1. Aims of the Project
Blockchain is a technology with a unique feature, such as a decentralized structure that does not need to recourse to any trusted third party (Wüst & Gervais 2018). Distributed notes and storage systems, smart contracts, and asymmetric encryption ensure network security, visibility, and transparency (Dutta et al. 2020).BC can transform the Supply Chain (SC) process, from SC foundations, business process re-engineering to security enhancement (Dutta et al. 2020). It plays an essential role in various sectors, ensuring the health care supply chain through remote monitoring facilities. Blockchain is a highly protected and decentralized interacting platform of multiple computers used to record data, transactions, and information to avoid alteration (Tanwar, Parekh & Evans 2020). Leeming, Cunningham and Ainsworth (2019) explained that implementing noble technology can deliver practical solutions to such challenges. According to Alsufyani and Alsuwat (2020) and others illustrate that blockchain is an innovative and attractive notion in the era of information technology that makes a noticeable change in a person’s life in many spheres. These offered to advance the reliability and security dealing between people regarding transection, information, and smart contract and provide medical staff relief through remote monitoring of in-house patients (Zaidi & Kumar Prasad 2020). The main characteristics of blockchain are decentralized, transparent, open-source, autonomous, immutable, and anonymous (Lin, I-C & Liao 2017).
The recent advancement of technology that tops the crypto-analysis system’s development had improved the administration’s efficacy for various organizations’ management, including the healthcare system (Friemann & Schönsleben 2016). BC uses the digital shared store. Once they add the records, it is impossible to edit them without modifying the previous records that make business operations extremely secure. It is used in different fields to develop intelligent contracts to detect financial fraud and safely exchange medical records between healthcare ((Bogucharskov et al. 2018; O’Leary 2019). Back to the healthcare system as one of the critical sectors in the modern world, plays a vital role and significant breakthrough disease prevention and health promotion create an effective environment for humans’ existence (Karagiannis & LeMaster 2007). The HSC involves the flow of goods and services from manufacturers to patients (Chavez et al. 2020; Yaga et al. 2019). In the health sector, BC is used to store and share health-related information, making the workflow easier, ensures security and accuracy of the data, and decreases maintenance costs (K. Harleen, J. Roshan & Victor 2019). Blockchain and IoT technology support the attribution of physical goods produced and transported inter-organizational by using traceability and constraints on Ethereum blockchain (Dutta et al. 2020). The establishment of SC validity provides certification, authentication, and tractability of products/ services, assurance of origin, and integrity across the entire supply chain (Tan et al. 2020; Tang & Veelenturf 2019).BC in HSC supports the attribution of physical goods produced and transported in inter-organizational, by using traceability and constraints on Ethereum blockchain (Kim, HM & Laskowski 2018). Adapting BC validity is established by providing certification, authentication, and tractability of products/ services, assurance of the origin, and integrity across the entire supply chain (Tan et al. 2020; Tang & Veelenturf 2019). According to Jayaraman, Salah and Nelson (2019), adaption BC in the pharma sector allows the storage of collection data, traceability for medication and vaccines, and enables trusted data sharing and drug recall management in clinical trials management.
Despite the tremendous benefits of emerging BC in the health sector, a growing trend in the Middle East found that stakeholders have made little progress in solving supply chain processes and related issues (Mathivathanan, Kannan & Haq 2018). The authors have to elucidate concerns in the technological industry on how incorporating innovations that include blockchain technologies were put in place to improve services (Balakrishnan et al. 2020). Additionally, Tandon, S, Landes and Woolverton (2011) address a gap in the healthcare supply chain’s blockchain adaption. Although most of the existing research only generalizes the knowledge that focuses on blockchain technology in healthcare, the gap is evident. Little research utilizes the experience of using blockchain technology in the healthcare supply chain (van Hoek 2019). A recent survey done by Alsubaei, F et al. (2019) observed that healthcare supply chain practices in emerging and established economies are highly susceptible to systematic errors. Inadequate adapting supply chain technology in healthcare imposes negative impacts on health outcomes and compromise patient safety Hughes, L et al. (2019)assured that a few studies had established blockchain implementation excluding concepts and feasibility studies. Saudi Arabia’s perception is that it is one of the most developed countries in the middle east of Asia, with various technologies implemented in the healthcare system (Algahtani 2020). Equally, there are some barriers to adopting blockchain technology in Saudi Arabian health sectors, including high funding requirement, scalability, high cost, hacking, and shadow dealing, complex to understand and embrace, lack of awareness and understanding, productivity paradox, lack of cooperation, security and privacy challenges, lack of regulatory clarity, and good governance(Carlozo 2017).
