Technological Forecasting & Social Change 201 (2024) 123256

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Technological Forecasting & Social Change

journal homepage: www.elsevier.com/locate/techfore

The impact of healthcare 4.0 technologies on healthcare supply chain

performance: Extending the organizational information processing theory
Esha Saha a, *, Pradeep Rathore b, *
a
Department of Management Studies & Industrial Engineering, Indian Institute of Technology (Indian School of Mines) Dhanbad, Dhanbad 826004, Jharkhand, India
b
Paari School of Business, SRM University, Amaravati, Andhra Pradesh, India

A R T I C L E I N F O A B S T R A C T

Keywords: Increasing supply chain performance in an uncertain environment is a challenge for every industry, predomi­
Healthcare 4.0 technologies nantly, healthcare sector. To address such issues, there is an urgent need for healthcare organizations like
Hospital supply chain processes hospitals to build new capabilities. We suggest using organizational information processing theory (OIPT) as
Performance
theoretical foundation for developing research model that investigates how healthcare 4.0 technologies (big data
Organizational information processing theory
(OIPT)
analytics, artificial intelligence and blockchain) enhance hospital supply chain processes and thereby the per­
formance. According to our analysis of survey data from around 255 hospital managers in Indian hospitals, the
three hospital supply chain processes, viz., operations, innovations, and risk management, and the supply chain
performance are significantly impacted by these healthcare 4.0 technologies. Additionally, hospital supply chain
operations and innovations partially mediate the association between healthcare 4.0 technologies and perfor­
mance. We also found, the interaction between healthcare 4.0 technologies and hospital supply chain operations
is moderated by type of healthcare organizations (private, and public hospitals). In addition to extending and
validating the OIPT in context of digital hospital supply chains, these findings offer healthcare professionals
empirical evidence to further maximize the benefits of healthcare 4.0 technologies for sustained hospital supply
chain performance and integrate digital supply management into health system development.

1. Introduction internal healthcare supply chain, i.e., the hospital supply chain, must
manage large number and great variety of healthcare products which
Healthcare organizations, which accounted for around 11 % of the are stored in the hospital central pharmacy, replenished from the
worldwide gross domestic product in 2023 (WHO, 2023), are under external suppliers, and distributed to patients at point-of-care locations
pressure to find ways to increase operational efficiency and lower rising (Saha and Ray, 2019a). Third, hospital supply chain must deal with
expenses due to recent healthcare policies and public demand. Histori­ unstructured and complex data for real-time decision-making under
cally, the cost of hospital supplies has accounted for up to 40 % of the uncertainties (Yu et al., 2021).
hospital’s operational budget (Vanbrabant et al., 2023). As a result, As compared to other industries such as manufacturing and retailing,
supply chain management has emerged as a critical domain for hospital industry experts have noticed that hospital supply chains are falling
management (Chatterjee et al., 2023a, 2023b). Historically, industrial behind (Chen et al., 2013; Rodríguez-Espíndola et al., 2022). Hospitals
and retail have dominated supply chain management literature. There face difficulties deriving the impact on their performance from the
are not many supply chain theories that specifically address the supply chain processes. As such, healthcare 4.0 technologies, which
healthcare sector (Choudhury et al., 2023). Healthcare supply chains are enables efficient processing and analysis of unstructured and complex
distinct from manufacturing supply chains in several ways. First, data necessary for making decisions in real time, has emerged as an
healthcare supply chains consist of external supply chain network and important information processing capability for hospitals (Tortorella
internal supply chain of flows, including materials, pharmaceuticals, et al., 2022a, 2022b, 2022c, 2022d, 2022e).
and medical/surgical supplies, etc. within the hospital, and the hospital This study examines the antecedents of hospital supply chain per­
is the primary point of care and the critical source of uncertainty in the formance. Indeed, the current body of research on the direct impacts of
healthcare supply chains (Beaulieu and Bentahar, 2021). Second, the technology investment on business success has been uneven. Instead of

* Corresponding authors.
E-mail addresses: [email protected] (E. Saha), [email protected] (P. Rathore).

https://doi.org/10.1016/j.techfore.2024.123256
Received 4 April 2023; Received in revised form 23 January 2024; Accepted 28 January 2024
Available online 7 February 2024
0040-1625/© 2024 Elsevier Inc. All rights reserved.
E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

focusing on the supply chain activities or processes that can be improved healthcare 4.0 technologies and hospital supply chain processes, viz.,
with the help of healthcare 4.0 technologies, researchers have focused operations, innovations, and risk management.
directly on investments in healthcare 4.0 technologies (Aceto et al., Our research offers several significant contributions particularly to
2020a, 2020b; Sony et al., 2023; Tortorella et al., 2020a, 2020b). An the healthcare, supply chain and information system literature. First, by
investigation of the mediating factors through which healthcare 4.0 employing the theoretical framework of organizational information
technologies advance to hospital supply chain performance will enhance processing to examine the digital healthcare supply chain, we surpass
the literature on digital healthcare, information systems and supply earlier research by recognizing the antecedents of supply chain perfor­
chain. More precisely, three research questions are addressed in this mance and highlighting the crucial function of supply chain processes,
study: (1) do healthcare 4.0 technologies help hospitals to improve their viz., operations, innovations, and risk management in shaping hospital
supply chain operations, innovations, and risk management system? (2) supply chain performance. Second, we conceptualize healthcare 4.0
how do these three hospital supply chain processes help hospitals to technologies as an important information processing capability, which
achieve the desired level of performance? (3) whether the associations directly affects hospital supply chain performance. Third, we capture
between healthcare 4.0 technologies and hospital supply chain pro­ hospital supply chain processes as mediators that convert hospitals’
cesses are affected by the type of healthcare organization (such as pri­ healthcare 4.0 technologies into capabilities which in turn impact sup­
vate and public hospitals) in diverse country like India? ply chain performance. Finally, we establish the type of healthcare or­
Given that building a digital health ecosystem and ensuring that all ganization (e.g., private, and public hospitals) as the moderating
Indian residents have access to its benefits is a national priority, India variable to attain important condition that can be studied in developing
offers an intriguing research environment. To develop a modern tech­ theories related to digital healthcare, information systems and supply
nological landscape for healthcare delivery, the government of India has chain.
been concentrating on developing a digital economy with emerging The rest of the paper is organized as follows: In Section 2, the
technologies (National Digital Health Mission, 2020). Hospitals in India theoretical framework, a review of the literature, and a conceptual
are also investing heavily in advanced technologies (Venkatraman et al., model are provided. In Section 3, the research hypotheses are formu­
2022). However, the multi-layered architecture of the Indian health lated. Methodology for research is covered in Section 4. Results of the
system—which includes both public and private ownership, coverage of model assessment are enumerated in Section 5. A discussion of the re­
rural and urban locations, a dense population, and a wide range of sults, implications, and potential future study is given in Section 6. The
diseases—makes technology adoption in healthcare difficult (PwC India, final remarks are presented in Section 7.
2018). The Indian healthcare ecosystem faces several challenges despite
the various initiatives launched by the government and private players, 2. Theory development and literature review
including fragmented information technology applications, unstruc­
tured medical data, unstandardized patient records, and a lack of The first part of this section presents the organizational information
collaboration among healthcare providers and supply chain stages (Vest processing theory in the perspective of implementation of healthcare 4.0
et al., 2017). Emerging technologies can help with these efforts. For technologies in the hospital supply chain management system. There­
instance, well-known private hospitals in India like Apollo Hospitals after, the literature review discusses and summarizes the various aspects
(www.apollohospitals.com), Manipal Hospitals (www.manipalhosp of healthcare 4.0 technologies, hospital supply chain processes (viz.,
itals.com) and Fortis (www.fortishealthcare.com) and public hospitals operations, innovations, and risk management) and hospital supply
such as All India Institute of Medical Sciences (www.aiims.edu) are chain performance.
adopting latest technologies like artificial intelligence, and robots for
patient treatments and surgery. Even though these elite organizations 2.1. Organizational information processing theory (OIPT)
may employ cutting-edge technology, healthcare 4.0 technologies’ full
potential has not yet been fully realized. There has not been much OIPT offers a viable theory for developing the research model that
empirical research done on how healthcare 4.0 technologies affect investigates the relationships between healthcare 4.0 technologies, the
hospital supply chain processes and performance in the Indian health­ hospital supply chain processes, and performance. According to OIPT,
care system. businesses must effectively and efficiently gather, evaluate, and apply
In this study, we define healthcare 4.0 technologies as big data an­ information, particularly while carrying out intricate activities that
alytics, artificial intelligence (AI) and blockchain (Karatas et al., 2022; involve a high degree of risk and uncertainty (Galbraith, 1974). The
Sood et al., 2022; Tanwar et al., 2020), hospital supply chain processes following factors contribute to the inherent uncertainties in hospital
as supply chain operations, innovations, and risk management (Fischer- supply chain operations: clinical variability, demand variability,
Preßler et al., 2020; Kogan et al., 2014; Yoon et al., 2016) and supply random patient arrivals, changing patient medical conditions, and
chain performance in terms of cost, value, and responsiveness (Zhao variability in physicians’ prescribing behavior (Saha and Ray, 2019a). In
et al., 2023). Utilizing the survey data collected from 255 Indian hospital hospital supply chain innovations, uncertainties are mainly changes in
managers, we test a research model using structural equation modelling the supply chain network, supply chain models, inefficient supply of
that places healthcare 4.0 technologies and hospital supply chain pro­ products and services, budgetary cuts, social concerns, sustainability
cesses as antecedents of hospital supply chain performance. Illustrating obligations, changing patient needs (Malacina and Teplov, 2022). In
from the OIPT (Galbraith, 1974), we propose that healthcare 4.0 tech­ hospital supply chain, risks are mainly medicine shortages, wastage
nologies acts as the information processing capability that fulfills the risks, error in patient medication supplies, reactions occurring from
needs for information processing to enhance hospital supply chain failure to supply proper medication to patients (Baryannis et al., 2019).
processes under uncertainties, and thereby achieve desired level of To cope with such uncertainties and risks, healthcare organizations such
performance. We posit healthcare 4.0 technologies as the predecessor of as hospitals require a greater amount of information processing capa­
hospital supply chain processes (e.g., operations, innovations, and risk bilities and thereby achieve a given level of performance.
management), which in line influence the hospital supply chain per­ According to the OIPT, the best way to boost performance is to find a
formance. Healthcare 4.0 technologies, as an information processing balance between the organization’s excess capacity (information pro­
capability, exerts both direct impact on hospital supply chain perfor­ cessing capacity) and the shock that demands processing capacity (in­
mance as well as indirect impact through its influence on supply chain formation processing needs) (Hamann-Lohmer et al., 2023; Wong et al.,
processes. In addition, the type of healthcare organization plays an 2020; Yu et al., 2022). Thus, hospital supply chain operations, in­
important moderating role, i.e., the type of healthcare organization (e. novations and risk management can be positively associated with per­
g., private, and public hospitals) moderates the relationships between formance when its capacity fits the scale of uncertainties and risks.

