As for the gaps in the existing literature, the main issue is the lack of empirical studies that would show the benefits and downsides of applying the green SCM in the healthcare industry sector. For example, there are theoretical papers from 1982; however, to this day, there are few case studies or research papers that managers can use to learn about the implementation of green SCM (Asgari et al., 2016). Moreover, Agi et al. (2021) and Haiyun et al. (2021) also point to the problem of not having data or best practices that would guide the management towards the effective implementation of GSCM.
This research has allowed one to determine some of the benefits of greening in the long run. For example, green SCM is beneficial for waste management, which means that the hospital can reduce the amount of recyclable and non-recyclable trash. Additionally, the green wing allows saving energy resources, which is also beneficial for the financial management of the facility.
UN-SDG goal addressed by this research is number 11, “sustainable cities and communities” (UN, no date). As hospitals, whether public or private, are essential institutions for communities, ensuring that their operations are efficient and do not harm the environment becomes essential. COPD30 strives to affect global climate change, and goal four of this initiative is the following: “accelerate action to tackle the climate crisis through collaboration between governments, businesses and civil society” (‘COPD30′, para. 4). Hospitals are a part of civil society, and the management of these facilities has to align with the goals for minimizing the impact of climate change. Therefore, the motivation for this research is the need to gather and analyze empirical data that hospitals’ management can use to effectively implement the GSC management practices.
The following paragraphs will provide the context for this research and the issue of sustainable hospital management and greening of SCM. On the one hand, sustainability and green practices within the SCM systems promise an enhanced way of managing the suppliers, the one that does not harm the environment while providing the necessary supplies on time and in required qualities. On the other hand, there is a risk of making the SCM system costly and ineffective when focusing on the greening of supply chains and omitting the business aspect of operations, which is important for hospitals, both private and public.
The current practices of supply chain management of the hospitals imply the use of supply chains that allow the hospitals to save money while receiving the products and services they need to operate (Fahimnia et al., 2018). Little attention is given to the issue of sustainability and the use of green practices in general, despite the fact that the notion of GSCM has existed for over thirty years (Fahimnia et al., 2018). Moreover, the main reference for GSM currently is the ISO standard since few research papers or case studies exist that would explain the best practices of GSCM. Hence, many healthcare facilities have already begun to transform their SC to comply with the ISO 9001-2015 standard, but the lack of research and empirical data makes it challenging to do this effectively.
Another issue is the balance between creating an effective supply chain, which is the one that allows receiving the resources that the hospitals’ employees require to provide the healthcare service with the green practices. For example, Fahimnia et al. (2018, p. 129) note that “both greening and buttressing can be costly, green supply chains are most sensitive to disruption, robust supply chains have strong long term benefits, and buttressing a green supply chain is a good investment.” Hence, despite the positive effect on the environment, GSC management remains expensive and not as effective as the traditional SCM practices. Moreover, greening practices are “requiring suppliers to be green and requiring additional greening investments may result in having fewer suppliers, influencing overall SC robustness,” which means that green supply chains are not equally effective for all industries (Farhime et al., 2018, p. 129). Therefore, this research helps determine whether GSCM is an adequate practice for private and public healthcare institutions.
Institutions and business organizations are facing pressure from the stakeholders to implement sustainable and green practices into their operations. Fahima et al. (2018, p. 129) state that “new environmental regulatory mandates and tighter sustainability reporting regulations” are the evidence that organizations have to adopt green practices into their operations. In addition, the COPD30 and UN-SDG initiatives draw the public’s and government’s attention towards the enhancement of the SCM and the need to focus on sustainability and the reduction of the environmental impact of human activities, which includes hospitals as well. Thus, this research helps managers explore the effective ways of managing the green SC and have a balance of robustness and environmental sustainability.
Thus, these two government and private hospitals require an in-depth study because their management has already begun the process of implementing GSM, and their examples, including the positive and negative effects of greening, can help avoid the potential mistakes for other healthcare facilities. Ther experience in managing green SC can help other healthcare institutions implement the same practice considering the experience, mistakes, and best practices described in this paper.
GSCM and Literature Review
To structure this study and the interpretation of the results, the authors have used a research framework. This research has used a Technology Organization Environment framework, which is an approach that allows reviewing a technology-linked phenomenon from an organizational perspective (Chiu et al., 2017). Under TOE, there are three primary factors that determine whether an organization will accept a technology-based change or not, which are: usefulness, internal issues, and business environment (Chiu et al., 2017). This means that for the successful adoption of GSCM frameworks, the organizations have to have a suitable company culture and no internal managerial issues, as well as an established service provision strategy. Additionally, the change in question has to provide an evident benefit for the business, which in part means that the effect on the company’s bottom line has to be positive. Finally, the competitors, business partners, and suppliers have to be prepared to support the change. In the healthcare environment, TOE means that the hospital’s management has to be prepared to implement the changes that are needed to support GSCM and sustainability, for example, address waste management issues or energy consumption problems. Additionally, the suppliers that cooperate with these hospitals have to have the capability to produce the items and materials that align with the sustainability requirements. The TOE framework allows one to look at the GSM from a structured perspective, analyzing the varied factors that impact the success of implementing GSCM.
