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Link to original published version: http://dx.doi.org/10.1108/13598541211212195
Citation: Xie Y and Breen L (2012) Greening community pharmaceutical supply chain in UK: a
cross boundary approach. Supply Chain Management: An International Journal. 17(1): 40-53.
Copyright statement: © 2012 Emerald Group Publishing Limited. Full-text reproduced in
accordance with the publisher’s self-archiving policy.
Greening community pharmaceutical supply chain in UK: a cross boundary approach
Abstract
Purpose
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.
Design/Methodology/Approach
The research is based on literature and on secondary resources.
Findings
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.
Research limitations/implications
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.
Practical implications:
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.
Social implications:
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.
Originality/value:
A cross boundary approach is developed to green the PSC, and it encourages total involvement
and collaboration from all participants in PSC.
Keywords:
Green supply chain, pharmaceutical supply chain, environmental practices.
Paper type:
Conceptual
1.
Introduction
Awareness of the world’s environmental issues such as global warming, carbon emissions, toxic
substance usage, and resource scarcity has escalated over the past decades. Policy makers and
activists are advocating for going green, and many organisations throughout the world have
responded to this by applying green principles. Wu and Dunn (1995) designed an
environmentally friendly supply chain (SC) for a single organisation where greening starts from
procurement and works its way through to storage, distribution and end-consumers. However,
the chain does not include cross company activities. To effectively manage products from start to
finish, green principles must be embedded and evident across the entire SC. Printing industries
such as Hewlett-Packard, IBM, Xerox and Digital Equipment Corporation have made their SC green
via integrating suppliers, distributors and relocating facilities (Ashley, 1993; Bergstrom, 1993;
Gillett, 1993 and Maxie, 1994). Xerox have taken environmental consciousness a step further by
supporting more environmentally friendly decision-making in the integrated SC and reducing the
negative impact from the SC (McIntyre et al, 1998).
The concept of Green SC Management (GSCM) emerged in the late 1990s, and encompasses the
reactive monitoring of general environmental management programs, moving to more proactive
practices such as the recycling, reclamation, remanufacturing and reverse logistics (RL), as well as
incorporating innovations (Zhu and Sarkis, 2004). For the last 20 years, GSCM has been adopted
by the companies to lower environmental risks and raise ecological efficiency, therefore to
achieve profit and increase market share (Van Hoek, 1999). Realising the significance of the
GSCM implemented by organisations, Sarkis (2003) developed a strategic decision framework
that aids managerial decision making in selecting GSCM alternatives. The foundations of this
decision framework are: product life cycle, operational life cycle (including procurement,
production, distribution and RL), organisational performance measurements and environmentally
conscious business practices. Considering the literature that addressed various elements of
GSCM (Carter et al., 1998; Walton et al., 1998; Zsidisin and Hendrick, 1998), Zhu and Sarkis
(2004) developed four categories of GSCM practices, i.e., internal environmental management,
external GSCM, investment recovery, and eco-design or design for environment practices. The
relationship between the practices and environmental and economic performance were examined
through empirical studies in the Chinese manufacturers.
The Pharmaceutical SC (PSC) is a special SC in which medications are produced, transported and
consumed. Academic researchers and practitioners believe that “pharmaceuticals are different;
they cannot be treated like other commodities” (Savage et al, 2006, p12). The reasons for this
sentiment were the high cost and long duration for research and development, and the
repercussions of the product not being available, hence again its criticality. Other unsupported
perception-based factors that appear to make this SC distinctive include: the level of regulation in
the product production, storage, distribution, consumption and the complexity of the fabric of
this SC (Knight, 2005).
Medication is produced and prescribed in large volumes every year, e.g., over 100 tonnes of
medications were prescribed in Germany in 1995 (Ternes, 1998), and over 100 tonnes of the top
three compounds medications (paracetamol, melformin hydrocholoride and ibuprofen) are
prescribed in the UK each year (Jones et al., 2002). Disposal of expired/unwanted medication can
be very costly and harmful to the environment, and medications have been detected in sewage
effluent (Ternes, 1998, Ternes et al., 1999; Daughton and Ternes 1999), surface water (Buser et
al., 1998), groundwater and even drinking water (Halling-Sorensen et al., 1998; Heberer 2002).
To help healthcare organisations and other producers meet legislative environmental
requirements, the Department of Health produced a series of guidance on best practice waste
management, e.g., “Disposal of Pharmaceutical Waste in Community Pharmacies” (Department of
Health, 2007), and “Safe Management of Healthcare Waste” (Department of Health, 2006). In line
with the guidance, community pharmacies are bound by contractual obligation to offer a returns
service for medication (Department of Health, 2008; Bellingham, 2004), the strategic aim of
which is to facilitate safe disposal, remove excessive storage of medicines in the home and to
reduce the environmental damage from inappropriate disposal methods. However, the research
shows that customer compliance in returning the medicines is low, which becomes an obstacle to
develop effective healthcare waste management in the community PSC. According to an
investigation into the disposal habits of the American public, only 1.4% of people return unused
drug to the pharmacy, while 54% throw them away and 35.4% flush them into the sink or toilet
(Kuspis and Krenzelok, 1996). Similarly, a survey conducted in south eastern England revealed
that 63.2% people discard unwanted drugs in household waste, 21.8% return them to a
pharmacist, and 11.5% empty them into the sink or toilet (Bound and Vouvoulis, 2005). The
survey indicates that the predominant method of disposal expired/unwanted drug in the UK is via
household waste, which causes environmental pollution.
Globally, in 2003 at least £0.56 billion worth of unused medications were flushed down the toilet
(Van Eijken, et al., 2003). From an economic point of view, efficiencies can be made in the form
of potential savings in pulling back stock from patients. Medication retrieved from patients
cannot be re-used and must be disposed of. It does however provide vital information and can
encourage more prudent prescribing. Safety is also paramount when broaching pharmaceutical
management and storage. Accidents can happen if products fall into the hands of children or
individuals who wish to abuse the product themselves or support a ‘grey’ market for product
exchange/sale for cash.
With the increasing focus on pharmaceutical waste management (Breen and Xie, 2009), there is
more pressure than ever to effectively green the PSC i.e., correctly disposing of
expired/unwanted medications and reducing the level of preventable pharmaceutical waste. As a
result of greening processes, the PSC will become safer when hazardous medications are
removed from the SC and kept away from vulnerable people, like children. However, there is very
little research and practice on medication recycling (Ritchie et al., 2000) or greening the PSC.
As explained above, it is vitally important to properly dispose of expired/unwanted medication
because of its hazardous nature, and it is even more critical for every producer of medication to
take actions on reducing waste. The fate of unused consumer pharmaceuticals is an issue that
has reached public consciousness more recently. There is emerging concern about the potential
impact of pharmaceuticals that reaches lakes and rivers via sewage plants and other sources
(New Hampshire Department of Environmental Services, 2009).
This research aims to design a green community PSC that reduces preventable pharmaceutical
waste and effectively disposes of inevitable pharmaceutical waste, using a XGPSC approach that
requires every participant in the PSC to take environmental practices. In Section 2, the research
framework and methodology are established; then a community PSC encompassing a RL system
is designed in Section 3; and the XGPSC approach is proposed in Section 4. Section 5 concludes
the paper summarising the findings, and research limitations. Future research is identified in
Section 6.
