Supply chains have become typical of the healthcare industry over the globe, including such countries as Australia and Turkey. The recent research literature on supply chains covers such topics as the purpose of supply chain management in organisations, the development of sustainable supply chains, the implementation of integrated supply chains, and the choice of green supply chains. Relevant scholarly sources on these topics have been reviewed in order to discover certain tendencies and debates in this field of knowledge that relates to supply chain management and consequently how they integrate ISO 14001-2015 and ISO 9001-2015. The available research on supply chain in healthcare facilities, the application of ISO standards and green supply chains in particular, have also been reviewed for this current study. The results of the review of the existing literature on supply chains and ISO 14001-2015, ISO 9001- 2015 with the focus on the context of the healthcare industry are provided in this chapter.
Supply Chain Management
As it is stated in the literature on managerial processes and operations, supply chain management is a specific field of knowledge that is related to principles and norms of coordinating the work of supply chains to make them highly controlled and effective. There are a plethora of sources and research articles on the topic of developing supply chain management in different types of organisations because this area of knowledge has become actively applied to practice during recent years (Chakraborty & Dobrzykowski 2014; Maleki & Cruz-Machado 2013; Nassirnia & Robinson 2013). Therefore, it is important to review the existing literature on supply chain management in general and in the context of the healthcare industry in order to understand the specifics of covering these aspects in scholarly works.
Sustainable Supply Chains
In recent years, supply chains have become discussed in the context of the idea of sustainability. Today, researchers and practitioners are inclined to view supply chains through the prism of the effect of their activities on the environment because the rapid growth of businesses and operations in different spheres potentially leads to increasing the amount of waste and costs. In their study devoted to formulating an effective theoretical model for creating supply chains, Liu et al. (2017) proposed a certain framework for sustainable chains with reference to the idea that these networks or systems should be balanced in terms of the flows of resources, costs, and information within them. Moreover, their influence on the environment, including natural and social settings, should also be balanced and positive. The idea of sustainable development became popular in the 1980s, and it influenced the vision of modern supply chains significantly (Liu et al. 2017; Silvestre 2016). However, the concept of sustainable supply chain management was formulated in detail only in the 2000s.
Integrated Supply Chains
The widespread development of integrated supply chains can be viewed as a modern tendency in supply chain management. While there were companies in the past that made efforts to control the entirety of their supply chains, they were considerably less numerous than they are now. Many organisations have become oriented to transforming their fragmented or separate supply chains into integrated ones in order to achieve a certain level of efficiency in operations and processes (Nassirnia & Robinson 2013). As a result, the concept of supply chain integration has recently developed further, and much attention should be paid to discussing specifics of integrated supply chains with reference to the existing literature on this issue.
The purpose of integrated supply chain management is to achieve control over most or all of its elements. In doing so, the company is able to modify its supply chain and refine to maximise efficiency (Maleki & Cruz-Machado 2013). In particular, one of the advantages of integrated supply chain management is better communication between its different elements, which now work toward a unified goal. This information sharing can also lead to the discovery and development of new synergies between different elements of the chain, reducing waste and improving efficiency. Additionally, the profit motive present in independent suppliers disappears, which can lead to lower costs for manufacturing and transporting supplies. While there are also challenges associated with adopting integration and adjusting systems across the supply chain to achieve the benefits, the advantages have popularised the concept.
Green Supply Chains
As it is stated in many studies on the topic, green supply chain management is oriented towards redesigning supply chain management into an effective system for the purpose of minimising a negative impact of organisations’ activities on the environment. Thus, as it is noted and explained in the review article by Toke, Gupta, and Dandekar (2010, p. 1), green supply chain management “refers to the way in which innovations in supply chain management and industrial purchasing may be considered in the context of the environment.” All the issues associated with implementing green supply chains are widely discussed in the scholarly literature today, and more attention should be paid to identifying tendencies in analysing these questions.
