Supply chain integration and supply chain sustainability relationship: a qualitative analysis of the UK and Ghana pharmaceutical industry

Figures & data

Table 1. Research question.

Research questions	Theory used
(1) What are the key SCI factors and how do they influence SCS?	We apply dynamic capability theory to explore (i) how and why companies create/extend/modify resources through effective/efficient SCI to impact SCS. We apply stakeholder theory to consider manufacturers, wholesalers, distributors, retailers, regulators, and national trading associations in studying the SCI- SCS relationship. We apply contingency theory to compare companies in Ghana and the UK.

Table 2. Interview respondents.

Respondent code	Company given code	Position/role	Years at current company	Type of player	Company classification	Country
RES-1	1. C1. 2. C2	1. CEO 2. Registration and Licence Officer	14 years	1. Wholesaler and Retailer 2. Regulator	1. SME 2. Large institution	Ghana
RES-2	C3	Head of research and product development, pharmacist by profession	6 years	Manufacturer, wholesaler and distributor, retailer	Large company	Ghana
RES-3	C4	Production Manager	16 years	Manufacturer, wholesaler and distributor, retailer	Large company	Ghana
RES-4	C5	Operations manager	9 years	Wholesaler	Large company	Ghana
RES-5	C6	Deputy marketing manager, pharmacist	4 years	Manufacturer, wholesaler and distributor, retailer	Large company	Ghana
RES-6	C7	Supply chain manager	14 years	Manufacturer, wholesaler and distributor, retailer	Large company	Ghana
RES-7	C8	Market access manager	N/A	Association for key pharmaceutical players in Europe and the UK	Multinational pharmaceutical institution	UK/Europe
RES-8	C9	Managing director/owner, pharmacist	8 years	Manufacturer	SME	Ghana
RES-9	C10	Public affairs manager	N/A	Association for all key community pharmacies in the UK	Large company	UK
RES-10	C11	Customer service and distribution manager	3 years	Wholesaler and distributor	SME	Ghana
RES-11	C12	Director/pharmacist	2 years	Manufacturer and retailer	SME	Ghana
RES-12	C13	Assistant store manager	N/A	Retailer	Large company	UK
RES-13	C14	Production manager	6 years	Manufacturer and wholesaler	Large company	Ghana
RES-14	C15	Pharmacist	6 years	Retailer	Large company	UK
RES-15	C15	Pharmacist	7 years	Retailer	Large company	UK
RES-16	C16	Pharmacist/supply chain expert	N/A	Retailer	SME	UK
RES-17	C17	Pharmacist/supply chain expert	N/A	Retailer	SME	UK
RES-18	C18	VP, global head of medical writing and medical information	N/A	Pharmaceutical research company	Large company	UK

RES: Respondent. C: Company.

1. UK context: SME’s- Annual turnover of less than £25 m, employees less than 250, and gross assets less than £12.5 m. Large company: More than £25 m turnover, 250 employees and £12.5 m gross assets (UKGOV 2012).

2. Ghana context SME’s: Less than 30 employees. Large company: More than 30 employees.

Table 3. Generated themes from data analyses.

Themes	Key dimensions (where applicable)	Included in semi-structured interview theme	Newly generated theme after interviews
Supply chain integration	Internal integration	✓
	Customer integration
	Supplier integration
Supply chain sustainability	Economic	✓
	Environmental
	Social
External uncertainty	Technology		✓
	Regulations
	Demand and supply
	Currency
Leadership style			✓
Patient satisfaction			✓

Table 4. Key steps for the analysis.

Key steps	Purpose
Transcribed all recorded interviews	To obtain all the interviews in a single transcription form to enable coding/analysis.
Read the transcription, and read over again	To familiarise with the data and start to identify important issues.
	To Understand the data from the participants perspective.
Coding	To identify key issues, meanings and themes from the data.
1st order coding, using a line-by-line approach	Meanings were identified and key issues were labelled in a descriptive format. This process is data-driven.
2nd order coding (based on 1st codes)	The first codes from the 1st order coding were further coded to generate the categories. This process is also data-driven.
Grouping of all same 1st codes under the 2nd codes	To generate and group all the codes for each category to form the sub-theme.
3rd order coding (based on 2nd coding and theory)	The sub-themes were reviewed and grouped, and the actual themes were generated. Themes relative to a wider conceptual and theoretical context.
Generation of qualitative framework based on themes	To show the direction and relationship of impact among the key themes. The framework shows how to achieve the ultimate output

Table 5. Key supply chain integration factors and their impact on supply chain sustainability.