Furthermore, Saudi has been addressing the Vision 2030 in 2016, including healthcare, shifting the country to technology through structural changes in all the sectors(Rahman 2020). There is a call to study technology adaption in different Saudi Arabia sectors (Almubarak 2017; Masmali, Campus & Miah 2019). Therefore, the research aims to:
1. Empirically investigate the challenging factors of adopting blockchain technology in the health supply chain in Saudi Arabia?
2. What is the impact of adopting blockchain on the health supply chain?
3. What is drives HSC in Saudi Arabia adaption Blockchain?
4. What is the level of current adaption of BC in the health supply chain in Saudi Arabia?
2. Contribution to Knowledge and Statement of Significance
2.1 Theoretical Contribution (Academic Contribution
The potential academic contributions aiming to bridge the gaps in the literature will provide an evidence-based concept by facilitating learning and building data on the application of blockchain technologies in the modern healthcare supply chain practices in Saudi Arabia. Although several studies have examined blockchain technologies’ potential in transforming conventional supply chain practices, contents in the currently available literature have limited knowledge concerning the practicality, effectiveness, and the effects of integrating technologies in the contemporary supply chain management landscape (Radanović & Likić 2018). Evidence shows little information concerning the barriers to adapting such automated information technology platforms in improving health outcomes. The knowledge of blockchain technology’s efficiency in the healthcare supply chain is scary; therefore, the study will provide the researchers with an adequate understanding of blockchain technology in the healthcare supply chain (Shen & Pena-Mora 2018). Previous studies majorly focused on how automated information platforms improved organizational safety through enhanced cybersecurity and overlooked blockchain’s significance in improving healthcare supply chain activities. As Hakak et al. (2020)examined the effects of IoT and blockchain on overall organization performance, the current research aims to remain essential to gain better insights and shed more light on the nature of the challenging factor to adapt BC technology. It can improve healthcare systems’ service sector due to the lake of this type of study in Saudi Arabia.
Additionally, the method will use in this study will add and inherence the exciting knowledge since there is a shortage of using empirically validated qualitative methodology in adapting various technologies in supply chain research (Iddris 2018). Furthermore, most of the current research addressing the adoption of BCT is either hypothetical or addresses the issues from an individual perspective, and there is a lack of empirical evidence (Malik et al., 2020). The adoption of DTOE theoretical framework within DOI theory was in HSC.
2.2 Practical Contributions
The current study offering several practical contributions of blockchain to the community is likely to benefit from acquiring a modern and assured system that will increase transparency, thus improving healthcare services received by Saudi Arabia patients (Moin et al. 2019). However, extensive research is continuously conducting this topic throughout the world, but in Saudi health supply, not yet conducted holistic research to contribute updated knowledge in this area. Therefore, the technologies to the Saudi Arabian healthcare outcomes enhance their supply chain activities’ effectiveness to minimize cost, maximize benefits, improve operational flexibility, and improve healthcare providers’ quality of products in Saudi Arabia (Reda et al. 2020).In essence, this study will support managers and policymakers in critical decision-making with knowledge and three practices for challenges regarding adapting blockchain to their health supply chain practices ((Nolan 2014). besides that, make them understand the efficient, improving blockchain process and influencing performance among the firms. The concept displayed by this research will assist the industrial sectors, especially corporations, in understanding the significance of blockchain technology in the management of financial transactions ((Wang, Han & Beynon-Davies 2019).
Moreover, Saudi Arabia (SA) seeks to develop a logistics hub Centre, as outlined in Saudi Vision 2030. After navigating the two pilot projects successfully, SA was an early technology adopter among the Gulf Cooperation Council countries, outlined in this insight. The most significant advantage of using Distributed ledger as blockchain is that it creates trust in the system, which has, in turn, strengthens stakeholder trust(Roychoudhury & Shetty 2019). On September 21, 2019, Saudi Customs, the Ministry of Communications and Information Technology, the Saudi Ports Authority, and logistics company A.P. Moller – Maersk jointly announced the successful completion of a blockchain pilot project tracking a shipping container from King Abdelaziz Port, Dammam to the Netherlands port of Rotterdam(Gazette 2019).To achieve this goal, the SA government ensured that the processes and institutions could smoothly interconnect with global trading systems. It has evolved a detailed road – map describing how the country will improve and reform its governance regulations, improve private sector participation, and ensure public-private agreements help develop logistics capabilities (Transport 2019). The researcher concludes that this study is very relevant, significant, and pragmatic for support and gives them the road map they required knowledge of adaption BC in the health supply chain in SA.
Studies encompassing health supply chains focus on numerous aspects of improving industry accountability (Salehi et al. 2020). While most of these studies’ conduction has been outside Saudi Arabia, they offer critical perspectives regarding actors involved in the supply chain, challenges in the sector, and the resources required to achieve higher efficiency levels towards adopting blockchain technologies (De Oliveira et al. 2020). Consequently, literature works in these areas could offer insights into the mechanics and requirements that would facilitate the research.
