Application of value stream mapping to design and develop an inventory management system in a hospital

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Rising demand often leads to shortages, while overstocking causes waste and expiration. These issues reflect inefficiencies in medical supply warehouse management and highlight the need for improvement. Therefore, enhanced resource management processes are essential to ensure a balanced and efficient medication reserve system. Lean Management is a systematic approach to eliminate waste, reduce costs, and improve efficiency. Value Stream Mapping (VSM), a core Lean tool, supports process redesign by categorizing activities as value-added (VA), necessary but non-value-added (NNVA), or non-value-added (NVA). In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse management system and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness. Method This research employed action research methodology with 22 participants from the drug warehouse, outpatient, and inpatient medicine rooms. A user-centered system was planned through focus group discussions. This phase emphasized conceptual framework development and planning. Potential improvements were expected to enhance satisfaction, reduce waiting time, and increase convenience, sufficiency, and availability. Result Phukhieo Chaleomphrakeit Hospital created a future state value stream map, reducing process steps from seven to six. The current system required 1,925 minutes. The redesigned system is expected to take 435 minutes, including 395 minutes for valuable activities. The proportion of value-added time increased to 20.52%, significantly reducing waste from waiting. Conclusion The study demonstrates the effectiveness of VSM in identifying inefficiencies and redesigning processes. The collaboratively developed system eliminated unnecessary steps, reduced waiting times, and enhanced operational efficiency. This provides a practical model for improving pharmaceutical supply chain management in similar hospital contexts. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-365/v2", "name": "Application of value stream mapping to design and develop an inventory..." } } ] } Home Browse Application of value stream mapping to design and develop an inventory... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Ritthaisong P and Kessomboon N. Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.12688/f1000research.159736.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] Praewchit Ritthaisong https://orcid.org/0000-0002-0420-7581 1 , Nusaraporn Kessomboon https://orcid.org/0000-0002-0420-7581 1 Praewchit Ritthaisong https://orcid.org/0000-0002-0420-7581 1 , Nusaraporn Kessomboon https://orcid.org/0000-0002-0420-7581 1 PUBLISHED 09 Oct 2025 Author details Author details 1 Khon Kaen University, Nai Mueang, Khon Kaen, Thailand Praewchit Ritthaisong Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Nusaraporn Kessomboon Roles: Conceptualization, Project Administration, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Health Services gateway. Abstract Background Insufficient drug reserves in hospitals pose significant challenges in management, procurement, and distribution. Rising demand often leads to shortages, while overstocking causes waste and expiration. These issues reflect inefficiencies in medical supply warehouse management and highlight the need for improvement. Therefore, enhanced resource management processes are essential to ensure a balanced and efficient medication reserve system. Lean Management is a systematic approach to eliminate waste, reduce costs, and improve efficiency. Value Stream Mapping (VSM), a core Lean tool, supports process redesign by categorizing activities as value-added (VA), necessary but non-value-added (NNVA), or non-value-added (NVA). In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse management system and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness. Method This research employed action research methodology with 22 participants from the drug warehouse, outpatient, and inpatient medicine rooms. A user-centered system was planned through focus group discussions. This phase emphasized conceptual framework development and planning. Potential improvements were expected to enhance satisfaction, reduce waiting time, and increase convenience, sufficiency, and availability. Result Phukhieo Chaleomphrakeit Hospital created a future state value stream map, reducing process steps from seven to six. The current system required 1,925 minutes. The redesigned system is expected to take 435 minutes, including 395 minutes for valuable activities. The proportion of value-added time increased to 20.52%, significantly reducing waste from waiting. Conclusion The study demonstrates the effectiveness of VSM in identifying inefficiencies and redesigning processes. The collaboratively developed system eliminated unnecessary steps, reduced waiting times, and enhanced operational efficiency. This provides a practical model for improving pharmaceutical supply chain management in similar hospital contexts. READ ALL READ LESS Keywords Value Stream Mapping (VSM), Lean Management, Inventory Management System, Medical supply warehouse. Corresponding Author(s) Nusaraporn Kessomboon ( [email protected] ) Close Corresponding author: Nusaraporn Kessomboon Competing interests: No competing interests were disclosed. Grant information: Faculty of Pharmaceutical Sciences, Khon Kaen University The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Ritthaisong P and Kessomboon N. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Ritthaisong P and Kessomboon N. Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.12688/f1000research.159736.2 ) First published: 31 Mar 2025, 14 :365 ( https://doi.org/10.12688/f1000research.159736.1 ) Latest published: 15 Apr 2026, 14 :365 ( https://doi.org/10.12688/f1000research.159736.3 ) Revised Amendments from Version 1 This revised version incorporates substantial improvements compared to the previously published article. The Background section has been refined to provide a clearer link between the problems of insufficient reserves and overstocking, emphasizing the need for balanced resource management. In the Method section, wording has been simplified and unnecessary repetition removed, while the description of focus group discussions has been clarified. The Results section has been condensed for clarity, with numerical values presented more directly to highlight the reduction of process steps and total time. In the Conclusion, phrasing has been revised for conciseness and stronger academic tone. Overall, the revised version enhances readability, reduces redundancy, and strengthens the presentation of the study’s contributions. This revised version incorporates substantial improvements compared to the previously published article. The Background section has been refined to provide a clearer link between the problems of insufficient reserves and overstocking, emphasizing the need for balanced resource management. In the Method section, wording has been simplified and unnecessary repetition removed, while the description of focus group discussions has been clarified. The Results section has been condensed for clarity, with numerical values presented more directly to highlight the reduction of process steps and total time. In the Conclusion, phrasing has been revised for conciseness and stronger academic tone. Overall, the revised version enhances readability, reduces redundancy, and strengthens the presentation of the study’s contributions. See the authors' detailed response to the review by Puree Anantachoti See the authors' detailed response to the review by Aamir Rashid See the authors' detailed response to the review by Rungpetch Sakulbumrungsil READ REVIEWER RESPONSES  There is a newer version of this article available. Suppress this message for one day. Introduction In hospital management, procurement, and distribution of medicines, several problems may arise, such as insufficient drug reserves ready for use, particularly in chronic disease medications or items that patients require continuously. For certain drugs with rapidly increasing demand, the reserve rate may be inadequate, leading to potential shortages. Consequently, hospitals often increase their stockpiles beyond normal levels, resulting in excessive inventory and a heightened risk of drug expiration. These issues reflect inefficiencies in medical supply warehouse management, highlighting the need for improvement to achieve greater effectiveness. Lean Management is a systematic approach designed to eliminate waste, thereby reducing costs and enhancing efficiency, making it more effective than other management systems ( Lanza-León, P., et al., 2021 ) delineate this system based on five core principles. • Specify Value – defining value from the service recipient’s perspective. • Identify the Value Stream – analyzing value streams to detect and eliminate waste. • Flow – ensuring processes are continuous and seamless. • Pull – initiating processes based on demand or readiness of the next step. • Pursue Perfection – striving for continuous improvement ( Womack & Jones, 1996 , 2003 ; Lanza-León et al., 2021 ). Since its application in the healthcare sector in 2009, Lean Management has demonstrated notable benefits, including reduced waiting times, decreased unnecessary hospital admissions, lower costs, and fewer errors. Moreover, thier adoption has bolstered the quality, safety, and efficiency of clinical processes ( Lanza-León, P., et al., 2021 ). Value Stream Mapping (VSM) is a key Lean tool that creates visual maps of resource and information flows throughout the supply chain. It categorizes activities into three types: Value-Added (VA), Necessary but Non-Value-Added (NNVA), and Non-Value-Added (NVA) ( Martin & Osterling, 2014 ; Shararah, 2013 ). This classification enables the identification of waste points and redesign of processes to reduce time and increase efficiency. VSM plays a crucial role in healthcare, such as reducing waiting times and eliminating unnecessary steps, thereby improving patient-centered services and satisfaction ( Nowak et al., 2017 ). However, to ensure effectiveness, staff education and training are essential to reduce resistance and promote a culture of continuous improvement ( Gellad & Day, 2016 ). VSM has been applied in multiple industries including textiles, pharmaceuticals, food, telecommunications, and oil & gas to optimize indicators such as lead times, inventory levels, and overall efficiency ( Batwara et al., 2023 ; Seth & Gupta, 2005 ). Studies have highlighted the use of VSM in various contexts: • Brazil : VSM to analyze healthcare environments. The results of this study indicate that the proposed VSM model can identify bottlenecks in operations and various forms of waste, leading to insights into operational inefficiencies and bottlenecks ( Henrique et al., 2016 ). • India : A Supply Chain VSM (SCVSM) was developed for government sponsored drug distribution, reducing non-value-added activities. Following the VSM guidelines, future SCVSM activities were reduced from 27 to 16 after the Kaizen implementation, leading to a 7.14% reduction in the total product lead time ( Dixit et al., 2021 ). • Malaysia : VSM in pharmaceutical warehousing reduced total processing time. The study revealed significant improvements: the total processing time decreased from 45,420 to 11,940 min, and the non-value-added time was reduced from 21,060 to 3,120 min. Workforce requirements also decreased from 51 to 31 (39.21%) ( Abideen & Mohamad, 2019 ). • Germany : VSM to reduce waste in the procurement process of tube expander coils (endovascular stents). The current state analysis using the VSM identified 13 steps in the procurement process. Among these, only two steps were recognized as value-adding activities, where as five steps were identified as non-value-adding activities ( Teichgräber & de Bucourt, 2012 ). • United States : VSM improved medication synchronization processes in pharmacies. As a result of these interventions, the two process steps were eliminated, leading to reduced packaging times. This demonstrates that Value Stream Mapping is a valuable tool for identifying and eliminating non-value-adding activities, thereby improving operational efficiency and standardization ( Renfro et al., 2022 ). • Literature reviews indicate that most VSM applications occur in tertiary hospitals, with positive outcomes but lacking standardization and environmental sustainability indicators ( Batwara et al., 2023 ). In Thailand, VSM has been applied in several hospitals. At Nopparat Rajathanee Hospital , VSM analysis of outpatient drug dispensing reduced average waiting times significantly. Before improvement, the average waiting time for receiving medicine was 54.01 ± 11.24 minutes. Following improvements facilitated by VSM, this waiting time decreased significantly to 46.11 ± 24.45 minutes ( Chanbancherd et al., 2012 ). Similarly, at Borabue Hospital in Mahasarakham, VSM was use to develop the drug disbursement process with the aim of identifying and reducing waste. Analysis of the ten work steps revealed that only three activities were value-adding, four activities were non-value-adding, and three were necessary but did not add value. Value-adding activities accounted for 30.60% of the total lead time, prompting the redesign of the work system to enhance efficiency ( Jitthananan, 2017 ; Jitthananan et al., 2017 ). Phukhieo Chaleomphrakeit Hospital, located in Chaiyaphum Province, is a small general hospital (M1) with 300 beds that, serves the entire Phukhieo District. It also acts as a host hospital and network leader challenges include emergency shortages, expired drugs, and excessive reserves beyond optimal levels. As of October 2021, the hospital has managed a list of 588 items. There are two service units with sub-stock: outpatient and inpatient medicine rooms. Consequently, there have been instances of drug shortages despite the availability of drugs in warehouses, contributing to an increasing number of expired medicines. The medical disbursement process within the hospital has been identified as lengthy and complex, contributing to insufficient readiness for use and placing a disproportionate workload on available personnel. Analysis of current workflows has identified inefficiencies, prompting the development of a plan to implement new systems aimed at reducing waste and enhancing the efficiency of drug distribution. VSM is thus recognized as an essential Lean Management tool for identifying and reducing waste, improving processes, and enhancing both patient and organizational outcomes. Its application requires multidisciplinary participation and fosters continuous improvement. Evidence from both domestic and international studies confirms that VSM can reduce waste, shorten waiting times, and improve drug management efficiency. Accordingly this study employed VSM to comprehensively analyze the drug disbursement process within the inventory management system, and identify existing waste and planning strategies for waste reduction. Designing a new system, such as the use of an e-Kanban system to enhance efficiency. The aim is to enhance the efficiency of the medical supply inventory management system. This study aims to design and develop a new medical supply inventory management system that is efficient and effective by analyzing current inventory management processes to identify inefficiencies, applying Value Stream Mapping (VSM) as a framework for designing the new system, and improving processes to reduce waste and enhance system efficiency. Method This research was conducted using action research methodology based on the concepts proposed by Kemmis and McTaggart (1988) and Kemmis, S., et al. (2014) . Action research is characterized by its participatory approach, which aims to enhance the efficiency and effectiveness of operational practices by analyzing current conditions and addressing existing challenges ( Chatakarn, V., 2015 ). It involves active engagement in problem-solving within real-world contexts, fostering continuous improvement in operational quality ( Johnson, AP, 2012 ). Action research typically involves four iterative steps: Planning, Action, Observation, and Reflection. These steps form a cyclical process of self-reflection and iterative improvement, in which each cycle informs subsequent actions and refinements ( Kemmis, S., & McTaggart, R., 1988 ). In this study, Value Stream Mapping (VSM) ( Martin, K., & Osterling, M., 2014 ) was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse management system. This phase primarily focused on the initial planning step, outlining the conceptual framework of the research. Participants Purposive sampling was employed to ensure inclusion of all units directly involved in the drug requisition and disbursement