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Leadership in Health Services
Logistics in hospitals: a case study of some Singapore hospitals
Zhi Xiong (Thomas) Pan Shaligram Pokharel
Article information:
To cite this document:
Zhi Xiong (Thomas) Pan Shaligram Pokharel, (2007),"Logistics in hospitals: a case study of some
Singapore hospitals", Leadership in Health Services, Vol. 20 Iss 3 pp. 195 - 207
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Logistics in
Logistics in hospitals: a case hospitals:
study of some Singapore hospitals Singapore
Zhi Xiong (Thomas) Pan and Shaligram Pokharel
School of Mechanical and Aerospace Engineering, 195
Nanyang Technological University, Singapore

Abstract
Purpose The purpose of this paper is to investigate logistics activities in Singapore hospitals. It
defines various types of activities handled by a logistics division. Inventory management policy and
the use of information and communication technologies (ICT) for logistics purposes are also discussed.
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The study identifies the nature of strategic alliances in Singapores health care industry.
Design/methodology/approach This study was conducted by utilizing a framework for data
collection, pre-testing the questionnaire and conducting interviews. Various relevant literature was
reviewed to design the questionnaire.
Findings This study finds that logistics division carry out many related activities and some of
them also provide engineering services. The hospitals make use of ICT. The hospitals are clustered
under various groups to minimize the cost of operation, including the logistics related costs. However,
hospitals do not see alliances with suppliers as a strategic option; rather they focus on outsourcing of
logistics services. The findings also show that Singapore hospitals have a good stocking policy for
both medical and non-medical items so that changes in patient mix can be easily handled.
Originality/value Singapore is continuously improving its health care industry and therefore, the
findings will help hospitals in other regions to adopt some of the practices, like concentrating on local
vendors, outsourcing, clustering, and maximum use of information technology as competitive factors
that can improve the service and reduce the cost of operation. The paper suggests motivators and
barriers to the use of ICT in logistics in the health care industry.
Keywords Hospitals, Distribution management, Communication technologies, Strategic alliances,
Singapore, Supply chain management
Paper type Research paper

Introduction
Logistics activities involve planning, designing, implementing and managing material
flows in a supply chain to support functions such as procurement, distribution,
inventory management, packaging and manufacturing (Pokharel, 2005). Logistics is
also recognized as a critical factor for competitive advantage (Bowersox and Closs,
1996; Bowersox and Daugherty, 1995; Christopher, 1993) and can be an enabler of
corporate success (Simchi-Levi et al., 2003).
As in any industrial process, logistics in hospitals have two main chains, one
internal chain and one external chain. Logistics service requirements in the internal
chain are immediate and have almost no lead time. Therefore, hospitals need to focus
on two aspects: the management of the external supply chain to minimize the costs and
the management of the internal supply chain to maximize service levels.
Leadership in Health Services
The first author, who conducted the interviews, would like to thank the managers from hospitals Vol. 20 No. 3, 2007
for providing their time and valuable inputs for this study. The study was partially funded by pp. 195-207
q Emerald Group Publishing Limited
the Division of Systems and Engineering Management in the School of Mechanical and 1751-1879
Aerospace Engineering. DOI 10.1108/17511870710764041
LHS Customer satisfaction can be measured according to the performance of processes to
20,3 handle the needs of the internal customer (Swinehart and Smith, 2005). Healthcare
providers believe that, unlike managers in the manufacturing industry, they are unable
to predict patient mix and the demand for a particular item; hence they are unable to
control or project their schedules (Jarrett, 1998). Stochasticity in the patient mix and the
average length of stay in hospitals is also mentioned by Van Merode et al. (2004) as one
196 the problems in scheduling of resources. Poulin (2003) mentions that more than 30 per
cent of total hospital expenses are invested in logistics activities and half of this cost
could be eliminated through logistics management. Improvements in the supply chain
in hospitals can lead to excellent operating room and pharmaceutical management,
better inventory management, enhanced vendor relationships, more satisfied patients
and more effective work flow for hospital employees (Burt, 2006).
In Singapore, there are 29 hospitals (13 public and 16 private) and 18 polyclinics
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(singstat.gov.sg). The hospitals have over 11,800 beds and more than 70 per cent of
them are in public hospitals. Out of about 414,400 hospital admissions, 76 per cent are
in public hospital. Data also show that about 70 per cent of hospitals provide acute care
patient needs.
The logistics activities in hospitals involve purchasing, receiving, inventory
management, management information systems, food services, transportation and
home care services (Aptel and Pourjalali, 2001). Consequently, it is important to
examine the functions of this department to improve services and reduce costs.
Although procurement and inventory management are non-value adding activities in
hospitals (Aptel and Pourjalali, 2001), Jarrett (1998) mentions that such activities are
required since the nature and volume of items needed on a daily basis are difficult to
predict. Therefore, service effectiveness can be enhanced by understanding logistics
practices and managing them, if necessary. In the sections that follow, various
literature related to healthcare logistics have been reviewed. A framework is developed
for data collection and the collected data are presented and discussed.

