title: Strategies to identify future shortages due to interruptions in the health care procurement supply chain and their impact on health services: a method from the English National Health Service.
abstract: OBJECTIVE
  The uninterrupted supply of essential items for patient care is crucial for organizations that deliver health care. Many products central to health care are derived from natural resources such as oil and cotton, supplies of which are vulnerable to climate change and increasing global demand. The purpose of this study was to identify which items would have the greatest effect on service delivery and patient outcomes should they no longer be available.
  
  
  METHODS
  Using a consensus development approach, all items bought by one hospital, over one year, were subjected to a filtering process. Criteria were developed to identify at-risk products and assess them against specific risks and opportunities. Seventy-two items were identified for assessment against a range of potential impacts on service delivery and patient outcomes, from no impact to significant impact. Clinical and non-clinical participants rated the items.
  
  
  RESULTS
  In the category of significant impact, consensus was achieved for 20 items out of 72. There were differences of opinion between clinical and non-clinical participants in terms of significant impact in relation to 18 items, suggesting that priority over purchasing decisions may create areas of conflict. Reducing reliance on critically scarce resources and reducing demand were seen as the most important criteria in developing sustainable procurement.
  
  
  CONCLUSIONS
  The method was successful in identifying items vulnerable to supply chain interruption and should be repeated in other areas to test its ability to adapt to local priorities, and to assess how it functions in a variety of public and private settings.
authors.affiliation: Research Fellow, Faculty of Health, Education and Society, University of Plymouth, Plymouth, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Grose
authors.forename: Janet
authors.initials: J
authors.lastname: Richardson
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D004864:Equipment and Supplies / Q000600:supply & distribution*; D006801:Humans; D011682:Purchasing, Hospital / Q000458:organization & administration; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom
keywords: health care; procurement; supply chains