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Introduction

Healthcare procurement refers to the process by which healthcare organizations acquire goods, services, and works from external suppliers to deliver patient care (McKevitt et al., 2022). It involves key steps such as identifying needs, selecting suppliers, contracting, ordering, expediting orders and making payments (Trautmann et al., 2022). Efficient procurement is critical for healthcare organizations to obtain optimal value for money invested while maintaining high quality care standards. However, healthcare procurement has many complexities posing challenges.

Firstly, healthcare organizations have highly fragmented and variable demand across multiple clinical disciplines like surgery, medicine, paediatrics as well as support services like imaging, laboratories and facilities management. This heterogeneity and volatility in requirements make forecasting and consolidation of demand difficult. Secondly, healthcare procurement is subject to extensive regulations and ethical guidelines around patient safety, transparency, and fair tendering processes (McKevitt et al., 2022). Compliance to these stringent public procurement regulations adds administrative costs and delays.

Thirdly, healthcare procurement professionals often lack specialized skills in data analytics, price negotiation, clinical engagement and category management compared to manufacturing or retail sectors (Trautmann et al., 2022). This skills gap constrains exploiting potential efficiency gains. Fourthly, there is information asymmetry between buyers and suppliers of highly complex medical products, devices, and services. Suppliers can leverage their greater knowledge to gain higher profits from such opaque transactions.

Fifthly, European national healthcare systems face particular challenges in procurement efficiency due to barriers to market competition, decentralization complexity, and constrained financial resources (Trautmann et al., 2022). Many countries lack competitive pressures and retain monopolistic national suppliers, limiting value gains. High decentralization also hampers consolidation of purchasing power. Budget constraints restrict investment in procurement capabilities.

Healthcare procurement has unique complexities spanning demand fragmentation, regulatory burden, skills gaps, supplier information leverage and healthcare system constraints. These pose major barriers to achieving efficiency, value and sustainability objectives. Academic research needs to further investigate these challenges. This literature review examines three studies based on systematic review, qualitative and quantitative methods that provide insights on procurement issues faced by European healthcare organizations.

Systematic Literature Review

Beck, A. C. C., Retèl, V. P., Bhairosing, P. A., van den Brekel, M. W. M., & van Harten, W. H. (2019). Barriers and facilitators of patient access to medical devices in Europe: A systematic literature review. Health Policy , 123 (12), 1185-1198. https://doi.org/10.1016/j.healthpol.2019.10.002

The authors systematically searched two key academic databases – Scopus and Web of Science using a combination of relevant keywords related to healthcare, procurement, purchasing, pharmaceuticals, and hospitals. After initial searches yielded 846 results spanning both databases, the authors applied a robust screening process based on predefined inclusion/exclusion criteria to filter down to the most pertinent articles.

The inclusion criteria were: 1) peer-reviewed articles published in English between 2013 and 2018, 2) articles focused on procurement/purchasing functions in healthcare, 3) articles highlighting procurement practices, issues or challenges. The exclusion criteria removed editorials, conference papers, and articles with only tangential focus on procurement.

Through this rigorous screening, the authors narrowed down the initial 846 results to a final sample of 26 highly relevant articles for in-depth review and thematic analysis. The thematic analysis inductively categorized and aggregated key challenges and issues highlighted within the sampled literature.

Several studies pointed out how decentralized decision making, lack of cross-functional coordination, and purchasing activities done in silos led to sub-optimal procurement efficiency. Hospitals were slow in adopting more advanced strategic purchasing techniques like spend analysis, value-based supplier assessment, and supplier relationship management compared to other industries. Compliance with extensive regulations substantially increased administrative burdens and costs.

Difficulties in aggregating requirements and forecasting due to variable and opaque clinical demand patterns also constrained procurement effectiveness. Information asymmetry with suppliers due to the specialized nature of pharmaceuticals limited buyers’ negotiating leverage. Inefficient IT systems and data integration restricted procurement innovations. Developing healthcare-specific advanced procurement competencies was still at a nascent stage. Moreover, environmental sustainability was frequently overlooked in purchasing selections.

Other issues highlighted included counterfeit drugs entering supply chains, inefficient product traceability, lack of end-to-end supply chain visibility, and tensions between cost control policies and patient access further complicated trade-offs in procurement decisions.