Analysis of previous research


The two main approaches used to plan the logistics activities in hospitals are inventory
oriented and schedule oriented (Lapierre and Ruiz, 2005). In the inventory oriented
approach, hospitals and/or medical departments place orders with the suppliers
whenever the reorder point is met. As mentioned by the authors, this approach would
require more manpower, more inventory space and will obviously result in a higher
cost of operation. The scheduling oriented approach focuses on developing good
schedules to handle purchasing operations. In this approach, replenishments,
purchasing activities and supplier deliveries are well scheduled so that resource
availabilities are respected and stock-outs are avoided. Avoidance of stock-outs
through periodic reviews in hospitals is also suggested by Nicholson et al. (2004). As
the care of patient is a sensitive issue due to unpredictable nature of services required
from the hospitals, especially those providing acute care, minimum stocking to
adequately handle situations like disease outbreak is important for hospitals.
Kim and Schniederjans (1993) identified three types of materials management systems
in the healthcare system: conventional, just in time (JIT) and stockless. From their
empirical testing, the authors found that JIT or stockless programs can be implemented
regardless of the size of the hospital. Effective materials management and JIT deliveries
can bring down healthcare costs (Heinbuch, 1995). Rivard-Royer et al. (2002) studied Logistics in
inventory system with conventional and stockless system and proposed a hybrid system hospitals:
for inventory management. Their case study in a Canadian hospital showed no significant
difference on total cost due to the implementation of their proposed method. Jarrett (2006) Singapore
mentions that implementation of JIT in hospitals can achieve significant cost reduction
which can eventually bring down the cost of providing services.
Aptel and Pourjalali (2001) compared logistics parameters in hospitals in France 197
and the USA. Their study reveals the differences in inventory management and
alliances between the hospital and hospital, and hospital and vendors. They observed
that, although hospitals provide critical services and require unexpected levels of
inventory, just-in-time (JIT) deliveries can be used to minimize the cost of inventory in
hospitals. Due to the uniqueness of the hospital characteristics, our study closely
follows the study by Aptel and Pourjalali (2001).
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Nicholson et al. (2004) compared an in-house three-echelon distribution network and


an outsourced two-echelon distribution network for the supplies of non-critical items.
Their analysis showed that the distribution of non-critical medical supplies directly to
the hospital departments results in inventory cost savings without an impact on
quality of care.
The above review shows that logistics activities are important activities in hospitals
and significant cost reduction can be achieved through a good logistics management.
Therefore, we need to identify different logistics parameters that characterize logistics
activities in Singapore so that a better system, if required, could be devised to make
hospitals more effective in delivering patient care services.

Framework development
The framework used to understand logistics activities in Singapore hospitals is given in
Figure 1. The parameters under profile category include the type of hospitals, hospital size,
and the activities handled by materials management divisions (MMDs) or logistics
divisions (LDs). Under inventory management, the parameters include replenishment,
warehousing and stocking methods for medical and non-medical items. Medical items refer
to soft-goods (such as masks, gloves and cotton wools; items which are generally easy to
store and non-bulky), medicines or parts and equipments (such as surgical tools and other
various medical equipments). Non-medical items refer to stationeries, food items, linen and
non-medical (office) equipment such as computers, scanners, printers and ink cartridges.
For replenishment, quantity and review policy for medical and non-medical items
are examined. For warehousing, the type of warehousing practice (central,
departmental or vendor managed inventory) is examined. For stocking policy, the

