An investigation of Dutch pharmaceutical supply chains: insights from the theory of swift and even flow

Purpose: This study aims to identify the main inhibitors limiting product flow across different stages of the pharmaceutical supply chain (PSC) and examine how they influence drug availability. Design/methodology/approach: Semi-structured interviews were held with actors at different stages in the PSC. The theory of swift and even flow (TSEF) is used to ground the insights obtained from multiple actors across the PSC and formulate propositions for further research. Findings: It is observed that most risk drivers hindering the swift and even flow of products – and thus threatening drug availability – are related to variability. Variability originates mainly from the regulatory environment in the form of non-value-added tasks and bottlenecks and, to a lesser degree, from the competitive environment. Our findings suggest that regulatory measures taken to reduce the cost of drugs, such as price law changes and tender frequencies, might create unintended consequences affecting drug availability. This highlights the impact that public policymakers have on drug availability. Originality/value: This study, in contrast to previous research, investigates the movement of drugs through multiple stages of the PSC and identifies the operating environments that hinder product availability using TSEF. Benefiting from the constructs of TSEF, this study extracts and structures the findings from expert interviews and formulates research propositions to create a better understanding of the factors influencing drug availability.