• Back to the future? A theoretically inspired musing on the concept of Product Stewardship and its implications for Corporate and Social Responsibility

      Breen, Liz; Xie, Y.; Cherrett, T. (2015-09)
      The concept of corporate and social responsibility (CSR) has gained increasing momentum and importance in business operations today and companies have globally responded to this philosophy. To what end though? Product Stewardship (PS) and the corporate, social and environmental responsibilities associated within this term are a key part of a business’s CSR agenda. In the extant literature, it is a challenge to clearly identify the boundaries of responsibility for PS - who sets these boundaries for governance and what are the actions taken under the guise of PS. This paper aims to start the process of demystification in responding to the title of this work, stimulate further musings and outline a future research agenda.
    • Breaking ‘Smart’ New Ground: A preliminary assessment of the uptake and use of Smart Technologies in NHS Hospital Pharmacies (UK).

      Breen, Liz; Xie, Y.; Cherrett, T.; Bailey, G. (2014-09)
      Medicines management is only one part of NHS (UK) procurement and management, but essentially a very expensive part. According to the Commercial Medicines Unit (Department of Health, 2013), NHS hospitals in England currently spend around £3.6 billion annually on pharmaceuticals, having risen from £2.2. billion in 2005. The NHS continuously strives to promote excellence in what it does and justify how it does it. In undertaking this preliminary analysis 45 pharmacy staff members contributed to an online survey. The results presented a broad mix of views on how smart technology (e.g. iPhone, iPad) could be used and if it should be used at all in this setting. The outcome of this small scale study demonstrates the lack of knowledge as to if and how such technologies could be used in hospital pharmacy and therefore present grounds for testing out the broader application of smart technology via academic and practitioner consultations.
    • An exploratory study of reverse exchange systems used for medical devices in the UK National Health Service (NHS)

      Xie, Y.; Breen, Liz; Cherrett, T.; Zheng, D.; Allen, C.J.
      Purpose This study aims to provide insights into the scale and use of Information Communication Technology (ICT) in managing medical devices in the NHS, with a focus on Reverse Exchange (RE) systems, as part of the broader Reverse Logistics (RL) systems, within which medical devices are returned and exchanged. Design/Methodology/Approach Two case studies were conducted with NHS Hospital Trusts, while another was built upon secondary resources. Primary findings were triangulated with information collected from the NHS Trusts’ reports, direct observation and a preliminary round of consultations with 12 healthcare professionals working in other NHS Trusts or Integrated Equipment Community Services. Findings The findings suggest that the sophistication of ICT implementation increases with the risks and value associated with medical devices. Operational attributes are derived from ICT implementations which can positively impact on RE performance. The forces that drive the adoption of ICT in the NHS include pressure from government, business partners and patients, competitive pressure, perceived benefits, organisation size, top management support and the availability of sufficient resources. Obstacles are mainly centred around the lack of sufficient resource. Research limitations/implications Although the Trusts that participated in this research are representative of different regions, the generalisation of the study results may be limited by the size of the sample organisations, so the results can only provide insights into the research problem. As this work is exploratory in nature, there is insufficient data on which to form definitive recommendations. Practical implications NHS Trusts may use the 6 operational attributes identified and verified by the case studies to benchmark their ICT implementation for device management. The actual and potential benefits of ICT implementation could inform technology development and encourage the uptake of ICT in healthcare. Governmental bodies can utilise this information to develop directives to actively drive ICT adoption in device management and the associated RE system. A well-considered training programme is needed to improve staff ICT skills in order to fully realise the potential of ICT systems which support the effective RE of medical devices. Originality/value The results suggest that ICT supported reverse exchange of medical devices backs up the supply chain reduces capital costs and medical risks and, facilitates the redeployment of funds to frontline medical treatment.
    • Greening community pharmaceutical supply chain in UK: a cross boundary approach

      Xie, Y.; Breen, Liz (2012)
      This research aims to design a green Pharmaceutical Supply Chain (PSC ) that reduces preventable pharmaceutical waste and effectively disposes of inevitable pharmaceutical waste. The main output of this study is the formulation of an integrated green PSC model involving all critical stakeholders, leading to improved environmental, economic and safety performance in medication management and delivery. The research is based on literature and on secondary resources. To green the PSC, every producer of waste is duty bound to facilitate the safe handling and disposal of waste. A Cross boundary Green PSC (XGPSC) approach is proposed to identify participants’ contribution to the PSC. Peripheral influences are also recognised from professional and regulatory bodies. This study focuses solely on community PSC in the UK where patients receive medication from local community pharmacies and thus may be limited. The proposed XGPSC approach also needs to be tested and validated in practice. It may also be difficult to transfer some of the environmental practices proposed in this research into practice. The environmental practices and actions proposed provide invaluable insight into various PSC activities, including purchasing, product design, prescription patterns and processes, medication use review, and customer relationship management. The proposed environmental actions encourage firm commitment from everyone to reduce, recycle or effectively dispose of pharmaceutical waste, with patients becoming stewards of medication rather than only consumers. A cross boundary approach is developed to green the PSC, and it encourages total involvement and collaboration from all participants in PSC.
    • Waste not, want not. What are the drivers of sustainable medicines recycling in National Health Service hospital pharmacies (UK)?