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E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

Previous research on supply chain has employed OIPT to investigate the blockchain and many more which have the capability to improve a
importance of emerging technologies in implementing supply chain patient’s journey by analyzing patient’s data and cycle it back to
management practices, such as supply chain visibility and flexibility enhance the patient’s journey. According to organizational processing
(Srinivasan and Swink, 2018), supply chain transparency (Zhu et al., theory, healthcare 4.0 technologies act as an information processing
2018), supply chain integration (Yu et al., 2020), and sustainable supply capability that analyzes, and processes complex and unstructured
chain (Chatterjee et al., 2023a). Still, there has not been much focus on healthcare data to enhance data-driven decision making under un­
how hospitals might improve their information processing capabilities certainties (Yu et al., 2020). For example, big data and artificial intel­
through specific healthcare 4.0 technologies, such as big data analytics, ligence (AI) are widely acknowledged as powerful tools in healthcare 4.0
artificial intelligence and blockchain, for improving their supply chain and have been applied in a variety of ways, such as evaluating complex
operations, innovations, risk management practices and performance, health data, assisting in the discovery of the most effective course of
especially considering the different types of healthcare organizations (e. therapy, utilizing medical imaging to analyze symptoms, and many
g., private/public hospitals). From the standpoint of OIPT, in this study other applications (Benzidia et al., 2021). Besides, for accessing and
we assert that healthcare 4.0 technologies acts as the information pro­ managing the hospital records, privacy blockchain-enabled secure
cessing capability that fulfills the needs for information processing to healthcare architecture is introduced (Cerchione et al., 2022; Saha et al.,
enhance hospital supply chain processes under uncertainties, and 2021). Overall, utilizing such healthcare 4.0 technologies can support
thereby achieve desired level of performance. Fig. 1 shows our con­ hospitals to be efficient, innovative, and reliable, and better real time
ceptual framework. decision-making.
According to the model, hospitals could benefit from the imple­ We measure healthcare 4.0 technologies in terms of big data ana­
mentation of healthcare 4.0 technologies by improving their supply lytics, AI and blockchain as these technologies have a great synergy
chain activities such operations, innovations, and risk management. The (Pablo et al., 2021). Big data analytics serves as the primary information
model also implies that the interaction between healthcare 4.0 and each source for AI and blockchain supporting not just data retrieval but also
of these supply chain processes may be moderated by the type of analytic and management procedures. AI and blockchain can obtain
healthcare organizations (private and public hospitals). Furthermore, more precise data because of the early processing of large data infor­
the research indicates that every hospital supply chain process acts as a mation. AI and blockchain expand and magnify the usage of big data
mediator in the link between performance and healthcare 4.0. Hospital analytics, developing complex analyses of the data and generating so­
supply chain performance, the conceptual model’s outcome variable, phisticated outputs. So, these healthcare 4.0 technologies have been
reflects the overall impact of healthcare 4.0 and every supply chain integrated to realize a more coherent effect. Hence, our study considered
process on performance. collection of technologies to measure healthcare 4.0 technologies and its
impact on hospital supply chain processes. Such an approach was also
used in similar studies on the topic of Industry 4.0 and Pharma 4.0 (e.g.,
2.2. Healthcare 4.0 technologies Li et al., 2020; Saha et al., 2022).

With growing population and technological advancements, it is

becoming pertinent to facilitate healthcare systems with versatile 2.3. Hospital supply chain processes
capability. Healthcare 4.0 technologies are utilized to provide enhanced
healthcare service while ensuring security, accountability, and system Effective hospital supply chain processes ensure uninterrupted de­
efficiency (Li and Carayon, 2021; Mavrogiorgou et al., 2019; Tortorella livery of medical supplies and pharmaceuticals to patients (Moons et al.,
et al., 2022a, 2022b, 2022c, 2022d, 2022e). It includes advanced 2018). Hospital supply chain processes are information-driven,
technologies such as big data analytics, artificial intelligence, requiring various kinds of information about the external suppliers,

Fig. 1. Conceptual framework.

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E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

medical supplies and medicines, patients, and their medical conditions, 2.4. Hospital supply chain performance
physicians, and their prescribing behavior, etc. Based on the past liter­
ature on supply chain processes (Bodendorf et al., 2023; Hsin Chang Improving hospital supply chain performance has always been
et al., 2019; Yu et al., 2022), we extend the concept related to healthcare recognized as an important factor as healthcare organizations strive to
by conceptualizing hospital supply chain processes into three processes, improve operational efficiency and value and reduce cost (Chen et al.,
viz., supply chain operations, innovations, and risk management. Hos­ 2013). However, healthcare research has not explored the issue
pitals need to improve operations, innovations, and risk management adequately with its importance (Yu et al., 2020). Hospital supply chain
systems to keep the hospital supply chain efficient. From the lens of performance reflects the extent to which the supply chain satisfies the
OIPT, to enhance the hospital supply chain processes in the presence of patient’s needs in terms of medical product availability and on-time
uncertainties prevailing in the hospitals there is a need for information delivery while minimizing costs (Belhadi et al., 2021). Past literature
processing capability (Xie et al., 2022). has widely demonstrated that at the organizational level, supply chain
performance involves resource performance (efficiency), output per­
2.3.1. Hospital supply chain operations formance (effectiveness), and flexibility performance (agility) (Chen
Hospital supply chain operations ensure effective and efficient et al., 2021; Kamalahmadi et al., 2022; Kim et al., 2023). According to
medical flow from external suppliers to hospital central pharmacy and Benzidia et al. (2021); Junaid et al. (2023), hospital supply chain per­
finally to the point-of-care locations (Neve and Schmidt, 2022). To meet formance involves operational performance and sustainable perfor­
the patient demand, every stage of the hospital supply chain (i.e., the mance. Vanbrabant et al. (2023) defined hospital supply chain
hospital central pharmacy as well as various point-of-care locations) performance in terms of costs/profit, service level, quality of care,
needs to maintain optimal inventory levels for large number and great environmental, social impact, time, distance, and wastage. Chen et al.
variety of healthcare products (Ahmadi et al., 2022). In fact, to maintain (2013) presented the factors that influence hospital supply chain per­
the inventory and to ensure that there are no stock-out or overstock formance as trust, knowledge exchange, information technology inte­
situations, accurate demand prediction is required. Further, to ensure gration between the hospital and its suppliers, and hospital-supplier
availability of adequate quality of medical products, efficient supply integration. Information technology has been viewed as a part of supply
management and procurement is essential (Utama et al., 2022). All these chain integration in some earlier research, which also established a
operational activities require the processing of lots of complex and un­ direct correlation between supply chain technology utilization and
structured data (e.g., patient health data, prescription data, inventory company performance (Abdallah et al., 2021; Yu et al., 2020). In this
tracking data, medical supplies, and medicines data, etc.) in a fast and study we define hospital supply chain performance in terms of cost,
accurate manner. By effectively processing and utilizing such informa­ value, and responsiveness.
tion, hospitals are expected to achieve operational excellence even
under uncertain environments, thereby achieving a desired level of 2.5. Summary
performance (Chen et al., 2013). Hospital supply chain operations are
recognized as crucial for increasing hospital supply chain performance Investing the effects of the antecedents to hospital supply chain
(Saha et al., 2022). performance through the OIPT is important as these standpoints help to
explain how the information process capabilities, such as healthcare 4.0
2.3.2. Hospital supply chain innovations technologies, and information processing needs by hospital supply
Hospital supply chain innovation entails developing new and chain, influences the performance. The hospital supply chain is
improved ways to design hospital supply chains and to provide better information-driven as it must function in an uncertain environment.
solutions for fulfilling patients’ needs. Delgado and Mills (2020); Hab­ Besides, hospital clinical and managerial data are highly complex and
idin et al. (2015); Malacina and Teplov (2022); Yu et al. (2022) suggest unstructured. Hence, effective supply chain processes and performance
that supply chain innovation promotes affordable and easy access to improvement is not highly probable without utilizing appropriate
medical products, reduced delivery time of medical products to patients, technologies.
improved quality of delivered products, and information technology
application, hence, hospitals should concentrate on this area of inno­ 3. Hypotheses development
vation in their supply chains. Prior research also suggested that hospital
supply chain innovation is a tool that facilitates smooth communication 3.1. Effects of healthcare 4.0 technologies on hospital supply chain
between all supply chain participants. Supply chain innovation will help processes and performance
hospitals in a highly competitive setting by guaranteeing an effective
flow of medical services to patients, boosting flexibility, and improving According to OIPT, technologies enable an organization to accu­
performance (Chatterjee et al., 2023a). rately and timely process and analyze complex and unstructured data to
help the organizations make data-driven decisions under variability and
2.3.3. Hospital supply chain risk management uncertainty, thereby achieving operational excellence (Galbraith,
The hospital supply chain literature indicates that hospitals 1974). To increase their information processing capacity for clinical and
encounter two critical supply chain risks while managing inventory of management tasks, healthcare organizations continue to make signifi­
medical products, viz. demand exceeds supply (supply risk) resulting in cant investments in a variety of clinical and operational information
stockouts or supply exceeds demand (inventory risk) resulting in surplus systems (such as electronic health record systems, patient health re­
inventory (Zepeda et al., 2016). Hospital supply chain risk management cords, hospital information systems, etc.) (Chen and Esmaeilzadeh,
is the process of detecting, evaluating, and mitigating the risks. It is also 2023). Healthcare 4.0 technologies helps hospitals to analyze unstruc­
defined as the ability to significantly increase resilience. For instance, tured data (e.g., patient medical conditions, physicians prescribing
proper inventory management reduces medicine shortages at hospitals behavior, provisional and final diagnosis, test results, type of hospital
to increase resilience (Zamiela et al., 2021). However, a significant care units, type of medicines and medical supplies and the suppliers,
obstacle that makes it more difficult to manage risks is the hospital inventory replenishment quantities, etc.) and process them into struc­
supply chains’ lack of visibility and transparency (Fischer-Preßler et al., tured analyzable format which can be effectively used to make data-
2020). Hence, data and information are needed related to supply and driven supply chain decisions in real time for enhanced supply chain
demand, seasonal variations, inventory status, potential pandemics, etc. processes and performance (Hofmann et al., 2024; Yu et al., 2021; Zhu
to anticipate and analyze risks, thereby managing the risks and et al., 2018).
achieving the desired level of supply chain performance. According to OIPT, healthcare 4.0 technologies enable healthcare