system, thereby guaranteeing that the data accurately represented the actual workflow. Engage in discussions and collaborative planning with pharmaceutical warehouse staff to understand their challenges. Consult with key personnel from the drug warehouse, outpatient medicine room, and inpatient medicine room, involving 22 individuals. • consisting of 6 staff members at the drug warehouse (1 pharmacist, 2 pharmaceutical officers, and 3 drug store staff ) • consisting of 16 personnel responsible for drug warehouse sub-stocks in each service unit (6 pharmacists, 4 pharmaceutical officers, and 6 pharmacy staff ). The researchers provided an explanation of the study and obtained informed consent from all participants involved in the discussion before conducting the study, using a written consent form. All participants were required to sign the consent form, which was approved by the ethics committee. Gather insights into their operational needs and areas requiring improvement in medical warehouse management. Procedures and data collection Plan the development of a user-centric system through focus group discussions aimed at identifying and prioritizing improvement opportunities. Conduct joint cause analysis sessions to effectively address the identified issues in routine operations. Developed the Current State VSM by: • Direct observation of every step in the drug requisition–disbursement process. • Time measurement (stopwatch timing) for each activity to obtain Process Time (PT); Lead Time (LT) was computed as PT + Waiting Time; Activity Ratio was calculated as the proportion of value-added time to total time. • Extracting quantitative data from requisition forms and the medical supply disbursement system Quantitative data were collected, such as the number of transportations and waiting times. Six categories of waste were identified, namely Defects, Transportation, Inventory, Overproduction, Waiting, and Non-utilized Talent. The current inventory management process was studied and analyzed comprehensively using Value Stream Mapping (VSM). The existing workflow across all stages was mapped to pinpoint inefficiencies and areas of improvement in drug supply warehouse operations. Future state design Integrate findings from the VSM analysis into the design of a future state value stream map for an enhanced inventory management system by focus group discussions. The future work plan was designed with development strategies proposed by the researchers, incorporating consultation and input from relevant stakeholders who participated in focus group discussions. Propose adjustments, such as transitioning from weekly to daily medication delivery to outpatient and inpatient medicine rooms. This change aims to minimize inventory levels in the dispensary and enhance the traceability of drug reserves. Streamline processes between the drug supply warehouse and pharmaceutical assistants by eliminating manual surveys and requisition writing. Outcomes and measurements • Waste (time-based): defined as non–value-added time occurring within each process step. • Process Time (PT): measured directly on site via stopwatch timing and cross-checked with data from the electronic disbursement system. • Lead Time (LT): calculated as the sum of PT and Waiting Time for each activity. • Activity Ratio: determined by dividing value-added time by the total process time. In cases where activity times varied across items, an aggregation rule was applied. Specifically, averages were calculated based on a standard number of requisition forms to ensure comparability across processes. • Open-ended questions were employed to capture perceptions and experiences of participants, such as: “Does the supply system facilitate timely, simple communication for drug requisition and replacement?” “How satisfied are you with the warehouse management system?” Prior to implementation, all open-ended questions were reviewed for content validity by a panel of three subject matter experts. Data analysis Qualitative data (focus groups): analyzed by content analysis with coding and thematic categorization of issues. Quantitative data (timings, inventory metrics): analyzed using descriptive statistics (means, percentages) and Current and Future State comparisons. Application of VSM per Martin & Osterling (2014) The VSM tool involves five steps, Step 1: Setting the Stage and Enabling Success This step was conducted over a period of 1 week • A team comprising six drug warehouse employees and 22 participants was involved in setting goals and understanding the existing inventory management system. • Officials from the medical supply warehouse section, pharmacists, pharmaceutical officers, and staff from the outpatient and inpatient medicine rooms were included. • Analyze operational problems by explaining workflows in each responsible section and plan initial data collection through observations. Step 2: Understanding the Current State This step was conducted over a period of 1 month • Engage all 22 officials in surveying and observing operations, with drug warehouse staff focusing on prescription receipt for medicine delivery to outpatient and inpatient rooms. • Record the observed operations and document the flow of activities from the drug warehouse to the substock of the medicine rooms. • Study and analyze the process diagram of the current inventory management system across all steps, identifying operational issues and gathering improvement needs. • Conduct focus group discussions to jointly analyze causes and propose solutions for routine work issues. • Create a value stream map using Visio 2013 to visualize the workflow from the medical