Yes / The effective management of pharmaceuticals in the National Health Service (NHS) is critical to patient welfare thus any risks attached to this must be identified and controlled. At a very basic level, risks in the pharmaceutical supply chain are associated with product discontinuity, product shortages, poor performance, patient safety/dispensing errors, and technological errors (causing stock shortages in pharmacies) to name but a few, all of which incur risk through disruption to the system. Current indications suggest that the pharmaceutical industry and NHS practitioners alike have their concerns as to the use of generic supply chain strategies in association with what is perceived to be a specialist product (pharmaceuticals). The aim of the study undertaken was to gain a more realistic understanding of the nature and prevalence of risk in the Pharmaceutical Supply Chain (PSC) to be used as a basis for a more rigorous research project incorporating in-vestigation in the UK, Europe and USA. Data was collected via a workshop forum held in November 2005. The outputs of the workshop indicated that there were thirty-five prevalent risks. The risks were rated using risk assessment catego-ries such as impact, occurrence and controllability. The findings indicated that the risks identified are similar to those prevalent in industrial supply chains, regardless of the idiosyncrasies of pharmaceuticals. However, the group consen-sus was that caution must be applied in how such risks are addressed, as there are aspects of the product that highlight its uniqueness e.g. criticality.

Yes

Yes / Purpose: This study explores the downstream Pharmaceutical Supply Chain (PSC) and provides insight to the delivery process of medicines and associated operational inefficiencies. Design/methodology/approach: An exploratory, qualitative approach was adopted to examine PSC inefficiency within two European contexts: the UK and Greece. Data was gathered through interviews and a thematic analysis conducted to analyse the data and identify challenges faced by both supply chains. Findings: The medicines delivery system needs to be enhanced in terms of quality, visibility, speed and cost in order to perform effectively. The findings demonstrated that although the healthcare supply chains in the two European contexts have different operational structures, the results are in concordance with each other. Financial, communication, waste and complexity issues were the major concerns. Research limitations/implications: To our knowledge this is the first study to examine aspects of the medicines supply chain via a cross-case analysis in the UK and Greece and extends the body of knowledge. A broader sample of responses is warranted to further validate these findings. Practical implications: The study outputs can inform pharmacies’ strategic to instigate targeted improvement interventions. The implications of which may be extrapolated further to other European healthcare organisations. Originality/value: This research contributes to the academic literature by adding further theoretical insights to supply chain strategy development, especially those that have been characterised as highly complex. The study identifies 4 key areas of intervention needed within this supply chain (in both countries) to promote higher level efficiencies and effectiveness.

yes / 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.

yes / 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.

No / Supply chain resilience has been suggested to curb the impact of disruptions on supply chains. While this proposition seems coherent in theory, empirical evidence supporting this is limited, as existing literature has centred on exploring the impact of supply chain resilience on disruptions which are based on set time frames, non-supply chain specific as well as examining non-dynamic disruptive events. This study contends that resilience strategies are dynamic and as such their applications within supply chains differ. Therefore examining the impact of resilience will be appropriate on a dynamic disruption within a specific supply chain. In view of this, the paper examines through existing literature the applicability of agility within the pharmaceutical supply chain when dynamic disruptions like drug shortages occur. The study finds alertness, accessibility, connectivity and visibility as dimensions of supply chain agility that are capable of reducing the impact of drug shortages.

Yes / Purpose The objective of this study was to advance our knowledge of pharmaceutical supply chain resilience using Complex Adaptive System theory (CAS). Design/methodology/approach An exploratory research design which adopted a qualitative approach was used to achieve the study’s research objective. Qualitative data were gathered through 23 semi-structured interviews with key supply chain actors across the PSC in the United Kingdom (UK). Findings The findings demonstrate that CAS, as a theory, provides a systemic approach to understanding PSC resilience by taking into consideration the various elements (environment, PSC characteristics, vulnerabilities and resilience strategies) that make up the entire system. It also provides explanations for key findings, like the impact of power, conflict and complexity in the PSC, which are influenced by the interactions between supply chain actors and as such increase its susceptibility to the negative impact of disruption. Furthermore, the antecedents for building resilience strategies were the outcome of the decision-making process referred to as co-evolution from a CAS perspective. Originality/value Based on the data collected, the study was able to reflect on the relationships, interactions and interfaces between actors in the PSC using the CAS theory, which supports the proposition that resilience strategies can be adopted by supply chain actors to enhance this service supply chain. This is a novel empirical study of resilience across multiple levels of the PSC and as such adds valuable new knowledge about the phenomenon and the use of CAS theory as a vehicle for exploration and knowledge construction in other supply chains.

