Systematic literature review of supply chain risk management in healthcare management

A systematic literature review on
supply chain risk management:
is healthcare management a
forsaken research field?
Pedro Senna and Augusto Reis
CEFET/RJ, Rio de Janeiro, Brazil
Igor Le~
ao Santos
Engenharia de Produlç~
ao, CEFET/RJ, Rio de Janeiro, Brazil, and
Ana Claudia Dias and Ormeu Coelho
CEFET/RJ, Rio de Janeiro, Brazil
Abstract
Purpose – This paper aims to present a systematic literature review (SLR) to investigate how supply chain
risk management (SCRM) is applied to the healthcare supply chains and which improvement opportunities are
being missed in this segment.
Design/methodology/approach – This SLR used the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) method to answer three research questions: (1) Which are the main gaps
concerning healthcare supply chain risk management (HCSCRM)? (2) What is the definition of HCSCRM? and
(3) What are the risk management techniques and approaches used in healthcare supply chains?
Findings – The authors present a complete summary of the HCSCRM body of research, investigating research
strings like clinical engineering and high reliability organizations (HROs) and its relations with HCSCRM; (1)
This research revealed the five pillars of HCSCRM; (2) The authors proposed a formal definition for HCSCRM
considering all the literature blocks explored and (3) The authors generated a list of risks present in healthcare
supply chains resulting from extensive article research.
Research limitations/implications – The authors only reviewed international journal articles (published in
the English language), excluding conference papers, dissertations and theses, textbooks, book chapters,
unpublished articles and notes. In addition, the study did not thoroughly investigate specific countries’
particularities concerning how the healthcare providers are organized.
Originality/value – The contribution of this article is threefold: (1) To the best of authors knowledge, there is
no other SLR about HCSCRM published in the scientific literature by the time of realization of authors’ work,
suggesting that is the first effort to fulfill this research gap; (2) Following the previous contribution, in this work
the authors propose a first formal definition for HCSCRM and (3) The authors analyzed concepts such as
clinical engineering and HROs to establish the building blocks of HCSCRM.
Keywords Supply chain risk management, Clinical engineering, High reliability organizations, Healthcare
management, Systematic literature review
Paper type Research paper
1. Introduction
Since supply chain risk management (SCRM) emerged as a concept in the early 2000s,
significant studies have been produced in the academic literature. For instance, the work by
Norrman and Jansson (2004) defines SCRM and describes a real-case study and respective
measures for the identification and mitigation of supply chain risks (SCRs), where SCRs can
be defined in simple terms, according to Juttner et al. (2003), as the possibility and effect of a
mismatch between supply and demand. Moreover, Sodhi et al. (2012), even eight years after
Norrman and Jansson (2004), stated that there is no consensus around the SCRM definition.
More recently, Baryannis et al. (2019) stated that there is no universally accepted definition of
either risks or SCRM and proposed building a SCRM definition by encompassing
identification, evaluation, mitigation and monitoring of risks.
Supply chain
risk
management in
healthcare
The current issue and full text archive of this journal is available on Emerald Insight at:
https://www.emerald.com/insight/1463-5771.htm
Received 22 October 2019
Revised 12 October 2020
Accepted 1 November 2020
Benchmarking: An International
Journal
© Emerald Publishing Limited
1463-5771
DOI 10.1108/BIJ-05-2020-0266

Despite its nonconsensual definitions, SCRM is consistently being applied by managers to
enhance performance metrics. For instance, by using SCRM in a hospital pharmaceutical
supply chain case study, Elleuch et al. (2013) obtained improvements in five dimensions: (1)
budget consistency, (2) reliability, (3) fluidity of drug circuit, (4) flexibility improvement and
(5) bullwhip effect control; where the bullwhip effect, for instance, can be especially harmful in
sectors that face the challenge of managing a wide variety of items. Elleuch et al. (2013)
applied a holistic method that includes risk identification, risk assessment and risk
mitigation, combining quantitative and qualitative approaches. And among the most studied
segments of application of SCRM are the (1) automotive (Thun et al., 2011; Sharma and Bhat,
2014; Heidari et al., 2018), (2) food industry (Song and Zhuang, 2017) and (3) electronics
industry (Rajesh, 2017).
Healthcare supply chains are a very unique segment, since its main objective is to save
lives instead of profit. Healthcare providers (clinics or hospitals) are the facilities that deal
with the patients and trigger demand throughout the healthcare supply chain. Either being
public or private, healthcare providers must be cost-effective for two main reasons: (1) private
healthcare providers must be profitable in order to guarantee business continuity and keep
providing healthcare and (2) public healthcare providers also must be cost-effective to ensure
that the taxpayer money is well spent. To manage risks and generate supply chain resilience
(SCRes), it is crucial to identify the supply chain main characteristics (Li et al., 2020).
Considering the upstream healthcare supply chain, constructs that generate resilience
include total quality management (TQM) (Sharma and Modgil, 2020), total productive
maintenance (Modgil and Sharma, 2016). Among the constructs that generate resilience to the
whole healthcare supply chain, we highlight trust, cooperation, supply chain connectivity,
supply chain visibility and information sharing (Dubey et al., 2019). Lately, recent studies are
also citing supply chain 4.0 and blockchain as resilience generators (Ivanov and Dolgui, 2020;
Dubey et al., 2020).
Although the healthcare segment is not mentioned by authors of the academic literature
as one of the most studied segments of application of SCRM, there are clear benefits of making
this association, and thus the research gap approached by this work emerges. On the one
hand, up-to-date management techniques, such as SCRM, used in the healthcare segment are
getting more relevant nowadays. For instance, medical devices nowadays can be of over
5,000 different types and be used in all aspects of healthcare (for example, tongue depressors
and pacemakers), representing a difficult management challenge (Dhillon, 2000) that could be
approached using SCRM. In addition to the inherent difficulties of managing medical devices,
current global population growth and aging are challenging. They drastically increase the
need of investments in the healthcare segment and stimulate the search for up-to-date
management techniques capable of handling their consequent complex scenarios, such as
SCRM. Thus, from different points of view, an essential gap in the literature is revealed,
respective to applying SCRM in the healthcare sector. Moreover, the academic literature
presents a significant number of literature review papers, approaching SCRes (Hohenstein
et al., 2015; Ho et al., 2015; Kamalahmadi et al., 2016); SCRM strategies (Kilubi, 2016b; Kilubi
and Hassis, 2015); bibliometric study in SCRM (Kilubi, 2016a); quantitative techniques in
SCRM (Hamdi et al., 2015) and the most recent (Gligor et al., 2019) discusses the differences
between SCRes and supply chain agility. However, within the literature consulted, there were
not any papers that presented a systematic literature review (SLR) in SCRM applied to
healthcare supply chains. In this sense, this paper offers a first effort to fulfill this gap in the
academic literature. In addition, we could not locate studies that systematically summarize
risk management techniques and approaches applied to healthcare supply chains.