supply warehouse to the two medicine room sub-stocks. • Discuss and address questions regarding process issues, identify waste steps, and establish timelines for each activity. Step 3: Designing the Future State This step was conducted over a period of 1 week • Develop an efficient work system by eliminating unnecessary steps, simplifying processes, and utilizing information management to reduce personnel involvement in certain steps. Step 4: Developing the Transformation Plan Step 5: Achieving and Sustaining Transformation In this study, steps 1-3 were utilized according to Martin and Osterling (2014) to design a future work system that enhances efficiency. Results During the focus group discussions involving twenty-two staff members, several critical issues with the current medical supply inventory management system were identified. The primary concerns included the practice of stocking medicines weekly, which led to maintaining a high inventory value. This approach often results in shortages of essential medicines, necessitating emergency restocking between regular supply cycles. Furthermore, staffing shortages exacerbate the workload, particularly during peak times when large quantities of drugs are dispensed. The inefficiencies caused by these practices were evident in the significant amount of manpower and time required to store drugs in the warehouse. Moreover, the weekly disbursement schedule created spikes in workload, increasing the risk of medication errors and straining the available storage space. These findings underscore the need to redesign the inventory management system to effectively address these operational challenges ( Figure 1 ). Figure 1. Current State Value Stream Mapping of the Inventory Management System at Phukhieo Chaleomphrakeit Hospital. = The Customer/Supplier relationship defines the drug warehouse as the supplier currently serving as the service provider for dispensing drugs to customers, namely the two medicine rooms. = Inventory, refers to medicines held in reserve, encompassing drug warehouses, outpatient medicine rooms, and inpatient medicine rooms. = In the current state, the process depicts each step in the workflow of the system, which comprises seven steps. = Kaizen Burst, referred to as a change indicator, signifies improvements planned for specific work processes, particularly in steps 5 and 7. = Manual Information is represented by an arrow indicating the flow of information, with personnel responsible for recording and transmitting data. = A Shipment Arrow. An arrow signifies drug transportation. = A Data Table is a display table that presents only Lead Time (LT) and Process Time (PT) data. = A Timeline Segment represents a segment of time. It shows the time at each step of the drug disbursement process using the lines. The line at the bottom represents Process Time, whereas the line at the top represents the Waiting Time. Process Time (PT) refers to the operating time of a step per unit volume of work. In this study, one unit of work corresponds to withdrawing two medicine requisition slips once a week. Waiting Time refers to the time between processes in the drug disbursement process. Lead Time (LT) refers to the total time, which is the sum of the Process Time and Waiting Time. The Current State Value Stream Map (VSM) encompasses three principal components: work flow, information flow, and time dimension. In its present configuration, the system consists of seven sequential processes, beginning with requisition receipt, approval, drug preparation, verification, and transportation, followed by drug receipt at the satellite pharmacies and the subsequent preparation of new requisition forms. The majority of these activities are undertaken within the supply warehouse, while certain processes are carried out at the sub-stcok in outpatient medicine rooms, and inpatient medicine rooms. Waste in the process The workflow analysis results aim to identify activities that add value and contribute to waste within the system. Six types of waste were identified using the core concept of value analysis, as follows: Tabel 1 . Table 1. Analysis of Waste in the Current State of the Drug Disbursement Process within the Hospital. Wastes Details of the wastes in current state 1. Defects - Writing medicine withdrawal requests without data on usage rates and approval without basic information, such as usage rates, results in dispensing medicines based solely on the amount allocated by the disbursement unit. 2. Transportation - The drug transports from the drug warehouse to the drug warehouse sub-stock room occur multiple times due to the large quantity of drugs withdrawn in each round. 3. Excess Processing - 4. Inventory - There is a substantial quantity of medicine in both sub-stock drug warehouses. 5. Overproduction - Medication withdrawals exceeding demand: Lack of information on actual usage rates prevents verification of the amount used. 6. Waiting - Wait for disbursement once per week. - Arranged and checked medicines must wait for delivery the following day. 7. Motion - 8. Non-Utilized Talent - In each drug room, two pharmaceutical assistants are responsible for documenting drug withdrawals, categorized by the dosage form of the drug. Here is a summary of the time spent on valuable and wasted activities in the work Table 2 . Table 2. Summary of Value/Waste and Duration of Activities in the Current Drug Disbursement Process within the Hospital. Step Activity Value type Wastes Process time * Waiting time * 1 Receive medication requisition and consider approval VA - 60 5 2 Deduct drug items from the inventory system VA - 60 20 3 Prepare drugs