شکل گیری سیستم های موجودی در خدمات بهداشتی و درمانی: تجزیه و تحلیل ذینفعان

Although many studies have addressed the diagnosing and redesign of inventory systems in an industrial setting, the field of operations management seems to lack a thorough understanding of the process of shaping inventory systems in a health care setting. In this article, a contribution is made to fill this gap by exploring the process of reshaping a hospital inventory system of medicines by means of an exploratory case study. In doing so, we concentrate on the question how the outcomes of this process are affected by the different stakeholders involved. Our case study indicates that decisions made during this reshaping process are heavily influenced by the dynamics of the relationships and interactions between the stakeholders involved in the project. Based on our case study there are also some strong indications especially in a health care setting, the existence of multiple stakeholders having a multi-goal focus regarding the inventory system can have a strong influence on the outcomes of inventory projects. For project managers it is important to be aware of these characteristics and circumstances in order to help health service organisations to develop and use inventory systems more effectively.

Since the 90s, the health care sector has changed rapidly. Due to increased competition, a growing influence of patients and a stronger necessity to deliver health services in a more efficient and effective way, many health care organisations have started projects in the area of service quality, clinical pathways, information systems and patient logistics (e.g. Stock et al., 2007; Mahmoud and Rice, 1998). Not only in practice but also from a theoretical point of view the area of health care management has changed significantly. During the past 15 years an impressive number of studies performed in disciplines like Economics, Business Logistics, Operational Research and Business Administration have enlarged our knowledge regarding the health care sector considerably (e.g. Li and Benton, 1996; Jarett, 1998; McFadden, et al., 2004; Ruiz, 2004). Notwithstanding the fact that hospitals carry large amounts of a great variety of items, health care organisations have paid little attention to the management of inventories (Nicholson et al., 2004). Studies performed in the past as well as more recent research suggest that inventory costs in the health care sector are substantial and are estimated to be between 10% and 18% of net revenues (e.g. Jarett, 1998). At the same time, hospitals are forced to increase their internal service performance and it is also for this reason why a strong focus on inventory management has become paramount in many hospitals nowadays. It will be of no surprise, therefore, that a large number of hospitals have started with projects in the area of inventory management in order to reduce costs and improve service levels. Despite having some rather unique characteristics only few studies have addressed the question how the design and implementation of inventory systems in a health service setting takes place. Many different stakeholders are involved in the (re)shaping of inventory systems and together with the diverse and unique characteristics of hospital products, projects in the area of inventory management are far from a simple, straightforward design process in hospitals. Moreover, only a limited number of empirical studies are available regarding the question how conflicting interests and power relationships between stakeholders influence the shaping and implementation of inventory systems in health services. Undoubtedly, having a clear understanding of how inventory systems are affected by the specific characteristics of hospitals can be helpful to strategic and tactical decision-making processes on inventory systems. Additionally, this understanding can also be beneficial for the effectiveness of inventory projects. In the next section, first the results of a literature study that guided the empirical part of our research are presented. In the second part of our paper, case data is analysed. In doing so we will concentrate on the question how the results of inventory projects in a health care setting are being affected by the different stakeholders involved. The cure and care context of the inventory project as well as some contingency factors that have influenced the outcomes of the inventory project are explicitly taken into account when analysing the case data. We view the contribution of this study from two perspectives. First, the paper aims to advocate the role of stakeholders during the process of shaping inventory systems. Noticeably, this role has not been fully explored in a health care setting and hardly any articles in the area of operations management have addressed this issue explicitly. Additionally, some tentative conclusions are drawn about how the hospital setting of the stakeholders might influence the design and performance of an inventory system. In this way, a contribution is made to identify various issues more profoundly regarding enablers and barriers to the shaping of inventory systems in hospitals.

Although the issue of inventory management often is associated with industrial companies, nowadays a strong focus on inventory management has also become paramount in many hospitals. Due to an increase of inventory costs and a strong necessity to improve service levels many hospitals have been forced to start up projects in the area of inventory management in order to improve their performance. In general, the (re)shaping of inventory systems includes many different stakeholders and together with the diverse and unique characteristics of a great variety of hospital products, projects in the area of inventory management are far from a simple, straightforward design process in hospitals. In spite of this, only few studies have addressed the question how the design and implementation of inventory systems in a health service setting takes place. In this paper, we tried to fill this void by exploring the process of reshaping an inventory system by means of an exploratory case study. Several conclusions can be drawn from our research. Most importantly, our case study clearly indicates that decisions made during the process of reshaping an inventory system are heavily influenced by the dynamics of the relationships and interactions between the stakeholders involved in the project. Especially in a health care setting, the existence of multiple stakeholders having a multi-goal focus regarding the project may easily result in different perceptions and expectations on the outcomes of the project. Based on our case study, there are many indications that the specific situation hospitals find themselves in can have a strong influence on the events taking place during inventory projects. A strong focus of the stakeholders on patient oriented care and cure processes, the federated-type meritocracy character of hospitals and the multidimensional character of inventory systems easily lead to a fragmented process of reshaping the inventory system which is more based on negotiation than on a logistical-oriented design rationale. For project managers it seems important to be aware of the influence these factors can have on the shaping of inventory systems. Our study clearly indicates that besides the technical aspects of inventory management, good project management needs to include a thorough understanding of the dynamics of the relationships and interactions between stakeholders as well. In doing so, one of the main challenges of top management is to balance the different interests of the stakeholders involved in inventory projects. Compared to manufacturing companies, hospitals more heavily rely on different coalitions of stakeholders with different interests and responsibilities, each of them having different mindsets and realities. In many cases, these coalitions are reflected in the organisational structure of hospitals and integrated performance management systems are for this reason often frequently limited by organisational arrangements. Inventory projects therefore, without any doubt need to be fully supported by top management teams. This support not only relates to facilitating the project and allocating sufficient budgets to the project; it also requires a full integration of all the different interests into a proper set of overall goals regarding the inventory system. The above mentioned conclusions are only a first step towards a design methodology for inventory systems in a health care setting and further research is required for getting an in-depth understanding of the process of reshaping inventory management system in hospitals. In particular it seems to be worthwhile to explore the differences between inventory systems in an industrial setting and inventory systems in a health care setting. Additionally, we feel more in-depth case studies of inventory projects executed in hospitals need to be performed in order to unravel the mechanisms that influence the outcomes of these projects. Hopefully, a more profound understanding of these mechanisms ultimately may help organisations to develop and use inventory systems more effectively.