Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective

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Research article

Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective Mehmood Khan a , Matloub Hussain a , Angappa Gunasekaran b, *, Mian M. Ajmal a , Petri T. Helo c a b c

College of Business Administration, Abu Dhabi University, P.O. Box 59911, Abu Dhabi, United Arab Emirates School of Business and Public Administration, California State University, Bakersfield, 9001 Stockdale Highway, Bakersfield, CA 93311, USA Department of Industrial Management, University of Vaasa, P.O. Box 700, FI 65101, Vaasa, Finland

article

info

Article history: Received 16 October 2017 Received in revised form 20 January 2018 Accepted 26 January 2018 Available online xxxx Keywords: Healthcare supply chains Social sustainability Motivators UAE

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a b s t r a c t This paper aims to identify the dimensions of motivation for social sustainability in healthcare in the United Arab Emirates (UAE). Further, the impact of these dimensions on the motivation for social sustainability is examined. A comprehensive questionnaire was developed based on interviews with administrators of large healthcare units in the UAE. The responses to this instrument are examined using principal component analysis to identify the five major dimensions of motivation for social sustainability. A measurement model (confirmatory analysis) is developed to examine the relationship among these dimensions. Finally, a structural model is developed to examine the significance of these dimensions regarding the concept of motivation for social sustainability in healthcare. Five major dimensions, namely, organizational practices, media and reputation, excellence and awards, technology and innovation, and attitudes, were identified as some of the key motivators of social sustainability in healthcare supply chains in the UAE. Organizational practices and attitudes are found to have the highest and lowest impact, respectively, on the motivation for social sustainability. This paper will enable healthcare units to examine the extent of their motivation for social sustainability. Hospital administrators, medical professionals and governmental departments will be able to use these findings to assess and benchmark their performance against that of other competitive hospitals. This will allow them to remain sustainable not only economically and environmentally but also socially. A comprehensive instrument of motivation for social sustainability is developed, and first and second order (measurement and structural) models for the dimensions that pertain to this motivation are examined. © 2018 Published by Elsevier B.V. on behalf of Institution of Chemical Engineers.

1. Introduction Governments around the world face a challenging mission to sustain their economies, environments, and, more importantly, societies (Epstein, 2008). The divide between their offerings and the needs of community will grow wider everyday if governments do not promptly respond to this daunting challenge. This is why sustainability is no longer a choice but a necessity, and it must be incorporated into the DNA of every activity and business. This has encouraged organizations to take the lead in the emergence of the concept of ‘‘sustainable development’’ (Fontaine et al., 2006). Following the moralities of stakeholder theory, organizations that pursue social sustainability must ensure that stakeholders are

* Corresponding author.

E-mail addresses: [email protected] (M. Khan), [email protected] (M. Hussain), [email protected] (A. Gunasekaran), [email protected] (M.M. Ajmal), [email protected] (P.T. Helo).

motivated to commit to social objectives. This is even more important in supply chains such as healthcare, where people’s lives are at stake. Hence, social progress has become a key objective and a concrete imperative within the field of healthcare. While the healing of patients is the primary outcome of healthcare services, providing access and training opportunities for preventative behaviour and wellness are equally important (Siebenaller, 2012). The supply chain includes services that require coordination among the various actors who work together to interact with clients and community and to sustain the services over time (Oslen, 1998). In fact, the human and/or social element is involved at every stage of the healthcare process, which makes it even more necessary to provide every required element for the involved actors, i.e., stakeholders should be motivated to support the social sustainability of the supply chain. While the available literature has focused on the factors that drive the adoption of environmental practices (Zhu and Sarkis, 2006; Lee and Klassen, 2008; Walker et al., 2008; Large and

https://doi.org/10.1016/j.spc.2018.01.006 2352-5509/© 2018 Published by Elsevier B.V. on behalf of Institution of Chemical Engineers.

Please cite this article in press as: Khan M., et al., Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption (2018), https://doi.org/10.1016/j.spc.2018.01.006.

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Gimenez Thomsen, 2011), few efforts cast light on the drivers of the adoption and implementation of social sustainability, especially within healthcare. This dimension has largely been emphasized only for legislative issues or human safety instead of the cultural ramifications of organizational decisions. Thus, an organization is required to consider the social impact of its choices and/or decisions throughout the life cycle of a service (Hutchins and Sutherland, 2008). Therefore, this paper aims to expand upon the literature by exploring those motivators from stakeholders’ perspectives. More specifically, based on a public healthcare unit, the paper presents an exploratory and confirmatory analysis of the motivators of social sustainability in the healthcare supply chains of the United Arab Emirates (UAE). Given the country’s vision of becoming among the best nations in the world by the year 2021, UAE has given priority to building a sustainable community, in which ‘‘social and economic development across the entire nation is balanced, sustainable, rationalized, and efficient’’ (VISION2021, 2010). Thus, the purpose of this paper is three-fold: 1. To explore the motivating factors for social sustainability in the UAE’s healthcare facilities, 2. To propose a comprehensive framework of social sustainability in healthcare supply chains; and 3. To investigate and validate the relationship among these dominant factors by introducing a First and Second Order Confirmatory Factor Analysis (CFA) model.

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The paper is organized as follows. A review of the relevant literature is presented in Section 2 to describe the notion of social sustainability, its theoretical background, key motivating factors, and insights into healthcare supply chains in the UAE. Section 3 presents the methodology of the paper. The analysis and findings are reported and discussed in Section 4, and Section 5 concludes.