The conference Green Supply Chain 2018 that was conducted in Thessaloniki, Greece, on July 2-4, 2018, attracted researchers from all over the globe to discuss these particular issues. The key topics that were covered by experts included the following ones: supply chains and sustainability, the design of supply chains, collaboration within chains, performance measurement, practices of supply chain management, energy and water consumption, eco-design, and many others (Conference topics 2018). These topics are actively analysed and discussed by experts in order to reflect practitioners’ interest in these spheres. From this point of view, to address changes in managerial perspectives regarding supply chain management, it is important to focus on the recently published literature on the topic of green supply chains that have become actively explored by researchers.
ISO-14001-2015 and ISO-9001-2015
The ISO-14001-2015 is the latest revision of the family of standards created by the International Organization for Standardization (ISO). Per the International Organisation for Standardisation (2015), it specifies the requirements which an organisation has to satisfy to enhance its environmental performance comprehensively and without omitting critical details. It is designed to be applicable to any organization and scalable regardless of the size. Similarly, the ISO-9001-2015 standard is the current revision of the requirements for an adequate quality management system at an organization. International Organisation for Standardisation (no date) claims that it is the only constituent of the 9000 standard family to which a company can be certified, from which over 1 million organisations worldwide benefit. It is also applicable to any organisation, though it should be noted that this quality also means that it necessarily avoids specifics, favouring broad and generic statements wherever possible.
The concept of supply chains has expanded substantially in recent decades, incorporating new ideas as their validity was established and responding to changing customer perceptions. Integration and sustainability, in particular, have been substantial examples of tendencies that have become popular because they have the potential to improve busines productivity. Green supply chains are an expansion of the second concept that aims to promote the long-term well-being of the company as well as the environment. Its rising popularity is associated with increasing popular concern regarding climate change and the effects of pollution, which it aims to minimise. With that said, as the ISO 9001 and ISO 14001 indicate, these concepts have also been applied to healthcare and warrant an investigation.
The purpose of this chapter is to present the research methodology selected for examining the set research questions. The research methods and design have been selected for this thesis with reference to their ability to effectively test the main research questions, as well as proposed sub-questions. This chapter is organised into several sections to provide the description of the appropriate research paradigm, approach, design, methods, instruments, sampling, and data analysis techniques chosen for this study. The validation of the selected research methodology and all details regarding the data collection and analysis are presented in this chapter with the focus on ethical questions pertaining to this research.
Depending on the type of research questions formulated for this study and the researcher’s expectations and assumptions, it is possible to state that pragmatism is a paradigm that is more appropriate for the study. A pragmatist paradigm combines the features of both positivism and interpretivism that allows for using this paradigm when conducting mixed methods studies that include quantitative and qualitative methods (Creswell & Poth 2017). The key quality of a pragmatist philosophy is that its proponents are oriented towards finding direct solutions to practical issues and problems in the world around without focusing on the nature of knowledge or truth, as it is typical of other paradigms (Bryman & Bell 2015; Creswell & Poth 2017). Thus, applying a pragmatist perspective, a researcher is interested in examining practical aspects and consequences of certain studied processes and phenomena.
In this study, the main focus is on identifying and analysing the major practical aspects, as well as benefits and risks, of greening supply chains in the healthcare sector with reference to two different national contexts. As such, pragmatism is more suitable to the purpose than any of ontology, epistemology, realism, or either of positivism and interpretivism alone. Referring to pragmatism, the researcher gets an opportunity to concentrate on collecting both numeric and narrative data for further analysis (Domínguez & Hollstein 2014; Neuman 2014). These advantages of pragmatism allow for selecting this paradigm as suitable for this study.
In this study, the focus on the pragmatist paradigm explains the choice of the approach that can combine the features of both deductive and inductive reasoning. This type of applying both principles to examining the phenomenon is known as abductive reasoning, and it is selected as the key approach for this study (Edmonds & Kennedy 2017). According to Bryman and Bell (2015, p. 27), “Abduction involves the researcher selecting the ‘best’ explanation from competing explanations or interpretations of the data,” and “this is related to the philosophical idea of the ‘hermeneutic circle,’ through which understanding is seen as a continuous dialogue between the data and the researcher’s preunderstandings.” The nature of the formulated research questions and the aim of the research explain the necessity of using the assumptions typical of inductive and deductive approaches in order to use different methods for examining the issue under discussion.
