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The 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study is to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout.

A single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019.

In total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout.

This paper explores a previously under researched area on stressors and potential burnout in 999 call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers.

This paper aims to evaluate the implementation of innovative programmes within the downstream domain of the pharmaceutical supply chain (PSC), with the aim of informing improved service provision.

A mixed-method approach was used to assess to what extent innovation could be adopted by hospital and community pharmacies to improve the delivery process of pharmaceutical products. Unstructured interviews and 130 questionnaires were collected and analysed to identify factors that facilitate or prevent innovation within PSC processes.

The analysis led to the creation of the innovative pharmaceutical supply chain framework (IPSCF) that provides guidance to health-care organisations about how supply chain management problems could be addressed by implementing innovative approaches. The results also indicated that the implementation of Lean and Reverse Logistics (RL) practices, supported by integrated information technology systems, can help health-care organisations to enhance their delivery in terms of quality (products and service quality), visibility (knowledge and information sharing), speed (response to customers and suppliers needs) and cost (minimisation of cost and waste).

The study’s recommendations have potential implications for supply chain theory and practice, particularly for pharmacies in terms of innovation adoption. The IPSCF provides guidance to pharmacies and health-care organisations to develop more efficient and effective supply chain strategies.

This research contributes to the academic literature as it adds novel theoretical insights to highly complex delivery process innovation.

This study aims to explore the downstream pharmaceutical supply chain (PSC) and provides insight to the delivery process of medicines and associated operational inefficiencies.

An exploratory, qualitative approach was adopted to examine PSC inefficiency within two European contexts, namely, the UK and Greece. Data was gathered through interviews and a thematic analysis conducted to analyse the data and identify challenges faced by both supply chains(SCs).

The medicines delivery system needs to be enhanced in terms of quality, visibility, speed and cost to perform effectively. The findings demonstrated that although the healthcare SCs in the two European contexts have different operational structures, the results are in concordance with each other. Financial, communication, waste and complexity issues were the major concerns.

To the knowledge this is the first study to examine aspects of the medicines SC via a cross-case analysis in the UK and Greece and extends the body of knowledge. A broader sample of responses is warranted to further validate these findings.

The study outputs can inform pharmacies’ strategic to instigate targeted improvement interventions. The implications of which may be extrapolated further to other European healthcare organisations.

This research contributes to the academic literature by adding further theoretical insights to SC strategy development, especially those that have been characterised as highly complex. The study identifies four key areas of intervention needed within this SC (in both countries) to promote higher level efficiencies and effectiveness.

The purpose of this study was to advance the knowledge of pharmaceutical supply chain (PSC) resilience using complex adaptive system theory (CAS).

An exploratory research design, which adopted a qualitative approach was used to achieve the study’s research objective. Qualitative data were gathered through 23 semi-structured interviews with key supply chain actors across the PSC in the UK.

The findings demonstrate that CAS, as a theory, provides a systemic approach to understanding PSC resilience by taking into consideration the various elements (environment, PSC characteristics, vulnerabilities and resilience strategies) that make up the entire system. It also provides explanations for key findings, such as the impact of power, conflict and complexity in the PSC, which are influenced by the interactions between supply chain actors and as such increase its susceptibility to the negative impact of disruption. Furthermore, the antecedents for building resilience strategies were the outcome of the decision-making process referred to as co-evolution from a CAS perspective.

Based on the data collected, the study was able to reflect on the relationships, interactions and interfaces between actors in the PSC using the CAS theory, which supports the proposition that resilience strategies can be adopted by supply chain actors to enhance this service supply chain. This is a novel empirical study of resilience across multiple levels of the PSC and as such adds valuable new knowledge about the phenomenon and the use of CAS theory as a vehicle for exploration and knowledge construction in other supply chains.

This study aims to explore the effect of power-based behaviours on pharmaceutical supply chain (PSC) resilience.