The more recent studies on GSCM and the implementation of green practices in hospital management produce mixed results. For example, Fahimnia et al. (2018) conclude that hospitals under their investigation experienced negative trade-offs when implementing GSCM since this approach was more costly when compared to the traditional or robust SCM. The authors note that there are industries where GSCM is especially effective, for example, for fresh food companies, GSCM means that the product is delivered in limited quantities and within specific time frames, which helps limit the amount of waste, preserve the environment, and save costs for the businesses. For hospitals, however, there is a need to invest in GSCM and sustainable practices, which does not produce results as effective as for other industries.
The question of balance between sustainable SCM practices, costs, and retention of the SC’s robustness remains an important topic in the literature. Fasan et al. (2021) argue that the main benefit of the traditional supply chains is their robustness, which is the ability of the SC to withstand a disaster, which is not the case with sustainable SC. Haiyun et al. (2021) analyze the efficiency of GSCM strategies using the QFD (quality function deployment) framework and conclude that understanding the customer’s expectations and having a proper customer relationship management system in place is the most important element for managing GSCs. By assessing the expectations of the consumers, the organizations can find a better balance between sustainable practices and the profits they want to retain from their operations. For hospitals, this might mean assessing the needs and expectations of the community members and policymakers to balance the profits with sustainability. Moreover, Haiyun et al. (2021) found that having a research and development department is helpful for organizations that aim to implement green practices since innovation is linked with sustainability, and these departments can help transform the operations of the business in general. Finally, Hayun et al. (2021) report that having an assessment of stakeholders’ opinions from different parties is an effective way to determine the strategies that the management should implement for sustainability. Thus, some studies link sustainability and implementation of GSC and the effectiveness of these strategies with the expectations of the stakeholders.
As was mentioned in the introduction, the notion of GSC management has existed for over thirty years; however, this approach has not gained sufficient attention from researchers and practitioners until recently. Agi et al. (2020) report that only within the past three years has there been an increase in the number of publications regarding GSCM, while before, the number of published articles was limited. However, the authors also note the majority of these papers are statistical models and two-level SCM structures (Agi et al., 2020). This suggests that little attention is given to the practice of implementing SCM strategies, which means that managers have limited access to the information and case study materials that would show them the best practices of GSCM. Agi et al. (2021) suggest that researchers focus on developing stochastic models and complex level GSCM to aid the practical implementation of this approach. Hence, this research paper contributes to the body of knowledge on GSCM in healthcare and addresses a critical gap in the literature, which is the lack of case studies and empirical data that would explore the experience of hospitals that have implemented GSCM strategies.
GSCM can be divided into internal supply chain management practices and external strategies. Stekelorum et al. (2021) argue that contemporary organizations have to embrace both strategies as the stakeholders require changes both in the way a company or institution operates and in how they procure the resources required for operations. Green supply is an external practice that many profit-oriented organizations have already adopted, which prompted the suppliers to change their operations and resort to environmentally friendly practices (Stekelorum et al., 2021). This suggests that currently, it is easier for companies to implement green practices as the infrastructure has evolved to support this approach and many suppliers understand the demand and the need to use sustainable production approaches. However, similarly to other studies explored in this review, Stekelorum et al. (2021) point to the mixed results of the financial performance that these firms show, as in many cases, GSCM leads to a decrease of costs, but only in specific industries. The main issue with GSCM is the high cost of the initial implementation, meaning that firms have to invest substantial financial resources into the initial implementation of GSCM. In many cases, the investment is justified as this practice reduces inventory investment and asset recovery, but the timeframe required for these benefits is also longer when compared to traditional SC. Again, this study points to a need to investigate GSCM further to develop a best practice approach suitable for organizations in terms of business benefits and stakeholders’ expectations.
Another important aspect of GSM is its potential positive impact during crisis or disaster times. An important feature of the traditional SCs is their robustness or their ability to withstand a natural or human-made disaster while retaining the same outputs, which is linked to the well-developed network of these types of supply chains. Fasan et al. (2021) report that US companies that used GSCM networks were able to withstand the negative effects of the COVID-19 pandemic better when compared to those using the traditional SCs. This suggests that GSCM has the potential of being more crisis resilient, which is especially important for the healthcare industry.