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2. Literature review

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2.1. Social sustainability

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Sustainability has become a predominant part of business today. The goal of sustainability is grounded in the concept of a triple bottom line, which implies the necessity of balancing the objectives that are related to profits, the planet, and people for corporations as they grow and compete in a global economy (Kleindorfer et al., 2005). True sustainability occurs at the intersection of the three areas — the environment, society, and the economy, where an organization explicitly and comprehensively incorporates its goals in developing a strategic vision as well as a longterm strategic mission (Carter and Rogers, 2008). However, there has been an extensive focus on the economic and environmental pillars of sustainability compared to the social one (Shrivastava, 1995; Starik and Rands, 1995; Seuring and Muller, 2008). This pillar has been described as the most elusive and conceptually vague in the sustainable development discourse (Thin, 2002; Dempsey et al., 2011; Casula Vifell and Soneryd, 2012). As a result, the concept of social sustainability has been under-theorized or oversimplified in the existing theoretical constructs (Littig and Grießler, 2005). In response to that, there has been increasing interest in the social pillar of sustainability, driven by the political agenda and business objectives that aim to develop communities. This drive has led to a variety of articles on the topic from a range of perspectives (Sachs, 1999; Polèse and Stren, 2000; Biart, 2002; Littig and Grießler, 2005; Colantonio, 2009). While a generalized definition of social sustainability is unachievable, this pillar has been commonly incorporated with the human side of sustainability, which includes human rights, health

Fig. 1. Theory-based literature on motivators of social sustainability.

and safety, and community (Huq et al., 2014). Accordingly, in response to their urge to keep pace with global transformations, communities and business organizations are increasingly interested in the adoption of social sustainability (Fontaine et al., 2006). 2.2. Key motivators of social sustainability: theoretical development This section presents a review of theory-based social sustainability studies and explores the motivators of sustainability within each theoretical construct in the broader scope of stakeholders’ perspectives. These theories are: Stakeholder theory, Transaction cost economics (TCE), Structuration theory, and Social exchange theory (Fig. 1). Belal (2002) was among the first to use stakeholder theory to elaborate the difference between stakeholder management and stakeholder accountability. He found that engaging stakeholders is driven by a positive impact on profit. This theory was also applied by Liu et al. (2011) to emphasize corporate values as determinants of the committed effort towards sustainable construction. Similarly, Park-Poaps and Rees (2010) found that responsible actions in an organization are driven by consumers, industry peers, media pressure. They highlighted that normative changes and trends within the supply chain are related to the level of proactive, valuebased labour management. This paper explores the motivators of social sustainability that involve various stakeholders in healthcare supply chains. The supplier is an important tier and stakeholder in healthcare supply chains. Transaction Costs Economics (TCE) theory examines the relationship between transaction characteristics (contract duration, cost pressure, and production complexity) and supplier commitment to maintaining a code of conduct (Jiang, 2009). Jiang (2009) highlighted open and honest communication at different levels of a supply chain as being essential to ensure compliance with a code of conduct. TCE was also used by Huq et al. (2014) to highlight a number of motivators of social sustainability, including external stakeholder pressure (e.g., media and consumer expectations), owner’s attitudes, and competition amongst suppliers for skilled labour as well as economic benefits. This paper uses TCE to investigate the motivators of social sustainability from the supplier’s perspective. In line with Liu et al. (2011), Pullman and Dillard (2010) found that social values are an important driver of sustainability.

Please cite this article in press as: Khan M., et al., Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption (2018), https://doi.org/10.1016/j.spc.2018.01.006.

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They employed structuration theory to indicate that organizational structures are motivated by the social values within an organization. Similarly, Marshall et al. (2015) employed strategic choice theory to demonstrate the impact of social sustainability practices on organizational culture. They argued that the entrepreneurial orientation of a firm plays a positive role in the development and adoption of its innovative practices. Structuration theory was first proposed by DeSanctis and Poole (1994) as a framework to examine the interplay between the expected structures for behaviour that the designers of IT systems had built into their systems and the structures that actually emerge. The latter is influenced by end-user thinking and behaviour, and users may ultimately adopt, modify, resist, or even reject the intended use of the technology. While structuration theory has received little attention in the operations management literature, some have argued for the ways in which it can elucidate attaining desired social values in a supplychain context (Lewis and Suchan, 2003). This paper uses structuration theory to indicate the motivators of social sustainability from the viewpoint of organizational structure and an important stakeholder, i.e., the employee. Social exchange facilitates the active management of various stakeholders by influencing, converting, or aggregating the individual preferences of stakeholders to form shared preference (Lockner, 2013). Stakeholders vary in the types of relationships that they have with the focal organization. Social exchange theory is used to model the outcomes of procedural and distributive justice in supply chain relationships. Social exchanges between organizations and their stakeholders can also provide insights into the impact of implementing social sustainability (Marshall et al., 2015) and drive the change to support sustainability practices. This paper employs social exchange theory to explore the relationship of society and/or customers with healthcare units in the context of social sustainability. There could be several other drivers that motivate social sustainability. For example, appropriate regulations may reinforce ethical behaviour within supply networks (Burchielli et al., 2009). Stakeholder groups with divergent goals may also be affected by e-government initiatives (Fedorowitz et al., 2010), or legislation (Yu, 2008). In addition, organizational strategy should be sustainability-oriented in a way that makes an organization proactive and committed towards economic, environmental, and social priorities in its decision making (Defee et al., 2009; Pagell and Wu, 2009). More importantly, an organization’s transformation towards social sustainability may also require cultural change (Harris and Crane, 2002; Yang, 2013; Pagell and Wu, 2009). This paper contributes to the literature by advancing the understanding of social sustainability in healthcare supply chains by viewing it from the perspective of all of the above-described theories. Hence, it is essential to examine in depth the perspective of stakeholders in terms of the factors that foster the implementation of social sustainability.

