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.

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.

The National Health Service (NHS) Five Year Forward View in 2014 issued a grave warning that if healthcare demand in the UK continued to grow as its current rate, and efficiency or funding changes were not instigated there could be a mismatch between the service (in terms of resource provision) and patients of up to £30 billion a year by 2020/21. The report asserted that in order to “sustain a comprehensive high-quality NHS; action will be needed on all three fronts – demand, efficiency and funding” (2014:5). Based on this escalating issue, and with a focus on the expanded and value-added role of Community Pharmacists, this study chooses to focus on this service operation in light of the pressures as highlighted above by examining what Sustainability means and how it is applied in Community Pharmacy as a service provider in the NHS (UK).

Purpose: The aim of this research therefore is to explore the causes of drug shortages within the pharmaceutical supply chain and assess the adopted mitigation strategies. Research Approach: The study is carried out from an inductive perspective where we seek to understand the phenomenon by a detailed review of extant literature followed by a series of semi-structured interviews with first tier consumers within a case study framework. The respondents were chosen using purposive sampling as those best to comment on the phenomenon under scrutiny. Data was analysed using thematic analysis, where a dual focus was adopted; 1) the preliminary focus was on the identification of system themes (where the system was impacted and the responds e.g. complexity, disruptions and product alternatives) and 2) the secondary focus was the impact on the patient as system recipient and product user (where themes such as stress, anxiety, and adverse drug reactions emerged). Findings and Originality: The analysis show that drug shortages within the pharmaceutical supply chain in the UK occur as a result of stringent regulatory frameworks, faults in the manufacturing processes, lack of Active Pharmaceutical Ingredients, monopolistic wholesaler markets; lack of information dissemination, offshore trading and price manipulations for profit. The impact on the consumers is reported to be extensive and can endure long after the disruptive event occurs. The findings indicate that existing recovery strategies are however cumbersome, add complexity to the supply chain and in extreme cases facilitate the infiltration of counterfeits. The study is innovative as it explores disruptive events and associated recovery strategies which have not been adequately addressed in supply chain management studies to date. Research Impact: This research contributes to existing literature by extending discussions on supply chain disruptions within a dynamic supply chain whilst focusing on product service supply chain recovery strategies and mechanisms. Practical Impact: This study provides Operations/Supply Chain Managers and Pharmaceutical companies and professionals with strategies that can be adopted can adopt in reducing and recovering in a more resilient manner to disruptive events. This thus presents the bedrock for resilient practice and systems design and development, thus reducing system vulnerability and ultimately leading to improved product availability and patient care.

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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.

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.

The lack of separation between urgent and non-urgent medical goods encourages sub-optimal vehicle fleet operations owing to the time critical nature of urgent items. An unattended electronic locker bank, to which individual urgent items can be delivered thereby separating urgent and non-urgent supply, was proposed for the Great Ormond Street Hospital in London, UK. This concept was quantified using ‘basic’ and ‘intuitive’ hill climbing optimisation models; and qualitatively using staff interviews and expert reviews. Results indicated that a locker bank with a fixed height (1.7 m) and depth (0.8 m) required a length of 4 m (basic model) and 3.63 m (intuitive model), to accommodate 100% of urgent consignments for a typical week. Staff interviews indicated the wider benefits such as staff personal deliveries.

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.

Purpose: The aim of this research is to evaluate if the Complex Adaptive Systems theory can be used to explain resilience strategies within the pharmaceutical supply chain Research Approach: An in depth review of literature surrounding resilience in the pharmaceutical supply chain. In order to pursue this study agenda, data was collected from Scopus, the largest peer review journal as well as EBSCOhost. The PRISMA guideline was adopted in the systematic review process where 34 peer reviewed papers in the field of CAS, supply chain and supply chain resilience were identified with respect to methodologies employed, location of the study and approaches. Findings and Originality: The systematic review of literature shows that there are inherent similarities between the concept of resilience and the CAS theory. The CAS theory explains that PSC’s are dynamic, have emergent behaviours complex, adaptive, interconnected as well as possess schemas that regulate their operations. Hence if resilience strategies are to be employed to mitigate disruptive events they need to be harnessed in a manner to fit this particular supply chain. This work is innovative as it provides a new insight into the contemporary discourse on resilience strategy creation and deployment, examining the use of this theory in the PSC, and thus provides original contribution. Research Impact: This study contributes to the existing literature base, by providing theoretical underpinnings in the area of resilience and the pharmaceutical supply chain. This furthers the CAS agenda, SCR agenda and also presents an innovative output which warrants more detailed analysis and feasibility testing. Practical Impact: Complexity principles are multi-scaled and multi-domain and as such the suggestions put forward in this theoretical framework can be adopted in various supply chain networks as well as disruptive events. It provides new insights with regards to structures for managers seeking to design and improve resilience supply chains, a key element of which is the adoption of a holistic analysis by SC managers when developing resilience strategies. This is critical if disruptions are to be identified and mitigated before their impact is felt.