Considering this preliminary discussion, three research questions arise: RQ1 – Which are
the main gaps concerning healthcare supply chain risk management (HCSCRM)? RQ2 – What
is the definition for HCSCRM? RQ3 – What are the risk management techniques and
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approaches used in healthcare supply chains? Therefore, the objectives of this paper are
threefold (respectively to each research question): (1) set a complete picture of HCSCRM
research field; (2) formally define SCRM applied to healthcare and (3) identify the relevant
studies in the healthcare segment that identify, assess and mitigate SCRs, the techniques and
approaches they apply and what they conclude. These research questions address three
important gaps that we found in the literature.
This paper is composed by 11 sections (including this introductory one). Section 2 offers
the theoretical background of this literature review, Section 3 presents the methodology,
Section 4 analyzes the main literature gaps, Section 5 discuss a formal definition of HCSCRM,
Section 6 shows the complete set of statistics regarding the papers found, Section 7 discuss
the findings, Section 8 discusses a future research agenda, Section 9 presents the research
limitations, Section 10 discuss the managerial implications and Section 11 closes the paper
with the conclusions.
2. Theoretical background
The term “supply chain risk management” (SCRM) started to be coined in the early 2000s by
authors such as Norrman and Jansson (2004), Juttner (2005), Sorensen (2005), Tang (2006)
among others. However, even before the concept became popular, the subject was studied,
although not yet formally defined as SCRM. For example, Bowersox et al. (1999) preconized
lean launch of products to mitigate the risks of higher inventory levels that a make-to-stock
(Push) strategy would generate. Lonsdale (1999) presented a model for mitigating risks
associated with outsourcing practices. Zsidisin et al. (2000) presented inbound supply risks
such as quality, design, cost, availability, manufacturability, supplier, legal, environmental,
health and safety. Hallikas et al. (2002) studied risks concerning a supplier, a buying company
and assess risks related to networking. Furthermore, Hallikas et al. (2004) expanded the
conceptual analysis brought by Hallikas et al. (2002), presenting methods for risk
management in a complex network environment. They also concluded that risk
management is an important development target in the studied supplier networks.
Therefore, it is reasonable to conclude that at the time, conceptual basis for establishing
the building blocks of the SCRM concept were complete and risks concerning inbound and
outbound logistics were studied in a way that already transcended companies’ functional
barriers. A new cross functional process-based linking supply chain business processes was
needed, and so, the SCRM concept came to fill this gap. Nevertheless, our studies reveal that
concerning healthcare supply chains, a significant body of literature would be left off if the
search strings included only SCRM and healthcare supply chains. Clinical engineering papers
present relevant studies on equipment maintenance and spare parts storage that have an
intrinsic link to supply chains and its risks. Papers that study high reliability organizations
(HROs) and high reliability networks (HRNs) present significant principles that can be
included in a SCRes framework, which is corroborated by Sawyerr and Harrison (2020).
Therefore, to build a solid theory concerning HCSCRM, we broadened the scope of the search
performed in this work, including these complementary frameworks.
2.1 Supply chain risk management (SCRM)
Competition and customer demands are constantly increasing and almost all industries face
intense competition and globalization effects on business (Fan et al., 2011). To become more
competitive, companies started to look at process integration, which is corroborated by
authors such as Von Brocke (2014) and Kannengiesser et al. (2016). The next stage after
internal process integration would be to integrate those processes, which flow through more
than one company, termed as supply chain integration. Most of the supply chain integration
Supply chain
risk
management in
healthcare

studies highlight which are supply chain’s main processes (Croxton et al., 2001), how to model
a supply chain (Saen et al., 2016) and key performance indicators (KPI) concerning a supply
chain (Coelho et al., 2009; Fang andWeng, 2010; Cai et al., 2009).
Researchers such as Croxton et al. (2001), Cooper et al. (1997), Lambert andPohlen (2001)
among others, preconize that supply chain management (SCM) is the integration and
coordination of key supply chain business processes going through all suppliers
and manufacturers, to end-user providing products, services and information for
customers and all stakeholders. Tang (2006) defines SCM as the management of all
material, information and financial that flows through an organization network that produces
and delivers products or services for the costumers. Coordination and collaboration of
processes and activities are key crucial features and include functions such as marketing,
sales, production, product design, procurement, logistics, finance and information.
Lately, with process integration inside and outside companies, the theoretical framework
for these subjects was complete and formed the required backbone for the emergence of
SCRM. Authors such as Norrman and Jansson (2004), Lavastre et al. (2012), Thun and Hoenig
(2011) and Pujawan and Geraldin (2009) show that this subject started to be a relevant field of
research throughout the world. A study by Neiger et al. (2009) shows supply chains that are
composed by hundreds and sometimes even thousands of companies over several tiers
presenting significant risks. Nevertheless, Shenoi et al. (2018) highlight that SCRM must be an
integral part of the supply chain. Companies and researchers are increasingly paying more
attention to SCRM, which is notably triggered by the frequency and intensity of catastrophes,
disasters and crises that are increasing on a global scale (Fan et al., 2011). Juttner (2003),
Juttner (2005), Thun and Hoenig (2011) agree that the first stage concerning SCRM analysis is
to visualize a supply chain as a set of cross-functional processes, therefore, avoiding local
solutions that do not result in supply chain optimum. Rahman (2002), Li et al. (2002) and
Croxton et al. (2001) highlight the urge to consider global optimum instead of local optimum.
Juttner et al. (2003) affirm that the lack of integration between companies within a SC (Supply
Chain) may lead to sub-optimal results. Norrman and Jansson (2004) affirm that the focus of
SCRM is to understand, and try to avoid, the devastating effects that disasters and
disruptions can have in a supply chain. Juttner (2005) affirms that, usually, companies
implement organization level risk management and stressed that there was still little
evidence of supply chain-level risk management implementation.
Managing risks that comprise the whole supply chain can become an exceedingly difficult
task. To make this hard task viable, specialists propose logical steps and phases that, if
followed thoroughly, result in a promising way of managing risks. For example, Sinha et al.
(2004) identified five steps for mitigating supplier risks: (1) identifying risks, (2) assessing
risks, (3) planning and implementing solutions, (4) conducting failure modes and effect
analysis and (5) improving continuously. Based on an extensive literature review, Sodhi et al.
(2012) summarized four key sub-processes for managing SCR: (1) risk identification, (2) risk
assessment, (3) risk mitigation and (4) responsiveness to risk incidents. This stream of
research has generated valuable insights into the SCRM process and has offered significant
implications for practitioners.
2.2 Supply chain resilience (SCRes)
Suppy chains must be resilient to disturbances to achieve competitiveness (Barroso et al.,
2010). Juttner et al. (2003) affirm that supply chain disruptions can be financial losses,
negative corporate image or bad reputation, eventually accompanied by demand loss, as well
as damages in security and health. In this sense, today’s globalized, leaner and just-in-time
supply chains are more vulnerable to natural and human-made disasters (Soni and Jain, 2011).