2.
Research framework and methodology
The objectives to meet the research aim are: i) design a physical network for community PSC
incorporating a RL system; ii) explore the roles of individual participants in delivering
environmental practices within the PSC; and iii) develop a XGPSC approach, in which the
environmental practices underpinning greening the PSC are identified from a broad perspective.
The proposed research framework is shown in Figure 1. It supports the proposition that a RL
system needs to be incoporated into the PSC network and each participant in the PSC adopts the
XGPSC approach, undertaking necessary environmental practices to green the PSC. Such a
combination of a PSC network and environmental practices can be complex, collaborative, costly
and different from other business sectors on the basis that the PSC is a special SC. As such it
would be impossible to conduct any empirical study to test any practice prior to a systematic
conceptual approach being formulated. Therefore, the community PSC network incorporating a
RL system and the XGPSC approach are designed as theoretical models, and developed from the
literature review and other secondary resources.
Take in Figure 1
A research literature review is defined as “ a systematic, explicit, and reproducible design for
identifying, evaluating, and interpreting the existing body of completed and recorded work
produced by researchers, scholars and practitioners” (Fink, 2005, p3). A literature review has
been well adopted by the researchers in the field of SC and logistics management to summarise
the existing research findings (e.g., Fleischmann et al, 1997, Croom et al, 2000, Power, 2005,
Burgess et al., 2006), to evaluate the research methodologies (e.g., Croom et al, 2000, Burgess et
al., 2006), or to develop theories and conceptual models (e.g., Seuring and Muller, 2008).
In this research, a comprehensive literature review was conducted with the aim of constructing
the theoretical foundation for the development of the physical PSC network and the XGPSC
approach, as shown in Figure 2. The theoretical foundation is composed of four parts: Part A: the
drivers and pressures for pharmaceutical waste management, the current service provision
(including the guidance and regulations provided by the professional bodies), and future
expectations; Part B: the obstacles, restrictions and limitations encountered in current provision;
Part C: the RL system design and applications; and Part D: the GSCM practices serving as the
evidence base from which appropriate environmental practices are to be adopted or moderated
for the participants in the PSC. The PSC network incorporating the RL system and the XGPSC
approach are developed from Part C and D respectively, while Parts A and B have the influences
on the development.
Take in Figure 2
2.1
Literature search and categorisation
To ensure the quality of the articles selected, the literature review focused on peer reviewed
journals that were retrieved from electronic journal databases, publications from professional
bodies that are accessible from their websites, and survey reports provided by pharmacies.
Part A of the theoretical foundation was identified by reviewing the literature in the areas of
pharmaceutical waste management, which were mainly sourced from professional pharmacy
journals. The authors also analysed the results of the pharmaceutical waste audit conducted by
Rowlands Pharmacy covering 462 branches in England and Wales. The audit outputs identified
costs attributed to wastage and reasons for waste levels. This information has been incorporated
into this study. The negative environmental impacts of pharmaceutical disposal were
investigated using environmental science journals.
The publications, surveys and legislations on pharmaceutical waste management were sourced
from the websites of the National Health Service (NHS), the Department of Health, and the Royal
Pharmaceutical Society of Great Britain (RPSGB), in order to obtain an overview on the current
service provision of the pharmaceutical waste management for Part A, and identify the obstacles,
restrictions and limitations for Part B. The Department of Health is a UK government department
with responsibility for health, social care and the NHS. The RPSGB is the statutory regulatory and
professional body for pharmacists and pharmacy technicians in UK, with the main objectives to
lead, regulate, develop and promote the pharmaceutical professions. These bodies have a
peripheral influence on pharmaceutical waste management, and the information acquired from
these bodies provides insights into the current pharmaceutical waste systems, contemporary
regulations and improvements. Information and data was also collected from other reliable
internet resources, such as environmental companies who provide services for environmental
improvement e.g. the PHS management group plc. The collation and triangulation of multiple
sources as identified present a realistic portrayal of the stakeholders in the PSC and the current
status quo.
Part C focuses on the definition of RL, the theoretical framework of RL design, and case studies of
RL application. Due to the limitation of literature on PSC, the forward logistics of the PSC network
is designed by specifying the roles of the participants in the generic SC network. The prevailing
RL theories and the successful RL implementations in other industrial sectors enable the current
RL models to be revised and built into the PSC network, focusing on establishing returning
channels, to achieve research objective i). The RL functions and roles within the operational
product life cycle are also reviewed to understand the environmental practices that the
participants in the PSC can take, which will be addressed in research objective ii).
Furthermore, the GSCM literature is reviewed to construct the evidence base in the Part D. To
achieve the research objectives ii) and iii), the GSCM practices are reviewed for all the participants
in the SC, from suppliers to the end customers. To identify the most appropriate environmental
practices for the XGPSC approach, the organisational research and implementation of GSCM are
analysed and compared, and the prescriptive models evaluating the GSCM practices and
technologies are also reviewed.
2.2
The development of the PSC network and the XGPSC approach.
Considering the individuality of the PSC, the roles and interactions of the participants in the PSC,
a RL system is built into the PSC network to deliver Part A, solve the problems in Part B, and
provide a physical network to realise the XGPSC approach, as shown in Figure-2.
Regarding the XGPSC approach, it is found that there is strong relationship between the GSCM
practices and positive environmental and economic performance (Zhu and Sarkis, 2004), and the
further studies compare the drivers, practices and performances of GSCM in different Chinese
industrial sectors (Zhu and Sarkis, 2006, Zhu et al., 2006). These studies indicate that
environmental and economic performance are not greatly improved if the GSCM implementation
is poor, especially when the cross functional cooperation is weak. The research outcomes from
Zhu and Sarkis (2004) and Zhu et al. (2006) are in line with the aim of this research and their
research findings are validated in the follow-on research, so the GSCM practices developed in Zhu
and Sarkis (2004) are adopted, moderated and customised for the participants in the GPSC. Zhu
and Sarkis (2004) also highlight that GSCM practices are integrative and are not oriented to a
single function or department, which underpins the philosophy of the XGPSC approach that
encourages cross functional cooperation among the participants in the PSC.
3.
A community PSC network with reverse logistics
As identified in Sarkis (2003), RL is one of the most important but least developed operational
functionthat serves as a foundation for GSCM practices. RL is defined as “the process of planning,
implementing and controlling the efficient, cost-effective flow of raw materials, in process
inventory, finished goods and related information from the point of consumption to the point of
origin for the purpose of recapturing or creating value or for proper disposal” (Rogers and
Tibben-Lembke, 1999, p2). RL facilitates return of products for recycling in many sectors, like
automobile (Lebreton and Tuma, 2006), electronic waste (Lau and Wang, 2009; Nagurney and
Toyasaki, 2005), computer (Shih, 2001), paper (Pati et al., 2008), packaging material (GonzálezTorre et al. 2004), bottling or glass (González-Torre and Adenso-Díaz, 2006) and batteries (Zhou
et al., 2007); this can be both for re-use or disposal. As one of the few research studies applying
RL in the medical area, Breen and Xie (2009) proposed an integrative customer relationship
management (CRM) facilitated RL system in UK community pharmacy for environmental,
economic and safety reasons.
