Achieving Integrated Green Supply Chains Serving Australian Hospitals

Abstract

The expansion of the health care sector is critical for the natural environment due to the specificities of materials used for providing medical care. Hospitals face the challenge of increased expenses and seek ways to reduce both costs and the negative impact on the natural environment. Moreover, most hospitals’ management still thinks the commitment to environmental requirements is burdening with more costs. Their mentality is still focusing on reducing cost and increasing profit more than investing in the friendly environmental practices.

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Implementing green supply chain management according to ISO 14001 and ISO 9001 is one of the ways to achieve both objectives contemporaneously. From this perspective, the aim of the research is to review potential innovation of Australian hospitals and challenges connected to the transition process. Addressing the research question relevantly and effectively will be of significant practical value due to amending the preconceived perception of ISO 14001 and ISO 90001 standards and integrated green supply chain management in hospitals, and designing the model of transition for one of the hospitals may be helpful for the health care sector as a whole.

Aims

This research study aims to discuss the connection between green supply chain management and ISO 14001 and ISO 9001, as well as to explain the procedures necessary for developing and implementing effective greening processes that comply with the abovementioned standards. These are critical issues for Australian public hospitals, which have grappled with the problem of increased health care expenditures and negative impact on the natural environment due to the growing number of patients, along with the volume of wastes that may be connected to increasing activities over the past decades (World Health Organization 2014). The problem is that, in Australia, public hospitals only start focusing on green supply chain initiatives, and the overall process of shifting to this practice is complex and problematic (Bhakoo, Singh & Sohal 2012). At this stage, supply chains in Australian hospitals are mostly disintegrated because of problems with information sharing, controlling processes, and planning interactions with suppliers and customers, and social costs associated with these challenges are high because they affect the quality of proposed services and care.

To address this problem, the research will build on an innovative framework based on an explanation of the influence of innovation on the traditional organization of business processes. Working in different contexts, similar approaches have been previously used by Bhakoo, Singh, and Sohal (2012) and Camgöz-Akdağ et al. (2016). This study will employ a mixed methods research technique in exploring the connection between the standards and the practice of green supply chain management. This model is widely used in the literature, but this will be the first time it is applied to Melbourne public hospitals using ISO 14001 and 9001 to green their supply chain management processes.

Certain practices are important to be implemented in Australian hospitals to improve supply chain management to overcome challenges associated with high costs, disintegrated processes, and resource-consuming operations. Therefore, the rationale for this study is in the importance of investigating how the application of ISO 14001 and ISO 9001 standards can contribute to building strong integrated green supply chains based on dyadic relationships in Australian hospitals. The research will address the problem of introducing greening procedures by posing the following research question and sub-questions:

Research question

What are the main benefits and challenges of implementing integrated green supply chain management in Australian hospitals?

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Sub-questions

  1. What is the significance of achieving greening in Australian hospitals?
  2. What are effective ways to effect change in management in Melbourne public hospitals?
  3. Why is the application of ISO 14001 and ISO 9001 in the context of integrated green supply chain management appropriate for Australian hospitals?
  4. What integrated green supply chain management procedures, corresponding with ISO 14001 and ISO 9001, are applicable to the sector?

Contribution to Knowledge

The development of the modern health care sector has been impressively rapid due to an increase in the numbers of treated patients and functioning hospitals. Such an increase in the volume of sector operations cannot but affect the condition of the natural environment. The impact of operations in the health care sector, just as in any other industry, on the natural environment has become a common subject of scientific and management interest. In order to minimize this impact, companies and international organizations are striving to develop environmentally friendly approaches to management, an approach generally referred to as green supply chain management – the transition from traditional supply chains to eco-friendly ones (Özkan, Akyürek & Toygar 2016).

The issue is of specific interest to Australian hospitals because the national government is emphasizing the implementation of greening techniques, thus minimizing the negative impact of the health care industry on the natural environment. As a result, it is essential to understand the role of integrated green supply chain management in greening procedures along with the benefits when considering public sector hospitals. The theoretical contribution of this study is in the fact that it will add to the scholarly literature on green supply chain management in Australian public hospitals. Currently, the identified subject of interest has been poorly investigated, especially from the perspective of Melbourne public hospitals that have either already implemented green supply chain management or plan to do so. Therefore, the proposed research offers impressive theoretical significance as the planned study will shed light on all aspects of ISO 14001 and 9001 as well as examine any potential drawbacks and benefits connected to arranging integrated green supply chain management according to the requirements set forth in these two standards (Özkan, Akyürek & Toygar 2016; Zainudin et al. 2014).