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2.3. Social sustainability in healthcare supply chains

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During the past few years, the healthcare supply chain has developed enormously in response to increased competition, the growing influence of patients, and the necessity of delivering health services in a more efficient and effective manner (Aptel and Pourjalali, 2001; de Vries and Huijsman, 2011). However, from a supply chain management perspective, the literature is fragmented regarding healthcare supply chains. Although many healthcare organizations have recognized the importance of adopting supply chain management practices, an industrial supply chain approach is not a satisfactory corollary. This is due to the unique features of the supply chain, such as the complexity of various technologies and the existence of multiple

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Fig. 2. Stakeholders in a healthcare supply chain.

stakeholders (de Vries and Huijsman, 2011). Typically, a supply chain contains three flows: physical; informational; and financial. In most cases, the supply chain design is primarily driven by the physical flow of products, associated constraints, and opportunities. The healthcare supply chain is unique because financial and informational flows play a critical role in its design (Singh et al., 2006). A large number of stakeholders are involved in healthcare supply chain practices. Therefore, the application of supply chain management practices in a healthcare setting is related to organizational aspects such as building relationships, allocating authority and responsibilities, and organizing interface processes (de Vries and Huijsman, 2011). Supply chain management in hospitals includes an internal chain (e.g., patient care units, storage) as well as an external chain (e.g., vendors, manufacturers, distributors) (Rivard-Royer et al., 2002; Schneller and Smeltzer, 2006). It incorporates business activities and operations that integrate a continuous and smooth flow of materials and services for healthcare (Rivard-Royer et al., 2002; Shih et al., 2009). Social sustainability in healthcare has evolved as a soft infrastructure of a healthy community. A healthcare service is sustainable when it is operated through an organizational system that is reinforced with sufficient resources and activities to meet individual and public health needs (Oslen, 1998). In addition, the human element is involved at every stage of the healthcare process (Santilli and Vogenberg, 2015). Social sustainability is also incorporated with the human side of sustainability, and supporting sustainability practices requires active interaction between hospitals and their stakeholders (Huq et al., 2014). This means that stakeholders such as employees and suppliers play significant role in supporting social sustainability objectives by driving the move towards sustainability and providing insights into the successful integration of sustainable healthcare practices (Marshall et al., 2015). Fig. 2 depicts the conceptual framework for measuring social sustainability in healthcare supply chains in the UAE. It is important to note that this framework is in line with the four theories in Fig. 1. 2.4. Healthcare in the UAE With the demographic transition and the rising prevalence of lifestyle-related diseases, the development of the healthcare supply chain has taken centre stage in the Gulf Cooperation Council countries. Governments have taken the initiative to ease the

Please cite this article in press as: Khan M., et al., Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption (2018), https://doi.org/10.1016/j.spc.2018.01.006.

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M. Khan et al. / Sustainable Production and Consumption xx (xxxx) xxx–xxx Table 1 Demographic and health-related indicators — UNDP (2014). Indicator

UAE

USA

UK

China

KSA

Population (millions) Human development index Rank in human development Life expectancy at birth Public health expenditure (% of GDP) Adult mortality rate, female (per 1000 people) Adult mortality rate, male (per 1000 people) Deaths due to tuberculosis (per 100,000 people) Infant mortality rate (per 1000 live births) Infants lacking immunization, DTP (% of one-year-olds) Infants lacking immunization, measles (% of one-year-olds) Under-five mortality rate (per 1000 live births) Health quality index (Rank of 149 countries)

9.4 0.835 41 77 3.2 59 84 0.1 7 6 6 8.2 28

322.6 0.915 8 79.1 17.1 76 128 0.1 5.9 2 9 6.9 32

63.5 0.907 14 80.7 9.1 55 88 0.5 3.9 2 5 4.6 20

1,393.8 0.727 90 75.8 5.6 76 103 3.2 10.9 1 1 12.7 40

29.4 0.837 39 74.3 3.2 67 89 3.9 13.4 2 2 15.5 45

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growing pressure on the healthcare systems (Vig, 2016). Identified as one of the priority supply chains by the UAE government, the healthcare supply chain has witnessed significant development and progress in the past few years. The supply chain is seeing an astonishing boom in both the quality and quantity of the services that it provides (Bell, 2016). Although the UAE has shown an upward trend in healthcare in comparison to other developing countries, it has yet to provide healthcare that matches that of industrialized countries (Business Monitor International, 2011). Table 1 compares health-related indicators in the UAE to those in other countries, namely: the USA, the UK, China, and Saudi Arabia. As the UAE is going through a transition from an oil-based to knowledge-based economy (Clayson et al., 2015), the focus on patients and improving the healthcare delivery system continues to drive the growth of the UAE healthcare supply chain (Vig, 2016).

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3. Paper plan and research methodology

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The focus of this paper is to explore the motivators of social sustainability and to propose a framework of these motivators of social sustainability in healthcare supply chains. To this end, the paper has been divided into three phases as is shown in Fig. 3. In the first phase, the paper has adopted an exploratory approach to collecting empirical data from healthcare units in the UAE. Thirtyfive administrators and/or experts from seven major public healthcare units in the different emirates of the UAE were interviewed to explore the motivators of social sustainability in their organization. Five experts were chosen from each healthcare unit. To cater to the entire supply chain in healthcare, experts were chosen from procurement, operations, administration, human resources and customer management departments. The interviewees were asked to report both the internal and external factors that drive their desire and energy to adopt standards of social sustainability. Their responses were filtered into a compiled list of thirty-six valid indicators of motivation for social sustainability in healthcare supply chains. As is shown in Fig. 3, the second phase adopts a quantitative methodology to generate a pool of items for a scale that measures the constructs of the motivators of social sustainability. This is an important step given that the literature is fragmented with regard to social sustainability motivators from a stakeholder perspective. An instrument of thirty-six questions was developed with a fivepoint Likert scale, and it was then ready to be sent for a pilot study. Conducting a pilot study provided the preliminary information about the reliability and validity of the measurement scales. This instrument was administered through Survey Monkey, and 207 responses were received from procurement, HR, administration, customer service, staff and other stakeholders in healthcare units across the UAE.

