Keywords

1 Introduction

Healthcare organizations should focus on everyone’s health in their region by advancing in reachability service, and dependableness so every individual who requires medical care from the healthcare organization should receive a great experience (Chassin 2013). Human development and progress is a continuous process and every industry should excel in it including developing healthcare organizations, for that it requires continuous laying out capital for uninterrupted advancement to sustain its effectiveness in terms of operations and services (Khan et al. 2021a). In the US, many hospitals in rural areas have been closed due to financial reason (Kissi et al. 2021). At the same time, prices in healthcare are moving up at a high speed (Bhandari et al. 2020; Pondhe et al. 2006). To cut down prices, healthcare organizations have to achieve maximum efficiency in their operations and services (Mubarik et al. 2021). On the other hand, healthcare organization efforts are inconvenient when we note the differences with other sectors (Miao et al. 2022). The health sector is distinctly separate from other sectors because the malfunction of health services will affect society (Ferreira et al. 2018).

One of the major parts of the healthcare industry is the pharmaceutical sector. In spite of the fact that the pharmaceutical industry has made it possible for drug makers to bring forth new and more effective medicines, continuous research should be conducted (Miao et al. 2022). In the field of supply chain effectiveness to make the process better than before (Khan et al. 2021a). Widespread research should be conducted on matters that affect the supply chain of pharmaceuticals (Narayanamurthy et al. 2018). When we focus on the pharmaceutical supply chain, the process of delivering medicine is long in duration and has been qualified more complicated in structure than in other organizations (Birkie et al. 2017). The aim of this study is to provide more insight and practical information on the operational inefficiencies of the pharmaceutical supply chain used in Pakistan.

This chapter will contribute to the lack of attention to the whole network of the existing Pharmaceutical Supply Chain. Whole pharmaceutical supply chain systems need to be improved in terms of quality, visibility, speed, and cost to function effectively. First, this article will examine and investigate the pharmaceutical supply chain practices to identify factors that influence system inefficiencies, which is an important step in developing and improving the end product offering for the customer (patient). Secondly, it is necessary to understand strategies implemented in the pharmaceutical supply chain to identify innovative approaches that could be implemented to enhance the performance of pharmaceutical supply chain.

From the above discussion, objectives of this chapter are as follows:

  1. 1.

    Find the root cause of problems related to poor pharmaceutical supply chain performance.

  2. 2.

    Optimizing the practices implemented in the pharmaceutical supply chain.

  3. 3.

    Identify innovative approaches that can improve operational efficiencies in the pharmaceutical supply chain.

From the above objectives, we derive the following research questions.

An exploratory and qualitative approach was chosen and followed; these questions are formulated for the direction of our book chapter study methodology:

  1. 1.

    RQ1. What are the challenges associated with the whole process within the pharmaceutical supply chain in Pakistan?

  2. 2.

    RQ2. What innovative approaches can be implemented in pharmaceutical supply chain to make system more effective?

2 Theoretical Background

Research scholars have formulated detailed, clear and deep perceptions into the area of operational efficiency, providing useful and valuable definitions. It is accepted that operational efficiency is majorly affiliated to “Doing things with right steps” (Forsund 2017). Efficiencies in operations can be estimate by the final result of the procedure in direction of the five performance factors such as caliber, being flexible, fast (logistics), being dependent and charging cost (Birkie et al., 2017). Measurement of efficient process relies on the context of environment (Bamford et al. 2015; Khan et al. 2022b). Centering towards the process of producing services of healthcare, there is requirement to make healthcare efficiency better regarding service of quality, satisfaction and safety of patients and in costing (Guerrini et al. 2018; Khan et al. 2022c).

The greater force applied towards organizations of healthcare to reduce their spending on pharmaceutical converts and this is required immediately (Al-Balushi et al. 2014). Expecting to get the better of the restrictions of an organization that is function based (Mubarik et al. 2022). Adopting approaches that leads towards improvement are an essential part of healthcare organizations (Bam et al. 2017). Even so, mostly such approaches are uneven and methodologically restricted (Narayanamurthy et al. 2018). Some important problems are highlighted regarding low performance by the extant literature detailed review.

