Department of Technology Management and Economics 
Division of Service Management and Logistics 
CHALMERS UNIVERSITY OF TECHNOLOGY 
Gothenburg, Sweden 2019 
Report No. E 2019:063 

 
 
 
 
 
 
 
 
 

 
 
Drone deliveries of medical goods 
in urban healthcare 
Patient safety improvements enabled by a 
drone-based logistics system 
Master’s Thesis in the Master’s Program Management and Economics of Innovation 
 
 
 

SOFIA MAGNUSSON 
PAULINE PETTERSSON HAGERFORS



 
 

 

  



Department of Technology Management and Economics 
Division of Service Management and Logistics 
CHALMERS UNIVERSITY OF TECHNOLOGY 

Gothenburg, Sweden 2019 

MASTER’S THESIS E 2019:063 
 
 
 
 
 

 
 

Drone deliveries of medical goods in urban 
healthcare 

Patient safety improvements enabled by a drone-based 
logistics system 

 
 

SOFIA MAGNUSSON 
PAULINE PETTERSSON HAGERFORS 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Tutor, Chalmers: Iván Sánchez-Diaz 
Tutor, Innovation Platform VGR: Magnus Kristiansson 

Tutor, Chalmers Centre for Healthcare Improvement: Patrik Alexandersson



 

 
Drone deliveries in urban healthcare 
Patient safety improvements enabled by a drone-based logistics system 
 
SOFIA MAGNUSSON 
PAULINE PETTERSSON HAGERFORS 
 
 
© SOFIA MAGNUSSON & PAULINE PETTERSSON HAGERFORS, 2019  
 
 
Master’s Thesis E 2019:063 
 
 
Department of Technology Management and Economics 
Division of Service Management and Logistics 
Chalmers University of Technology  
SE-412 96 Gothenburg Sweden  
Telephone + 46 (0)31-772 1000 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chalmers Reproservice  
Gothenburg, Sweden 2019



 

 
Drone deliveries of medical goods in urban healthcare 
SOFIA MAGNUSSON 
PAULINE PETTERSSON HAGERFORS 
Department of Technology Management and Economics 
Chalmers University of Technology   

Abstract  
There is an ongoing trend of centralization and specialization in the healthcare sector that entails 
requirements for fast, flexible and reliable deliveries of medical goods between healthcare facilities. 
Logistics systems in healthcare are additionally highly impacted by the importance of high patient 
safety. Due to the potential time savings compared to road-based transports in urban areas, unmanned 
aerial vehicles (UAVs), more commonly known as drones, are emerging as a mode of transport. This 
qualitative single case study intends to combine findings in healthcare and logistics, and from a patient 
safety perspective assess the potential benefits of a drone-based delivery system of medical goods. The 
study combines literature on patient safety, centralization and the state of the art of drones, together 
with a comprehensive current state analysis of the urban delivery system of medical goods in 
Gothenburg, Sweden. The analysis is based on a total of 17 interviews, six observations and historical 
data on delivery statistics. 
  
The study shows that the delivery system of medical goods in Gothenburg is extensive and complex, 
partly due to centralization and scattered facilities, and includes both regular and on-demand deliveries 
chosen based on required delivery lead time. It is also shown that transports are impacted by an 
unpredictable traffic environment today, resulting in long and unreliable delivery lead times. Thus, there 
are benefits, primarily related to the possibility to reduce delivery lead time, which can be enabled by a 
drone-based delivery system. Additional benefits are increased flexibility and reliability of deliveries, 
reduced risk of errors and potential for security improvements. Through the translation of patient safety 
aims into logistics performance indicators, we further show that these benefits could improve patient 
safety in a healthcare organization. 
  
Furthermore, characteristics of medical goods are mapped in order to investigate the compatibility and 
suitability with drone deliveries. We conclude that urgently needed replaceable medical goods with low 
economic value and low risk of theft, which are lightweight and frequently delivered on-demand in low 
volumes between facilities, are suitable for drone deliveries. This study mainly focuses on urban drone 
deliveries of medical goods from a strategic point of view, hence, it is of great importance to explore 
operational and design aspects of drone delivery systems in future research. The findings from this study 
can be used as guidance for healthcare organizations’ strategic decisions upon the use of drones as a 
mode of transport for medical goods.  
 
 
 
 
 
 
 
Keywords: drones, UAVs, patient safety, healthcare, medical goods, urban logistics, centralization 



 

Table of content 
1. Introduction 1 

1.1 Background 1 

1.2 Project background 2 

1.3 Research contribution 3 

1.4 Delimitations 3 

2. Theoretical framework 4 

2.1 Patient safety 4 

2.2 Centralization 6 

2.3 Drones 8 

3. Methodology 15 

3.1 Research design and approach 15 

3.2 Literature review 15 

3.3 Primary data 16 

3.4 Secondary data 19 

3.5 Data analysis 19 

4. Empirical findings 20 

4.1 Organizational context 20 

4.2 Medical goods logistics 23 

4.3 Logistics system risk factors 36 

5. Discussion 38 

5.1 Potential benefits of drone deliveries of medical goods 38 

5.2 Medical goods’ suitability and compatibility with drone deliveries 44 

5.3 Logistics design aspects 46 

6. Conclusion 48 

References 50 

 
 

 



 1 

1. Introduction 
In this introductory chapter, the research and project background is firstly presented in order to address 
the relevance of the study’s purpose. The research background aims to justify the need for this research, 
whereas the project background is exclusively related to the case study. The two background sections 
are followed by a section with the research contribution, where the purpose and related research 
questions are presented. Lastly, the delimitations of the study are presented.  

1.1 Background 
Urban areas, or cities with high population density, have evolved due to the benefits arising from the 
increased number of contacts available for both citizens and decision-makers. However, urbanization 
results in several major challenges such as those related to environmental impact, logistics and transport 
related issues (Antrop, 2004). The number of transports to, from and within cities is increasing for each 
year, resulting in problems such as traffic congestions, noise and pollution. Additionally, urbanization 
puts high pressure on the healthcare sector with requirements to meet the needs of a large number of 
citizens, and organize the services accordingly (Prewitt, 1997).  
 
The specific characteristics of healthcare organizations result in complex supply chains of support and 
delivery services, where the requirements for speed, availability and security are of high importance 
(Vincent, 2010). A way of organizing in order to handle these challenges is to centralize activities, 
services and inventory (Abrahamsson, 1999), which is an ongoing trend in the healthcare sector. 
Centralization entails requirements for fast, flexible and reliable transports that are able to meet the 
demands in the healthcare sector where time often is of high importance (Abrahamsson, 1999; Vincent, 
2010). According to patient safety principles, all activities in a healthcare system should also be 
designed in a safe, effective, patient-centered, timely, efficient and equitable way (Vincent, 2010), 
which further puts pressure on transports in the healthcare sector. 
 
As a response to the increasing volumes of transported goods in urban areas, the use of drones as a 
mode of commercial transport has developed rapidly lately. One of the main benefits of using drone 
deliveries are the time saving potential compared to road-based transports (Stolaroff, Samaras, O’Neill, 
Lubers, Mitchell & Ceperley, 2018). As a consequence of the maturity of the drone technology and 
potential time savings that can be reached through drone deliveries, several healthcare organizations 
and related transport partners have started to explore the use of drone deliveries of medical goods 
between healthcare facilities. The use of autonomous drones, or unmanned aerial vehicles (UAVs), 
results in increased reliability of transports (Wertheimer, 2018), less environmental impact compared 
to road transports (Stolaroff et al., 2018; Fosse, 2018; Wertheimer, 2018), less traffic on the roads 
(NESTA, 2019b), faster test results to patients (Fosse, 2018; Sundhedsdroner, 2019; NESTA, 2019b), 
improved patients logistics by predictable time from sampling to analysis and allowance for 
centralization (Fosse, 2018). Although the ongoing healthcare projects for drone deliveries in urban 
areas reveal some of the benefits associated with drone deliveries, the existing literature on the topic is 
currently limited.  
 
Based on the potential time saving that drones offer, and limited existing literature on the use of drones 
within urban healthcare, this thesis aims to investigate the needs and potential benefits of drones as a 
mode of transport of medical goods. Although the time saving potential is already known, there is a 
need to investigate a current healthcare delivery system of medical goods in order to find the greatest 



 2 

need for faster and more flexible deliveries, and how drone deliveries can enable for improvements of 
patient safety. Furthermore, there is no existing literature on what types of medical goods that are most 
suitable for drone-transports, why this thesis aims to contribute by mapping characteristics of goods 
that have most potential to be delivered by drones from a patient safety perspective. 

1.2 Project background 
Gothenburg is Sweden’s second largest city with 1.03 million inhabitants in the region, where 570 000 
live in urban areas (Statistiska centralbyrån, 2018). As the city is growing both geographically and in 
the number of citizens (Stadsutveckling Göteborg, 2019), so does the demand for a well-functioning 
infrastructure. Medical goods are often time sensitive and are in Gothenburg delivered with road-based 
transports today, which are affected by traffic congestions and geographical hinders that results in 
unpredictable and unreliable delivery lead times. In order to explore the potential benefits of drone 
deliveries of medical goods within the Gothenburg region, the two regional departments the Innovation 
platform VGR and Regionservice were assigned to investigate the potential application areas between 
the three main hospitals in the city. Thus, a pre-study was performed with a limitation to the 
transportation of blood and laboratory samples between the three hospitals Mölndals Sjukhus (MS), 
Sahlgrenska Sjukhuset (SS) and Östra Sjukhuset (ÖS) in central Gothenburg with focus on the time 
saving potential of using drones. Based on calculations from the Gothenburg based drone company 
Everdrone, presented in Damgaard’s (2019) pre-study, the table below shows the time difference 
between road-based and drone-based transports between SS-MS and SS-ÖS.  
 