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organizations’ information processing capability to process information analytics, artificial intelligence and blockchain. However, there is a
to forecast medicine demand, monitor, control, and optimize inventory huge investment cost involved regarding these new technologies, so it is
levels, meet uncertain patient demands and future healthcare trends, important to find whether the implementation of such technologies have
thereby enhancing the hospital’s supply chain operations. Developing the potential in enhancing hospital supply chain processes and perfor­
healthcare 4.0 technologies enables hospitals to analyze real-time pa­ mance without hampering the hospital ecosystem (Tortorella et al.,
tient and medical supply information collected from various devices 2022a, 2022b, 2022c, 2022d, 2022e). Hence, we posit that:
(such as wearables, internet-of-things, etc.) to track patient arrivals and
H1. Healthcare 4.0 technologies have a significant positive impact on
their medical conditions, physician allocated, their prescribing
(a) hospital supply chain operations, (b) innovations, (c) risk manage­
behavior, medication requirements, inventory levels, drug-disease in­
ment and (d) performance.
teractions, etc. Such versatile and complex information is analyzed using
emerging technologies like big data analytics and artificial intelligence
3.2. Effects of hospital supply chain processes on performance
to help hospital managers to effectively conduct their supply chain
operational activities and achieve desired patient outcomes (Aceto et al.,
From an OIPT perspective, the hospital supply chain processes
2020a, 2020b; Karatas et al., 2022; Tortorella et al., 2022a, 2022b,
enable the hospital to be efficient, innovative, and responsive in ways
2022c, 2022d, 2022e).
that enable hospitals to enhance their supply chain performance. Hos­
Analyzing medical flow data provides meaningful insights to help
pital supply chain operations are necessary for forecasting demands of
hospitals to decide whether there is any need to innovate their existing
medicines and medical items, efficient resource allocation, managing
supply chain. Lack of effective standard models in hospital supply chain,
procurement, supply management and distribution of healthcare prod­
fragmented supply chains, lack of coordination, etc. results in ineffective
ucts, and take-back strategy to collect any leftover healthcare products
and inappropriate supply chain design leading to huge cost, less coor­
(Moons et al., 2018). Not only that, in the hospitals maintaining in­
dination and delay in service delivery (Lee et al., 2011). Prior studies
ventory of medicines based on patient information, ensuring less expi­
have found applications of healthcare 4.0 like big data analytics, arti­
ration of medicines, and has become essential to provide excellent
ficial intelligence and blockchain that analyzes the relationships be­
healthcare service (Saha and Ray, 2019b). Hospital supply chain oper­
tween patients, products, and medical needs and accordingly support
ational activities ensure cost effective solutions with high service level.
hospitals to develop new approach towards supply chain such as rede­
Hence, efficient hospital supply chain operations could help impact the
sign healthcare supply chain network, reconfigure medical flow design,
hospital supply chain performance.
and build intensive and close coordination between supply chain stages
Past studies observed that when hospitals work on supply chain in­
within hospitals (Hartley et al., 2022; Yoon et al., 2016; Yu et al., 2022).
novations, they will redesign and enhance their supply chain network
This helps to fulfil and deliver medical supplies and pharmaceuticals to
which will speed up the patient response times, ensure visibility, reduce
patients in a cost-effective and timely manner. In the context of
medical inventory, reduce the time needed to administer the medicines
healthcare 4.0 technology, it will be possible for hospitals to develop
to patients, and thereby enhance the hospital supply chain performance
integration of data as well as data privacy abilities which are consider­
(Delgado and Mills, 2020; Su et al., 2011; Yoon et al., 2016). Moreover,
ably helpful for developing hospital supply chain innovation (Chatterjee
in the rapidly changing world, it is essential to advance the supply
et al., 2023a, 2023b). Based on these discussions, we expect that the
chains for immediate responding to the healthcare dynamics. Generally,
presence of healthcare 4.0 technologies enables a hospital to innovate
during and even after any crisis, hospital supply chains are restructured
their supply chain system.
based on the learnings and informational aspects are updated. Eventu­
Through the lens of OIPT, the healthcare 4.0 technologies facilitate
ally, these adjustments to the supply chain flow in accordance with the
information processing capabilities to anticipate supply chain risks in
changing needs will contribute to improved supply chain performance
the hospital such as unavailability of critical medical supplies or life-
(Chang et al., 2019).
saving medicines leading to delay in the patient treatment, worsening
Due to uncertainties and risk prevailing in the hospitals such as
of patient conditions, leading to fatal consequences. Technologies like
random patient arrivals with unknown severity of illness and need for
big data analytics and artificial intelligence can predict such risks and
medical treatment, as well as variation of environmental, political,
reduce the possible impact of risks. Numerous studies have shown that
technological scenario and potential pandemics, hospitals face diffi­
the pre- as well as post-pandemic period had an impact on the supply
culties in managing their supply chain (Munir et al., 2020; Xu et al.,
chain for necessary medical supplies (Tortorella et al., 2022a, 2022b,
2020). Hence, hospitals must create their supply chain risk management
2022c, 2022d, 2022e). Hence, this is expected that hospital supply chain
systems to overcome such issues. The tenets of OIPT suggest that a
risk management systems can be advance with support from healthcare
balance between the organizational capacity and the shock that needs
4.0 technologies. For instance, suppliers sharing their risks with hospi­
capacity to process helps to improve performance (Fan et al., 2016;
tals (even though they may be reluctant to share such kind of informa­
Hamann-Lohmer et al., 2023). Here, hospital supply chain risk man­
tion), and hospitals utilizing information and technologies to run
agement can be positively associated with performance when its ca­
simulations to anticipate supply chain risks (Ersahin et al., 2023; Li
pacity is appropriate for the level of risks in the hospital supply chain
et al., 2023).
(Wong et al., 2020). Overall, from an OIPT perspective, the hospital
It has been observed that the major components of healthcare 4.0
supply chain processes viz., operations, innovative, and risk manage­
technologies like big data analytics, artificial intelligence and block­
ment maintains lateral relations and could help impact their supply
chains can help hospitals and key supply chain players to ensure better
chain performance. Hence, we posit that:
hospital supply chain performance. Past research discovered that
healthcare 4.0 technologies increase visibility in the hospital supply H2. (a) Hospital supply chain operations, (b) innovations, and (c) risk
chain which helps in efficient monitoring of medications and medical management are positively associated to hospital supply chain
supplies with better security and transparency thus enhancing the performance.
overall hospital supply chain performance in terms of cost, value, and
responsiveness (Chatterjee et al., 2023a; Tortorella et al., 2022a, 2022b, 3.3. Mediating effects of hospital supply chain processes
2022c, 2022d, 2022e).
Overall, Tortorella et al. (2023) and Chatterjee et al. (2023a, 2023b) Given the set of hypotheses (H2a, H2b, and H2c), to better under­
have found that to boost hospital supply chain operations, innovations, stand the effects of hospital operations, innovations, and risk manage­
risk management system and overall performance, hospitals are seeking ment, we examine the mediating effects of these three supply chain
support from specific healthcare 4.0 technologies such as big data processes in the relationship between healthcare 4.0 technologies and

