A PORTER-SCOR MODELING APPROACH FOR THE

HOSPITAL SUPPLY CHAIN

C. DI MARTINELLYa, F. RIANEa, A. GUINETb

a
Centre de Recherche en Gestion Industrielle, FUCAM, Mons-Belgique, dimartinelly@fucam.ac.be
b
Laboratoire PRISMA, INSA de Lyon, Lyon-France, alain.guinet@insa-lyon.fr

Abstract: This article proposes a conceptual approach to model the pharmaceuticals supply chain.
In a first time, we position it towards the hospital supply chain to ensure that the changes made lead
to a global improvement. To apprehend this complex reality we need a modeling framework. In a
first time, we use the Porter’s model to identify the best strategy to follow according to the market
context. We then identify activities that generate value for care. To go further in our analysis, we
need a modeling tool. We tend to apply the SCOR model to describe processes, to make
comparisons between practices to get benchmarks and to define performance measures. The
description of activities is made through logical diagrams to allow for simulation.
Keywords: pharmaceuticals supply chain, modeling, Porter, SCOR

1 Introduction
European hospitals are facing today challenges similar to those faced by industrial
firms twenty years ago. The healthcare organizations have to deal with a changing
environment and accelerated technological development both in medical equipments and in
managing tools. There is now competition between hospitals and Governments force them
to rationalize expenses by cutting subsidizes. Therefore, logistics has gained much attention
in the sense that they may increase efficiency and flexibility of organizations as logistical
costs make up a significant part of annual budget, up to 40% according to a study lead by
Landry (Landry and Beaulieu, 2000) in several countries. The main logistics activities are
patient oriented, clinic pharmacy, laundry, catering, administrative and technical support
(AS GHC, 2002). Its objective is to determine the most efficient way to dispense care
(Dallery, 2004). Among these activities, the pharmacy amounts for half of the logistic
expenses. Therefore, the optimization of its working can lead to interesting cost savings.
Before claiming to optimize the pharmaceuticals supply chain while considering the
hospital working, it is first necessary to analyze and diagnose the current situation. We thus
need a modeling framework to apprehend the complex reality of a hospital. In this paper we
adapt global approaches from the enterprise modeling to the healthcare sector. We use the
current working of a Belgian hospital as starting point to our study. In a first time, we use
the Porter’s model to identify activities that generate value for care. In a second time, we
use the SCOR model to describe the processes of the supply chain and to define
performance indicators. Finally, activities are described through logical diagrams to allow
for simulation.

2 Problem description
The purpose of the pharmaceuticals supply chain is to guarantee a safety and
traceable dispense of drugs in each hospital department, under regulation constraints.
 The illustration 1 highlights the different steps to put medicine at patient’s disposal
and the specificities of the supply chain. The different actors are also identified.
Care units and medico-technical units