Table 1. Time savings from drone-based deliveries compared to road-based deliveries (Damgaard, 
2019). Adapted by authors. 
Route Blood car Drone Time saving 
SS-MS 10 min 3 s 4 min 33 s 5 min 30 s 
SS-ÖS 21 min 36 s 6 min 53 s 14 min 43 s 

 
The calculation is based on a speed of 70 km/h, height of 60 meters and a six-axis drone (Damgaard, 
2019) whereas it is possible to fly even faster with other types of drones (Sällström, March 13, 2019). 
The flight route between SS and MS is 4,46 km and between SS and ÖS 7,16 km. In both cases, the 
flight routes have been laid to minimize flight over populated areas. The time saving of using drones 
was estimated to be between 50-70 % compared to road transport. The calculations reflect the actual 
transport time, whereas handling time before pick up and drop off are excluded. According to Mion 
(2018), there is a major time saving potential from the use of drones also in terms of handling the goods 
in connection to the transports. 
  



 3 

1.3 Research contribution 
The aim of this master thesis is to investigate the potential benefits that can be enabled by drone 
deliveries of medical goods in the urban healthcare sector. Thus, there is a need to map a current delivery 
system of medical goods between healthcare facilities in an urban setting in order to investigate whether 
there is a need for improvements that are enabled by drone deliveries, as well as to map the 
characteristics of the medical goods in order to find the most suitable goods for drone deliveries from a 
patient safety perspective. Therefore, this master thesis aims to answer the following research questions: 
 
RQ1: How can patient safety be supported by a drone-based delivery system of medical goods within 
an urban healthcare organization? 
 
RQ2: Which types of medical goods are initially most beneficial to be delivered by drones from a patient 
safety perspective? 
 
By answering these research questions, strategic suggestions for the use of drones as a mode of transport 
for medical goods in an urban healthcare organization are presented. 

1.4 Delimitations 
The study is delimited to the urban transportation system of medical goods between the three hospitals 
SS, MS and ÖS in Gothenburg, Sweden. The transport of medical goods to, from and internally within 
the hospitals is only briefly considered. Transplantation logistics are excluded from the medical goods 
investigated. Operational and regulatory aspects of the use of drones are not elaborated on. The study 
focuses on the current transportation system during the spring of 2019, whereas collected data span 
from 2011 to the beginning of 2019. Technical specifications of drones are only briefly considered.  

 
 
 

 
  



 4 

2. Theoretical framework  

The first part of this chapter aims to describe theories about patient safety, which is an overall goal in 
the healthcare sector. Patient safety can for instance be ensured through improved logistics, where 
centralization and time-based distribution are two concepts presented in the framework that can support 
a patient safe logistics system. However, centralization and time-based distribution require fast and 
reliable transport modes. Drone deliveries are both fast and reliable compared to road-based deliveries, 
hence, the final part of this chapter presents the state of the art of drones, application areas within 
healthcare and drone deliveries of medical goods in urban healthcare. 

2.1 Patient safety 
Patient safety is defined as “The avoidance, prevention and amelioration of adverse outcomes or 
injuries stemming from the process of healthcare.” (Vincent, 2006), and is of the utmost importance 
when working in and with healthcare. A patient safety focus addresses health damage events such as 
errors, deviations and accidents (Vincent, 2010), where health damage refers to either suffering, bodily 
or mental injury, illness or even death of a patient that could have been avoided if adequate measures 
have been taken in the patient's contact with the healthcare system (Socialstyrelsen, 2019). The Swedish 
patient safety act Patientsäkerhetslagen (2010:659) is a law with the aim to promote a high level of 
patient safety within both healthcare and dental care in Sweden (Riksdagen, 2019). The law includes, 
among other things, regulations for caregivers and healthcare staff who are obliged to plan, manage and 
control the operations in a systematic way so that the requirement for safe healthcare is fulfilled. Risks 
should be eliminated if possible, or kept under control (Socialstyrelsen, 2019). 
 
Security is an important part of patient safety. Security refers to procedures and measures used to 
prevent data and health records from being exposed to unauthorized access, modification or use (Turn 
and Ware, 1976; Nass, Levit & Gostin, 2009). Any transfer of patients, physical goods or information 
increases the vulnerability in a system, where each transfer represents a higher risk of errors, deviations 
or accidents (Vincent, 2010). Human errors also represent a considerable risk in a system, where some 
but not all can be avoided through standardization and technology. For instance, there are technologies 
directly targeted at the reduction of error and the improvement of safety. Thus, some technologies do 
directly reduce the variability that humans provide in a system. 
 
When improvements projects are made within the healthcare sector, patient safety should always be one 
of the top priority factors. Improvement work for increased quality of care should according to Vincent 
(2010, pp. 38-39) have the six following specific aims: 
  



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Table 2. Specific aims for improvement in terms of patient safety (Vincent, 2010, pp. 38-39) 
Aim for improvement Explanation 

Safe Avoiding injuries to patients. 

Effective Avoiding underuse and overuse of services to patients based on scientific 

knowledge. 

Patient-centered Providing respectful care based on patient values based on individual 

preferences, needs and values. 

Timely Reducing wait and harmful delays for both patients and healthcare 

professionals. 

Efficient Avoiding waste of resources, ideas and energy. 

Equitable Providing equal care that does not vary in quality because of personal 

characteristics or geographic location. 

 
Although some improvement work might have considerable effects on factors such as cost or 
satisfaction of healthcare personnel, the patient safety factor should always be prioritized before other 
factors in case the aims collide (Vincent, 2010).  

2.1.1 Patient safety in medical goods logistics 
The specific aims for improvement in terms of patient safety (Vincent, 2010), can be translated into the 
logistic performance indicators (table 3). Each logistics performance indicator is further explained 
below the table. 
 
Table 3. Patient safety aims translated into logistics performance indicators (Vincent, 2010). Adapted 
by the authors and a healthcare logistics expert. 
Patient safety aims Logistics performance indicators 

Safe Percentage of deliveries conducted without deviations such as destroyed or 

lost goods, or dissemination of personal information. 

Effective Transport system is sufficient to meet the demand for deliveries of the 

customer. 

Patient-centered Flow efficiency. Value-adding activities in relation to the throughput time. 

Timely Percentage of goods delivered on time. Can be put in relation to 

dependability, where the sequence of activities is of high importance. 

Efficient Utilization rate of resources, such as modes of transport, or percentage of 

time healthcare professionals spends on non-patient related activities such 

as administrative tasks or goods handling. 

Equitable Availability of deliveries independent of location, day of the week or time 

of the day. 

 
Deviations such as destroyed or lost goods or dissemination of personal information, can have major 
negative consequences for patients in terms of default or reduced quality of care. Therefore, safety can 



 6 

be measured by the percentage of deliveries conducted without deviations. For an organization to be 
effective from a patient safety perspective, it is important to match the capacity with the demand 
(Jacobsson, April 25, 2019). From a logistics point of view, it means to match the capacity of the 
transport resources with the demand for deliveries. Overcapacity indicates an ineffective system with 
waste of resources whereas undercapacity can result in negative consequences from a patient safety 
perspective.  
 
Patient-centered healthcare can be measured through flow efficiency, where the performance is 
measured by the value-adding activities in relation to the throughput time (Jacobsson, April 25, 2019; 
Modig & Ahlström, 2012). The patient is regarded as a customer in the healthcare system and the 
assumption is that customer satisfaction is increased if the throughput time through the healthcare 
system, before and after the value adding activities, is as short as possible. Thus, the value adding 
activities, such as when the patient receives care from or meets the caregivers, should not be shortened. 
Delays of deliveries are associated with wait for patients or healthcare professionals, which reduces the 
quality of care and sometimes result in harmful consequences impacting the patient’s health. Therefore, 
the patient safety aim “timely” should be measured by the percentage of goods delivered on time 
(Jacobsson, April 25, 2019). Furthermore, the term dependability is important to have in mind since 
some activities must be performed in certain sequences, where goods cannot be delivered either too 
early or too late in relation to other activities in a particular sequence. 
 
The efficiency of medical goods logistics can be measured by the utilization rate of transport resources, 
or by the percentage of time healthcare professionals spend on non-patient related activities such as 
administrative tasks or goods handling, where first should be as high as possible whereas the latter 
should be as low as possible (Jacobsson, April 25, 2019). The utilization rate is a measurement of how 
much a resource is utilized in relation to a specific time period (Modig & Ahlström, 2012). The 
equitability of medical goods logistics can be measured by the availability of deliveries independent of 
location, day of the week or time of the day since these factors should not affect the quality of care.  
 
Furthermore, the two aims of effectiveness and efficiency can be matched. When a healthcare unit has 
control over variations that can be controlled, there is a basis for creating an effective patient flow 
without major variations (Jacobsson, April 25, 2019; Schmenner & Swink, 1998). However, some 
variations that cannot be controlled due to the nature of healthcare. It is therefore crucial to reduce 
unwanted variations, such as variations in lead time, in order to create efficient processes. Additionally, 
the more even and fast a process flow is the higher the productivity in the system. 

2.2 Centralization 
This section aims to describe centralization as a way of organizing goods and services, and the related 
benefits and challenges for an organization. Benefits associated with centralization are cost reductions, 
better utilization of resources and improved service levels by decreased uncertainty and variations. 
Challenges are related to the geographical distance between units that centralization results in. Lead 
times are of high importance in the healthcare sector since short lead times can reduce wait and harmful 
delays for both patients and healthcare professionals, hence, fast and reliable transports are crucial when 
healthcare services and goods are centralized. A way of organizing inventories according to demanded 
lead time, while at the same time making use of the benefits associated with centralization, is time-
based distribution that is a theory further explained in 2.2.1. Theories on time-based distribution are 
followed by examples of centralization initiatives in the healthcare sector. These findings are important 



 7 

in order to understand how services and goods are or should be organized, and how the centralization 
affects the requirements of transport modes in healthcare. 

2.2.1 Time-based distribution 
In contrast to traditional logistics and marketing models, where the distribution structure is a function 
of several variables, lead time is the only variable to consider when deciding upon the number of 
warehouses in a system (Abrahamsson, 1999). There are two important tools to use when setting up a 
time-based distribution system, where the lead time determines the distribution structure and 
information systems are used to decrease the lead time (Abrahamsson, 1999). Lead time can be divided 
into administrative lead time and physical lead time, where modern information systems enable the 
administrative lead time to be almost negligible.  
 