Figure 1.
The proposed theoretical
framework for analysis
LHS type of stocking, stocking place (central warehouse or departmental stores) and the
20,3 stock levels are examined.
With Singapore being an ICT savvy country and with a lot of ICT investments
made by the government to develop it as an information hub in the region, we felt that
it is also important to understand the use of ICT in managing hospital logistics. Johns
(1997) has also mentioned that ICT is an important tool for increasing competitiveness
198 in healthcare industry. The author mentions that ICT can help in total integration of
healthcare. Stefanou and Revanoglou (2006) mention that the use of large-scale ICT
such as enterprise resource planning (ERP) in hospitals is increasing. Therefore, it is
worthwhile to examine the status of ICT in Singapore hospitals. The study also
examines the perception of ICT in terms of motivators and barriers.
Alliances form a long-term partnership to leverage on each others expertise and
services to serve a patient. Alliance between hospitals for logistics is the main
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consideration here. The second form of alliance considered is between suppliers and
hospitals. Information is also collected to understand the outsourcing practice for
logistics activities.

Data collection
In this study, all the interviews were conducted by the first author both for pre-testing
of questionnaire and final data collection. For pre-testing, a questionnaire was
developed in-house and was shown to one of the managers in MMD of a hospital. The
feedback required modification of some questions as they were not clear. It was also
found that funds-related questions, such as financial value of inventory and hospital
revenues are sensitive information in a close-knit healthcare environment in Singapore.
Therefore, such questions were taken out from the questionnaire. The improved
questionnaire was used for data collection.
Of all 29 hospitals contacted by telephone, only eight showed their eagerness to
contribute to the study. Among the respondents three were from public acute care
hospitals, two from private hospitals and three from specialty centres. Data reference to a
particular hospital was avoided on the request of the manager. This is a prevalent practice
in the surveys on logistics and healthcare. The hospitals which did not want to participate
in the study cited reasons like unavailability of personnel, their priority to cover in-house
activities and confidentiality of their data. Similar instances of low participations in
surveys in Singapore are also noted by Nanang et al. (2003) and Pokharel (2005).

Profile of respondents
The classification of hospital size in this study follows that by Chua and Goh (2000).
Interviews were collected from four smaller hospitals (less than 100 beds), two
middle-sized hospitals and two large-size hospitals, as shown in Table I.

Specialty centers and


hospitals with less than Between 101-500 More than 500
100 beds beds beds Total

Table I. Total number 10 12 7 29


Responding hospitals Respondents 4 2 2 8
The three most common items handled by logistics divisions (Figure 2) are medical Logistics in
equipment, stationeries, and office equipment. Among the surveyed hospitals, six hospitals:
hospitals reported that supplies of goods to operating theatres, radiology, wards and
laboratories also falls in their purview. It is seen that some hospitals require their Singapore
logistics division (LDs) to handle services such as telecommunications, facilities,
maintenances and engineering services.
The response indicated that all material management divisions (MMDs) or LDs 199
have responsibilities in purchasing, receiving, internal distribution, supplier
management and inventory management. The logistics division in one hospital did
not have the responsibility for inventory management directly as its supplies were
managed by another hospital (which did not take part in this study). Therefore, from
this study, it is seen that MMDs are not only looking at external supply chains but also
the management of internal supply chains.
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Inventory management
The study showed that periodic reviews and replenishments methods are used for
medical supplies. As the requirements of soft-goods are generally known and the items
are rather standardized for use in any department in the hospitals, the use of periodic
review and replenishment method might be a good inventory management policy.
However, it can be seen (Figure 3) that not all the hospitals practice this inventory
management method. Some hospitals still order based on the demand by individual
departments and some even consider periodic replenishment. As these hospitals do not
have a large demand for the supplies, periodic replenishment is considered a better
option. As one of the hospitals jointly handled medicine supplies with another hospital
(which did not participate in this study) its review policy could not be established here.

Figure 2.
Items handled by logistics
department
LHS
20,3

200
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Figure 3.
Replenishment methods
for medical items

For stationeries and non-medical items, inventory is replenished after an order is


generated by various departments (four hospitals) or through period reviews (three
hospitals). Only one hospital practiced a periodic replenishment possibly due to smaller
quantities used in that hospital. The fact that some of the non-medical items are bulky
and have a long shelf-life, means it is more practical to deliver such items as per the
need basis.
Data show (Figure 4) that most hospitals practice a weekly replenishment policy for
medicines. Only two hospitals use daily replenishment to reduce their warehousing
costs. For soft goods and equipments, two of the hospitals practice monthly
replenishment, three hospitals use weekly replenishment and three use replenishment
every fortnight.

