by an

inventory management service, revealed that a significant proportion of hospitals, specifically

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43%, encountered a decline in nurse staffing levels, while 12% witnessed a reduction in the

number of doctors. These decreases were attributed to supply limitations imposed over the

course of the Covid-19 pandemic (Moosavi, Fathollahi-Fard et al. 2022). Moreover, The

healthcare business has considerable challenges in effectively overseeing its supply chain as a

result of various variables, including the diverse array of products, evolving information

technology trends, unpredictable product life cycles, and increasing dependence on

outsourcing (Kwon, Kim et al. 2016). One of the primary obstacles encountered by the

HSCM is the inherent problem of attaining cost efficiency. This challenge arises from various

disruptive factors, including manufacturer alliance realignments, climate-related incidents,

political disruptions, and the ongoing process of digitalizing the supply chain (Lund, Manyika

et al., 2020). The aforementioned interruptions necessitate that integrated delivery networks

adopt a reactive approach in response to backorders and recalls of crucial medical supplies.

Consequently, there is a rise in the overall cost connected with the Health Supply Chain

Management (HSCM). Hence, it is crucial to devise sustainable strategies for healthcare

supply chain management (HSCM) that offer economically viable medical items while

ensuring profitability for the business sector. Moreover, Almutairi et al. (2020) asserted that

the integration of cost-effective healthcare supply chain management (HSCM) enables

healthcare industries to offer medical goods at reduced prices, ultimately leading to the

preservation of human lives.

1.2 Background

Based on the findings of Gartner (n.d.), it has been determined that SC costs account

for 37.7% of the overall patient costs in the global healthcare sector. Consequently, the

implementation of a contemporary healthcare supply chain management approach yields

positive effects on patient outcomes, worker safety and productivity, as well as cost savings
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for healthcare providers. Furthermore, the prompt provision of healthcare services is crucial

for effective patient management; nevertheless, there is a prevalent issue of patients

experiencing delays in obtaining the necessary equipment and resources. The scope of the

Healthcare Supply Chain Management (HSCM) includes a wide range of components,

ranging from advanced medical gadgets and equipment of essential needs of hospital. An

efficiently functioning supply chain enables healthcare providers to allocate their attention

towards patient care, rather than expending valuable time and effort in pursuit of essential

materials and equipment.

Given the ongoing financial difficulties caused by the epidemic, the partial recovery

of patient volumes, and the possibility of an economic downturn, health institutions are

actively seeking ways to enhance fiscal responsibility and generate cost savings. Bowen et al

(2022) assert that the supply chain function is responsible for managing the external

expenditure of health systems, which can account for up to 40 percent of the total expenses.

There is distinct evidence of a research deficit in relation to optimizing performance.

Moreover, the implementation of a high-performing and cost-effective supply chain function

has the potential to enhance resilience, improve care quality, increase physician satisfaction,

lower supply expenditures by a maximum of 10 percent, and strategically position health

systems to successfully attain their growth objectives.

1.3 Research questions

Is it necessary to establish a Supply Chain Resilience strategy in order to mitigate the

financial implications of supply chain operations and mitigate the risk of product shortages

during periods of disruption?

SC resilience refers to the capacity to effectively handle and mitigate interruptions

and shocks in a manner that minimizes any substantial disruptions to patient care and the
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overall delivery of healthcare services. The healthcare supply chain resilience encompasses

three fundamental components, namely agility, robustness, and visibility. Agility is a term

used to measure the ability of a supply chain to adapt to quickly and effectively, minimize the

impact of, and proactively prevent product shortages when faced with disruptions. The notion

of robustness in the domain of supply chain management pertains to the capacity of the

supply chain to efficiently manage and adjust to unforeseen surges in demand. This is

accomplished through proactive efforts implemented to predict and mitigate interruptions, if

possible. Visibility pertains to the ability of stakeholders within a supply chain to proficiently

observe possible risks, employ data-driven insights for informed decision-making, and

effectively bounce back from any disruptions that may arise.