VA - 240 10 4 Repeat drugs check NVA - 90 960 5 Prepare and deliver drugs NVA - Waiting - Moving 60 180 6 Receive drugs into the sub-stock warehouse and check the quantity and the list of medicines NNVA - Inventory 60 - 7 Check the items to be withdrawn, write a drug requisition slip, and deliver the drug withdrawal slip directly to the drug warehouse NVA - deficiency - excessive production - Not using human resources to their full potential - Waiting 180 - Total time in the system: 1,925 minutes. Time spent on valuable activities: 395 minutes. Percentage of time spent on valuable activities: 20.52%. * Lead Time for each activity (lead time) is the Process Time combined with the Waiting Time. Table 3. Compares the results of drug inventory management before and after system development. Performance Before After %Improvement Total lead time (min) 1925 435 77.40% Total process time (min) 750 240 68% Activity ratio (%) 38.96 55.17 41.61% The waste analysis revealed that waiting was the most significant waste in the system. Reviewing the current status, waiting occurs due to delays in receiving medical requisitions from both the outside and inside medicine rooms and waiting for the delivery of prepared medicines. These delays are exacerbated by incomplete information on the bills of lading and large quantities of medicines that need to be moved to the outside and inside medicine rooms. This results in excessive inventory and production as the reserves exceed actual needs, leading to unnecessary stockpiling. Additionally, human resources are not used to their full potential, as pharmacy officers must inspect medicines before disbursing them, adding to their workload. To address these issues, future work must be planned to eliminate waste and improve efficiency. Proposed work system To review the current status, identify waste, and plan for its reduction while adding value to the drug supply inventory management system. The future work plan was designed with development strategies proposed by the researchers, incorporating consultation and input from relevant stakeholders who participated in focus group discussions. We employed four key methods: 1) eliminating unnecessary parts, 2) combining several steps to save time and effort, 3) simplifying the process to avoid complexity and redundancy, and 4) using information management to replace manual tasks. The detailed actions based on these methods are as follows: 1. Eliminating Unnecessary Parts: To address unnecessary waiting periods, we identified that medication requirements from outpatient and inpatient medicine rooms should no longer be processed weekly. Instead, the drugs should be disbursed daily. This change aims to reduce waiting times and minimize the need for transportation from the warehouse to medicine rooms. 2. Combine Multiple Steps to Save Time: The current system requires drug warehouse employees to arrange medicines and then wait for officials to re-inspect them before the pharmaceutical assistant can dispense them. By switching to daily disbursements, we anticipate a reduction in the number of drug items and quantities. Consequently, the steps of organizing and checking can be combined. Drug warehouse employees and pharmaceutical assistants can complete the medication arrangement and inspection in the same step, thus eliminating the need for post-arrangement checks and reducing overall waiting time. 3. Simplifying the Process: To avoid complexity and redundancy in sending disbursement information to outpatient and inpatient medicine rooms, we will utilize electronic information transmission. By applying the concepts of the Kanban and vendor-managed inventory (VMI) systems, the approval process for drug disbursement will become more efficient and streamlined. This approach will ensure timely information delivery, making the disbursement and approval processes easier and reducing deficiencies in withdrawal information. The Kanban system is a lean concept tool used to control product inventory by maintaining low stock levels. This process is driven by customer demand, reducing costs and preventing overproduction to keep up with fluctuating needs ( Womack, J. P., et al., 1990 ). Electronic Kanban (e-Kanban) enhances this system by keeping it more up-to-date and timely, and managing just-in-time inventory based on actual demand ( Donnelly, G. T., et al., 2016 ). The VMI system is used to help reduce inventory and manage products to keep them moving according to the demand. Deliver raw materials that are made daily to order and can control delivery products that can withstand time can be combined ( Waller, M., et al., 1999 ). 4. Information management is essential for planning the implementation of the e-Kanban and VMI systems to manage pharmaceutical stockpiles effectively. These systems aim to reduce inventory levels and excessive production, ensuring that human resources are utilized for their full potential. A team of IT staff has begun developing an inventory management system in which the hospital is preparing to install it in drug warehouses and outpatient and inpatient medicine rooms. Upon reviewing the current process, the future state value stream map has been streamlined from seven to six steps, as shown in Figure 2 . Figure 2. Future State Value Stream Mapping of inventory management system at Phukhieo Chaleomphrakeit Hospital. When adjusting the medical supply inventory management system, improvements were made to enhance efficiency, resulting in a reduced total lead time and total process time, as well as an increased activity ratio (activity ratio), as shown in Table 3 . • Total lead time: The sum of lead