As a result, while referring to the idea of intersubjectivity typical for the combination of inductive and deductive approaches, it is possible to state that abductive reasoning allows for testing certain assumptions from both theoretical and empirical perspectives (Bryman & Bell 2015). Applying the combination of deductive and inductive approaches in the form of abductive reasoning, the researcher in this study receives an opportunity to examine the problem from different sides, without selecting this or that approach. Moreover, the researcher overcomes the limitations associated with using the other discussed approaches.
In order to address the research questions and purpose of this study, it is necessary to apply the research design, according to which it is possible to answer questions requiring the analysis of both qualitative and quantitative data. Therefore, the application of both descriptive and exploratory research designs is reasonable for this study (Edmonds & Kennedy 2017). The causal design is less relevant, as no experiments will be conducted in the course of this study. The principles of the descriptive design are important to be implemented in order to work with quantitative data to explain factual benefits and weaknesses of selecting and integrating green supply chains in hospitals of Australia and Turkey. The principles of the exploratory research design should be used to collect and evaluate qualitative data in order to examine the problem from the perspective of participants involved in implementing green supply chains in the healthcare sector (Domínguez & Hollstein 2014). Thus, the rules typical of a convergent parallel design need to be applied to this study (Creswell 2014; Creswell & Poth 2017). In this case, the collection and analysis of quantitative and qualitative data are realised not sequentially but independently.
For this study, mixed methods research is selected as the most appropriate option to address the set research questions. The reason is that the mixed methods methodology provides a researcher with a variety of approaches and techniques to choose from in order to conduct the high-quality research that will not be limited by the approaches typical of only qualitative or only quantitative methods (Domínguez & Hollstein 2014; Edmonds & Kennedy 2017). This study is aimed at determining possible benefits and risks associated with implementing green supply chains in hospitals of Australia and Turkey with the focus on possible similarities and differences in these countries’ experiences. The complex character of this purpose supports the idea that only the combination of qualitative and quantitative methods can help a researcher to collect appropriate data for analysis to conclude regarding the experience of the Australian and Turkish healthcare systems in greening supply chains.
The provided research questions can be effectively answered only with reference to collecting both quantitative and qualitative data for further analysis. The financial data explaining the establishment of green supply chains in hospitals can be successfully analysed with reference to the principles of descriptive research and the quantitative method (Jason & Glenwick 2016; Pelto 2015). On the contrary, ideas and views of managers implementing green supply management principles, administrators in hospitals, and the personnel should also be taken into account, and the qualitative methodology allows for collecting this information (Merriam & Tisdell 2016; Pelto 2015). Views regarding possible advantages or challenges associated with greening supply chains in healthcare systems of two different countries can be collected with the help of interviews. As a result, focusing on the mixed methods methodology, the researcher receives more opportunities to examine the situation with greening supply chains in Australia and Turkey from objective and subjective perspectives to make accurate and relevant conclusions.
The Selected Case and Setting in Australia
For the purpose of this research, the Royal Melbourne Hospital located in Parkville, Victoria, was selected as an Australian public hospital to be included in this study. This hospital is one of the largest public healthcare facilities not only in Melbourne, Victoria, but also around Australia. This hospital was established in 1848, and today it belongs to the Melbourne Health group (The Royal Melbourne Hospital 2018). The Royal Melbourne Hospital has the reputation of a healthcare facility, the leaders of which are oriented towards adopting the latest technologies and applying the most innovative approaches to their practice. Furthermore, the hospital has developed an effective program oriented towards greening their operations and improving waste management and achieved certain successes in designing and integrating green supply chains. The examination of the experience of this hospital in implementing supply chain management is important in the context of this case study research.
The Selected Case and Setting in Turkey
Derindere Hospital (Hastane Derindere) is located in Kagithane province, Turkey, and it is one of the leading private hospitals in the country that has operated in the region since 2015. The hospital is famous for paying attention to clinical research and implementing innovative methods and practices to deliver care. Moreover, the hospital has received ISO 9001 and ISO 14001 certifications, and it has experience in improving its supply chain management and waste management to address global standards (Derindere Hospital 2020). This particular experience needs to be studied and explained in the context of this selective case study.