Also, to respond to these risk drivers, supply chains should develop strategic response
capabilities to assess and mitigate disruptions (Singh and Singh, 2019).
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If a manager only emphasizes lower costs and higher efficiency, lacking resilience
practices, the supply chain system will be more vulnerable (Shuai et al., 2011). Although
resilience is increasingly becoming an important subject, there are still not many quantitative
studies about it. Ponomarov and Holcomb (2009) define resilience as an adaptive capability of
the SC to prepare for unexpected events, respond to disruptions and recover from them
maintaining continuity of operations at the desired level of connectedness and control over
structure and function. Barroso et al. (2011) and Carvalho et al. (2012) affirm that SCRes is a
matter of survival. Additionally, SCRes is concerned with the system’s ability to return to its
original state or a new, more desirable one after experiencing a disturbance and avoiding the
failure modes (Carvalho and Cruz Machado, 2007). Resilience was later defined by Barroso
et al. (2010) as the ability to react to the adverse effects brought by disturbances that occur
specific moment to maintain SC’s objectives. Resilience can also be considered a way to
overcome SC vulnerability (Peck, 2005) and prevent shifting to undesirable states, the ones
where failure modes could occur (Carvalho et al., 2012). Kilubi (2016b) presents eight main
strategies to deal with SCRs, which are “visibility and transparency”, “flexibility”,
“relationships/partnerships”, “postponement”, “multiple sourcing”, “redundancy”,
“collaboration” and “joint planning and coordination”. Some of these strategies are also
found in papers that approach SCRes, which is the case of Kamalahmadi and Parast (2016).
The authors discuss SCRes principles such as “collaboration”, “redundancy”, “agility”,
“SCRM culture” and “SC reengineering”. The similarity of these factors shows the
complementarity of both concepts showing that SCRM is a way of creating a solid SCRes.
Considering SCRes strategies, Haimes (2006) affirms that resilience strategies can be
implemented (1) to recover the desired values of the states of a system that has been
disturbed, within an acceptable period and at an acceptable cost and (2) to reduce the
effectiveness of the disturbance by changing the level of effectiveness of a potential threat.
According to Sheffi (2005), companies can develop the resilience in three general ways: (1)
creating redundancies throughout the supply chain; for example, holding extra inventory,
maintaining low capacity utilization and contracting with multiple suppliers, (2) increasing
supply chain flexibility; for example, with adoption of standardized processes, using
concurrent instead of sequential processes, planning to postpone and aligning procurement
strategy with supplier relationships, and (3) changing the corporate culture. The concept of
resilience is closely related with the capability of a system to return to a stable state after a
disruption (Bhamra et al., 2011). Based on the literature, Figure 1 shows a summarizing
framework.
Figure 1 shows a conceptual framework that summarizes nowadays’ consensus regarding
the required steps to manage SCRs. The first step consists in risk identification that can be
company or supply chain level. The second step consists in risk assessment, this step mainly
means that managers should prioritize which risks they have to deal immediately and which
risks are less likely to become undesirable events; the last step consists and mitigate and
monitor risks, meaning that managers have to tailor mitigation plans and even actions that
will take place if the risk materializes.
2.3 Clinical engineering
A Clinical Engineer can be defined as a Biomedical Engineer with broader responsibilities
such as financial or budgetary management, service contract management and maintenance
tasks in healthcare organizations (Cruz and Guar
ın, 2017). Clinical engineers are technology
specialists who can help healthcare-related professionals to deal with, use, evaluate, acquire,
manage and adequately maintain and secure biomedical equipment (Del Solar et al., 2017).
Clinical engineering began in the USA during the 70s, having main task as the management
of hospital’s equipment (Calil and Ram
ırez, 2000). Clinical engineering is a branch of
Supply chain
risk
management in
healthcare

engineering applied to clinical care. The term clinical engineering is used to denote
engineering involved in the hospital setting (van der Putten, 2010). Healthcare technology
management presents itself as a crucial tool to support clinical engineers, following the
revolutionary changes that healthcare services are delivering (Walker, 2012). Healthcare IT
(HIT) systems became a core infrastructural technology in healthcare and have the potential
of mitigating patients’ risks. However, this means that a failure in such systems has the
potential of leading to patient harm (Hablia et al., 2018). Medical devices are increasingly
becoming necessary for diagnosis and disease management; nowadays, medical procedures
rely not only on the physician medical but also on the performance of medical devices
(Kramer et al., 2012). In this sense, risk-based prioritization methods are used to identify the
critical medical devices subject to a rigorous maintenance program (Mahfoud et al., 2016). An
important alternative from purchasing the device is Medical Equipment Loan Services
(MELS), which exist to improve availability of equipment for both patients and clinical users,
managing and reducing clinical risk, reducing equipment diversity, improving equipment
management and reducing the overall cost of equipment provision (Keay et al., 2015).
The identification and assessment of risks associated with medical equipment is a crucial
part of clinical engineering (Iadanza et al., 2019). Risk management frameworks are usually
limited to one company; however, Cruz and Haugan (2019) conduct a survey that considers
the impacts of maintenance in a supply chain level. Also, efficient equipment maintenance
plans play an essential role in healthcare supply chains due to (1) managing less defective
equipment mean that managers can save budget that can be spent in training healthcare
professionals and keeping safe medicine stock full; (2) a good maintenance plan can unburden
the logistic channels reducing emergency deliveries of spare parts (which will also result in
money-saving) and (3) healthcare professionals will be less stressed due to equipment failures
and will be able to increase the service level offered to the patient. Clinical engineering is
essential for the development of maintenance plans, helping to identify equipment-related
risks that are even related to budget risks, as they can estimate how many spare parts are
needed and whether an expensive equipment can be repaired or have to be replaced.
Considering that a piece of repaired equipment avoids its replacement, an efficient clinical
engineering department can positively impact supply chain decisions. In this sense, clinical
engineering plays a significant role concerning risk management.
Supply Chain Resilience
Environment
Government
Terrorism
Operations
Income
Identify Risks
1 3
2
Assess Risks
Continuous iterative process
Mitigate and
Monitore Risks
Resilience
Metrics
Input Process Output
Source(s): Authors’ own elaboration
Figure 1.
Conceptual framework
based on the literature
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2.4 High reliability organizations
HRO can be considered systems that perform their operations in a nearly error-free basis,
even when belonging to risky environments (Roberts, 1990). The devastating effects of
incidents led companies to the necessity of improving their resilience and reliability (Agwu
et al., 2019). HRO scholars study complex types of organizations that, despite operating in
environments where errors could lead to catastrophic consequences, seem to maintain high
levels of safety performance. Examples of such operating environments are nuclear power
plants, air traffic control and nuclear-powered aircraft carriers (Milch andLaumann, 2018;
Høyland et al., 2018). These HROs have specific characteristics and practices that enable them
to achieve sustained reliable safety performance and demonstrate unique and consistent
characteristics, including operational sensitivity and control, situational awareness,
hyperacute use of technology and data and actionable process transformation (Milch
andLaumann, 2018). In an HRO, safety and quality are organizational priorities, and all
workforce members are continuously learning and improving their work (Aboumatar et al.,
2017). In the context of HROs, resilience assessment allows organizations to increase their
level of awareness of the environment and their ability to react to threats (Gonçalves et al.,
2019). The literature on HROs has identified safety concepts and principles for achieving and
maintaining safety at an organizational level (Høyland et al., 2018). Table 1 shows HRO safety
concepts and principles.
