Developing sustainable supply chains for healthcare

Abstract

The focus of this thesis is to provide hospitals and local authorities in an urban setting with a set of recommendations for sustainable methods of supply for healthcare institutions, to minimise the negative externalities of freight associated with urban hospitals. The structure and nature of the healthcare supply chain engenders unsustainable freight patterns as a result of the poor communication and unpredictability of inventory demand from hospitals to suppliers, resulting in high freight volumes (403 freight movements recorded over a 5-day period during a November 2011 survey), and the mixing of urgent and non-urgent goods within the same supply chain. In addition to this ancillary hospital services such as hospital laboratory couriers are found to be a large traffic generator with 476 individual services booked over a 3 month period (January – March 2014). In fulfilment of these issues three solutions are proposed to improve the economic and environmental sustainability of freight: mobile consolidation, to address the high numbers of deliveries received by hospitals; unattended locker bank delivery, to separate urgent goods from the supply chain; and, consolidation of laboratory courier services. Assessment of the mobile consolidation centre for GOSH only operating over 1 site to 4 sites, using 93 records from the 2011 freight survey indicated savings for the week between: 10,591 VKm (1 site operation) and 12,173 VKm (4 site operation); 181.53 – 225.05 journey time hours for 2 site and 4 site operations, respectively; and, 2 – 2.33 tonnes of CO2 equivalents between 1 site and 4 site operations. Implementation of a London-wide scenario indicated reductions of 64,204 VKm, 579 Journey Time Hours and 89 tonnes of CO2e. Assessment of the proposed electronic locker bank was assessed using a hill climbing model operating with a database of consignment movements; and qualitatively using staff interviews. Results indicated that a locker bank measuring 3.69m length, 1.7m height and 0.8m depth, comprising 19 partitions would be required to accommodate all urgent consignments for any given day. Staff perceptions of the concept were positive suggesting the locker would potentially improve the speed and quality of healthcare delivered to patients. Current hospital and courier service providers’ practices centre on collecting items as and when they arrive for outward journeys at the hospital. Using a database of 323 courier journeys at Great Ormond Street Hospital, 8 different consolidation scenarios, varying the length of time an item is delayed (ranging between 30 minutes to 10 hours). Findings indicated that consolidated approaches yielded reductions in vehicle numbers, between 120 and 255, compared to the current model of operation, but that the current model of operation is actually more environmentally efficient, generating 0.42 to 0.84 fewer metric tonnes of CO2 than consolidated approaches. Assessments of other hospitals such as University Hospital Southampton indicated that the three proposed solutions may be considered relevant to other hospitals. However, in the citywide context, the benefits for each solution when implemented at a single hospital site were minimal suggesting a greater number of hospital sites would be required to deliver larger gains.

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Identifiers

ORCID for T.J. Cherrett: orcid.org/0000-0003-0394-5459

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