Considering the operations of a community PSC in UK, a preliminary community PSC network is
designed and presented in Figure 3, where a forward logistics network is depicted in which
medication is produced by the pharmaceutical manufacturer, transported by the logistics
providers to community pharmacies, and finally is consumed by customers who can be patients
or buyers. The figure also incorporates a RL network for the expired/unwanted medications to be
returned to the manufacturer. The expired/unwanted medications are encouraged to be returned
for two reasons (Breen and Xie, 2009): i) it removes the product from circulation and from the
domestic environment therefore reducing the risk of accidental injury or planned product abuse;
ii) it provides valuable information which can be used to assess the efficiency of the prescribing
process (who the prescriber is, the nature of the product and the quantity dispensed).
Take in Figure 3
As shown in Figure 3, a RL network is one of the key resources needed to facilitate product
recycling. A channel must be available for the expired medication to be sent back to
manufacturers, and can be built in a number of ways: i) customers return the expired/unwanted
medication to the pharmacies or the GPs in person, and the pharmacies or the GPs return them
back to manufacturer via the logistics providers; ii) the pharmacies return the unsold or expired
medications to manufacturer when appropriate; and iii) logistics providers or wholesalers get
involved in the system acting as either independent operators, carrying out functions such as
collecting, sorting, recycling and disposing, or cooperating with other actors in the system (de la
Fuente et al., 2007; Krumwiede and Sheu, 2002). The dashed line in Figure 3 represents the
recycling channel for expired medication.
In the process of recycling, logistics providers or wholesalers take the role of collecting from the
community pharmacy and transporting to manufacturers or suitable places for disposal. The
manufacturers, logistics providers/wholesalers, GPs and community pharmacies are classified as
direct participants in the PSC because their roles and activities have a direct impact on the
performance of the PSC, while the professional and regulatory bodies influence PSC indirectly via
offering suggestions to the direct participants. In the middle of Figure 3, guidance and
instructions from professional and regulatory bodies (RPSGB, Department of Health, or waste
management agencies etc.) will be given to the direct participants in the PSC, and have a
peripheral influence on the actions taken by direct participants.
Although RL has a great influence in greening the SC, recycling behaviours are classified as
proactive green approaches, and the most far-reaching approach is value-seeking (Van Hoek,
1999). This is where companies consciously integrate environmental practices into their business
strategy (Kopicki et al., 1993). Medications returned by customers cannot be re-used and must be
disposed of, therefore they have no residual value. The value therein in effectively recycling such
products is increased environmental protection, economic savings (in using the information
retrieved to manage future prescribing) and safety considerations. As illustrated in the shaded
boxes in Figure 3, the participants in the PSC are expected to reduce medication waste by
integrating environmental practices into their ‘normal’ activities. The specific actions to be taken
by the participants to reduce waste will be discussed in the next section.
4.
A Cross boundary Green PSC (XGPSC) approach
To green the community PSC, not only a physical PSC network needs to be constructed, but also
GSCM practices should be implemented by all participants in the chain from the holistic system
perspective, to minimise the total environmental impact of a business (Van Hoek, 1999).
From the literature, the drivers of green PSC are summarised as environmental, economic and
safety considerations, the supposition being that instigating greener practices will improve
performance in these areas. It has been argued that new opportunities of competition can be
realised (Hansmann and Kroger,2001) and organisations can benefit if environmental actions are
undertaken (Alvarez Gil et al., 2001). The opportunities and benefits can be improved
organisational reputation (Welford, 1995), reduced cost, improved organisational efficiency,
increased market share, getting ahead of competitors and legislation, access to new markets, and
increased employee motivation (Porter and van der Linde, 1995; Shrivastava, 1995; Beaumont et
al., 1993; Guimaraes and Liska, 1995).
Using empirical results from 186 respondents on GSCM practice in Chinese manufacturing
enterprises, Zhu and Sarkis (2004), found that an organization’s environmental and economic
performances are improved if they apply the four GSCM practices, i.e., internal environmental
management, external GSCM, investment recovery, and eco-design or design for environment
practices. Internal environmental management requires commitment and support from senior
managers in the organisation, as well as the implementation of total quality environmental
management and audit programmes. The external GSCM practices focus on cooperation between
suppliers and customers for environmental objectives, e.g., communication on product design,
clean production and green packaging. The investment recovery is a traditional business practice
in which excess inventories/materials are resold, or the scrap/used materials are resold. The ecodesign requires organisations involved in manufacturing processes to design products which
consume less new materials by adopting reusable or recyclable materials, and reduce the use of
hazardous components. The investment recovery practice is not applicable to the PSC as returned
medication to community pharmacies cannot be reused or resold. So the three categories of
GSCM practices except investment recovery (i.e., internal environmental management, external
GSCM, and eco-design) will be used to develop a XGPSC approach.
As shown in Figure-1 participants are encouraged to adopt environmental practices to green the
PSC, and to improve environmental and economic performances. Considering the hazards that
the out-of-date and unused medicines pose on children and other vulnerable people, a green PSC
reduces excess medicines in households, and therefore reduces the propensity for these groups
to take the expired/unwanted medications, which ultimately leads to improved safety
performance of the PSC.
Based on the three categories of GSCM practices adopted from Zhu and Sarkis (2004), the XGPSC
approach is proposed in Figure 4 to encourage participants to adopt environmental practices in
order to convert the community PSC in Figure 3 to be a green PSC. The XGPSC approach
recommends the adoption of the following four environmental practices: i) top management
commitment: each participant in the PSC commits to GSCM, as evidenced by the top management
team and environmental management system; ii) supplier certification and cooperation: each
participant should evaluate their suppliers’ environmental practices and work with suppliers in
developing joint environmental objectives; iii) customer cooperation: each participant should
cooperate with customers or support them critical processes such as proper recycling or
disposal; and iv) eco-design: the participant should become involved in the manufacturing
process, designing products for reduced materials/energy, for reuse, recycle, recovery of
materials, and for the reduced use of hazardous components.
Take in Figure-4
Recommendations i) and iv) are classified as internal environmental management that take place
inside an organisation and play key roles in improving the orgnisational performance (Carter et
al., 1998). Recommendations ii) and iii) are external environmental practices that are more
difficult to implement and require information, support and collaboration from other participants.
However, to successfully green the PSC, the recommended practices are integrative and need
cross-functional cooperation (Xie, 2009). The recommendations are henceforth applied to the
various participants in the PSC as detailed below.