Fig. 3. Research Methodology.

4. Data analysis The third phase was to test these responses. Principle Component Analysis (PCA) was used to explain the maximum amount of common variance with the smallest number of explanatory constructs (factors or latent variables). These factors represent clusters of the motivators that correlate highly with each other. A Cronbach’s Alpha (α ) of 0.912 showed that the responses are reliable enough for further analysis. Confirmatory Factor Analysis (CFA) was used to assess and validate the constructs that describe social sustainability in the healthcare units.

Please cite this article in press as: Khan M., et al., Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption (2018), https://doi.org/10.1016/j.spc.2018.01.006.

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M. Khan et al. / Sustainable Production and Consumption xx (xxxx) xxx–xxx Table 2 KMO Test and Bartlett’s Test. Bartlett’s Test of Sphericity

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Approx. Chi Square Df Sig

4788 630 0.000

4.1. Exploratory Factor Analysis (EFA) This analysis was used in the pilot study, which involved doctors, administrators and other stakeholders in the healthcare units. Several conditions must be met prior to testing whether the items are suitable to run the analysis. The tests include the Kaiser– Meyer–Olkin Test (KMO) and Bartlett’s Test of Sphericity. The results are shown in Table 2. The Kaiser–Meyer–Olkin Test (KMO >0.50) shows that these items are suitable for the factor analysis that was performed and showed no problems of serious multicollinearity in the data. Bartlett’s Test of Sphericity (Sig. <0.05) showed that the correlation between items is sufficient to run the factor analysis. After the two tests, EFA was used with a principal component analysis extraction method and Varimax rotation on the 36-item instrument. The number of factors to retain was based on a combination of methods (e.g., eigenvalue >1.0, scree plot) and the theoretical salience of the rotated factors. Items should preferably load greater than 0.40 on the relevant factor and less than 0.40 on all of the other factors (Stevens, 2012). Two factors were dropped from subsequent analysis as they only had one item each (22 and 32) associated with them. This procedure resulted in a 34-item instrument that accounted for 65.33% of the variance in the responses. The factor pattern and item loadings are presented in the following Rotating Matrix Component Matrix (Table 3). The next step

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is to analyse the content of the questions that load highly on the same factor to try to identify common themes. The questions that load highly on factor 1 appear to relate to different aspects of social responsibility; therefore, this factor can be labelled as social practices. This factor consists of 10 items and accounts for 18.96% of the variance. The questions that load highly on factor 2 all appear to relate to the desire for reputation. Therefore, this factor can be labelled as media and reputation. This factor consists of 8 items and accounts for 14.79% of the variance. The questions that load highly on factor 3 all appear to relate to the desire for quality awards; therefore, this factor can be labelled as excellence and awards. This factor consists of 6 items and accounts for 14.49% of the variance. Similarly, the questions that load highly on factor 4 all appear to relate to the use of technology; therefore, this factor can be labelled as technology and innovation. This factor consists of 7 items and accounts for 10.38% of the variance. Finally, the three questions that load highly on factor 5 contain some component of culture in society; therefore, this factor can be labelled as attitudes. This factor consists of 3 items and accounts for 6.71% of the variance. 4.2. Internal consistency and content validity

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Organizational practices Competitive advantage Internal tasks and processes Green standards Cooperation with government initiatives Hospital’s strategy Recycling Market trends Corporate responsibility Responsibility towards society Environmental practices Gaining media attention Penetrating well in the market Advertising Patients cantered vision and goals Quality conscious facilities Greater market attention Gaining close attention to their services Patients’ satisfaction Quality awards Employees’ empowerment Sense of accountability Independent auditing Performance improvement Higher standards of performance Design process and technology Business improvement Open communication and feedback system Opportunity for innovation Promoting electronic services Clarity and simplicity Technological advancements Culture in a society Equality of opportunity Providing needed medical consumables

.751 .724 .719 .703 .665 .632 .607 .604 .561 .500

The degree of consistency of the responses over a construct is referred to as its reliability. The reliability coefficient, Cronbach’s α , is generally used for this test. As shown in Table 4, the Cronbach’s α for the five latent constructs of social sustainability range between 0.79 and 0.92. These results show that the suggested constructs exhibit good psychometric properties. Convergent Validity Convergent validity can be evaluated by the use of the Bentler– Bonett’s Normed Fit Index (NFI). This index provides the degree to

Average variance extracted Construct reliability

18.96% 0.92

Media & reputation

Excellence & rewards

Technology & innovation

Attitudes

.622 .609 .602 .554 .540 .525 .504 .419 .758 .685 .668 .589 .538 .438 .649 .625 .601 .588 .574 .505 .400 0.783 0.671 0.465 14.79% 0.87

14.49% 0.87

10.38% 0.85

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Table 3 Rotated component matrix. Items

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6.71% 0.79

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M. Khan et al. / Sustainable Production and Consumption xx (xxxx) xxx–xxx Table 4 Construct validity analysis.

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Factors/constructs

Convergent validity Bentler–Bonett NFI

Discriminant validity Factor Cronbach’s α – Average correlation between factors

Organizational practices Media and reputation Excellence and awards Technology and innovation Attitudes

0.95 0.90 0.95 0.94 0.99

0.19 0.14 0.14 0.12 0.06

which the different approaches to measure a construct generate the same results (Ahire et al., 1996). According to a generally accepted principle, the NFI values of 0.90 or above are considered to be a satisfactory fit index (Bentler, 1992). As is shown in Table 4, the items in each construct converge well for further analysis.