Even though the pharmaceutical supply chain objective is to secure demands of customers in effective manner, that means patients are able to receive medical products easily (Mubarik et al. 2022). It is portrayed as enterprise with complexities as it has to meet with aims with different conflicts and constraints that are not traceable (Bam et al. 2017; Arif et al. 2023). Multiple researchers have gone through the pharmaceutical supply chain, says that multiple elements are involved in inefficiency to the process (Bhakoo et al. 2012).

When different stakeholders are involved in pharmaceutical supply chain process, for example like physicians, management, suppliers, staff working in clinics, and pharmacists, than inefficiency increases in logistics of drugs (De Vries and Huijsman 2011, Zaman et al. 2023b). Everyone in the pharmaceutical supply chain are designated to different roles and have their own responsibilities and are responsible for their actions, so if the information is not shared accordingly it results in lower strength of flow of information between the departments (Bhakoo et al. 2012; Zaman et al. 2023a). Adding that physicians are the decision makers and if purchasing of prescribed drugs are without brought into focus about extended knowledge of supply chain management SCM and operation management OM patterns then it will result into lower performance (Bhakoo et al. 2012). Breen and Xie (2015) focused towards the pharmacist’s role that how well they explore their skills of critical management that is required to effectively perform. Davies and Edwards (2013) emphasized that the growth in constant manner of pharmacy sectors need to have more qualified pharmacist, if we not focus on the modules of management that lacks it result in under growth. Supply chain management skills are needed when pharmacist enhance their quality regarding service (Uthayakumar and Priyan 2013).

Pressures from regulatory and institutions causes issues in identifying exact forecast of sales with side to formulation of long cycles of the medical products of pharmaceutical causes difficulty if applying strategies of supply chain SCS (Bhakoo et al. 2012; Khan et al. 2021b). There is hard in foretelling the accurate demand for drugs, partially because of the standard nomenclature lack and partially because of the factual information that drugs are stored in multiple units of healthcare organization (Mustaffa and Potter 2009). Likewise, it is thought provoking to foretell the patient mix, apprehend their requirements and the supply intake (Scheller and Smeltzer 2006), and in sudden unforeseen interventions. This unexpected demand shows that it is the element that forces healthcare sectors to store high degree of safety stocks prevent the occurrence of uncertainties just like demand fluctuations in daily basis and bottleneck supply (Bhakoo et al. 2012). These patterns could rise the stage of wastage discovered in pharmaceutical supply chain, that means many expired or unnecessary drugs should have been disposed of, and that hits the potential level of environment and living health (Wang et al. 2015). Drugs are not cheap products and also can change over to harmful or unusable products for customers as they get closer to their expiry (Cherrett et al. 2012; Jiang et al. 2018).

An important issue, hence, dealing this industry is inefficiency in the process that is related to distribution of pharmaceutical (Miao et al. 2022). Robust logistics and systems with proper planning can eliminate inefficiencies in the existing system (Jamali et al. 2010; Khan et al. 2022a). It is known that standard distribution strategy systems can play vital role in instructing policies in other logistic sectors are not easily applied in pharmaceutical supply chain (Papalexi et al. 2015) because of the listed numbers in points of consumption, such factors like lengthy lead time, and extreme unexpected nature of when we talk about bio pharmaceutical manufacturing, which have made uncertainties (Bhakoo et al. 2012; Zaman et al. 2023b).

Figure 9.1 shows the structure of this complex supply chain, including the upstream, central, and downstream domains of the pharmaceutical supply chain that involve various stakeholder groups.

Fig. 9.1
A graph of visibility versus material flow presents the structure of the pharmaceutical supply chain. It includes the upstream, central, and downstream domains, from bottom left to top right, involving various stakeholder groups.

Source Papalexi (2017)

Structure of the supply chain.