Blockchain and BC in health SC
Blockchain technology is a decentralized system that does not rely on any other intermediaries such as clearinghouses, banks, and escrow institutions to send and record (Kakavand, Kost De Sevres & Chilton 2017). The traditional form of business depends on using various and different ledgers for each stakeholder in the market. All stakeholders are on the same networks, which help reduce trust issues (Zachariadis, Hileman & Scott 2019).BC concept involves mining nodes that assist the transaction by utilizing the various blocks within the specified node (Hofmann 2019). The idea of consensus protocol is used widely during the transaction process, wherein the presented network nodes check for the validation of the transaction by implementing the protocol (Aggarwal et al. 2019). The consensus mechanisms allow the blockchain to adopt the aspect of operating on a peer-to-peer basis without intermediary involvement (Alzahrani et al. 2020). According to (Ahmad, Khan & Kamal 2019); Tandon, A et al. (2020)addresses a gap in adopting blockchain technology in the healthcare supply chain. Most of the existing research only generalize the knowledge that focuses on blockchain technology in finance.
BC remains a lucrative concept in supply chain management in recent times. The latter perceives blockchain as a recording method and sharing information such that sensitive data remains impossible or difficult to hack or change. Several successful examples of adaption BC can include transformations SC; it also enhances the digital networks’ functionality and security, using the Internet of Things and other technology (Cai, Choi & Zhang 2020). other feathers of BC, authenticity, confidence, safety cost reduction, decentralization, productive operation, and reduced waste (Gurtu & Johny 2019; Philipp, Prause & Gerlitz 2019). Nevertheless, the architectures of blockchain technologies possess the potential to enhance visibility and traceability of products in the quest for improving activities, such as managing recalls, counterfeits, and shortages throughout the Saudi Arabian healthcare supply chain(Bai, Cordeiro & Sarkis 2020). Traceability of blockchain technology allows ease of track of every transaction, thus increasing transparency (Hussien et al. 2019). While healthcare systems faced challenges, there is a consensus that combining the Internet of Things with blockchain innovations can offer sustainable means of securing, tracking, and tracing products and sharing information via blockchain networks (Fekih & Lahami 2020). Alsubaei, D (2019)emphasized the critical aspect of BC innovation in privacy protection and maintaining trust among stakeholders in a healthcare supply chain system. Likewise, Van Reede, Poll and Koens (2020)used a patient-centric approach in demonstrating the significance of blockchain technology in privacy protection. Krishnan et al. (2020)discussed blockchain applications that enable information security between patients and care providers via IBM’s Hyperledger. However, Jabbour et al. (2020)argued that the advent of blockchain adaption had met several challenges, including the inadequate number of experts and lack of infostructure. Besides usability, privacy (Guerreiro et al. 2020), and cost (Zhang & Wen 2017), there is a lack of study adaption of BC in the health supply chain in Sadia Arabia. The main challenge of adopting technology in the healthcare sector is the complexity of the system and the skilled workforce resistant to change (Khan, HU, Ahmad & Abdollahian 2013). The review of Blockchain technology was limited in the previous studies (Saberi et al. 2019; van Hoek 2019)such as Gurtu and Johny (2019); Hidayanto and Prabowo (2019) emphasis on investigating blockchain adoptions for SCM applications understanding and potential research. Besides, Hastig and Sodhi (2020)Examined supply chain traceability by using blockchain.
Healthcare Supply Chain and Saudi health
The healthcare supply chain system is one of the critical sectors in the modern world since it plays a vital role in disease prevention and health promotion (Iyengar et al. 2020). Development in the healthcare industry has led academics and professionals in healthcare supply chains that have grown significantly over the past decades. This growing interest ignited a series of new research lines dealing with various supply chain activities with significant managerial implications. The health supply chain deals with the flow of goods and services from manufacturers to patients(Chang, SE, Chen & Lu 2019).In recent years HSC is gaining popularity due to logistics, patient satisfaction, and even pharmaceutical products to improve the quality of services offered in the healthcare sector (Khosravi & Izbirak 2019). The invention of technology has seen a significant breakthrough in the healthcare sector. More specifically, fundamental healthcare supply chain activities are included but are not limited to monitoring counterfeits, expiration, shortages, lack of tractability, and product recalls. Implementing and executing such activities in a trusted, efficient, secure, globally traceable, and accessible manner has met several challenges because of the fragmented nature of supply chain processes in the diverse field of healthcare practices (Khan, M et al. 2018). Development in the healthcare industry has led academics and professionals in healthcare supply chains that have grown significantly over the past decades. This growing interest ignited a series of new research lines dealing with various supply chain activities with significant managerial implications.