Figure 4.
Replenishment periods
Warehousing Logistics in
The interviews showed that hospitals have at least one in-house central warehouse. hospitals:
However, seven hospitals reported having more than one in-house storage areas. These
hospitals have implemented SAP systems to monitor the stock levels between Singapore
individual storage areas and the central warehouse.
The study also found that seven hospitals do not share a common central
warehouse for pharmaceutical and non-pharmaceutical products. A reason for this 201
could be that pharmaceutical and non-pharmaceutical products need to be handled
differently and are generally managed by different departments.

Stocking policy
Data shown in Figure 5 indicate that most hospitals maintain a stock level for a
two-week time period. Therefore, each delivery would replenish the quantities to meet
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demand for two weeks. This could be due to the reason, as mentioned earlier, that
medicines are generally considered fast-moving items and thus are replenished quite
often, hence hospitals do not need to stock a larger volume of items. For non-medical
items, the majority of hospitals keep two weeks supply. However, they do not refer to
items like printers and copiers. In case of stationeries, most hospitals stock the supplies
for two weeks demand. For non-medical equipment, stocking is avoided to the best
extent possible, as it may not be required on a regular basis.
Aptel and Pourjalali (2001) gave three basic models for the distribution of supplies:
delivery to medical departments via a central warehouse, semidirect delivery via
medical departments warehouses, direct delivery via daily replenishment of small
medical departments storage facilities.
The interview used four basic distribution methods: direct delivery to medical
department for use; direct delivery to medical departments storage for later use; direct
delivery to central warehouses and then delivery to medical department for use; and
direct delivery to central warehouse and then delivery to departments storages. For

Figure 5.
Amount of medical
supplies delivered to the
hospitals each time
LHS medical items, except for one hospital, direct delivery to medical departments is not
20,3 practiced. Most hospitals receive deliveries in central warehouses for distribution to
medical departments or departmental stores. For non-medical items, stationeries are
received by most hospitals (six hospitals) in the central warehouses. Office equipments
are either received in the central warehouse (three hospitals) or directly delivered to the
medical department (five hospitals). As office equipment are not fast moving items,
202 direct delivery on order basis would considerably reduce cost for storage and handling.

ICT usage in handling logistics functions


Information and communications technology (ICT) plays a greater role in enhancing
logistics efficiency in the industries. Studies by Nanang et al. (2003) and Pokharel
(2005) show an increasing trend of ICT use in logistics functions in Singapore. Table II
shows that all hospitals use computers and internet, extranet and intranet for their
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logistics functions. Enterprise resource planning (ERP) systems are also used by seven
of the responding hospitals. Bar coding is used by only four of them especially to track
and trace the internal delivery of the goods. Two of the hospitals reported using
automated guided vehicles. One hospital also used personal digital assistants (PDAs)
to record and transmit logistics related data. This clearly shows a very good level of
ICT penetration in Singapore hospitals.
The use of ICT is particularly focused on the accounting/financial management,
e-commerce, inventory management and internal distribution.

Perceived motivators and barriers for ICT


A list of motivators and barriers was provided to the interviewee. The response were
recorded using a five-point Likert-type scale, with 5 referring to Strongly agree, 4
referring to Agree, 3 referring to Slightly agree, 2 referring to Disagree and
1 referring to Strongly disagree.
The results presented in Table III show that increasing efficiency, reducing data
entry error, decreasing operational cost and decreasing labour cost are some of the
main reasons for ICT adoption in hospitals. Pokharel (2005) also got similar results
while conducting the survey of logistics companies in Singapore. Respondents
considered that the use of ICT may not necessarily bring down the inventory cost.
Despite several logistics options, such as just-in-time delivery and vendor-managed
inventory available to the hospitals, respondents generally believed that it would be

Types of implemented ICT Number of respondents

Computers 8
Internet/intranet/extranet 8
Financial (accounting) system 7
Enterprise Resource Planning (ERP) 7
Barcoding and scanning 4
Order processing system 4
Video cameras (e.g. Close circuit camera and CCTV) 2
Cameras (other types) 2
Table II. Automated Guided Vehicle (AGV) 2
ICT usage in hospitals Handheld computers/personal digital assistants (PDAs) 1
risky to reduce the inventory kept at warehouses by a large degree due to the inability Logistics in
to predict future patient mix and consumption. However, the cost of managing hospitals:
inventory records has gone down with ICT.
With seven hospitals already using ERP systems and one hospital not directly Singapore
involved in warehousing, the barriers to ICT adoption could not be established.
Therefore, questions were modified again to understand the barriers if a new
large-scale ICT were considered for the replacement of the existing system. For such a 203
case, Table IV shows that, the cost of implementation the availability of expertise to
handle such new ICTs could be the main barriers. Besides, the time period between
planning, implementation and fully-fledge operation of new ICT could take a long time.
The study showed that incompatibility and obsolescence of technology are not of
concern to the managers. As hospitals use ICT systems after careful evaluation to meet
their specific needs, these two barriers are considered as subtle. The study further
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shows that MMD managers do not feel that there are too many ICT standards to follow
for hospital logistics.