Latent errors are defined as events, activities or conditions that deviate from expectations
(Ramanujam and Goodman, 2003; Høyland et al., 2018). Høyland et al. (2018) define the
“mindfulness” construct as composed by the following: (1) Sensitivity to operations:
management and staff comprehend their processes, how they might go wrong and are aware
of how the systems are performing; (2) Reluctance to simplify: When failure occurs, HROs
refuse simple explanations for the failure; instead, they pursue and understand each failed
system; (3) Preoccupation with failure: HROs maintain a constant pursuit of perfection; (4)
Deference to expertise: Leaders listen and respond to the insights into the front line,
regardless of rank or title. Humans and systems always make mistakes and things will
probably go wrong; therefore, organizational resilience in HROs means that companies can
quickly identify an adverse event to rapidly contain and mitigate the error. Høyland et al.
(2018) define the construct upon the following pillars: (1) robustness , for example, when a
team is designed to keep functioning despite suffering stresses and demands; (2) redundancy
is any technical or extra human resources that can be used due to demanding tasks/
operations; (3) resourcefulness is an organization’s ability to identify problems, establish
priorities and mobilize resources to handle disruptions and achieve goals; (4) rapidity can be
seen in an organization capable of achieving various goals in an effective and timely manner.
Nevertheless, Milosevic et al. (2018) affirm that previous knowledge is not always enough
considering that the dynamism in HROs creates nonroutine problems; in this sense,
HRO safety concepts HRO safety principles
Latent errors and mindfulness Sensitivity to operations (SO)
Reluctance to simplify (RS)
Preoccupation with failure (PF)
Commitment to resilience (CR)
Deference to expertise (DE)
Organizational resilience Robustness (Rb)
Redundancy (Rd)
Resourcefulness (Rs)
Rapidity (Rp)
Table 1.
HRO safety concepts
and principles
Supply chain
risk
management in
healthcare

leadership becomes essential, mostly because of its potential of keeping an operation safe by
collective priority (Martinez-C
orcoles, 2018).
Interorganizational networks are defined as a group of three or more organizations
connected in ways that facilitate achievement of a common goal (Berthod et al., 2016). Berthod
et al. (2016) define three types of governance that describe how this network will behave: (1)
shared governance, implies an absence of central governance structure among participating
organizations, (2) lead-organization governance, in which the lead organization implies the
coordination of the network by one participant and (3) network administrative organization
based governance implies a separate, neutral administrative body, set up to function as a
central broker to coordinate the activities of the whole network. Therefore, Berthod et al.
(2016) define HRNs as interorganizational networks that must function with dual,
uninterrupted attention to both the anticipation and the containment of incidents and
peaks in activities.
Concerning healthcare organizations, the literature mentions the high reliability health
care maturity (HRHCM) model, a model for helping healthcare organizations to achieve high
reliability, which incorporates three major domains: leadership, safety culture and robust
process improvement (Sullivan et al., 2016).
3. Methodology
Our full research methodology is presented in the workflow seen in Figure 2.
3.1 Formulation of research questions
In the first step of our methodology, we make sure that the research scope is in adherence to
the objectives, and the underlying study questions are defined (Kilubi, 2016a). Furthermore,
Light and Pillemer (1984) affirm that a precise focus for research starts to be set with an exact
research question.
RQ1. Which are the main existent gaps concerning HCSCRM?
RQ2. What is the definition for HCSCRM?
RQ3. What are the risk management techniques and approaches used in healthcare
supply chains?
3.2 Selection of databases
In order to search for our research terms, we chose the Scopus database, which is the largest
database of peer-reviewed literature. Additionally, we decided the ISI Web of Science, which
is not as large as Scopus, but can recover papers from a higher year range than Scopus.
Moreover, using Scopus and ISI as search engines allows locating papers of Science Direct,
Taylor and Francis, Emerald, Springer and other important bases used by this SLR.
3.3 Definition of search terms
Regarding our first research question, we used the following strings of word combinations
(STR1): (1) supply chain risk management, (2) SCRM and (3) supply chain resilience.
Regarding STR1, the healthcare segment appeared in five studies while we found three
studies concerning the pharmaceutical industry. Since the pharmaceutical segment is a
component of the HCSC (Healthcare Supply Chain), we considered both categories
(pharmaceutical and healthcare) as a single category. In order to construct a broader
theory, we searched for healthcare supply chain papers in general, aiming to capture insights
into recurrent risk themes, generating a second search using the word combinations (STR2):
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Formulate research
question
Select database
Step
1
Step
2
Step
3
Step
4
Step
5
Step
6
Results
section
Define search terms
Records identified
through database
searching (Scopus +
WOS, n = 911)
Records after
duplicates removed
(n = 641)
Records screened
(n = 641)
Full text articles
assessed for
eligibility (n = 297)
Screening
Identification
Eligibility
Included
Methodology
section
–
Article
selection
process
Studies included in
this SLR (n = 8)
Further
exclusion due
to not fitting in
Healthcare
research
Records
excluded due to
not fitting the
research scope
(n = 344)
Additional
records
identified
through other
sources (n = 0)
Records identified
through database
searching (Scopus +
WOS, n = 427)
Records after
duplicates removed
(n = 303)
Records screened
(n = 303)
Full text articles
assessed for
Studies included in
this SLR (n = 114)
Records
excluded due to
not fitting the
research scope
(n = 189)
Additional
records
identified
through other
sources (n = 0)
Records identified
through database
searching (Scopus +
WOS, n = 307)
Records after
duplicates removed
(n = 272)
Records screened
(n = 272)
Full text articles
assessed for
Studies included in
this SLR (n = 119)
Records
excluded due to
not fitting the
research scope
(n = 153)
Additional
records
identified
through other
sources (n = 0)
Hohenstein et al. (2015); Kamalahmadi et al. (2016); Kilubi (2016b)
Hohenstein et al. (2015); Kamalahmadi et al. (2016); Kilubi (2016b); Kilubi (2016a);
Kilubi and Hassis (2015); Hamdi et al. (2015); Ho et al. (2015)
Kilubi and Hassis (2015); Hamdi et al. (2015)
Kilubi and Hassis (2015); Ho et al. (2015)
Kamalahmadi et al. (2016); Kilubi (2016b); Hamdi et al. (2015); Ho et al. (2015)
Analyze Papers
Reporting and using
results
Source(s): Authors’ own elaboration
Figure
2.
Research
methodology
workflow
Supply
chain
risk
management
in
healthcare

(1) healthcare procurement, (2) healthcare supply chain risk, (3) healthcare supply chain and
(4) healthcare warehouse.