times across each step of the value chain process, measured in minutes. • Total process time: The sum of process times across each step of the value chain process, measured in minutes. • Activity ratio: Calculated using the formula: • Activity ratio = (Total process time/Total lead time) × 100 Discussion By studying the current status of the drug inventory management system, Phukhieo Chaleomphrakeit Hospital was able to draw a map of the value stream in the future state, adjusting from seven to six steps. The total time spent in the current system was 1,925 min. However, when designing and planning the future state of the pharmaceutical inventory management system, it is expected that the total time spent in the system will be reduced to only 435 min, with the time spent on valuable activities reduced to 395 min. The percentage of time spent on valuable activities was 20.52%, which reduced waste while waiting. When adjusting the drug inventory management system, it was found that the efficiency of the system increased by reducing the total lead time by 77.40%, the total process time by 68%, and by increasing the activity ratio by 41.61%, which is consistent with previous studies. Six types of waste were identified: defects, transportation issues, excess inventory, overproduction, waiting times, and the inefficient use of human resources. These findings are consistent with international studies. In India, the application of Supply Chain Value Stream Mapping (SCVSM) reduced the number of activities in the drug distribution system from 27 to 16, with total waiting time decreasing by 7.14% ( Dixit et al., 2021 ). In Malaysia, the total process duration was reduced from 45,420 minutes to 11,940 minutes, confirming the effectiveness of VSM at the system level ( Abideen & Mohamad, 2019 ). Similarly, eliminating two steps in the process can be eliminated, resulting in a 69.4% reduction in packaging time in the workflow ( Renfro et al., 2022 ), total waiting time of the process and improve patient care by 3.7% from the beginning to the end of the process in emergency departments ( Cardoso, W., 2020 ). In addition, data were collected from healthcare systems in various countries with a review of relevant studies. The use of Value Stream Mapping (VSM) techniques to improve systems has shown positive effects on the time-related dimensions of process quality and outcomes. Specifically, VSM has been effective in reducing non-value-added time, such as waiting time, and various types of waste ( Nowak, M., et al., 2017 ; Marin-Garcia, J.A., et al., 2021 ; Zdęba-Mozoła, A., et al., 2022 ). In Thailand, limited studies exist, but an investigation at Borabu Hospital, Maha Sarakham Province, aimed to find and reduce waste in the disbursement process. An analysis of all 10 work steps found only three valuable activities, with four activities that did not add value and three that did not add value but were necessary in the process. The trend in this study indicates a consistent direction. From this study, it is necessary to assess the current status to plan future work in managing the medical supply warehouse, designing work systems that reduce waste and adding value to make work more efficient. This finding is consistent with previous studies and further reinforces the existing evidence. Given the limited number of studies conducted in Thailand, this research provides an additional contribution by highlighting the benefits of applying VSM. And this study has planned the use of an e-Kanban system for future system development, which represents an additional contribution beyond previous research. In this study, VSM was applied as a tool to analyze the overall drug distribution process, corresponding to the planning stage of action research. The research covered steps one through three of the VSM methodology ( Martin & Osterling, 2014 ), focusing on the design of a future system to enhance efficiency. There should be continuous work in Step 4, which involves developing the transformation plan, creating a monitoring plan, and reporting the plan regularly to ensure continuous operations and improvement. Step 5, which focuses on achieving and sustaining change, must also be implemented. This includes regularly and continuously applying the PDSA (Plan Do Study Adjust) cycle. Regarding potential improvements, it is expected that enhancing the satisfaction period concerning waiting time for those involved will likely increase sufficiency and availability, making work more convenient. Through the application of the system, the highlight of this study is the design of the work systems by those involved. This tool helps reduce waste and has been developed collaboratively to make operations run more smoothly. For continuous development, once the system design and development plan has been established, it should be implemented in practice with designated responsibilities and clear communication to all those involved. The system should be designed to facilitate ease of use by integrating IT participation to simplify operations. Moreover, continuous monitoring and evaluation of outcomes are required, with the results systematically reflected back to involved at different levels to inform future planning, adjustments, and improvements. Limitations Important principles of work system development using VSM include delivering valuable work to service recipients, primarily from the service recipient’s perspective. VSM is a simple and effective tool; however, this study had several limitations. First, the service recipients in this study were outpatients and inpatients in medicine and drug supply warehouses. These