Additionally, the implementation has improved the healthcare system’s management, thus improving healthcare delivery (Thota et al. 2018). However, the sudden outbreak of pandemic COVID-19 (Coronavirus) has affected almost all countries and significantly influenced healthcare and treatment services (Javaid et al. 2020). The health sector is one of the largest service sectors in SA and continuously growing in terms of size ((Alotaibi, Helliar & Tantisantiwong 2020), even though Saudi is struggling against the pandemic, especially in the field of providing medical services (Iqbal et al. 2020).In this context, the health care supply chain demands much attention, attachment, devotion, and perseverance to achieve its goals. At the same time, comprehensive blockchain technology can initiate the accomplishment of desired goals. According to Francisco and Swanson (2018), the current innovation level allows industries to employ transparency protocols to incorporate blockchain technology.
Moreover, the authors contend that the need to use blockchain technology in the supply chain arises from the concerns of accountability that might result from reliance on centralized intermediaries (Dobrovnik et al. 2018). Al-Jaroodi and Mohamed (2019)made the same argument by stating that transparency issues resulted from a centralized system. A few parties are in charge of regulating and other activities across the entire supply chain.
Saudi Arabia’s healthcare industry has also been analyzed and investigated by previous research, which allows Saudi to spend approximately US$ 430 million per year for the increase in hospital bed capacity to keep pace with growing demand from 2.7 to 3.2 percent per year (Nazki, Sameer & Ganaie 2014). Recently the high budget allocation of nearly 21 USD billion to the health market is designed to enhance the service delivery of 50 existing facilities, growth and expansion of existing clinics and hospitals, improve the health of the elderly and reduce lifestyle disease mortality rates (Nazki, Sameer & Ganaie 2014).
Over the last ten years, local pharmaceutical manufacturing has grown drastically. Out of 32 registered pharmaceutical manufacturing plants, 27 are operating. However, they only cover 20-25% of Saudi’s prescription drug consumption (AlAzmi & AlRashidi 2019).To protect the gap in demand, the government resorts to importing the drugs among other pharmaceutical products, resulting in more imports than local production. Problems associated with more implications have necessitated transparency in the supply chain.
The current challenges facing the health supply chain
Today, some significant challenges facing the healthcare sector, such as fragmented supply chain, inefficient data processing, insecure data exchange, drug counterfeiting, a lake of sound traceability system; besides that, the solution of weak systems from these obstacles is via improving data management and using blockchain technology (Dutta et al. 2020; Figorilli et al. 2018). Likewise, we can use BC to establish a traceable blockchain and accountability vaccine that would build trust within organizations and patients (Jamil et al. 2019; Yong et al. 2020). Drug counterfeiting is a major global issue. ‘Pharma-co-surveil company’ suggested for the transformation using blockchain systems the whole pharmaceutical distribution chain. We can use Blockchain-based Hyper ledger fabric to boost supply chain and drug information (Jamil et al. 2019). Also, a ‘Gcoin blockchain company’ reported that the main problem is the double-spending and counterfeiting pharma challenges (Tseng et al. 2018). The last implication of Smart Contracts Based on Blockchain It can seek to install the intellectual property associated with selling drugs and completing transactions to the original owner. It could also track the cold supply chain and control sensitive drugs’ temperature (Clark & Burstall 2018). Besides the current lack of visibility in the health supply chain, there are no strong communication channels between the supply chain stakeholders, leading to a lack of transparency and records discrepancies. Khan, M et al. (2018)suggests overcoming these challenges by employing advanced technology such as blockchain, Revolution 5.0 technology, and the Internet of Things. Several ministries and health agencies have built valuable strategies to identify potential medical shortages and to handle disruption incidents in the supply chain (Godman et al. 2019). De Weerdt et al. (2015) distinct elements, such as cost, supply chain, distribution, availability, permanent drug cessation, and time frame, have been defined to represent a common drug shortage concept across countries in Europe, France, Belgium, Italy, Bulgaria, Canada, and Colombia. They have adopted concepts that include a shortage perspective, some characteristics of the supply chain, and factors that influence the market (Hicks et al. 2018).