The number of warehouses in a traditional logistics system is usually a result of three factors 
(Abrahamsson, 1999). First, if the demand for short lead times from order to delivery is high and the 
customer demand is hard to predict, the number of warehouses usually increases, and warehouses are 
placed near the customers. Second, if the consequences and costs related to default deliveries are 
considerable, the number of warehouses usually increases. Third, the number of warehouses is affected 
by the results of a total cost analysis, where coordinating functions are of high importance and are used 
in order to reduce the total distribution costs. The total distribution costs in a system includes inventory 
cost, transportation cost and costs associated with default deliveries (Abrahamsson, 1999). The primary 
cost implications related to centralization or concentration of warehouses is less tied up capital, 
decreased costs of operating warehouses and administration of the physical distribution. 
 
The time focus in a time-based distribution system implies that the gap between warehouses and 
customers is measured in terms of minutes or hours, instead of distance (Abrahamsson, 1999). 
Simplified, the design of a time-based distribution system starts with the identification of lead times 
demanded by customers; if one warehouse is enough in order to reach the customer with the chosen 
transport mode within the requested lead time, then no additional warehouses needs to be added to the 
system. Otherwise, another warehouse must be added, or faster transports must be used. In the planning 
and design phase of a time-based distribution system, it is important to have a so called “helicopter-
view” on the organization and activities connected to logistics in order to see potential benefits instead 
of getting stuck in problems on the unit or department level (Abrahamsson, 1999). Furthermore, it is of 
the utmost importance to use fast transports to secure good customer service. 
 
A major benefit associated with a time-based distribution system is more timely deliveries, which 
implies higher customer satisfaction and reduced costs of default deliveries (Abrahamsson, 1999), 
which in the healthcare sector can be translated to improved patient safety. It also enables for correct 
and fast information about deviations of the deliveries to the customers. Furthermore, from a total cost 
perspective, a time-based distribution system entails several of the benefits associated with centralized 
inventories. 

2.2.2 Centralization in healthcare  
During the past years, there has been a trend of centralization in the healthcare sector where both 
services, activities and inventories have been centralized. In Denmark in 2007, there was a large 
reorganization of healthcare sector services where the number of acute hospitals was significantly 
reduced from 40 to 21 (Christiansen & Vrangbæk, 2018). In addition, a few centralized “joint acute 
care facilities” with specialist doctors in the front line replaced the previous many scattered emergency 



 8 

care services. In order to achieve increased quality, medical specialties were centralized at fewer 
hospitals. The performance results ten years after the reorganization in Denmark were positive, both 
activity levels and overall productivity had increased meanwhile costs were stable, which indicates a 
successful reform. Additionally, centralization of specialized healthcare services has taken place in UK, 
where a new model of commissioning specialized services was launched in the recent years (Svederud, 
Virhage, Medin, Grundström, Friberg & Ramsberg, 2015). In the new system, the treatment of a range 
of rare medical conditions was centralized.  
 
In addition to the benefits of centralizing activities and services, there are several positive aspects of 
centralizing inventories; costs are reduced, resources are better utilized, and service levels are improved 
by decreased uncertainty (Duan, Su, Zhu, & Lu, 2018). One example of a distribution system that 
benefits of centralized inventories is blood product supply. It is proven that the blood management could 
be improved by having a centralization strategy. Through centralization, hospital costs can be reduced, 
shortage and waste of blood supplies can be decreased, and the occupancy of resources can be reduced.  
 
However, major issues can arise in a system if a centralized function does not work. In systems with 
decentralized functions, one function could cover for another when problems arise, but this is not an 
option in centralized systems (Gustafsson, 2019). This has for instance been shown at the newly built 
hospital Nya Karolinska Sjukhuset where a new centralized sterile center was built, replacing a number 
of sterile technique units. The aim with the centralized sterile center was to benefit of economies of 
scale and to streamline the production for sterile goods to be delivered “just-in-time”. The 
implementation of the centralized sterile unit was unsuccessful, which led to several problems in the 
healthcare organization, such a shortage of sterile instrument, delayed surgeries and a decrease in the 
overall productivity and capacity. The problems worsened due to the fact that there were no storages of 
sterile goods in connection to the surgery rooms as a result of the centralization strategy.  

2.3 Drones 
The development of commercial uses of drones has been rapid the recent years, and drones are now 
considered as a fast and environmentally friendly alternative to road-based transports. The global drone 
industry is experiencing rapid growth, both in the military defense and civilian area, and the 
development of both software and hardware of drones is fast (Business Insider Intelligence, 2016). 
Drones offer a wide range of possible application areas due to its ease of use and technical capabilities. 
In this section, the state of the art of drones is briefly presented, followed by examples on application 
areas in the healthcare sector in general and within urban deliveries of medical goods specifically. 
Additionally, the benefits and challenges of drone-based deliveries are presented in this section. 

2.3.1 Drone characteristics 
Unmanned aerial vehicles (UAVs), more commonly known as drones, are aircraft without human pilots 
aboard. The definition of drones is wide and comprises a range of aircraft (Holcombe, 2018). There is 
a difference between remote-controlled and autonomous drones, where the former requires that a human 
operator steers the drone and where the latter is self-driven without direct human guidance (Coyne, 
2018). Drones are usually designed for different missions, resulting in a lot of different shapes and 
attributes of the aircrafts. In a literature review on design challenges, applications and classifications of 
drones by Hassanalian and Abdelkefi (2017), more than 100 different types of drones are presented. 
Additionally, there are several types of navigation systems and software that can be used with different 
types of hardware. Thus, drones can vary widely in several aspects such as size, weight, flight range, 
material, flight control systems and equipment. 



 9 

 
Drones were first used in military purposes, equipped with cameras and most commonly used for 
reconnaissance (Nationalencyklopedin, 2019). Today, it is not unusual to see hobbyist drones for 
civilian purpose. Commercial drones usually have small rotary wings and the training required for 
operation is minimal. The capacity of drones in terms of flight time and payload varies depending on 
the size of the drone. The typical payload a small commercial drone can carry is slightly above 2 kg 
during 30 to 60 minutes of flight time (Thiels, Aho, Zietlow & Jenkins, 2015). According to Otto, Agatz, 
Campbell, Golden and Pesch (2018), drones can usually only carry one package per sortie and a payload 
of maximum 3 kg. The capacity of the drones’ energy storage unit is closely related to the limitations 
the payload along with size, configuration and usually even the cost of the drone. Based on the limited 
capabilities and environmental impact from drone deliveries compared to road-based transports, it has 
been found that most environmental benefits of using drones are achieved for light packages whereas 
heavier packages are left for ground vehicles (Stolaroff et al., 2018). 
 
A limiting factor for the utility of smaller drones is weather conditions, such as wind, rain or snow that 
could affect the operations and make the flight times uncertain (Otto et al. 2018). In addition, humidity 
and coldness results in risk of frost formations on the wings of the drones (Johannesson, April 5, 2019; 
Sällström, March 13, 2019). However, larger drones are not significantly affected by weather and have 
similar limitations to conventional aircraft (Thiels et al., 2015). The flight speed of a military drone with 
fixed wings can be over 160 km/h, whereas commercial drones usually have smaller rotary wings and 
are typically limited to about 65-95 km/h. Depending on fuel source and payload, military drones have 
a flight distance range up to 1600 km, whereas smaller commercial drones are limited to 30 up to 100 
km.   
 
Most drones carry an energy unit of limited capacity, such as a battery, with the exception for tethered 
drones that receives energy via a power cord (Otto et al., 2018). A multitude of factors affects a drone’s 
energy consumption, such as what type of drone it is (fixed wing or rotorcraft), weather conditions, 
payload, speed, flight conditions (e.g. forward flight or hovering) and flying altitude. The limited 
capacity of the energy unit is often referred to and modelled as the maximal flying distance, operation 
time or a limited number of stops during flight. The assistance of a human operator is usually required 
for battery swaps or refueling but fully automated platforms exist.  
 
Drones receive instructions and transfer collected data through communication links with ground 
control stations (Otto et al., 2018). The most common communication tool used is line-of-sight, which 
could be problematic in urban areas or indoors, where the signal gets weaker in the shadow of buildings. 
Other sources of disturbance that may cause signal interference are transmission lines and 
telecommunication towers. Handling by a human operator might be required due to regulations in some 
countries. Human operators are also sometimes required to the setup operations before a drone takes 
off or after its landing. With the use of drone autopilots, it is possible to hold a required altitude, maintain 
flight stability, and autonomously land and take off. Depending on the type and size of the drone, a 
specific size of the landing area is required. With some types of drones, it is possible to land at spots 
with little to no specialized facilities and require very little space to land (Thiels et al., 2015).  

2.3.2 Drone deliveries of medical goods 
In a literature review about the surgical and medical applications of drones by Rosser, Vignesh, 
Terwilliger and Parker (2018), it is shown that there has been an accelerating maturation of application 
of drone technology in several areas. Despite this, the development within the area of medical 



 10 

applications has been slower than in other areas, such as surveillance of military purposes. Rosser et al. 
(2018) explain this by stating that medical applications are more challenging due to the urgency of 
clinical situations, where date, time and location are factors that do not allow for control. Regulations 
and laws also heavily restrict the healthcare sector. Depending on how the drone is designed and what 
features it is equipped with, areas of use in healthcare could be search and rescue missions, to assess 
patients in disasters, to film accidents or medical services, where drones can enable for patient care at 
home and remote telemedicine. 
 
One application area of drones in the healthcare sector is delivery of medical goods. In order to provide 
an overview of objects in a hospital, Kriegel has (2009) divided each type of item according to different 
criteria and logistics fields, where medical goods is a hospital logistics criterion with five subgroups. 
The characteristics of objects in hospitals are presented in figure 1 below. 
 

 
Figure 1. Characteristics of hospital logistics (Kriegel, 2009) 

 
Medical goods include both biological and non-biological material and constitutes of medical devices, 
pharmaceuticals, sterile goods, blood and transplantation products, and laboratory samples. An example 
of medical goods deliveries with drones is the supply of blood products to remote villages. In Rwanda, 
the company Zipline has been working with the government and delivered blood supplies on-demand 
to 21 regional hospitals since 2011 (Glauser, 2018). More than 50 drones take off every day and the 
next step is to start delivering vaccines and medicines to hundreds of clinics, both in Rwanda and 
Tanzania.  
 