The practical contribution of the study is that its results will help managers and administrators in Melbourne public hospitals and other public hospitals in Australia identify and overcome complexities or challenges related to using ISO 14001 and 9001 standards as a foundation for their supply chain management procedures. The findings will be helpful for administrators to choose the most effective ways to apply ISO 14001 and ISO 9001 standards in the Australian context (Bhakoo, Singh & Sohal 2012; Zainudin et al. 2014). In addition, the study findings will contribute to determining the most efficient green supply chain management procedures for the health care sector of Australia with reference to activities of policy makers in this area.

Statement of Significance

In addition to the potential contribution to the existing knowledge, the proposed research offers practical significance as well. It is evident that the major issue that maximizes the study’s significance is the increased impact of the health care sector on the natural environment as well as a rising interest in seeking ways to diminish this influence. The transition to environmentally friendly management strategies as well as legislation strictly controlling the level of impact on the natural environment is a common tendency across most developed states (OECD 2015; Mathew 2015). However, the Australian government is currently taking its first steps in this direction. Thus, numerous challenges and complexities are connected to the abovementioned transition due to a lack of appropriate theoretical and practical instruments and recommendations for making the process effective and productive.

Therefore, it is obvious that the proposed research is of practical significance and can be viewed and explained at several levels. First, it can be helpful for health care units because they will be provided with framework for implementing this transition. Moreover, because the research will incorporate an investigation into practical experience and the implementation of green supply chain management approaches in Melbourne public sector, it can consequently be applied by other health care organizations and units in order to avoid the most common problems as well as maximize benefits. Even more significant, the proposed research can be used by different companies across other industries to modify the experience of the health care sector in addition to learning how to go green. As a result, all of the abovementioned organizations are likely to reduce environmental expenditure along with the volume of resources used to make supply chains more effective. In all, the main argument for believing in the practical significance of the research is the following: the study is likely to eliminate an existing gap in knowledge, thus making green management according to ISO 14001 and 9001 more easily achievable.

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As a result, the proposed research is related to the existing knowledge and associated with theoretical and practical significance that lay stress on the minimization of different types of pollution as the foundation of greening (Purdy 2013; Vincente et al. 2015). As stated, pollution reduction is a minimal requirement of going green as well as the initial step in the transition to eco-friendliness. From this perspective, the research comprises significant potential value and connection to modern knowledge because it is developed and planned with respect to the central problem, which is an environmental control measure. In terms of identified gaps, the value of the proposed research goes beyond mere control measures due to the additional focus on recycling and effective allocation of resources. With that consideration, the study completely corresponds with the current and common knowledge of green supply chain management. In addition, it potentially contributes to the generation of new knowledge following the pursuit of a more comprehensive investigation of green supply chain management according to the recommendations of ISO 14001 and 9001. Furthermore, the study addresses new areas of research – the impact of greening and these standards on Melbourne public sector hospitals, along with the challenges connected to implementing such changes.

Literature Review

Supply Chain Management

Supply chain management is a term that is used referring to the management system that includes such operations as logistics, relations with suppliers, relations with customers, and trade processes. From this perspective, a supply chain is a specific network or a cycle that includes all operations from contacting suppliers to contacting customers (Chege 2012). The aim of supply chain management is the provision of high-quality services or products to satisfy customers’ needs (Zainudin et al. 2014). This network involves a lot of resources to exchange, share, and use in order to achieve the desired outcome. Therefore, managers are interested in finding approaches to making supply chains efficient and sustainable (Chege 2012). Currently, organizations pay much attention to making their supply chains cost-efficient with the focus on the key principles of sustainability.

Integrated Supply Chains

Integrated supply chains are characterized by a high level of integration where each process and operation depends on one another, and they can be viewed as inseparable. This holistic approach to organizing supply chains in the industry allows organizations to control their processes in cooperation with their partners and other stakeholders. Integration is typical of dyadic relationships that are a characteristic feature of supply chains (Nassirnia & Robinson 2013). Furthermore, integration is also possible to be applied to those organizations whose supply chains are organized according to similar principles, as it is in the health care sector (Bhakoo, Singh & Sohal 2012). In addition, integration means the improvement of relationships between organizations, their suppliers, and customers based on the idea of collaboration.