Conceptual Framework (DTOE)with DOI theory +Thong+Hofsterd models
Researchers can implement models during the study because they are responsible for integrating various technological principles (Reeves, Herrington & Oliver 2005).Earlier studies have contributed to the development of several models for emerging technology implementations in different areas of the supply chain (SC), such as monitoring, tracking (Dolgui et al. 2020), forecasting demand (Hofmann 2019), and analytics of risk(Liu et al. 2019). Adapt blockchain technology to monitor and optimize different aspects of the performance of the supply chain in particular, because of BC’s ability to facilitate and automate different business transaction processes for more direct relationships between parties, BC became considered as its backbone (Chang, Y, Iakovou & Shi 2020) (Dutta et al. 2020; Saberi et al. 2019).After reviewing the literature, the researcher found that many theories and models could apply to this study. They include; Institutional Theory(Lee & Whang 2015), Theory of Reasoned Action (TRA) (Fishbein 1979), Planned Behavior Theory (TPB)(Lian, Yen & Wang 2014), Technology Acceptance Model (TAM(Lou & Li 2017), Technological-Organizational-Environmental Framework (TOE), and Innovation Theory Diffusion (DOI) in the healthcare industry(Wong, Tan, et al. 2020). The researcher found framework (TOE) was a classic model that proposes factors to consider during innovation. Potential effects emphasize three aspects of an innovation or the adoption of emerging technologies on the society or organization and the environment relevant to this study built by Tornatzky and Fleischer(Tornatzky, L & Fleischer 1990).As such, Gökalp, Gökalp and Çoban (2020)observed that the recent integration of IoT and blockchain technologies in the healthcare supply chain had raised serious concerns in terms of formalization, organizational culture, potential impacts on staff morale, quality of services, and patient outcomes in Saudi Arabia. Although there is inadequate empirical support for the TOE framework’s glowing recommendation in healthcare supply chains across the world, Tarofder et al. (2019)concluded that successful implementation depends on how organizational culture conceives the three fundamental tenets of the model. This framework’s important component is that it allows the researcher free space to identify attributes in a wide domain under each setting. The evaluation of variables under each background was usually from previous research considered appropriate for each study’s situation. Furthermore, (TOE) preferred many IT adoption studies to identify specific variables related to the health supply chain (Lin, H-F & Lin 2008). The (TOE) framework should be associated with other theory as DOI for understanding adoption behavior (Alatawi et al. 2012; Chong & Chan 2012).DOI theory investigates the widespread acceptance of technology through the perception or product innovation, the stages of understanding, justification, the decision, and implementation (Rogers 2004).Because these two models, including the understanding of innovation features, complement each other in those specific aspects, instead of the individual study level as (TAM) model and (TPB) (Oliveira & Martins 2011),the DTOE explain the inter-organizational level. This study adopted three (DOI) variables and installed them under the context of technology. These considerations are relative advantages, compatibility, and complexity (Rogers 1995),for the choice variables of environmental as well as organizational has been selected from previous and recommended literature review. Furthermore, this research will adopt the Thong model, which calls for the characteristics of decision-makers in combination with the context of technology, organization, and the environment (Thong 1999). In Thong’s perspective, IT adoption mainly depends on the perceptions, functions of decision-makers representing emotions, motives, and attitudes towards technology acceptance. Decision-makers take the most crucial decisions. This research, therefore, adds to the fourth dimension in connection with the advantages provided by them (Technological, Organizational and Environmental contexts).Finally, this study will also adapt to the third framework which is the cultural dimension within the organization, which has the greatest influence on the adoption of technology Cultures with a high level of uncertainty avoidance and are more likely to accept emerging technology because technical solutions have more confidence than human decisions(Hoppe & Eckert 2014). De Mooij and Hofstede (2002)designed a framework that contains five-dimensional to explain variations in consumer behaviour across nations. It can be distinguished between individualism/collectivism, distance from power, avoidance of uncertainty, masculinity/femininity, and long-term/short-term orientation. The five-dimensional model can be used for the acceptance of the technology which will be a valuable dimension in this study. Previous other scholars investigated the national culture as moderators with the TAM model, the results showed that national culture had a major influence on perceived value, perceived ease of use, attitude towards use which indicates the culture plays a main role in user behavior (Al-Azawei 2017; Ayeh, Au & Law 2016; Kim, KJ 2016; Srite & Karahanna 2006).
Technological dimension: involves technology currently and internally used throughout the organization and external obtainable technologies accessible by an organization (Almubarak 2017). Relative advantage refers to the positive difference between organizational benefits and efforts to implement blockchain technology that focuses primarily on non-tangible benefits such as enhanced credibility, increased customer loyalty, and increased response speed (Kim, J et al. 2020). Relative advantage has been an essential factor in adopting emerging new technological applications (Kapoor & Dwivedi 2020) that adopt blockchain (BC) and health supply chain. They can bring many advantages due to greater transparency and enhanced security for improved supply chain traceability (Puklavec, Oliveira & Popovič 2018). Another factor to be considered in this study is a technical affinity (TA) that continually explores emerging technologies and is an essential function for successful interaction with technology (Franke, Attig & Wessel 2017). Previous research has shown that a vital determinant of a broad range of technology adoption is technology’s attitude (Modahl et al. 2020; Zhou & Teo 2017). Thus, Individuals with a higher affinity are more motivated to increased effort and motivation (Attig & Franke 2019). The last factor is that complexity relates to the complexity of technology application and technology itself (Bhattacharya 2015). Mostly, a high degree of difficulty confuses and causes users to have a problem understanding and to use a technology that may harm their decision to adopt BC (Tamilmani, Rana & Dwivedi 2020).
