Integration issues in the healthcare supply chain

The efficacy, quality, responsiveness, and value of healthcare services provided is increasingly attracting the attention and the questioning of governments, payers, patients, and healthcare providers. Investments on integration technologies and integration of supply chain processes, has been considered as a way towards removing inefficiencies in the sector. This chapter aims to initially provide an in depth analysis of the healthcare supply chain and to present core entities, processes, and flows. Moreover, the chapter explores the concept of integration in the context of the healthcare sector, and indentifies the integration drivers, as well as challenges.

Evaluation of integration technology approaches in the healthcare supply chain

Healthcare organisations are increasingly being challenged to look at their operations and find opportunities to improve the quality, efficiency and effectiveness of their supply chain services. In light of this situation, there is an apparent need for healthcare organisations to invest in integration technologies and to achieve the integration of supply chain processes, in order to break up the historical structure characterised by numerous interfaces and the segregation of responsibilities. The aim of this paper is to take an independent look at the healthcare supply chain and identify at different levels the core entities, processes, information flows, and system integration challenges which impede supply chain quality improvements to be realised. Moreover, this paper proposes, from an information systems perspective, a framework for the evaluation of different integration technology approaches, which can be used as a potential guideline tool for assessing integration technology alternatives, in order to add value to a healthcare-supply-chain management system. Copyright © 2007 Inderscience Enterprises Ltd.

Resource-efficient supply chains:a research framework, literature review and research agenda

Purpose: To define a research agenda for creating Resource-Efficient Supply Chains (RESC) by identifying and analysing their key characteristics as well as future research opportunities. Design/methodology/approach: We follow a systematic review method to analyse the literature and to understand RESC taking a substantive theory approach. Our approach is grounded in a specific domain, the agri-food sector, because it is an intensive user of an extensive range of resources. Findings: The review shows that literature has looked at the use of resources primarily from the environmental impact perspective. It shows a lack of understanding of the specific RESC characteristics, and concludes more research is needed on multi-disciplinary methods for resource use and impact analyses as well as assessment methods for resource sensitivity and responsiveness. There is a need to explore whether or not, and how, logistics/supply chain decisions will affect the overall configuration of future food supply chains in an era of resource scarcity and depletion and what the trade-offs will be. Research limitations/implications: The paper proposes an agenda for future research in the area of resource–efficient supply chain. The framework proposed along with the key characteristics identified for RESC can be applied to other sectors. Practical implications: Our research should facilitate further understanding of the implications and trade-offs of supply chain decisions taken on the use of resources by supply chain managers. Originality/value: The paper explores the interaction between supply chains and natural resources and also defines the key characteristics of RESC.

Fully probabilistic control design in an adaptive critic framework

Optimal stochastic controller pushes the closed-loop behavior as close as possible to the desired one. The fully probabilistic design (FPD) uses probabilistic description of the desired closed loop and minimizes Kullback-Leibler divergence of the closed-loop description to the desired one. Practical exploitation of the fully probabilistic design control theory continues to be hindered by the computational complexities involved in numerically solving the associated stochastic dynamic programming problem. In particular very hard multivariate integration and an approximate interpolation of the involved multivariate functions. This paper proposes a new fully probabilistic contro algorithm that uses the adaptive critic methods to circumvent the need for explicitly evaluating the optimal value function, thereby dramatically reducing computational requirements. This is a main contribution of this short paper.

Logics of marginalisation in health and social care reform:integration, choice, and provider-blind provision

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.

Low gravity rotational culture and the integration of immunomodulatory stem cells reduce human islet allo-reactivity

Modification of human islets prior to transplantation may improve long-term clinical outcome in terms of diabetes management, by supporting graft function and reducing the potential for allo-rejection. Intragraft incorporation of stem cells secreting beta (β)-cell trophic and immunomodulatory factors represents a credible approach, but requires suitable culture methods to facilitate islet alteration without compromising integrity. This study employed a three-dimensional rotational cell culture system (RCCS) to achieve modification, preserve function, and ultimately influence immune cell responsiveness to human islets. Islets underwent intentional dispersal and rotational culture-assisted aggregation with amniotic epithelial cells (AEC) exhibiting intrinsic immunomodulatory potential. Reassembled islet constructs were assessed for functional integrity, and their ability to induce an allo-response in discrete T-cell subsets determined using mixed islet:lymphocyte reaction assays. RCCS supported the formation of islet:AEC aggregates with improved insulin secretory capacity compared to unmodified islets. Further, the allo-response of peripheral blood mononuclear cell (PBMC) and purified CD4+ and CD8+ T-cell subsets to AEC-bearing grafts was significantly (p < 0.05) attenuated. Rotational culture enables pre-transplant islet modification involving their integration with immunomodulatory stem cells capable of subduing the allo-reactivity of T cells relevant to islet rejection. The approach may play a role in achieving acute and long-term graft survival in islet transplantation.