      Breen, Liz; Xie, Y. (2015)
      Medicines management is only one part of NHS (UK) procurement and management, but essentially a very expensive part. In December 2012 the Department of Health issued an action plan to improve the use of medicines and reduce waste. There is an onus therefore on the NHS to ensure that they are as efficient in the medicines management as possible in all aspects of the supply chain in order to ensure sustainability (economically and operationally). To do this consideration must be given to medicines optimization, from procurement, through to storage, dispensing, compliance and finally waste prevention and reduction and waste retrieval. As part of the larger National Health Service (UK), hospital pharmacy places strong emphasis on contributing to the efficiency targets through reductions in waste and drug spending, and best practice. The purpose of this study is to examine medicines reverse logistics practice within the NHS hospital pharmacies, and the operational strategy which drives such practices. The overarching aim is to explore through qualitative analysis the variance and commonality in strategy and practice in what is a standard logistical activity. The outputs offer transparency of medicines RL as practiced by NHS professionals and contribute to ongoing discussions within the Department of Health (NHS UK) on best practice governing waste medicines recycling processes. A qualitative approach was adopted in undertaking this research study, utilizing a purposive study sample. The survey examined practice in 45 hospitals as individual cases across all stages in the medicines reverse logistics system. The findings indicated there is some commonality in the strategy employed in conducting medicines recycling, and all 3 drivers are prevalent in undertaking recycling and encouraging a more sustainable approach, i.e., economic, corporate citizenship, and legislation. However, the means by which the same objective was achieved differed, such as resource utilisation, training etc.
    • Where are you? A preliminary examination of the track and trace mechanisms in place to facilitate effective closed-loop medical equipment retrieval in the National Health Service (NHS) (UK)

      Breen, Liz; Xie, Y.; Cherrett, T. (2016-09)
      The National Health Service (UK) is wholly accountable and heavily scrutinised for its strategy, activity, performance and spending (Appleby, 2016; NHS Confederation, 2016; Parliament UK, 2010), and much research has been undertaken as to its effectiveness at managing its operations and its competency in doing so (Gov.Uk, 2016; National Audit Office, 1999)). The impact of not performing adequately combined with threats such as funding cuts (King’s Fund, 2016), government intervention and private sector competition; has led to uncertainty and disillusion with the sustainability of the service (Hunter, 2016). Based on current economic concerns, this paper chooses to focus on the area of Medical Equipment Loans Services where products are released to patients to aid therapeutic rehabilitation and physical mobility. The aim of this study is to examine the process of product retrieval in a multi-case study analysis and consider how value-added technologies can be used to improve retrieval success rates.
    • Who cares wins? A comparative analysis of household waste medicines and batteries reverse logistics systems

      Xie, Y.; Breen, Liz (2014)
      The purpose of this paper is to determine how best to reduce, reuse and dispose of household waste medicines in the National Health Service (NHS) (UK). Through a combination of literature review and empirical work, this research investigates the existing household waste medicines reverse logistics (RL) system and makes recommendations for improvement by benchmarking it against household waste batteries RL. The viability and feasibility of these recommendations are evaluated through in-depth interviews with healthcare professionals and end user surveys. The batteries RL system appears to be a more structured and effective system with more active engagement from actors/stakeholders in instigating RL practices and for this very reason is an excellent comparator for waste medicines RL practices. Appropriate best practices are recommended to be incorporated into the waste medicines RL system, including recapturing product value, revised processing approaches, system cooperation and enforcement, drivers and motivations and system design and facilitation. This study offers academics and professionals an improved insight into the current household waste medicines RL system and provides a step towards reducing an existing gap in this under-researched area. A limitation is that only a small sample of healthcare professionals were involved in subjectively evaluating the feasibility of the recommendations, so the applicability of the recommendations needs to be tested in a wider context and the cost effectiveness of implementing the recommendations needs to be analysed. Reducing, reusing and properly disposing of waste medicines contribute to economic sustainability, environmental protection and personal and community safety. The information retrieved from analysing returned medicines can be used to inform prescribing practice so as to reduce unnecessary medicine waste and meet the medicine optimisation agenda. This paper advocates learning from best practices in batteries RL to improve the waste medicines RL design and execution and supports the current NHS agenda on medicine waste reduction (DoH, 2012). The recommendations made in the paper not only aim to reduce medicine waste but also to use medicines effectively, placing the emphasis on improving health outcomes.