Specialists

Nurses
Care process

Patients Patients

Prescribe Administer

Prescription

Advanced
inventories

Dispense

- prescriptions analysis
- medicine preparation
- information

Pharmacists
List consumption
Deliver
List of patients’
consumption

General
inventory

Fix the price of

Supply
pharmaceuticals
Prices of
pharmaceuticals
Order form

Pharmacy
Suppliers

Illustration 1: The pharmaceuticals supply chain

• Providers: the pharmaceuticals market is dominated by few firms providing a large
range of products from medical equipment to drugs. The pharmaceuticals selling
prices to patients are imposed by INAMI (Institut National d’Assurance Maladie
Invalidité) in Belgium.
• Inventory and general pharmacy: there are numerous legal constraints on pharmacist
activities and pharmaceuticals dispensing, storage and reimbursement.
Furthermore, the drugs inventory management is made more complex by the wide
variety of products, volume and packaging, the use-by date management, the
specific storage conditions (fridge, secured space for narcotics…).
• Advanced inventories: each medical unit has a pharmaceuticals inventory locally
managed by nurses. The management process is different from care unit to
medico-technical unit. These stocks tend to be oversized because the care process
can’t be delayed and the nurses take extra stocks to prevent from any shortage.
• Care process: like advanced inventories management, the care process is different
from care unit to medico-technical unit. For instance, pharmaceuticals dispense
should be nominative in a unit of care but the prescription is made after the
dispensing in a medico-technical unit. In addition, the care process, which is at
the root of drugs demand, is highly influenced by the human factor.
 • Information flows: These flows are of primary importance to ensure a proper
dispensing. There are several software’s on the market that manage the pharmacy
and pharmaceuticals dispensing but in most cases they don’t manage magistery
preparations, total parenteral nutrition and cytostatics. These products amount for
more than 30% of drugs dispensing in some hospitals. The information flow
should allow prescriptions, contraindications of a medicine, traceability (for
instance for products such as blood), finance activities (invoicing, third party
payers information, insurance),... .
• Actors: there are numerous people involved in the process and they should have a
technical and a medicine competence. The pharmaceutical flow is therefore
managed independently.
• Pharmaceuticals demand: it is initiated by a prescription or a medical order. The
demand is therefore dependent on the patient flow and is twice random because
both the patient’s number and the patient’s characteristics are unknown.

We have found few papers on the pharmaceuticals supply chain in the literature. This
lack of researches can be due to legal aspects, numerous constraints and human factor
influence (Beretz, 2002). Table 1 summarizes the researches done on the healthcare supply
chain. We use a classification system based on the decision level and the problem scope.
strategic tactical operational
Chabrol et al ., 2005 Besombes et al. , 2004
Organisational
Ducq et al. , 2004
design
Staccini et al. , 2004
Staccini et al. , 2004
Information
Colin et al. , 2004
system
Romeyer et al ., 2004
Rossetti et al. , 1998
Resources sizing
Rossetti and Selandari, 2001
Beaulieu and Patinaude, 2004 Taher H., 2006 Baboli et al. , 2003
Inventory Dellaert and Van De Poel, 1996
management Epstein and Dexter, 2000
Lapierre and Ruiz, 2003
Timetabling Lapierre et al. , 2003
Planning Fontan et al. , 2004
Banerjea et al. , 1998
Distribution
Hassan et al. , 2003

Table 1: Classification of healthcare supply chain researches

Most of the articles related to the pharmaceuticals supply chain mainly focus on a
single problem such as inventory management, distribution or sizing and don’t take into
account the rest of the supply chain. However some recent papers on the hospital supply
chain adopt a process-oriented view to design the information system (Colin et al., 2004;
Staccini et al., 2004) or to set up a new organizational design (Besombes et al., 2004;
Chabrol et al., 2005; Staccini et al., 2004). These researches are based on the patient flow
and adopt a modeling transverse to the organizational and functional design.
The identified problematics have been already studied in industrial management and
can potentially be adapted to the healthcare sector. Authors like Groot et al. (1993) and
Flagle (2002) considered a hospital like a production centre with specificities but enough
common characteristics, the timely deployment of scarce resources to meet a critical and
partly uncontrollable demand, to applied OR techniques largely used in industrial
management.
The literature reviews provided by Thomas (Thomas and Griffin, 1996) and Slats
(Slats et al., 1995) enhance the numerous studies already made on these problems. The
taxonomy used by Min (Min and Zhou, 2002) to classify the recent works done highlights
the lack of researches done on the whole supply chain. These studies are however needed to
lead to a global optimization: local optimization does indeed not strive for the optimization
of the whole. The same problem occurs in healthcare management. We need to study the
whole hospital supply chain to be sure that the changes made to the pharmaceuticals supply
chain lead to a global improvement.