This study used a mixed-method approach to explore the role of power-based behaviours in PSC resilience. Qualitative interviews from 23 key PSC stakeholders, followed by thematic analysis, revealed the underlying perceptions regarding PSC resilience. Quantitative propositions were then developed based on the themes adopted from PSC resilience literature and the qualitative findings. These were tested via a survey questionnaire administered to 106 key stakeholders across the various levels in the PSC. Structural equation modelling with partial least squares was used to analyse the data.

The data analysed identified proactive and reactive strategies as resilience strategies in the PSC. However, power-based behaviours represented by quota systems, information and price control influenced these resilience strategies. From a complex adaptive system (CAS) perspective, the authors found that when power-based behaviours were exhibited, the interactions between PSC actors were mixed. There was a negative influence on reactive strategies and a positive influence on proactive strategies. The analysis also showed that PSC complexities measured by stringent regulations, long lead times and complex production moderated the effect of power-based behaviour on reactive strategies. Thus, the negative impact of power-based behaviours on reactive strategies stemmed from PSC complexities.

This research particularly reveals the role of power-based behaviours in building PSC resilience. By evaluating the nexus from a CAS perspective, the analysis considered power-based behaviours and the moderating role of PSC complexities in developing resilience strategies. This study considers the interactions of PSC actors. This study shows that power asymmetry is a relational concept that inhibits the efficacy of reactive strategies. This study thus advocates the importance of power in achieving a more resilient PSC from a holistic perspective by highlighting the importance of the decision-making process among supply chain (SC) partners. The findings are particularly relevant if PSC resilience is viewed as a CAS. All the interactions and decision-making processes affect outcomes because of their inherent complexities. Although this study focused on the PSC, its implications could be extended to other SCs.

The authors identified that power-based behaviours influenced resilience strategies. It was detrimental to reactive strategies because of the complexities of the PSC but beneficial to proactive strategies through resource-sharing. PSC actors are therefore encouraged to pursue proactive strategies as this may aid in mitigating the impact of disruptions. However, power-based behaviours bred partner dissatisfaction. This dissatisfaction may occur even within strategic alliances indicating that power could be detrimental to proactive strategies. Therefore, it is pertinent to identify conditions that lead to dissatisfaction when pursuing strategic partnerships. This study provides insight into actual behaviours influencing resilience and quantifies their effects on the PSC. These insights will be valuable for all SC partners wanting to improve their resilience strategies.

Previous PSC management and resilience studies have not examined the role of power in building resilience in the PSC. This paper thus provides a unique contribution by identifying the role of power in PSC resilience, offers empirical evidence and a novel theoretical perspective for future practice and research in building PSC resilience strategies.

Medicine shortages have a detrimental impact on stakeholders in the pharmaceutical supply chain (PSC). Existing studies suggest that building resilience strategies can mitigate the effects of these shortages. As such, this research aims to examine whether resilience strategies can reduce the impact of medicine shortages in the United Kingdom's (UK) PSC.

A sequential mixed-methods approach that involved qualitative and quantitative research enquiry was employed in this study. The data were collected using semi-structured interviews with 23 key UK PSC actors at the qualitative stage. During the quantitative phase, 106 respondents completed the survey questionnaires. The data were analysed using partial least square-structural equation modelling (PLS-SEM).

The results revealed that reactive and proactive elements of resilience strategies helped tackle medicine shortages. Reactive strategies increased relational issues such as behavioural uncertainty, whilst proactive strategies mitigated them.

The findings suggest that PSC managers and decision-makers can benefit from adopting structural flexibility and proactive strategies, which are cost-effective measures to tackle medicine shortages. Also engaging in strategic alliances as a proactive strategy mitigates relational issues that may arise in a complex supply chain (SC).

This study is the first to provide empirical evidence of the impact of resilience strategies in mitigating medicine shortages in the UK's PSC.

This research aims to design a green pharmaceutical supply chain (PSC) that reduces preventable pharmaceutical waste and effectively disposes of inevitable pharmaceutical waste. The main output of this study is the formulation of an integrated green PSC model involving all critical stakeholders, leading to improved environmental, economic and safety performance in medication management and delivery.