The use of drones for medical goods has mainly been focused on rural areas in developing countries but 
several projects within urban areas have recently emerged. In Delft, the Netherlands, a not yet 
commercialized ambulance drone has been developed with a heart defibrillator and a smaller toolbox 
containing essential supplies for life support (Delft University of Technology, 2019). The whole drone 
is designed as a medical device, equipped with a video supported channel that enables a two-way 
communication through which an emergency operator gives personalized instructions to the first 



 11 

responder. One of the main purposes with this drone is that people suffering from cardiac arrest or other 
medical critical states should receive help faster compared to current solutions, where faster emergency 
care could increase the survival rates.  
 
There are several ongoing projects related to drone deliveries of medical goods in urban areas; in 
Switzerland, the United Kingdom, Norway and Denmark, just to present some examples. Drones are 
used as a mode of transport in Switzerland today, whereas the other countries’ projects are at a research 
state. Since the first Swiss drone delivery took place in October 2017, more than 3000 flights of 
laboratory samples have successfully been completed between clinics in Lugano and Zurich (Furer, 
2019). In Denmark, a project called Sundhedsdroner started in 2019, with the aim to deliver patient 
samples, medicine and medical equipment between hospital units, medical practitioners and home-
visiting nurses. According to Sundhedsdroner’s official website (2019), a future goal is to transport 
persons in urgent situations, such as highly specialized doctors needed for surgeries. In London, the 
movements of pathology samples for post-kidney transplants between Guy’s and St Thomas’ hospitals 
are currently investigated in order to understand the feasibility of drone deliveries. Lastly, in Oslo, the 
medical goods that initially are planned to be transported between the hospitals are blood samples, blood 
banking products, tissue samples and biopsies (Fosse, 2018). In a future state, the goal is to transport 
both light and heavyweight medical goods with several different types of drones where small drones 
could be used short distances and the goods could be consolidated and delivered long distances with 
larger drones (Johannesson, April 5, 2019). 
 

Laboratory samples are the most common medical goods that are, or are planned to be, delivered by 
drones in the ongoing projects. One of the arguments for drone deliveries of laboratory samples in 
Switzerland is that deliveries of laboratory samples often are of a time-sensitive matter and could be of 
the uttermost importance for physicians and patients (Mion, 2018). Additionally, drones can easily carry 
blood vials and pathology samples due to their lightweight nature. According to Mion (2018), the 
products are furthermore not unique products and have a little intrinsic value per se, why the risk of 
theft and consequently monetary loss is low. Moreover, in case of theft or an accident, it is argued that 
sampling could be repeated. Therefore, the benefits of delivering laboratory samples with drones are 
considered to overweight the risks. 
 
The choice of drone deliveries of samples for post-kidney transplant monitoring in London was based 
on that the analysis results of these samples are used to control the dose of drugs applied, and the 
timeframe from when the sample is taken until the results are analyzed is critical (NESTA, 2019a). The 
locations were chosen based on the proximity to each other, the high frequency and volume of daily 
traffic between the locations, and the institutional links between the hospitals. The deliveries are today 
restricted to weekdays when existing logistic solutions are running, whereas drones could enable 
deliveries even on weekends. The future state delivery network in London, including drones, could 
enable for urgent medical products, such as blood products, pathology samples and equipment, to 
routinely be carried between the hospital facilities.  

2.3.2.1 Benefits of drone deliveries 
The projects in Switzerland, the United Kingdom, Denmark and Norway are all partly based on the time 
saving potential that drones offer compared to road-based transportation. The incentive for operating 
drones at the hospitals in Switzerland is the time saving potential from switching from delivery by taxi 
(Furer, 2019). There are three flight routes that are between 2 to 5,8 km long, and one of the routes 
crosses the Zurich lake basin. From the Swiss project at the multisite hospital Ente Ospedaliero 



 12 

Cantonale (EOC), it has been found that the use of drones results in overall time saving of 4.5-39.5 
minutes compared to conventional road transport (Mion, 2018). At the route across the Zurich lake 
basin, the transport time is reduced by up to 80 % when drones are used (Swiss Post, 2019). Between 
the hospitals RHL-C and RHL-I, the delivery time by the most common mode of transport was earlier 
up to 30 or even 50 minutes at one of the routes during the worst-case scenarios, such as traffic 
congestions, compared to 2.47 minutes with drones (Mion, 2018).  
 
In London, the goods transported between the hospitals are in many cases time sensitive. However, 
deliveries are restricted due to the varying road speed across the city, where the average traffic speed is 
about 30 km/h and in the central parts about 13 km/h, causing unreliable and unpredictable delivery 
lead times for medical deliveries (NESTA, 2019a). In order to achieve more reliable transport times, a 
future state goal is to create a drone delivery system for medical goods between 34 hospitals in London, 
which are located relatively close to each other and make use frequent deliveries between the hospital 
facilities. Similar to this is has been found from the Danish project that the route between Odense 
University hospital and Svendborg hospital are expected to take less than an hour with drones, compared 
to road transports in delivery routes that take up to 12 hours (Sundhedsdroner, 2019).  
 
Earlier, every hospital in Oslo ran its own operations with laboratories at each hospital site but due to 
the centralization of healthcare services, transports between hospitals are needed to a larger extent today 
(Forskningsrådet, 2019). The current transportation system between hospitals is road-based and 
characterized by delays due to traffic congestions. The congestions in Oslo result in a slow delivery 
service with unpredictable transport time. The unpredictability, lack of control and status of the 
transports in the delivery process represents a risk to patient safety. Today, it takes about four hours 
from the point where the sample is taken until it is analyzed in Oslo (Erichsen, 2018). With drone 
transports, the time is reduced to one hour. 
 
Value expected to be added by drone transports, other than faster transport time, are increased reliability 
of transports (Wertheimer, 2018), less environmental impact compared to road transports (Fosse, 2018; 
Wertheimer, 2018), less traffic on the roads (NESTA, 2019b), faster test results to patients (Fosse, 2018; 
Sundhedsdroner, 2019; NESTA, 2019b), reduced use of antibiotics (Autonomous Mobility, 2019), 
improved patients logistics due to that the time from sampling to analysis is predictable, and allowance 
for centralization (Fosse, 2018). There are also potential cost savings from using drones for medical 
deliveries, where €19 billion are estimated to be saved annually in the UK (Minion & Postelnicu, 2018) 
and €27 million to be saved annually in Denmark (Sundhedsdroner, 2019). 

2.3.2.2 Challenges for drone deliveries 
There are several challenges related to drone deliveries in the healthcare sector, both operational and 
organizational. A critical aspect of operation of drone-based deliveries today is that there currently are 
no fully autonomous solutions for takeoff or landing. In the Swiss project, the drone flight is 
autonomous whereas takeoff and landing currently are handled by operators (Mion, 2018). A future 
state scenario is to have autonomous take-off and landing operations, including an automated battery 
and package exchange, where additional time savings could be enabled.  
 
In cities with dense population, high buildings and extensive air traffic there are specific challenges of 
using drones. For example, London has one of the busiest air spaces in the world (Telegraph, 2018), 
has about 9 million inhabitants (Statista, 2019) and a large number of skyscrapers, where the number is 
increasing for each year (Kollewe, 2019). This environment poses several challenges, for instance 



 13 

problems for drone navigation and flight planning. From the urban UK drone project, it was found that 
several key challenges must be identified and addressed related to technology, safety, laws, regulations, 
infrastructure and privacy (NESTA, 2019a).  
 
One main organizational issue highlighted in the Norwegian project is the need for hospitals and 
laboratories to adapt their internal solutions and logistics in order to realize the full effect from drone 
transport (Forskningsrådet, 2019; Johannesson, April 5, 2019). In order to avoid human handling while 
loading and receiving small medical goods, pneumatic tubes have been suggested to be connected to 
the drone landing platform in a fully automated solution (Johannesson, April 5, 2019). Another 
challenge investigated in the Norwegian projects is that different samples should be transported in 
different temperatures that require extra cold or heating, a fact that complicates the use of drones. 
Therefore, an ongoing study in Oslo aims to investigate the possibilities of transporting several of these 
samples in 37ºC due to the fact that bodily fluids usually have this temperature prior extraction by 
sampling. 
 
Furthermore, a study by Amukele, Sokoll, Pepper, Howard & Street (2015) was performed in order to 
investigate the effects from drone deliveries on biological samples, where 336 samples for chemistry, 
hematology and coagulation analysis from healthy volunteering individuals were tested. Half of the 
samples were held stationary and half were flown with drones for a range of time, from 6 to 38 minutes. 
The 33 most common tests within chemistry, hematology and coagulation were performed after the 
flights. The routine chemistry, hematology and coagulation tests results from selfsame samples showed 
that the accuracy of was not affected for the laboratory specimens that were transported by drones. 
However, the precision was slightly poorer for some analytes. Johannesson (April 5, 2019) adds to these 
findings by stating that the same accuracy and precision might not be reached when testing on ill patients 
with deviating sample results. 
 
The challenges of weather conditions in relation to drone operations are very much dependable on the 
climate in which the drones are operated. An issue highlighted in the Norwegian drone project is the 
Scandinavian climate where weather conditions can be both windy and cold, which pose challenges for 
drone operations (Forskningsrådet, 2019).  

2.3.2.3 Risks and safety systems 
In a study by Ekström and Johnsson (2019) about autonomous drone deliveries of laboratory samples, 
some major risks of drone operations were identified. The identified risks during flight were engine 
breakdown, collision, navigation and/or localization system failure, shooting by object, and flight 
during unauthorized weather conditions. The risk analysis was based on the assumption that three safety 
systems are used; (1) a parachute is installed on the drone that slows down the speed in case of accident 
during flight, (2) the flight control station is informed in case of accident and (3) the autonomous flight 
is taken over by a human operator. The consequences if any of the risks incidents occur depend on 
whether the safety systems are functioning or not, where harm to people on the ground or damage on 
the drones or carried items are not likely if all three security systems are functioning. On the other hand, 
if none of the safety systems are in place, critical consequences might occur such as harm to people or 
objects on the ground, damage on the drone and destroyed goods. If the parachute unfolds but the other 
two safety system fail, the drone might not be located, and the goods are lost. If the parachute unfolds, 
the flight control station is informed but there is a failure in taking over the operations by a human 
operator, there is a risk of damage on the drone and the goods, but the items can be located and there is 
a chance that the carried goods are salvaged. 