2.1 Modeling approach

Before attempting to analyze and claim to optimize a complex organization like a
hospital, it is first advisable to understand its working. Therefore, the modeling approach is
well suited and can also be used as tool of representation, communication, and analysis.
This will enable a better comprehension of the way the real system work, the nature and the
logics of interactions between the various actors around actions and operations and to
identify malfunctioning.
There are numerous modeling approaches based on common methodologies but using
different point of views and analysis levels. However, as far as we know, there is no
methodology or referent dedicated to the healthcare sector.
We choose a process modeling approach that seems well suited for the healthcare
sector (Artiba et al., 2004) and that had been successfully applied to hospital projects
(Besombes et al., 2004; Chu et al., 2000; Fontan et al., 2004; Staccini et al., 2001; Staccini
et al., 2004, Su et al., 2003). We use the Porter’s model (Porter, 1985) as framework to
support our approach. The model is indeed process-oriented and has been already applied to
diagnose the American healthcare system (Porter and Teisberg, 2004). It has also been used
as framework model to design a medico-technical unit (Besombes et al., 2004). It helps us
to identify and structure the processes that we model to analyze the value creates for care.

2.1.1 The adapted Porter’s model

The value chain is a tool to diagnose the competitive advantage of a firm and plays a
valuable role in designing its organizational structure. There are two steps in the approach.
In a first time, an analysis of the industry and competitors determines the strategy
appropriate for gaining a competitive advantage. In a second time, the use of Porter’s model
will help a firm to put the generic strategy into practices.
The structural analysis of the industry is needed to evaluate the collective strength of
five forces: the entry of new competitors, the threat of substitutes, the bargaining power of
buyers, the bargaining power of suppliers and the rivalry among existing competitors.
These five forces determine the industry profitability (influence on costs, prices and
required investments) and the appropriateness of a firm strategy and activities that can
contribute to performance.
The five forces identified for our problematic are:
 • The pharmaceutical groups are the main suppliers of hospitals. They provide them
with drugs and medical materials. Their bargaining power is relatively high
although the prices of pharmaceuticals are fixed by state.
• The threat of new entrants is relative light because of the investments needed to set
up a hospital and of government’s policies. The healthcare sector in Belgium is
highly regulated and partly subsidized by public funds. The new legislation
released in 2002 ultimately reduced the number of subsidized beds.
• The patients are the buyers. They have limited information on care partly because
services are highly customized. Furthermore, the care prices are in great part fixed
by state. The buyers’ choice is mainly based on the quality perceived and their
sensitivity.
• The threat of substitutes, like unconventional medicine, is in our opinion, relatively
low. Furthermore, the costs of these unconventional medicines are high for the
patients because they are not reimbursed.
• The rivalry between hospitals is mainly based on services, reputation and quality.
There are very few private hospitals in Belgium (mainly for esthetical care).

However, the Porter’s model has been designed for the private sector (in the United
States, the healthcare sector is largely private as a majority of American activities). On the
contrary, the healthcare sector is state-controlled in Belgium, as in many other European
countries: a great part of hospitals annual budget is funded by State. Government and para-
governmental agencies play an active role and influence competition between hospitals.
Among other things they impose cost of care, cost of pharmaceuticals products, they define
the rules of competition between the hospitals,… .
To take into account this reality, we add a sixth competitive force, the regulator,
which has an influence on each of the five other forces, as shown in illustration 2. In the
private sector, the sixth competitive force is mainly played by the market that regulates the
competition between firms. However, Governments also intervene by setting commercial
rules.
Hospitals provide a service as base product. As researches done by Langlois
(Langlois and Tocquer, 1992) show it, firms providing a service as base product can gain a
competitive advantage by developing clients’ relations and reducing costs. However, sole
cost cutting objectives are not the solution on the long term. The American health system,
largely private and subject to more competition than virtually any place in the world, has
unsatisfactory performance in both costs and quality partly because of this wrong objective
of cost reduction (Porter and Teisberg, 2004). The client’s relations are influenced by the
perceived quality of care and prices. Hospitals have therefore to improve the quality of care
while maintaining costs under control. Hospitals can work on medical and/or managerial
activities to implement this strategy.
 Potential
entrants

