RELACIÓN OBJETIVOS ESPECÍFICOS, RESULTADOS Y CONCLUSIONES

This chapter discusses the findings of the study. The discussions are based on the specific objectives that are aimed at determining elements that constitute supply chain integration, supply chain performance evaluation approaches and their application and performance indicators for critical process in the supply chain. The study is based on donor funded supply chains currently being carried out at Phillips Healthcare Service Limited as the case study. The chapter is organised into the following sections: a summary of the study, followed by discussions of the findings. Major conclusions are also presented in this chapter as well as recommendations for further studies.

5.2 Summary

The general purpose of the study was to evaluate supply chain performance of donor funded healthcare supply chain programs managed by Phillips Healthcare Services Limited. The specific objectives were to explore integration of supply chain in healthcare, investigate supply chain performance evaluation approaches and identify key performance indices for the health care supply chain.

A descriptive study design was used to evaluate supply chain programs integration, performance evaluation approaches and key performance indicators. The sample for this research was determined by the scope of work covered by the programs, the level of staff for the various programs and was divided into 3 main groups of respondents that constituted the program implementers, program managers and outsourced supply chain partners. The study considered 4 programs with 20 staff as respondents, 36 project managers and 16 outsourced supply chain partners. The questionnaires administered to workers in the healthcare supply chain were selected using stratified random sampling procedures. The research carried out used a data analysis method by administering questionnaires to the respondents. The data obtained from the questionnaires was analyzed using to generate appropriate frequencies and tables. The data analysis procedures used were of descriptive statistics.

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The study sought the perceptions of the program implementers, program managers and outsourced supply chain partners on various areas related to elements that constitute supply chain integration, supply chain performance evaluation approaches and their application and performance indicators for critical process in the supply chain. The study at each stage looked at various factors that affected each of the research objectives. The study collected opinions as to how various respondents in the healthcare supply chain viewed the program’s supply chain management.

The findings ascertained that the respondents were aware of the importance of supply chain integration which they felt if well implemented could lead to efficiencies and effective management of the programs. Most were involved in the implementation of the programs with senior management involved in multi-stakeholder engagement activities through workshops and joint regular planning sessions. Some supply chain programs were able to provide quarterly fact sheets on their performance over a period of time developed jointly with other agencies involved in the areas of concern. There was also indication of quality management systems in place with some supply chains being ISO 9001:2008 certified. Key personnel for each of the supply chain programs were easily identified and provided good feedback on the partnerships involved. Elements of management of change were also picked form the respondents with key personnel indicating that they have been responsive to changes that occur in their sectors and ability to adopt new innovations in their supply chains.

The study was able to determine that supply chain performance evaluation was a critical element in determining the success of the programs being carried out. Most programs had their own approaches in determining their supply chain’s performance and varied among themselves. Generally, most programs involved various stakeholders in obtaining feedback on their performance and were able to act on information obtained in meetings, workshops and communications received primarily from the Ministry of Health and its Agencies. Customers were key to the various healthcare programs with over 300,000 recipients as the key focus. Most programs had objectives established that guided their work activities and to support efficient delivery of healthcare services to most of the population served in the country and its various regions. Relationship management was a critical element in management of the partnerships involved beyond contractual

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obligations entered into. An elaborate procurement process was identified in most of the programs to ensure an efficient delivery system that enabled for cost effective delivery of quality affordable healthcare commodities to end users in the country. Innovativeness in the supply chains was crucial to most of the supply chains with most respondents elaborating the changes or modifications that have been put in place over the lifetime of the supply chain programs.

The research showed that most of the respondents were qualified with degrees and professional certifications in healthcare supply chain management. In addition, most of the respondents had over 5 years of experience in the healthcare industry. This indicates that the program’s key personnel had good experience in the industry and could confidently respond to the administered questionnaires.

5.3 Discussion

This section of the research report focuses on discussions of the key findings of the study based on the specific objectives and in line with the literature reviewed on supply chain performance management.

5.3.1 Supply Chain Integration

The observations made in the study from various respondents indicated that 95.8% programs were developed out of a need to partner with other organisations to develop an effective and efficient supply chain for their healthcare programs. Respondents felt that it was important for each of the partners involved needed to collaborate to ensure that objectives established for the programs were achieved. According to Christopher (2011), the first steps in achieving supply chain integration is through each company in the supply chain looking to their internal structures to see if they are aligned and integrated. This way, firms with their specialty areas can integrate their internal and external processes to achieve wider integration with other collaborating companies.

The study indicated that for 100% of the programs, partner organisations had good interactions between senior management prior to roll out of the programs and in the course of implementing the programs. Involvement of leadership in the management of the programs indicated their commitment to the business, set up and use of

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professionalism so as to ensure that efficiency was achieved. Strategic planning works well if it involves commitment of top management and quite often also that of middle and lower management so as come up with an integrative point of view (Raps, 2005). The various program managers and leadership of the programs had interactions on an ongoing basis to gauge performance of the programs and also to address major issues in the running of various activities involved.