 14 

 
An example of a drone operation safety system is the one that is used in Switzerland, where the safety 
system triggers the drone rotors to switch off and a parachute to unfold if the drone registers an 
unsolvable problem or deviates from its defined route (Furer, 2019). In addition, the drone starts to beep 
and flash while it descends to the ground. The safety systems were triggered during a flight over Lake 
Zurich at January 25th, 2019, where the Swiss Post lost contact with one of their drones of the type 
Matternet M2 V9. The cause of the accident is at this date unknown, but the crashed drone was located 
in the search area and recovered by divers from the water police. The drones operated by University 
hospital of Zurich and Lugano hospital will remain on the ground until the cause of the crash has been 
examined.  
 
 
 
 
  



 15 

3. Methodology  
This chapter describes how the study was conducted and why certain methods were considered suitable 
for the research purpose. The research design and approach, the literature review, data collection and 
analysis are described in detail in this chapter. 

3.1 Research design and approach 
The qualitative research design chosen for the study was a single case study. Since this study 
investigated the potential benefits of using drones as a mode of transport of medical goods from a patient 
safety perspective, the case context of the hospitals and professionals involved in the transport system 
were of high relevance. According to Baxter and Jack (2008), a case study approach is suitable when 
the aim of the study is to answer “how” and “why” questions and when contextual conditions are 
relevant to take into consideration. The benefit of using a case study design is that it allows for using a 
variety of data sources, which ensures that the phenomenon investigated is explored from several 
different viewpoints. One of the drawbacks of a single case study is that the results reflect one single 
organization at a given time, and that the results from studying another healthcare organization or at 
another time could be different from our findings. There is also a risk that the findings must be adjusted 
within a relatively short time frame due to the rapid technical development of drones. Due to the nature 
of the research questions that aim to contribute to generalizable findings, the relatively large number of 
interviewed professions, and the theoretical findings of state of the art of drones, the result from this 
study should be applicable to other healthcare organizations as well.  
 
Case studies are based on the underlying philosophical paradigm of constructivism, which claims that 
truth is relative and dependent on each person’s perspective (Baxter & Jack, 2008). By using a case 
study approach, the researcher collaborates with the participants who are able to describe their view of 
reality. Furthermore, the case study design allows combining the qualitative findings from the 
participants of the study with quantitative data. Quantitative data, such as time and frequency of 
transports, are relevant for this study as well as qualitative data from professionals with insight in patient 
safety and from those involved in the current transport system in the region Västra Götaland (VGR) 
that Gothenburg's main hospitals are a part of. A benefit of combining different types of data is that a 
greater understanding of the case is promoted (Baxter & Jack, 2008). The case study is of an exploratory 
character due to the fact that the outcomes of the study neither was clear, nor predictable from the 
beginning and that several potential outcomes were possible. 

3.2 Literature review 
The literature review process was based on the steps presented by Easterby-Smith, Thorpe and Jackson 
(2015). The first step according to Easterby-Smith et al. (2015) is to set the topic including scope and 
aim. Literature about healthcare, centralization, patient safety and drones were in this case chosen to 
constitute the basis for the topic (figure 2). 
 



 16 

 
Figure 2. The research topic of the study. Authors’ own copyright. 

 
The second step in the process is to search for relevant literature (Easterby-Smith et al., 2015). 
Keywords such as “drones” and “healthcare” were thus combined and used as search phrases in library 
databases such as Chalmers University Library database and Google Scholar. Articles that were 
considered to be the relevant for the chosen topic were used in the study and articles were left out if 
considered to not be relevant. Other selection priorities were that the articles should preferably be peer-
reviewed, have a large number of citations and be up to date. A literature search was also done through 
screening published literature reviews on the chosen topics, and through looking into the reference list 
of articles that were considered to be relevant. 
 
The third step of the process was to organize the selected articles based on theme and content and to 
later read and evaluate them. The final step of the process is according to Easterby-Smith et al. (2015) 
to write the actual literature review, which in this case was done during several different stages of the 
study. When details in the scope of the study or the nature of the research question were changed, the 
literature review process was repeated with new keywords and, hence, new occasions of writing.  

3.3 Primary data 
Primary data were collected through interviews, observations and small talks. Details about the 
sampling and collection are further described in the following sections. 

3.3.1 Interviews 
The main goal with the interviews conducted in this case study was to gain knowledge about the 
organization that was not possible to get through a literature review or through secondary data. In order 
to get an understanding of the current situation of the transportation system between the three hospitals, 
interviews were held with professionals within VGR. Based on Kriegel’s (2009) characteristics of 
hospital logistics, interviews were held in order to gain knowledge about transportation of medical 
goods within the hospital logistic fields; medical device logistics, pharmaceutical logistics, sterile goods 
logistics, laboratory logistics and blood product logistics. All respondents chosen worked at a unit or 
department connected to activities handling these kinds of medical goods within the region.  



 17 

 
Since the study was conducted within the healthcare sector, which has a complex organizational 
structure and is a difficult setting, snowball sampling was chosen as sampling method. Snowball 
sampling is recommended when studies are performed in settings where it is difficult to access relevant 
data (Easterby-Smith et al., 2015, pp.138). The method suggests that sampling should be based on 
previous respondents’ recommendations. Therefore, the sampling took off by interviewing the author 
of the pre-study, who recommended other participants relevant to the study, who in turn referred to 
others with knowledge of transportation of medical goods.  
 
All interviews conducted during the study are presented in table 4. The chosen respondents have insight 
into deliveries of medical goods within their area of expertise and were, therefore, relevant to interview 
in this study. However, not all recommended professionals were interviewed since not all of them 
worked within a relevant field of this study. Examples of suggested interviewees that were excluded are 
unit managers at healthcare centers with extended opening hours outside SU. 
 
Table 4. List of interviews conducted during the study 

Role of the 
respondent  

Department/ 
organization 

Interview focus Length of 
interview 

Location Date 

Project 
Coordinator 

Innovation 
platform, VGR 

Pre-study 120 min Innovation 
platform office 

2019-02-05 

Service Manager Regionservice, 
VGR 

The transportation 
system of medical 
goods 

120 min Janitorial 
office 

2019-02-21 

Department 
Manager 

Regiontransport, 
VGR 

The transportation of 
primarily laboratory 
and blood samples 

120 min Sisjön Depot 2019-02-27 

Transport 
Coordinator 

Sisjön Depot, 
VGR 

The transportation of 
medical goods from 
the depot 

45 min Sisjön Depot 2019-03-07 

Unit manager Clinical 
chemistry MS, 
VGR 

Deliveries of blood 
bags, laboratory and 
blood samples 

60 min Clinical 
chemistry MS 

2019-03-08 

Operations 
Developer 

Orthopedics and 
sterile 
techniques, VGR 

Deliveries of sterile 
goods 

30 min Orthopedics 
and sterile 
techniques SU 

2019-03-12 

CEO Everdrone Drones and logistics 
system including 
drones 

60 min Everdrone 
office and test 
site 

2019-03-13 

Unit Manager Clinical 
chemistry ÖS, 
VGR 

Deliveries of blood 
supplies, laboratory 
and blood samples 

45 min Clinical 
chemistry ÖS 

2019-03-14 

Project Leader in 
Infrastructure and 
Development 

Biobank Väst, 
VGR 

Deliveries of blood 
bags, laboratory and 
blood samples 

90 min Biobank Väst 
office 

2019-03-15 

Quality 
responsible 
pharmacist  

Hospital 
pharmacy, 
Management 
Healthcare, VGR 

The transport of 
pharmaceutical goods 

40 min Skype 2019-03-18 

Project Manager Högsbo 
Specialist 
Hospital, VGR 

Drones and logistics 
system  

30 min Regionens hus 
(Region’s 
building) 

2019-03-19 



 18 

Unit Manager Surgery 1 MS, 
VGR 

Blood product and 
lead time 
requirements  

30 min Surgery 1 MS 2019-03-27 

Unit Manager Clinical 
immunology and 
transfusion 
medicine, VGR  

Blood product 
distribution and 
transport 

30 min Blood center 
SS 

2019-03-28 

Department 
Manager 

Clinical genetics, 
VGR 

The transport of 
samples 

25 min Telephone 2019-04-03 

Researcher and 
Project Manager 
of Drone 
Transportation in 
Healthcare  

Intervention 
Center, Oslo 
University 
Hospital 

Oslo drone project 50 min Skype 2019-04-05 

Expert in 
Healthcare 
Logistics and 
Organization 

Chalmers Centre 
for Healthcare 
Improvement 

Patient safety 20 min Telephone and 
e-mail 

2019-04-24 

Quality 
Coordinator 

Bacteriological 
laboratory, VGR 

The transport of 
samples 

 E-mail 2019-04-26 

 
The interviews were semi-structured. Prior to the interviews, lists of semi-structured interview questions 
were prepared in order to keep the conversation around particular topics. The choice of semi-structured 
interviews enabled the respondents to talk freely and allowed for flexibility to explore the topics further. 
Swedish was chosen as interview language since it was the mother tongue of both the interviewers and 
respondents, hence enabling the participants to express themselves easily. Complementary emails were 
also sent to some respondents in order to clarify certain details. The decision to hold one of the 
interviews through email correspondence was based on the limited number of questions to and 
accessibility of the respondent. The interviews held orally were recorded, transcribed and most of the 
interviews were coded by a method inspired by Burnard (1991). Coding and analysis are further 
explained in section 3.5.  

3.3.2 Observations 
In order to get insight into how the transport system of blood products works between the three hospitals 
MS, SS and ÖS, observer-as-participant was chosen as data collection method. Since the transport 
system, and not the driver’s behavior per se, was in focus during the observation, observer-as-participant 
was chosen as the most suitable research method. The observer-as-participant research method means 
that researcher engages relatively passively in the field of study by asking questions, but at the same 
time tries to avoid influencing the field of study (Easterby-Smith et al., 2015, pp.162). This method 
enables researchers to not only observe activities but also to explore why certain activities are conducted 
as they are pursued. When using the observer-as-participant method, the persons observed are aware of 
the researcher’s status as a researcher (Bryman, 2011). The advantage of using observations compared 
to qualitative interviews is that it enables the researchers to in person see how something works, instead 
of having a topic retold and described. Through observations, information that is less likely to surface 
in an interview, due to the fact that a respondent might take it for granted, could be obtained (Bryman 
& Bell, 2011, pp. 495). 
 