Full size image

The pharmaceutical supply chain does not have single dimension and it involves various lines in distribution. For example, when we talk about the upstream area of pharmaceutical supply chain it only involves the pharmaceutical companies that manufacture the goods and this area can have middleman/distributor. The writer believes that the diagram plays an important aim in illustrating the complex pattern of real situation. Literature shows that lack of focus in involved in pharmaceutical supply chain in study (Narayana et al. 2014). Usually, scholars focuses on the processes of upstream business, that brings out rising interest in interactions between the Research & Development and pharmaceutical manufacturing in biotechnology sector (Sen et al. 2013). This study will contribute to the existing lack of focus on the pharmaceutical supply chain system as it investigates the pharmaceutical supply chain practices taking place in the Pakistan.

The above factors impact drug logistics and hinder improvement efforts. However, there is a wealth of research examining inefficiencies in pharmaceutical logistics (Bhakoo et al. 2012; Xie and Breen 2014). The focus of this study is to extend the existing literature by examining the pharmaceutical supply chain system in Pakistan. This will identify factors that affect the system by decreasing performance (in supply chain) applied in pharmaceutical companies of Pakistan. This study raises awareness of such factors that pharmaceutical companies in Pakistan can choose to avoid or take advantage.

3 Methodology

3.1 Context

Phenomenology approach was used, as we wanted to know the shared expressions of experienced managers in pharmaceutical companies (Khan et al. 2022c). Researcher conduct data from interviewee’s by their enliven experience in pharmaceutical firms in Pakistan. The research was exploratory, as the issue has no clear answers in the context of Pakistan. Researcher conducted in-depth interviews with candidates in related fields. Researchers select samples that meet several criteria and answer the research questions to reach for aim and objectives of study (Matthews and Ross 2010; Ishizaka et al. 2023).

3.2 Development of Semi-structured Interviews

Semi-structured interviews are meetings in which the interviewer asks open-ended questions rather than following a rigid, formalized list of questions. The interview included a list of her three-part open-ended questions:

  1. (1)

    The first part relates to general questions about research phenomena and the role of respondents within them.

  2. (2)

    The second part contained questions specific to issues identified through review of the report and previous research, such as factors that impede effective supply chain processes.

  3. (3)

    Part 3 focused on respondents' personal views and beliefs about whether perceived issues related to system inefficiencies could be improved by implementing improvement approaches.

3.3 Qualitative Data Collection

Interviews were conducted from three managers of different pharmaceutical firms. Interviews were used to gather thick description by conducting detailed interviews.

3.4 Data Analysis

Conducting thematic analysis, it is a basic method of qualitative data analysis. This tool allows researchers to identify and analyze themes within the collected data. Our model contains process of five methods to analyze our data gathered through interview. Researcher started to select the significant statements that are related to the study as shown in Table 9.1. Then in Table 9.2, all those significant statements that were extracted from transcription are now converted into formulated meaning that shows the expressions and what interviewees meant. Then in Table 9.3, we formed initial themes by merging similar formulated meaning so we can contextualize our study. In last Table 9.4 shows the formulation of cluster themes by merging of initial themes and then transforming them into emergent themes.

Table 9.1 Qualitative inquiry process
Full size table
Table 9.2 The significant statements
Full size table
Table 9.3 Meaning formulation
Full size table
Table 9.4 Cluster and emergent themes
Full size table

In particular, after the recording has been transcribed and formed into transcription then following steps were followed as shown in Fig. 9.2.

Fig. 9.2
A process flow presents the steps involved in transcription. It involves interview transcription, significant statements, meaning formulation, developing initial themes, and cluster and emergent themes.

Source Author

Steps involve in transcription.

Full size image

4 Higher End Qualitative Analysis

Table 9.1 shows the higher end qualitative analysis where significant statement are separated from the overall transcription.

Table 9.2 shows how meaning is given to the extracted significant statements keeping in mind the context of the situation, setting and the research in mind.

Table 9.3 shows how initial themes are derived from the formulated meaning statements that were extracted from the significant statements.

Table 9.4 shows how Themes clusters are extracted from initial themes that were derived from the formulated meaning statements which were extracted from the significant statements.

4.1 Findings

In Table 9.4, four key emergent themes are taken from the information shared by the managers of pharmaceutical firm in Pakistan. These emergent themes give the main points behind the operational inefficiencies of pharmaceutical supply chain in Pakistan and a how can we overcome by choosing such innovative approaches that can eliminate such inefficiencies. These factors have been classified into four themes, emerge from the data and be interpreted and explained in more detail in the following sections.