An integrated supply chain can be viewed as more efficient in comparison to other types of supply chains because it allows participants to decrease their costs, achieve higher results due to cooperation, improve controlling and monitoring systems, and maximize profits. Integrated supply chains have such features as information sharing, the focus on collaboration, and the integration of technologies (Nassirnia & Robinson 2013). Organizations receive opportunities to improve their services, focus on profits, control costs, and monitor the quality. However, in spite of their advantages, integrated supply chains are difficult to be applied completely and successfully, and many supply chains remain to be partially integrated or disintegrated (Nassirnia & Robinson 2013). Therefore, it is important to further research approaches to implementing integrated supply chains in different contexts effectively, including the health care industry.

Green Supply Chains

The organization of supply chains reflects modern tendencies in industries, and the focus on overcoming environmental issues and addressing sustainability principles makes companies move to developing green supply chains. Modern organizations understand their responsibilities regarding their impact on the environment and regulate these processes with the help of green supply chain management systems (Chiarini 2015). Green supply chains are typically focused on redesigning operations, reducing wastes and costs, and reusing materials and resources to eliminate negative effects on the environment (Camgöz-Akdağ et al. 2016). Furthermore, organizations also choose to use green materials and remanufacture processes to minimize waste with the help of sustainable designs. From this point, the transition to green supply chain management along with other techniques and strategies aimed at reducing the negative impact of industries on the natural environment is a topic of scientific interest and research.

Still, the health care sector across the globe is in the initial stages of transitioning to green supply chain management because hospital management has only recently begun to develop strategies that correspond with the requirements of ISO 14001 and 9001 (Gerwig 2015; Nolan 2016). To understand the causes of such a slow transition in the health care sector, it is essential to identify the main challenges connected to the implementation of the standards’ requirements. To begin, the allocation of additional resources will be required. These investments are necessary for upgrading technologies and retraining staff. In addition, companies tend to focus on the need for investments, in terms of short-term spending, instead of estimating the value of long-term benefits (Nolan 2016). Because of these two factors, hospitals, like individual companies that operate in other industries, perceive green supply chain management, as well as ISO 14001 and ISO 9001, as a negative development (Chiarini 2015). As a result, the senior management of hospitals may choose to avoid the transition or drag their feet, making the process extremely slow and ineffective. With regard to the ineffectiveness of the transition in such cases, preference is given to decreasing the volume of gas emissions into the atmosphere; at the same time, other critical factors, such as reviewing an approach to hospital operation (namely, the volume of wastes or resources), are commonly ignored.

In addition, according to Toke, Gupta, and Dandekar (2010), the perception of green supply chain management and the necessity to adhere to the recommendations developed in ISO 14001 and ISO 9001 are ambiguous because of constant changes in their understanding. This factor can be explained by the fact that the level of perception of related responsibilities is different. In other words, companies as well as hospitals either believe that they should invest in developing and going green or ignore the criticality of their influence on the natural environment. This is true regardless of the dramatic challenge related to the condition of the planet and natural environment, combined with the risks associated with deleterious developments in this aspect of human activities as a part of the evolution of civilization.

Regardless of the opinions identified and described above, Shen (2013) believes that governments and companies begin to realize the criticality of preserving the natural environment and reducing the impact of civilization on it. According to this assumption, there is a growing awareness of the benefits of green supply chain management, which is connected to an increased green consciousness. As a result, Shen (2013) lays stress on the interconnectedness of the two concepts, thus concluding that higher levels of green awareness are inseparable from the growing popularity of green supply chain management.

Supply Chains in Hospitals in Australia

In Australian hospitals, principles of supply chain management are also realized, but they have some specific features. Managers and administrators in Australian hospitals can experience certain problems while applying supply chain management strategies and practices because of the specifics of the industry (Bhakoo, Singh & Sohal 2012). Supply chains in the health care industry are complex, and they involve physicians and administrators as decision-makers who collaborate with pharmaceutical companies and firms providing equipment as suppliers. The quality of the provided services should be so high that positive patient outcomes are guaranteed. Additionally, supply chains are regulated by state policies, and organizations can experience certain pressures while selecting suppliers to work with (Bhakoo, Singh & Sohal 2012). In Australia, supply chains are extremely important for hospitals as they include manufacturers, distributors, and hospitals as partners, and the effective work of this supply chain influences provided services and patient outcomes.