94.4% of the respondents felt that there were good strategies that had been jointly developed in their programs. They were of the opinion that senior management was involved in developing shared vision, supply chain strategies and in benchmarking activities. Components in strategic supply chain integration include formation of strategic partnerships, management of inter- and intra-organisational processes in order to achieve efficiencies (Sillanpaa, 2010).

According to the findings 90.27% respondents agreed that various stakeholders were involved in information sharing to address supply chain issues for the various programs being implemented while 100% felt that there was good interactions between senior management of organisations. The effective use of relevant and timely information by all functional elements within the supply chain is a key competitive and disguising factor (Tompkins et al., 1999). Strategic supplier partnerships highlight a direct, long-term relationship and encourage reciprocal plan and difficulty or problems solving efforts (Gunasekaran 2001). Such strategic partnerships are entered into to support shared benefits among the parties and ongoing participation in one of more key strategic areas (Yoshino et al. 1995). An effective supplier partnership can be a critical component of a leading edge supply chain (Noble 1997).

The study revealed that 72.2% of the respondents were at manager level with degrees and could comfortably respond to the administered questionnaires based on their understanding. The findings showed that the respondents had had experience interacting with other players and professionals in the industry. According to Cousins (2002), a factor in achieving supply chain integration is the concept of shared capabilities and competencies. The result of this study showed that most programs were run by qualified

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and experienced personnel and this is a key contributor to the effective management and operation of the various programs.

5.3.2 Supply Chain Performance Evaluation Approaches

86.1% respondents were of the opinion that measurement of performance of organisations involved in a supply chain could help better manage the supply chain process. The performance metrics have three basic functions: control, communication and improvement. Control means that the metrics enable managers and workers to evaluate and control the performance of the resources. The performance is communicated for internal needs and external stakeholders’ purposes by the metrics. Improvement means the possibility to identify the gaps between performance and expectations and to indentify the areas where the development work is needed (Melnyk et al. 2004).

80.5% of the respondents between partners strongly felt that customer relationship management was key in making decisions relating to forecasting demand and sourcing activities for their supply chains. Customer relationship management is a key element of supply chain practices (Noble, 1997). Strong relationships with supply chain members, including customers, are needed for successful implementation of supply chain management programs (Moberg et al. 2002). Close customer relationship allows an organisation to differentiate its product from competitors, sustain customer loyalty and dramatically extend the value it provides to its customer (Magretta 1998).

83.3% of the respondents strongly agreed that stakeholder’s perspectives had been considered in their supply chain. They responded that due to the nature of healthcare and policies involved, a lot of stakeholder engagement was involved in the industry. The performance prism approach provided a balanced picture of the business, significantly highlighting external and internal measures, as well as enabling financial and non- financial measures and measures of efficiency and effectiveness (Neely et al., 2005). Well defined internal business objectives had been developed according to 76.4% of respondents. Many of the program implementers and project managers were relatively satisfied with measures that had been put in place to improve the operation of their supply chains. Brewer et. al (2000) argue that the internal business perspective has to do with

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those activities and processes that create the highest levels of customer satisfaction. This was achieved through monitoring, evaluating and improving quality, efficiency and other business processes through a focus on operations, collaborations and innovation to meet the supply chain’s healthcare expectations. 23.6% of those who were not directly involved were not aware of developments in this area.

87.5% of the respondents felt that through innovation and learning the ability of the supply chain to create, maintain and improve partnerships was critical because partnerships enabled the supply chain to take advantage of the capabilities, skills, knowledge and resources of various entities to deliver excellent customer service. Brewer et. al (2000) argue that innovation and learning in supply chain performance evaluation impact on the ability of all entities in the supply chain and also those processes that ensure that the supply chain as a whole maintains a competitive advantage.

On elaboration of the interrelationships and combination of the balanced scorecard perspectives, 86.1% of the respondents agreed that the customer, business processes and innovativeness in the supply chain could help improve decision making processes among the supply chain participants. According to Kaplan and Norton (1992), the balanced score card aims to make the contribution and the transformation of soft factors and intangible assets into long-term financial success explicit and thus controllable.

5.3.3 Supply Chain Performance Indicators

77.7% of respondents were strongly of the opinion that their supply chain partners provided excellent information provision to customers relating to the supply chain. This is important in carrying out supply chain activities in the form of availability of proper information in order that proper decisions could be made by each of the entities involved. Quality of information sharing includes such aspects as the accuracy, timelines, adequacy, and credibility of information exchanged (Moberg et al., 2002). While information sharing is vital, the major of its impact on supply chain management depends on what information is shared, when and how it is shared and with whom (Holmberg, 2000).