Is it necessary to investigate the obstacles hindering the implementation of the

Healthcare Supply Chain Management (HCSM) in order to mitigate the costs associated with

the supply chain?

The hurdles encompassed several factors, such the absence of endorsement from top-

level management, incongruent or contradictory motivations, the necessity for data gathering

and performance evaluation, and insufficient knowledge on supply chain matters. In the

present competitive landscape, healthcare supply chain management holds considerable

significance and warrants substantial research focus. This is because the healthcare industry

is confronted with the task of meeting increasingly high consumer demands while

maintaining a reasonable cost structure.

Is it necessary to optimize the healthcare supply chain in order to effectively address

the challenges posed by the pandemic?

The healthcare supply chains had undergone a process of increased efficiency and

worldwide integration in the period preceding the onset of the COVID-19 pandemic.

However, these very characteristics rendered the supply systems more susceptible to potential
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disruptions. Amidst the global pandemic, a network of local medical suppliers and

community groups was developed with the aim of mitigating the inadequacies in the

accessibility of medicine and other indispensable provisions. The cost-effectiveness of the

preceding supply chain exceeds that of the locally based, decentralized model that has arisen.

Nevertheless, specific characteristics of the latter can be integrated into a revolutionary

supply chain framework for the healthcare industry.

2. Review of literature

The major cost of medical products is due to the cost of healthcare supply chain

management (HSCM). In case of inefficient HSCM, the cost of medical products

significantly increases, and it can restrict the healthcare center to provide medical products at

low cost and safe lives of humans (Kwon, Kim et al. 2016). HSCM can be Inefficient due to

lack of information sharing between the manufacturers, distributors, wholesalers, and

providers (Campling, Grocott, & Cowley, 2008). In order to resolve these issues, researchers

used different frameworks and theories. The research of the suggested HSCM framework

highlights the interconnection between environmental, social, and economic sustainability as

a catalyst for progress. Certain items that are being included into the healthcare supply chain

have the potential to contribute to the generation of novel ideas and the introduction of

innovative products. The emerging theories and frameworks used to resolve these issues are

explained below:

2.1 Co-creation theory and complexity theory

In order to resolve this problem of HSCM, Dobrzykowski and Vonderembse (2009)

proposed and implement a framework healthcare supply chain and Information Systems (IS)

strategies. The proposed framework consists of two theories such as value co-creation theory
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and complexity theory to aid with the four-stage causal model proposing relationships

between, supply chain and IS strategies, operational complexity, supply chain practices, and

lastly quality and cost of products. Result indicated that Information Systems (IS) strategies

plays a significant role for the coordinates of the patients and there exist several suppliers

throughout the healthcare process that have the potential to yield enhancements in quality,

reductions in expense, and augmentations in customer pleasure.

2.2 Lean theory

Recent research studies have indicated that healthcare organizations should use supply

chain management (SCM) as a means to enhance the efficiency of their systems by reducing

non-value-added elements. Similarly, lean theory is widely recognized as a potent approach

for eliminating non-value-added components from a system. Hence, the integration of lean

principles into the supply chain appears to have the potential to enhance the aforementioned

healthcare challenges (Khorasani, Cross, & Maghazei, 2020). Smart and lean supply chain

management (SLSCM) proposed by the (Akbal & Doğan, 2023) and stated that the lean

mindset is a prominent operations management theory that has the potential to enhance

patient safety, cut healthcare expenditures, mitigate litigation, decrease reliance on

Government and Insurance, and bolster profitability. The concept of lean entails enhancing

customer value through the reduction of waste within the system and the optimization of

resource utilization. The primary objective of SLSCM in the healthcare sector is to eliminate

inefficiencies stemming from non-value-added activities. These activities encompass several

aspects such as overproduction, waiting, inventory, transportation, motion, underutilization of

workers, and unnecessary processing. These inefficiencies not only incur significant costs but

also pose significant challenges within the healthcare industry.

