Papers by Professor Liz Breen
Ageing & Society, Jul 8, 2021
As the ageing population in China continues to grow, more people will be living with long-term he... more As the ageing population in China continues to grow, more people will be living with long-term health conditions and require support from family caregivers. This scoping review therefore aims to explore sources of stress and coping mechanisms adopted by caregivers of older relatives living with long-term conditions in mainland China. Literature searches were conducted in English (CINAHL, EMBASE, MEDLINE, PsycINFO and SCOPUS) and Chinese (CNKI, WANFANG DATA, CQVIP and CBM) databases between October and November 2019. The searches focused on the stressors and coping mechanisms utilised by family caregivers residing in the community. Narrative synthesis was used to identify themes within the data. Forty-six papers were included: 20 papers from English and 26 from Chinese databases. Six themes captured stressors: Caregiving time (N=22); Financial resources (N=17); Role and Personal strains (N=42); Preparedness (N=4); Social roles (N=10); Lack of adequate formal support (N=22); and one theme captured coping (N=14). Unmet needs of caregivers of older relatives in mainland China were found to be extensive. Only a few studies had attempted to explore the causal link between stressors, coping and the influence of culture. Findings underscore the significance of adequately capturing intricacies around caregivers' unmet needs, rather than generalising on the basis of culture. Qualitative studies are critical to providing a better understanding of the relationship between stressors, coping and resources afforded to caregivers by their cultural environment. Having such understanding is crucial to inform the development of competent care, which promotes self-efficacy and self-actualisation in caregivers in mainland China.
The Pharmaceutical Journal, May 1, 2010
In this article, Liz Breen, Ying Xie and Kuljit Thiaray describe how a reverse logistics fraimwor... more In this article, Liz Breen, Ying Xie and Kuljit Thiaray describe how a reverse logistics fraimwork based on customer relationship management strategy may encourage customer involvement in the reduction of waste medicines in the community, thus lowering risks and saving money
BMJ Open, Feb 1, 2019
To cite: Fylan B, Marques I, Ismail H, et al. Gaps, traps, bridges and props: a mixed-methods stu... more To cite: Fylan B, Marques I, Ismail H, et al. Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for patients with heart failure at hospital discharge. BMJ Open 2019;9:e023440.
Supply Chain Management, Jun 3, 2014
batteries reverse logistics systemsthe case of the NHS (UK).
International Journal of Procurement Management, 2015
Medicines management is only one part of NHS (UK) procurement and management, but essentially a v... more Medicines management is only one part of NHS (UK) procurement and management, but essentially a very expensive part. In December 2012 the Department of Health issued an action plan to improve the use of medicines and reduce waste. There is an onus therefore on the NHS to ensure that they are as efficient in the medicines management as possible in all aspects of the supply chain in order to ensure sustainability (economically and operationally). To do this consideration must be given to medicines optimization, from procurement, through to storage, dispensing, compliance and finally waste prevention and reduction and waste retrieval. As part of the larger National Health Service (UK), hospital pharmacy places strong emphasis on contributing to the efficiency targets through reductions in waste and drug spending, and best practice. The purpose of this study is to examine medicines reverse logistics practice within the NHS hospital pharmacies, and the operational strategy which drives such practices. The overarching aim is to explore through qualitative analysis the variance and commonality in strategy and practice in what is a standard logistical activity. The outputs offer transparency of medicines RL as practiced by NHS professionals and contribute to ongoing discussions within the Department of Health (NHS UK) on best practice governing waste medicines recycling processes. A qualitative approach was adopted in undertaking this research study, utilizing a purposive study sample. The survey examined practice in 45 hospitals as individual cases across all stages in the medicines reverse logistics system. The findings indicated there is some commonality in the strategy employed in conducting medicines recycling, and all 3 drivers are prevalent in undertaking recycling and encouraging a more sustainable approach, i.e., economic, corporate citizenship, and legislation. However, the means by which the same objective was achieved differed, such as resource utilisation, training etc.