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Discriminant validity Discriminant validity is the degree to which different latent constructs and their indicators can be distinguished from the other constructs and their indicators (Bagozzi et al., 1991). To calculate the discriminant validity, the Cronbach’s α of a latent construct is compared with its mean correlations with other latent constructs. A significant difference between these two measures is an indicator of discriminant validity (Ghiselli et al., 1981). As is shown by the values in Table 4, the five constructs are conceptually distinct.

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4.3. Confirmatory Factor Analysis (CFA)

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The exploratory factor analysis in this research identified organizational practices, media and reputation, excellence and awards, technology and innovation, and attitudes as a priori factors of social sustainability practices in a healthcare unit. In the firstorder model organizational practices, media and reputation, excellence and awards, technology and innovation, and attitudes are correlated measurement factors for social sustainability practices implementation. Alternatively, social sustainability practices implementation may be operationalized as a second-order model, where the five factors are governed by a higher-order factor, i.e., social sustainability practices implementation. The results of the model estimation are shown in Figs. 4 and 5. The first-order model for testing social sustainability (Fig. 4) implies that organizational practices, media and reputation, excellence and awards, technology and innovation, and attitudes are correlated but not governed by a common latent factor. Although χ 2 is significant (p = 0.000), other fit indices, which are shown in Fig. 4, acceptably support the first order model for social sustainability practices in the healthcare facility. The test of the second-order model (Fig. 5) implies that a higherorder latent factor, i.e., the overall trait of social sustainability practices implementation, governs the correlations among organizational practices, media and reputation, excellence and awards, technology and innovation, and attitudes. The second-order model also produces an acceptable goodness of fit. An examination of the second-order model of the social sustainability construct reveals that all of the coefficient estimates of organizational practices, media and reputation, excellence and awards, technology and innovation, and attitudes, which describe the relationships or paths of the five factors on the higher-order construct of social sustainability practices implementation, are significant. It can be seen that the highest and the lowest impact of social sustainability appear to be on organizational practices and attitudes, respectively.

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5. Discussion and implications

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The objective of this paper is to explore the extent to which organizational practices that are triggered by motivators lead to a

higher level of social sustainability implementation in healthcare supply chains. While business organizations integrate economic and environmental sustainability, they appear to struggle when they attempt same for social sustainability. As this is the result of a conflict of interest of different parties, the dearth of an empirical social sustainability research framework, with stakeholders and their social interactions being the centre of attention, makes it difficult for both managers and researchers to understand the social issues within a supply chain and therefore, which prevents them from fruitfully undertaking sustainable management in both practice and research. To fill this gap, the present research aims to broaden the knowledge of social sustainability by providing empirical evidence on how UAE-based healthcare facilities implement social sustainability initiatives. More specifically, the purpose of this paper is to address the factors that drive a healthcare supply chain’s decision to focus on integrating social sustainability and to explore the extent to which those drivers lead to tangible performance outcomes with regard to sustainability in the context of healthcare. To this end, this paper is the first to combine stakeholder theory and social exchange theory in the sustainability literature. The findings are mostly consistent with these theoretical views, and the paper offers a theoretical contribution to the area of social sustainability by incorporating the role of stakeholder theory from a social perspective in the case of motivators in the healthcare context. First, this paper highlighted the stakeholder perspective on the adoption of social sustainability. Stakeholder theory has been popularized as a useful lens to view stakeholder influence on specific corporate objectives and decisions, and it is therefore closely linked to the analysis of the social responsibility or the social accountability of an organization (Poddi and Vergalli, 2009). By adopting stakeholder theory as a theoretical base, this paper examines the complex interrelations among social sustainability drivers within healthcare. Second, the results of this paper provide synthesizing views on social exchange theory for the examination of social interactions and exchanges throughout a business. Social exchanges between hospitals and their stakeholders can provide insights into the impact of integrating social sustainability into healthcare facilities (Marshall et al., 2015) and drive changes in healthcare practices to support sustainability practices. The inclusion of the four theories in the conceptual framework that was developed for this paper was to examine the direct impact of five major factors on the implementation of socially sustainable practices by healthcare facilities. This provides new insights into how stakeholders and their interactions drive a sustainability agenda and institutionalize it into the fabric of a hospital in terms of the study’s methodological contribution. This paper suggests that healthcare supply chains are struggling in the implementation of social sustainability standards. This is evident from the social complexities among stakeholders. Healthcare managers and practitioners must implement continuous quality improvement programs to maintain high patient-satisfaction levels. Accordingly, a group of motivators should be put into place for managers to drive the transformation towards more human-centered processes.

Please cite this article in press as: Khan M., et al., Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption (2018), https://doi.org/10.1016/j.spc.2018.01.006.

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Fig. 4. First order measurement model for motivators of social sustainability practices.

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Using 207 surveys from healthcare units in the UAE, the key research objectives to which this research is aimed are: (1) to explore the motivating factors for social sustainability in the UAE’s

healthcare facilities; (2) to propose a comprehensive framework of social sustainability in healthcare supply chains; and, (3) to investigate and validate the relationship among these dominant factors

Please cite this article in press as: Khan M., et al., Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption (2018), https://doi.org/10.1016/j.spc.2018.01.006.

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Fig. 5. Second order measurement model for motivators of social sustainability practices.