4.1 The Manufacturer
i) Top management support: As the producer and designer of pharmaceutical products,
manufacturers can contribute to the green PSC through innovative and environmentally friendly
medication designs. The commitment to GSCM from the management team is essential to realise
and ensure total green operational processes covering procurement, production, distribution and
RL. It is also recommended that an environmental management system should be designed to
improve the total quality environmental management and ISO14000 certification achieved (GEMI,
2001). To monitor and evaluate the organisation and its suppliers’ practices, a series of
environmental compliance and auditing programmes should be set up (Zhu and Sarkis, 2004).
ii) Supplier certification and cooperation: Florida (1996) claims that close bonds with suppliers
facilitate cleaner production. Supplier selection and procurement decisions have a positive impact
on the GPSC through the procurement of materials that are hazardous or non-hazardous,
recyclable or reusable, or have already been recycled (Sarkis, 2003). Therefore manufacturers are
encouraged to develop green purchasing strategies (Green et al., 1998, Murray, 2000) that add
environmental, health and safety elements to their strategic sourcing initiatives, and provide a
practical resource for procurement staff to understand and pursue opportunities that will add
business value to their companies (GEMI, 2001). In choosing new suppliers, those with
ISO14000certification are preferable to lessen the environmental risks associated with material
procurement.
iii) Customer cooperation: By collaborating with customers (the wholesalers or the pharmacies in
this research) and increasing transparency regarding design specifications and recycling
opportunities (of products), manufacturers can contribute to innovative medication designs,
cleaner production methods/processes and green packaging (Zhu and Sarkis, 2004).
A strong relationship with wholesalers and pharmacies will encourage recyclable packaging
provided that this RL channel is available. Manufacturers can also support this if they provide
effective RL channels and communicate the essential nature of this activity to their customers.
iv) Eco-design: According to Kreisberg, 2007, medication can be designed to be more ecologically
sensitive, e.g., biodegraded more quickly, more efficient for lower doses, or less harmful. The
shelf life of medication can be brought into closer alignment with real time by refining the
expiration dates. In terms of medication packaging, recyclable materials can be used; the
package can be designed by adding more complete/direct information about proper ways of
disposal; and the package shapes and sizes can be designed for easy returning and
transportation (e.g., mail back returning). In addition, multiple choice of packaging size can be
made available for the GPs or pharmacists to minimise prescription quantity.
4.2 The wholesaler and logistics providers
The development of a RL system enables pharmacies to transport all unsold or expired
medications as products back through these firms to the manufacturer for credit. The activities of
transportation in the RL system can be implemented by the wholesaler, or the logistics providers
including third party logistics (3PL) companies (Meade and Sarkis, 2002). Any expired items that
do not meet the manufacturers’ return policies are automatically disposed of (Smith, 2002).
Waste movement and disposal in the RL system needs to be effectively managed by wholesalers
and logistics providers, for the purpose of greening PSC.
i) Customer cooperation: The role of the wholesaler is to support manufacturing operations
through warehousing and distributing stock to community and hospital pharmacies. They have
an established logistics network and so are well placed to enhance their service package through
RL activities (Breen, 2004). They provide such a service for their own products (manufactured by
their company or their customers) in retrieving defective products e.g. short-dated or incorrect
items. The role of a 3PL has been investigated in a hospital pharmacy with a view to consolidating
deliveries. Wholesalers can provide such a service in their current position in the PSC (Breen,
2004).
The services provided by the wholesaler and logistics providers can go beyond transportation
(Dowlatshahi, 2000), and include gatekeeping (Caldwell, 1999), collection (Schwartz, 2000;
Rogers and Tibben-Lembke, 1999), classification, warehousing (Dowlatshahi, 2000),
manifestation, destruction, and disposal of medications (Schwartz, 200). If the wholesalers or the
logistics companies act as the waste management brokers, they are expected to classify and
segregate the medication according to the hazardous or non-hazardous characteristics, and then
manage them under appropriate streams (Smith, 2002). Employing them in the RL network can
reduce the amount of pharmaceutical waste generated and disposed improperly. But it is
important to select a wholesaler or logistics provider that complies with environmental
regulations, and acquires licenses for these services before they are contracted.
4.3 General Practitioner
i)
Supplier certification and cooperation: General Practitioners (GPs) should evaluate their
pharmacy suppliers’ environmentally friendly practices and support them in developing greener
processes/systems/activities. MURs are thought to have a vital role to play in medication
management (Lammy, 2007), and Dispensed Review of the Use of Medicines (DRUMs) are
regularly conducted by GPs and community pharmacies (as part of NHS contract obligations) to
improve the way that medications are used, to reduce unnecessary medication in circulation and
to make informed decisions regarding pack sizes and synchronization as advised by the National
Prescribing Centre etc (NHS Cumbria, 2009). The DRUM can be conducted based on the
medication and patients’ information recorded in the GPs’ databse.
ii)
Customer cooperation: A GP plays an important role in the community PSC, as s/he is the
first point the patient (customer) contacts in the chain, providing an ideal point to educate the
patient as to how to properly dispose of or return the unused medications.
According to a waste audit conducted by Rowlands Pharmacy (2009), GPs sometimes might have
prescribed medication for a longer period than customers’ need, which results in unused
medication accumulating in households. Therefore, GPs need to consider the timeframe needed
for prescriptions prior to dispensing. Shorter periods of prescriptions have been trialed in Canada
based on 7-14 days (Paterson and Anderson, 2002). Haughton (2003) suggested the
development of a database to monitor the distribution of prescription and Over-The-Counter
(OTC) medications (information on the OTC medications is difficult to obtain at the present),
which can more accurately predict the presence of medication waste in households. Therefore, it
is proposed that an efficient Management Information System (MIS) is developed for GPs, with a
database built in, where patients’ consultation and personal details will also be recorded,
together with Medicines Use Reviews (MUR) results, to facilitate GPs to monitor patients’ progress
and remind them to return pharmaceuticals via text, call or email.
4.4 Community Pharmacies
Community pharmacies play different roles in the process of greening the PSC: i) they are
customers of the pharmaceutical manufacturers, and are responsible for communicating with
manufacturers or wholesalers regarding product information; ii) they are a communication point
with customers for advice and education on the proper disposal of medication; iii) they act as an
accessible site for customers returning back unwanted/unused medication; iv) and they act as a
site where pharmacists conduct repeating or supplementary prescription to reduce unnecessary
medication entering the PSC. So the environmental practices to be taken by community
pharmacies will be:
i)
Supplier certification and cooperation: Community pharmacies are also encouraged to
adopt green purchasing strategies in their sourcing to improve their environmental performance
and sustainability (Green et al., 1998, Murray, 2000) in the PSC. As the end-retailers in the PSC,
these pharmacies are the companies that most strategically influence the environmental
behaviour of suppliers upstream in the PSC (Green et al., 2000). In keeping with the ethos of
XGPSC they are advised to evaluate suppliers’ environmental practices and choose those with
ISO14000 certification or higher environmental compliance. In addition, they can manage their
inventory with manufacturers, and collaborate on operational activities such as planning,
forecasting and replenishment to minimise the amount of expired medication. They should also
collaborate with manufacturers to support ecological medication design, and provide feedback to
manufacturers regarding package sizes and labeling information on recycling.
Efforts can be made to introduce supplier development initiatives which would encourage
interaction between suppliers and customers and facilitate knowledge exchange (Breen, 2004b).
It could also allow for development opportunities such as vendor managed inventory services
where pharmaceutical companies can share their SC management expertise.
ii)
Customer cooperation: As seen in Figure 2 it is clear that community pharmacy is closer to
the customer so has greater opportunity to build relationships with these parties. They act as a
site to communicate with customers about the proper disposal of expired/unwanted medication,
and provide facilities for customers to drop off those medications. According to previous
studies, 95% of pharmacies in British Columbia have recycle bins, which allow consumers to bring
their expired/unwanted medicines back (Kreisberg, 2007). There is no comparable figure for this
in the UK, so it is recommended that similar provision is made to facilitate this practice. In
addition, open events for returning medications can be organised by the pharmacies in
collaboration with local councils, to launch a public campaign on reducing medication waste and
protecting the environment e.g. Calderdale Primary Care Trust (2006) Wasted and Dangerous
Campaign.