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2.3 Simulation based lean theory

The simulation-based lean method is an empirical and theoretical and paradigm

proposes the integration of lean principles and discrete-event simulation. Simulation and lean

methodologies are employed with the objective of enhancing effectiveness and productivity

of service delivery processes within the healthcare supply chain. While simulation and lean

approaches have the potential to complement one other, they have traditionally been

implemented separately (Yılmaz, Yeni, Yılmaz, & Özçelik, 2023). The simulation-based lean

strategy aims to integrate simulation with lean principles in order to enhance process

improvement. (Diaz, Kolachana, & Falcão Gomes, 2023) have presented a simulation-based

lean theory framework with the aim of optimizing the common logistic practices utilized by

biopharmaceutical manufacturing enterprises. The authors employed theoretical expertise and

employed the Taguchi Orthogonal methodology to build experiments. They subsequently

conducted an Analysis of Variance test to evaluate the significance of various policy factors

in the healthcare domain. The results showed that in a multi-echelon capital-intensive supply

chain system, policy variables have a significant influence on supply and demand uncertainty.

Moreover, these uncertainties are further intensified by the presence of distinct regulatory

frameworks, hence amplifying the cumulative effects of these factors.

2.4 Transaction cost economics

Richard Coase proposed the transaction cost technique. The concept being explored

here relates to the process of establishing the value of goods or services in the marketplace

instead of setting a fixed price for them, as examined by Coase (1937). This phenomenon

results in increased flexibility and facilitates the implementation of a lean supply chain.

According to the findings of (Seddigh, Shokouhyar, & Loghmani, 2023). the enhancement of

service quality within the pharmaceutical supply chain can be achieved through the
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implementation of appropriate pricing strategies. Therefore, the utilization of theoretical

frameworks such as transaction-cost economics has the potential to lead to a decrease in drug

supply chain management expenditures. (Jraisat, Jreissat, Upadhyay, & Kumar, 2023) argued

that Blockchain technology holds significant potential in facilitating the attainment of

sustainable supply chain management objectives, particularly in relation to the financial

components of supply chain management. Furthermore, it is beneficial to comprehend and

establish a robust foundation for the implementation, administration, and results of

sustainable supply chain management, particularly in relation to the financial aspects. This is

crucial as it significantly contributes to the reduction of expenses associated with medical

products that are distributed through the healthcare supply chain management system.

2.5 Theory of constraints

A pharmaceutical corporation to establish sustainable digital supply chain

management studied by (Shashi, 2023) using the theory of constraints. This approach offers

potential benefits such as cost reduction in operations, improved asset management, increased

shareholder value, effective response to consumer demand, and generation of profits.

Informed by the theory of constraints, the primary objective was to investigate the techniques

employed by pharmaceutical managers in the digitalization of integrated supply chain

systems, with the ultimate goal of enhancing sustainability and profitability. The research

findings presented in this study have had a beneficial impact on social change by enhancing

the productivity of supply chain systems within the pharmaceutical industry. This

improvement has resulted in reduced costs and has contributed to the provision of more

affordable healthcare for the community. Furthermore, Moreover, the study conducted by

(Bacelar-Silva, Cox III, & Rodrigues, 2022) explored the use of the theory of constraints in

comprehending and identifying the limitations that impede the supply chain operations from
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attaining enhanced performance. The conclusion drawn by the authors suggests that the use

of the theory of limitations conceptual framework, in combination with digital tools and

technology, played a significant character in enabling the successful digitalization of the

supply chain system by the pharmaceutical managers participating in the study. The

implementation of these solutions played a vital role in reducing the costs that do not

contribute value to supply chain management, hence ensuring the accessibility of affordable

medical items.