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90.2% of the project implementers and program managers were satisfied with the technical support and problem solving approaches for their customers. Supply chain partnership is a collaborative relationship between a buyer and seller which recognizes some degree of interdependence and cooperation on a specific project emphasizing direct, long term association and problem solving efforts (Lambert et. al, 2004). Technical queries related to patient drug interaction, technical data relating to treatment regimes, patient prescriptions among others that were addressed to specialized staff in the respective programs. Most respondents indicated that the queries were responded to in good time and records were available to countercheck this measure.

93% of the respondents were of the opinion that quality delivery documentation was provided by the supply chain partners. Accurate and reliable delivery documentation was important in the supply chain to enable proper reporting, tracking of customer concerns and ability to provide information for information generation and provision. Key information in the various documentation required related to stock levels, customer orders, and batch numbers among other data that was used to make decisions. By comparing these with the previously made agreement, it can be determined whether perfect delivery has taken place or not, and areas of discrepancy can be identified so that improvements can be made.

97.2% of the respondents were of the opinion that their supply chain deliveries were of acceptable levels of frequency of deliveries with short lead times in making the deliveries. The total order cycle time was measured by the time elapsed in between the receipt of customer order until the delivery of finished goods to the customer. The reduction in order cycle time leads to reduction in supply chain response time, and as such is an important performance measure and source of competitive advantage (Christopher, 1992). It directly interacts with customer service in determining competitiveness.

87.5% of the respondents were of the opinion that they had build up the capacities and skills of their staff over the period that they had been running their programs. Most shared that internal trainings, joint workshops and capacity building initiatives had been undertaken for most of the staff. Key supply chain agents require skills that enable them

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to influence, motivate and manage others and perform functions different from their normal duties. These skills were necessary to move people from existing positions towards change goals, generate confidence in changes being made and to monitor their performance over time.

5.3.4 Respondent Opinion on Supply Chain Relationship

100% of the respondents expressed their satisfaction with the services provided by their partners and would recommend them to others. The specialized functions and processes involved in each of the partners were well appreciated. Lee & Billington (1992) and van Hoek et al. (2001) emphasized that to assess supply chain performance, supply chain metrics must center on customer satisfaction. Customer relationship management is a key element of supply chain practices (Noble, 1997). Committed relationships are the majority sustainable advantage because of their inherent obstacles to. The growth of mass customization and personalized service is leading to an era in which relationship management with customers is becoming crucial for corporate survival. Strong relationships with supply chain members, including customers, are needed for successful implementation of supply chain management programs (Moberg et al. 2002).

In relation to customer relationships in the supply chains, customer satisfaction surveys had been conducted over the past years to evaluate the extent of customer satisfaction and areas of concern and improvement noted in the various programs. To a world class organisation, a happy and satisfied customer is of the utmost importance. In a modern supply chain customers can reside next door or across the globe, and in either case they must be well served. Without a contented customer, the supply chain strategy cannot be deemed effective. Customer should be satisfied with the product or service which are received. There are three elements of customer satisfaction such as pre-transaction satisfaction, transaction satisfaction and post transaction satisfaction (Christopher, 1994). 100% of the respondents appreciated the study conducted with them. There was positive feedback from the respondents and most were cooperative in providing information for the study. The respondents in the interviews were able to provide information on their supply chain partnership network and this helped gather further insights for the qualitative study based on their experiences with the organisations they worked with. The respondents were of the opinion that the research was relevant to their work area due to

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the integration approach of the partnership structure covered in the supply chain where various organisations are involved and with clear mandates set out in carrying out their operations. This helped them assess their contribution to the supply chain and offered primary source of data. Secondary data was also gathered in the study based on feedback from the respondents as they could relate to their other partners and provide feedback relating to the other’s performance in the partnership. Internal and external customer is an important role in the performance of supply chain.

5.4 Conclusion

The study conducted provided substantial information on integrated supply chain management, performance evaluation approaches and key performance indices important for the evaluation of performance of the supply chains. Based on the findings made, the following conclusions are made from the discussion on the objectives of the study.

5.4.1 Integration of Supply chain Management

The research conducted found that there were elements of supply chain integration for most of the supply chains. Elements relating to flow of goods, information and funds in the supply chain were well coordinated according to most of the respondents. This had helped them meet their customer’s or client’s needs as goods moved along the overall value chain. Internal and external integration was exhibited as various supply chain members performed specific processes, had close linkages, managed products and passed on information as processes moved across organisational and enterprise boundaries. The respondents were of the view that operational and strategic aspects in managing the supply chains had been implemented progressively with various outcomes achieved. Supply chain opportunities had been evaluated and guiding vision and strategy developed by the leadership involved in the programs. Well developed communication channels and organisational alignment had been put in place to help translate strategies into action. Adopting an all compassing specific performance measurement approach of donor funded healthcare supply chain is very complex due to specific characteristics of the chain.