SCI dimension	SCI factors and their impact sign	Impact level rating	Supply chain sustainability
			Economic	Social	Environmental
Internal integration	Monthly departmental meetings (−)	High	C3	C3	C3
	Inadequate internal communication (−)	High	All companies	C3, C7	NIDI
	Unsynchronised departmental activities (−)	High	C4, C7, C9	NIDI	NIDI
Customer integration	Use of market reps to communicate sales to customers (+)	Low	C3, C4, C5, C6, C7	C4, C5	NIDI
	Use of country reps: Make use of own scientific offices to communicate OR Host by customer at local site (+)	High	C3, C5, C8	C3, C5, C8	NIDI
	Use of distribution zone reps (+)	Low	C3, C4, C7, C13	C3, C4, C7	NIDI
Supplier integration	Information sharing among local importers sourcing from same supplier only (+)	Low	C1, C5	C1	NIDI
	Barter trading among importers (+)	High	C1, C5	C1, C5	C1, C5
	Sharing market authorisation(+)	Low	C4, C5, C14, C15	C4	NIDI
	Capacity sharing (+)	High	C3, C7, C9, C17	C3, C7, C9	C3, C7, C9
	Companies host major foreign suppliers at local site (+)	High	C5	C5	NIDI
Entire supply chain	Lack of communication across the chain (−)	High	C1, C8, C11, C12	C8, C11	NIDI
	Less integration among players due to price differences (−)	High	C5, C9, C8, C15, C16, C17, C18	C8	C8

Note: (−): Inhibitor/ Ineffective and or inefficient (+): Enabler/Effective and or efficient NIDI: No identified direct impact C: Company. E.g. C1 = Company 1.

Table 6. Supply chain sustainability factors from cross-case analysis enabling and inhibiting supply chain sustainability.