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by introducing a First and Second- Order CFA model. The criterionrelated validity of the measures on the framework was investigated by using two approaches. First, the convergent and discriminant validity was demonstrated by correlations, and, secondly, the correlations among the five motivators of social sustainability scale were discussed. Thus, the convergent validity of the framework that is demonstrated in this paper leads to high confidence in the new scale. Moreover, factor analytic techniques including exploratory factor analysis and first- and second-order confirmatory factor analysis were employed. The results indicated a five-factor model of social sustainability measures with a total of 34 items. These two techniques resulted in a framework of five motivators, which

include organizational practices, media and reputation, excellence and awards, technology and innovation, as well as attitudes. In relation to the drivers of social sustainability for a healthcare organization, the relationships between all of the five factors are demonstrated in the First-order Model for social sustainability. The model predicts 65.33% of the variance of social sustainability. This explanatory power is caused by different aspects of social responsibility, the desire for reputation and for quality awards, the use of technology and innovation, and the impact of culture in society. The estimated coefficient of 0.94 (t = 0.00) between ‘‘organizational practices’’ and social sustainability suggests that organizational practices have a direct effect on Social Sustainability.

Please cite this article in press as: Khan M., et al., Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption (2018), https://doi.org/10.1016/j.spc.2018.01.006.

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This finding is consistent with the earlier literature (Scott, 1987; Clarkson, 1988, 1995; Andersson and Bateman, 2000; Yu, 2008; Epstein, 2008; Pagell and Wu, 2009; Burchielli et al., 2009; Lubin and Esty, 2010; Wu and Pagell, 2011). For social sustainability to be effectively embedded in the supply chain, managers must rethink and redesign organizational practices. Those organizational practices have the highest impact on social sustainability as they explain 18.96% of the variance in social sustainability integration. However, ‘‘attitudes’’ have the lowest impact, although it is significant, on social sustainability performance. Attitudes are defined as a psychological tendency that is expressed by evaluating a particular entity with some degree of favour or disfavour (Eagly and Chaiken, 1998). The definition suggests that people’s behaviour is a reflection of their cognitive and affective perceptions, which means that the way in which stakeholders view sustainability objectives in business affects their decision to go along with a corporation’s change towards the social issues within a supply chain. One explanation may be that social sustainability is yet to have an overall endorsement from all types of stakeholders. This suggests a need for greater awareness to motivate people and groups to engage in the whole process of sustainable development. Despite this lower impact, attitudes still play a vital role in the movement towards more sustainable practices. Within the context of the UAE, people are more knowledgeable with regard to sustainability, as they are looking towards the achievement of the country’s vision for the year 2021, which encompasses the three pillars of sustainability and will position the UAE among the best nations. The present research confirms that multiple factors and their measurement items should be comprehensively incorporated to obtain an overall image of social sustainability practices implementation in organizations. There is a need for organizations to promote social sustainability drivers from a holistic perspective. By focusing on each driver in isolation from others, organizations are disregarding the benefits that might be obtained if actions were taken to motivate stakeholders in all five areas. Our findings reveal that organizations must follow a comprehensive and coherent approach to develop more supportive perceptions towards social sustainability in healthcare. This multi-dimensional image provides many benefits to healthcare supply chains in the UAE by increasing the competitive advantage of the supply chain in comparison to other regions in the world. Moreover, it helps the government to coordinate the efforts of all healthcare stakeholders by increasing communication and information sharing efficiency, which will eventually lead to high quality service and, therefore, foster a culture of ‘‘prevention is better than cure’’.

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5.1. Limitations, and future research directions

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The suggested framework in this paper is mainly linked with the stakeholder perspective as the basis for the integration of the issues that pertain to social exchange within healthcare facilities. It is expected that the social sustainability measures of the motivators in this paper will be suitable for use with many types of service industries, not only that of healthcare. Evidently, this framework is a valid and effective instrument to measure the motivators and guide the efforts of practitioners to integrate social sustainability. Knowledge of the areas of focus will help the UAE’s healthcare practitioners to lead the transition towards a people-oriented approach and to support social progress and human capital. The healthcare facilities in the UAE must take part in the nationwide movement towards a more sustainable future. While the present social sustainability framework is suitable for use with healthcare, other service industries in the UAE can also benefit from the insights that it offers to guide their efforts to reach to more socially sustainable levels.

