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 department’s 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 it’s 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, it’s 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. It’s 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 could be used to compare against the individual cost components and stockouts for the drug to refine the existing suggested inventory management policies.

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)

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 retailer’s 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 sector’s 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 hospital’s 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 it’s 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 RFID’s 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, Nazaré 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 doesn’t 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 fromother 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 hospital’s 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.