• Identifying green logistics best practices leading to the effective usage of pharmaceuticals: a case study of Thailand’s Public Hospitals

      Bandoophanit, Thianthip; Breen, Liz; Barber, Kevin D. (2017-09)
      Purpose Pharmaceuticals are a key input into healthcare operations and so their effective management is vital. This issue is of key importance in Thailand and is aligned with the Thailand’s 2nd National Logistics and Supply Chain Research Strategies (2012-2016) focusing on healthcare green logistics. Pharmaceuticals in hospitals account for more than 50% of the total hospital purchasing budget. Moreover, the overuse of medicine was generally found to be prevalent in Thai hospitals despite serious financial concerns. The aim of this study was twofold: Phase (i) to investigate the movement and lifecycle of pharmaceuticals within Thai hospital sites and Phase (ii) identify the GL practices that effectively control/minimize the use of pharmaceuticals. Research Approach Using a case research method six hospitals were examined, to give coverage of the different types/sizes, locations and a range of environmental performance issues. Hospital visits were undertaken during January to July 2014, to obtain data by using a multi-method approach: interviews, documentation reviews and in situ observation. Purposive respondent sampling was undertaken to ensure that data was collected from staff with experience of pharmaceutical management and a bespoke form of content analysis used for the data review before further cross-case analysis. Findings and Originality The result of Phase (i) revealed that pharmaceutical flows appeared to be sophisticated and problematic, caused by issues such as limited budget allocation, ineffective governmental processes, and the over-prescribing of medicine for chronic patients. The findings also identified effective GL practices such as: (i) prescribing medicines for only 1-2 months for some patient conditions/drug types and increasing the frequency of follow-up reviews, (ii) conducting a medicines return programme and (iii) having a clearly defined system of pharmaceutical product review. The outcomes of the study proposed key practices to support a Sustainable Health System at both policy and hospital levels. Within this were: (i) a representation of stakeholder views, (ii) the provision of healthcare education and communication, (iii) addressing self-health management issues and (iv) planned system review and improvement. The design and execution of such a system should be grounded in Thailand’s Sufficiency Economy Philosophy (SEP) concept. Research Impacts In the GL research paradigm public healthcare, developing nations, human elements and life-cycle products have received limited attention; this study therefore contributes to the reduction of these gaps. The SEP concept was highly recommended by the United Nations, instead of Sustainable Development, in addressing GL practices in Thai culture to promote sustainable health standards and this underpins the focus and the originality/impact of this study. Practical Impacts This study recommends that staff in Thai hospitals focus on effective pharmaceutical management to contribute to the sustainability of good GL practices (as identified) and to the design and delivery of a Sustainable Health System in Thailand. The study presents guidance and support to do this.
    • Investigating the laundry logistics system of small-sized public hospital: Can the efficiency of operations be improved under the constraints of Thailand’s administrative culture?

      Bandoophanit, Thianthip; Breen, Liz; Naipinit, A.; Pila-Ngarm, P.; Permwanichagun, P.; Saenchaiyathon, K. (2017)
      Purpose All internal logistics systems contribute to the overall success of healthcare service delivery; laundry management (as a closed loop logistics system) is a critical system which facilitates patient recovery and rehabilitation. Studies indicate that applying efficiency measures/improvement tools in such systems, can deliver financial savings and strengthening of in-house competencies (Banerjea-Brodeur et al. 1998; Golden et al. 2008). This study focuses on the review and improvement of laundry management systems in a Thailand Hospital and the organizational culture underpinning this. This hospital was awarded the highest level of hospital accreditation (high level of quality and environmental compliance within this site). Despite this, problems existed at a very basic level with the laundry management, which can undermine patient dignity and respect and increase risk infection and health complications. This study contributes to the Thai healthcare agenda, a core mission of which is to “Develop efficient and equitable integrated health service system for both normal situation and emergency with emphasis on basic rights, specialized service and emergency medicine, surveillance system, disease prevention and control and health threats” (MOPH 2003). Research Approach The key research methods employed include literature review, in-depth interview, observation, documentation and content analysis. A mixed methods methodology was considered appropriate for this study for a number of reasons including a lack of previous insight into this system and the number of actors involved. To this end a triangulated view of the laundry management system was realized. Findings and Originality Delays in the provision of linen and patient clothing (1-4 days bottleneck) were adversely affected by unstructured laundry operations, insufficient personnel, poor job design and worn-out equipment. As a result of this analysis several solutions were steadily implemented which led to: (i) linen shortage was reduced by 12.12% - 28.48%, and (ii) the total cleaning time per cycle was reduced by 130 minutes (45.12%). The impact of the improvement practices in place were perceived to be undermined by cultural factors such as very high internal conflict, the new hospital Director with relatively low power, and limited budget allocated to purchasing linen. Research Impacts Very few studies have explored a closed-loop supply chain of hospital laundry management systems, fewer collected data from key users using a mixed methods methodology. Reverse Exchanges (RE), a new theoretical framework, was adopted to examine the laundry processes. This study attempts to this study fill these gaps. Although this research studied one district hospital; the practices can be greatly generalized; and the diagram of laundry operations and this research design can be replicated. Practical Impacts Improvement measures have been identified which directly impact on the effectiveness and efficiency of this operation. Whilst this is once case study site analysis, this can offer a positive contribution to the healthcare agenda within this country.