Strategic alliances and outsourcing


As mentioned earlier, strategic alliance between the hospitals and between the
hospitals and suppliers can enhance the service levels. Therefore, an attempt was made
to understand the alliance situation in Singapore hospitals. It is to be noted that public
hospitals in Singapore fall under two clusters (National Healthcare Group and
SingHealth Group). Private hospitals are either independent or grouped under Pacific
Healthcare, Parkway Group Healthcare, Raffles Medical Group and Thomson Medical
Group. Therefore, it can be seen that there is a certain degree of alliance already
existing between the hospitals within a cluster. With the publication of healthcare cost

Perceived motivators Mean ^ Std

Increasing efficiency 5.00 ^ 0.00


Reducing data entry error 4.75 ^ 0.46
Decreasing operational cost 4.38 ^ 0.52
Decreasing labour cost 4.25 ^ 0.71
Increasing customer service level 4.13 ^ 0.84
Reducing order processing time 4.00 ^ 0.54 Table III.
Facilitating timely payment 4.00 ^ 0.54 Perceived motivators
Decreasing inventory cost 3.88 ^ 0.84 for ICT

Perceived barriers Mean ^ Std

Difficulty in justifying start-up and on-going cost 4.38 ^ 0.74


Insufficient ICT resources 4.25 ^ 0.63
Integration with the legacy systems 4.00 ^ 0.76
Long implementation time 3.75 ^ 0.46
Incompatibility with customers or suppliers 2.88 ^ 0.64 Table IV.
Rapid obsolescence of technology 2.88 ^ 1.13 Perceived barriers
Too many industry standards to follow 2.75 ^ 1.17 for ICT
LHS data in different hospitals for different medical conditions by the Ministry of Health
20,3 (www.moh.gov.sg), these hospitals are under pressure to implement as many possible
cost-cutting measures as possible. Therefore, hospitals might seek alliances or
outsource logistics activities to remain competitive. Jarrett (2006) mentions that instead
of regulatory measures, which may create market distortion and change access
patterns, an alternative approach that allows greater price competition among the
204 service providers can help in reducing the cost of healthcare service. In this respect,
Singapore governments effort to publicize the cost of healthcare service through its
web portal can be lauded. Jarrett (2006) mentions that competition on prices can help
the healthcare industry adopt similar cost accounting methods and improve supply
management practices as has happened in the manufacturing sector.
In public sector hospitals, each health cluster has their own Group Procurement
Offices (GPOs) to take care of their overall logistics and procurement matters. MMD
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managers form part of the members of the GPO. These GPOs for both the clusters
purchase items for hospitals in their own cluster as well as conduct a combined and
inter-cluster purchase for some common items. This practice can prevent a few
suppliers from monopolizing the public healthcare industry. Another point to note is
that the GPOs for the clusters do not purchase all items for the hospitals in their
cluster. Ad hoc purchasing of unique items required by individual hospitals is also
practiced. In terms of services, alliances in terms of food services and linen
warehousing were also found. Most hospital alliances for these services have existed
for more than one year and there were no reported problems in managing logistics in
these alliances. In private sector hospitals, both medical and non-medical items are
mostly purchased by MMDs/LDs based on the requests by the end-user departments,
possibly due to the smaller volume of such purchases.

Strategic alliances between hospitals and vendors


The study shows that most hospitals recruit two to three suppliers to supply an item.
As the type of products can vary within a category (for example, different types of
medicine), there might have been the need to recruit more than one supplier for one
category. With a limited number of suppliers, electronic transactions can also be
streamlined better.
As hospitals review suppliers performance on an annual basis, a long-term alliance
is not possible in the current setting. However, a proactive supplier would have enough
opportunity to understand the working system and environment for them to optimize
costs and performance so that long-term alliance could potentially be secured.
Considering the volume of business, existing suppliers might be in an advantageous
position compared to the new suppliers.
All managers highlighted that their supplies (medical and non-medical) come
mostly from local distributors. This practice can reduce lead time, guarantee the
availability of supplies on a short notice, thus they might be able to meet the order on a
short notice, if needed. The study showed that the maximum lead time for orders of
medicine supply is three days and that for non-medical items, it is seven days.