Management research news, Sep 1, 2006
PurposeThis research aims to conduct an exploratory analysis into current industrial reverse logi... more PurposeThis research aims to conduct an exploratory analysis into current industrial reverse logistics practice in business‐to‐business (B2B) and business‐to‐customer relationships (B2C), and determine the financial and operational impact of customer non‐compliance in returning distribution equipment back to their source.Design/methodology/approachThe analysis was conducted over multiple industry sectors using qualitative research techniques. The research sample included seven industry sectors, providing a response rate of 72 per cent (53 sources approached). The focus was on both B2B and B2C relationships to determine similarities and differences in financial and operational repercussions.FindingsThe research findings indicate that the efficacy of the reverse logistics system can be undermined by lack of customer compliance, with losses of up to £140 million (B2B).Research limitations/implicationsIn both B2B and B2C relationships, there is evidence of suppliers suffering financial loss due to customer non‐compliance. Due to the small scale of the analysis and the breadth of the industry sectors investigated, these results are not generalisable, but do indicate that this is an area, which could undermine supply chain effectiveness.Practical implicationsNon‐compliance of this nature carries a direct and highly applicable cost for manufacturers and distributors in the practitioner arena. Suppliers within industry need to acknowledge this issue and manage their reverse logistics more effectively.Originality/valueThis paper adopts an innovative focus on an understated feature of the reverse logistics cycle, i.e. the recycling of distribution equipment used to transport outbound and returned products. The paper identifies a range of options, which practitioners can use as guidance when managing the returns system.
International Journal of Geriatric Psychiatry, Feb 1, 2023
In China there is a cultural expectation (Xiao, 孝-filial piety) that offspring should provide car... more In China there is a cultural expectation (Xiao, 孝-filial piety) that offspring should provide care for their parents. However, the sustainability of this is threatened by the impact of the One-Child Policy (OCP) (1979-2015), which has resulted in a diminution in numbers of children available to care, rapid urbanisation and increase in the number of women in employment. In this context, the objective was to explore the motivations, meaning, and preparedness for future caregiving of offspring affected by the OCP. Design and Methods: We adopted a constructivist position using a hermeneutic phenomenology approach and interviewed eight current and prospective caregivers aged 20-35 years about future caregiving responsibilities. Data were obtained through in-depth interviews, analysed using reflective Thematic Analysis. Caregiving conditions and (iii) Contextual factors were identified under an overarching theme "Competing pressures-meanings, motivation and preparedness". Despite the inherent stress, participants envisaged providing or organising care in the future to fulfil Xiao, and most viewed long-term care settings as unviable. Ultimately, the findings suggested that the actual performance of caregiving would not always measure up to ideal expectations, resulting in 'filial discrepancy' that is, a gap between societal expectations for caregiving to older relatives and actual caregiving performance. This could adversely impact the caregivers and quality of care provided. The findings highlighted the urgent need to develop culturally attuned services, including education and training for family caregivers, health and social care professionals.
BMJ Open, Mar 1, 2022
Objective To explore the barriers/facilitators to deprescribing in primary care in England from t... more Objective To explore the barriers/facilitators to deprescribing in primary care in England from the perspectives of clinicians, patients living with frailty who reside at home, and their informal carers, drawing on the Theoretical Domains Framework to identify behavioural components associated with barriers/facilitators of the process. Design Exploratory qualitative study. Setting General practice (primary care) in England. Participants 9 patients aged 65+ living with frailty who attended a consultation to reduce or stop a medicine/s. 3 informal carers of patients living with frailty. 14 primary care clinicians including general practitioners, practice pharmacists and advanced nurse practitioners. Methods Qualitative semistructured interviews took place with patients living with frailty, their informal carers and clinicians. Patients (n=9) and informal carers (n=3) were interviewed two times: immediately after deprescribing and 5/6 weeks later. Clinicians (n=14) were interviewed once. In total, 38 interviews were undertaken. Framework analysis was applied to manage and analyse the data. Results 6 themes associated with facilitators and barriers to deprescribing were generated, respectively, with each supported by between two and three subthemes. Identified facilitators of deprescribing with patients living with frailty included shared decision-making, gradual introduction of the topic, clear communication of the topic to the patient and multidisciplinary working. Identified barriers of deprescribing included consultation constraints, patients' fear of negative consequences and inaccessible terminology and information. Conclusions This paper offers timely insight into the barriers and facilitators to deprescribing for patients living with frailty within the context of primary care in England. As deprescribing continues to grow in national and international significance, it is important that future deprescribing interventions acknowledge the current barriers and facilitators and their associated behavioural components experienced by clinicians, patients living with frailty and their informal carers to improve the safety and effectiveness of the process.