ISO 14001 and ISO 9001

Nowadays, the transition to green supply chains is commonly observed and based on two international standards: ISO 14001 and ISO 9001 (Rao et al. 2014; Stoimenova, Stoilova & Petrova 2014). ISO 14001 has been developed with an eye to improving environmental practices in all industries, without exception. This standard controls the environmentally friendly management with reference to supply chain processes. ISO 9001 is devoted to improving the overall performance of companies and organizations as well as the quality of manufactured products or delivered services (Chiarini 2015; Moradi et al. 2016). In the context of the supply chain management, this standard is important to guarantee the sustainability of processes and the quality of services. The primary appeal of these two standards is that they are easily applicable to all industries and sectors of the economy as well as to all countries, regardless of the level of their development. Furthermore, these standards are directly related to applying integrated green supply chains in health care organizations in order to minimize negative effects on the environment, eliminate waste, decrease costs, and improve performance.

Gaps in the Research

In summary, some gaps can be noted in the current research of green supply chain management and its benefits, especially in the case of hospitals as a whole and the Australian health care sector in particular. To begin with, opposing views exist regarding the subject under consideration. Moreover, the impact of greening on the health care sector has been poorly investigated. Having to build upon such a scanty foundation, it can be complicated to make proper conclusions regarding the effectiveness of the studied approach. Therefore, there is a need for additional research that would focus on the Australian health care sector and answer all questions related to risks, benefits, and challenges. From this perspective, the main recommendation is to implement as many changes as possible towards going green. Thus, it is recommended that organizations invest in greening according to their financial and human resources and increase the rate of transition to greening as they acquire additional resources.

Methodology

Research Design and Methods

This study is based on the application of ISO 14001 and ISO 9001 standards and the integrated green supply chain management approaches and methods as a conceptual framework for this research. To answer the research questions properly, it is critical to select an appropriate research method. In the case of the proposed research, preference will be given to the combination of both qualitative and quantitative research: the mixed methods research. Several reasons may be named for selecting this approach. First, the study is planned with the aim of addressing the risks and benefits of implementing green supply chain management. In this case, it is better to focus on both the financial and human aspects of the question. The financial aspect is commonly associated with a quantitative approach aimed at establishing cause-and-effect relationships. In particular, reviewing the financial reports of the selected public sector hospital and identifying the main tendencies in environmental expenditures definitely reflects a quantitative aspect.

With regard to the human aspect of the research, in order to estimate the benefits and challenges to the maximum extent, it is essential to understand the perception of greening among those who will be responsible for implementing this process: senior management, administration, and hospital workers. Investigating the perceptions of respondents is a major characteristic of the qualitative approach. Qualitative structured interviews are appropriate for this study to collect data on administrators’ and employees’ perceptions of advantages and disadvantages of applying green supply chains, faced challenges, and identified effective ways to implement ISO 14001 and ISO 9001 standards. An interview protocol should include open-ended questions (e.g., How are ISO 14001 and ISO 9001 standards applied in your organization?). The collected answers will be transcribed and analyzed with the help of NViVo to identify themes.

However, it is imperative to understand why preference was given to the mixed research method. The proposed study is multidimensional in nature. This means that addressing the inquiry from a solely qualitative or quantitative perspective would not answer the research questions in a comprehensive, detailed, and accurate manner. Nevertheless, the mixed methods approach offers other significant benefits. For instance, the combination of two approaches can minimize risks to validity as a result of collecting data from different sources of information (Creswell 2013). Moreover, for the same reason, the chances of making relevant and accurate conclusions are higher (Thonon et al. 2015). The mixed methods approach in research is a more comprehensive process because it provides the reader with a measure of freedom in choosing on which aspect to base his or her perception of the conclusions: qualitative or quantitative.

Research Sample

Two public hospitals selected for the case study analysis in the context of this research are the Alfred Hospital and the Royal Victorian Eye and Ear Hospital. Both hospitals are located in Melbourne, Australia. Representatives of senior management and administration in these hospitals, as well as the hospital staff, including physicians and nurses, will be interviewed for the purpose of this study. These two hospitals are selected to be included in the case study because they specialize in providing different types of services, and this aspect influences characteristics of their supply chains. Furthermore, managers of these hospitals are interested in implementing the principles of integrated green supply chains.