To complete the body of research strings, we included concepts that are often neglected by
SCRM researchers (STR3): (1) clinical engineering, (2) resilient engineering and (3) HROs.
3.4 Article selection process
The article selection process was based in Patel and Desai (2018), Marques et al. (2019) and the
PRISMA protocol created by Moher et al. (2009). PRISMA is an acronym for Preferred
Reporting Items for Systematic Reviews and Meta-Analyses method. This protocol is mostly
used in healthcare SLR and meta-analysis; nevertheless, it is also used in industrial
engineering segment, see for example Muhs et al. (2018). In the filtering stage, we followed the
criteria of Patel and Desai (2018) and Marques et al. (2019): (1) we excluded conference papers,
short notes, book chapters and editorial notes and (2) we considered only papers written in
English language. In addition, a “.bib” file was generated for each search and analyzed in R
language where a single database file was generated with duplicates removed to generate a
bibliometric analysis. The complete set of statistics and analysis performed in our work is
depicted in the following sections.
4. Which are the main gaps concerning healthcare supply chain risk
management?
In this section, we present the main findings of SCRM and SCRes related to healthcare. Our
initial hypothesis considered that studies on healthcare supply chains were not as much as
studies on supply chains in general. In this sense, we conducted an initial search considering
strings such as “supply chain risk management” and “supply chain resilience”, as well as the
acronyms. Therefore, the search using STR1 and its postprocessing resulted in eight papers.
The searches using STR2 and STR3 returned 114 and 119 studies, respectively. Since the
number of papers returned varies, our approach also changes accordingly. We discuss each
of the eight articles found by the search using STR1 and its postprocessing and detail their
main contributions and research gaps, whereas in searches using STR2 and STR3, we
summarize the main findings. Table 2 shows the eight papers composing the result of the
search using STR1 and its postprocessing.
Analysis of Figure 3 shows that healthcare and pharmaceutical papers are the third
category in terms of published articles considering all segments. Pharmaceutical and
healthcare categories present numerous particularities. Nevertheless, they embody the
healthcare supply chain construct. Healthcare studies are more clinical-related papers, while
pharmaceutical articles deal with OEM (original equipment manufacturer) related issues.
Considering that the pharmaceutical category includes one review and one conceptual
framework, we can affirm that literature in this segment lacks empirical studies. Jaberidoost
Authors Segment Approach
Jaberidoost et al. (2013) Pharmaceutical Literature review
Jaberidoost et al. (2015) Pharmaceutical AHP
Elleuch et al. (2013) Pharmaceutical FMEA, AHP and Doe
Aguas et al. (2013) Healthcare System dynamics
Zepeda et al. (2016) Healthcare Econometric methods
Riley et al. (2016) Healthcare SEM
Jafarnejad et al. (2019) Healthcare Fuzzy and system dynamics
Haeri et al. (2020) Healthcare Fuzzy
Table 2.
Detailing of healthcare
and pharmaceutical
papers
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et al. (2013) present a literature review focused on a pharmaceutical manufacturer (OEM)
where they are classified into five major risk categories: (1) supply and suppliers issues, (2)
organization and strategies issues, (3) financial, (4) logistic, (5) market, (6) political and (7)
regulatory. The authors conclude affirming that risk identification and mitigation can
optimize SCM as well as improve performance measures such as accessibility, quality and
affordability.
Jaberidoost et al. (2015) is an empirical paper in which the authors identify risks presented
by the literature and then assess those risks interviewing professionals. They extended the
risk list present in Jaberidoost et al. (2013) and came up with 86 risks identified. The main
conclusion of the paper is that the main pharmaceutical SCRs are regulation-related ones.
Elleuch et al. (2013) propose a framework for systematic approaching SCRM including (1)
FMECA (Failure Modes, Effects and Criticality Analysis), (2) Design of an experiment to
design risks mitigation and action scenarios, (3) Discrete event simulation to assess risks
mitigation action scenario, (4) AHP (Analytic Hierarchy Process) to evaluate risk
management scenarios and (5) desirability function approach to minimize the risk. The
authors validate their methodology in a pharmaceutical supply chain case. Although
presenting an empirical robust method, the study does not go into an in-depth discussion
concerning risk identification.
Aguas et al. (2013) conducted a supply chain risk analysis applying system dynamics to
the Colombian healthcare sector, more specifically, in the oncology healthcare SC. Among the
main risks detected by the authors are delays in delivering times and lack of medication to
treat all the patients.
Figure 3.
Absolute number and
cumulative percentage
of SCRM papers per
segment
Supply chain
risk
management in
healthcare

Zepeda et al. (2016) focus on hospital inventory costs and investigate the potential
mitigating effects of affiliation with multi-hospital systems and came up with inventory-
related hypothesis and use econometric methods to test them. As main conclusions, the
authors concluded that there is a relationship between demand uncertainty for a hospital’s
clinical requirements and a hospital’s inventory costs. The assumption that demand
uncertainty for clinical requirements moderates the relationship between system affiliation
and a hospital’s inventory costs was not supported.
Riley et al. (2016) conduct a survey where they test assumptions such as (1) Do internal
hospital integration result in an improved warning and recovery capabilities? (2) Do
improved information-sharing competences result in an improved warning and recovery
capabilities? (3) Do enhanced training competences result in an improved warning and
recovery capabilities? and (4) Do improved warning and recovery capabilities result in
improved performance? The authors found evidence suggesting that internal integration
could be used to enhance organizations’ SCRM capabilities.
Jafarnejad et al. (2019) investigate the key factors affecting the resilience of the supply
chain of medical equipment. The authors apply fuzzy to determine the key factors and system
dynamics to analyze the relationship between them. The methodology can be applied to other
healthcare chains to compare the results.
Haeri et al. (2020) study a blood supply chain, which is very complex due to donation
uncertainties. The authors use data envelopment analysis to measure the efficiency of the
supply chain. Since disruptions in the bloodstock can cause a collapse in the network,
different measures of resilience as optimization tools were considered.
The literature on risks presents a wide range of techniques. Still, they have been scarcely
adapted to the needs of SCM and even more scarcely considering healthcare supply chains
(Khan and Burnes, 2007). In the last five years, SCRM has been largely studied with many
different approaches and applications. However, when research is conducted with the specific
objective of finding SCRM applied to healthcare, namely HCSCRM, only a few papers were
found. These few papers can be sorted into two types, papers that explicitly analyze SCRM
applied to HC (Healthcare) organizations and articles which eventually discuss solutions to
problems that consist of significant risks and may cause service rupture. Concerning papers
that approach HCSCRM, Vanvactor (2011) highlights the importance of disaster mitigation to
prevent SC breakdown and draws attention to crisis mitigation concepts. Thus, based on
Vanvactor (2011), we can define healthcare SC resilience as a capability to be responsive to
disasters, as well as SC breakdowns still being able to provide a full continuum of services to
all patients arriving at a facility for care. A study seen in Zepeda et al. (2016) highlights the
risks concerning mismatch between supply and demand and discusses risks of higher
inventory costs. Other papers discuss issues that may indirectly contribute to measure and
mitigate risks, as is the case in Eiro and Torres-Junior (2015), which discuss cases of
healthcare organizations that implemented TQM and Lean through the implementation of
tools like value stream map (VSM) and failure mode and effect analysis (FMEA). Such tools,
techniques and concepts are process improvers that have been used in the last decades to
mitigate intra organizational undesired effects. Nevertheless, such local improvements can
also generate supply chain-level benefits; for example, a supply chain reverse flow may be
started because of quality problems or lack of efficiency (which is often improved by the
adoption of Lean practices).