The information obtained from pharmacist-led and GP-collaborated MURs can be sent to GPs for
proper description and manufacturers for medication design and it also can be used by
pharmacies to identify the reason for return and take appropriate actions to reduce waste. MURs
completed in Huntingdonshire for 100 patients indicated that 49% of patients were found to have
medicines that could be stopped and 430 interventions were made to reduce wasting these no
longer needed medicines (Lammy, 2007). Similar conclusions regarding medication reviews were
raised by Braybrook et al (1999) and Boivin (1997). Effective MURs in community pharmacy have
also been linked to a reduction in hospital admission for asthma patients (Jerram, 2009).
More advanced systems are being launched in the NHS medication management system, such as
repeating dispensing (Department of Health, 2007) and supplementary prescribing (PSNC, 2005;
RPSGB, 2006), and these services are treated as essential steps in green PSC.
Repeat dispensing in community pharmacies allows patients to collect their repeat medication
directly from their chosen pharmacy without consulting with a GP each time (Department of
Health, 2007). Supplementary prescribing revolutionised the way medicine management was
traditionally organised allowing more flexible team working. Supplementary prescribing allows
pharmacists to prescribe medications within the context of a Clinical Management Plan which is
signed and agreed with a patient’s GP prior to the consultation (PSNC, 2005; RPSGB, 2006). The
two systems allow patients improved access to medicines and is seen as an important advance in
the management of patient’s long term conditions. The service offered by the two systems allows
community pharmacists to engage in a two way conversation with patients to ascertain that they
are taking their medication as they should be and/or if they are experiencing any side effects
(concurs with Jesson et al’s findings, 2005). If designed in this way, this will reduce unnecessary
medications entering into the RL pharmaceutical system.
4.5 Professional and regulatory bodies and waste management companies
The professional and regulatory bodies and waste management companies are treated as indirect
participants who have a peripheral influence on the direct participants in the PSC. Public
awareness of the importance and necessity of pharmaceutical recycling can be raised, and advice,
instructions and support given from professional and regulatory bodies to individual
organisations will have a positive impact on greening the PSC. Such practices have been adopted
in the United States (Practice Greenhealth, 2009). Waste management companies can also make
suggestions and advice on improving practice.
i)
Customer cooperation: In 2006, the Department of Health and RPSGB in UK produced
guidance on best practice pharmaceutical waste management (Department of Health, 2006) and
regulations on hazardous waste (RPSGB, 2005), which provides practical advice and guidance for
waste producers in the healthcare system. Pharmacists within the PSC are required to understand
and ensure compliance with said guidance and regulations. However, legislation is also required
to ensure that manufacturers comply with environmental protection in terms of procurement,
production, distribution, RL and packaging.
Waste management companies provide services and advice to their customers on secure disposal
of pharmaceutical waste and compliance with legislations (PHS Group, 2007; Veolia
environmental services, 2007). It is expected that waste management companies propose
reasonable suggestions that would reduce medicinal waste.
The data collated from MURs and DRUMs can be fed back into the PSC via professional bodies
and associations e.g. RPSGB and Association of the British Pharmaceutical Industry (ABPI), and
they can make suggestions to manufacturers on medication design and package or to GPs on
prescription quantities or further medication monitoring.
4.6 Customers
To green the PSC, the role of the customer is not only as a consumer of medication/healthcare
service, but also as an actor to reduce unneeded medication and return the unwanted
medication. They need to be educated to manage unwanted medication differently e.g. to bring
the medication to a collection site or hazardous waste facility rather than dispose of medication
into water or domestic waste systems. They can also buy smaller quantities of medication if
possible, and buy products with recyclable packaging. There is a need, therefore, to raise
awareness of the impact of medication on the environment and effective disposal methods.
i)
Supplier cooperation: The management of returned medication cannot happen unless the
customer is compliant and becomes involved, e.g., to return the expired/unwanted medication to
the suppliers (either GPs or pharmacies). Breen and Xie (2009) recognise that the customer
operating in this new role is the only party in the PSC who pays for a product but is then
expected to act altruistically for the good of the PSC by initiating product recycling. Any guidance
and support infrastructure put in place by the government and regulatory bodies will not ensure
success in medication recycling unless the customer participates. Unlike the traditional model of
recycling, e.g. where goods can be recovered and reused, pharmaceutical products take a
different recycling pathway, which is final disposal by a third party. The value of the product
return in this case is based on the reduction of risk due to the product being taken out of
circulation and no longer being a safety hazard.
Patient engagement with healthcare is sometimes purely on a transactional basis or if there has
been a length of servitude, it can result in something akin to loyalty. It is this element that
community pharmacy management needs to secure and build upon to ensure the success and
sustainability of returning medication in the PSC. This can be facilitated by a CRM system which
places customer involvement at the forefront of this system, but also prompts and supports
customer involvement by the use of information systems and technology (Breen and Xie, 2009).
4.7 A Green PSC
The cost of recycling medication in the PSC is difficult to quantify. The cost of final disposal is
easy to identify but the cost of retrieval is a different matter. What is the price of an effective RL
system which facilitates effective customer management and ensures recycling behaviour? How
much does it cost to raise awareness and educate/energise customers to want to bring back
unwanted medication? Regardless of cost, the message is clear. For economic, environmental,
and safety considerations, medication within the PSC needs to be reduced in order to reduce the
quantity of stock destined for final disposal. The effective delivery of this objective requires the
efforts of the complete PSC. Successful contribution of all participants will lead to a greener and
more sustainable PSC.
5.
Conclusion
There are increasing concerns regarding the adverse environmental consequences of
inappropriately disposed medications, the economic loss caused by the preventable medication
waste, and the safety problems caused by the expired or hazardous medications. To address
these concerns, proper medication waste management becomes a new frontier in health care
system design. This is investigated in this paper limited to community PSC in UK, which is one of
the most frequently participated SC by patients and medication buyers. Effective pharmaceutical
waste management requires the involvement of the entire SC, from manufacturers, through
wholesalers/logistics providers, to GPs, community pharmacies and finally to customers to green
the PSC. This will result in reducing preventable pharmaceutical waste and more effective
recycling and disposal of inevitable pharmaceutical waste.
To provide a channel for taking back the expired/unwanted medication, a PSC network is
designed encompassing RL to enable community pharmacies and customers to recycle
medication. However, the recycling behaviour is only counted as a proactive environmental
practice, and a XGPSC approach is designed as a far-reaching approach to integrate
environmental practices into the business strategy and co-ordinate companies in the PSC to
reduce their negative impact on the environment. The environmental practices and actions which
should be employed by participants in the PSC are identified in the XGPSC approach. Such an
approach requires total involvement and cross-sector collaboration from participants.