The observation of the transportation system of blood supplies took place during half a day where the 
researchers followed the driver of the blood car a morning between 9.00-12.30. Questions were asked 



 19 

in order to understand why the driver took certain decisions. The focus area of the observation was to 
understand how the blood car transportation system works, to see the locations of the pick up and drop 
off points, to gain knowledge about the drivers’ role in the transportation system and to see how goods 
are handled in connection to the transport. Notes were taken during the observation and later that day 
summarized and discussed by the researchers. The data was later used as a base for the description of 
blood supply logistics in the empirical findings. 
 
In addition to the observation related to the blood car, limited observer-as-participant observations were 
held in connection to the interviews at the locations of clinical chemistry (which is a division that is 
responsible for conducting analyses on bodily fluids, further referred to as CC) at MS and ÖS, 
transfusion medicine, Everdrone and the Sisjö depot.  

3.4 Secondary data 
Secondary data about potential time savings though drone deliveries within VGR have been obtained 
from the pre-study by Damgaard (2019). In addition, interview material from the pre-study was used as 
a complement to the primary data collected in this report. Furthermore, statistics about the frequency of 
blood product deliveries between the three hospitals were provided by Regionservice VGR. The 
frequency data were compiled and analyzed in Excel and later visualized in tables in the empirical 
findings chapter. 

3.5 Data analysis 
The analysis process was based on an inductive approach since an inductive approach allows for 
generalization to be made based on data obtained during the study (Kvale & Brinkmann, 2014). Data 
analysis was performed concurrently with data collection, which according to Baxter and Jack (2008) 
is crucial in order to understand an overall case and not just various parts. When the recordings of 
interviews had been transcribed, the analysis method presented by Burnard (1991) was used. According 
to the method, each relevant transcribed quote is transformed into a phrased sentence that in turn results 
in a code of 2-3 words, which are sorted into a category. Codes from each category are then analyzed 
and translated into a paragraph in the empirical findings. When new questions arose during the analysis, 
the earlier interviewed participants or new participants were asked for explanation. 
 
The KJ-Shiba method was used as the data analysis method of the literature review and empirical 
findings. The method was considered suitable due to a large amount of coded qualitative data. The KJ-
Shiba method consists of four fundamental steps (1) label making, (2) label grouping, (3) chart-making 
and (4) written or verbal communication (Scupin, 1997). Label making was done jointly by the authors 
of both the empirical findings and the existing literature. About 100 labels were written on sticky notes 
and randomly placed on a wall. One of the authors grouped and moved the labels depending on the 
topic, and the grouping was afterwards adjusted by the other author. Adjustments of the grouping were 
done until the authors reached consensus about the groups of labels. Chart-making of problems, 
solutions and relationships between labels were done jointly and verbally communicated. The KJ-
method was used to extract key takeaways from the collected data, and to find problems and connections 
that were relevant based on the purpose of the study.  
 
 
 
  



 20 

4. Empirical findings 
The following chapter presents the organizational context, including involved parties, modes of 
transport and ongoing projects, in order to give the reader an overview of the context of the study. 
Additionally, regular and on-demand deliveries of medical goods transported between SS, MS and ÖS 
are described, as well as characteristics of the medical goods transported. Lastly, the current logistics 
system’s risk factors are addressed. All information in this chapter is retrieved from interviews and 
observations, unless otherwise stated. 

4.1 Organizational context 
VGR is responsible for healthcare, development and public transport within the region of Västra 
Götaland in Sweden. Healthcare is the most extensive function within VGR with its 48.000 employees 
(Västra Götalandsregionen, 2018), and consists of four units of hospitals, primary care and dental care. 
One of the units of hospitals is Sahlgrenska University Hospital (SU), which includes five hospital sites; 
SS, MS, ÖS, Högsbo Sjukhus (HS) and Queen Silvia’s Hospital for Children and Young People, all 
located in the city of Gothenburg. In this section, the main actors and units related to deliveries are 
presented, as well as examples of projects affecting the future medical goods deliveries. 

4.1.1 Regionservice 
Regionservice is a supplier of materials, including food and equipment, and services such as transports 
and communication tools internally within VGR. The function is also responsible for personnel 
transports between the hospital locations. Regionservice’s customers are hospitals, healthcare centers, 
public dental clinics and VGR’s departments, privately owned companies and a few municipalities in 
other regions. The aim is to provide effective service functions in order to facilitate for healthcare 
departments to focus on their core activities. 
 
There are several depots with medical goods within VGR. The Sisjö depot is a Regionservice depot that 
works as a central warehouse for consumables with about 16 000 articles from about 350 suppliers, to 
4 000 customers in the region. the Sisjö depot is responsible for freight and price control, invoice 
handling, warehousing, customer packing and distribution to customers. The purpose of the Sisjö depot 
is to provide a comprehensive supply of consumables in customized quantities and to ensure that critical 
consumables are available within VGR. In addition to the Sisjö depot, there is one VGR depot handling 
medical goods such as ostomy bags, one VGR depot that handles helping aids and lastly a depot of 
pharmaceuticals, where external parties operate the latter. 

4.1.2 Transport modes within VGR 
The most common transport modes for deliveries of medical goods between the SU facilities are 
Regiontransport, the blood car and external carriers. These modes are described below. 
 
Regiontransport 
Regiontransport is in charge of most regular deliveries in the region and is VGR’s haulage for transport 
of samples, pharmaceuticals, mail and small goods. Mail and goods are sent internally with 
Regiontransport within the region. Regiontransport delivers a variety of goods in the region and one 
important function is to deliver different kinds of blood and laboratory samples for analysis from 
healthcare facilities to CC units. In addition, Regiontransport is responsible for meeting the healthcare 
needs of empty boxes used for deliveries of medical goods. 



 21 

 
Through a extensive network of transport loops, Regiontransport’s drivers visit most of the region’s 
administration and healthcare facilities daily. There are 41 cars connected to Regiontransport in the 
region, that handles 12 to 60 customers a day per car. 19 of these cars are located in central Gothenburg. 
The cars are operated daytime on weekdays, as long as the primary care is open, between hundreds of 
different units. Regiontransport’s 19 cars in Gothenburg city deliver about 9000 samples to CC every 
weekday.  
 
Blood car 
Regionservice is a function with the primary mission to supply MS, which do not have a blood center, 
with blood from the main blood center at SS. This so-called blood car is manned 24 hours a day, each 
day of the year. In order to make use of its excess capacity, the blood car is also used for some regular 
and on-demand deliveries of laboratory samples. The blood car is driven by fossil fuel, runs about 200-
250 km a day and costs approximately €100.000 per year to operate. The number of deliveries per year 
and month completed by the blood car is relatively evenly distributed. In average, the blood car 
performs about 4000 deliveries per year (Regionservice VGR, 2018a), where less than 2 % of the 
deliveries were acute and driven with emergency lights in 2017 (Regionservice VGR, 2018b). The most 
common delivery hauls are presented in table 5 below.  
 
Table 5. Most common hauls October 2017-September 2018, on-demand deliveries conducted by the 
blood car (Regionservice VGR, 2018a). Adapted with permission 
Pick up unit Drop off unit Most common good 

transported 
Average 
frequency/ 
month 

Frequency 
min/max 

CC MS Blood center SS Samples for BAS-test 127 103/147 

CC MS CC SS Laboratory samples 109 83/129 

Blood center SS CC MS Blood products 44 27/55 

Memory unit Neuro chem. Unit 7 Laboratory samples 14 5/26 

CC MS CC ÖS Laboratory samples 11 4/15 

 
The distance between the units, CC MS and the blood center, which is the main mission for the blood 
car to serve, is 4,7 km one way and constitutes of approximately 53 % of the total number of deliveries 
performed by the blood car per year. Since the blood car is stationed at MS, all deliveries to and from 
SS entails that the distance must be driven twice each time; a total 9,4 km. In addition to the hauls 
presented in the table, there were within one year 98 other delivery distances with less than five 
deliveries per month performed in order to use the excess capacity of the blood car. These more 
uncommon deliveries are otherwise performed by external carriers. The drivers of the blood car 
prioritize to be available for deliveries of BAS-test samples and blood products between the blood center 
at SS and MS, hence deliveries to and from ÖS are avoided during rush hours. The deliveries of blood 
products and laboratory samples are further described in 4.2. 
 
External carriers 
External pre-procured carriers are used to a wide extent. For regular deliveries of goods from the Sisjö 
depot, an external haulage firm is used and when deliveries are required outside the regular transport 
system, an external carrier is usually used. The external carriers are mainly used during evenings and 



 22 

weekends, and for on-demand deliveries of different types of goods, foremost helping aids but also 
medical goods such as blood bags and laboratory samples. All external carriers and haulages are 
procured through the principle of public procurement and the vehicles are neither equipped with or have 
permission to drive with emergency lights. VGR pays approximately €50 for each on-demand delivery 
within the city of Gothenburg, independent of the size, weight or volume of the delivered good.  

4.1.3 Ongoing hospital projects in VGR 
There are several ongoing projects in the region. Two main projects that will influence the transportation 
system of medical goods investigated in the near future are the building of Högsbo specialist hospital 
and new laboratory buildings at ÖS and SS.  
 
Högsbo specialist hospital 
The building of a new specialist hospital, Högsbo specialist hospital (HSS), should be completed in 
2023. The plan is to replace HS as well as another specialist hospital that will be closed down in order 
to improve the overall healthcare capacity in the region. The day surgery operations and related patient 
reception will be moved from SS to HSS in order to relieve the emergency care at SS and enable for a 
larger part of non-acute care to be performed outside SS. SS is an acute care hospital occasionally 
exposed to low availability and long waiting times. 
 
HSS will be built without any storage for pharmaceuticals, blood products, sterile instruments or other 
medical goods, based on the logistics principle “just-in-time”. There will for instance not be a sterile 
technique unit, CC unit or blood center at Högsbo. Since most of the surgeries and activities at HSS 
will be planned in a so-called planned production, there is no instant need of having medical goods 
stored or all medical functions available at the hospital location. Instead, a new supply solution with a 
hub in the center of the region is under construction, where the hub will constitute a unit that produces 
and delivers medical goods to several hospitals. From the hub, medical goods will be delivered directly 
to HSS. In order to enable sequencing and ensuring that the right material comes to the right place and 
at the right time, different types of medical goods will be consolidated. Initially, HSS will receive most 
of the supplies from MS. Healthcare laboratory samples will be transported to CC SS for analysis, 
except for the few most common analyses that not require advanced laboratory equipment.  
 