Nevertheless, papers are mentioning healthcare SCRs , although not directly. For example,
Rakovska and Stratieva (2017) mention that pharmaceuticals and medical devices are of
particular interest because they must meet specific requirements of several clinical
departments and therefore, present significant risks of stock out. Mandal and Jha (2017)
and Niemsakul et al. (2018) analyze the role of collaboration considering hospital–supplier,
which helps mitigate risks related to demand changes. Syahrir et al. (2015) highlight how a
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healthcare supply chain plays a major role in natural disasters mitigation. Mandal (2017) uses
SEM (Structural Equation Modeling) to empirically confirm the hypothesis that develop,
group and rational cultures contributes positively to healthcare supply chain resilience (HC
SCRes) while hierarchical culture inhibits it. Still limited systematic research has been
conducted to identify practices and strategies for improving hospital supply chain
performance (Zepeda et al., 2016). Lack of proper studies concerning risks in healthcare are
specifically hazardous. According to Riley et al. (2016), a shortage of supply or unanticipated
demand spike for hospitals can lead to catastrophic consequences beyond low in stock
metrics. When a hospital experiences an unexpected demand spike or supply shortage,
supply managers must have the means to alter and/or reconfigure the supply chain (Riley
et al., 2016). The authors conclude that by developing SCRM capabilities, organizations can
better address an array of SCRs.
5. Defining healthcare supply chain risk management
Up to this point, our paper showed that SCRM applied to healthcare supply chains lacks
empirical studies. One reason is the lack of a formal definition of SCRM in healthcare. Is it only
a straightforward merge of the two concepts or does it have particularities that require
further definition to be effectively studied? Fan and Stevenson (2018) divide SCRM
definitions into three categories: (1) SCRM process – definitions that identify the main stages
that companies must go through to manage risks in a supply chain level; (2) Pathway to
SCRM – these are the definitions that highlight the importance of implementing SCRM
strategies and (3) Objective of SCRM – many definitions set establish the ultimate goal of
SCRM that can be insure cash-flow management, cost saving and guarantee business
continuity.
Nevertheless, healthcare management must include other elements, considering they form
a SC that should care more about lifesaving than profit itself. Table 3 shows the main
definition elements.
Therefore, the definition of HCSCRM is defined as follows:
“The process of identifying, assessing, mitigating and monitoring SCRs aiming to provide
the best quality of care through SC processes integration, with sustainable profit avoiding
supply shortage, valuing HC and clinical engineering professionals, having in consideration
that local actions may generate hazards to all HCSC generating SCREs and HRHCN”.
Definition
element Text Reference
SCRM stages The process of identifying, assessing,
mitigating and monitoring SCRs
Fan and stevenson (2018), Nabelsi (2011)
Objectives Aiming to provide the best quality of care Kokilam et al. (2016), Mishra et al. (2018)
Pathway to
SCRM
Through SC processes integration, with
sustainable profit avoiding supply shortage
and HC professional’s unhappiness
Borelli et al. (2015), Abukhousa et al. (2014),
Mustaffa and Potter (2009), Breen and
Crawford (2005), Iannone et al. (2014),
Balc
azar-Camacho et al. (2016), Mishra et al.
(2018)
Generating
reliability
Having in consideration that local actions
may generate hazards to all HCSC
Authors
Human
resources
Valuing HC professionals as well as clinic
engineers
Chen et al. (2018)
Generating
resilience
In that way generating SCREs and high
reliability healthcare network (HRHCN)
Authors
Table 3.
Construction of the
HCSCRM definition
Supply chain
risk
management in
healthcare

The proposed definition sought to contemplate the main building blocks responsible to
mitigate SCRs and generate SCRes. In addition, the definition comprises often-neglected
concepts such as clinical engineering and features that are essential in building a high
reliability organization that is part of a high reliability network. Supply chains that are often
studied (such as automotive and food) refer to businesses where there is a well-defined
product, with well-defined outcomes and KPIs and can be comprised by SCRM definitions
that are already fairly discussed in the literature. Nevertheless, healthcare supply chains have
particularities: (1) their main objective is to save lives providing the best quality of care and (2)
it is a SC that still needs revenues in order to survive. Considering this idiosyncratic SC and
the lack of HCSCRM studies, it is essential to supplement the theory with clinical engineering
and HRN concepts. Therefore, HCSCRM is constructed by SCRM, SCRes (concepts within
SCM domain) and supplemented by clinical engineering and HRO. Figure 4 represents the
proposed framework.
6. Techniques and approaches in healthcare supply chains
This section summarizes the main approaches and techniques found in the literature. Due to
its particularities, the strings are analyzed separately.
6.1 STR2 analysis
Concerning the papers found by STR2 search, Table 4 summarizes the main approaches to
obtain healthcare supply chain improvements.
Papers that conduct survey analysis (either qualitative or quantitative) are about 24.6% of
the studies, and conceptual analysis represent 13.2% of the studies. Literature review, survey
and conceptual papers totalize 46.5% of papers, meaning that literature could benefit from
more applied studies.
Table 5 shows some more interesting statistics regarding the analysis.
Almost all the papers present some sort of identification technique or at least they discuss
an already known problem. In terms of assessment techniques (techniques that allow to
thoroughly know the risks magnitude), we notice a considerable fall, which shows
considerable opportunities regarding risk assessment. Considering mitigation actions to
either minimize risk probability or diminish the risk effects, we found out that only 36.8%
carry on such actions. In terms of continuous monitoring (once the risks are identified,
Healthcare Supply Chain Risk
Management
Supply Chain
Risk
Management
Supply Chain
Resilience
Clinical
Engineering
High
Realiability
Organizations
Supply Chain
Management
Figure 4.
Healthcare supply
chain risk management
constructs
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assessed and mitigated) is where we notice the greater gap with only 9.6% of the papers
presenting KPI able to control this process systematically. Table 6 shows a similar analysis
about healthcare supply chain tiers.
From Table 6, we infer that HCSC studies focus more on the internal hospital chain,
highlighting the central storeroom. Considering the upstream SC, we perceive how they are
considerably less studied.