Regulator
Threat of new
entrants

Bargaining power Industry Bargaining power

Suppliers of suppliers of buyers Buyers
competitors

Threat of substitute
products

Regulator
Substitutes

Illustration 2: The six competitive forces of the healthcare sector

From the medical point of view, numerous studies show that when physicians or
teams treat a high volume of patients who have a particular disease or condition, they create
better outcomes and lower costs. In healthcare, as in most industries, cost and quality can
improve simultaneously as providers prevent errors, boost efficiency and develop expertise.
The idea is to develop hospitals networks, each specialized, to provide an efficient
geographic cover at lower cost for each care service. Furthermore, the collaboration
between hospitals can increase their bargaining power towards pharmaceuticals groups and
therefore lead to better sales conditions. However the development of such networks will
take time and the results will only be significant on the long term.
From the managerial point of view, we will interest to the supply chain. We apply the
value chain analysis to identify activities that create value for care and to configure them in
order to minimize costs, given the hospital competitive strategy, the improvement of care
quality while maintaining costs under control.
The notion of “value” in the healthcare sector is composed of two elements: the
quality of care for the patient and the economical value in the sense of productivity and
competitiveness of the production system of care (Besombes et al., 2004). The performance
of the system is measured by the efficiency and effectiveness of activities that use
technical, human and financial resources to produce care of quality for the patient (Lebas,
1995).
The links between activities have an impact on hospital performance and costs. The
model will help us to highlight links between the hospital main activity, patient’s care, and
one of hospital support activities, the pharmaceuticals supply chain and to estimate the
impact of a pharmaceutical process modification on the care process.
The illustration 3 is our adaptation of the Porter’s model to the hospital, based on the
study of a Belgian healthcare center. We rename each of the categories to be closer to the
hospital terminology. The primary processes are activities devoted to care patients. The
support processes support primary activities by providing human, technical and material
resources. Primary activities are divided into 5 sub-categories.
 • Admission logistics: processes associated with patient’s admission and management
of their documents.
• Care: processes associated with care dispensing and their management.
• Discharge logistics: processes associated with patient’s discharge.
• Marketing and sales: processes associated with the financial return of care:
invoicing to patient and third party payers, information exchange with state-
controlled organization, price setting activities.
• Service: processes associated with care activities and that can add value to care.

As we mentioned it earlier in this paper, the objective of the pharmaceuticals supply

chain is to put medicine at patient’s disposal. Patients receive drugs under treatment. The
demand coming from a unit of care triggers the activity of the pharmaceuticals supply chain
and occurs during the patient’s stay. Among these processes, the different Porter’s
categories can also be identified.
• Inbound logistics: processes associated with pharmaceuticals purchase and
reception.
• Production: processes associated with pharmaceuticals preparation.
• Outbound logistics: processes associated with the distribution throughout the
hospital.
• Price setting: processes associated with the pharmaceuticals price setting,
reimbursement demand, ... .
• Service: processes associated with pharmaceuticals testing, pharmaceuticals care.

These activities produce value for the medical staff, third party payer and patients and
are for the most part legally defined. They come intrinsically within the competences of the
pharmacists. Pharmacy support processes are less specific and are mainly the same as those
of the hospital. Among them, the information system has to support a perfect coordination
between the patient’s flow and the pharmaceuticals flow to allow an optimal management
and a correct invoicing. Value is based on the ability to coordinate the activities from the
pharmaceuticals and hospital supply chain.
As we mentioned it earlier in this paper, the starting point of our study is the case of a
Belgian hospital that set up a new organizational structure for its pharmacy. The application
of the Porter’s model (illustration 3) helps us to identify processes that create value for care
and to identify some malfunctioning, for instance, repeated activities. All activities directly
implied in the ordering, preparation, warehousing, delivery and traceability of drugs
(primary activities) add value to care and are specific to the clinic pharmacy. We also
identified some repeated activities like invoicing (invoicing for hospital stay and invoicing
for pharmaceuticals). We have to reorganize processes. To do so and because of the
complexity of the hospital working, a global approach is needed to apprehend the reality. A
modeling tool is needed to communicate, to use a common language, to make comparisons
between practices to get benchmark. Furthermore, performance measures must be defined
to characterize the situation and evaluate the impact of process modifications. We therefore
choose to apply the SCOR model (Supply Chain Operations Reference model) that is a
global approach to analyze, evaluate and improve the supply chain and that is largely used
in industrial management.
 Hospital