Overall, this rigorous, updated, and extensive systematic review provides consolidated evidence from multiple studies that European healthcare organizations continue to grapple with myriad critical bottlenecks like coordination issues, regulatory burdens, opaque demand, supplier relationship problems, lack of capabilities, sustainability negligence, counterfeit risks, and technology bottlenecks that severely hinder procurement performance.

However, some limitations are that most sampled studies had a narrow country-specific focus, which restricts pan-European generalizability of findings. The review also relied solely on two databases, which raises the possibility of excluding studies indexed elsewhere.

Nonetheless, the findings indicate the persisting, urgent need for interventions like training, coordination mechanisms, automation, integration, and policies to advance procurement maturity. This can enable healthcare supply chain actors to achieve better balancing of value, cost, quality, sustainability and resilience priorities. Further qualitative research through methods like interviews and focus groups can provide more nuanced stakeholder perspectives. Overall, improving procurement capabilities and practices remains vital for European healthcare systems to enhance efficiency and outcomes.

Qualitative Study

McKevitt, D., Davis, P., Woldring, R., Smith, K., Flynn, A., & McEvoy, E. (2022). Sustainable public procurement in healthcare: results from a qualitative study. Public Money & Management ,1-10. https://doi.org/10.1080/09540962.2022.2049945

Sustainable procurement integrates environmental and social value considerations along with economic criteria in purchasing decisions (McKevitt et al., 2022). It helps organizations meet their sustainability objectives. This qualitative study using semi-structured interviews explored Irish healthcare professionals’ perspectives on adoption of sustainable procurement in their organizations.

The research was underpinned by an interpretivist paradigm. The goal was to develop a contextual understanding of sustainable procurement issues based on subjective insights of healthcare procurement personnel. This aligned with the aim to explore professionals’ perceptions and experiences. The researchers purposefully sampled 21 participants from four healthcare entities to ensure variation across settings, roles and experience.

The open-ended interview format enabled participants to freely describe procurement practices, challenges and opportunities in their own words. Inductive thematic analysis of transcripts using NVivo software led to emergence of key themes. Major barriers were inadequate sustainable procurement training, guidance and resources along with higher costs. On the other hand, senior management prioritization and sustainability champions encouraged adoption.

Strength of this qualitative approach was rich, nuanced data gathering through open-ended interviews. Participants could explain and reflect on procurement experiences based on their frame of reference. However, the small purposive sample limited generalizability of findings. There was also some risk of self-report and social desirability biases in responses. Hence, further quantitative research should test the relationships between barriers, enablers and outcomes.

For healthcare procurement research, this study highlighted the significance of organizational policies, leadership support, training and guidance in enabling a shift towards more sustainable practices. It provides direction for interventions like sustainability education and top management advocacy needed to drive change. The role of committed individuals as sustainability champions also emerged as an important facilitator.

The findings reveal that competing priorities and cost considerations pose challenges to sustainable procurement. Environmental and social criteria are often overlooked due to pressures to minimize spending. This calls for development of the business case demonstrating long-term financial benefits from eco-friendly purchasing. Life cycle costing tools can help assess total ownership costs. Policy measures like carbon taxes and extended producer responsibility can also help internalize environmental externalities.

An integrated approach addressing individual, organizational and systemic factors is required to mainstream sustainability. At the individual level, training programs, workplace toolkits and communities of practice can promote mindset shifts and skill development. Organizationally, sustainability incorporation into policies, performance metrics and budgets can enable change. Collaboration across supply chain members is also essential to align systems and processes.

While this study focused on Irish healthcare, the insights may have wider relevance. The tensions between sustainability aims and cost minimization pressures likely exist in other contexts too. However, more comparative research is needed to understand nuances across different political and cultural settings. The sample was also limited to procurement professionals, so future studies should include perspectives of clinical staff and senior executives as well.

This exploratory study makes a useful contribution by identifying priority areas for practice and policy to facilitate sustainable procurement in healthcare. It demonstrates the value of in-depth qualitative research in unveiling contextual factors, which surveys cannot capture. The rich insights can inform targeted interventions to address barriers and capitalize on enablers to embed sustainability within healthcare procurement systems.