Approach Quantity
Survey analysis 28
Conceptual analysis 15
Literature review 10
Statistical analysis 9
Simulation 8
DEA 5
Data warehouse 4
Mathematical programming 4
Neural networks 3
Literature review and survey analysis 2
Procurement improving 2
AHP 2
Mathematical model 2
Interviews 2
Game theory 2
Healthcare process reengineering 1
Accounting analysis 1
Algorithm development 1
Collaborative practices implementation 1
Survey analysis and simulation 1
CPFR and AHP 1
Risk-sharing approach implementation 1
FMEA and IDEF0 1
Pareto analysis 1
Inventory management 1
ABC classification 1
VMI implementation 1
Problem-solving framework 1
Performance management 1
Resource-based view 1
DEMATEL 1
Identification Assessment Mitigation Monitoring
112 80 42 11
98.2% 70.2% 36.8% 9.6%
Vendors Manufacturers Distributors Hospital central store room Nursing units Points of care
46 49 63 83 58 65
40.4% 43.0% 55.3% 72.8% 50.9% 57.0%
Table 4.
Healthcare supply
chain approaches
Table 5.
SCRM stages
approached
Table 6.
Supply chain tiers
approached
Supply chain
risk
management in
healthcare

6.2 Analysis of STR3
The STR3 returned two main concepts, which provide a relevant contribution to the study;
clinical engineering (82 papers) and HRO (37 articles), which are separately analyzed.
6.2.1 Clinical engineering findings. The clinical engineering area of study has the potential
of complementing the SCRM theory because the studies provide local solutions that may
positively impact the whole supply chain. Figure 4 shows that CE (Clinical Engineering)
papers give insights on subjects, which are also in the SCRM context. Concerning risk
management applied in healthcare supply chains, only a few papers can be found. Even in
these few papers a whole body of literature constituted by clinical engineering is left out of the
analysis. To define healthcare SCRM, it is essential to do analyze this area of knowledge to
close these gaps.
Clinical engineering papers present relevant medical studies which include (1) medical
devices maintenance management (Wang et al., 2013), (2) clinical engineering systems (Ibey
et al., 2015), (3) quality management (Koustenis and To, 2012) and (4) risks (Chen et al., 2018;
Mahfoud et al., 2016). Such studies present analyzes and solve problems that are often supply
chain related, therefore presenting real possibilities of completing the SCRM theory. Figure 5
shows statistics regarding (CE) STR3 search.
Clinical engineering studies excel in areas such as maintenance management, quality
management, medical equipment management and support to systems implementation.
These subjects are the backbone of CE and the speciality of clinical engineers; nevertheless,
clinical engineers are increasingly required to perform management tasks. The quantitative
analysis of clinical engineering studies is found in Table 7.
Figure 5.
Absolute number and
of clinical engineering
sub-areas of study
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In terms of approaches, STR3 has 73.1% of practical/applied papers, which shows
considerable improvement comparing to STR2 paper types. Nevertheless, a qualitative
analysis based on the STR3 paper reading shows that there is not much formal reference to
supply chain issues, even though there are very recurring problems such as medical device
defects, order delays and incomplete orders, which are classic supply chain problems.
Figure 6 shows analysis of STR3 approaches.
6.2.2 High reliability principles applied to HC. Papers including HRO concepts include
many different segments. Table 8 shows the quantitative analysis on HRO.
Figure 7 shows the HRO approaches.
6.2.3 HCSC risks identified. The SCRM literature already has a significant amount of
studies identifying risks (Juttner et al., 2003; Norrman and Jansson, 2004; Barroso et al., 2010;
Petit et al., 2013). Based on risk categories created by Juttner et al. (2003) and Petit et al. (2013),
we summarized the HCSC list of risks (Table 9).
7. Discussion
This paper aimed to conduct a systematic literature review to answer three research
questions: RQ1– Which are the main existent gaps concerning HCSCRM? RQ2 – What is the
definition for HCSCRM? and RQ3 – What are the risk management techniques and
approaches used in healthcare supply chains? In section 4, we answered the RQ1 by
discussing the papers we found and concluding that the SCRM literature is lacking HCSCRM
studies. In section 5, we addressed the RQ2, proposing a complete definition of HCSCRM. In
section 6, we answered RQ3, analyzing the tools and techniques that scholars are using to
approach SCRM. Table 9 is a product of a systematic literature review where the risks were
Approach Quantity
Statistical analysis 23
Process improvement 7
Cost analysis 3
Risk analysis 3
Multiple linear regression 2
Qualitative interviews 2
Survey 2
AHP 1
Application development 1
Behavioral quality assurance 1
Data mining 1
Decision support system 1
Fuzzy 1
Interviews 1
Literature review 1
Multi-criteria analysis 1
Multi-criteria decision-making 1
Multivariate regression 1
QFD 1
Risk classification 1
Simulation 1
Web-based platform 1
FMECA 1
Resource-based view 1
Computerized maintenance management system 1
Table 7.
Quantitative analysis
studies
Supply chain
risk
management in
healthcare

identified. There was a detailed work of analyzing the risks to conclude which categories they
should be in and which risks that appear with different names could mean the same risk.
Approaches Quantity
Risk management 6
HRO principles 5
Survey 3
Role framework for workforce 1
Relational aspect 1
Quality reference model 1
Literature review 1
Lean/six sigma HRO 1
Interviews 1
High reliability networks 1
High reliability health care maturity model 1
High reliability culture 1
Adoption of aviation practices 1
Confirmatory factorial analysis 1
Benchmarking 1
FMECA 1
Figure 6.
Absolute number and
techniques
Table 8.
HRO approaches
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Table 9 can also be detailed to answer to specific investigation in further studies. Concerning
the five constructs presented in Figure 6, there are five pillars. SCM is a well-consolidated
concept that was tailored by professionals and scholars in the last three decades and is the
basis for all SC analysis. SCRM and SCRes are two concepts that have been studied and
defined in the last 15 years; therefore, there is still some divergence in the literature, although
many convergences. First, it is essential to highlight that SCRM involves an understanding
that a SC is a set of processes and local risks that can generate troubles for the entire SC;
therefore, risk identification, assessment, mitigation and monitoring are the essential stages
of obtaining SCRM. SCRes is the capability that a SC has to endure crisis and arise at the same
level of performance or even better, so it is a set of capabilities that should be forged in any SC.
Clinical engineering plays a major role in HCSC. Clinical engineers have great potential to give
consultancy and generate savings in the HCSC. CE is a SC tier that is responsible for
approving a 100,000 US$ equipment or diagnose that the same equipment can be repaired for
half the cost; therefore, it is a SC link that is also responsible to bridge the gap between
management and giving patients better quality of care. HRO and HRN provide principles that
converge to the generation of SCRes and the generation of resilience in HCSC.
Figure 7.