The aim of HSS is to improve accessibility, increase productivity and to reduce costs for performing 
healthcare. However, the lack of storages will make HSS sensitive to interferences and it is therefore 
crucial to manage distribution of goods in a reliable way. Therefore, transport reliability and short lead 
times will be of high importance. Even if no acute care will be performed at HSS, there will still be a 
need for acute deliveries of medical goods due to deviations and unpredictable situations.  
 
Laboratory facilities 
The laboratory units at SS and ÖS are currently scattered at the hospital sites. There are ongoing projects 
at both locations, which should enable the laboratory operations to be more centralized in the future. At 
ÖS, a new modern facility of 9,900 square meters and additional 5,600 square meters of renovated and 
rebuilt facilities, are planned to be finished in 2023. The units for intensive care and clinical physiology 
will be located in the new facilities, as well as a new pressure chamber (Västfastigheter, 2019a). The 
new facilities will enable for coordinating personnel in a more efficient way and for a 24/7 reception of 
more types of samples than today.  
 



 23 

The project at SS is called Sahlgrenska Life and aims to create an environment that enables 
collaboration between healthcare, academia and business. In this project, four new buildings of 115 000 
square meters will be built (Västfastigheter, 2019b). The laboratory activities that today are spread at 
hospital site, will be centralized in the new buildings. The construction starts in 2019 and is planned to 
be finished in 2023.  

4.2 Medical goods logistics 
Based on Kriegel’s (2009) characteristics of hospital logistics, medical goods within the hospital logistic 
fields are divided into medical device logistics, pharmaceutical logistics, sterile goods logistics, 
laboratory logistics and lastly blood product logistics. Blood products are further referred to as blood 
supplies, and laboratory samples are divided into healthcare laboratory samples and research laboratory 
samples. When requesting deliveries of medical goods between MS, SS and ÖS, there are several 
options regarding the mode of transport. The choice of transport depends on how acute the delivery is, 
which time of the day it is and which vehicles that are available. If the deliveries of medical goods are 
not acute, goods are usually delivered by vehicles in fixed routes, also referred to as regular deliveries. 
If the deliveries of medical goods are acute, there are several options depending on the time of the day, 
type of medical good, place of the ordering and receiving unit and availability of internal vehicles. This 
type of immediate transport that is used upon requests when a demand arises, compared to a scheduled 
delivery, is referred to as an on-demand delivery. In general, healthcare personnel within VGR use 
regular deliveries as far as possible before ordering on-demand deliveries. Otherwise, external carriers 
are usually used for on-demand deliveries. 

4.2.1 Medical device logistics 
Medical devices are, simply put, any device intended for medical purposes. The core medical equipment 
for each unit within a hospital is usually permanently placed at the unit. There are also medical device 
commodities, such as injection needles and consumable surgery equipment, which are distributed from 
external or internal depots, but these goods are seldom transported between hospitals. 
 
Regular deliveries 
Most deliveries of medical device commodities from the depots are planned in advance and made with 
regular transports provided by Regionservice in trucks to goods receptions at the hospitals (figure 2). 
The goods are then transported from the goods reception to each health care unit within the hospital.  
 
 



 24 

 
Figure 2. Regular deliveries of medical devices to the SU hospitals. Authors’ own copyright. 

 
The frequency of the regular deliveries varies depending on the size and needs of the healthcare facilities 
in the region. MS, SS and ÖS receive delivers several times a day, whereas small healthcare centers can 
receive deliveries once a week or less often. The volume, size and weight of the deliveries are often 
large, and trucks are used as a mode of transport.  
 
On-demand deliveries 
Medical device commodities are stored in inventories within the hospitals and ordered regularly from 
the depots by personnel when a stock reaches a low level, hence, deliveries of these goods seldom are 
acute. However, in case of a shortage of medical device commodities, there can be a need for urgent 
deliveries from a depot to a healthcare facility and in these cases, external carriers are used. These on-
demand deliveries are made directly to the ordering unit without passing the goods reception. 
 
Goods characteristics 
Medical devices vary in both size and weight. Since it simply put could be any device intended for 
medical purposes, the goods could range from a small tweezer to a large X-ray device or a wheelchair. 
The most common medical devices are usually durable, however larger electrical medical devices could 
be very susceptible to shocks.  

4.2.2 Pharmaceutical logistics 
A hospital pharmacy is defined as all the activities that are required in order to ensure that there are 
pharmaceuticals available for a healthcare organization. Within VGR, a regional hospital pharmacy 
function is in charge of the supply of pharmaceuticals and local units are responsible for performing the 
activities required for delivering pharmaceuticals to the healthcare units’ inventories. There are two 
types of pharmaceutical supply chains; pharmaceuticals from a standardized assortment and extempore 
pharmaceuticals that are custom-made for an individual patient or patient group. Standard 



 25 

pharmaceuticals are distributed from a regional warehouse, also called RGL, which is managed by two 
privately owned companies. There are two extempore pharmacies within SU, one at SS and one at ÖS. 
 
Regular deliveries 
Each unit at the hospital is responsible for ordering pharmaceuticals from RGL or from the extempore 
pharmacies. The pharmaceuticals are delivered during the night by RGL to goods units located at the 
hospital sites in connection to the goods reception. Regionservice is responsible for delivering the 
pharmaceuticals from the goods units to the healthcare units at the hospitals in fixed routes. The 
distribution system is presented in figure 3 below. 

 
Figure 3. Regular deliveries of pharmaceuticals to the SU hospitals. Authors’ own copyright.  

 
The figure visually presents the regular distribution system of pharmaceutical goods to the SU hospitals, 
where one single pharmaceutical warehouse is responsible for the supply of standard pharmaceutical 
goods and two units are responsible for the supply of extempore pharmaceuticals. 
 
On-demand deliveries 
When pharmaceuticals are needed urgently, due to shortage in the inventories or in case a patient needs 
a type of pharmaceutical that is not available in stock, and on-demand deliveries can be performed any 
time of the day. In these cases, the ordering unit registers an order in an IT system and calls RGL in 
order to inform the RGL pharmacist about how acute the delivery is. The ordered pharmaceutical good 
should be prepared and ready for delivery within two hours from when the order has been placed and 
the transport must take less than three hours, a maximal lead time of five hours from order to delivery. 
The acute deliveries are made directly from the RGL warehouse to the ordering unit with an external 
carrier, without passing the goods unit. When the acute delivery reaches the ordering unit, the order 
must be receipted by a healthcare professional. In rare cases, pharmaceuticals can also be delivered 
between units at the hospitals and when deliveries are needed between the hospitals, external carriers 
are used. 
 



 26 

Goods characteristics 
The pharmaceutical goods transported within VGR range from small and lightweight to large and 
heavyweight goods. Some goods are transported in glass ampoules and are, therefore, fragile and must 
be handled carefully. Fluid pharmaceutical goods are sometimes delivered in very large and heavy 
packages, where a trolley is needed in order to move them. There is a constitution by the Swedish 
Medical Products Agency with requirements on how the distribution of pharmaceutical goods should 
be arranged, with certain requirements that need to be met during transport. The healthcare providers 
are obliged to ensure that the requirements are met, such as that pharmaceuticals are kept inaccessible 
to unauthorized persons and that the quality of pharmaceuticals does not deteriorate during transport. 
Pharmaceutical goods must not be exposed for dirt, contamination risks, incorrect temperatures or 
humidity. Photosensitive pharmaceutical goods should be protected from light and some pharmaceutical 
goods must be delivered in an unbroken cold chain. In addition, some pharmaceutical goods are classed 
as narcotics and are thus theft-attractive. The temperature is traced during transport for the 
pharmaceutical goods that require special temperature conditions and the boxes in which the 
pharmaceuticals are delivered are sealed with cable ties that must be cut in order to access the goods.  

4.2.3 Sterile goods logistics 
Sterile goods are both reusable and consumable medical instruments and material. The sterile technique 
units are functions responsible for ensuring that medical instruments are sterilized and to a certain extent 
stored. Each of the three hospitals SS, MS and ÖS has their own sterile technique unit at the hospital 
sites but all three units are organized in one common business area. The sterile technique units are 
located in the basements of each hospital where sterile goods are sterilized and stored between usage.  
 
From the Sisjö depot, sterile consumable goods are delivered to the sterile technique units where the 
goods are re-packed together with reusable sterile goods (figure 4). Sterile goods are distributed from 
sterile technique units at the hospital sites, mainly to units performing surgeries. The ordering units 
usually have some sterile commodities stored and these are refilled when needed, whereas reusable 
sterile goods are ordered directly from the sterile technique unit before surgery. 

 
Figure 4. Supply chain of sterile goods within SU. Authors’ own copyright. 

 
At MS, most of the internal deliveries from sterile technique are regular, compared to SS where most 
of the deliveries of sterile goods are on-demand. A reason for this is that more acute surgeries are 



 27 

performed at SS compared to MS, where the surgeries usually are planned at least 24 hours in advance. 
The internal deliveries of sterile goods at each hospital are handled by Regionservice.  
 
Regular deliveries 
Orders are placed from the surgery units in a surgery planning system and the personnel at sterile 
technique pick the orders. When an order is ready, Regionservice delivers it from the sterile technique 
unit to the ordering unit. When a reusable medical instrument has been used during surgery, it is 
transported back to the sterile technique unit where it is sterilized, packed, controlled and stored until it 
is used again. Since the sterile technique units are located at each hospital location, each sterile 
technique supplies the hospital it is located at, which results in that regular deliveries of sterile goods 
are not needed between MS, SS and ÖS. The regular deliveries of consumable sterile goods from the 
Sisjö depot are consolidated with other goods from the depot and transported with external carriers. 
 