Hospital infrastructure

Recruiting and training people for admission

Recruiting and training emergency medical technicians

Recruiting and training nurses and physicians Human Resource Management

Recruiting pharmacists

Recruiting and training administrative personnel

Decision support system for diagnoses

Automated prescription software

Planning and scheduling sofware Technology development

Automated dispensing system

Care value

Linen

Cattering

Waste management Procurement

ADMISSION CARE DISCHARGE MARKETING & SERVICE

LOGISTICS LOGISTICS SALES

Patient admission
Patient’s diagnostic
Patient’s discharge
Invoicing
« Taxi service »

Emergencies
Prescription
Patient ‘s tranfert to
Insurance
«home hospitalisation »

Patient treatment in care other medical
Ambulatory
units and in medico- establishments
Office visit
technical units

Planning and scheduling
for patient treatment

Planning and scheduling
for medico-technical units

Analyses

Drugs dispense

Drugs management

Clinic pharmacy
Hospital infrastructure
Human Resource Management
Technology development
Procurement

Care value
INBOUND OPERATIONS OUTBOUND MARKETING & SERVICE
LOGISTICS LOGISTICS SALES

Pharmaceuticals and
Pharmaceuticals
Pharmaceuticals and
Pricing
Validation of prescription
materials ordering preparation and control materials distribution in

Pharmaceuticals and
pharmaceuticals care unit and medico-
materials reception and packaging technical units
control
Inventory management
Fill in cabinets for

Inventory management of final products medecines
of « parts » products
Pharmaceuticals return
management

