PurposeThe COVID-19 pandemic is considered a major disruptive event of this decade, raising unforeseen socio-economic implications worldwide. This novel virus has increased the influx of patients in hospitals, and healthcare organisations are facing unprecedented constraints in their operations to deal with increased demand and pressed capacity. Thus, this article evaluates the impact of the COVID-19 pandemic on healthcare systems' demand, resources and capacity and provides research directions.Design/methodology/approachThis is a viewpoint article and uses timely information on healthcare operations from both scholars and managers, published by diverse sources during the COVID-19 outbreak.FindingsThe authors discuss the focus on “flattening the curve of infection” as a measure to protect healthcare, delay the impact of increased demand and reorientate healthcare supply chain practices. Furthermore, the authors evaluate the role of lean practices on managing demand and capacity and improving quality across healthcare operations and supply chain. Finally, the authors suggest research directions on modern operational issues that emerged during this pandemic, such as discussions around the sustainability of lean post-pandemic, “just in time” practices, inventory trade-offs and lack of organisational responsiveness during untenable events.Originality/valueIn this article, the authors provide a contemporary assessment of the implications of the COVID-19 pandemic on healthcare operations, underscoring main economic and operational elements that can be affected, such as unforeseen demand, resources and capacity shortage. Therefore, the authors assess that healthcare organisations, practitioners and governments have to anticipate operational and economic impacts and, ultimately, to reassess their plans to deal with such adverse events.

Purpose This paper aims to explore how resilience is evident in healthcare supply chains in the public sector when faced with pandemic disruption and to identify any learnings to inform recovery and future-readiness phases. Design/methodology/approach An exploratory case study was conducted, consisting of seven semi-structured interviews with public sector supply chain actors in the healthcare personal protective equipment supply chain. The data included document analysis. Findings Key findings show how specific resilience strategies such as agility, collaboration, flexibility and redundancy, contributed to supply chain resilience during the COVID-19 pandemic response. Collaboration is identified as a key mechanism for resilience with public sector networks viewed as facilitating this. Established collaborative relationships with suppliers pre-pandemic did not support increased visibility of tiers within the supply chain. Originality/value This is one of the first papers to provide in-depth resilience insights through an example of healthcare supply chains during the COVID-19 pandemic.

Lean is endorsed as policy in practice in the UK but the challenges and complexities affecting Lean in healthcare are still to be adequately assessed. Through a qualitative single case study of an NHS organisation implementing Lean, 43 interviews with multidisciplinary team members involved in Lean were conducted. The progress of Lean is found to be inhibited as medical professionals have failed to engage or provide clinical leadership in supporting the trajectory of Lean. This resulted in limited outcomes, sustainability implications, and failed projects. Lean is challenged by complexity and this is evident in conflicts between professional identity, corresponding status and clinical/managerial relationships. Medical professionals as a group have received a limited focus in papers assessing the progress of Lean in Healthcare from an operational perspective. Going forward, strategies for mitigating the negative impact of this can be developed to support operational managers in the healthcare domain.

Reverse exchange (RE) in dealing with the return, recycle and reuse of products is receiving a growing focus. When properly handled, RE in healthcare can deliver an economic benefit of cost minimisation and has extensive positive impacts on both human health and the environment (Li and Olorunniwo, 2008) but to date, RE research is mostly limited to pharmaceutical return. This paper investigates the potential for RE benefits in the UK National Health Service (NHS) supply chain for medical devices. Hearing aids supplied to adults with hearing loss are used as an illustrative example. This research applied a consensus approach through the use of dispersed nominal groups in order to obtain qualitative data on information, barriers, solutions and priorities to support findings. Findings illustrate that the end user behaviour of returning the device, and the requirement by NHS Procurement for manufacturers to meet RE targets are secondary to the importance of audiology departments who have the autonomy to design RE processes and successfully implement initiatives. A schematic highlighting the information and materials flow of the supply chain and the barriers and facilitators to RE is presented for hearing aid devices with potential for transferability to other small medical device supply chains.

Background Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the impairment results from spinal cord pathology that impairs motor control and sensation of the bladder and bowel. Currently, there is uncertainty about which interventions are effective. Objective The objective was to summarise the available evidence on and current practice for improving continence in children and young people with neurodisability. Design A systematic review of the effectiveness, cost-effectiveness and factors that modify intervention implementation, alongside a cross-sectional, online survey of current practice with health professionals, parent carers, school and care staff and young people with neurodisability. Results Twelve databases were searched in the review, resulting in 5756 references; 71 studies (72 papers) were included in the analyses. Most of the evidence was for children with spinal cord pathology, which involved evaluations of pharmacological approaches and surgical techniques, whereas the evidence pertaining to those with non-spinal-cord-related pathology tended to be for behavioural interventions. The methodological quality of studies was rated as being moderate to poor. There were three robust qualitative studies about the experience of continence among children with spinal cord pathology. We found substantial heterogeneity across the interventions that we evaluated in terms of quality, study design and outcomes measured. No economic studies were found. The results were synthesised narratively and reported in text and tables. We did not find any eligible studies evaluating interventions using toilet and clothing adaptations in the review, although the survey highlighted that these types of interventions are frequently used and considered. In total, 949 people responded to the survey: 202 health professionals, 605 parent carers, 122 school and social care staff, and 20 young people. The survey results illustrated the different roles that professionals have in improving continence, highlighting the importance of a multidisciplinary approach to supporting children and young people and their families. Clinicians employ a range of assessments and interventions to improve continence or independent toileting, depending on the needs of the child. Limitations Quantitative studies in the review were not methodologically robust. The survey had a risk of response bias. Conclusions Our research found a dearth of good-quality evidence for many of the interventions currently in use, and no evidence of experiences of implementing interventions for children with non-spinal-cord-related pathology. There was also no evidence of cost-effectiveness of any of the interventions. Future work There is a need to involve young people and families in the design of high-quality evaluative research for interventions that aim to improve continence. This is especially the case for children with autism and learning disability, who have been neglected in previous evaluative and qualitative research. We recommend better training for health, education and care professionals about toileting, informed by evidence and the lived experiences of children and their families. We recommend a joined-up multidisciplinary and holistic approach to improving continence to maximise independence, dignity and comfort. It is vital that children and young people with neurodisability have early access to regular, integrated assessment of their bladder and bowel health, and are fully supported with appropriate personalised treatment. Study registration This study is registered as PROSPERO CRD42018100572. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 73. See the NIHR Journals Library website for further project information.