On-demand deliveries 
The occasions for when on-demand deliveries of sterile goods are needed between hospitals are limited. 
Acute deliveries from the sterile technique units to surgery units are made within 15 minutes if the 
ordered good is available. If there is a lack of a sterile reusable medical instrument, it is not always 
possible to wait for the sterile technique unit to sterilize it since the process takes several hours, why 
instruments are sometimes borrowed between the units. For this purpose, instruments are sometimes 
transported between the hospitals and external carriers are used. However, this is extremely uncommon. 
When there is a lack of a consumable sterile good, an external carrier delivers it from the Sisjö depot 
directly to the ordering unit.  
 
Goods characteristics 
Sterile goods vary in both weight and volume. For instance, the prefabricated sterile goods packages 
required during an eye surgery are often very small in size, about 15x15 cm, while orthopedic surgeries 
could require saws or drilling machines which are bulky and heavy. Surgery packages can easily weigh 
more than 20 kg in total. Most sterile goods must be transported in three-layers packages, where the last 
layer often constitutes of a delivery box. In addition to the prefabricated packages of sterile goods, 
sterile technique is responsible for preparing customer specific kits that are delivered on-demand to 
ordering units. 

4.2.4 Blood supply logistics 
Blood supplies refer to whole blood, thrombocytes and plasma. Clinical Immunology and Transfusion 
Medicine is a department at SU, with one unit at SS and one unit at ÖS, which is responsible for the 
diagnosis of disease states that affect the body's immune system. The unit is responsible for the blood 
supply and for medical care with blood components, as well as examinations and advice prior to blood 
transfusions. The units also handle the blood centers within SU. Blood bags from blood donation 
locations in Gothenburg are collected and transported to the main blood center located at SS (figure 5). 
The blood center at SS works as a centralized warehouse of blood supplies and is responsible for 
distributing blood supplies to the other blood center, which is located at ÖS, as well as to other units 
within Gothenburg. MS has no blood center, hence, blood supplies are ordered on-demand from SS to 
MS. The most common volume transported from SS to MS is one to six blood bags.  
 



 28 

 
Figure 5. Deliveries of blood supplies within SU. Author’s own copyright. 

 
The reason why MS does not have a blood center is that MS is a relatively small hospital located near 
SS that has the main regional blood center and centralization makes it easier to keep track of stock levels 
and reduces costs. Surgeries at MS are usually planned, which enables for the ordering of blood supplies 
in advance prior to each surgery. In addition, most surgeries performed at MS are of a standardized 
character and do not require large volumes of blood supplies. When the maternity ward was moved 
from MS to ÖS in 2017, the need for acute deliveries of blood decreased drastically but there is still a 
need for acute deliveries of blood between SS and MS. CC MS works as an intermediary responsible 
for ordering transport of blood supplies from the blood center at SS to the ordering units at MS, as well 
as to store the blood supplies until they are picked up by someone from the ordering unit.  
 
Prior to each blood transfusion, two analyzes are required. Firstly, a sample is used for blood grouping 
analysis. This sample can be at taken any time at all hospitals within SU, and the results of the analysis 
are stored in a database. Secondly, a sample is used for a so-called BAS-test, which is a compatibility 
analysis that is required to be taken in connection to the actual transfusion. The BAS-test takes 
approximately one hour and if a patient is in an acute need of a blood transfusion, universal blood is 
transfused until the result of BAS-test is ready. BAS-tests are conducted both at the blood center at SS 
and the blood center at ÖS, but not at MS. 
 
Regular deliveries 
There are regular deliveries both from the blood donation locations to the main blood center at SS, and 
from the main blood center at SS to both the blood center at ÖS and CC MS. An external carrier is used 
for deliveries between blood donation locations to the blood center at SS, as well as the routes between 
the blood center at SS to the blood center at ÖS. Both Regiontransport and the blood car are responsible 
for the routine deliveries between the blood center at SS to CC MS. Unused or excess blood supplies at 
MS and ÖS are returned with the regular deliveries to the blood center at SS. 
 
 
 



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On-demand deliveries 
Although ÖS has a blood center, acute deliveries on-demand for blood supplies are sometimes needed 
from the blood center at SS. In these situations, an external carrier is used. However, due to the lack of 
a blood center at MS, most on-demand deliveries of blood supplies are between the blood center at SS 
to MS. In order to handle the supply of blood to MS, the blood car is used. This blood car and its drivers 
are stationed at MS where they await calls from hospital units in need of deliveries. The driver receives 
information about the pick up and delivery units, and how acute the delivery is through a phone call 
from either CC MS or other ordering units. If the driver receives several orders within a short time span, 
it is up to the driver to decide where to go first, depending on how acute the deliveries are. However, it 
is up to the ordering person to let the driver know if it is an emergency light transport. The driver is 
responsible for picking up, transporting and delivering goods directly from the sending to the receiving 
units. The pick up and drop off points can be located at different distances from where the blood car is 
parked. Sometimes it is a stair or two, other times the driver have to walk a longer distance. 
 
CC MS is responsible for coordinating the need for blood supplies at MS and works as an intermediary 
to facilitate the hospital’s units with blood supplies. If the need for blood supplies at MS is acute, the 
blood car delivers the blood from SS to MS within 30 minutes if the results from the blood grouping 
and the BAS-test are ready. Otherwise, a sample must be sent to the blood center at SS in order to 
conduct a BAS-test before the blood supplies are sent from SS to MS. The process, when BAS-test has 
not been done in advance, is visualized in figure 6 below. 
 

 
Figure 6. The process of ordering and delivering blood supplies from SS to MS, when a BAS-test has 

not been conducted in advance. Authors’ own copyright. 



 30 

 
1. Someone at the ordering unit at MS walks to CC MS with a BAS-test sample 
2. CC MS calls the blood car to come and pick up the BAS-test sample 
3. The blood car drives to CC MS and picks up the BAS-test sample 
4. The blood car delivers the BAS-test sample from CC MS to the blood center at SS 
5. A BAS-test is conducted at the blood center at SS 
6. The blood center calls CC MS when the analysis of the BAS-test is ready and blood supplies 

are available 
7. CC MS calls the blood car and ask for pick up of blood supplies at the blood center 
8. The blood car drives to the blood center 
9. The blood car delivers the blood supplies to CC MS 
10. The blood center calls CC MS to notice them that the blood supplies have been sent 
11. CC MS calls the ordering unit to notice them that the blood supplies have arrived and are ready 

for pick up 
12. Someone at the ordering unit walks to CC MS and collects the blood supplies 

 
Out of these 12 process steps, all except for the BAS-test (5) are points of transfers. Although it happens 
that a BAS-test is required urgently, it is more usual that it has been done in advance. The process of 
ordering blood supplies, when BAS-test has been done in advance, is less complex and is visualized in 
figure 7 below. 

 

 
Figure 7. The process of ordering and delivering blood supplies from SS to MS, when BAS-test has 

been conducted in advance. Authors’ own copyright. 
 



 31 

1. Ordering unit calls to CC MS and orders blood supplies  
2. CC MS calls the blood center and orders blood supplies 
3. CC MS calls the blood car and asks for pick up of blood supplies at the blood center 
4. The blood car drives to the blood center 
5. The blood car delivers blood supplies from the blood center to CC MS 
6. The blood center calls CC MS to notice them that the blood supplies have been sent 
7. CC MS calls the ordering unit to notice them that the blood supplies have arrived and are ready 

for pick up  
 
All these seven process steps are points of transfer. The process of ordering and delivering blood 
supplies from SS to MS, when BAS-test has been conducted in advance, is less complex and require 
fewer transfers of both goods and information compared to when a BAS-test has not been done in 
advance. 
 
Goods characteristics 
Blood, thrombocytes and plasma are stored in 250-300 ml bags. Blood bags transported from the blood 
donation locations to the blood center are slightly larger, 450 ml. The blood supplies have different 
requirements during transport. Blood bags need to be kept under cooling, in a temperature between 2℃ 
to 6℃, at all times, and stable during transport since shaking could destroy the red blood cells in the 
blood. Thrombocytes are transported in temperature between 20℃ and 24℃, and should be kept in 
rocking motion. Plasma is stored and kept frozen, between -18℃ and -25℃, at the blood center and 
some bags of plasma are thawed. During transport, the bags of plasma are frozen when the intention is 
to store the products, and in thawed condition when the intention is to use the products immediately. 
Cooling or styrofoam boxes, with predetermined places to put ice packs, are used in order to keep the 
goods in the right temperature. The BAS-test samples and blood grouping samples are transported in 
test tubes and are durable and the temperature during transport is not strictly regulated. However, 
thrombocytes are not transported with extra heating even if it is cold outside. 

4.2.5 Laboratory logistics 
The medical goods within the field of laboratory logistics can be divided into two separate logistic 
systems, healthcare laboratory logistics and research laboratory logistics.  

4.2.5.1 Healthcare laboratory logistics 
CC is a division with several subunits at SS, ÖS and MS that is responsible for conducting analyses on 
bodily fluids. The fluids analyzed are collected within the hospitals and from a large variety of 
healthcare centers and units in the region. There is a 24/7 unit within CC at each hospital site that has 
almost the same range of analyses available. The analyses performed at the 24/7 CC units are usually 
of common types. Additionally, there are several special labs at SS and ÖS that perform analyses of 
more uncommon types, for instance the department Clinical Pathology and Genetics. The delivery 
system of laboratory samples within SU is visualized in figure 8 below. 
 



 32 

 
 

Figure 8. Deliveries of healthcare laboratory samples within SU. Authors’ own copyright. 
 
CC works as an intermediary for samples, where the units either analyze the received samples or sends 
the samples forward to special laboratories, either within SU or to other laboratories in Sweden or even 
Europe.  
 
Regular deliveries 
The regular deliveries from different healthcare facilities to the 24/7 CC units and from the 24/7 CC 
units to other SU-laboratories are performed both by Regiontransport and the blood car. Regiontransport 
handles the majority of the transports, whereas the blood car has been assigned one single route in order 
to make use of its excess capacity. If the blood car driver receives an order for an acute on-demand 
delivery, the route is interrupted in favor to the acute delivery and is hence delayed. Depending on the 
size and need of each healthcare unit, the deliveries takes place at different frequencies. The laboratory 
samples are always picked up and delivered directly to and from the laboratories. The predetermined 
deliveries allow healthcare facilities to plan the sampling based on the time for deliveries when the 
samples are time sensitive.  
 
On-demand deliveries 
The need for on-demand deliveries of laboratory samples