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performance. Based on the hypothesis (H1d), we intend to find out obtained from analysis by healthcare 4.0 technologies and can leverage
whether a direct effect exists between healthcare 4.0 technologies and this capability to provide risk management strategies and achieve su­
performance. However, the lack of a significant coefficient for such a perior performance. Past studies have observed organizational resilience
path indicates that hospital supply chain operations, innovations and skills act as a mediator in the link between digital technologies and
risk management fully mediate the effect of healthcare 4.0 technologies resilient systems (Furstenau et al., 2022). We argue that healthcare 4.0
on performance (Yu et al., 2020). technologies will facilitate more information about risks to hospitals
According to OIPT, organizations require a stabilizing mechanism (such as, supply risk and demand uncertainties), enabling hospitals to
that entails having the necessary resources and operational capacity to better identify, prevent, mitigate, and respond to such risks thereby
cope with uncertainties that jeopardize the regular operations of busi­ enhance their risk management systems. As a result, the hospitals’
ness processes (Wong et al., 2020). Within hospital supply chain, oper­ performance will increase, and they will be better equipped to recognize
ational activities can increase the complexity of decision-making which and manage possible risks.
will increase the requirement for new and extra information from Hence, we contend that hospital supply chain risk management has a
healthcare organizations (Dobrzykowski et al., 2014; Zhu et al., 2018). mediating role in the link between healthcare 4.0 technology and per­
Hospital supply chain operations can be seen from the OIPT’s point of formance. These arguments lead us to propose the following theories:
view as an information processing requirement that motivates firms to
H3. (a) Hospital supply chain operations, (b) innovations and (c) risk
gather data to support decision-making along the supply chain
management positively mediates the link between healthcare 4.0 tech­
(Hamann-Lohmer et al., 2023). For instance, if a hospital experiences
nologies and performance.
supply uncertainties due to capacity issues and if the occurrence of these
unforeseen scenarios rises significantly, this would suggest a mismatch
3.4. Moderating effect of type of healthcare organization
between information processing needs and information processing
capability. Additional capabilities are hence needed to address the
Healthcare organizations such as hospitals are working to enhance
emerging requirements to achieve the desired level of performance.
their supply chains to thrive in this cutthroat business market. Imple­
Here, we consider how healthcare 4.0 technologies can serve as the
menting healthcare 4.0 technology in the hospital supply chain opera­
capability that can address information processing requirements for
tions, innovations, and risk management, can enhance the hospital
operational activities to achieve a desired level of performance (Bardhan
supply chain performance (Kogan et al., 2014; Lee et al., 2011; Zepeda
and Thouin, 2013; Göleç and Karadeniz, 2020). We argue that a link
et al., 2016). Besides, our study considers hospitals with both public and
between healthcare 4.0 and performance exists because of the presence
private ownership because a comprehensive healthcare 4.0 deployment
of hospital supply chain operations. There is a greater chance that a
necessitates investments in expensive information and communication
hospital will obtain precise supply and demand data with healthcare 4.0
technology. Further, that would enable us to determine the extent to
technologies which might lead to effective and efficient operations and
which healthcare 4.0’s effects on healthcare organizations with various
thereby lead to performance improvement.
capital expenditure capacities affect supply chain operations, in­
Information processing capabilities, such as gathering, interpreting,
novations, and resilience (Tortorella et al., 2022a, 2022b, 2022c, 2022d,
synthesizing, coordinating information, and processing the information
2022e). The higher pervasiveness of healthcare 4.0 is somewhat
in a structured way enable firms to redesign and innovate their supply
coherent with the assumption that private hospitals in developing are
chains to operate effectively in a fast-paced environment (Yu et al.,
likely to have larger capital expenditure capacity than public ones, thus
2020). Hospital supply chain innovations can raise the uncertainty in
supporting wider adoption of digital applications (Tortorella et al.,
decision-making and subsequently increase healthcare organizations’
2020a, 2020b). Besides, in the prior research, differences are observed
needs for new knowledge (Abdallah et al., 2021). From the viewpoint of
in supply chain models at different hospitals (public and private)
OIPT, hospital supply chain innovations need information processing.
(Fischer-Preßler et al., 2020). In hospitals, it is observed that private
This promotes organizations to build information processing capability
hospitals are generally concerned about technology adoption whereas
to support decision-making along the hospital supply chain. For
public hospitals are generally concerned about technological usefulness
instance, hospitals utilize technologies for hospital supply chain in­
(Beaulieu and Bentahar, 2021; Mandal, 2017). With respect to the mo­
novations, resulting in new paths of designing healthcare service de­
tivations on healthcare 4.0, unlike public hospitals, which are mainly
livery, and solving medical logistics issues. According to Belhadi et al.
driven by external requirements (e.g., government and large suppliers),
(2021); Chang et al. (2019); Tan et al. (2015), healthcare 4.0 technol­
private hospitals acknowledged healthcare 4.0 as strategy for achieving
ogies have the potential to drive creative processes by expediting the
higher performance and competitiveness (Beaulieu and Bentahar, 2021;
development of new approaches to supply chain problems. The supply
Fischer-Preßler et al., 2020). Additionally, compared to private ones,
chain can provide a high degree of service and reduce costs in the pro­
public hospitals in developing nations like India are more likely to lack
cess by accelerating innovative capabilities, which improves perfor­
resources (such as employees, equipment, and infrastructure) (Shukla
mance. Hence, we argue that a link between healthcare 4.0 and
et al., 2021). As a result, such resource shortage may impose additional
performance exists along with the presence of hospital supply chain
obstacles to the adoption of healthcare 4.0, creating an organizational
innovations.
setting that could have a negative impact on the level of implementation
Prior studies such as El Baz and Ruel (2021); Ersahin et al. (2023);
of its associated technologies (Adere, 2022; Tortorella et al., 2020a,
Fischer-Preßler et al. (2020) asserted that sharing and analysis of supply
2020b; Tortorella et al., 2022a, 2022b, 2022c, 2022d, 2022e). In
chain risk information is crucial for effective risk management which aid
response, we contend that the interaction between healthcare 4.0
in minimizing disturbances and achieving successful mitigation. Supply
technology and hospital supply chain processes may be moderated by
chain risks can increase hospitals’ requirements for real-time informa­
type of healthcare organization (i.e., private, or public hospitals). For
tion. Hospital supply chain risk management, from the viewpoint of the
instance, according to the OIPT, healthcare 4.0 technologies might not
OIPT, is an information processing need that encourages organizations
contribute to hospital supply chain operations, innovations, and risk
to process risk related information to assist risk management throughout
management improvements in the type of organizations where risks and
the hospital supply chain. According to Junaid et al. (2023); Tortorella
uncertainties are low (Venkatraman et al., 2022). In the hospitals with
et al. (2022a, 2022b, 2022c, 2022d, 2022e), healthcare 4.0 technologies
low risks and uncertainties, the increased capacity reserved for supply
are prone to lead risk management by providing risk information.
chain activities will be adequately exploited to enhance performance
Hence, healthcare 4.0 technologies constitute hospital supply chain risk
resulting in surplus resources. Hence, we posit that:
information processing capability. For instance, hospitals can effectively
reduce supply chain risks through effective use of risk information H4. Type of healthcare organization moderates the association

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E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

between healthcare 4.0 technologies and (a) hospital supply chain op­ hospitals across various Indian areas were chosen at random using
erations, (b) innovations and (c) risk management. LinkedIn, hospital websites, and other social media and personal net­
works. Hospital managers (e.g., senior executives, senior managers-
4. Methodology operations, purchase managers, head of operations, project manager,
product manager, finance manager, quality head, information technol­
We used a research methodology based on an online survey to gather ogy manager, etc.) who oversaw various hospital managerial re­
information from hospital managers using a questionnaire to assess the sponsibilities received the survey invitations via LinkedIn message,
research hypotheses. Next, we present the measures and data collection email, WhatsApp, and other channels. It also appears that most re­
procedure for this study. spondents had enough experience to respond to the survey questions
because they had held their positions for longer than five years. Addi­
4.1. Measures and control variables tionally, a guideline was provided stating that this survey is intended for
participants who are familiar with and understand various technologies
To create the instrument, we modified several currently used, reli­ used in healthcare systems. Participants were also welcome to clear up
able measuring scales from the literature (see Appendix - A Table A1). any of their queries. In the end, 267 responses in all were received;
We carried out a pilot test with senior hospital executives and academic approximately 12 false and incomplete responses were eliminated,
experts in the relevant field to demonstrate content validity of the leaving 255 valid and useful responses (i.e., a response rate of around 36
questionnaire and its measurement scales. To guarantee the accuracy of % which is acceptable as per the literature Rathore and Sarmah (2021);
the data, we furnished respondents with explanations on the theoretical Yu et al. (2020)).
constructs (hospital supply chain operations, innovations, risk man­ Table 1 lists the demography of the respondents along with the at­
agement, and performance) and healthcare 4.0. This enabled them to tributes of their respective hospitals. From Table-1 it can be observed
accurately comprehend the survey questions and provide truthful re­ that around 32 % of managers have about one to three years of work
sponses. The theoretical framework’s constructs were all determined experience, 18 % have about three to five years of work experience, and
using five-point Likert scale, with 1 signifying strongly disagree and 5 around 50 % have above five years of work experience indicating
signifying strongly agree. The healthcare 4.0 metrics were adapted from diverse experience. In addition, among the total responses, around 60 %
Benzidia et al. (2021); Tanwar et al. (2020); Tortorella et al. (2021) and of the responses were from managers working in private hospitals and
were modified to include items that reflected hospital perspectives on 72 % of the responses were from managers working in hospitals located
the use of artificial intelligence, big data analytics, and blockchain in in the urban areas where the awareness of latest technologies is huge (Al
hospital supply chain management. These three selected technologies Dahdah and Mishra, 2022).
are having a great synergy (Pablo et al., 2021). We conceptualized
hospital supply chain processes as hospital supply chain operations, 4.3. Non-response bias and common method bias
innovations, risk management. We adapted the items developed by Yu
et al. (2020); Zhu et al. (2018) to measure hospital supply chain oper­ To determine whether there are any meaningful variations between
ations, which emphasizes a hospital’s activity in leveraging supplier the early and late responses, it is appropriate to test for non-response
expertise and resources, improving service delivery by understanding bias in survey research (Saha et al., 2022). Late responders are more
patient and clinicians’ needs, and focusing on cost reduction. We likely to respond to survey questions in the same way as non-
adapted the measures of hospital supply chain innovations from Belhadi respondents. We compared the early and late responders across all
et al. (2021); Yoon et al. (2016), which included the active investment factors in our study to assess non-response bias using a paired t-test, and
on innovations in supply chains, and actively innovating hospital supply the findings revealed no significant differences (p < 0.05) (see
chain network design. We adapted scale to measure hospital supply Appendix-B Table B1). The findings demonstrate that non-response bias
chain risk management from Fan et al. (2016); Wong et al. (2020), was not a noteworthy issue in this study.
which included reducing risks related to supply, improving risk pre­ A few techniques were used to prevent common method bias (CMB)
diction, and reducing risks of stockouts. The measures for hospital (Yu et al., 2020). We randomized the measuring items in the question­
supply chain performance were adapted from Benzidia et al. (2021); naire survey during design to make it impossible for respondents to
Chen et al. (2013), including items to measure performance of hospital discern between the independent and dependent variables. To ensure
supply chains in terms of cost, value, and responsiveness. that responders could appropriately answer the questions, we also made
There are two control variables in our study: hospital location sure the items were succinct, uncomplicated, and precisely phrased.
(whether the hospital is in urban, rural, or sub-urban area) and work Additionally, we made sure that the scale that was used to gather the
experience of the respondents (number of years) as they can influence replies had a range of choices and that the responses were gathered on
the outcomes. For instance, urban hospitals compared to sub-urban and
rural hospitals may have more skilled resources and digital literacy for
Table 1
adopting new technologies for the development of healthcare 4.0 tech­ Summary of respondents’ demographic profile and characteristics of their
nologies and performance improvement (PwC India, 2018). Also, there hospitals.
is great disparity in the number of multi-specialty hospitals and tech­
Details Frequency Percentage (%)
nology advanced hospitals between urban, sub-urban and rural areas
(Venkatraman et al., 2022). In addition, years of work experience of Healthcare organization type (in terms of ownership)
Private 153 60
hospital managers who responded to our survey is also considered as
Public 102 40
control variable as it can lead to variation in knowledge about the
healthcare systems and development of healthcare 4.0 technologies,
Work experience of hospital managers (in number of years)
thereby the outcomes of the study (Abadie et al., 2023; Lewis et al., 1–3 years 82 32
2023). 3–5 46 18
>5 127 50
4.2. Data collection
Location of the hospital
To test the research approach, primary survey data from Indian Urban 184 72
hospitals was collected using a questionnaire. The information was Sub-Urban 25 10
Rural 46 18
gathered between January and April of 2022. Approximately 700

