Mapping and Analyzing Internal Hospital Material Flows: A Case Study of the Best Service System at Kalmar Hospital

Abstract

This study examines the operational stage of an internal hospital logistics system, Best Service, implemented at Kalmar Hospital in Region Kalmar. The purpose is to develop a practice-level understanding of how traceability limitations, routine variation, and coordination practices shape the reliability and efficiency of the material flow between the central warehouse and the emergency department. The study also aims to identify areas for improvement in flow reliability, efficiency, and workload in hospital logistics operations. A qualitative case study design was adopted, based on seven semi-structured interviews and 24 hours of direct observations across the warehouse, transport unit, and emergency department. The empirical material was analyzed abductively using four complementary theoretical perspectives: Lean principles, process flow analysis, organizational routines, and a sociotechnical perspective. The findings show that the material flow is characterized by interrelated procedural challenges, particularly limited traceability across process stages, variation in routines and flow timing, reliance on manual coordination, delayed detection of disruptions, and limited visibility into prioritization. These conditions give rise to searching, checking, follow-up, and informal communication. From a Lean perspective, such activities can be interpreted as non-value-adding. At the same time, the analysis shows that such activities function as compensatory practices that help sustain continuity under conditions of limited system visibility and coordination uncertainty across process interfaces. The study contributes conceptually by showing that reliability in internal hospital logistics does not emerge solely from formal process structures, but through compensatory coordination practices that stabilize incomplete sociotechnical systems in everyday work. These practices include searching, follow-up, informal communication, and manual coordination across process interfaces. Practically, the study identifies areas for improvement related to enhanced traceability, stronger feedback mechanisms, and improved prioritization visibility. It also highlights the need for better alignment between planned process structures and actual execution to support a more reliable and resilient material flow.