3. Research method

To ensuring the accessibility of medical supplies to clients is a fundamental necessity

for healthcare organizations. In this regard, (Bentahar, Benzidia et al. 2023) employed a

qualitative methodology to investigate the significant factors influencing sustainable

healthcare supply chains. They also sought to establish a connection between these factors

and the taxonomy of environmentally conscious practices within the healthcare industry. This

study employed a multiple case study methodology, utilizing 60 interviews conducted with

nine hospitals in France, representing both the private and public sectors. The rationale for

selecting hospitals as the focus of this research stems from their substantial environmental

footprint, as they engage in various energy and water-consuming activities, while also

generating significant amounts of general waste and infectious medical waste.

The data gathering process involved conducting in-depth qualitative interviews with

important managers from nine French organizations, providing the study team with valuable

access to these individuals. The authors employed the intra-case analysis method, as

suggested by (Miles, Huberman et al. 2019) to ensure the accessibility of medical supplies to

clients is a fundamental necessity for healthcare organizations. This approach aids purchasers

in the supplier selection process. The findings of studies indicated that various factors are
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essential for effectively implementing sustainable healthcare supply chains. The identified

components encompass regulatory compliance, initiatives for reducing costs, a firm

commitment from upper management, extensive programs for training employees, efficient

utilization of information technology, and the application of suitable metrics for monitoring

environmental performance. The report also emphasizes a number of emerging important

factors, including the environmental champion, purchasing group, building development, and

the incorporation of safety and green practices for healthcare supply chain management.

Qualitative synthesis methods highlight the acquisition of factual information and

necessitate a more profound comprehension of the phenomena under investigation compared

to quantitative procedures. One factor contributing to this phenomenon is the lack of

directness in articulating the research aims within the titles of predominantly qualitative

investigations (Thomas 2021). Therefore, the process of locating and examining qualitative

studies is typically more intricate and challenging when compared to quantitative studies.

In order to address this issue, the researchers (Bvuchete, Grobbelaar et al., 2020)

employed interviews and cross-sectional qualitative surveys as research methodologies. Their

objective was to propose a demand-driven supply chain management (DDSCM) approach

and establish a framework specifically tailored for the public healthcare sector. The author

employed a methodology based on grounded theory to construct the framework, utilizing

conceptual framework analysis (CFA).

The CFA, as developed by Jabareen (2009), comprises a series of eight processes.

These steps included reading and categorizing data, mapping data sources, and naming

concepts, integrating concepts, identifying, synthesis and resynthesis, framework evaluation,

and rethinking the framework. To facilitate the execution of the study, the researchers

employed three distinct methodologies, namely: the formulation of a comprehensive review

plan, the implementation of the review process, and the subsequent reporting and distribution
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of the findings. During the planning and review stage, the authors engaged in the formulation

of study questions, establishment of criteria for reporting study accessibility, and

determination of inclusion and exclusion criteria. During the review step, the author

identified the concepts that needed to be included in the search, determined the appropriate

search keywords and terms, and selected suitable databases for the research. Finally, during

the reporting and dissemination phase of data collecting, the authors successfully identified

the primary contributors to the main research, determined the geographical locations of these

contributors, and established the timeframe in which the research was undertaken by said

contributors. In addition, authors employed systematic reviews and meta-analysis techniques

to ensure the selection of data that minimizes issues related to replicability, bias, and

believability. The authors conducted a classification of the research based on their publication

year in order to identify the necessity for healthcare supply chains to shift from a pure push

strategy to a pull strategy. The findings of the study suggest that the proposed framework

offers a solid basis for gaining a full grasp of the fundamental aspects that can be

implemented within the healthcare industry.