Illustration 3: Porter’s model adapted to hospital

2.1.2 The SCOR Model (SCC, 1996)

The Supply Chain Council (SCC), a not-for-profit organization established in 1996
that now has over 650 organizations members worldwide, has developed the SCOR model,
a framework that takes into account the whole supply chain and integrates the strategic
decision making. It is a process reference model which is intended to be an industrial
standard and that provides a structure for linking business objectives to supply chain
operations. It contains a standard description of management processes, a framework of
relationships among the standard processes, standard metrics to measure process
performance, management practices that produce best-in-class performance, and a standard
alignment to software features and functionality (Huang et al., 2005).
We apply SCOR to our problematic to make operational our first analyze made with
the Porter’s model. It is well suited for our problematic for three main reasons. Firstly, the
SCOR model has been already applied to the healthcare sector and more precisely to the
downstream pharmaceuticals supply chain (Baboli et al., 2005) as a diagnostic tool.
Secondly, the healthcare sector needs standards to communicate. As we mentioned it
earlier, the development of care network should allow providing better outcomes in care at
lowest costs. European governments favor this strategy as it can rationalize the offer of
care. SCOR provides standard processes and indicators. The performance measures defined
on the basis of standard processes will allow comparisons between hospitals, benchmarks
and the definition of best practices that yield the optimal overall performance. Thirdly, our
ultimate goal is to tend to optimize the pharmaceuticals supply chain. We therefore need to
reorganize some processes and the SCOR description provides us a framework model to
redesign them given strategic objectives.
We adapt the model used by Baboli et al. (2005) to describe the pharmaceuticals
supply chain and we add a layer, the hospital supply chain. In fact, the pharmaceuticals
supply chain is part of the hospital supply chain and is not isolated. The supply chain
working of the hospital has an influence on the pharmaceuticals supply chain. There is
numerous information coming from the patient’s treatment that determine the drugs flow.
The type of drugs is conditioned by the hospital strategy: if a hospital gets a specialization
in cancer research, the clinical pharmacy will contain more cytostatics and there will be
more fridges to store them. The hospital physical organization determines the delivery
frequency. Illustration 4 shows our adaptation of SCOR model on process categories. We
rename process categories to be closer to the healthcare reality.
• Admit: processes that describe patient’s admission in a hospital. We identify 4 main
types of admission processes.
• Treat: processes that apply a treatment to care patients. Treatment processes take
place in a unit of care or in medico-technical units.
• Discharge: processes that discharge patient to another medical establishment or to
home.
• Return: processes associated with patient’s transfer to a more appropriate medical
establishment or with a new treatment for a patient.
• Plan: processes that balance care demand and care supply/capacity to develop a
course of actions which best meets admission, treatment and discharge requirements.
The definition of performance indicators takes place at level 3 with the description of
process elements. For each process elements, input and output information are identified
and five types of performance attributes can be defined. Illustrations 5 and 6 give an
overview of a process element description.
The description and the identification of indicators will help us to diagnose and to
quantify the current pharmaceuticals supply chain organization. It is a prerequisite before
tempting to optimize its working.
The level 4 of the SCOR Model is the implementation level where each process
element is decomposed into activities. The SCOR model doesn’t provide a framework to
make this description. We therefore use logical diagrams (Cattan et al., 1998) to describe
activities. We identify actors, inputs and outputs, activities, their logic and sequence.
Illustration 7is a logical diagram of one process element.
 Plan

Patient’s flow
Admit Treat Discharge

A1: in-patient planned
T1: in-patient planned
D1: in-patient planned

A2: in-patient in emergency
T2: in-patient in emergency
D2: in-patient in emergency

A3: outpatient planned
T3: outpatient planned
D3: outpatient planned

A4: outpatient in emergency
T4: outpatient in emergency
D4: outpatient in emergency

Return treat Return discharge

RT1: transfer to another medical
RD1: new treatment
establishment

Enable

Plan
pharmaceuticals flow
Materials and

Source Make Deliver

S1: source specialities
M1: make specialities
DE1: deliver specialities

S2: source medical materials
M2: make medical materials
DE2: deliver medical materials

S3: source pharmaceuticals bulk products
M3: make pharmaceuticals bulk products
DE3: deliver pharmaceuticals bulk products

Return Return

SR1: return defective pharmaceuticals
DR1: return defective pharmaceuticals (use-

by-date, damaged packaging,…)

SR3: return excess pharmaceuticals


DR3: return excess pharmaceuticals

Enable
Illustration 4: Level 2 description of hospital supply chain.
Patient’s

Admission types plan

Hospital
flow

Hospital organisation
supply framework

Medico-technical units
chain organisation
Materials and pharmaceuticals

Pharmaceuticals sourcing plan

Production pharmaceuticals
schedule
Product pull signals
Input
Replenishment signal
Sourced pharmaceuticals
Pharmaceuticals inventory
Payment terms
(inventory management rules) location

Defective pharmaceuticals

Excess pharmaceuticals
flow

Schedule product Authorize supplier

Receive product Verify product Transfer product
delivery payement

Scheduled receipts
Inventory availability

Output
Sourced pharmaceuticals
Receipt verification
Receipt verification
Daily replenishment
on order requirements

Illustration 5: SCOR level 3 description: source specialties.