Supply chain sustainability	Supply chain stage	Supply chain sustainability factors	Enabler	Inhibitor	Correspondence of factors to SCI
Economic	Production	High cost for AI importation		✓	II, SI
		High cost for power/energy		✓	II
		High port charges		✓	II, SI, CI
		Frequent technology change is costly		✓	II
		High minimum order points for local importers		✓	II, SI
		Highly expensive testing procedures		✓	II, SI
		Squeeze on manufacturers profit margins		✓	II, CI
		Quality issues		✓	II, SI
		High cost for equipment and facilities to be GMP compliant		✓	II, SI
		High cost for R&D		✓	II, SI
		High number of drug failures		✓	II
		Long lead time for drug model development, testing, and approval		✓	SI
		Cross-contamination of drugs		✓	SI
		Long production and testing cycle resulting in high inventory holdings		✓	II
		High manufacturing cost for locally produced drugs affects the selling price of these drugs		✓	II, SI, CI
		Expensive local manufacturing due to high tariffs *		✓	SI
		Over-reliance on foreign suppliers for raw materials *		✓	II, SI
		Long lead time for most raw materials *		✓	SI
		Good efficacy for locally manufactured drugs *		✓	II
	Distribution	Inadequate storage capacity to meet high demands		✓	II, SI
		Parallel trade		✓	II, SI
		Counterfeit and expired drugs		✓	CI, SI
		Limited funds to purchase appropriate vehicles, maintenance, repairs, fuel and driver salaries		✓	II, SI
		Long port processing times		✓	II, SI
		High storage cost due to long port processes		✓	II, SI
		High demurrages		✓	SI
		High transportation cost		✓	II
		High cost for raw material importation due to less local input manufacturers		✓	SI
		Road constraints and traffic constraints in major cities		✓	II, SI
		Competitive pressure and uncertainty: IT advancement, DTP		✓	II, SI, CI
		Squeeze on wholesalers profit margins		✓	II, SI, CI
		Less efficiently designed route systems to balance between low distribution cost and service levels		✓	II
		Squeeze on wholesalers profit margins		✓	II, CI
		Issue of combining the duties of drug importation and distribution even with low capacity		✓	II, SI, CI
		Regulation differences in West Africa incur high cost for transportation activities *		✓	II, CI
		Less efficiently designed route systems to balance low distribution cost and service levels*		✓	II, SI, CI
		Less sophisticated software to optimise distribution*		✓	II
		Issue of combining the duties of drug importation and distribution even with low capacity*		✓	II, SI, CI
		More time and resources for exceptionally long deliveries extending to sparsely populated villages. Affects cost. *		✓	II, CI
		Expired drugs		✓	II
	Retail	High cost and competitive pressure		✓	II, SI, CI
		Saturated market affecting profit margins		✓	II, CI
		High use of MCA’s due to high cost of operations and hiring pharmacists *		✓	II
		Lack of funds		✓	II, SI, CI
	Entire chain	Reduction in government funding support		✓	SI
		Long lead times due to lack of funds		✓	II, SI
		Unfavorable credit periods		✓	SI, CI
		Fewer profit margins		✓	II, SI, CI
		Improper forecast leading to shortages and expiries		✓	II, SI, CI
		Weak pharmacovigilance		✓	II, SI, CI
		Drug shortages and unavailability		✓	II, SI, CI
		Proper disposal of waste is costly		✓	II, SI, CI
		Frequent technology changes are costly		✓	II, SI, CI
		The high cost of operations affecting profit margins		✓	II
		Payment delays		✓	II, SI, CI
		Drug counterfeits		✓	II, SI, CI
		High competition affecting profit margins		✓	II, SI, CI
		Limited use of technology, resulting in less flow of information across the supply chain		✓	II, SI, CI
		Fragmented nature of the pharmaceutical supply chain		✓	II, SI, CI
		Unregulated prices *		✓	SI
		Prices are regulated **	✓		SI
		Falsified medicine directive **	✓		II, SI
		Use of effluent plant and septic tanks	✓		II
		Less internal transparency especially with finance which affect supply chain activities		✓	II
Re-use of recycled water		✓		II
Environmental	Production	Use of non-recyclable materials		✓	II, SI
		Use of ethical materials sourced from ethical suppliers	✓		II, SI
		Re-called and expired drugs		✓	II, SI
		Improper waste, damaged, wrong and expired drug disposal		✓	II, SI, CI
	Distribution	Gifting customers products termed/perceived ethical		✓	CI
		None found
		Inadequate supervision of the distribution activities. Leading to falsified drug introduction		✓	SI, CI
	Retail	Climate change leading to shortages and unavailability		✓	II, SI
	Entire chain	Not environmentally conscious		✓	II, SI, CI
		Been environmentally friendly is not economically viable		✓	II, SI, CI
		Improper waste and expired drugs disposal		✓	II, SI, CI
		Use of non-recyclable materials		✓	II
		Education on proper drug disposal	✓		II, SI, CI
		Good environmental practices, not a requirement for selecting suppliers or customers*		✓	II, SI, CI
		Heavy reliance on importations mostly subjected to high uncertainty and vulnerable to the introduction of imitated drugs*		✓	II, SI
Social	Production	Limited funds to purchase appropriate vehicles, maintenance, repairs, fuel and driver salaries		✓	II, SI
	Distribution	Free transport for staff	✓		II
		High use of MCA’s sometimes results in administering interacting drugs*		✓	II
		Bargaining power of retailers affecting wholesalers		✓	CI
	Retail	Gender discrimination avoidance	✓		II
		Pay/Salary is OK	✓		II
	Entire chain	Engagement in numerous corporate social responsibility activities	✓		II, CI
		Hiring is based on expertise	✓		II
		Fragmented nature of the pharmaceutical supply chain		✓	II, SI, CI
		Weak pharmacovigilance *		✓	SI, CI
		Free accommodation for the majority of the employees *	✓		II

Note: **: Peculiar Issues to the UK (developed countries). *: Peculiar Issues to Ghana (developing countries). Listed issues with no asterisks apply to both the UK and Ghana companies. II: Internal integration SI: Supplier integration (embodies not only raw material and product suppliers but also regulators and governmental bodies as they issue various licences and operational regulations for the pharmaceutical companies) CI: Customer integration. II, SI, CI: Currently, no integration/no effective and/or efficient integration causing a negative impact. II, SI, CI: Effective and/or efficient causing a positive impact

Table 7. IECF’s and their impact on supply chain sustainability.