The organizational dimension involves many contexts such as scale, scope, and management involvement (Almubarak 2017). Refer to readiness to provide assistance or barriers from the top management (Yeh & Chen 2018). The definition of maximum management support is the degree to which managers recognize the importance of engaging the blockchain’s adoption (Ooi et al. 2018). Technological readiness(TR) is an essential factor in influencing the IT team to adopt BC (Kamble, Gunasekaran & Arha 2019; Larasati & Santosa 2017; Pattansheti et al. 2016; Widyawani & Santosa 2017). Previous studies have examined the technology readiness factor, its influence on the adoption of emerging technology(Alkhater, Walters & Wills 2018; Clohessy, Acton & Rogers 2019; Shirahada, Ho & Wilson 2019; Sun et al. 2018), and the amount of money allocated that agreed to the modern technology(Weiner 2020). Besides that, Blockchain technology is considered an investment that requires software and hardware, which is costly for both organizations and their partners (Mougayar 2016; Yuan et al. 2019). The trust factor has focused on many different studies context for developing technological adaption factors (Alzubaidi, Slade & Dwivedi 2020). Suppose there is a trust for BC technology. That will positively contribute to organizations hence enhancing current procedures, leading to making investments to improve the infrastructure and resources for adaption (Wong, Leong, et al. 2020). The last factor, the cultural aspect, tends to affect the customer’s behavior significantly. The business sector needs to manage its customers differently depending on their culture, behavior, and motivation (Wahl 2016). Hofstede (2011)defined national culture as “the collective programming of the mind which distinguishes the members of one human group from another” (p.3).
Environmental dimension: The systems of competitive and government pressure relate to the effects of outside the organization policies & regulations (Gökalp, Gökalp & Çoban 2020). The rules refer to the government’s policy initiatives to accelerate the rate of adaption technology innovation (Almubarak 2017; Angelis & da Silva 2019; Tornatzky, LG, Fleischer & Chakrabarti 1990). Competitive pressers mean the organization’s level of pressure from competitors within the sector (Azmi et al. 2018; Oliveira & Martins 2010).
The decision-maker dimension containing two variables included in this context was their innovativeness, which is defined as the decision-makers’ level of preference to try a solution and evaluate the risk (Thong 1999). Their knowledge in information technology refers to the essential ability to process the advantage to adapt to the new technology (Thong 1999). They consider decision-makers’ voices to adapt to new technology or future projects’ planning processes (Alshahrani, Stewart & MacLure 2019). Decision-makers should be aware of technology implementation’s advantages to determine investment and talent development (Wong, Leong, et al. 2020). Many technology evaluation models commonly use decision-maker team judgments; some of the situations organizations have expressed related to the most unfamiliar areas of applying blockchain to supply chain processes, such as transparency and traceability (Hughes, A et al. 2019). Therefore, blockchain technology evaluates methods to consider various views and consider the decision-makers, hesitate(doubt) to prevent any future regret (Bai, Cordeiro & Sarkis 2020)A recent study of adaption BC in Malaysia done by Wong et al. (2020) recommend that including the decision-maker group for better understanding in term of technological readiness and capabilities for the adaption new technology.
Methodology design and approach
The research will adopt an exploratory qualitative research design using an open-ended and semi-structured interview. The research design adopted for this study is experimental. In social sciences, exploratory research entails a systematic undertaking intended to discover generalizations that lead to the description and understanding of a problem or phenomenon (Stebbins 2001; Yin, RK 2017). Exploration tends to produce valid and insightful findings (Karagiannis & LeMaster 2007). For most purposes, exploratory research makes qualitative data, and some of the effective techniques deployed involve a conversation between researcher and participant. It includes focus groups, case studies, and semi-structured interviews using a questionnaire (Griffith et al. 2012).
The qualitative method explores more information on the adoption intention of Blockchain technology (BCT) and the challenges behind the adoption. Creswell and Poth (2017); Locke (2002) suggest using the qualitative method when the phenomenon under investigation is unknown and unarticulated, and the literature is scant. It is noteworthy for Saudi Arabia. Many previous studies have used this approach to explore the adoption intention such as e-commerce, ICT, and business analytics (Dwivedi, Papazafeiropoulo & Scupola 2009; Leung et al. 2015; Ramanathan et al. 2017). In the novelty of blockchain in healthcare, the experimental method deems appropriate for answering the research question (Yin (Yin, K et al. 2018). Recent studies such as Korpela, Hallikas and Dahlberg (2017) used a focus group method to develop emerging blockchain use-cases. Verhoeven, Sinn and Herden (2018) discussed examples of effect goals in the supply chain.