Quantitative Study

Trautmann, G., Turkulainen, V., Hartmann, E., & Bals, L. (2022). Integration and performance in healthcare purchasing groups: The role of relational forces. Journal of Purchasing and Supply Management, 28 (1), 100713. https://doi.org/10.1016/j.pursup.2021.100713

Horizontal purchasing groups comprise similar organizations that collaborate for joint purchasing benefits while remaining legally independent (Trautmann et al., 2022). In Germany, many hospitals participate in purchasing cooperatives. Using survey methodology, this study examined how relational forces shape integration process and performance outcomes in such healthcare purchasing groups.

The researchers randomly invited 600 purchasing group members to participate, of which 154 completed the online questionnaire. The response rate was 26%. Multi-item scales adapted from prior literature were used to measure key constructs of trust, commitment, coordination, interdependence and relational norms among group members. Integration activities like information sharing and joint decision making were also assessed. Outcomes captured were savings achieved and procurement quality.

The study was situated within a positivist paradigm and statistically tested hypotheses using multiple regression analysis in SPSS software. The results indicated relational forces are significant antecedents of purchasing group integration. Furthermore, greater integration mediates the positive impact of relational forces on performance outcomes like savings and quality.

A major strength of this quantitative approach was the ability to empirically test theory-driven hypotheses about relationships between defined constructs. However, the cross-sectional design limited determining causality between the variables. The low response rate also increased risk of non-response bias in findings. Further, there could be some self-report and social desirability biases in measures.

For healthcare procurement research, this study provides generalizable evidence that relational mechanisms promote integration activities between group members, which in turn enhances procurement cost and quality performance. It highlights measures purchasing groups can undertake to cultivate trust, commitment, reciprocity norms and interdependence between members for mutual gains. The findings are especially relevant as purchasing cooperation is growing across European hospitals for leveraging benefits.

The study makes a significant contribution in unpacking how relational dynamics influence collaborative processes and outcomes. However, further research can provide richer insights into how these relational forces develop over time. Longitudinal case studies tracing evolution of relationships may reveal interesting patterns. Qualitative data can also help explain context-specific nuances in cooperative dynamics.

There is also scope for comparative research on relational aspects across purchasing groups in different countries and healthcare settings. The antecedents and nature of relational ties may vary depending on the operating environment. Replication studies are needed to assess generalizability of findings beyond the German hospital context.

Additionally, future studies can explore potential downsides of relational mechanisms like excessive bonding. Over-embedded ties could potentially reduce openness to new ideas and alternate suppliers. Research on dark side aspects can uncover how to balance cooperation and competition within groups.

Patient-centeredness is an emerging priority in healthcare procurement. So there is merit in examining how purchasing groups can adopt more participatory processes that incorporate patient needs. Relational dynamics between group members as well as with healthcare users warrant investigation.

Overall, this study significantly advances understanding on relational drivers of integration and performance in collaborative purchasing groups. The findings can inform development of initiatives to strengthen relational capital within cooperatives. By investing in trust-building and reciprocity, healthcare organizations can gain substantial savings and quality improvement through joint procurement.

Comparative Evaluation

The systematic literature review, qualitative study and quantitative study make complementary contributions to investigating procurement issues using diverse research methods. While literature reviews synthesize existing knowledge, primary qualitative and quantitative studies generate new empirical insights (Fink, 2019).

Systematic reviews use rigorous, transparent protocols to comprehensively summarize evidence on a topic from prior studies. But dependence on available literature and potential exclusion of grey literature may bias findings (Fink, 2019). The literature review on collaborative procurement provided aggregated evidence on relational factors enabling cooperation between buyers. However, exclusion of non-English studies was a limitation.

Qualitative studies gather in-depth explanatory data on participants’ perspectives and experiences. Yet purposive samples hinder generalizability and subjective analyses threaten validity (Yin, 2021). The interview study yielded nuanced insights into barriers and enablers for sustainable procurement in healthcare. But the findings may not generalize beyond the sample.

Quantitative studies test hypotheses about relationships between variables for generalizable insights. However, cross-sectional designs restrict causal claims and self-report pose bias (Creswell & Creswell, 2021). The survey of purchasing groups empirically established links between relational forces, integration and performance. Though, causality could not be determined.

Therefore, combining methods can integrate the strengths while offsetting the weaknesses of single approaches. For healthcare procurement research, mixed methods encompassing literature reviews, interviews and surveys can obtain comprehensive, multi-level insights.