IECFs	Level in supply chain (where applicable)	IECFs factors and their impact sign	Impact level ratings	Supply chain sustainability			IECFs factors mainly influence the level of
				Economic	Social	Environmental
External uncertainty	Upstream	Currency fluctuations* (−)	High	C5, C7, C9, C10, C12	NIDI	NIDI	II,SI,CI
		High technology changes (−)	High	C3, C4	NIDI	C4	II
		Dynamic and unpredictable change of manufacturing regulations (−)	High	C3, C4, C9	NIDI	NIDI	II
		Uncertain and long manufacturing lead time (−)	High	C8, C10	NIDI	NIDI	II
	Downstream	Demand uncertainty (−)	High	C1, C3, C10, C11, C13	NIDI	NIDI	II,CI
		Forecast difficulty and inaccuracy (−)	High	C1, C3, C11	NIDI	NIDI	II,SI,CI
		Unpredictable market (−)	High	C1, C4, C8	NIDI	NIDI	CI
		Free zone regulation* (−)	High	C2, C3, C4	C2,C3,C4	NIDI	II,SI,CI
	Entire supply chain	Fund and payment uncertainty (−)	High	C6, C7, C9, C12	NIDI	C1	CI
		Unpredictable drug shortages (−)	High	All companies	C3, C4, C8, C10	NIDI	II,SI,CI
		High price differences and fluctuations (−)	High	C7, C8, C10, C14	C1, C4, C5, C16	C17	II,SI,CI
		Dynamic regulations (−)	High	C3, C11, C18	NIDI	NIDI	II,SI
Leadership style		Autocratic (−)	High	C3, C4, C6, C7	C4, C5, C7	NIDI	II
							IECF factors facilitated/impacted by
Patient satisfaction		Reputable brand names (+)	High	All companies	All companies	C3, C4, C6, C9, C13, C15	II, SI, CI
		Quality (product efficacy and effectiveness) (+)	High	CI, C3, C4, C5, C6, C7, C9, C11, C13, C14, C15, C16, C17, C18	All companies	NIDI	II, SI, CI

Note: C: Company. E.g. C1 = Company 1. (−): Inhibitor (+): Enablers NIDI: No identified direct impact II: Internal integration SI: Supplier integration CI: Customer integration *: Peculiar issues to Ghana.

Figure 1. Proposed framework for supply chain sustainability through supply chain integration.

Table 8. Emergent themes from the study and relative literature.

Themes	Key dimensions (where applicable)	Quotes from sampled companies	Literature
Supply chain integration	Internal integration	It is stressful when you demand something from another department and their schedule doesn’t fit in with your request which ends up in long hours of wait and delays.	Narasimhan et al. (2010) (s): Swink et al. (2007) (s).
	Customer integration	Beyond that when it gets to the retail level, if you have your sales reps or marketing reps, they solicit and introduce the products and they let them know the companies you importing from. This helps to increase our sales and profit.	Narayanan et al. (2011) (s): Narasimhan and Kim (2002) (s).
	Supplier integration	There is virtually no competition among wholesalers however they do trade together. Sometimes they do barter trade which reduces cost and improves flexibility.	Flynn et al. (2010) (c): Scannell et al. (2000) (s).
Supply chain sustainability	Economic	There are payment issues mostly due to NHIS inconsistencies. The debt affects the product range that the company provides to customers. There is also a high cost for production, rising from high power tariffs and the high cost of labour.	Yu et al. (2014) (s).
	Environmental	We are not conscious of the environment. Most of us use plastics instead of paper bags. I don’t think I will gain a competitive advantage when I’m conscious of the environment and use more friendly materials.	Pagell and Wu (2009) (c).
	Social	The working condition is OK and the pay is comfortable. We use 5% of our annual salary to train personnel. We engage in numerous CSR activities. Yes, we experience counterfeit but FMD is to help eliminate counterfeit from the chain.	Balabanis et al. (1998) (s): EFPIA (2020) (s).
Additionally identified internal and external contextual factors
External uncertainty		It is a very dynamic industry. Unfortunately, the market is very erratic. Regulations are uncertain and they change frequently from time to time. What is good today might not be good tomorrow.	Donkor 2020 (s): Donkor et al. 2021 (s) Harper and Gyansa-Lutterodt (2007) (s): Shah (2004) (s).
Leadership style		Day to day management and decisions are mainly made by the owner alone. Financial decision is mainly controlled by the owner of the company, yes one-man company. Even to the extent that the chief accountant does not know the full size of the elephant.	Chen and Paulraj (2004) (c): Farh and Cheng (2000) (s).
Patient satisfaction		There will always be issues when it comes to regulators. However, we focus on the patient and make sure what we give them is quality, safe, effective and efficient. Satisfying our patients help us to grow as a company.	Dotson and Allenby (2010) (s): Narayanan et al. (2011) (s).