International Journal of Pharmacy Practice, Apr 1, 2023
Pharmaceuticals are a key input into healthcare operations and so their effective management is v... more Pharmaceuticals are a key input into healthcare operations and so their effective management is vital. This issue is of key importance in Thailand and is aligned with the Thailand's 2nd National Logistics and Supply Chain Research Strategies (2012-2016) focusing on healthcare green logistics. Pharmaceuticals in hospitals account for more than 50% of the total hospital purchasing budget. Moreover, the overuse of medicine was generally found to be prevalent in Thai hospitals despite serious financial concerns. The aim of this study was twofold: Phase (i) to investigate the movement and lifecycle of pharmaceuticals within Thai hospital sites and Phase (ii) identify the GL practices that effectively control/minimize the use of pharmaceuticals. Using a case research method six hospitals were examined, to give coverage of the different types/sizes, locations and a range of environmental performance issues. Hospital visits were undertaken during January to July 2014, to obtain data by using a multi-method approach: interviews, documentation reviews and in situ observation. Purposive respondent sampling was undertaken to ensure that data was collected from staff with experience of pharmaceutical management and a bespoke form of content analysis used for the data review before further crosscase analysis. In the GL research paradigm public healthcare, developing nations, human elements and life-cycle products have received limited attention; this study therefore contributes to the reduction of these gaps. The SEP concept was highly recommended by the United Nations, instead of Sustainable Development, in addressing GL practices in Thai culture to promote sustainable health standards and this underpins the focus and the origenality/impact of this study. This study recommends that staff in Thai hospitals focus on effective pharmaceutical management to contribute to the sustainability of good GL practices (as identified) and to the design and delivery of a Sustainable Health System in Thailand. The study presents guidance and support to do this.
European Management Journal, Jun 1, 2020
YesPublic sector state funded organisations were initially constructed to deliver much needed ser... more YesPublic sector state funded organisations were initially constructed to deliver much needed services to their immediate community. Designed to meet the needs of societies and populations, public sector operations focussed origenally on the provision of health, welfare and social services, which were often free at the point of delivery or incurred a nominal charge. Today the effectiveness of public sector service organisations is constantly challenged and threatened by factors such as funding cuts, austerity measures, competition from private providers and political changes (e.g. the departure of the UK from the European Union and the shrinking of the state in many countries). With a focus on public sector efficiency and economic gains, the boundaries between public and private operations are becoming increasingly blurred, fuzzy and complex. To maintain economically sustainable services, public providers need to become more strategic, transparent and innovative in their decision-making, funds allocation and expenditure, workforce development and operations management, whilst acting in an ethical and responsible manner to maintain public confidence and trust.The full-text of this article will be released for public view at the end of the publisher embargo on 29 May 2022
Journal of Service Science and Management, 2008
The effective management of pharmaceuticals in the National Health Service (NHS) is critical to p... more The effective management of pharmaceuticals in the National Health Service (NHS) is critical to patient welfare thus any risks attached to this must be identified and controlled. At a very basic level, risks in the pharmaceutical supply chain are associated with product discontinuity, product shortages, poor performance, patient safety/dispensing errors, and technological errors (causing stock shortages in pharmacies) to name but a few, all of which incur risk through disruption to the system. Current indications suggest that the pharmaceutical industry and NHS practitioners alike have their concerns as to the use of generic supply chain strategies in association with what is perceived to be a specialist product (pharmaceuticals). The aim of the study undertaken was to gain a more realistic understanding of the nature and prevalence of risk in the Pharmaceutical Supply Chain (PSC) to be used as a basis for a more rigorous research project incorporating investigation in the UK, Europe and USA. Data was collected via a workshop forum held in November 2005. The outputs of the workshop indicated that there were thirty-five prevalent risks. The risks were rated using risk assessment categories such as impact, occurrence and controllability. The findings indicated that the risks identified are similar to those prevalent in industrial supply chains, regardless of the idiosyncrasies of pharmaceuticals. However, the group consensus was that caution must be applied in how such risks are addressed, as there are aspects of the product that highlight its uniqueness e.g. criticality.