The study conducted by Borges, Tortorella et al. (2019) examines the use of lean

production procedures in the healthcare supply chain and identifies the challenges that hinder

their implementation. The author employed the methodological method developed by Arksey

and O'Malley (2005), which comprises five distinct stages. The steps involved in this process

encompass the identification of the research question, the establishment of a comprehensive

bibliographic portfolio, the consolidation of research axes, the execution of bibliometric

analysis, the organization of data using charts, and the subsequent analysis and discussion of

theoretical perspectives. The bibliographic portfolio approach entailed the integration of

many study axes. After the formulation of the definitive definition of BP, a bibliometric

analysis was conducted to quantitatively evaluate the production and distribution of

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knowledge related to the authors and journals in the field being studied. In this particular

situation, the bibliometric analysis was conducted in two distinct stages. The primary

objective of the initial analysis is to investigate the scholarly journals, notable authors, and

temporal patterns of publication in the subject of BP. The study undertaken by the authors

focused on examining the key lean practices employed in the healthcare supply chain, with

the barriers that impede their successful adoption. Furthermore, an analysis was conducted on

the research methodology utilized in these investigations. The results of the analysis indicated

that out of the 57 papers analyzed in this research, 33 papers specifically concentrated on the

application of lean principles in healthcare supply chains.

4. Research finding

The findings of comprehensive review studies by Tortorella et al. (2019) show that

there exists a prevailing agreement regarding the possibilities of implementing lean

manufacturing practices inside the healthcare supply chain management (HSCM). However,

the majority of studies continue to observe that such implementation remains limited to

certain units or value streams within a hospital. The next level of findings involves that

Healthcare organization’s face persistent demands to minimize expenditures and

inefficiencies while enhancing service quality and ensuring patient safety. Moreover, the

supply chain of the organization typically offers significant prospects for enhancement,

including cost reduction and improved the key performance indicators of HSCM. In this

sense, it is found that the implementation of lean production practices and ideas has gained

significant acceptance within the healthcare industry. Nevertheless, research found that the

majority of implementations do not meet their intended objectives due to their fragmented

nature and lack of a comprehensive system-wide approach.

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The study conducted by Dixit, Routroy, and Dubey (2019) about the implementation

of lean tools in HSCM. It is found that the drug distribution system and patient safety within

the HSCM are crucial factors that contribute to the enhancement of healthcare supply chain

management, as the expenses associated with supply chain management are contingent upon

these specific domains.

Similarly, sustainable applications in HSCM were studied by Scavarda, Daú,

Scavarda, & Korzenowski (2019). The authors find out that the coordination,

implementation, and oversight of activities pertaining to the segregation of healthcare solid

waste. Furthermore, they found that Educational program is enhanced not only to improve the

understanding of the public but also to raise societal awareness regarding appropriate waste

disposal practices. The implementation of an educational plan has the potential to enhance

sustainable visibility through several perspectives. The implementation of the Triple Bottom

Line places focusses not only on the feasibility of selling recyclable materials, but also on the

execution of measures that benefit local communities. The aforementioned efforts might be

exemplified by the implementation of recycling cooperatives, local sewing cooperatives, craft

fairs, vocational courses, and the integration of community workers into healthcare

institutions. The finding drawn from this analysis is that HSCM has the potential to enhance

the overall quality of life for the people and provide new perspectives for sustainable

applications. Moreover, the healthcare organization is required to adopt an educational

program, foster corporate social responsibility, and engage with the community, in

accordance with the principles of the Triple Bottom Line.

A systematic review about the implementations of lean tools in the HSCM conducted

by the (Khorasani et al., 2020). Authors found that lean tools such as simulation lean theory,

knowledge-based view the theory of swift and theory of constraint played important role to

find out the causes of waste in the healthcare supply chain such as overproduction,
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inappropriate processing time, inventory and underutilization and improved the efficiency

and productivity of healthcare supply chain. Furthermore, author found there is still research

gape in the healthcare supply chain management to further improved using the lean tools. The

author also found circumstances in which healthcare organization’s derive comparable

objectives from the implementation of supply chain and lean techniques. The author

additionally presented an application for lean methodology in the context of enhancing

supply chain operations within the healthcare sector. At the end, authors found that flow time

of medical products in the healthcare supply chain reduces through the implementation of

lean tools such as value stream mapping in the healthcare sector.

