Measuring what matters: operational and resilience performance in hospital drug warehouses

Purpose: Modern healthcare supply chains underscore the need for performance measurement systems that balance operational efficiency with resilience. This study aims to examine hospital-level pharmaceutical supply chains and propose a performance dashboard with key performance indicators (KPIs) from both areas. Design/methodology/approach: A qualitative case study was conducted at the pharmaceutical warehouse of a large public hospital in Northern Italy, using process mapping, risk analysis (failure mode and effects analysis and fault tree analysis) and expert workshops to identify relevant metrics. Findings: In total, 15 KPIs were initially selected from the literature and evaluated by a multidisciplinary panel of hospital professionals according to 5 criteria: relevance, measurability, data availability, interpretability and actionability. A final shortlist of nine operational and resilience indicators was incorporated into a prototype dashboard, supported by a roadmap for gradual implementation based on data maturity and staff readiness. The findings show that resilience indicators, such as time to recovery and failure rate, complement traditional metrics, such as stockout rate and order fulfilment, offering a more comprehensive view of performance. Originality/value: This study proposes a novel approach that addresses the tension between efficiency and resilience in the hospital supply chain. It provides managers with a concrete, actionable tool, moving beyond the fragmented and often theoretical nature of existing literature and demonstrating how the joint use of both operational and resilience indicators enhances the monitoring and management of drug supply chain vulnerabilities within a complex adaptive system.