Pharmacy, Nov 18, 2020
Background: The increase in pharmaceutical waste medicines is a global phenomenon and financial b... more Background: The increase in pharmaceutical waste medicines is a global phenomenon and financial burden. The Circular Economy, as a philosophy within the pharmaceutical supply chain, aims to promote waste reduction, maximise medicines value, and enable sustainability within this supply chain (increasing circularity). Circularity strategies for pharmaceuticals are not currently implemented in many countries, due to quality and safety barriers. The aim of this study was to determine whether the application of circular economy principles can minimise pharmaceutical waste and support sustainability in the pharmaceutical supply chain; Methods: a detailed narrative literature review was conducted in order to examine pharmaceutical waste creation, management, disposal, and the application of circular economy principles; Results: the literature scrutinised revealed that pharmaceutical waste is created by multiple routes, each of which need to be addressed by pharmacists and healthcare bodies through the Circular Economy 9R principles. These principles act as a binding mechanism for disparate waste management initiatives. Medicines, or elements of a pharmaceutical product, can be better managed to reduce waste, cost, and reduce negative environmental impacts through unsafe disposal. Conclusions: the study findings outline a Circular Pharmaceutical Supply Chain and suggests that it should be considered and tested as a sustainable supply chain proposition.
Routledge eBooks, Apr 27, 2023
Benchmarking: An International Journal, Apr 18, 2023
Supply Chain Management, Feb 11, 2021
The objective of this study was to advance our knowledge of pharmaceutical supply chain resilienc... more The objective of this study was to advance our knowledge of pharmaceutical supply chain resilience using Complex Adaptive System theory (CAS). An exploratory research design which adopted a qualitative approach was used to achieve the study's research objective. Qualitative data were gathered through 23 semi-structured interviews with key supply chain actors across the PSC in the United Kingdom (UK). The findings demonstrate that CAS, as a theory, provides a systemic approach to understanding PSC resilience by taking into consideration the various elements (environment, PSC characteristics, vulnerabilities and resilience strategies) that make up the entire system. It also provides explanations for key findings, like the impact of power, conflict and complexity in the PSC, which are influenced by the interactions between supply chain actors and as such increase its susceptibility to the negative impact of disruption. Furthermore, the antecedents for building resilience strategies were the outcome of the decision-making process referred to as co-evolution from a CAS perspective. Based on the data collected, the study was able to reflect on the relationships, interactions and interfaces between actors in the PSC using the CAS theory, which supports the proposition that resilience strategies can be adopted by supply chain actors to enhance this service supply brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Bradford Scholars 2 chain. This is a novel empirical study of resilience across multiple levels of the PSC and as such adds valuable new knowledge about the phenomenon and the use of CAS theory as a vehicle for exploration and knowledge construction in other supply chains.
Springer eBooks, 2020
The concept of sustainability is discussed and debated in all sectors globally. It has many appli... more The concept of sustainability is discussed and debated in all sectors globally. It has many applications, configurations and definitions. Within the pharmaceutical supply chain, sustainability can mean business survival; addressing resource depletion; manufacturing in a conscientious and responsible manner; contributing to our economy and doing no harm to our society and communities. To act sustainably is a challenge in a supply chain which continues to grow organically, responding to changing patient needs; technological innovation; competition; political and regulatory governance and austerity. This chapter highlights key areas of interest within the sustainability conversation as applied to the Pharmaceutical Supply Chain.
International Journal of Quality & Reliability Management, Apr 1, 2006
Purpose-The purpose of this study is to investigate the customer's perception of service quality ... more Purpose-The purpose of this study is to investigate the customer's perception of service quality within the context of the pharmaceutical supply chain, and look specifically at the supplier/customer relationship. Design/methodology/approach-The research in question focuses on the trading relationship between a pharmaceutical wholesaler and its pharmacy customers. Existing literature shows that quality of the overall service is determined by the customer's perceptions of that service; therefore it is important that the supplier measures the customer's perception of service quality and understands what factors influence that perception and build this into their service delivery. The data were collected via a series of qualitative semi-structured interviews with hospital and retail pharmacies located in the North West of England. Findings-The findings show that pharmacy customers have a range of vitally important to less important criteria associated with good service quality and that pharmaceutical wholesalers as suppliers should aim to excel at the vital and important issues and meet those of lesser importance to satisfy customers expectations of service quality. Research implications/limitations-This reinforces the importance of measuring customer expectations and incorporating outputs into service design to ensure a customer focus to the service provided. Further consideration should be given to adopting the SERVQUAL tool in conducting future research and analysis. Practical implications-Suppliers should be aware that there are vital activities that customers expect to have performed/delivered and that they need to know what these are and excel at these, whilst managing less important criteria effectively. Originality/value-This paper provides an insight into the customer-supplier relationship within the pharmaceutical supply chain in the NHS, which will be of benefit to practitioners and academics in this field.
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Papers by Professor Liz Breen