1. (s): Given reference supports quote 2. (c): Given reference contradicts the quote

Table A1. Literature review summarising the perspectives SCI-performance has been widely analysed and the identified gap.

Author(s)	SCI scope	Industry	Methodology	Moderator	Mediator	Performance	Main arguments
Ataseven and Nair (2017)	SI, CI, II	Mixed industries	Meta-analysis	None	None	Financial and operational performance	The various dimensions of SCI impact financial performance. The study argues that there are existing moderators that moderate the SCI-performance relationship. Hence the SCI-performance needs to be further studied from a contingency perspective to uncover the role of moderating factors.
Wong et al. (2011)	SI, CI, II	Automotive industry (Suppliers)	Quantitative (survey)	Technological and demand uncertainty	None	Customer delivery	CI has no direct effect on customer delivery whilst SI and II do. Technological and demand uncertainty moderates the SI-customer delivery, and II- customer delivery relationships
Chaudhuri et al. (2018)	II, EI	International manufacturing strategy survey	Quantitative (survey) hierarchical regression	Supply chain risk management (SCRM)	None	Manufacturing flexibility	No significant relationship between EI-flexibility. However the II-flexibility relationship was known to be positive. SCRM moderates the EI-flexibility relationship.
Danese et al. (2020)	II, EI	Manufacturing	Quantitative (survey)	International supplier network (ISN)	None	Responsiveness	Positive relationship between EI, II, and responsiveness. ISN moderated EI-responsiveness positively but has no moderating effect on the II-responsiveness relationship.
Flynn et al. (2010)	II, SI, CI	Manufacturing	Quantitative (survey)	CI, SI	None	Operational and Business performance	II serves as the foundation for operationalising SCI. II and CI are strongly related to operational and business performance than SI. The SI-operational performance, and EI-business performance relationships are insignificant.
Frohlich and Westbrook (2001)	SI, CI	International Manufacturing Strategy Survey	Quantitative	None	None	Operational performance	Supplier and customer integration increase operational and financial performance.
Gimenez and Ventura (2005)	SI, CI, II	Manufacturing	Quantitative (survey)	None	None	Operational performance	Integration in the logistics‐marketing interface does not lead to reductions in costs, stock‐outs and lead‐times.
He et al. (2017)	SI	Manufacturing (Mix of manufacturing plants)	Quantitative (survey)	Product Complexity; Competition Intensity	None	Operational performance	Positive relationship between SI-operational performance. The aforementioned relationship is moderated by product complexity and competition intensity
Jacobs et al. (2016)	II, EI	Manufacturing (mixed industries)	Quantitative (survey)	None	II, Employee satisfaction	EI	Employee satisfaction mediates in a partial way the internal communication-II relationship. II mediates the employee satisfaction-external integration relationship.
Kang et al. (2018)	II, CI, SI	Manufacturing (mixed industries)	Quantitative (survey)	Sustainability management practices (SMP)	None	Social, environmental, social performance, Sustainability management practices (SMP)	II and CI enables inter and intra organisational SMPs. Inter and intra organisational SMPs are positively associated with SCS whilst inter and intra organisational SMPs jointly interact to influence social and environmental dimensions.
Koufteros et al. (2005)	II, CI, SI	Manufacturing (Mix of manufacturing companies)	Quantitative (survey)	Uncertainty, Equivocality, Platform strategy	None	Quality, Profitability, Product innovation	No direct relationship between supplier process integration and quality. Integration-performance relationship is moderated by equivocality
Leuschner et al. (2013)	Information, operational, relational	Mixed industries	Meta-analysis	II, CI, SI	None	Business, relational, and operational performance	The link between SCI and firm performance was identified to be positive and significant. Sub-group analysis indicated that the majority of samples showed a positive relationship between the operationalisation of SCI and firm performance.
Mackelprang et al. (2014)	II, CI, SI	Mixed industries	Meta-analysis	None	None	Financial, market and operational performance	Integration is not universally associated with improved performance. The majority of the integration-performance studies are subject to some moderating factors which are unknown. The identification of these unknown moderating factors is paramount to building and refining the theoretical foundations of supply chain integration.