Four environmental practices are recommended: top management commitment, supplier
certification and cooperation, customer cooperation, and eco-design. Under these environmental
practices, specific actions are addressed for direct participants including manufacturers,
wholesalers/logistics providers, GPs, community pharmacies, and customers. The key actions
include committing to developing environmental objectives, evaluating and selecting suppliers
with ISO14000 certificate, educating patients for proper disposal of medication, reducing
medication in circulation through MURs, changing prescription period, and designing ecologically
sensitive medication. Indirect contribution is also recognised from peripheral influences from the
professional and regulatory bodies and waste management agencies.
The proposed XGPSC approach identifies environmental practices from a holistic perspective, and
adds valuable knowledge to the existing academic research on GSCM practices. It can act as
guidance for all those involved in the management of medication waste, and provide practical
advice and guidance for waste producers. With a firm commitment from participants to take
action reducing and recycling medication waste, and becoming stewards of medication rather
than only consumers, the PSC will become greener in the future. Professional bodies or
government may use this approach as a reference to define regulations and instructions for best
practice of medication waste management. The PSC network incorporating the RL system bridges
the gaps between the current RL theories and its application in the pharmaceutical area.
6.
Limitations and future work
The research work is built on a contemporary literature review, so the applicability of the XGPSC
approach is not tested or verified. The XGPSC approach needs to be further validated and
improved in the future through empirical study. Also, the scope of the research is limited to the
community PSC in the UK, and future research will investigate the pharmaceutical waste
management in NHS hospitals and care homes (NHS and private providers).
The success of the XGPSC approach requires total involvement of all the participants in the chain,
therefore weak cooperation from some of the PSC parties in practice may become an obstacle in
greening the PSC. For example, the less environmentally conscious manufacturers or pharmacies
may be reluctant to make ongoing commitment to the environment in their production and
supplier selection; the GPs or pharmacies may be unwilling to accept responsibility for educating
customers in recycling medication; and customers may be incompliant in returning medication;
all of the above will undermine the efficacy of the XGPSC approach. Research on improving the
cooperation among PSC parties will be the cornerstone of this study and will be developed
further.
The most contentious aspect of the XGPSC approach is the cost: who should pay? There may be
reluctance from any of the PSC participants to pay the additional cost for proper medication
disposal, especially when returned medications cannot be reused. Future investigations into this
area will examine whether the cost of disposal should be included in the cost of the medication
or become part of mandatory tax. The recycling of medication needs to be performed for all of
the reasons discussed in this paper. This is a non-profit practice. Adopting the proposed XGPSC
approach will ensure that action and practice reduces the accumulation of unwanted medications
and the need for disposal, reducing environmental risk and safety hazards, and economic loss.
Figures:
Figure 1: Research framework for greening PSC using an XGPSC approach
Figure 2: Research design and processes
Figure 3: A community pharmaceutical supply chain with reverse logistics
Figure 4: The Cross boundary Green PSC (XGPSC) approach
Appendix: Acronyms
3PL:
Third Party Logistics
ABPI:
Association of the British Pharmaceutical Industry
CRM:
Customer Relationship Management
DRUM:
Dispensed Review of the Use of Medicines
GP:
General Practitioner
GPSC:
Green Pharmaceutical Supply Chain
GSCM:
Green Supply Chain Management
MIS:
Management Information System
MUR:
Medicines Use Review
NHS:
National Health Service
OTC:
Over The Counter
PSC:
Pharmaceutical Supply Chain
RL:
Reverse Logistics
RPSGB:
Royal Pharmacy Societies of Great Britain
SC:
Supply Chain
XGPSC:
Cross boundary Green Pharmaceutical Supply Chain
References:
Alvarez Gil M.J., Jimenez J.B. and Lorente, J.C. (2001), “An analysis of environmental management,
organizational context and performance of Spanish hotels”, Omega: International Journal of
Management Science, Vol. 29 No. 6, pp. 457–471.
Ashley S. (1993), “Designing for the environment”, Mechanical Engineering, Vol.115 No. 3, pp.52–
55.
Beaumont, J.R., Pedersen, L.M. and Whitaker, B.D. (1993), Managing the Environment: Business
Opportunity and Responsibility, Butterworth-Heinemann, Oxford.
Bellingham C. (2004), “How to dispose of unwanted medicines”, The Pharmaceutical Journal,
Vol.273 No. 7324, pp.686.
Bergstrom RY. (1993), “An annotated essay: environmental affairs”, Production, Vol.105 No. 4,
pp.36–41.
Boivin, M. (1997), “The Cost of Medication Waste”, Canadian Pharmaceutical Journal, May, pp. 3239.
Bound J.P. and Voulvoulis N. (2005), “Household disposal of pharmaceuticals as a pathway for
aquatic contamination in the United Kindom”, Environmental Health Perspectives, Vol.113, No.12,
1705-1711.
Braybrook, S., John, D.N. and Leong, K. (1999), “A survey of why medicines are returned to
pharmacies”, The Pharmaceutical Journal, Vol. 263, pp. 7063. Pharmacy Practice Research. Papers
presented at the British Pharmaceutical Conference, Cardiff, September 13 to 15 1999 pR30.
http://www.pharmj.com/editorial1999/19990918/pharmacypractice/braybrook2.html
Breen L, (2004a) “Is there a place for Third Party Logistics providers in the NHS Pharmaceutical
Supply Chain in Hospital Pharmacy? - the case of Central Manchester and Manchester Children’s
University Hospitals NHS Trust (CMMC)”, Hospital Pharmacist, Vol. 11, pp. 33-36
Breen L, (2004b) “Does Supplier Development benefit Hospital Pharmacy? - The case of Central
Manchester and Manchester Children’s University Hospitals NHS Trust”, Pharmacy Management,
Vol.20 No.3, pp.1-14.
Breen L. (2006), “Give me back my empties or else! A preliminary analysis of customer
compliance in reverse practices (UK)”, Management Research News, Vol. 29 No. 9, pp. 532-551.
Breen L. and Xie Y. (2009), “Examining the role of the customer in facilitating reverse logistics
system in NHS community pharmacy in the UK”, proceeding of the Logistics Research Network
annual conference, 9-11 September, 2009, Cardiff, UK, 588-591.
Buser H.R., Muller M.D. and Theobald N. (1998), “Occurrence of the pharmaceutical drug clofibric
acid and the herbicide mecoprop in various Swiss lakes and in the North Sea”, Environmental
Science & Technology. Vol.32, No.1, pp.188–192.
Calderdale Primary Care Trust (2006), “Wasted and Dangerous”, available at:
http://www.calderdale.nhs.uk/public-information/publication-scheme/disclosure-log/disclosurelog-item/article/28/545/neste/5/ (accessed 26 September 2008)
Caldwell B. (1999), “Reverse logistics”, Information Week, No.729, pp.48-56.
Carter C.R., Ellram L.M. and Kathryn L.M. (1998), “Environmental purchasing: benchmarking our
German counterparts”, International Journal of Purchasing and Materials Management, Vol. 34
No.4, pp.28-38.
Croom S., Romano P., and Giannakis M. (2000), “Supply chain management: an analytical
framework for critical literature review”, European Journal of Purchasing & Supply Management,
Vol. 6, pp.67-83.