  1. 1.

    Government Regulations

  2. 2.

    Product Expertise

  3. 3.

    Continuous Forecasting

  4. 4.

    Technological Advancement

4.2 Government Regulations

Researcher finds out that government regulations are important while conducting business but it negatively affects the business process. Government policies badly affect the process by creating delays in process. Time is important and usually processes takes longer time because of these regulations and should work on minimizing that time. Because delays in any single process affects the whole system of supply chain of pharmaceutical firms (Ghauri et al. 2022).

4.3 Product Expertise

Due to lack of product knowledge, it affects the pharmaceutical supply chain and results as operational inefficiencies. It is high in cost to develop such practice but it lift ups the efficiency of firms operations as by the help of such practice you would have the product knowledge and control in the markets (Maio et al. 2022).

4.4 Continuous Forecasting

Researcher finds out that due to inexperienced situations, which are experienced first time can be challenging and affects the operations of supply chain of pharmaceutical firms. Managers of firm can initiate such approach to overcome such challenges by maintaining proper stock levels all the time and go with more advance real time forecasting tools to avoid such inefficiencies. This can be opt as innovative approach (Jiang et al. 2019).

4.5 Technological Advancement

Due to lack of technology operations of supply chain gets inefficient in pharmaceutical firms and if the pharmaceutical firms invest in new technologies with time so it will result in bringing efficiencies to the operations of supply chain. This can be used as innovative approach by installing new technologies to avoid operation inefficiencies (Zaman et al. 2023a).

5 Conclusion

The purpose of this study was to assess the entire pharmaceutical supply chain within Pakistan. The known issues can be viewed as innovational approaches implemented to amend the supply chain systems of pharmaceutical companies that have inefficiencies in their operations.

This study fills a gap in the literature on supply chain management in pharmaceutical companies in the Asian region of Pakistan. It also contributes to the literature by examining the full extent of the pharmaceutical supply chain, using pharmaceutical companies as central organizations. Previous book chapter examining aspects of the pharmaceutical supply chain focused primarily on the upstream part of his pharmaceutical supply chain, including pharmaceutical manufacturers (Narayana et al. 2014).

The current investigation identifies four key areas of inefficiency affecting his pharmaceutical supply chain in Pakistan: Government regulations, continuous forecasting, product expertise, and technological advancements. In addition, this paper focuses on the issues observed in Pakistan, providing greater clarity on pharmaceutical supply chain processes applied in Asian contexts and allowing generalization of research findings.

5.1 Insights and Implications Post-Covid Practice

This study is intended for exploration and gives useful farther theoretical understanding to development of supply chain strategies. The findings places four critical areas of intercession needed across the pharmaceutical supply chain. These findings may help us understand the operational inefficiencies facing by pharmaceutical companies and guide us to appropriate innovative solutions that can improve levels of efficiency and effectiveness (Ishizaka et al. 2023). This study examines a pharmaceutical company's supply chain in the context of Pakistan. The results of the survey therefore provide information on ineffective practices or best patterns that can be applied in Pakistan. This study focuses on drug supply chain practices in pharmaceutical companies. It is also worth investigating and studying the pharmaceutical supply chains of other healthcare institutions to understand the impact produced by the actions of other stakeholders. While this study provides insight into the factors that can influence the performance of a pharmaceutical business, focusing on a specific pharmaceutical supply chain can add additional information, based on that can make research that is more reliable (Zaman et al.). Future research is needed on the pharmaceutical supply chain strategies that are followed by other different Asian countries and to the opposite side of Asian borders. Additionally, future studies may improve the generalizability of the findings when conducted in other industries, such as the food industry.

5.2 Limitations

Given the relatively high workload of professionals working in pharmaceutical companies, some potential participants were reluctant to participate in this study. Furthermore, the study only focused on pharmaceutical companies, excluding professionals operating in the supplier and consumer sectors. Another obstacle encountered, especially in the data collection process, is related to geographical distance, the researcher only approached potentially reachable participants. Finally, a final limitation of this study arose from how data analysis was performed as the thematic analysis was conducted by the researcher.