The sample will be drawn from the professionals engaged in the healthcare supply chain comprising pharmacists, wholesalers, manufacturers in health care organizations, and hospitals in Saudi Arabia. Consequently, the sample will constitute manufacturers, distributors, warehouses, hospitals, retailers, and customers. Moreover, the participants will be limited to people within Saudi Arabia, considering that this is the setting of interest (Alruthia et al. 2018). Consequently, the respondents will be purposefully selected based on their interest in the industry and network when respondents are from companies. The sampling technique will use snowball and random sampling methods. The interviewees were carefully chosen based on the qualification requirements. The researcher reached the potential participants our data collection targets by working in the health supply chain organization starting from Jamjoom Medical Industries -( JMI). It is the largest medical device and healthcare manufacturing company in Saudi Arabia through NUPCO, a value-driven and centralized health care procurement, re-exporting, warehousing, and distribution company for pharmaceuticals and medical equipment, and supplies in the Kingdom of Saudi Arabia. Founded in 2009 and wholly-owned by Public Investment Fund ending to logistic and pharmaceutical department managers in National Guard Hospital, The Ministry of National Guard Health Affairs (NGHA) is a governmental healthcare institution serving the population of National Guard employees their dependents. NGHA has seventy-four healthcare facilities in kingdom-wide (JMI 2020; NGHA 2020; NUPCO 2020). The data triangulation increases the reliability and accuracy of the findings (Yin 2017), and the target number is thirty interviews, every interview lasting 45–60 min. (The sample size calculation will be determined later). Based on the essential research question and conceptual framework, the researcher derived an initial structure with topics designed open-ended questions which targeted staff for board discussions to increase a great understanding (Raghubir & Srivastava 2009).
Measures and Data Collection
The participants will be contacted and informed about the research’s purpose from the distribution networks and emails. Consequently, there will be issuing dates for those who will agree to participate in the study for face-to-face or online interviews depending on their locations by keeping the precautions and safe distance (Nurunnabi 2020). There will be information about anonymity and privacy regarding their participation in the research process passed across. Furthermore, the participants will be requested to provide contacts for communication on the specified dates. The participants’ engagement in interviews will be semi-structured and constituting open-ended questions (Francisco & Swanson 2018). Recording o their responses will be made using electronic recording tools to be coded and assessed later.
Interviews could provide the best primary data in qualitative research, making the researcher the ideal instrument for collecting and analyzing the data. In this regard, a constructivist approach will explore people’s ideas, opinions, and perspectives regarding adopting blockchain technology in streamlining activities across the supply chain (Al-Emran, Mezhuyev & Kamaludin 2018). With the aid of the Internet platforms and databases that can contact parties in the industry, the interview could avail relevant information regarding the mechanics that could facilitate the integration of services across the health supply chain using blockchain technologies (Francisco & Swanson 2018). The participants could offer insightful opinions regarding the mechanics that could help streamline operations in the industry (Al-Ruithe, Benkhelifa & Hameed 2018). Furthermore, considering the utilization of both open and closed-ended questions in the interview, the perspectives could help derive inferences regarding the challenges that undermine the integration of activities across the supply chain (Al-Emran, Mezhuyev & Kamaludin 2018).
The data analysis of the interview will utilize NVIVO software. The process’s achievement is through coding processes depending on the participants’ responses and entries on the interview questions, which will be achieved procedurally (Hassan, Yuen & Niyato 2019). Consequently, there will be an arrangement of themes, patterns, and relationships, depending on the specific perspectives regarding streamlining operations within the pharmaceutical network(Nurunnabi 2020). It will be arranged categorically based on the characteristics and properties of a thing or a phenomenon part of these criteria that include challenges, opinions, beliefs, and new ideas on ways to integrate blockchain technology. Thematic analysis is quite similar to content analysis, with the differentiating factor being that thematic pays more considerable attention to the qualitative elements of the data or materials being analyzed (Alhashim 2018). They have performed multiple iterations of data analysis to extract relevant and valid findings. The underlying concepts were drawn by examining the transcribed interviews line-by-line—the identified ideas’ grouping into different categories based on their similarity and differences. Finally, the classes were mapped with the DTOE framework as the study will conduct based on the qualitative approach, collected data.
The study is feasible on the account that the methods used are practical. The issues would undermine this study’s feasibility, including the research topic’s validity and credibility, the participants’ nature, and research costs. The only visible costs will involve the software and the travel ticket when needed; nonetheless, these costs will still be manageable. The participants are over 18 years of age, and their participation will be voluntary. Lastly, the topic is valid, an issue that is currently being faced in the real world. The outcome of the research also has real-life implications, further indicating feasibility.