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E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

various days of the week and at various times of the day. Additionally, is determined. Here, high R2 value (between 0.6 and 1) indicates the
we considered the responders’ privacy. The Harman single-factor test is high prediction ability of the model, while low R2 value (between 0 and
also used to evaluate CMB in more detail. It is noted that the one factor 0.3) leads to low prediction ability. Lastly, a hypotheses test was per­
accounts for 23.261 % variance explained, and it is within the recom­ formed by analyzing the structural model. Both t-value and p-value were
mended level, i.e., below 50 % (Podsakoff et al., 2003). Additionally, the calculated to decide the acceptance and rejection of proposed
single marker variable test is carried out (Lindell and Whitney, 2001), hypotheses.
and the results indicate an insignificant outcome (i.e., p > 0.05) when p
< 0.05 is taken into consideration as the significance level. These find­ 5.1. Measurement model assessment
ings lead us to the conclusion that common technique bias poses no
substantial risk in this investigation. We also carried out the full Confirmatory factor analysis is utilized to evaluate the measuring
collinearity variance inflation factors (VIF) test, which Kock (2015) scales for construct reliability, convergent validity, and discriminant
recommended, to determine CMB. The author suggests using a VIF validity. According to the findings presented in Table 2, there is enough
threshold of 3.3 for CMB testing when factor-based partial least square evidence of reliability because the composite reliability scores, which
structural equation modelling methods are used. Table 2 shows the full varied from 0.833 to 0.873, are much higher than the generally recog­
VIF value for each construct. These values are <3.3, suggesting that nized cut-off value of 0.70 (Hair et al., 2020). Table 2 further indicates
there may not be any CMB in the study model (Kock, 2015). that the average variance extracted (AVE) values (ranging from 0.802 to
0.842) are higher than the suggested cut-off value of 0.50 (Fornell and
5. Data analysis and results Larcker, 1981) and that all item loadings are statistically significant and
>0.70 (Hair et al., 2020). The convergent validity of the constructs in
Following data collection, the reliability and validity of the measures the model is thus supported by these results.
were assessed (measurement model) using the SmartPLS 4.0 version Discriminant validity is confirmed by the square root of AVE of each
software’s partial least squares structural equation modelling (PLS-SEM) theoretical construct which is bigger than the inter-construct correla­
method. PLS-SEM has been found to have strong predictive power in tions (Fornell and Larcker, 1981) ensuring that each factor is individual
numerous investigations (Fosso Wamba, 2022; Saha et al., 2022). and significantly different from each other (see Table 3). Overall, the
Furthermore, studies show that PLS-SEM can analyze the data’s reli­ measuring model represents the strong construct validity and reliability
ability and validity, as well as the model’s predicted accuracy and required to evaluate the structural model.
goodness of fit. PLS-SEM has also been utilized in other studies to assess In addition, fitness of the model is analyzed using the model fit
formative structure, mediating, and moderating factors (Kautish and indices such as Root mean square error of approximation (RMSEA),
Khare, 2022; Ranganathan et al., 2011). Hence, PLS-SEM is utilized in Standardized root means square residual (SRMR), Goodness of fit index
this study to analyze the data’s reliability and validity (Hair et al., 2019, (GFI), Adjusted goodness of fit index (AGFI), Normed fit index (NFI),
2020; Sarstedt et al., 2021). For reliability, the composite reliability Comparative fit index (CFI), and Normed chi-square (χ2/df). It is
(CR) of each factor is determined because CR describes the internal
consistency of factors which indicate reliability of the data for future Table 3
investigation. Similarly, for validity, data’s convergent validity (CV) is Discriminant validity score.
identified because CV shows the magnitude to which the construct
HC 4.0 HCSCI HCSCO HCSCP HCSCRM
converges to describe the variance of its items. CV comprises of two
measures; factor loading, and average variance extracted (AVE). HC 4.0 0.895
HCSCI 0.691 0.912
Therefore, in this study, the factor loading of each indicator and AVE of HCSCO 0.700 0.759 0.917
each construct is calculated. Later, to check the construct distinctive­ HCSCP 0.793 0.811 0.662 0.916
ness, discriminant validity ratings were identified. For model predict­ HCSCRM 0.677 0.719 0.895 0.645 0.907
ability coefficient of determination (R2) value of each endogenous factor

Table 2
Measurement model assessment.
Constructs Indicators Mean Standard deviation Loadings CR AVE VIF

Healthcare 4.0 technologies (HC 4.0) HC1 3.45 0.490 0.875 0.873 0.802 1.091
HC2 3.65 0.947 0.928
HC3 3.47 1.152 0.895
HC4 3.57 0.974 0.868
HC5 3.60 1.116 0.919
HC6 3.57 0.995 0.886
HC7 3.40 1.093 0.910
HC8 3.62 0.943 0.949
HC9 3.47 1.111 0.820
Hospital supply chain operations (HCSCO) HCSCO1 3.20 0.980 0.926 0.864 0.842 1.017
HCSCO2 3.22 1.084 0.898
HCSCO3 3.25 1.019 0.935
HCSCO4 3.40 0.970 0.906
HCSCO5 3.32 0.985 0.921
Hospital supply chain innovations (HCSCI) HCSCI1 3.65 1.014 0.951 0.837 0.832 1.097
HCSCI2 3.37 1.041 0.855
HCSCI3 3.60 0.970 0.927
Hospital supply chain risk management (HCSCRM) HCSCRM1 3.40 0.995 0.896 0.833 0.822 1.017
HCSCRM2 3.27 0.948 0.931
HCSCRM3 3.27 0.922 0.893
Hospital supply chain performance (HCSCP) HCSCP1 3.60 1.044 0.878 0.854 – –
HCSCP2 3.77 0.935 0.908
HCSCP3 3.60 1.068 0.939
HCSCP4 3.75 1.112 0.940

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E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