Shashi et al. (2018)	II, EI	Manufacturing (mixed industries)	Quantitative (survey)	None	None	Sustainable procurement (SP), Sustainable design (SD), Environmental and cost performance	External integration influences SP positively whilst II influences SD positively. SP was known to influence environmental and not cost performance whilst SD influence both environmental and cost performance.
Schoenherr and Swink (2012)	II, SI, CI	Manufacturing, distribution and retail firms	Quantitative (survey)	II	None	Operational performance	II increases the impact of external integration delivery and flexibility, but not on quality and cost.
Vanpoucke et al. (2014)	Supplier integrative capabilities	Manufacturing	Quantitative (survey)	Market and technological dynamics	None	Operational performance	Supplier integrative capability improves cost and flexibility performance. The aforementioned relationship is strengthened by market and technological dynamics.
Vanpoucke et al. (2017)	SI, CI	International Manufacturing Strategy Survey	Quantitative (survey)	IT	Operational integration	Operational performance	Operational integration mediates the exchange of information-operational performance relationship. IT improves the impact of SI.
Vereecke and Muylle (2006)	SI, CI	International Manufacturing Strategy Survey	Quantitative (survey)	None	None	Operational performance and procurement	Weak correlation between supplier and customer collaboration and operational performance and procurement. Stronger collaborations leads to stronger performance.
Wang et al. (2018)	Internal and external green practices	High Performance Manufacturing HPM data (Mixed industries)	Quantitative (survey)	Firm size	None	Environmental performance	Internal and external green practices have a positive impact on environmental performance. Firm size moderates the aforementioned relationships.
Wang et al. (2021)	SI (in the form of supplier involvement), II (in the form of sustainable design practices)	Manufacturing	Quantitative (survey)	Supplier Involvement	None	Environmental and Economic performance	SI positively influences the relationship between sustainable design practices and economic and environmental performance.
Wiengarten et al. (2014)		Manufacturing	Quantitative (survey)	EU	None	Operational performance	Both internal and external dimensions increase operational performance.
Wiengarten et al. (2019)	SI, CI	International Manufacturing Strategy Survey	Quantitative (survey)	Delivery, cost, quality, flexibility	None	Operational and financial performance; Competitive priorities	The SCI-financial performance is contingent on company competitive priorities
Wong et al. (2011)	SI, CI, II	Manufacturing (Automotive)	Quantitative (survey)	EU	None	Operational performance	Both internal and external integration has a positive relationship with operational performance.
Yeung et al. (2013)	Supplier partnership	Manufacturing (Electronics)	Quantitative (survey)	EU, specific investment	None	Cost	There is a direct relationship between Supplier partnership-cost. The aforementioned relationship is strengthened by specific investment and not EU
Yu et al. (2013)	SI, CI, II	Manufacturing (mixed industries) (organisational learning theory)	Quantitative (survey)	None	Customer satisfaction	Financial performance	CI has no significant impact on financial performance. II serves as the foundation for operationalising EI. Customer satisfaction mediates the CI-financial performance relationship
Zhu et al. (2018)	SCI	-Young executives in China	Quantitative (survey)	None	Supply chain learning	Customer service performance; innovation performance.	Positive SCI-customer service, and SCI-Innovation performance relationship. Supply chain learning mediates the aforementioned relationships.
This paper	SI, CI, II	Manufacturers, retailers, distributors, suppliers, regulators, national trading bodies	Qualitative (interviews)	EU, leadership style	Patient satisfaction	Environmental, Social, and Economic performance	We uniquely consider all the dimensions of SCI and SCS and study the direct influence of SCI on SCS, we also consider all the key stakeholders within and across the supply chain, whilst studying the SCI-SCS relationship comparatively from a developed country (UK) and developing (Ghana) country perspective. More crucially, we adopt a qualitative approach to understand the how and why reasons behind the SCI-SCS relationship. Our proposed framework details how the IECF’s external uncertainty (EU)’, ‘patient satisfaction’, and ‘leadership style’ influences the SCI-SCS relationship.

Note: CI- customer Integration, SI- supplier integration, II- internal integration.

Source: Adapted from Donkor et al. (2021).

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