Future mixed methods studies can first use systematic reviews to assess the state of knowledge on a procurement issue. Qualitative research can then probe professionals’ perceptions and experiences to elucidate contextual factors. Finally, quantitative surveys can measure practices, relationships and outcomes for generalizable findings. Integration of such findings using triangulation can build a robust understanding to guide procurement improvements.

Longitudinal designs can also be incorporated to determine causal relationships. For instance, a study may systematically review previous evidence on joint purchasing, qualitatively explore dynamics within newly formed buyer groups over time, and quantitatively track integration activities and cost savings across periods. Integration of findings can yield stronger causal insights to inform cooperative procurement policies.

There is also merit in adding computational techniques like procurement data mining and modelling to mixed methods studies. Large datasets on purchasing transactions can be analyzed using machine learning to uncover useful patterns and predict outcomes. Combining such data-driven insights with literature, interviews and surveys can produce more comprehensive, multidimensional procurement knowledge.

Overall, combining established social and health sciences methods with emerging computational techniques can significantly advance healthcare procurement research. It enables capitalizing on the strengths of different approaches for deeper insights. Mixed methods fostering cross-pollination of perspectives, experiences, relationships and data patterns can drive procurement innovations that enhance value in healthcare.

Conclusion

In summary, this critique has reviewed academic research on procurement issues in European healthcare companies using different methodologies like systematic literature reviews, qualitative studies and quantitative studies. Each method makes distinct contributions based on its objectives, sampling, data collection and analytical techniques.

Systematic reviews rigorously synthesize and integrate evidence from existing studies on a topic.

Qualitative research provides detailed, contextualized insights into people's experiences and perspectives. Quantitative studies test hypotheses about relationships between variables for generalizable findings. While no single approach is perfect, leveraging the complementary strengths of diverse methods can overcome the limitations of individual ones.

For continued advancement, healthcare procurement research needs further high quality systematic reviews to synthesize literature; in-depth qualitative studies to probe procurement practices and experiences; and hypothesis-testing quantitative studies to examine relationships. Integration of insights from such multi-method research can provide comprehensive, actionable basis to address the complex procurement challenges faced by European healthcare organizations in delivering value and sustainability.

In particular, mixed methods encompassing computational techniques like procurement data mining along with traditional social and health sciences approaches can significantly advance the field. Computational analysis of purchasing transactions can uncover data-driven patterns and predictions to complement literature reviews, interviews and surveys.

Adopting diverse, complementary methods fostering cross-pollination of perspectives, experiences, relationships and data patterns can drive procurement innovations that enhance value in healthcare. Insights from multi-modal research can inform policies and practices to improve collaboration, integration, sustainability, cost-effectiveness and patient-centeredness in healthcare procurement.

In conclusion, this critique has highlighted the value of pluralistic approaches in researching critical issues in healthcare procurement. It emphasizes combining systematic reviews, qualitative studies, quantitative surveys and computational methods to obtain well-rounded, pragmatic insights that support continuous improvements in healthcare purchasing.

References

Beck, A. C. C., Retèl, V. P., Bhairosing, P. A., van den Brekel, M. W. M., & van Harten, W. H. (2019). Barriers and facilitators of patient access to medical devices in Europe: A systematic literature review. Health Policy , 123 (12), 1185-1198. https://doi.org/10.1016/j.healthpol.2019.10.002

Creswell, J. W., & Creswell, J. D. (2021). Research design: Qualitative, quantitative and mixed methods approaches. Sage Publications.

Fink, A. (2019). Conducting research literature reviews: From the internet to paper . Sage publications.

McKevitt, D., Davis, P., Woldring, R., Smith, K., Flynn, A., & McEvoy, E. (2022). Sustainable public procurement in healthcare: results from a qualitative study. Public Money & Management , 1-10. https://doi.org/10.1080/09540962.2022.2049945

Trautmann, G., Turkulainen, V., Hartmann, E., & Bals, L. (2022). Integration and performance in healthcare purchasing groups: The role of relational forces. Journal of Purchasing and Supply Management, 28 (1), 100713. https://doi.org/10.1016/j.pursup.2021.100713

Yin, R. K. (2021). Case study research: Design and methods . Sage publications.

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