observed that the RMSEA value for the model is 0.068 which is less than indirect impact of hospital supply chain risk management on the link
the cut off value 0.08 and thus implies good model fit (Rana et al., 2023). between healthcare 4.0 and performance is not significant (H3c: β =
Similarly, it is identified that SRMR value is 0.07, GFI is 0.97, AGFI is 0.083, n.s.).
0.94, NFI is 0.93, CFI is 0.79, and χ2/df is 2.14. These values of indexes Additionally, we tested the moderating effects of types of healthcare
indicate that the model is a good fit (Bilgihan, 2016; Kumar and Kaushik, organizations (private or public hospitals) on the link concerning
2022). healthcare 4.0 technologies and the three hospital supply chain pro­
cesses. Table 4 indicates that among the three hospital supply chain
processes, the hypothesis that the types of healthcare organizations
5.2. Structural model assessment (private or public hospitals) moderate the association between health­
care 4.0 technologies and hospital supply chain operations (H4a) is
Table 4 presents the results of structural model which indicates that statistically significant (β = − 0.331, p < 0.05). However, the moderating
healthcare 4.0 technologies is positively related to hospital supply chain effect of types of healthcare organizations (private or public hospitals)
operations (β = 0.718, p < 0.001), innovations (β = 0.888, p < 0.001), on the link between healthcare 4.0 technologies and hospital supply
risk management (β = 0.688, p < 0.001), and performance (β = 0.721, p chain innovations (H4b: β = 0.043, n.s.) and risk management (H4c: β =
< 0.001) supporting H1a, H1b, and H1c. Hospital supply chain opera­ − 0.281, n.s.) are not supported.
tions (β = 0.634, p < 0.01), hospital supply chain innovations (β = Additionally, this study evaluated the explained variance (R-square)
0.717, p < 0.001) and hospital supply chain risk management (β = of all endogenous constructs to determine the model’s explanatory
0.601, p < 0.05) are positively associated with hospital supply chain ability (Table 4). R-square values can be strong (0.75), moderate (0.50),
performance, suggesting that H2a, H2b and H2c are supported. or weak (0.25) (Hair et al., 2017). The values for hospital supply chain
We also test the mediation of hospital supply chain operations, in­ operations (0.802), innovations (0.600), risk management (0.544), and
novations, and risk management by conducting the bootstrap method performance (0.666) are displayed in Table 4. These numbers show that
with 5000 bootstrap resamples, and the results of the analysis are pre­ the model has a high capacity for prediction, meaning that it will be able
sented in Table 4. The indirect effect of hospital supply chain operations to accurately forecast changes in endogenous components if exogenous
and innovations on the relationship between healthcare 4.0 and per­ constructs change.
formance is statistically significant at p < 0.001. The direct effect of
hospital supply chain operations (β = 0.634, p < 0.01) and innovations
(β = 0.717, p < 0.001) on performance is also significant. Hence, the 5.3. Robustness test
results indicate that hospital supply chain operations and innovations
partially mediate the relationship between healthcare 4.0 and perfor­ 5.3.1. Assessment of nonlinear effects
mance. Hence, the test results provide support for H3a and H3b, sug­ We adhered to Svensson et al. (2018) and performed two tests to
gesting that healthcare 4.0 technologies affect performance indirectly, check for potential nonlinearities in the structural model linkages. We
through hospital supply chain operations and innovations. However, the first used Ramsey (1969) RESET on the latent variable scores extracted
after the convergence of the original model’s PLS-SEM algorithm. We
Table 4 find that neither the partial regression of hospital supply chain opera­
Structural model assessment. tions on healthcare 4.0 (F = 0.9872, p = 0.5306), hospital supply chain
innovations on healthcare 4.0 (F = 1.7986, p = 0.1801), hospital supply
Hypothesis Effect β t-value p-value Supported?
[Yes| No] chain risk management on healthcare 4.0 (F = 0.2833, p = 0.6902) nor
the partial regression of hospital supply chain performance on health­
H1a HC 4.0 -> 0.718 7.905 0.000*** Yes
HCSCO
care 4.0, operations, innovations and risk management (F = 1.2711, p =
H1b HC 4.0 -> 0.888 15.262 0.000*** Yes 0.2991) has nonlinearities. Then, to depict the quadratic impacts be­
HCSCI tween (1) healthcare 4.0 on hospital supply chain operations, in­
H1c HC 4.0 -> 0.688 6.177 0.000*** Yes novations, and risk management, and (2) healthcare 4.0, hospital supply
HCSCRM
chain operations, innovations, and risk management on hospital supply
H1d HC 4.0 -> 0.721 8.415 0.000*** Yes
HCSCP chain performance, we included interaction terms. According to the
H2a HCSCO -> 0.634 2.873 0.002** Yes results of bootstrapping using 5000 samples (see Table 5), neither of the
HCSCP nonlinear effects are found significant. Hence, we conclude that the
H2b HCSCI -> 0.717 3.638 0.000*** Yes linear effects model can be trusted.
HCSCP
H2c HCSCRM -> 0.601 2.340 0.024* Yes
HCSCP 5.3.2. Assessment of endogeneity
H3a HC 4.0 -> 0.651 4.031 0.000*** Yes By using the latent variable scores from the initial model estimation
HCSCO -> and the Gaussian copula approach, we assess the possibility of
HCSCP
H3b HC 4.0 -> 0.636 3.337 0.001*** Yes
HCSCI -> Table 5
HCSCP Nonlinear effects results.
H3c HC 4.0 -> 0.083 0.361 0.718 No
Nonlinear relationship Coefficient p f2 Ramsey’s RESET
HCSCRM ->
value
HCSCP
H4a TOO*HC 4.0 -> − 0.331 1.965 0.050* Yes F = 1.7986, p =
HC 4.0 * HC 4.0 -> HCSCI 0.025 0.905 0.286
HCSCO 0.1801
H4b TOO*HC 4.0 -> 0.043 0.411 0.681 No F = 0.9872, p =
HC 4.0 * HC 4.0-> HCSCO 0.203 0.518 0.028
HCSCI 0.5306
H4c TOO*HC 4.0 -> − 0.281 1.354 0.176 No HC 4.0 * HC 4.0-> F = 0.2833, p =
0.320 0.316 0.022
HCSCRM HCSCRM 0.6902
2 2 2 2 HC 4.0 * HC 4.0-> HCSCP − 0.107 0.674 0.177
[Note: R (HCSCI) = 0.802; R (HCSCO) = 0.600; R (HCSCRM) = 0.544; R
HCSCI*HCSCI -> HCSCP 0.093 0.639 0.123
(HCSCP) = 0.666]. F = 1.2711, p =
HCSCO*HCSCO -> HCSCP − 0.022 0.893 0.026
*
p < 0.05. 0.2991
HCSCRM*HCSCRM ->
** − 0.089 0.528 0.011
p < 0.01. HCSCP
***
p < 0.001.

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E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

endogeneity (Huit et al., 2018). First, we determine whether the vari­ Table 6
ables’ distributions are nonnormal to rule out endogeneity. We accom­ Endogeneity test results.
plish this by performing the Kolmogorov-Smirnov test with Lilliefors Test Construct Coefficient p-
correction on the latent variable scores of healthcare 4.0, hospital supply value
chain operations, innovations, and risk management, which act as in­ Gaussian copula of model 1 (endogenous HC 4.0 0.825 0.000
dependent variables in the partial regressions of the partial least square variables; HC 4.0) HCSCI 0.634 0.002
path model (Sarstedt et al., 2020). The findings demonstrate that none of HCSCO 0.717 0.000
the constructs have scores that are normally distributed, enabling us to HCSCRM 0.601 0.024
c
HC 4.0 0.104 0.471
continue using Gaussian copula method. The findings in Table 7
−
Gaussian copula of model 2 (endogenous HC 4.0 0.721 0.000
demonstrate that neither of the Gaussian copulas (i.e., healthcare 4.0, variables; HCSCI) HCSCI 0.742 0.000
hospital supply chain operations, innovations, and risk management) is HCSCO 0.717 0.000
significant (p > 0.05). Considering hospital supply chain performance’s HCSCRM
c
0.601 0.024
HCSCI 0.108 0.357
four predictor constructs as probable endogenous produces nonsignifi­ −
Gaussian copula of model 3 (endogenous HC 4.0 0.721 0.000
cant copulas of − 0.104 for healthcare 4.0 (p = 0.471), − 0.066 for op­ variables; HCSCO) HCSCI 0.634 0.002
erations (p = 0.621), − 0.108 for innovations (p = 0.357), and − 0.012 HCSCO 0.783 0.000
for risk management (p = 0.932). Recall that none of the other Gaussian HCSCRM 0.601 0.024
c
copula combinations that were part of the model are significant despite HCSCO − 0.066 0.621
Gaussian copula of model 4 (endogenous HC 4.0 0.721 0.000
our checks (Table 6). We therefore infer that endogeneity is nonexistent variables; HCSCRM) HCSCI 0.634 0.002
in this investigation, supporting the robustness of the structural model’s HCSCO 0.717 0.000
findings in this regard (Huit et al., 2018). HCSCRM 0.613 0.000
c
HCSCRM − 0.012 0.932
Gaussian copula of model 5 (endogenous HC 4.0 0.781 0.000
5.3.3. Assessment of unobserved heterogeneity
variables; HC 4.0, HCSCI) HCSCI 0.694 0.000
We initially performed the FIMIX-PLS technique on the data, which HCSCO 0.717 0.000
is a systematic method for identifying and, if necessary, treating unob­ HCSCRM 0.601 0.024
served heterogeneity in partial least square path models developed by c
HC 4.0 − 0.069 0.651
c
Sarstedt and Ringle (2010). We initiated the process by assuming a one- HCSCI − 0.090 0.469
Gaussian copula of model 6 (endogenous HC 4.0 0.806 0.000
segment solution, using 10− 7 as stop criterion, 5000 iterations, and 10
variables; HC 4.0, HCSCO) HCSCI 0.634 0.002
repetitions. Sample size needed to estimate each segment was initially HCSCO 0.762 0.000
calculated to establish the maximum number of segments to extract. The HCSCRM 0.601 0.024
c
findings of a post hoc power analysis, which considered an impact size of HC 4.0 − 0.094 0.528
c
HCSCO 0.050 0.715
0.30 and a power level of 80 %, indicate that 45 samples are the bare −
Gaussian copula of model 7 (endogenous HC 4.0 0.818 0.000
minimum needed, allowing for the extraction of up to five segments. variables; HC 4.0, HCSCRM) HCSCI 0.634 0.002
Therefore, we ran FIMIX-PLS again for two to five segments using the HCSCO 0.717 0.000
same settings as in the initial analysis. HCSCRM 0.591 0.030
c
The fit indices for the one- to five-segment solutions are displayed in HC 4.0 − 0.106 0.479
c
HCSCRM 0.010 0.944
Table 7. When AIC3 and CAIC suggest the same number of segments, as
Gaussian copula of model 8 (endogenous HC 4.0 0.712 0.000
demonstrated by Sarstedt et al. (2011), the results probably indicate the variables; HCSCI, HCSCO) HCSCI 0.732 0.000
right number of segments. AIC3 and CAIC, in our analysis, indicate a HCSCO 0.744 0.000
two-segment solution. AIC4 and Bayesian information criteria (BIC) HCSCRM 0.601 0.024
c
HCSCI 0.100 0.427
often perform well when used to calculate the number of segments in c
−
HCSCO − 0.029 0.835
FIMIX-PLS. Both criteria indicate a two-segment solution, which the EN Gaussian copula of model 9 (endogenous HC 4.0 0.712 0.000
criterion suggests is densely clustered. There is a clear propensity for the variables; HCSCI, HCSCRM) HCSCI 0.753 0.000
minimal description length with factor 5 (MDL5) criterion to over­ HCSCO 0.717 0.000
estimate the number of segments. Therefore, it is often recommended HCSCRM 0.572 0.034
c
HCSCI 0.119 0.349
that researchers extract more segments than MDL5 suggests Sarstedt
−
c
HCSCRM 0.038 0.805
et al. (2011). Gaussian copula of model 10 (endogenous HC 4.0 0.712 0.000
Additionally, the minimum sample size criteria for each segment are variables; HCSCO, HCSCRM) HCSCI 0.634 0.002
met by a two-segment approach (Table 8). Overall, the result uncovered HCSCO 0.736 0.146
HCSCRM 0.532 0.037
by segmentation explains the organizational demographic differences c
HCSCO − 0.019 0.110
(e.g., private, and public hospitals), and hence, the unobserved hetero­ c
HCSCRM 0.069 0.128
geneity is turned into observed heterogeneity (Becker et al., 2013). Gaussian copula of model 11 (endogenous HC 4.0 0.782 0.000
variables; HC 4.0, HCSCI, HCSCO) HCSCI 0.712 0.000
6. Discussion HCSCO 0.740 0.000
HCSCRM 0.601 0.024
c
HC 4.0 − 0.066 0.669
6.1. Summary of findings c
HCSCI − 0.084 0.524
c
HCSCO − 0.023 0.869
The three supply chain processes—supply chain operations, in­ Gaussian copula of model 12 (endogenous HC 4.0 0.790 0.000
variables; HC 4.0, HCSCI, HCSCRM) HCSCI 0.730 0.000
novations, and risk management are all valuable, as the empirical
HCSCO 0.717 0.000
findings demonstrate. Hospital supply chain processes are also found HCSCRM 0.554 0.033
crucial for improving performance in terms of cost, value, and respon­ c
HC 4.0 − 0.074 0.633
siveness. This is a significant finding since other research has shown c
HCSCI − 0.102 0.441
c
concerns on how difficult it is for hospitals to improve organizational HCSCRM 0.047 0.765
Gaussian copula of model 13 (endogenous HC 4.0 0.844 0.000
performance from supply chains, and how hospitals that have a well- variables; HC 4.0, HCSCO, HCSCRM) HCSCI 0.634 0.002
managed supply chain can reap significant organizational benefits HCSCO 0.782 0.000
from both financial and clinical standpoint (Ala et al., 2024; Moadab (continued on next page)
et al., 2023).

