STRATEGIC NOTES Nº3

Hospital logistics, for far too long relegated to an invisible support function, has now emerged as a strategic variable that determines not only cost efficiency but also the very quality of clinical outcomes. The Institute of Medicine (2013), in Best Care at Lower Cost: “The Path to Continuously Learning Health Care in America”, demonstrated that around 30% of healthcare expenditure in the United States was associated with operational inefficiencies, with logistics standing out as a silent determinant.

The Organisation for Economic Co-operation and Development (OECD, 2019), in “Health at a Glance” 2019, reinforced that the absence of structured flow policies generates waste that undermines both financial sustainability and public trust.

International literature converges on this view: the World Health Organization (2020), in “Shortages of Essential Medicines in High-income Countries”: An Increasing Concern, estimates that failures in supply chains account for up to 25% of shortages of essential medicines in high-income countries. These failures are not merely statistics, they compromise therapeutic continuity and erode social trust in healthcare systems.

More than supply circuits, logistics is a matter of governance architecture. Recent experience in the British NHS showed that the adoption of real-time traceability systems reduced wastage of critical consumables by 15% (Sustainability Report 2021).

In Singapore, the SingHealth model integrated predictive forecasting, based on ARIMA algorithms, to align inventories with real demand, releasing capital and strengthening institutional resilience (Tan, Lim & Ong, 2022, Journal of Health Management).

In the Middle East, reference hospitals such as the Cleveland Clinic Abu Dhabi turned logistics into a strategic asset, centralising processes in a digital hub that guarantees both efficiency and reliability (Alhashmi & Salloum, 2021, International Journal of Information Technology & Decision Making).

The challenge, however, is not only technological, it is cultural and structural. Chopra & Sodhi (2021), in “Supply Chain Management in Healthcare: Risk and Resilience (Springer)”, demonstrate that the logistical literacy of teams directly influences operational resilience. Institutions that approach logistics as a science of decision-making, rather than a mechanical operation, display lower vulnerability to critical shortages and greater adaptive capacity in times of crisis.

When treated merely as an invisible operation, logistics becomes fertile ground for fragmented responsibilities. By contrast, when elevated to a criterion of governance, it imposes transversal accountability, from the clinician who prescribes to the manager who defines contracts.

Portugal faces here a structural blind spot. Despite having national production of consumables with international certification and export capacity, it continues to import materials at increased costs, without integration into contingency contracts or intelligent supply cycles. The result is predictable: budgetary overload, vulnerability in times of crisis and loss of institutional autonomy.

Healthcare governance, to be solid, must incorporate logistics as a criterion of legitimacy. It is not an operational detail but a political variable with direct impact on Return on Investment, on patient safety and on institutional reputation.

By redesigning flows, segmenting critical supplies through the Kraljic matrix (1983, Harvard Business Review) and integrating contingency contracts, hospitals cease reacting to shortages and instead govern with predictability.

Excellence in logistics is not invisible, it manifests itself in the silence of normality. By recognising logistics as strategic infrastructure, institutions not only optimise resources, they also redefine their architecture of power. What was once a secondary function becomes a pillar of legitimacy, capable of sustaining organisational resilience and public trust in moments of greatest pressure.