 Schedule specialities delivery

Performance attributes Metric

Reliability % Schedules generated within supplier's lead time
Responsiveness Schedule specialities deliveries cycle time
Flexibility N.I.
Costs Schedule deliveries costs as a % of specialities acquisition costs
Assets Return on SC assets

Illustration 6: Performance attributes for a level 3 process element description

The logical diagrams allow us for identifying responsibilities, adding information on
event-driven aspects of activities and the rules of resources availability. This description is
necessary to model the working of the pharmaceuticals supply chain and to use a simulation
tool, RAO (Di Martinelly, 2004). The use of a simulation model will allow us to test
different organization scenarios and to follow the variation of performance indicators
during the system walk. This approach has been used several times to reorganize or to size
care units before implementing the solution (Cahill and Render, 1999; Dumas, 1984; El
Darzi et al., 1998; Vissers et al., 1998;…).

3 Conclusion
Healthcare organizations are currently facing new challenges similar to those faced
by industrial firms twenty years ago. Logistics activities have therefore gained much
attention in the sense that it may increase efficiency and flexibility. Among them, the
pharmaceuticals supply chain activities amount for half of the total costs. The optimization
of their working could lead to interesting cost savings. However, we have to be sure that the
changes made lead to a global improvements. The pharmaceuticals supply chain has to be
considered in relation with the hospital supply chain.
Before claiming to optimize the working of the pharmaceuticals supply chain while
considering the hospital activities, it is first necessary to analyze and diagnose the current
situation. We thus need a modeling framework to apprehend this complex reality. In a first
time, we use the Porter’s model to identify the best strategy to follow according to the
market context. We then identify activities that generate value for care. All activities
directly implied in the ordering, preparation, warehousing, delivery and traceability of
drugs (primary activities of the pharmaceuticals supply chain) add value to care and are
specific to the clinic pharmacy. The support processes are less specific and are mainly the
same as those of the hospital and have to support a perfect coordination between the
patient’s and the pharmaceuticals flows. To go further in our analysis, we need a modeling
tool. We tend to apply the SCOR model to describe processes, to make comparisons
between practices to get benchmarks and to define performance measures. The process-
oriented approach is well adapted to our problematic because it describes processes
transverse to the organizational and functional design. Links between activities are
therefore more obvious. The SCOR model gives a modeling framework that allows clear
communication. However the definition of performance indicators should be made
cautiously and should be filled in by a decision view to clearly identify responsibilities to
ensure coherence between objectives definition and performance measurement. We also
use logical diagrams to describe each process element. We identify responsibilities, we add
information on event-driven aspects of activities and the rules of resources activities. The
use of logical diagrams will allow us to simulate the working of the hospital supply chain,
to follow the variation of performance indicators during the system walk and to test
different reorganization scenarios for optimization.
Schedule products delivery

Providers Pharmacy Care units Medico-technical units

Consultation plan Intervention plan

Prescriptions Prescriptions

Collect
prescriptions for Manage local
pharmaceuticals inventories
ordering

Prescriptions

Replenishment
signal?

Yes

Order
pharmaceuticals

Make
(SCOR level Medical orders
2 process)

Pharmaceuticals

Return defective Return defective

or excess or excess
Deliver pharmaceuticals pharmaceuticals
pharmaceuticals
(SCOR level 2
process) Pharmaceuticals Pharmaceuticals

Manage
inventories

Replenihment
signal?

Yes

Order
pharmaceuticals

Orders

Order

Pharmaceuticals Receive
pharmaceuticals
(SCOR level 3
process)

Illustration 8: Description of a process element: “schedule product delivery”

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5 Biography
CHRISTINE DI MARTINELLY studied business at the Catholic University of Mons. Since
2002, she is PHD student and teaching assistant at the group of Prof. RIANE. She is mainly
interested in healthcare management and supply chain.
FOUAD RIANE is professor at the Catholic University of Mons. He is director of the
CREGI. His main research interests are supply chain management and maintenance.
ALAIN GUINET is professor at Institut National des Sciences Appliquées de Lyon. His main
research interests are operating theatre planning, staffing and scheduling, hospital logistics.