Some of the limitations that the investigator anticipates include technicalities in using analytic tools such as NVIVO. This limitation will be addressed by consulting experts in data analysis. Secondly, access to the study subjects can be a challenge due to distance and unprecedented commitments during the study. As such, the researcher will plan interviews and liaise for availability from the participants in advance. This aspect will help in the proper planning of the research. Lastly, the language barrier might constitute an issue, especially when individuals from diverse backgrounds consideration. Hence, recordings and translators will be used where appropriate. Moreover, scheduling the interviews with the participants in their free time will resolve the challenges of meeting the participants. The researcher will send emails to book appointments with the participants to schedule the interviews conveniently for both parties.
The current study recognizes the significance of researching within recommended ethical frameworks. As such, the researcher will obtain ethical approval from relevant individuals. Furthermore, the present study will select participants voluntarily, and participants have the right to continue or withdraw from the study at any time. All knowledge gained from previous literature is recognized and cited appropriately (Bell & Bryman 2007). Additionally, ethical considerations have a particular resonance due to the in-depth nature of the study process. All ethical issues will be maintained strictly to balance the potential risks of research and its possible benefits. Research ethics will sustain this study.
This study’s authors adhere to a no harm policy to individuals or groups belonging to any segment. Additionally, in this research, all participants’ sensitive information will be hidden to ensure their sanctuary and protection. The concept of health and safety issues will be addressed during the research process, whereby the researchers will effectively address the hazards associated with the research activities (O’Fallon & Dearry 2002). The data collection process will involve traveling for researchers to conduct interviews with the study’s selected sample size. In Saudi Arabia, security is not adequate, and that may exhibit some challenges to the researcher if the interview process extends past the regular working hours(Crabtree 2010). The researchers may contact infected participants, which may pose a challenge to the research team due to data collection’s slowing, and lack of enough data for the anticipated time frame (Lou & Li 2017). Safety measures will be put in place to help control such risks during data collection (Van Aalst, Cannon & Burton 2008). The action will help improve the efficiency and the efficacy of the data collection process since the researchers will feel safe, thus staying focused on the research study (Larsson & Teigland 2019). The submission of ethical approval will help interview the participant’s informed consent, whereby they will only be answering the appropriate research question. Ethical approval will help maintain the interview’s confidentiality, thus encouraging the participants to freely respond to the research questions (Willis, Slade & Prinsloo 2016).
Occupational Health and Safety Risks
The anticipated occupational health and safety risks entail the data collection processes, as, during these periods, the teammates will be commuting to conduct the interviews (Spinelli & Pellino 2020). Considering that some of the interviewees are not located within company premises, such traveling can bear certain risks. Nonetheless, part of the research group performs screening the participants and identifying whether the places of interviews are safe and do not pose significant threats (Avdiu & Nayyar 2020). Moreover, considering the ongoing pandemic, the risk of contracting the COVID-19 virus still looms. Therefore, the team must take the necessary measures to ensure that they are safe from contracting the virus. Furthermore, the teammates must assure the interviewees that full measures will limit contacts to prevent contamination risks (Spinelli & Pellino 2020).
The research is motivated by the need to make a significant change in the Saudi Arabian health supply chain(Avdiu & Nayyar 2020). Over the past years, the country has achieved technological advancements, which offer relevant opportunities to achieve improvements (Salehi et al. 2020). Besides Saudi Arabia, various countries across different continents are equally advancing their technological landscapes, which means that they have the opportunity to integrate streamline operations within their health sector. The proposed study will explore and empirically investigate the challenging factors of adopting blockchain technology in the health supply chain in Saudi Arabia. Through the qualitative method, open-ended interviews will be used with ten respondents consisting of information that will help increase the understanding of the concept from executives, directors, specialists, and managers in health care organizations. The proposed research question is significant since gaps are also exhibited in the research and have been unexplored in past literature, displaying some aspects of the academic researcher’s unique area to advance the health supply chain system. The study could support decision-makers to enhance and manage all healthcare supply chain issues, especially after identifying how to resolve the challenges realized across the supply chain network. The study has a significant implication, such as developing improved aspects of transparency in the healthcare supply chain transactions. Moreover, this study will provide a comprehensive scenario of blockchain adoption in HSC in Saudi Arabia.
Conferences (Domestic registration+ travel+ accommodation) 1500
Stationery items 700
Research method training and support 1000
Travelling (for retail industry partner visits for case studies) 500
2021 2022 2023
Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2
Literature Review – (Ch-2)
Additional Coursework/ methodology training
1st Draft – Ch 3 (Methodology)
Training to support outcomes (pubs, conferences, 3MT)
1st Draft – Ch 4
1st Draft – Ch 5
1st Draft – Ch 1
1st Draft – Ch 6
1st Draft – Conclusion
Thesis Revision and Final
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