Absolute number and
of HRO approaches
percentages
Supply chain
risk
management in
healthcare

Risk category Risks Reference
Environmental Disasters Vanvactor (2016)
Environmental risks Chiarini et al. (2017), Viani et al. (2016)
Flood Farley et al. (2017)
Government risks Chandra (2008)
Hazardous wastes risks Viani et al. (2016)
Legal risks Askfors and Fornstedt (2018)
Sustainability risks Gelderman et al. (2017)
Deliberate threats Corruption Cavalieri et al. (2017)
External pressures Purchasing cost higher than expected Lin and Ho (2014)
Insufficient e-government services Katsaliaki and Mustafee (2010)
Lack of health service supply chain
design
Helo (2016)
Lack of macro-ergonomics conditions
in HCSC
Azadeh et al. (2016)
Procurement risks Meehan et al. (2017)
Technology risks Mandal (2017)
Organizational/
resource limits
Blood wastage Arvan et al. (2015)
Capability Meehan et al. (2017)
Costs Campling et al. (2017), Mudyarabikwa et al.
(2017)
Culture risks Mandal (2017), Campling et al. (2017), Mandal
(2017), Mandal (2017), Mandal (2017)
Drug recalls management Bevilacqua et al. (2015)
Excess of packaging material Kumar et al. (2008)
financial risks Mudyarabikwa et al. (2017)
No comprehensive e-procurement
system
Lin and Ho (2014)
Institutional pressures (coercive,
mimetic and normative and
endogenous pressures)
Bhakoo and Choi (2013)
Internal conflicts Ancarani et al. (2016)
IT risks Afshan and Sindhuja (2015), Borelli et al.
(2015)
Lack of efficiency Mudyarabikwa et al. (2017)
Lack of executive support McKone-Sweet et al. (2005)
Lack of expertise McKone-Sweet et al. (2005), Campling et al.
(2017)
Lack of product rotation Hall (2016)
Lacking provision of dressings to
nurses
Jenkins (2014)
Long waiting times Kumar et al. (2009)
Misalignment of priorities Ancarani et al. (2016)
Prescription errors Awofisayo et al. (2011)
Time waste (from nonvalue added
activities)
Bendavid et al. (2010)
Turnover Ancarani et al. (2016)
Sensitivity Expired drug management Bevilacqua et al. (2015)
Huge variety of drugs Lin and Ho (2014)
Management of product expiration
date
Kastanioti et al. (2013)
Performance measurement risks McKone-Sweet et al. (2005), Nabelsi (2011)
(continued)
Table 9.
HCSC risks identified
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8. Conclusion
8.1 Managerial implications
Healthcare supply chain managers daily deal with the dilemma of mitigating risks costs
versus costs and losses caused by the risks. Concerning healthcare, managers must consider
that minimizing costs could not result in lesser care for the patients. In this sense, it would be a
natural consequence to invest in control towers that can manage all KPIs and data science
applications to be always and automatically identifying, assessing, mitigating and
monitoring risks.
8.2 Research limitations
While this research carefully examined the extensive SCRM literature, it has limitations. As
the main limitations, we cite the fact that we reviewed international journal articles (published
in the English language), excluding conference papers, master and doctoral dissertations,
textbooks, book chapters, unpublished articles and notes.
In terms of selection criteria, Kilubi and Haasis (2015), Kamalahmadi and Parast (2016)
used ABS (associationofbusinessschools.org) ranking and limited to journals with 3 or 4
grade. Kilubi (2016) included in her paper peer-reviewed journals with a VHB ranking (vhb.
online.org/startseite) of Aþ, A, B or C, which were defined as one of the criteria. Nevertheless,
Risk category Risks Reference
Network Communication risks Askfors and Fornstedt (2018), Grudinschi
et al. (2014)
Credibility risks Kumar et al. (2005), Kokilam et al. (2016),
Afshan and Sindhuja (2015), Meehan et al.
(2017)
Data management risks Hall (2016), Jannot et al. (2017), McKone-Sweet
et al. (2005)
No integrated and unified information
system between hospital and its
suppliers
Lin and Ho (2014)
No information sharing between
hospital and its suppliers
Lin and Ho (2014)
No collaboration Lin and Ho (2014)
Information risks Hall (2016), Jannot et al. (2017), Chandra
(2008), Iannone et al. (2014), Kumar et al.
(2009)
Picking risks Piccinini et al. (2013)
Relationship risks McKone-Sweet et al. (2005), Grudinschi et al.
(2014)
Warehouse management risks Spisak et al. (2016), Meehan et al. (2017)
Supplier/customer
disruptions
Demand risk Balc
azar-Camacho et al. (2016), Kokilam et al.
(2016)
Distribution risks Kumar et al. (2005), Afshan and Sindhuja
(2015), Spisak et al. (2016), Arvan et al. (2015),
Mustaffa and Porter (2009)
Hospital–supplier integration–
mitigators
Afshan and Sindhuja (2015)
Quality risks Kastanioti et al. (2013), Kumar et al. (2005),
Mudyarabikwa et al. (2017)
Supply risks Campling et al. (2017), Chandra (2008), Spisak
et al. (2016), Kastanioti et al. (2013), Iannone
et al. (2014), Chandra (2008) Table 9.
Supply chain
risk
management in
healthcare

this paper did not impose any journal restriction on our list to ensure that all relevant studies
were captured, which is consonant with the vision of Ho et al. (2015). Additionally, this paper
chose not to use this ranking because a broader scope was needed, and since the SCRM
papers related to healthcare are only few, adding more constraints could reduce to none the
amount of papers related to healthcare.
In addition, the study did not thoroughly investigate specific countries’ particularities
concerning how the healthcare providers are organized (for example, specificities of countries
that have public and private healthcare organizations). In this sense, there could be
idiosyncrasies that were not considered by this study.
8.3 Final remarks
Thispaper had the objective of conducting a SLR to investigate SCRM applied tothe healthcare
segment via three research questions: (1) Which are the main existent gaps concerning SCRM?
(2) What is the definition for HCSCRM? and (3) Which approaches are being used to identify,
assess and mitigate healthcare supply chain risks? As the main conclusion, we highlight the
lack of empirical studies concerning this stream of research; therefore, we addressed the three
research questionsgenerating four innovativeproducts:(1) Webroughta completesummary of
this bodyof research, investigating research strings likeclinical engineering and HRO and their
relations with HCSCRM; (2) This broader search revealed the five pillars of HCSCRM,
summarized by Figure 6; (3) Considering the whole literature investigated, we proposed a
formal definition for HCSCRM considering all the literature blocks investigated and (4) We
generated a list of risks resulting from an extensive article research.
8.4 Future research agenda
As a recommendation of future research agenda, we propose that the framework presented in
this paper be further investigated and empirically tested in a real-case study. Researchers
should conduct qualitative and quantitative interviews to validate all the information
presented by this paper. Applying the framework of identifying, assessing, mitigating and
monitoring could include a whole automation of this process. The paper showed that there are
only few studies of HCSCRM; in this sense, there is a whole stream of research to be explored
in this segment.
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Further reading
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Zeng, B. and Yen, B.P.C. (2017), “Rethinking the role of partnerships in global supply chains: a risk-
based perspective”, International Journal of Production Economics, Vol. 185, pp. 52-62.
Corresponding author
Ana Claudia Dias can be contacted at: missdias@gmail.com
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