A literature survey on healthcare supply chain management

A. Supply Chain Planning

Wieland examined hospital-supplier cooperation in the healthcare supply chain to determine common goals and strategies for reaching them.¹⁷ In that trial, some businesses pooled resources to pay for full-time professionals to oversee logistics.¹⁸ The results of the study suggested that improving patient care may be achieved by collaborating with other organizations. The two companies weighed the merits of sharing information and learning about one another's operations.¹⁹ The authors highlight the difficulties and constraints of blockchain technology implementation while outlining the potential advantages in supply chain operations, such as better transparency, improved efficiency, and lower prices. The article further discusses the need for additional studies to fill in knowledge gaps and establish best practices for the supply chain implementation of blockchain technology.²⁰ By reducing the time and effort spent searching for a suitable alternative to an out-of-stock item, these delay management strategies can enhance patient care. Their focus was on pharmacists' roles in both primary and secondary care settings. According to Yu et al., and Queiroz et al., to achieve patient outcomes at the lowest feasible cost, medication management should be a collaborative effort between patients and clinicians that considers all aspects of patient usage.^20,21 To aid the new service in identifying areas that may be improved as part of the ongoing process of hospital quality improvement,²² they propose an integrated management of pharmaceuticals within the hospital that seeks to cover the main components and analyze the effect of their administration. Researchers considered the whole course of a patient's hospitalization; from the moment they were admitted to the moment they were discharged.

B. Demand Forecast

Several factors, including the nature of the injury, the patient's age, and the patient's financial situation, among others, contribute to an inaccuracy in the demand forecast for materials and medications, as stated by Venkatesh et al.²³ This is especially true in the case of medical supplies, where different types of supplies are used on different schedules depending on the individual's condition. For this reason, people frequently rely only on their expertise while shopping for medical products. Due to the ambiguity in how demand is defined, Rowan et al., found that there are occasionally surpluses and other times there are shortages of medical supplies.²⁴ To address this issue, they first suggested using the Activity Based Costing (ABC) curve, a technique that divides items into three groups and emphasizes 80% of the company's most crucial products. A hospital's inability to accurately estimate demand is further complicated by the absence of quantifiable metrics that would enable smart buying, according to Govindan et al.²⁵ According to the authors, a common cause of medication supply inconsistencies is the lack of reliable logistic data to support the hospital's scheduled procurement plan.²⁶ They recommended obtaining accurate and quantifiable information from three sources: (1) a study of “internal and external processing” times of prescription drug instructions that ensure safe stock levels; (2) a list of standardized medications with “descriptions, units of supply, and spreadsheets to track monthly” samples to utilize each piece of equipment in the hospital and (3) an ABC classification of the meds.^26,27 The hospital can enhance its inventory control and management procedures by obtaining precise and quantifiable information from the sources mentioned, such as the internal and external processing times of prescription drug instructions, a list of standardized medications with descriptions and units of supply, and an ABC classification of medications. This can have several advantages, including lowering waste and stockouts, increasing inventory efficiency, enhancing patient safety, and lowering expenditures related to outdated or unused pharmaceuticals. Ultimately, these advancements may help HSC perform and operate more effectively.²⁵

C. Purchasing

The public sector purchases medications through a competitive public auction procedure, which was the subject of research.²⁷ According to the Tönnissen & Teuteberg, overstocking frequently resulted from a lack of integrated systems to manage supply, distribution, and consumption.²⁸ The environment is not suitable for public service, as noted by.²⁸ There are a few things they recommend doing to work better with vendors: (1) gathering out pertinent information about the vendor and compiling a shortlist of credible candidates based on such research “information system that addresses legal capacity, suitability, financial standing, and technical suitability”; and (2) learning about the product itself. Medicines are an example of a product category with a lot of technical details. The logistics process requires the participation of qualified specialists, including pharmacists and trained technological workers. Additional indications of the quality of the inputs should be employed, such as the verified “observations of individuals who use the product in the organizations”. The healthcare supply chains in Sri Lanka are managed by several different organizations, all of which report directly to the Ministry of Health.²⁹ These organizations are responsible for providing the necessary medical supplies to healthcare facilities, as well as ensuring the quality and safety of the services they provide. Registration with the Cosmetics, Devices, and Drugs Regulatory Authority (DRA) is required for all pharmaceutical companies wishing to submit bids to the State Pharmaceutical Corporation (SPC).

A. Healthcare Stakeholders

Providing patients with high-quality, cost-effective care requires a well-oiled supply chain in the healthcare industry.³⁰ According to their roles in the healthcare supply chain, the various participants may be divided into four broad groups: manufacturers, buyers, distributors, and providers (Figure 1).

Figure 1. Stakeholders of healthcare system.