Daughton C.G. (2003), “Cradle-to-cradle stewardship of drugs for minimizing their environmental
disposition while promoting human health. I. Rationale for and avenues toward a green
pharmacy”, Environmental Health Perspectives, Vol.111, pp.757–774.
Daughton C.G. and Ternes T.A. (1999), “Pharmaceuticals and personal care products in the
environment: agents of subtle change?”, Environmental Health Perspectives, Vol.107, pp.907-938.
de la Fuente, M.V., Ros, L. and Cardós, M. (2007), “Integrating Forward and Reverse Supply
Chains: Application to a metal-mechanic company”, International Journal of Production
Economics, Vol. 111, No. 2, pp.782-792.
Department of Health (2006), “Health Technical Memorandum 07-01: Safe Management of
Healthcare Waste”, available at:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_07
3328.pdf (accessed 06 April 2010)
Department of Health (2007), “Environment and sustainability Health Technical Memorandum 0706: Disposal of pharmaceutical waste in community pharmacies”, ISBN 9780113227976.
Department of Health (2007), “NHS repeat dispensing schemes in England: Department of Health
– Health care”, available at:
http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/DH_400015
7 (accessed 3 December 2009)
Department of Health (2008), “Pharmacy Contractual Framework. Briefing Paper for website.
February 2008 – Gateway reference 9484”, available at:
http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Communitypharmacy/Com
munitypharmacycontractualframework/index.htm (accessed 20 October 2008)
Dowlatshahi S. (2000), “Developing a theory of reverse logistics”, Interfaces, Vol.30 No.3, pp.143155.
Fink A (2005), Conducting research literature reviews: from paper to the internet. 2nd Edition,
Thousand Oaks: Sage Publication, California.
Fleischmann M., Bloemhof-Ruwaard J.M., Dekker R., van der Lann E., van Nunen J.A.E.E., and Van
Wassenhove L.N. (1997), European Journal of Operational Research, Vol.103, pp. 1-17.
Florida, R., (1996), “The Environment and the New Industrial Revolution”, California Management
Review Vol. 38 (Autumn), pp. 80–115.
GEMI (Global Environmental Management Initiative) (2001), New Paths to Business Value. GEMI,
Washington DC.
Gillett J. (1993), “Ensuring suppliers’ environmental performance”, Purchasing & Supply
Management, pp.28-30.
González-Torre, P.L. and Adenso-Díaz, B. (2006), “Reverse logistics practices in the glass sector in
Spain and Belgium”, International Business Review, Vol. 15 No.5, pp.527-546.
Green K., Morton B. and New S. (2000), “Green purchasing and supply policies: do they improve
companies’ environmental performance?”, Supply Chain Management: An International Journal,
Vol.3, No.2, pp.89-95.
Guimaraes, T. and Liska, K. (1995), “Exploring the business benefits of environmental
stewardship”, Business Strategy and the Environment, Vol. 4 No.1, pp. 9–22.
Halling-Sorensen B., Noris-Nielsen S.N., Lanzky P.F., Ingerslev F., Holten Lutzhoft H.C., and
Jorgensen S.E. (1998), “Occurrence, fate and effects of pharmaceutical substances in the
environment-a review”, Chemophere, Vol. 36, No. 2, pp.357-393.
Hansmann, K.W., Kroger, C. (2001), “Environmental management policies”, In Sarkis, J. (Ed.),
Green Manufacturing and Operations: From Design to Delivery and Back. Greenleaf Publishing,
Sheffield, UK, pp. 192–204.
Heberer T. (2002), “Occurance, fate, and removal of pharmaceutical residues in the aquatic
environment: a review of recent research data”, Toxicology Letters, Vol.131, Issues.1-2, pp.5-17.
Jerram, P. (2009), “Medicine Use Reviews Reduce Asthma Admissions”, Pharmacy Management,
Vol. 25 No.3, pp. 15-19.
Jesson, J., Pocock, R. and Wilson, K. (2005) “Reducing waste in community pharmacy”, Primary
Health Care Research and Development, Vol. 6 No.2, pp. 117-124.
Knight, L.K. (2005) “Roles, Relationships and Dynamics of the Pharma Network. A discussion
document on opportunities for supply research”, Draft internal report to the NHS Purchasing and
Supply Agency 2005.
Kopicki, R., Berg, M.J., Legg, L., Dasappa, V. and Maggioni, C. (1993), Reuse and Recycling –
Reverse Logistics Opportunities, Council of Logistics Management, Oak Brook, IL.
Kreisberg J. (2007), “Green pharmacy: preventing pollution, a cross sector approach” The Journal
of Ecologically Sustainable Medicine, Spring/Summer 2007, pp.,25-29.
Kreuger R.A. (1988) Focus groups: a practical guide for applied research. London: Sage.
Krumwiede, D.W. and Sheu, C. (2002), “A model for reverse logistics entry by third-party
providers”, OMEGA: International Journal of Management Science, Vol. 30, pp. 325-333.
Kuspis D.A. and Krenzelok E.P. (1996), “What happens to expired medications? A survey of
community medication disposal”, Veterinary & Human Toxicology, Vol.38, pp.48–49.
Lammy D. (2003), “Speeches on 5th March 2003: Medicine Management”,
http://www.dh.gov.uk/en/News/Speeches/Speecheslist/DH_4000633 (Accessed 3 December,
2009)
Lau, K.W. and Wang, Y. (2009), “Reverse logistics in the electronic industry of China: a case
study”, Supply Chain Management: An International Journal, Vol.14 No.6, pp. 447-465.
Lebreton, B. and Tuma, A. (2006), “A quantitative approach to assessing the profitability of car
and truck tire remanufacturing”, International Journal of Production Economics, Vol. 104 No.2,
pp. 639-652.
Maxie E. (1994), “Supplier performance and the environment”, In proceedings of International
Symposium on Electronics and the Environment, IEEE, San Francisco, CA, pp.323-327.
Meade L., and Sarkis J. (2002), “A conceptual model for selecting and evaluating third-party
reverse logistics providers”, Supply Chain Management: An International Journal, Vol. 5, No.5,
pp.283-295.
McIntyre K., Smith H., Henham A. and Pretlove J. (1998), “Environmental performance indicators
for integrated supply chains: the case of Xerox Ltd”, Supply Chain Management: An International
Journal, Vol. 3 No.3, pp.149-156.
Murray G.J. (2000), “Effects of a green purchasing strategy: the case of Belfast City Council”,
Supply Chain Management: An International Journal, Vol. 5 No.1, pp.37-44.
Nagurney, A. and Toyasaki, F. (2005), “Reverse supply chain management and electronic waste
recycling: a multitiered network equilibrium framework for e-cycling”, Transportation Research
Part E: Logistics and Transportation Review, Vol. 41 No.1, pp.1-28.
New Hampshire Department of Environmental Services (2009) “How to address unwanted
medicine disposal in New Hampshire”, available at:
http://des.nh.gov/organization/commissioner/pip/publications/wmd/documents/unused_medici
ne.pdf (accessed 28 May 2009)
NHS Cumbria (2009), “Dispensing review of the use of medicines (DRUM)”, available at:
http://www.cumbria.nhs.uk/ProfessionalZone/MedicinesManagement/DispensingDoctors/Home.
aspx (accessed 3 December, 2009).