10
E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

Table 6 (continued ) uncertainties, which in turn yield high performance. This is an essential
Test Construct Coefficient p- finding because, to improve performance, healthcare organizations must
value increasingly make data-driven supply chain decisions (Ali and Kannan,
HCSCRM 0.584 0.032
2022; Govindan et al., 2020; Shafique et al., 2024).
c
HC 4.0 − 0.130 0.376 Ultimately, our study results demonstrate the existence of a moder­
c
HCSCO − 0.068 0.196 ating impact that is pertinent to our model. We discovered that the type
c
HCSCRM 0.017 0.104 of healthcare organization—private and public hospitals—plays a key
Gaussian copula of model 14 (endogenous HC 4.0 0.815 0.000
role in determining how healthcare 4.0 technologies interact with hos­
variables; HC 4.0, HCSCI, HCSCO, HCSCI 0.741 0.000
HCSCRM) HCSCO 0.894 0.000 pital supply chain operations. This is an important finding as previous
HCSCRM 0.538 0.035 studies have demonstrated that there is disparity between private and
c
HC 4.0 − 0.097 0.522 public hospitals (Bisceglia et al., 2023) and is a challenge in India
c
HCSCI − 0.107 0.410 (Khetrapal et al., 2019; Venkatraman et al., 2022).
c
HCSCO − 0.177 0.095
c
HCSCRM 0.063 0.091
6.2. Implications for theory

Our research makes multiple theoretical advances. First, the present

Table 7
study looks at hospital supply chain operations, innovations, and risk
Fit indices results.
management from an empirical perspective, together with healthcare
Criteria Number of segments
4.0 technologies. There has not been much empirical research in this
1 2 3 4 5 field, despite strong regulatory pressure on hospitals to operate more
AIC 315.043 268.073 260.114 253.792 238.268 efficiently, creatively, and resiliently. As a result, this study has
AIC3 326.043 291.073 295.114 300.792 297.268 contributed to our present understanding of this interesting occurrence
AIC4 337.043 314.073 330.114 347.792 356.268 and will enable future researchers to use the information to investigate
BIC 333.621 306.917 319.225 333.169 337.912
other phenomena pertaining to operations and supply chain in
CAIC 344.621 329.917 354.225 380.169 396.912
HQ 321.76 282.118 281.487 282.492 274.296 healthcare.
MDL5 495.931 646.294 835.668 1026.678 1208.488 Second, this study extends the OIPT by integrating healthcare 4.0
LnL − 146.522 − 111.036 − 95.057 − 79.896 ¡60.134 technologies and hospital supply chain processes to enhance perfor­
EN na 0.937 0.784 0.892 0.929 mance. Based on the conceptual model of Galbraith (1974); Hamann-
NFI na 0.951 0.782 0.885 0.910
Lohmer et al. (2023); Tushman and Nadler (1978), our study demon­
NEC na 2.525 8.633 4.329 2.831
strates that decision-making based on healthcare 4.0 technologies en­
Note: AIC: Akaike’s information criterion; AIC3: modified AIC with factor 3; hances the internal healthcare supply chain’s information processing
AIC4: modified AIC with factor 4; BIC: Bayesian information criteria; CAIC: capabilities to counterbalance the increased information processing
consistent AIC; HQ: Hannan Quinn criterion; MDL5: minimum description
needs. Our argument that hospitals equipped with healthcare 4.0 tech­
length with factor 5; LnL: Log Likelihood; EN: entropy statistic; NFI: non-fuzzy
nologies can facilitate hospital supply chain processes and thereby the
index; NEC: normalized entropy criterion; na: not available; numbers in bold
indicate the best outcome per segment retention criterion. performance is supported by the study result. As utilization of OIPT in
the study of hospital supply chains has not received enough attention,
the present study’s findings are significant contributions.
Table 8 Thirdly, the present study provides new evidence on how the link
Relative segment sizes (N = 255). between healthcare 4.0 technologies and hospital supply chain perfor­
Number of Segment Segment Segment Segment Segment mance is mediated through hospital supply chain operations and in­
segments 1 2 3 4 5 novations. The result draws attention to the fact that the hospital supply
1 1.000 chain is an information-driven network (Bag et al., 2023), where in­
2 0.789 0.211 formation and data-driven decision making in the face of uncertainty are
3 0.402 0.389 0.208 critical for efficient supply chain operations and innovations. Based on
4 0.470 0.204 0.200 0.126 the organizational information processing theory, hospitals can reduce
5 0.315 0.237 0.175 0.150 0.123
the uncertainties prevailing in the hospitals by increasing their infor­
mation processing capabilities (Benzidia et al., 2021; Saha and Rathore,
Our study reveals that healthcare 4.0 technologies, which are in­ 2022b).
formation processing capabilities, have a direct effect on hospital supply Lastly, we note that the moderating factor further influences several
chain processes, which have information processing needs, to achieve of the relationships in our model. We note that the interactions in the
the necessary level of performance. This result is in line with the OIPT model are influenced by different types of healthcare organizations,
and supports the findings of Hamann-Lohmer et al. (2023), who showed such as public and private hospitals. Based on these results, we conclude
how digital technologies impact information needs and capabilities and that healthcare 4.0 technologies that affect hospital supply chain oper­
how organizations must boost their information processing capabilities ations are influenced by the type of healthcare organization.
to offset rising information processing needs.
Furthermore, we note a series of intriguing mediating connections 6.3. Implications for practice
between healthcare 4.0 technologies and performance via hospital
supply chain processes. It is observed that the effect of healthcare 4.0 The study’s findings have significant implications for hospital
technology on hospital supply chain performance is partially mediated administration and supply chain executives. It is recommended that
by hospital supply chain processes, particularly operations and in­ hospital administrators adopt an activity-based healthcare 4.0 technol­
novations. This aligns with the existing literature (Kaartemo and ogy adoption process. For instance, hospitals can adopt big data ana­
Nyström, 2021; Sukkird and Shirahada, 2015; Tan et al., 2015) which lytics to develop dynamic inventory management systems for healthcare
points that a hospital is more likely to process and analyze real-time units, making internal flow more integrated and further making external
clinical and operational data accurately with healthcare 4.0 technolo­ distribution more seamless. However, the capacity of information pro­
gies to execute supply chain operational and innovative tasks under cessing capabilities invested for hospital supply chain processes should
be as per the scale of uncertainties prevailing in the hospital (Lewis