The Front National:from systematic opposition to systemic integration?

For most of its existence, the Front National (FN) fitted the classic definition of the anti-system party, opposing the founding values, institutions and elites of the Fifth Republic. Now, under Marine Le Pen's leadership, it has embarked on a strategy to integrate to the regime it once defied. Does this strategy of normalisation bear scrutiny? Using a framework drawn from Giovanni Sartori and Robert Michels, this article asks whether the FN is a one-time anti-system party that is becoming mainstream, and also whether these simple oppositional categories are adequate for understanding ideological and policy evolution in the FN's case. Through an analysis of continuity and change in FN strategy and programmes, the article shows a party torn between anti-system differentiation and institutional adaptation. It may claim to have cast out its demons but has not undertaken the necessary moderation of its programme to substantiate that claim. The FN today is on no linear path of deradicalisation but exhibits a combination of consistent, diminished and increasing radicalism across different policy areas. Despite an upward dynamic and a hugely favourable context, it remains almost entirely excluded from power and far from the breakthrough required to become a party of government.

Degree of vertical integration and its buffering effects on political uncertainty

The focus of this study is on the governance decisions in a concurrent channels context, in the case of uncertainty. The study examines how a firm chooses to deploy its sales force in times of uncertainty, and the subsequent performance outcome of those deployment choices. The theoretical framework is based on multiple theories of governance, including transaction cost analysis (TCA), agency theory, and institutional economics. Three uncertainty variables are investigated in this study. The first two are demand and competitive uncertainty which are considered to be industry-level market uncertainty forms. The third uncertainty, political uncertainty, is chosen as it is an important dimension of institutional environments, capturing non-economic circumstances such as regulations and political systemic issues. The study employs longitudinal secondary data from a Thai hotel chain, comprising monthly observations from January 2007 – December 2012. This hotel chain has its operations in 4 countries, Thailand, the Philippines, United Arab Emirates – Dubai, and Egypt, all of which experienced substantial demand, competitive, and political uncertainty during the study period. This makes them ideal contexts for this study. Two econometric models, both deploying Newey-West estimations, are employed to test 13 hypotheses. The first model considers the relationship between uncertainty and governance. The second model is a version of Newey-West, using an Instrumental Variables (IV) estimator and a Two-Stage Least Squares model (2SLS), to test the direct effect of uncertainty on performance and the moderating effect of governance on the relationship between uncertainty and performance. The observed relationship between uncertainty and governance observed follows a core prediction of TCA; that vertical integration is the preferred choice of governance when uncertainty rises. As for the subsequent performance outcomes, the results corroborate that uncertainty has a negative effect on performance. Importantly, the findings show that becoming more vertically integrated cannot help moderate the effect of demand and competitive uncertainty, but can significantly moderate the effect of political uncertainty. These findings have significant theoretical and practical implications, and extend our knowledge of the impact on uncertainty significantly, as well as bringing an institutional perspective to TCA. Further, they offer managers novel insight into the nature of different types of uncertainty, their impact on performance, and how channel decisions can mitigate these impacts.

Growth, uniformity, local responsiveness, and system-wide adaptation in multiunit franchising

Using the resource-based view framework, we investigate the link between multiunit franchising (MUF) and performance on four key challenges in franchise chain management: growth, uniformity, local responsiveness, and system-wide adaptation. Our findings support the assertion that system growth is positively related to MUF rate within a system, in particular in relation to geographic expansion. Interestingly, while uniformity does not seem to be related to MUF rate, we find marginal support for an inverted u-shaped relationship between system-wide adaptation and MUF rate. Furthermore, the data suggest that local responsiveness and MUF rate are related in a u-shaped function.

Effects of truck traffic on top-down fatigue cracking performance of flexible pavements using a new mechanics-based analysis framework

The mechanics-based analysis framework predicts top-down fatigue cracking initiation time in asphalt concrete pavements by utilising fracture mechanics and mixture morphology-based property. To reduce the level of complexity involved, traffic data were characterised and incorporated into the framework using the equivalent single axle load (ESAL) approach. There is a concern that this kind of simplistic traffic characterisation might result in erroneous performance predictions and pavement structural designs. This paper integrates axle load spectra and other traffic characterisation parameters into the mechanics-based analysis framework and studies the impact these traffic characterisation parameters have on predicted fatigue cracking performance. The traffic characterisation inputs studied are traffic growth rate, axle load spectra, lateral wheel wander and volume adjustment factors. For this purpose, a traffic integration approach which incorporates Monte Carlo simulation and representative traffic characterisation inputs was developed. The significance of these traffic characterisation parameters was established by evaluating a number of field pavement sections. It is evident from the results that all the traffic characterisation parameters except truck wheel wander have been observed to have significant influence on predicted top-down fatigue cracking performance.