5. Conclusion and recommendations

The study conducted by Dixit, Routroy, and Dubey (2019) about the implementation

of lean tools in healthcare supply chain management (HSCM) concluded that the healthcare

supply chain (HSC) is characterized by significant financial and service level obligations.

The authors of the study concluded that the presence of unpredictable and high demands

inside healthcare sector posed a substantial obstacle to the successful application of lean

practices. The research has indicated that incorporating the adaptability in both demand and

suppliers of patients delivery for medical products might result in a more comprehensive

actual effects of lean implementation in the HSC. Moreover, it has been noted that the

existing literature review lacks comprehensive investigations on the obstacles hindering the

achievement of a successful lean implementation within the HSC. Moreover, it has been

ascertained that the examination of lean implementation within the external supply chain

relies on case studies conducted in the internal supply chain, with a predominant emphasis on

a single department within the hospital. The majority of existing studies primarily concentrate

on individual sectors that possess distinct characteristics. Consequently, there is a need for
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research that presents a framework for coordinating the adoption of lean principles across the

HSC. Such research can offer valuable theoretical insights and have substantial practical

ramifications. Nevertheless, the evaluation of lean adoption within the HSC remains

infrequent. Hence, it is advisable to establish a comprehensive framework in subsequent

undertakes that encompasses diverse value streams and encompasses both external and

internal supply chains. This framework would serve as a strategic reference for enhancing the

HSCM by minimizing inefficiencies and waste.

In their study, Khorasani et al. (2020b) reached the conclusion that there are benefits

to be gained from cost reduction and the provision of improved service quality In the HSCM.

The use of Lean Supply Chain Management in healthcare (LSCM) has the potential to serve

as an efficient solution for enhancing cost of HSCM, patient safety, instrument utilization and

pharmaceutical distribution systems within the healthcare industry. The study revealed that

the drug distribution system is a significant domain within the field of SCM. However, it is

worth noting that there is a limited amount of existing research on this particular subject

matter. Likewise, the issue of enhancing patient safety within the HSC is a significant

subject, although there exists a noticeable dearth of scholarly investigation in this domain.

The study's secondary pool revealed a mere three papers pertaining to this topic. An

additional avenue for future investigation involves the comparison of costs and potential

savings associated with the application of lean methodologies within each HSC target area.

While the advantages of incorporating lean principles in SCM have been frequently

acknowledged in the available literature, their quantification is not consistently addressed,

and the associated costs are generally overlooked. In addition, it is imperative for

forthcoming researchers to investigate the ramifications of employing several lean

applications within each specific domain of lean implementation. This is crucial as existing

studies predominantly concentrate on singular or limited applications, sometimes neglecting

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to explore the interconnections across these applications. Furthermore, the examination of the

consequences associated with the implementation of several lean applications in each specific

target area was beyond the purview of the current study. Consequently, the authors suggest

that comprehending the influence of multiple apps would serve as a significant expansion of

this research results.

According to the regarded as a significant subject of interest within professional and

the academic areas of logistics and HSCM. The findings of this study indicate that there are

still various technological, administrative, and strategic obstacles that need to be addressed in

order to promote the effective application of DSC. Moreover, the authors reached the

conclusion that it is imperative to advance the ongoing study conducted on the

implementation of technologies and their influence on the supply chain. In order to achieve a

thorough comprehension of the matters pertaining to DSC, forthcoming studies ought to

employ a diverse range of theoretical frameworks, including skill acceptance models and

theory such as dynamic capability theory, structural project management theory, innovation

adoption theory, and stakeholders theory. Additionally, these investigations should integrate

various research methods, both quantitative and qualitative, as well as adopt different

epistemological perspectives such as constructivism, positivism, and pragmatism. There is a

need for researchers to priorities the examination of topics pertaining to the digitalization of

supply chains in small and medium-sized enterprises (SMEs) as well as public supply chains,

specifically those inside public hospitals, which have received limited scholarly attention.

