This thesis focuses on the supply chain of the wine industry from a smaller scale operational perspective. A standard process from converting grapes to wine has been identified and confirmed. The sequential order of harvest, destemmer/crusher, fermentation, press, barrels, bottling, and distribution constitute the main tasks in the red wine conversion process. Variations in production between red and white wines are observed; but, the overall process is roughly the same with white wines switching the fermentation and press steps and eliminating the barrels task. In addition, it is established that supply chain considerations do effect overall quality such as taste, aroma, and smell. The ability to utilize a combination of diverse techniques, such as wooden barrels or stainless steel tanks for aging, is what contributes to the differentiation of each wine and makes it unique. While the production methodology and use of specific materials/inputs will alter the quality of wine, it must be recognized that the majority of wine quality is influenced directly by the grape itself. The use of technology and machinery in the wine making process is investigated and determined to be pivotal to the creation of wine and the survival of any size winery. Technology has facilitated the wine making process and the current creation path could not occur without it. Wine operations will adapt and incorporate new procedures to take advantage of growth in technology as it occurs, especially in automation. The information used to assess the wine supply chain was obtained from an extensive literature review, interviews with industry professionals, and onsite tours of production facilities. Given all the results and data, it is evident that the production of wine can greatly benefit from the use of supply chain practices and concepts. The ability to reduce variation in the process and determine which aspects contribute most to wine quality are vital for small scale winery operations to remain competitive and become successful.

This article summarizes exploratory research conducted on private and public hospital systems in Australia and Costa Rica analyzing the trends observed within supply chain procurement. Physician preferences and a general lack of available comparative effectiveness research—both of which are challenges unique to the health care industry—were found to be barriers to effective supply chain performance in both systems. Among other insights, the ability of policy to catalyze improved procurement performance in public hospital systems was also was observed. The role of centralization was also found to be fundamental to the success of the systems examined, allowing hospitals to focus on strategic rather than operational decisions and conduct value-streaming activities to generate increased cost savings.

Despite significant growth in research about supply chain integration, many questions remain unanswered regarding the path to integration and the benefits that can be accrued. This dissertation examines three aspects of supply chain integration in the health sector, leveraging the healthcare context to extend the theoretical boundaries, as well as applying supply chain knowledge to an industry known to be immature in terms of its supply chain practices.

In the first chapter, a supply chain operating model that breaks away from the traditional healthcare supply chain structures is examined. Consolidated Service Centers (CSCs) embody a shared services strategy, consolidating supply chain functions across multiple hospitals (i.e. horizontal integration) and disintermediating several key roles in healthcare supply chains such as the group purchasing organizations and national distributors. Through case studies, key characteristics of CSCs that enable them to reduce the level of supply chain complexity are examined.

The second chapter investigates buyer-supplier relationships in healthcare (i.e. supplier integration), where a high level of distrust exists between hospitals and their suppliers. This context is leveraged to study both enablers and barriers to buyer-supplier trust. The results suggest that contracting counteracts the negative effects of dependence on trust. Furthermore, the study reveals that hospital buyers may, in some situations, perceive dedicated resource investments made by suppliers as trust barriers, associating such investments with supplier upselling and entrenchment tactics. This runs contrary to how dedicated investments are perceived in most other industries.

In the third chapter, the triadic relationship between the hospital, supplier, and physician is taken into consideration. Given their professional autonomy and power, physicians commonly undermine hospital efforts in supply base rationalization and standardization. This study examines whether physician-hospital integration (i.e. customer integration) can drive physicians towards supply selection practices that align with the hospital’s sourcing strategies and ultimately result in better supply chain performance. This study utilizes theory on agency triads and professionalism and tests hypotheses through a random effects regression model applied to data about hospital financial performance and physician-hospital arrangements.

Surgery is one of the most important functions in a hospital with respect to operational cost, patient flow, and resource utilization. Planning and scheduling the Operating Room (OR) is important for hospitals to improve efficiency and achieve high quality of service. At the same time, it is a complex task due to the conflicting objectives and the uncertain nature of surgeries. In this dissertation, three different methodologies are developed to address OR planning and scheduling problem. First, a simulation-based framework is constructed to analyze the factors that affect the utilization of a catheterization lab and provide decision support for improving the efficiency of operations in a hospital with different priorities of patients. Both operational costs and patient satisfaction metrics are considered. Detailed parametric analysis is performed to provide generic recommendations. Overall it is found the 75th percentile of process duration is always on the efficient frontier and is a good compromise of both objectives. Next, the general OR planning and scheduling problem is formulated with a mixed integer program. The objectives include reducing staff overtime, OR idle time and patient waiting time, as well as satisfying surgeon preferences and regulating patient flow from OR to the Post Anesthesia Care Unit (PACU). Exact solutions are obtained using real data. Heuristics and a random keys genetic algorithm (RKGA) are used in the scheduling phase and compared with the optimal solutions. Interacting effects between planning and scheduling are also investigated. Lastly, a multi-objective simulation optimization approach is developed, which relaxes the deterministic assumption in the second study by integrating an optimization module of a RKGA implementation of the Non-dominated Sorting Genetic Algorithm II (NSGA-II) to search for Pareto optimal solutions, and a simulation module to evaluate the performance of a given schedule. It is experimentally shown to be an effective technique for finding Pareto optimal solutions.