Paterson J.M. and Anderson G.M., (2002) “Trial Prescriptions to reduce drugs wastage: results
from a Canadian program and a community demonstration project”, American Journal of
Managed Care, Vol. 8, pp. 151-158.
Pati, R.K., Vrat, P. and Kumar, P. (2008), “A goal programming model for paper recycling system”,
OMEGA: International Journal of Management Science, Vol. 36 No.3, pp. 405-417.
PHS Group (2007), “Environment and sustainability: health technical manual 07-06, disposal of
pharmaceutical waste in community pharmacies”, available at:
http://www.phs.co.uk/15754.file.dld (accessed 3 November 2009)
Porter, M.E. and van der Linde, C. (1995), “Green and competitive: ending the stalemate”, Harvard
Business Review, Vol. 73.5, pp.120–134.
Powell R.A., Single H.M., Lloyd K.R. (1996) “Focus groups in mental health research: enhancing
the validity of user and provider questionnaires”, International Journal of Social Psychology,
Vol.42 No.3, 193-206.
Power D. (2005), “Supply chain management integration and implementation: a literature review”,
Supply Chain Management: an International Journal, Vol.10 No.4, pp.252-263.
Practice Greenhealth (2009), “Pharmaceutical waste minimisation, why should pharmaceutical
waste be minimised?” available at:
http://cms.h2e-online.org/ee/waste-reduction/waste-minimization/pharm (accessed 24
November, 2009)
Primary Care Comissioning (2009) “NHS Community Pharmacy Contractual Framework Essential
Service – Disposal of Unwanted Medicines”, available at:
http://www.pcc.nhs.uk/uploads/Pharmacy/march_08/disposal_of_unwanted_medicines.pdf
(accessed 14 December 2009)
PSNC (Pharmaceutical Services Negotiating Committee) (2005), “NHS Community Pharmacy
Contractual Framework Enhanced Service – Supplementary Prescribing by Pharmacists”, available
at:
http://www.psnc.org.uk/data/files/PharmacyContract/enhanced_service_spec/en10__supplement
ary_prescribing.pdf (accessed 06 April 2010)
Ritchie, L., Burnes, B., Whittle, P. and Hey, R. (2000), “The benefits of reverse logistics: the case of
the Manchester Royal Infirmary Pharmacy”, Supply Chain Management: An International Journal,
Vol. 5 No. 5, pp. 226-233.
Rogers, D.S. and Tibben-Lembke, R.S. (1999), “Going Backwards: Reverse Logistics Trends and
Practices”, Reverse Logistics Executive Council Press, Pittsburgh, PA.
Rowlands Pharmacy (2009) “Waste Audit – Summary of Results”.
RPSGB (Royal Pharmaceutical Society of Great Britain), (2005), “The hazardous waste (England and
wales) regulations 2005, interim guidance for community pharmacists for England and Wales and
information for Scotland”, available at:
http://www.rpsgb.org.uk/pdfs/hazwastecommphguid.pdf (accessed 06 April 2010)
RPSGB (Royal Pharmaceutical Society of Great Britain), (2006), “Supplementary prescribing one
year on”, available at:
http://www.rpsgb.org.uk/pdfs/supplpresconf05.pdf (accessed 06 April 2010)
Sarkis J. (2003), “A strategic decision framework for green supply chain management”, Journal of
Cleaner Production, Vol. 11, pp. 397-409.
Savage, C.J., Roberts, K.J., and Wang, X.Z. (2006), “A holistic analysis of pharmaceutical
manufacturing and distribution: are conventional supply chain techniques appropriate?”
Pharmaceutical Engineering, July/August, pp. 10-18.
Schwartz B. (2000), “Reverse logistics strengthens supply chain”, Transportation and Distribution,
Vol.41, No.5, pp.95-100.
Seuring S. and Muller M. (2008), “From a literature review to a conceptual framework for
sustainable supply chain management”, Journal of Cleaner Production, Vol. 16, pp. 1699-1710.
Shih, L.H. (2001), “Reverse logistics system planning for recycling electrical appliances and
computers in Taiwan”, Resources, Conservation and Recycling, Vol. 32 No.1, pp. 55-72.
Shrivastava, P. (1995), “Environmental technologies and competitive advantage”, Strategic
Management Journal, Vol.16 (Special issue, Summer), pp. 183–200.
Smith C.A. (2002), ‘Managing pharmaceutical waste-what pharmacists should know’, Journal of
the Pharmacy Society of Wisconsin, Nov/Dec 2002, pp. 17-22.
Ternes T.A. (1998), “Occurrence of drugs in German sewage treatment plants and rivers”, Water
Research, Vol.32, No.11, pp.3245-3260.
Ternes T.A., Stumpf M., Mueller J., Haberer K., Wilken R.D., Servos M. (1999), “Behaviour and
occurrence of estrogens in municipal sewage treatment plants-inviestigations in Germany,
Canada and Brazil”, Science of the Total Environment, Vol.225, pp.91-99.
Van Eijken M., Tsang S., Wensing M., De Smet P.A.G.M., and Grol R.P.T.M. (2003), “Interventions
to improve medication compliance in older patients living in the community: A systematic review
of the literature”. Drugs & Aging., Vol. 20 No.3, pp. 229-240.
Van Hoek R. I., (1999), “From reversed logistics to green supply chains”, Supply Chain
Management, An International Journal, Vol. 4 No.3, pp. 129-135.
Veolia environmental services (2007), “Birmingham clinical waste”, available at:
http://www.veoliaenvironmentalservices.co.uk/birmingham/pages/publications.asp (accessed 19
November 2009)
Walton S.V., Handfield R.B. and Melnyk S.T. (1998), “The green supply chain: integrating suppliers
into environmental management process”, International Journal of Purchasing and Materials
Management, Spring, pp. 2-11.
Wu, H.-J. and Dunn, S.C. (1995), “Environmentally responsible logistics systems”, International
Journal of Physical Distribution & Logistics Management, Vol. 25 No. 2, pp. 20-38.
Xie Y. (2009), “Greening pharmaceutical supply chain in China”, In proceedings of the 20th
International Conference on Production Research, 2nd-6th August, Shanghai, P.R.China, pp137.
Zhou, L., Naim, M.M. and Wang, Y. (2007), “Soft systems analysis of reverse logistics battery
recycling in China”, International Journal of Logistics: Research and Applications, Vol.10, No.1,
pp. 57-70.
Zhu Q.H. and Sarkis J. (2004), “Relationships between operational practices and performance
among early adopters of green supply chain management practices in Chinese manufacturing
enterprises”, Journal of Operations Management, Vol. 22, pp. 265-289
Zhu Q.H., and Sarkis J. (2006), “An inter-sectoral comprison of green supply chain management in
China: drivers and practices”, Journal of Cleaner Production, Vol.14, pp. 472-486.
Zhu Q.H., Sarkis J. and Lai K.H. (2006), “Green supply chain management: pressures, practices
and performance within the Chinese automobile industry”, Journal of Cleaner Production, Vol.15,
pp. 1041-1052.
Zsidisin G.A. and Hendrick T.E. (1998), “Purchasing involvement in environmental issues: a multicountry perspective”, Industrial Management and Data Systems, Vol. 7, pp. 313-320.