Chadha et al (2013) [9] explores how supply chain management (SCM) integration

can improve the quality of healthcare systems. SCM can aid in the creation of
better facilities for product design research. Moreover, SCM improves forward and
backward integration. A positive level of strategic partnership with suppliers,
coupled with an efficient ordering system and integrated inventory management
can enhance forward integration; a good level of communication and interaction
with patients greatly helps with backward integration. Having high levels of forward
and backward integration then improves the overall quality management of
hospitals.
Hence, this findings in this article is relatively useful as it allows hospitals to
understand how quality management systems can be catalysed by supply chain
integration. With the help of these findings, hospitals can reframe their supply
chain management strategies to identify areas in which they can improve the
quality of service for efficient patient care.
However, this research is limited in its effectiveness as it may not be applied to
healthcare systems in general because this research is written specifically in the
context of Chandigarh. Thus, in order to apply this research to healthcare
systems in general, future research can expand their geographical circumference.
Other than that, scope of study can also be further expanded into other industrial
sector and target audiences.
However, improving SCM will inevitably increase costs. Detlef et al (2011) [10]
discusses a transformative hospital supply chain that balances cost with quality
healthcare. The hospital supply chain undergoes three stages of maturity. At the
foundational level, the hospital uses a segmented approach and delivers each
departments need, making sure that supplies are available. After this level, an
optimization model is adopted. A close relationship and collaboration between
different hospital departments is strived for so that costs can be reduced through
economies of scale. Also, the outsourcing of non-core SCM functions and
standardisation increases efficiency. The last stage of maturity, the transformation
model, moderates cost and the level of satisfaction among patients. To achieve
the transformation mode, collaborative governance, automated and integrated IT
systems and streamlined processes such as procurement and materials
management are necessary elements.
The article is relatively useful as the suggested transformational SCM model
enable hospitals to be more flexible and effective while enhancing their holistic
hospital operations, shaping long-term alliance with suppliers with whom they can
work and cooperate closely to provide greater service to patients.
However, it is not easy to achieve the transformation mode. Firstly, expert hospital
SCM talents are scarce and its difficult for hospitals to attract and retain top

hospital SCM talents. One way to overcome this challenge is by engaging clinical
leadership and acknowledging the importance of having SCM. Secondly, its
difficult to create a strong governance model because the SCM organization in
hospitals may be lacking in the necessary structure to liaise with stakeholders and
include them in important decision making. Hospitals can overcome this challenge
by establishing such a model with senior leadership position from both a clinician
and an administrative point-of-view and have dialogues sessions. Thirdly, data
may not be available and dependable. Its not the common for SCM to obtain data
sets which are of high quality and comprehensive. Hence, to obtain
comprehensive data sets, hospitals should invest in extensive IT systems that can
automate obtain-to-pay processes. Lastly, one challenge that hospitals may face is
that SCM may order the wrong item or wrong quantities if SCM processes are
fragmented or incomplete. This challenge can be solved by restructuring its
obtain-to-pay process with competent IT systems.
There are several internal inventory management policies that companies have
used to improve SCM. Gebicki et al (2013) [3] explores the medication inventory
policies in hospitals. A bullwhip effect the increase in demand variability when
moving upstream in supply chain was identified. Information sharing, channel
alignment and operational efficiency were proposed to handle the bullwhip effect.
4 policies were analysed. The first policy adopts a classical method to determine
reorder points and par levels. The second policy, similar to the first, is modified
with reorders made based on the criticality of the drug. The third policy determines
if a drug should be placed in a dispensing machine. Similar to the third policy, the
fourth policy includes the ordering of drugs for the main pharmacy as well.
This article is useful as it identified elements that would make an inventory
management policy effective such as analysing the drug availability, criticality,
expiration window, demand and cost, especially when making future reordering
decisions. From this article, it was concluded that out of the 4 policies the last one
proved to be the best. It involved placing orders only after looking at the expected
inventory position in all locations. It aimed to eliminate inventory in the main policy
when it was not needed and to prepare for restocks of dispensing machines by
predicting their activities ahead of time. This led to less wastage, lower holding
costs and reduced main pharmacy stockouts1. However, the usefulness of the
findings presented in this article is undermined as even though the recommended
policy resulted in lower reordering costs and fewer local stockouts, it also resulted
in greater global stockouts.
Hence, more research could be done to find existing correlations between the
drug characteristics and the policy used. Thereafter, the results from that research
1 Cost of the additional work necessary to deal with the stock out (i.e time to
find and deliver medication from the pharmacy, or to find medication in
another dispensing machine)