Logistics is concerned with a wide range of tasks, including but not limited to: managing demand and supply, controlling manufacturing, operating, stocking inventories, distributing goods, and transporting people and goods.³¹ The first function of logistics is resource management, which includes things like wheelchairs, stretchers, and ambulance availability, as well as the storage and distribution of medical supplies and pharmaceuticals (patient, wheelchair, stretcher, ambulance). Logistics duties, such as managing resources, are essential to healthcare stakeholders, such as wheelchairs, stretchers, ambulance accessibility, and medical supplies. Healthcare supply chain stakeholders are essential in managing these resources. For instance, to meet patient needs, hospitals, and clinics must ensure that they have sufficient medical supplies and medications. To ensure they are used successfully and efficiently, they must control the distribution and availability of other resources, including staff, beds, and medical equipment. Moreover, the transportation of patients and medical supplies between facilities such as hospitals, clinics, and warehouses may involve coordination between healthcare stakeholders. Rigorous planning and coordination are required to guarantee that resources are deployed effectively and that they reach their intended destination on time.^25–27

B. Healthcare Information System

The management of resources and cost optimization in healthcare nowadays revolves around maintaining patient health. The hospital tasks are carried out via a variety of subsystems. Electronic Health Record (EHR) systems–Data about patients, such as medical history, lab results, and medication records, are managed through these systems. Picture Archiving and Communication System (PACS) - this system is used to manage medical images. Hospital Information Systems (HIS) - hospital operations are managed by this system, including admissions, scheduling, and billing. Pharmacy Information Systems - it oversees medication orders, inventory, and dispensing. Clinical Decision Support Systems (CDSS) - the purpose of these systems is to assist healthcare professionals in making decisions based on patient information.³² Most healthcare organizations are moving away from unit procedures and toward supply chains to save money and make better use of available resources.³³ This study examined many hospital procedures to illustrate the significance of supply chain management, including medical strategy and service excellence, patient admission and reception, diagnosis and treatment, medical record maintenance, patient release, and rehabilitation services (Figure 2).

Figure 2. Flowchart of the Hospital Information System.

The administrative pillars of a hospital include check-in details (critical patient information), inventory management, billing and collections, patient medical records, staff information systems, and patient information security (Table 1).

C. Pharmacy Supply Chain

The hospital's ultimate focus is to provide patients with high-quality medical care. What's needed is a robust stock of high-quality pharmaceuticals available in local drugstores. Supply chain management is essential for the hospital pharmacy to ensure the timely availability of drugs at the most cost-effective purchasing price. Different Suppliers,³⁴ “Vendor Agreements,¹⁴ Floating of Tenders, rounds of negotiations, and freezing on processes of product delivery”²⁵ are required in the supply chain since some medications can only be carried at specific temperatures. It is challenging to foresee the precise demand for medications. To determine the trend of drug usage, it is crucial to collect correct data. Due to the lack of expertise in supply chain management among today's hospital storekeepers, the supply chain is sometimes plagued by situations of “High Demand and Low Availability”²¹ or “Reverse, with Low Demand and High Availability”¹¹ for some medicines, thereby increasing the likelihood of medication expiration and extending shelf life.³⁵

D. Blood Bank Supply Chain

The crucial issue in healthcare is the control of the blood supply. Dynamically managing the blood supply chain is the hospital's aim.³⁶ According to a study,⁴ donor blood supply is erratic; hence the places chosen for blood collecting sites need to be considered. This study stated that dynamically managing the blood supply chain is a crucial issue in healthcare, and hospitals aim to balance the demand and supply of blood to achieve the goal of providing blood as needed. This study further demonstrated that the number and location of blood banks should be chosen carefully to ensure a balanced supply and demand for blood, and delivery systems should be tightly coupled to satisfy runtime requirements. The authors also suggest that blood banks should be opened around the clock to ensure a timely response to emergencies in hospitals or nearby hospitals. Depending on the transfusion services supply that is needed, the number of local blood banks, that demand and supply should be balanced to achieve the goal, transporting blood as needed, Delivery systems must be coupled tightly to satisfy runtime requirements. For any emergency in hospitals or nearby hospitals, blood banks should be open around-the-clock.^4,37

E. Patient Safety Supply Chain

According to research, 440,000 patients each year pass away due to medical mistakes that could have been avoided and unsafe work environments.

Figure 3 depicts the drug flow supply chain. The vital life and smooth operation of the company are crucially dependent on the healthcare supply chain. Better healthcare supply chains increase patient safety and improve the standard of service.³⁸ The management of expired medications by automating the monitoring and identification of medications and products, as well as taking appropriate action, has been connected by many hospitals to patient safety and other operations in the correct manner.³⁹

Figure 3. Drug flow supply chain.

Reducing drug-search times, human error, and unnecessary processes can be achieved by streamlining the whole supply chain. To cut down on repetition and human error, the whole data sheet filled out by the doctor needs to be electronically input utilizing RFID technology.⁴⁰ To increase patient satisfaction and take into account the value of human life, all procedures must adhere to supply chain transparency. A supply chain function and patient safety practices can be found in Figure 4.

Figure 4. Patient safety practices supply functions.