This section presents the information on the procedures used to receive the participants’ informed consent and protect their confidentiality and privacy. According to Hancock and Algozzine (2016, p. 47), “the researcher must adhere to legal and ethical requirements for all research involving people. Interviewees should not be deceived and must be protected from any form of mental, physical, or emotional injury.” Thus, the aspects of using an informed consent form are described in detail. Approaches to resolving the issue of confidentiality in this study are discussed in the second sub-section in order to guarantee that all ethical concerns are addressed without violating the interests of the participants involved in the study. The approval of the administration of the hospitals in Australia and Turkey was required for conducting this research to involve the employees as participants in this study. To recruit the participants, the researcher contacted the administrators at both organisations via email using formal letters to request and receive their approval for organising the study based on their data and involving employees as participants.
In order to protect participants’ privacy and guarantee their psychological comfort, it is important to focus on the concept of confidentiality and how it works in the context of this study. Those personal data that are used in this study for collecting qualitative information should be secured and presented in this study only as confidential answers to interview questions (Kumar 2014; Mertens 2014). The researcher ensures that all information that can be used for indicating participants is removed from records, and personal information is concealed. These procedures are required in order to avoid the situation of violating subjects’ confidentiality and disclosing their private information. The participants should be informed that their names and identities are de-identified, and confidentiality is protected in the context of the study.
In the context of this study, the researcher keeps the names of participants and other personal data confidential while preparing records of interview sessions and transcribing them. In order to distinguish between participants, ID numbers are assigned to subjects, and they are used for marking records and narratives. The researcher is the only person who knows the names and contacts of subjects invited to participate in the study that are reflected in informed consent forms. This information is kept secret and secured by the researcher, and the access to the data which can be used for identifying participants is restricted.
The participants’ agreement to join the study with the focus on its specific conditions and purpose is known as informed consent. Potential participants selected with the help of purposive sampling can be viewed as voluntarily deciding on being involved in the study, and informed consent forms reflect this decision (Bryman & Bell 2015). The selected respondents agreed to participate in interviews after receiving all the required information about the nature and purpose of this study by email and from the administrators cooperating with the researcher in the two hospitals. They reviewed and signed the prepared informed consent form before being invited to participate in interview sessions and answer questions. In order to guarantee that the informed consent form can be effectively used for protecting participants’ interests, some type of information should be added to this form.
Thus, the provided informed consent forms had the following details: the study’s purpose and type, the description of collecting the information with the help of interviews and associated procedures, and the information about options for withdrawing at any stage of research. Additional details include the information about protecting participants’ confidentiality and anonymity and the statement indicating the voluntary participation in the study (Creswell & Poth 2017). It is important to note that the researcher started to conduct interviews with the invited participants only after receiving the signed informed consent forms from all subjects. As a result of applying the informed consent form, it is possible to address ethical questions while conducting the study and guarantee the protection of participants’ interests.
Overall, the study aims to address questions of both the reasons for the adoption of green supply chain management practices and ISO 9001-2015 and ISO 14001-2015 compliance and their effectiveness. As such, a mixed design in terms of both the research paradigm and the research methodology appears to be the most appropriate. With that said, it is important to note the drawbacks of the design chosen, particularly in terms of the specifics. The sample size is relatively small at only one hospital for each nation, which can exclude critical context such as the situation on the national level. Moreover, the study is characterised by its high complexity with a number of mixed approaches, which introduces the potential for bias. As such, they will be taken into consideration and addressed in later sections.
Overall, green supply chain management is a somewhat novel concept in business, especially scholarly studies regarding it. Moreover, research into it and its adoption in hospitals have been limited, as limited consideration has been given to them in the specific context. With that said, the situation is now changing, as the cases of Derindere Hospital and the Royal Melbourne Hospital have demonstrated. The methodology reflects a lack of adoption and knowledge of best practice in the theory surrounding green hospital SCM. It aims to explore the approaches the two different facilities have taken to implementing the practice and the success they have had in doing so. To that end, it collects a mixture of quantitative and qualitative data, which it will analyze separately and use to answer the research questions. All of the necessary precautions have been observed, but the study still has limitations that will be discussed in the conclusion.
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