could be used to compare against the individual cost components and stockouts
for the drug to refine the existing suggested inventory management policies.
Claudia et al (2014) [4] suggests the point-of-use hybrid inventory policy. This
policy is a combination of periodic stock replenishment with reactive stock
replenishment whenever the inventory level is low.
This new hybrid policy suggested is particularly useful as it combines planned
periodic and reactive continuous replenishment, allowing for replenishment lead
time to be reduced, as compared to out-of-cycle replenishment where personnel
have to gather required inventory from the central warehouse. However, its
usefulness might be undermined as there is a lack of consideration of inventory
coordination across multi-ADM (automated dispensing machine) systems and
incorporation of warehouse inventory into a multi echelon supply chain model.
Future research can thus consider how best to do this and study how it joint
replenishments could best be carried out, under a multi-item setting.
Automated dispensing machines are utilised and this increases inventory visibility,
improving the dispensing and control of hospital supplies. Amrik et al (2012) [5]
cites collaborative methods that can be harnessed to enhance hospital supply
chain. Danas (2002) proposes forming a virtual hospital pharmacy where
information on different pharmaceutical stock-keeping units around the same
geographical area can be accessed, allowing supplies to be shipped out when
required. A classification framework where drugs are ranked in order of importance
is also adapted for the virtual pharmacy. Nicholas (2004) suggests the outsourcing
non-critical medical supplies while Scheller and Smeltzer (2006) suggest the
outsourcing of distribution function, which allows the hospital to allocate capital to
other critical functions. Whitson (1997) recommends that a just-in-time (JIT)
system is suitable for the materials management and pharmacy departments.
Rivard-Royer (2002) tested a hybrid stockless method in which the stockless
method was merged with the traditional way by distributing goods through a
hospital central store. The central store will then separate items into point-of-use
quantities and supply to individual patient care units. The vendor managed
inventory (VMI) system where the supplier monitors retailers inventory levels and
makes periodic replenishment decisions could accurately determine the
consumption levels in the hospital.
The findings prove to be relatively useful as it provides suggestions to tackling the
healthcare sectors difficulty in implementing effective supply chain management
by exploring how manufacturers, distributors and hospitals in the hospital supply
chain can collaboratively manage their inventory.
However, the usefulness of these findings are limited as there is no clear
evaluation of the impact of the government regulatory agencies and group
purchasing organisations. In this case, agencies could accelerate the adoption of
vendor management inventory (VMI) strategies by relaying information between
parties and encouraging hospitals to share crucial market intelligence data.

Moreover, the hospitals used in this study had not outsourced their information
systems. Therefore, a future avenue of research would be to conduct an in-depth
case studies with hospitals that had outsourced their information systems before
and identify how doing so has enhanced a hospitals willingness to engage in a
VMI partnership with trading partners.
Bendavid et al (2010) [6] proposes the use of radio frequency identification (RFID)
in the replenishment process of medical supplies. RFID is used in patient safety,
inventory management and asset tracking in the hospital setting so far. RFID can
be further harnessed into the RFID-enabled e-kanban replenishment solution, in
which a replenishment signal is detected when the item storage location is empty,
serving as a signal for the delivery of items.
One of the limitations of RFID is that it is not easy to obtain for users to adapt to
the new information systems and not many use the new information systems.
Also, like other normal projects, health IT projects may still fail as its difficult to
obtain cooperation from all stakeholders.
In evaluation, the paper is in line with recent research suggestions by authors
(Ngaiet al., 2008; Curtin et al., 2007) about developing models, theories, concepts,
frameworks, methods, techniques and tools to support the needs of RFID
professionals to develop and implement such technologies.
Thus it can be said to be relatively useful as it provides direction for practitioners
on how to assess RFIDs potential impact in the healthcare supply chain.
However, there is still a need to conduct further research in this area as it
represents a great potential for performance improvements. Moreover, its
usefulness could also be undermined as the paper isolates the impact of RFID
from change management and process redesign often intertwined in such
projects, which is not realistic of the current times.
Besides inventory management techniques, Nazar et al (2013) [1] discusses a
procurement strategy in supply chain management - a hybrid approach for
integrated healthcare cooperative purchasing and supply chain configuration. The
purpose of the approach is for hospitals to form Group Purchasing Organisations
(GPO) so that supplies can be ordered in bulk, and costs are reduced.
This article proves to be useful in supporting the design and evaluation of
alternative cooperative purchasing strategies for healthcare supply chains.
Moreover, the flexibility of the suggested approach allows for purchasing groups
with different characteristics to implement it, even if it were under different
operative and market circumstances. The suggested approach can also be used
to promote and facilitate the cooperation process since it is easily applicable and it
renders the financial impact of the various cooperation alternatives transparent,
facilitating the negotiation process with regards to the allocation of the costs and
gains of cooperation between the participating hospitals. Moreover, the future
incorporation of a Decision Support System can significantly contribute to an