Ethics Approval

The main risks associated with this research are connected to the confidentiality of information, and this is true for both the quantitative and qualitative aspects of the study (Beauchamp & Childress 2013). To mitigate these risks, several steps will be taken. First, all financial data will be collected only after consultation with the senior management of the selected hospitals. Once they are informed about the aims and significance of the proposed study, they will be asked to sign the permission to grant access to the needed information. Here, the management should also be guaranteed that no unnecessary details will be included in the study, and no third persons will have access to the information. This strategy is essential for coping with confidentiality issues related to collecting and analyzing quantitative data.

With regard to qualitative data, the risks are even more significant. In this case, to address confidentiality issues as well as possible misinformation risks, all participants should be provided with any necessary and detailed descriptions of research aims and benefits. Once all of the respondents have been notified of the needed research details, they should be asked to sign consent forms (Foster 2013). In this case, participants should also be guaranteed anonymity, which means that their names and other personal information will not be mentioned in the study or shared with any third persons.

Finally, there are some risks connected to publishing and organizing the research process. First, it is essential to be sure that the hospital administration supports the research and its publication. This factor is connected with the risks of failing to complete the research and properly answer the research questions. To address this risk, it is critical to negotiate the right to carry out the research and publish the research findings before initiating communication with the workers in the selected hospital or collecting information about its performance (Sever 2017).

Research Development

To develop and successfully complete this research study, it is essential to possess certain skills. Some will already have been developed, while others should be elaborated. For instance, past experience of planning and conducting studies makes it possible to conclude that satisfactory skills are in place with regard to academic writing and research development necessary to answer research questions and deliver a final version of the study. Furthermore, to cope with the aims of the research, it will be essential to work on refining interpersonal communication skills. Even in the case of an adequate level of communication skills, it remains necessary to further develop these skills to make it possible to select communication strategies that are appropriate for different categories of participants who are cooperating in the study: senior management, hospital administration and respondents. In addition, it is necessary to continue to work on critical thinking skills to facilitate accurate conclusions. Finally, it is of significant importance to learn to deploy the necessary quantitative and qualitative techniques because they are the foundation of proper research development and accurate conclusions.

Occupational Health and Occupation Risks

In the case of the given research, no health-related risks are involved, including physical, psychological and medical, for either the researcher or the respondents. This can be easily explained by the fact that no experiments, field investigations or laboratory tests are implied by the proposed research. Instead, some occupational risks may arise, specifically in the case of the respondents who are workers within the selected Melbourne public-sector hospital. In this case, the risks are connected with failing to fulfil job duties due to the necessity of communicating with the researcher. In addition, there are some cooperation risks – in other words, the risks of lawsuits because of misunderstanding during the research preparation stage. Finally, occupational risks are connected to failing to identify all critical aspects of the research and properly inform the respondents as well as hospital administration and senior management.

Conclusion

Rapid growth and the expansion of the health care sector are critical factors in the impact of operations in that sector on the natural environment. This can easily be explained by the fact that medical care is characterized by specific and environmentally dangerous materials and resources. Thus, hospitals commonly face increased expenses, and senior management will invariably seek ways to reduce such. The most responsible hospitals tend to work on diminishing the impact of hospital operations on the natural environment. This is commonly achieved by implementing green supply chain management, following ISO 14001 and 9001 to achieve the objectives found in both standards.

Based on the research details mentioned above and the main aims of the proposed study, it is of both practical and theoretical significance. In terms of practice, the study will potentially contribute to the improvement of hospital performance. The introduction of ISO 14001 and 9001 commonly leads to the reduction of expenditures, leading to an increase in efficiency because these resources can be reallocated and invested in green innovation. In terms of addressing all research questions properly and in detail, the practical value of the research cannot be underestimated. In particular, it will be beneficial for designing a model for implementing green supply chain management in Melbourne public-sector hospitals, in addition to offering strategies for making this model operational. As a result, the developed model can be used not only by the hospitals under consideration but also other hospitals in Australia and around the globe, as well as companies and organizations that operate in other industries and sectors. In other words, the model to be developed can be deployed as a practical and theoretical framework for other organizations. In addition, the research is of significant theoretical significance as it will help in coping with existing gaps and will contribute to the generation of new knowledge.