The research is based on literature and on secondary resources.

To green the PSC, every producer of waste is duty bound to facilitate the safe handling and disposal of waste. A cross boundary green PSC (XGPSC) approach is proposed to identify participants' contribution to the PSC. Peripheral influences are also recognised from professional and regulatory bodies.

This study focuses solely on community PSC in the UK where patients receive medication from local community pharmacies and thus may be limited. The proposed XGPSC approach also needs to be tested and validated in practice. It may also be difficult to transfer some of the environmental practices proposed in this research into practice.

The environmental practices and actions proposed provide invaluable insight into various PSC activities, including purchasing, product design, prescription patterns and processes, medication use review, and customer relationship management.

The proposed environmental actions encourage firm commitment from everyone to reduce, recycle or effectively dispose of pharmaceutical waste, with patients becoming stewards of medication rather than only consumers.

A cross boundary approach is developed to green the PSC, which encourages total involvement and collaboration from all participants in PSC.

This study aims to provide insights into the scale and use of information and communication technology (ICT) in managing medical devices in the National Health Service (NHS), with a focus on reverse exchange (RE) systems as a part of the broader reverse logistics (RL) systems, within which medical devices are returned and exchanged.

Two case studies were conducted with NHS Hospital Trusts, whilst another was built upon secondary resources. Primary findings were triangulated with the information collected from the NHS Trusts’ reports, direct observation and a preliminary round of consultations with 12 health-care professionals working in other NHS Trusts or Integrated Equipment Community Services.

The findings of this paper suggest that the sophistication of ICT implementation increases with the risks and value associated with medical devices. Operational attributes are derived from ICT implementations which can positively affect RE performance. The forces that drive the adoption of ICT in the NHS include pressure from government, business partners and patients; competitive pressure; perceived benefits; organisation size; top management support; and the availability of sufficient resources. Obstacles are mainly centred around the lack of sufficient resources.

Although the trusts that participated in this research are representative of different regions, the generalisation of the study results may be limited by the size of the sample organisations, so the results can only provide insights into the research problem. As this work is exploratory in nature, there is insufficient data on which to form definitive recommendations.

NHS Trusts may use the six operational attributes identified and verified by the case studies to benchmark their ICT implementation for device management. The actual and potential benefits of ICT implementation could inform technology development and encourage the uptake of ICT in healthcare. Governmental bodies can utilise this information to develop directives to actively drive ICT adoption in device management and the associated RE system. A well-considered training programme is needed to improve staff ICT skills to fully realise the potential of ICT systems which support the effective RE of medical devices.

The results of this paper suggest that the reverse management of medical devices backs up the supply chain attained through using ICT, which in turn reduces capital costs, medical risk and increases the finance available for frontline medical treatment.

This research aims to conduct an exploratory analysis into current industrial reverse logistics practice in business‐to‐business (B2B) and business‐to‐customer relationships (B2C), and determine the financial and operational impact of customer non‐compliance in returning distribution equipment back to their source.

The analysis was conducted over multiple industry sectors using qualitative research techniques. The research sample included seven industry sectors, providing a response rate of 72 per cent (53 sources approached). The focus was on both B2B and B2C relationships to determine similarities and differences in financial and operational repercussions.

The research findings indicate that the efficacy of the reverse logistics system can be undermined by lack of customer compliance, with losses of up to £140 million (B2B).

In both B2B and B2C relationships, there is evidence of suppliers suffering financial loss due to customer non‐compliance. Due to the small scale of the analysis and the breadth of the industry sectors investigated, these results are not generalisable, but do indicate that this is an area, which could undermine supply chain effectiveness.

Non‐compliance of this nature carries a direct and highly applicable cost for manufacturers and distributors in the practitioner arena. Suppliers within industry need to acknowledge this issue and manage their reverse logistics more effectively.

This paper adopts an innovative focus on an understated feature of the reverse logistics cycle, i.e. the recycling of distribution equipment used to transport outbound and returned products. The paper identifies a range of options, which practitioners can use as guidance when managing the returns system.