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Despite the high correlation of media and reputation with social sustainability, one may argue that quality of healthcare would be meeting the health needs with professional standards and regulations at the lowest cost (Ali, 2013). However, the recent trend is to consider patients’ perception as an important source of information for assessing this quality (Ovretveit, 1992). In the wake of modern age of internet, the world in the last few years has evolved to an extent that the patients’ perception about healthcare services is reaching unimaginable bounds. Modern media (social, print, TV and Movies) are playing a critical role in building and transforming this perception. This results in an instant judgement of the services one receives at a clinic or hospital. The subsequent level of satisfaction may depend on patient’s age; education; psychology and economic status (Vuong et al., 2017). The wide range of contrast in these services among different providers would be non-existent in developed countries where society (regime) bears the responsibility of providing healthcare to their habitants (Vuong, 2017). On the contrary, developing societies always face the challenge of making their healthcare services more and more patient-oriented (Rao et al., 2006). To get higher ratings and reputation, a hospital would be required to enhance their service levels in all the different sections such as registration desk; outpatient department; procedure rooms as well as pharmacy (Amatya et al., 2017). Waiting time also plays a critical role in setting the patients’ flow and thus their level of satisfaction with the provided service in these sections. This paper has some other limitations as well. First, the primary respondents of this paper came from public healthcare units. Future studies might also examine the framework in the private sector. Second, the framework of this paper was tested under Abu Dhabi’s healthcare organizations. As other emirates have some unique healthcare systems (for example, Dubai-based facilities must abide by the Dubai Health Authority), future studies might examine how the socially sustainable supply chain framework that is developed in this paper can be differently applied to other emirates. While the UAE has many similarities with the GCC countries, the healthcare system in the UAE is unique with regard to other countries, which suggests the need to conduct a comparative study between UAE and the other GCC countries and developing regions. References Ahire, S.L., Golhar, D.Y., Waller, M.A., 1996. Development and validation of TQM implementation constructs. Decis. Sci. 27, 23–56. Ali, M.M., 2013. Healthcare service quality: Towards a broad definition. Internat. J. Health Qual. Assur. 26 (3), 203–219. Amatya, B., Koirala, S., Schmidt, K., Hung, L., 2017. A case study on measuring patients’ perception of quality of health service at Kirnetar Health Centre, Dhulikhel Hospital by a patient satisfaction survey. Andersson, L., Bateman, T., 2000. Individual environmental initiative: Championing natural environmental issues in U.S. business organizations. Acad. Manag. J. 43, 548–570. Aptel, O., Pourjalali, H., 2001. Improving activities and decreasing costs of logistics in hospitals: a comparison of US and French hospitals. Internat. J. Account. 36 (1), 65–90. Bagozzi, R.P., Yi, Y., Phillips, L.W., 1991. Assessing construct validity in organizational research. Admin. Sci. Quart. 421–458. Belal, A.R., 2002. Stakeholder accountability or stakeholder management: A review of UK firms’ social and ethical accounting, auditing and reporting (SEAAR) practices. Corp. Soc. Responsibility Environ. Manag. 9 (1), 8–25. Bell, J., 2016. 2016-last update, The state of the UAE’s health. Available: http:// gulfnews.com/ 2017. Bentler, P., 1992. On the fit of models to covariance. Psychol. Bull. 88, 588–606. Biart, M., 2002. Social sustainability as part of the social agenda of the European community. Business Monitor International, 2011. United arab emirates pharmaceuticals & healthcare report Q4 2011. (No. 1748-2275). Business Monitor International, London, UK. Burchielli, R., Delaney, A., Tate, J., Coventry, K., 2009. The fairwear campaign: an ethical network in the Australian garment industry. J. Bus. Ethics 90, 575–588.

Please cite this article in press as: Khan M., et al., Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption (2018), https://doi.org/10.1016/j.spc.2018.01.006.

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10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68

M. Khan et al. / Sustainable Production and Consumption xx (xxxx) xxx–xxx

Carter, C.R., Rogers, D.S., 2008. A framework of sustainable supply chain management: moving toward new theory. Int. J. Phys. Distrib. Logist. Manage. 38, 360–387. Casula Vifell, A., Soneryd, L., 2012. Organizing matters: how ‘‘the social dimension’’ gets lost in sustainability projects. Sustain. Dev. 20, 18–27. Clarkson, M., 1988. Corporate Social Performance in Canada. JAI Press, pp. 1976– 1986. Clarkson, M.B.E., 1995. A stakeholder framework for analyzing and evaluating corporate social performance. Acad. Manag. Rev. 20. Clayson, N., King, A., Lynch, L., 2015-last update, 10 things to know about sustainability in the UAE. Available: http://www.nortonrosefulbright.com/ knowledge/publications/125011/10-things-to-know-about-sustainability-inthe-uae 2016. Colantonio, A., 2009. Social Sustainability: A Review and Critique of Traditional Versus Emerging Themes and Assessment Methods. Oxford Brookes University, UK. Defee, C.C., Esper, T., Mollenkopf, D., 2009. Leveraging closed-loop orientation and leadership for environmental sustainability. Supply Chain Manag. Internat. J. 14, 87–98. Dempsey, N., Bramley, G., Powers, S., Brown, C., 2011. The social dimension of sustainable development: defining urban social sustainability. Sustain. Dev. 19, 289–300. DeSanctis, G., Poole, M.S., 1994. Capturing the complexity in advanced technology use: adaptive structuration theory. Org. Sci. 5 (2), 121–147. de Vries, J., Huijsman, R., 2011. Supply chain management in health services: an overview. Suppl. Chain Manag.: Internat. J. 16 (3), 159–165. Eagly, A.H., Chaiken, S. (Eds.), 1998. Attitude, Structure and Function. McGowan-Hill, New York, USA. Epstein, M.J., 2008. Making Sustainability Work. Greenleaf Publishing, Sheffield, UK. Fedorowitz, J., Gogan, J.L., Culnan, M., 2010. Barriers to interorganizational information sharing in egovernment: A stakeholder analysis. Inf. Soc. 26, 315–329. Fontaine, C., Haarman, A., Schmid, S., 2006. The Stakeholder Theory of the MNC. Ghiselli, E.E., Campbell, J.P., Zedeck, S., 1981. Measurement Theory for the Behavioral Sciences. WH Freeman San Francisco. Harris, L.C., Crane, A., 2002. The greening of organizational culture: Management views on the depth, degree and diffusion of change. J. Org. Change Manag. 15, 211–231. Huq, F.A., Stevenson, M., Zorzini, M., 2014. Social sustainability in developing country suppliers: an exploratory study in the ready made garments industry of Bangladesh. Int. J. Oper. Prod. Manage. 34, 610–638. Hutchins, M.J., Sutherland, J.W., 2008. An exploration of measures of social sustainability and their application to supply chain decisions. J. Cleaner Prod. 16, 1688–1698. Jiang, B., 2009. Implementing supplier codes of conduct in global supply chains: process explanations from theoretic and empirical perspectives. J. Bus. Eth. 85, 77–92. Kleindorfer, P.R., K. Singhal, L.N., Van, W., 2005. Sustainable operations management. Prod. Oper. Manage. 14, 482–492. Large, R.O., Gimenez Thomsen, C., 2011. Drivers of green supply management performance: evidence from Germany. J. Purch. Supply Manage. 17, 176–184. Lee, S., Klassen, R.D., 2008. Drivers and enablers that foster environmental management capabilities in small- and medium-sized suppliers in supply chains. Prod. Oper. Manage. 17, 573–586. Lewis, J., Suchan, I., 2003. Structuration theory: its potential impact on logistics research. Int. J. Phys. Distrib. Logist. Manage. 33 (4), 296–315. Littig, B., Grießler, E., 2005. International. J. Sustain. Dev. 8, 65–79. Liu, A.M.M., Fellows, R., Tuuli, M.M., 2011. The role of corporate citizenship values in promoting corporate social performance: towards a conceptual model and a research agenda. Constr. Manag. Econ. 29, 173–183. Lockner, A.O. (Ed.), 2013. Steps to Local Government Reform: A Guide to Tailoring Local Government Reforms to Fit Regional Governance Communities in Democracies. iUniverse. Lubin, D., Esty, D.C., 2010. The sustainability imperative. Harv. Bus. Rev. 88, 42–50. Marshall, D., McCarthy, L., McGrath, P., Claudy, M., 2015. Going above and beyond: how sustainability culture and entrepreneurial orientation drive social sustainability supply chain practice adoption. Supply Chain Manag. 20, 434–454. Oslen, I.T., 1998. A framework for analyzing sustainability. Health Policy Plan. 3–287.