Budget

In the initial stages of creating a research proposal, it can be complicated to identify all the resources necessary for completing the study, especially those of a financial nature. Nevertheless, it is still possible to categorize resources into several groups. The first, intellectual resources, comprises all the skills that were mentioned in the research development section. These are critical because these resources are the foundation of successful research completion and making accurate conclusions. Another group of resources covers financial expenses, which incorporates spending for access to online and ordinary libraries, purchasing necessary reports, books and articles and preparing necessary presentations. In addition, completing work on a thesis requires participation in a conference and publishing research findings. To achieve this objective, further financial resources are necessary. The final stages of working on the thesis may be associated with the need to pay special attention to cooperation with editors and proof-readers, another possible source of expenditure. In all, the preliminary budget of $3000 is assumed to be enough to cover all abovementioned expenses. However, the budget is not fixed, and funds can be added in the case of necessity.

Timeline

2017 2018 2019 2020
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
PhD core coursework
Candidature Proposal
Ethics Approval
Literature Review
Thesis Write up
Conference Attendance/Participation
Methodology Training
Data Collection and Analysis
Conclusion
Thesis Revision and Finalization
Submission

Reference List

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Camgöz-Akdağ, H, Beldek, T, Aldemir, G & Hoşkara, E 2016, ‘Green supply chain management in green hospital operations’, The IIOAB Journal, vol. 7, no. S1, pp. 467–472.

Chege, EN 2012, Green supply chain management practice and supply chain performance of private hospital in Nairobi, Kenya, MBA Thesis, University of Nairobi. Web.

Chiarini, A 2015, Sustainable operations management: advances in strategy and methodology, Springer, New York, NY.

Creswell, J 2013, Research design: qualitative, quantitative, and mixed methods approaches, Sage Publications, Thousand Oaks, CA.

Foster, C 2013, Human dignity in bioethics and law, Bloomsbury Publishing, New York, NY.

Gerwig, K 2015, Greening health care: how hospitals can heal the planet, Oxford University Press, New York, NY.

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Nassirnia, P & Robinson, R 2013, ‘Supply chain integration and chain efficiency: the importance of changing perspective toward whole chain integration’, Journal of Applied Sciences and Engineering Management, vol. 1, no. 1, pp. 13-23.

Nolan, J 2016, ISO 14001 case study for hospitals: how to identify environmental aspects, weblog. Web.

OECD 2015, OECD reviews of health care quality: Japan 2015, OECD Publishing, Paris.

Özkan, O, Akyürek, ÇE & Toygar, ŞA 2016, ‘Green supply chain method in healthcare institutions’, in SS Erçetin (ed), Chaos, complexity and leadership 2014, Springer, Cham, pp. 285-293.

Purdy, T 2013, Designing and implementing a hospital environmental management framework. Web.

Rao, KA, Carp, H, Fischer, RKD & DeCherney, AH 2014, Principles and practice of assisted reproductive technology, Jaypee Brothers Medical, Philadelphia, PA.

Sever, C 2017, Anatomy of writing for publication for nurses, 3rd edn, Sigma Theta Tau International, Indianapolis, IN.

Shen, ZJM 2013, ‘Green supply chain design and management’, in F Chen, Y Liu & G Hua (eds), LTLGB 2012: proceedings of international conference on low-carbon transportation and logistics, and green buildings, Springe, Beijing, pp. 5-7.

Stoimenova, A, Stoilova, A & Petrova, G 2014, ‘ISO 9001 certification for hospitals in Bulgaria: does it help service?’, Biotechnology & Biotechnological Equipment, vol. 28, no. 2, pp. 372-378.

Thonon, F, Boulkedid, R, Teixeira, M, Gottot, S, Saghatchian, M & Alberti, C 2015, ‘Identifying potential indicators to measure the outcome of translational cancer research: a mixed methods approach’, Health Research Policy and Systems, vol. 13, no. 1, pp. 13-72.

Toke, LK, Gupta, RC, & Dandekar, M 2010, Green supply chain management: critical research and practices. Web.

Vincente, SG, Suarez-Varela, MM, Monros, AM & Gonzalez, AL 2015, ‘Development of certified environmental management in hospital and outpatient hemodialysis units’, Nefrologia, vol. 35, no. 6, pp. 539-546.

World Health Organization 2014, Safe management of wastes from health-care activities, 2nd edn, WHO Press, Geneva.

Zainudin, MZ, Habidin, NF, Roslan, MH, Norazlan, ANI & Abdul Hadji, S 2014, ‘Green supply chain management and environment performance in Malaysian healthcare industry’, European Journal of Academic Essays, vol. 1, no. 6, pp. 22-27.

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