title: Impacts of pandemic outbreaks on Healthcare Supply Chains: Lessons from COVID-19 in developing nation
Creators: name: Tiwari, M
Publisher: name: Liverpool John Moores University
Year: 2024

description: Purpose The global COVID-19 crisis has significantly disrupted supply chains in the healthcare sector, leading to severe shortages of critical items like PPE kits, medicines, and sanitisers. This situation has highlighted the need for extensive research on the impact of pandemics on healthcare supply chains and the importance of building resilience. This thesis investigates the factors that enhance resilience in healthcare supply chains and their interconnections. It establishes a theoretical model based on the relational view, focusing on how relational competencies such as information visibility, swift trust, and collaboration affect healthcare supply chain resilience (HSCR). It also examines the role of crisis leadership in moderating the relationship between collaboration and HSCR. This research addresses gaps by integrating the relational view with the upper-echelon theory. It aims to contribute valuable insights to the academic literature and practical guidance for practitioners and policymakers. Overall, it seeks to make a meaningful impact on healthcare supply chain management. Design/methodology/approach I used the problematisation approach Alvesson &amp; Sandberg (2011) recommended to identify research gaps. I established two objectives: creating an operational definition of HSCR and developing a theoretical model. To achieve these, I employed both inductive and deductive methods. For the first objective, I conducted a systematic literature review (SLR) to identify eighteen enablers of HSCR. I then performed a DELPHI study, contacting forty experts to rank these enablers. After collecting their feedback, I developed a structural self-interaction matrix (SSIM). I created an interpretive structural model (ISM) using MICMAC analysis to illustrate the enablers of a social support healthcare resilient system. I integrated the relational view and upper-echelon theory to address the second objective of developing a theoretical model. I created a survey questionnaire using a seven-point Likert scale, following Dillman’s total design method, and collected responses from a diverse group of 111 participants from Indian hospitals and clinics. I calculated the minimum required sample size based on Kock and Hadaya’s (2018) methods to ensure sample size validity. This confirmed that my sample was sufficient for statistical analyses using WarpPLS 7.0 and PLS-SEM. Findings The study reveals key factors contributing to effective healthcare systems with strong social support. It highlights the crucial role of government support in driving top management to enhance visibility, financial backing, and family support. The research shows how these elements interconnect to improve information sharing and resilience in healthcare systems. Structural equation modelling (PLS-SEM) findings indicate that information visibility and swift trust are vital for collaboration in the healthcare supply chain during crises. Additionally, collaboration significantly affects the supply chain’s resilience. Interestingly, the study finds that crisis leadership can negatively impact collaboration, as committed leaders may inadvertently create confusion during crises. These insights challenge traditional views on leadership and enhance our understanding of crisis dynamics. In conclusion, the research supports an integrated approach that merges relational views with upper-echelon theory, offering deeper insights into crisis leadership complexities. Research Limitations Upon reflecting on my work, I recognise the limitations of my study despite the considerable effort I put in. I used samples from India, but including samples from other developing nations could have provided a fuller understanding of the context. This would require extensive travel and communication with healthcare providers to gather rich insights. My literature review revealed that national culture greatly influences organisational strategies during crises. For instance, Japan’s crisis management approach differs significantly from those of the United States, the United Kingdom, and India. Although I decided to exclude national culture as a moderating factor for simplicity, I now realise that exploring this dimension could have added valuable insight. I found that resource dependence theory (RDT) is crucial for understanding collaborative relationships during crises and enhancing the resilience of the healthcare supply chain. RDT highlights how organisations rely on external resources and the impact of these interdependencies on decision-making. I used interpretive structural modelling (ISM) to explore the complex interrelationships among eighteen variables affecting healthcare supply chain resilience in my analysis. However, I encountered inconsistencies in the DELPHI study. To address this, I propose using fuzzy theory, which offers a more nuanced representation of relationships between variables. Lastly, I utilised cross-sectional data to test my hypotheses. While I took precautions to mitigate common method bias, longitudinal data could have been more beneficial, as it allows for observing changes over time for a deeper understanding of the phenomena. Practical Implications The research highlights the significant challenges faced by the healthcare sector during the COVID-19 crisis, including a lack of visibility, governance, collaboration, and ownership. These shortcomings led to severe shortages of PPE, sanitisers, medications, and healthcare facilities. Supported by qualitative and quantitative analyses, this study aims to provide insights for healthcare professionals and administrators to address similar issues in the future. Effective government support is crucial for a nation's well-being. It offers direction and ensures stability through policy implementation, resource allocation, and public services. Top management support and leadership are vital for healthcare supply chain resilience. Their commitment is essential for implementing strategic initiatives and providing the necessary resources. Understanding the qualities of crisis leaders can inspire collaboration, drive innovation, and foster a resilient organisational culture. Additionally, prioritising the well-being of employees' families during crises is important for healthcare workers, helping them manage stress and focus on their roles. Information visibility and trust also play critical roles in collaboration within healthcare organisations. Clear, accessible data promotes communication and strengthens relationships, improving patient care and outcomes. Finally, effective communication among healthcare managers is essential during crises. Being transparent, empathetic, and respectful fosters collaboration and is crucial for managing virtual teams in challenging situations. Originality/value The thesis represents an original and valuable contribution to existing theory. The research study significantly enhances the understanding of HSCR and further extends the boundaries of the relational view to encompass the critical role of crisis leadership. The findings offer a nuanced and in-depth comprehension of crisis leadership, shedding light on an area that has traditionally received less attention. Collectively, the study's results contribute substantially to the ongoing theoretical discussions about healthcare supply chain resilience, relational competencies such as swift trust, information visibility, collaboration during times of pandemic, and crisis leadership. Keywords: Healthcare Supply Chain, Healthcare Supply Chain Resilience, Information Visibility, Swift Trust, Collaboration, Relational View, Social Support Systems, Interpretive Structural Equation Modelling, Partial Least-Squares Structural Equation Modelling.