increase of healthcare supply chains efficiency and encourage the establishment

of cooperative partnerships between their members.
However, this usefulness of this paper could be limited as there is no suggestion
as to how various problems such as how the optimal size of purchasing groups
could be determined under the various different circumstances. Thus, it might not
be able to conclusively reflect the real demands of the healthcare industry.
Moreover, there are issues regarding cooperation and order size between
hospitals in a GPO arising from this approach. The proposed solution would be to
consolidate purchasing cooperation without having mandatory compliance from
hospitals. Information regarding the hospital's supply chain structure and
transactional data should be obtained and then analysed. One recommended
strategy would be to adopt the best hospital structure among the GPO that
minimises total cost to enhance supply chain management.
Apart from procurement strategies and inventory management techniques, Wafi et
al (2013) [2] provides additional insight on the effects of knowledge management
on the hospital supply chain. Inept knowledge management results in a knowledge
disparity and misunderstanding between supplier and beneficiaries. This
knowledge revolves around medical procurement, management of supply chain,
relationship to the user and procurement process. A gap in professional culture
due to different backgrounds and working environment of beneficiaries and
supplier also results. Human communication and interaction are required to bridge
this gap. Lastly, being overly dependent on management science techniques,
which are insufficient, should use mixed techniques. These effects of inept
knowledge management eventually lead to project failures.
However, there are several limitations to the research. Firstly, time constraints are
the most impactful limitations in the collation and analysis of data. Secondly, not all
parties may be obliged to participate in the study and share their perspectives in
the views of the medical profession as others may tend to copy or steal their
perspectives. Lastly, this research limited as it doesnt use a quantitative
approach. The context of this research is based in the UK. In order to validate the
framework, future research can expand their scope by studying other healthcare
systems from
other locations like US or Asia.
Hence, this article proves to be useful as it identifies the key areas that are
important in establishing smart and functional requirements in the business
organisation, such as knowledge management, effective communication and
supply chain management. Information on such areas would allow for hospitals to
develop better supply chain practices as it matches beneficiary requirements with
supplier specifications. However, the results could be limited in its scope thus
undermining its usefulness as it only investigates the situation in the UK
healthcare. Hence the findings might not be applicable to other healthcare
systems.

Chen et al (2013) [7] present a relational view that enhances hospital supply chain
performance. Having hospital-supplier integration is able to enhance hospital
supply chain performance as delivery speed of suppliers and responsiveness to
customers improved. Hospital-supplier integration can be achieved through high
levels of knowledge exchange, strong IT integration between hospital and
suppliers, and trust between hospitals and key suppliers. These factors eventually
improve hospital-supplier integration, and hospital supply chain performance is
enhanced.

However, the outcome of this study may only be applicable to US hospitals due to
the context of study. Future research can expand their scope to international level
so that the outcome of this study can be applicable to hospitals in general. Also,
this study was carried out from the standpoint of hospital. This can be improved if
future research includes other stakeholders standpoint, for example, the
suppliers. In addition, future research may also carry out the study in long term to
find out how the process progresses over time. Lastly, future research should look
to examine tacit aspects of knowledge that can lead to supply chain performance
to understand relevance of knowledge development and transfer context in which
organisation-supplier integration is able to influence supply chain performance
should be examined at a more granular level to assess what factors moderate this
relationship.

Overall, the article is rather useful as it provides relevant insights on major issues
such as how the hospital-supplier integration is positively associated with hospital
supply chain performance, how the level of knowledge exchange between a
hospital and its suppliers is positively associated with hospital-supplier integration,
how the level of IT integration between a hospital and its suppliers is positively
associated with hospital-supplier integration and how a hospitals trust with its key
suppliers is positively associated with hospital-supplier integration. However, its
usefulness might be limited as it is still relatively grounded in theory, through the
relational view and the mediation view of the return on IT investment. Furthermore,
other aspects should also be considered such as strategic management,
organisational design, and operations management. In addition, the framework
mentioned in the article was not extended to international contexts. The study
might also be slightly bias as it was done only from the perspective of a hospital or
organisation.

Overall, the suggested policies are in line with current trends, as suggested by
Chandra as he mentions a need to integrate every stage of the healthcare supply
chain: demand management, order management, supplier management, logistics
management and inventory management. He suggests various methods such as
having an effective forecast of demand and how RFID could be used to keep
better track of inventory level, which will aid in the reordering process. He also
mentions how hospitals can tap on group purchase orders to order in bulk, thus
saving costs.