Outsourcing in logistics functions


Hospitals also outsource some activities such as cleaning, security, cafeteria, food and
laundry, in order to cut costs and increase customer satisfaction (Moschuris and
Kondylis, 2006). The study shows that outsourcing of some of the logistics activities is Logistics in
prevalent in Singapore hospitals. Housekeeping as well as repair and maintenance hospitals:
services was found to be outsourced by four hospitals covered in this study. Three
hospitals reported outsourcing of information system services and two hospitals Singapore
reported outsourcing of linen and warehousing services. Only one hospital outsources
food services. Other hospitals showed concern about food supply and quality when it is
outsourced. MMD managers believed that although outsourcing has not helped them to 205
reduce the logistics costs significantly (there have been some reductions though), the
benefits are obtained in terms of expertise held by the outsourced companies. This
finding supports the conclusions obtained by Young (2005) who found that same
savings as obtained from outsourcing can be obtained by the use of other internal
change processes such as the introduction of new technology, changing structures and
the promotion of working flexibility. Therefore, it can be said that with the high level of
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technological inputs to execute various functions, hospitals in Singapore use


outsourcing as their strategic option to enhance service levels rather than forging
alliances with the vendors. In the long run, due to the need to focus on core competency
and to reduce the costs, hospitals may outsource more logistics services to the service
providers.

Conclusions
This study contributes in understanding logistics parameters in hospitals in
Singapore. Although there are 29 hospitals and specialty care centers in Singapore, this
study could cover only eight of them. As the study was done on a voluntary basis, and
some of the hospitals fell under the public healthcare providing groups, we believe that
the contents presented here reasonably represent the logistics activities in hospitals.
As a back-end for provision of an efficient service, logistics becomes an important
function in hospitals. With increased cost competitiveness, the hospitals have to look at
some of the functions that should be eliminated (like paper work), outsourced or made
efficient. Risk pooling among the hospitals could be another strategic policy to increase
cost effectiveness of hospitals.
This study also found that in the clustered hospitals, purchasing, which is usually
considered as a non-value logistics function, is done through a central unit for the
common items. However, due to the specific nature of service provisions in hospitals,
the purchasing of non-common items and small items were left to the individual
hospitals. This can be considered a good move because with the bulk purchase of
common and standardized items on a regular basis, economies of scale can be achieved.
Further, by allowing hospitals to purchase small and non-common (special items),
quality control can be better assured by the respective hospitals.
Hospitals in Singapore generally keep two weeks of stocks in their warehouses.
When the capacities of local suppliers increase in terms of understanding the needs of
specific hospitals, alliances based on trust, efficiency and efficacy could be formed with
suppliers to reduce the stock levels to as low as one week of supply. This may further
reduce logistics cost. Vendor-managed inventory can also be practiced to reduce stock
levels at the hospitals. As suppliers are from the local area and hospitals do practice
electronic commerce, implementation of JIT or VMI may not cause any problem in
maintaining the flow of supplies. Moreover, this study finds that outsourcing is being
LHS practiced in Singapore hospitals and outsourcing may not necessarily bring down the
20,3 costs of products and services in hospitals.
Although this study could not establish cost savings due to ICT use, it found that
ICT use is prominent in hospitals. This could be due to the need for effective record
keeping and service management in hospitals.
This study provides a general direction as to the formalization of logistics
206 parameters in Singapore hospitals, therefore, the results should be used with caution as
changes could have been made in logistics activities after the completion of this study.
This study was mostly based on interviews with MMD managers and provides a
holistic picture on logistics. Taking a lead from this study, further studies can be
conducted to focus on specific items such as inventory management or the use of ICT
by collaborating with hospitals. A focused study on logistics can provide a benchmark
for hospitals, not only in Singapore but also around the region and the world, so that
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overall efficiency of logistics functions can be increased. The cooperation of all


hospitals for such a study need not be underlined.

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Corresponding author
Shaligram Pokharel can be contacted at: mspokharel@ntu.edu.sg

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