Ovretveit, J., 1992. Health Service Quality: An Introduction to Quality Methods for Health Services. Blackwell Scientific. Pagell, M., Wu, S., 2009. Building a more complete theory of sustainable supply chain management using case studies of ten exemplars. J. Suppl. Chain Manag. 45, 37–56. Park-Poaps, H., Rees, K., 2010. Stakeholder forces of socially responsible supply chain management orientation. J. Bus. Eth. 92, 305–322. Poddi, L., Vergalli, S., 2009. Does corporate social responsibility affect the performance of firms? In: Coalition Theory Network Workshop. Polèse, M., Stren, R. (Eds.), 2000. The Social Sustainability of Cities, Diversity and the Management of Change. pp. 15–16. Pullman, M.E., Dillard, J., 2010. Values based supply chain management and emergent organizational structures. Int. J. Oper. Prod. Manage. 30, 744–771. Rao, K.D., Peters, D.H., Bandeen-Roche, K., 2006. Towards patient-centered health services in India—a scale to measure patient perceptions of quality. Int. J. Qual. Health Care 18 (6), 414–421. Rivard-Royer, H., Landry, S., Beaulieu, M., 2002. Hybrid stockless: A case study: Lessons for health-care supply chain integration. Int. J. Oper. Prod. Manage. 22 (4), 412–424. Sachs, I., 1999. Social sustainability and whole development: exploring the dimensions of sustainable development. Santilli, J., Vogenberg, F.R., 2015. Key strategic trends that impact healthcare decision-making and stakeholder roles in the new marketplace. Am. Health Drug Benefits 8 (1), 15. Schneller, E.S., Smeltzer, L.R., 2006. Strategic Management of the Health Care Supply Chain. Jossey-Bass, San Francisco, CA. Scott, W.R., 1987. The adolescence of institutional theory. Adm. Sci. Quart. 493–511. Seuring, S., Muller, M., 2008. From a literate review to a conceptual framework for sustainable supply chain management. J. Cleaner Prod. 16, 1699–1710. Shih, S.C., Rivers, P.A., Hsu, H.S., 2009. Strategic information technology alliances for effective health-care supply chain management. Health Serv. Manag. Res. 22 (3), 140–150. Shrivastava, P., 1995. The role of corporations in achieving ecological sustainability. Acad. Manag. Rev. 20, 936–960. Siebenaller, B., 2012-last update, Connecting Sustainability to the Healthcare Mission. Available: http://www.healthcaredesignmagazine.com/article/connectin g-sustainability-healthcare-mission,2016. Singh, M., Rice, J.B., Riquier, D., 2006. Transforming the Global Health Care Supply Chain. MIT Center for Transportation and Logistics. Starik, M., Rands, G.P., 1995. Weaving an integrated web: Multilevel and multisystem perspectives of ecologically sustainable organizations. Acad. Manag. Rev. 20, 908–935. Stevens, J.P., 2012. Applied Multivariate Statistics for the Social Sciences. Routledge. Thin, N., 2002. Social Progress and Sustainable Development. ITDG Publishing, London, UK. Vig, S., 2016. 2016-last update, Double-digit growth expected in UAE healthcare. Available: http://gulfbusiness.com/double-digit-growth-expected-in-uae-heal thcare/.. VISION2021, 2016. 2010-last update, UAE’s vision 2021. Available: https://www. vision2021.ae/en, 2016. Vuong, Q.H., 2017. Survey data on vietnamese propensity to attend periodic general health examinations. Sci. Data 4, 170142. Vuong, Q.H., Vuong, T.T., Ho, T.M., Nguyen, H.V., 2017. Psychological and socioeconomic factors affecting social sustainability through impacts on perceived health care quality and public health: The case of Vietnam. Sustainability 9 (8), 1456. Walker, H., Di Sisto, L., McBain, D., 2008. Drivers and barriers to environmental supply chain management practices: lessons from the public and private sectors. J. Purch. Suppl. Manag. 14, 69–85. Wu, Z., Pagell, M., 2011. Balancing priorities: decision-making in sustainable supply chain management. J. Oper. Manage. 29, 577–590. Yang, M.G., 2013. Developing a Focal Firm’s Sustainable Supply Chain Framework: Drivers, Orientation, Practices and Performance Outcomes. Yu, X., 2008. Impacts of corporate code of conduct on labor standards: a case study of Reebok’s athletic footwear supplier factory in China. J. Bus. Ethics 81, 513–529. Zhu, Q., Sarkis, J., 2006. An inter-sectoral comparison of green supply chain management in China: drivers and practices. J. Cleaner Prod. 14, 472–486.

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