An Integrated Lean-Green Performance Evaluation Framework for the Social Security Organization's Hospital Supply Chain

Introduction: Improving quality, increasing efficiency, and controlling costs while reducing the negative environmental consequences of hospital supply chain (HSC) operations have called for both managers and researchers to pay attention to both lean and green paradigms simultaneously. In response to this need, the present study aims to provide a framework for evaluating lean and green performance in one of the major hospital supply chains in Iran, using the balanced scorecard tool.

Methods: First, a comprehensive list of 44 lean and green performance criteria was extracted from the history of manufacturing and service supply chains. These criteria were then refined using the fuzzy Delphi technique, based on the five principles of accessibility, relevance, reliability, ease of measurement, and comprehensibility. This process resulted in 33 criteria, which were classified under six strategic objectives across five dimensions: economic, stakeholder satisfaction, care and treatment processes, growth and learning, and environment. Next, fuzzy DEMATEL was employed to determine the key degree of the identified goals and criteria, and to understand the role of each in the lean and green performance evaluation system of the HSC.

Results and Discussion: The results indicate that the strategic goal of "earning a reasonable and sustainable profit for the continuity and development of services" plays the most critical role. In contrast, the strategic goal of "improving environmental performance" has the least critical role in the network of strategic goals within the supply chain under study. Additionally, "improving green performance" and "implementing care and treatment processes that are fast, timely, effective, reliable, efficient, cost-effective, standardized, safe, and free from defects and errors" are goals with a causal function. "Earning a reasonable and sustainable profit for the continuity and development of services" and "increasing the satisfaction of the patient and their companions, and having satisfied, loyal, and stable employees" are goals with a causal function. "Developing human and organizational capital" is a goal with a causal relationship. In the economic dimension, "management efficiency" and "current ratio" are the most critical criteria for achieving the strategic goal of "earning a reasonable and sustainable profit." The "complaint rate" and "employee satisfaction" are the most critical criteria for achieving the strategic goal of "increasing patient and companion satisfaction and having satisfied, loyal, and stable employees." "Patient length of stay" and "cost of services" are the most critical criteria for achieving the goal of "implementing care and treatment processes that are fast, timely, effective, reliable, efficient, affordable, standardized, safe, and free from defects and errors" within the supply chain under study. Furthermore, the research findings indicate that "training" and "effective employee participation" are the most critical criteria for ensuring the "development of human and organizational capital" within the supply chain under study. Lastly, "waste recycling" and "amount of solid waste generated" are the most critical criteria for monitoring the goal of "improving environmental performance" within the supply chain under study.

Conclusions: While most recent studies have focused on either the lean or green paradigms when designing frameworks and systems for assessing healthcare supply chain performance, the main innovation of the present study lies in designing a framework that integrates both concepts simultaneously. The proposed framework of this study helps to identify potential deviations in the lean and green aspects of operations in the HSC and provides a basis for evaluating chain actions and initiatives to reduce waste and improve environmental performance.