11
E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

et al., 2023). In addition, hospital supply chain operations and in­ investigate the barriers and opportunities in specific types of healthcare
novations are critical mediators through which healthcare 4.0 technol­ organizations in the context of implementation of healthcare 4.0
ogies influence performance. This outcome explains why organizations technologies.
may not always observe a direct link between technology investments Furthermore, a comprehensive study on the digitalization of the
and performance. Because emerging technologies may help organiza­ entire healthcare supply chain—both internal and external—may be
tions in their operational activities and restructuring, which ultimately carried out in the future. This is because the operational activities,
enhance organizational performance. innovative requirements, and risks in each of healthcare supply chain
Moreover, it is evident from the study that healthcare 4.0 technol­ stages is unique and complex (Saha et al., 2022). For instance, phar­
ogies enhance hospital supply chain processes and performance, hos­ maceutical suppliers may face risks of shortages of active pharmaceu­
pital managers and administrators can put efforts on organization tical ingredients. Pharmaceutical production factories may be at risk due
readiness through employee training, change management and new to their location; the location of factories may be in the high-risk areas
policies related to technology implementation and maintenance (Errida (e.g., areas suffering from cyclones, earthquakes, pandemics, geopolit­
et al., 2023; Oliveira et al., 2024). ical instability, etc.). To be precise, to enhance the overall healthcare
Overall, the study offers a significant theoretical contribution and supply chain performance, information sharing about such risks among
crucial information for managers and decision-makers who may support all the healthcare supply chain stages (suppliers, manufacturers, dis­
hospitals in their shift from traditional to digital healthcare. In fact, the tributors, and hospitals) are essential. In fact, to improve the overall
study will be helpful to the healthcare organizations since they are healthcare supply chain performance, the OIPT emphasizes the signifi­
frequently skeptical about whether to invest in cutting-edge technology cance of concurrently aligning information processing capacity at the
and whether doing so could save money on hospital staff, inventory, internal and external levels of the hospital supply chain (Benzidia et al.,
tracking, research, communication, etc. (Saha and Rathore, 2022a; 2021). However, the challenge is that each of the supply chain players
Tortorella et al., 2022a, 2022b, 2022c, 2022d, 2022e). may be reluctant to share such kind of information with the hospitals.
Future investigation is required on how healthcare 4.0 technologies can
6.4. Limitations and future research directions facilitate healthcare supply chain players to share relevant information
with the hospitals securely and seamlessly, and how hospitals can utilize
Although the current work has made a substantial contribution to the such information to anticipate external supply chain risks.
area of knowledge, there is still a need for more research given its Finally, healthcare researchers and practitioners can attempt to
findings and limits. Firstly, this study was only carried out in a single provide empirical evidence about the ways to adopt healthcare 5.0
country whose healthcare system has its own characteristics. However, technologies to develop responsive healthcare supply chain (Nayeri
in the same breath, this limitation offers its potential for replication in et al., 2023) where emotive recognition coupled with personalized and
other settings. Second, it is crucial to explore more extensively the field pervasive health applications, emotive smart devices, etc. represents
of the healthcare supply chain from a theoretical standpoint. The OIPT healthcare 5.0 technologies (Bhavin et al., 2021; Ghosh et al., 2022;
provides the theoretical foundation for the research model used in this Mbunge et al., 2021).
work. To further expand the knowledge in this study area, more theo­
retical perspectives from socio-technical theories (Abadie et al., 2023), 7. Conclusions
paradox theory or grounded theory (Singh et al., 2024).
Third, based on the body of existing research, we also looked at the Finally, we conclude that this study examined how hospital supply
important antecedent to hospital supply chain performance in this study chain processes like operations, innovation, and risk management affect
that were connected to hospital supply chain processes. Subsequent hospital supply chain performance. We also investigated the effects of
investigations must focus on expanding the model to encompass more healthcare 4.0 technologies like artificial intelligence, big data analytics
variables that could potentially aid hospital supply chain processes and and blockchain, on hospital supply chain performance. The empirical
achieve operational excellence, such as supply chain visibility, infor­ findings demonstrate that digital technologies can facilitate hospitals to
mation sharing, supplier relationships, etc. It would be especially enhance their supply chain performance. Moreover, we discover that the
interesting to look at any moderating effects between the antecedent performance is improved by all three of the hospital supply chain pro­
factors such as digital literacy, hospital size, organization stress due to cesses. It is observed that innovations and supply chain operations play a
digital change, etc. (Kraus et al., 2021). In fact, to further understand the partial mediating role in the effect of healthcare 4.0 technology on
significance of technology acceptance and deployment, future study performance. Additionally, we note that a certain type of healthcare
should focus on implicit elements of healthcare 4.0 technologies that can organization functions as a moderating variable in the model and
contribute to healthcare supply chain performance. To determine what significantly moderates the link between healthcare 4.0 technology and
factors, moderate this relationship, a more thorough examination of the hospital supply chain operations. We anticipate that this study will serve
context in which an organization’s information processing capa­ as a basis for advance studies into the ways in which a healthcare system
bility—healthcare 4.0 technologies—and information processing may enhance supply chain operations and achieve higher performance
need—hospital supply chain processes—can influence performance is levels.
warranted. It will be fascinating to see, for instance, whether the impact
of healthcare 4.0 technologies on hospital supply chain performance is CRediT authorship contribution statement
higher if hospitals face uncertain environmental conditions.
Fourth, future studies should also examine the specific categoriza­ Esha Saha: Writing – original draft, Validation, Methodology,
tion of different kinds of healthcare organizations, including corporate Investigation, Formal analysis, Data curation, Conceptualization, Soft­
hospitals that offer top-notch medical care, low-cost hospitals that treat ware, Visualization, Writing – review & editing. Pradeep Rathore:
the local population, and healthcare organizations that offer subsidized Writing – review & editing, Investigation, Formal analysis, Methodol­
care (Venkatraman et al., 2022). For instance, corporate hospitals may ogy, Software, Validation, Visualization, Writing – original draft,
be mature enough to widely adopt healthcare 4.0 technologies for their Conceptualization, Data curation.
clinical, operational as well as administrative purposes, while low-cost
hospitals may be mature in the clinical domain, however, may not be Data availability
mature enough to adopt healthcare 4.0 technologies for its operational
and administrative domain. Hence, further studies are required to The data that has been used is confidential.

12
E. Saha and P. Rathore Technological Forecasting& Social Change 201 (2024) 123256

Appendix A
Table A1
Constructs and Indicators.

1. Healthcare 4.0 technologies, Source: (Benzidia et al., 2021; Tanwar et al., 2020; Tortorella et al., 2021)
Artificial intelligence can improve hospital supply chain responsiveness.
Artificial intelligence will improve hospital inventory management.
Artificial intelligence can reduce hospital supply chain risks.
Big data analytics can process complex health information.
Big data analytics can improve hospital supply chain operations.
Big data analytics can improve forecasting of hospital demand.
Blockchain can increase information transparency in hospital supply chain.
Blockchain can improve product traceability in hospital supply chain.
Blockchain can provide privacy and security to patient personal data.
2. Hospital supply chain operations, Source:(Yu et al., 2020; Zhu et al., 2018)
We actively focus on leveraging supplier expertise and resources to drive better hospital supply chain outcomes.
We actively focus on improving service delivery through comprehensive understanding of patient and clinician’s needs.
We actively focus on reducing transactional burden and improving information.
We focus on reducing the operating and purchasing costs of hospital supply chain.
We actively focus on investing in internal people to improve their contribution in improving hospital supply chain.
3. Hospital supply chain innovations; Source: (Belhadi et al., 2021; Yoon et al., 2016)
Technological innovations in hospital supply chain are investment and not an expense.
We actively innovate across hospital supply chain.
Ability to redesign and applying new ideas will improve hospital supply chain.
4. Hospital supply chain risk management, Source: (Fan et al., 2016; Wong et al., 2020)
We actively focus on reducing risks related to supply.
We actively focus on improving risk prediction.
We actively focus on reordering and restocking process to reduce the risks of stock-outs.
5. Hospital supply chain performance, Source: (Benzidia et al., 2021; Chen et al., 2013)
Hospital supply chain should be economical.
Hospital supply chain should focus on sustainability.
Hospital supply chain should be oriented towards well-being of the society.
Hospital supply chain should focus on improving value and responsiveness.

Appendix B
Table B1
Analysis of Non-response bias by Paired t-test.

Pairs t-statistics Sig. (2-tailed)

HC1_Early - HC1_Late 0.776 0.681

HC2_Early – HC2_Late 1.202 0.211
HC3_Early – HC3_Late 0.833 0.533
HC4_Early – HC4_Late 1.318 0.191
HC5_Early – HC5_Late 0.999 0.259
HC 6_Early – HC6_Late 1.113 0.248
HC7_Early – HC7_Late 1.038 0.143
HC8_Early – HC8_Late 1.128 0.248
HC9_Early – HC9_Late 0.745 0.761
HCSCO1_Early - HCSCO1_Late 0.759 0.705
HCSCO2_Early - HCSCO2_Late 0.883 0.625
HCSCO3_Early - HCSCO3_Late 0.688 0.939
HCSCO4_Early - HCSCO4_Late 0.771 0.655
HCSCO5_Early - HCSCO5_Late 0.818 0.563
HCSCI1_Early - HCSCI1_Late 0.823 0.614
HCSCI2_Early - HCSCI2_Late 0.955 0.386
HCSCI3_Early - HCSCI3_Late 0.793 0.611
HCSCRM1_Early - HCSCRM1_Late 0.891 0.458
HCSCRM2_Early - HCSCRM2_Late 0.696 0.800
HCSCRM3_Early - HCSCRM3_Late 0.679 0.759
HCSCP1_Early - HCSCP1_Late 1.129 0.170
HCSCP2_Early - HCSCP2_Late 1.111 0.173
HCSCP3_Early - HCSCP3_Late 1.232 0.128
HCSCP4_Early – HCSCP4_Late 1.278 0.105

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Esha Saha is currently an Assistant Professor at the Department of Management Studies &
production inventory model in supply chain: a systematic review. Oper. Res.
Industrial Engineering, Indian Institute of Technology (Indian School of Mines) Dhanbad,
Perspect. 9 (January) https://doi.org/10.1016/j.orp.2022.100221.
India. She completed her PhD from the Department of Industrial and Systems Engineering,
Vanbrabant, L., Verdonck, L., Mertens, S., Caris, A., 2023. Improving hospital material
Indian Institute of Technology Kharagpur, India. Her research interest includes healthcare
supply chain performance by integrating decision problems: a literature review and
systems, pharmaceutical inventory management, operations and supply chain manage­
future research directions. Comput. Ind. Eng. 180, 109235 https://doi.org/10.1016/
ment, Industry 4.0, and decision-making under uncertainty. She has publications in
j.cie.2023.109235.
reputed international journals, book chapters and conference proceedings.
Venkatraman, S., Sundarraj, R.P., Seethamraju, R., 2022. Exploring health-analytics
adoption in Indian private healthcare organizations: an institutional-theoretic
perspective. Inf. Organ. 32 (3) https://doi.org/10.1016/j.infoandorg.2022.100430. Pradeep Rathore is currently an Assistant Professor at Paari School of Business in SRM
Vest, J.R., Grannis, S.J., Haut, D.P., Halverson, P.K., Menachemi, N., 2017. Using University, Amravati, Andhra Pradesh, India. He completed his PhD from the Department
structured and unstructured data to identify patients’ need for services that address of Industrial and Systems Engineering, Indian Institute of Technology Kharagpur, India. He
the social determinants of health. Int. J. Med. Inform. 107, 101–106. https://doi. is an active reviewer of many international journals. His research interests include
org/10.1016/j.ijmedinf.2017.09.008. empirical models, mathematical modelling, operations management, supply chain man­
Wong, C.W.Y., Lirn, T.-C., Yang, C.-C., Shang, K.-C., 2020. Supply chain and external agement, and sustainability. He has publications in reputed international journals and
conditions under which supply chain resilience pays: an organizational information book chapters and participated in various international conferences in India and abroad.
processing theorization. Int. J. Prod. Econ. 226, 107610 https://doi.org/10.1016/j.
ijpe.2019.107610.

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