There exists a necessity to establish a shared theoretical framework for the digital supply

chain in order to facilitate forthcoming empirical investigations and attempts pertaining to

this subject matter. Future research efforts should be focused on providing support to

managers' initiatives through the development of conceptual models and theoretical

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frameworks, as well as the conduct of case studies and the creation of innovative practices

and projects for decision support systems (DSC).

The study conducted by Benzidia et al. (2023) utilized a qualitative methodological

approach to examine the primary determinants that impact sustainable healthcare supply

chain management (HSCM). Additionally, the researchers aimed to establish a relationship

between these characteristics and the classification of environmentally conscious practices

within the healthcare sector. Several elements have been identified to greatly influence the

impact of monitoring environmental performance and successfully implementing sustainable

healthcare supply chains These factors include cost reduction strategies, regulatory

compliance, comprehensive employee training program, strong commitment from top

management, the use of appropriate metrics, and effective utilization of information

technology. The study also noted the presence of several important factors, such as the

purchasing group, integration of safety and green practices, and environmental champion

contributed to the advancement of green SCM implementation in the healthcare industry. In

the future, it is imperative to focus on a singular hospital's workflow in order to closely

examine its developmental cycle and the circulation of flows throughout its supply chain, as

well as to assess its environmental performance. Furthermore, future research efforts may

involve doing quantitative studies to enhance the existing findings. This could entail

administering surveys to individuals involved in HSCM, allowing for additional examination

and validation of the concerns addressed in this study. Depending on the availability of data,

additional modelling efforts can be conducted to examine the flows associated with the green

SCM. The objective is to highlight the specific sections and aspects where significant

enhancements can be achieved during the implementation of green supply chain practices.
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6. References

Almutairi, A. M., Salonitis, K., & Al-Ashaab, A. (2020). A framework for

implementing lean principles in the supply chain management at health-care organizations:

Saudi’s perspective. International Journal of Lean Six Sigma, 11(3), 463-492.

Ahmadi, E., Mosadegh, H., Maihami, R., Ghalehkhondabi, I., Sun, M., & Süer, G. A.

(2022). Intelligent inventory management approaches for perishable pharmaceutical products

in a healthcare supply chain. Computers & Operations Research, 147, 105968

Ageron, B., Bentahar, O., & Gunasekaran, A. (2020). Digital supply chain: challenges

and future directions. Supply Chain Forum, 21(3), 133–138.

Arksey, H., & O'Malley, L. (2005). Scoping studies: towards a methodological

framework. International Journal of Social Research Methodology, 8(1), 19-32.

doi:10.1080/1364557032000119616

Bentahar, O., Benzidia, S., & Bourlakis, M. (2023). A green supply chain taxonomy

in healthcare: critical factors for a proactive approach. The international journal of Logistics

Management, 34(1), 60-83.

Bvuchete, M., Grobbelaar, S. S., & Van Eeden, J. (2020). Best practices for demand-

driven supply chain management in public healthcare sector: a systematic literature review.

South African Journal of Industrial Engineering, 31(2), 11-27.

Bowen, B., Galceran, B. C., Karim, S., & Weinstein, W. (2022, August 23).

Optimizing health system supply chain performance. McKinsey & Company.

https://www.mckinsey.com/industries/healthcare/our-insights/optimizing-health-system-

supply-chain-performance

Borges, G. A., Tortorella, G., Rossini, M., & Portioli-Staudacher, A. (2019). Lean

implementation in healthcare supply chain: a scoping review. Journal of Health Organization

and Management, 33(3), 304-322

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Dixit, A., Routroy, S., & Dubey, S. K. (2019). A systematic literature review of

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Appendix A

Healthcare unit and serviced involved in the Healthcare supply chain management

(Scavarda et al., 2019)