Thus, the literature has been critically analyzed to explore the gaps that exist in understanding the GSCM practices and their application in services. The TOE framework provides three critical elements that determine the success of implementing a technology-based innovation into the operations. However, TOE has not been used to explore the specifics of sustainability and GSCM in particular. Moreover, little research exists that addresses TOE and the application of GSCM in the healthcare industry, while the stakeholders, such as policymakers, consumers, and international organizations, pressure healthcare institutions to use sustainable practices.
Objectives and RQs
This study used a TOE framework to address the main issues with the implementation of GSCM from the organizational perspective. The objective of this research is to address the literature gap on GSCM practices in healthcare, which is the lack of studies that would explore the practice of implementing the GSCM standards aligning with ISO 14001 and 9001 in the healthcare system. The current literature either explores the theory of GSCM or focuses on statistical data. Moreover, only a few studies explore GSCM within the healthcare system, and no study was found that compares the application of GSCM to public and private institutions. Therefore, by analyzing the application of GSCM practices in Australia and Turkey, the researcher aims to create a case study that healthcare institutions’ managers can use to implement GSCM in their facilities effectively.
Moreover, the analysis of the literature shows that the input of stakeholders is essential for the proper implementation of GSCM. The stakeholders, such as the hospital’s patients, community members, policymakers, and international organizations, are the ones pressuring these healthcare facilities to implement greener practices into their operations. Hence, this case study will serve as a reference point for managers who want to understand the needs of their stakeholders when implementing GSCM.
Hence, the research question for this case study analysis is the exploration of the expectations and the effects of implementing GSCM practices on hospitals. The case study is written using data collected from two hospitals, one private and one public, to showcase the management differences of the two approaches.
Research question: what are the effective strategies for implementing a GSCM management strategy that hospital managers can use, and what potential limitations of GSCM will they face?
Some of the themes that arise in this section are a result of the researcher’s own analysis of data rather than directly from the case study. The coding process was used to find the correlation between the practices and management approaches of the two hospitals.
Cross-section analysis of the two hospitals shows that the two institutions manage their supply chains in a very similar manner. The quantitative analysis has shown a decrease in profit margins between the years 2018 and 2019 for both hospitals, which suggests that the implementation of GSCM has had a negative effect on the financial performance of these institutions. The qualitative findings suggest that the support of the policymakers is important during the implementation of the GSCM, which was the main highlight of the interviews with the three employees of the Australian hospital and with the interviewees from Turkey. However, it appears that the Australian government has put pressure on the hospital’s management to reduce the levels of CO2 emissions and implement recycling procedures, which is also consistent with the findings from the literature. The Turkish hospital’s management does not appear to face the same pressure from the policymakers, which may be linked to the ownership type of this healthcare facility. The public hospital, as opposed to the privately owned one, has to report to the community members and address their concerns and needs, which are currently based on the environmental sustainability of this facility. The private hospital in Turkey does not face the same pressure, and its environmental and sustainability strategy is linked with the need to comply with the ISO standards. In contrast, to the Turkish hospital, the employees of the Australian facility had little knowledge of the ISO standards and implementation process, suggesting that the management is more focused on complying with the government’s regulations rather than with the international quality standards. Moreover, the main focus of the Australian hospital’s management SCM was on the reduction of GHG emissions. This hospital was also able to achieve some positive results in terms of reducing the costs as part of the GSCM implementation. The participants from the Turkish hospital could not cite any significant effects of the GSCM on the operations of their facility, as it was in the initial stages at the time of the interview. Another issue is the lack of government-led regulations in this state that would promote the development of sustainable supply chains. This issue also explains why the hospital’s main focus is the ISO standard and not the legislations and initiatives created by policymakers.
This section will detail the main takeouts from this research. The financial performance of the Australian hospital has decreased over the observed period, which may be linked to the investment required to facilitate the transition towards a GSCM. Although this implication aligns with the literature review’s findings regarding the initial investment required to facilitate the implementation of GSCM practices, one can conclude that in the short-term perspective, this approach has harmed the business performance of this entity. Moreover, the analysis shows that the lack of governmental support, which is evident in the case of the Turkish hospital, is a substantial barrier that limits the implementation of GSCM practices, as opposed to Australia, where the government requires hospitals to implement sustainable management practices and GSCM.
Based on the results of this study, there are several theoretical and practical implications. The study is limited by the timeframe of data collection, which was between 2018 and 2019, and does not allow to determine the long-term effects of sustainable practices on the operation of the hospitals. However, the short-term financial performance of both facilities decreased in association with implementing ISO standards and sustainability management approaches. Additionally, the government’s input into the development and management of sustainable practices and GSCM has had a substantial impact since the management of the hospital in Turkey has faced many barriers associated with sustainable practices, unlike the management of the Australian hospital.
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