ارزیابی عملکرد لجستیک زنجیره تامین بیمارستان داخلی Measuring the logistics performance of internal hospital supply chains – a literature study

1. Introduction The internal supply chain in hospitals is characterized by its complexity, uniqueness and operational challenges, such as extremely expensive products and medical devices used in operating rooms, difficult inventory tracking due to the urgency of treatments, and unpredictable demand for medical supplies [60]. Many different types of supplies are stored in multiple storage rooms within the hospital and many processes (clinical, logistics, administrative, etc.) interact to contribute to the achievement of highquality patient care [82]. Therefore, it is beneficial to have effective logistics practices in a hospital for controlling and distributing the supplies to patient care units. In recent years, however, the cost of logistics operations (e.g. handling, moving and processing of materials) has increased, ranging between 20% up to 45% of the total hospital operating budgets, partly due to the considerable amount of wastes in healthcare supply chain processes [54,97]. The operating theatre, in particular, turned into a major cost driver for a hospital [63,71], with the medical supplies and equipment used in the operating rooms taking up 40% to 60% of the hospital supply expenditures. However, effectively managing these supplies have long been a challenge [15]. The healthcare sector exhibits special features that directly affect the quality of patient care. Non-availability of materials may postpone a surgical procedure and possibly results in planning trouble and/or hazard of patient’s health, whereas hidden stocks or overstocking of supplies in patient care locations increase costs and cause supply chain ineffi- ciencies [26,30]. Healthcare Supply Chain Management (SCM) refers to “the information, supplies and finances involved with the acquisition and movement of goods and services from the supplier to the end user in order to enhance clinical outcomes while controlling costs” [27]. The companies that make up the supply chain need to interact and cooperate in order to fulfill the purposes of the logistics processes (i.e. supply, distribution and warehousing) [8]. Coordination and integration between the processes positively contributes to the performance of the healthcare supply chain. The fields of Industrial Engineering (IE), Operations Research (OR) or Operations Management (OM) provide (analytical) methodologies to support the supply chain or logistics operations of hospitals. Chase and Jacobs [20] define OM in healthcare as “the design, management and improvement of the systems that create and deliver healthcare services” . It is, however, a major challenge for operational researchers to ensure high-quality patient care by considering limited resources (e.g. healthcare professionals, operating rooms, supplies, etc.) and high process variability due to patient characteristics and physician preferences, and to engage multiple stakeholders with conflicting interests to cooperate. Stakeholders have different goals for efficiency management because there is no consensus on what constitutes efficiency and what actions to take to improve it [62]. The ultimate goal is to achieve “a well-coordinated system that delivers care with great efficiency and quality, at reasonable cost, matching the resources for care to where (and when) they are needed most” [40].