Pharmaceutical supply chains are susceptible to disruptions which impact on the operational and financial performance of firms as well as patient safety. This study aimed to explore why the Pharmaceutical Supply Chain (PSC) in the UK is susceptible to the impact of dynamic disruptions and examine how resilience strategies have were employed to reduce the effects of these disruptions. The Complex Adaptive System (CAS) theory was used as a framework in an exploratory research design using mixed-methods. The qualitative data were gathered through 23 semi-structured interviews with key supply chain actors across the PSC in the UK to explore their experiences. The findings from these semi-structured interviews were used to develop a survey which was distributed to a broader spectrum of supply chain actors where the final sample from the survey was (n=106). The data were triangulated to discuss the research findings. The initial results revealed power, conflict and complexities as drivers of vulnerabilities in the PSC. Antecedents for building resilience strategies included visibility, flexibility and joint decision making as recovery strategies and resource sharing as the resistance strategy. CAS provided a systemic approach to understanding PSC resilience rather than in parts. In doing so, it took into consideration the various elements that make up the entire system. Thus, vulnerabilities and resilience strategies were outcomes of the interactions between supply chain actors. The findings demonstrated that CAS, as a theory, provided a framework that was beneficial in exploring and gaining insights into PSC resilience. Also, by combining the two datasets (interviews and survey), an original output was proposed -the Pharmaceutical Supply Chain Resilience Framework (PSCRF)- which was used to recommend resilience strategies suitable for mitigating disruptions in the PSC.

Yes / Purpose This study explored the effect of power-based behaviours on pharmaceutical supply chain (PSC) resilience. Design/methodology/approach This study used a mixed-method approach to explore the role of power-based behaviours in PSC resilience. Qualitative interviews from 23 key PSC stakeholders, followed by thematic analysis, revealed the underlying perceptions regarding PSC resilience. Quantitative propositions were then developed based on the themes adopted from PSC resilience literature and the qualitative findings. These were tested via a survey questionnaire administered to 106 key stakeholders across the various levels in the PSC. Structural equation modelling with partial least squares was used to analyse the data. Findings The data analysed identified proactive and reactive strategies as resilience strategies in the PSC. However, power-based behaviours represented by quota systems, information and price control influenced these resilience strategies. From a complex adaptive system (CAS) perspective, we found that when power-based behaviours were exhibited, the interactions between PSC actors were mixed. There was a negative influence on reactive strategies and a positive influence on proactive strategies. Our analysis also showed that PSC complexities measured by (stringent regulations, long lead times and complex production) moderated the effect of power-based behaviour on reactive strategies. Thus, the negative impact of power-based behaviours on reactive strategies stemmed from PSC complexities. Research implications Our research particularly reveals the role of power-based behaviours in building PSC resilience. By evaluating the nexus from a CAS perspective, the analysis considered powerbased behaviours and the moderating role of PSC complexities in developing resilience strategies. The study considers the interactions of PSC actors. It shows that power asymmetry is a relational concept that inhibits the efficacy of reactive strategies. This study thus advocates the importance of power in achieving a more resilient PSC from a holistic perspective by highlighting the importance of the decision-making process among supply chain partners. Our findings are particularly relevant if PSC resilience is viewed as a complex adaptive system (CAS). All the interactions and decision-making processes affect outcomes due to their inherent complexities. Although this study focused on the PSC, its implications could be extended to other SCs (supply chains). Practical implications We identified that power-based behaviours influenced resilience strategies. It was detrimental to reactive strategies due to the complexities of the PSC but beneficial to proactive strategies through resource-sharing. PSC actors are therefore encouraged to pursue proactive strategies as this may aid in mitigating the impact of disruptions. However, power-based behaviours bred partner dissatisfaction. This dissatisfaction may occur even within strategic alliances indicating that power could be detrimental to proactive strategies. Therefore, it is pertinent to identify conditions that lead to dissatisfaction when pursuing strategic partnerships. This study provides insight into actual behaviours influencing resilience and quantifies their effects on the PSC. These insights will be valuable for all supply chain partners wanting to improve their resilience strategies. Originality/value Previous PSC management and resilience studies have not examined the role of power in building resilience in the PSC. This paper thus provides a unique contribution by identifying the role of power in PSC resilience, offers empirical evidence and a novel theoretical perspective for future practice and research in building PSC resilience strategies.

Yes / 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 full-text of this article was released for public view at the end of the publisher embargo on 3 Nov 2015.