stakeholders may not have fully responded to all suggestions, such as having drug warehouse employees deliver and store medications in each room to reduce the workload for outpatient and inpatient medicine room employees. Additionally, the inspection process should involve staff from each room checking and receiving the delivered medicines from the medicine room for double checking. This can increase the workload in the medicine room, which requires daily storage. The study period was limited to developing and implementing a Future State. There has been no follow-up or regular improvement in work. Future studies should include additional planning to follow up on the work system development plan and continuously develop a plan for future state assessments. This clarifies whether valuable work can be delivered to service recipients. Indicators that clearly demonstrate the value of work are required to reduce waiting times and improve efficiency. The study's results are inconclusive but indicate the direction for application to increase efficiency. This study involved only a small group, reflecting limited perspectives, and the duration of the study was short. If a larger number of people were involved and the observation and discussion periods were extended, a wider variety of perspectives could be revealed, providing a broader view of the system. Clear and detailed communication with all those involved, is essential when implementing changes in the management system. Regular supervision, consultation, and observation are necessary to ensure correct practice and to address potential resistance or fear of new methods arising from limited knowledge or understanding. Suggestions The design of the future state should be presented to the pharmaceutical and therapeutic committee to ensure consistency with the hospital's policy. This includes support for transportation, information, personnel, and other resources that are necessary to create an efficient new work system. The system should be capable of managing and monitoring the work for continuous development. There should be a structured approach to follow-up and report work results to the hospital's Pharmaceutical and Therapeutics Committee. Additionally, the PDSA (Plan Do Study Adjust) cycle should be implemented regularly and continuously. Improvements should be reported every six months to one year to ensure ongoing progress and adaptation. The system should be applied to other supply warehouses, including those in same hospitals as well as sub-district health promotion hospitals within the network. As this study required only a modest budget, it may be particularly suitable for hospitals at the initial stage of system development. Identified issues were reflected back to relevant departments to plan for further solutions. Following implementation, development outcomes, along with challenges and obstacles, to ensure that the findings could guide improvements in the new system processes and serve as a foundation for further development. Moreover, future studies should also record additional contextual factors that may influence system effectiveness, such as changes in hospital drug policies or staff turnover and rotations of new physicians. Conclusion The study analyzed the process diagram of the drug inventory management system in all its steps using Value Stream Mapping (VSM), a key tool in Lean Healthcare principles. The VSM provides visibility to current workflows, facilitating the design of more efficient future systems. This study made significant improvements by identifying problems in the medical supply inventory and incorporating them into the design of the value stream map for a newly developed drug inventory management system. The cycle was adjusted from once a week to sending medicine to outpatient and inpatient medicine rooms on regular business days. This adjustment was expected to decrease the amount of medicine in the dispensary, with the treasury reserve rate now decreasing and trackable. Additionally, the pharmaceutical officer in the drug room no longer needs to survey the drugs and write requisitions according to the form submitted to the drug supply warehouse, thereby reducing storage space and minimizing waiting times. VSM, acts as a visualization tool for the supply chain and value stream. This allows the team to see the flow of the work system, search for waste, and design future work systems that are more responsive and efficient. Ethics and consent This research was approved by Center for Ethics the Human Research of Khon Kaen University on January 27, 2023, referene no. is HE652237. The researchers provided an explanation of the study and obtained informed consent from all participants involved in the discussion before conducting the study, using a written consent form. All participants were required to sign the consent form, which was approved by the ethics committee. Data availability Figshare: Application of Value Stream Mapping to Design and Develop an Inventory Management System in a Hospital. Doi: https://doi.org/10.6084/m9.figshare.28366301 ( Praewchit, R., 2025 ). This project contains the following underlying data: Requests for English excerpts are welcome for data in non-English languages. • Focus Group Discussion Data Collection Form.docx • Calculation.docx • VSMcurrentandfuturestate.vsdx Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgments We thank the director of the Phukhieo Chaleomphrakeit Hospital for allowing this study to be conducted to improve the system. Special thanks to the Head of the Pharmacy Department and all relevant officials, including pharmacists, pharmacy assistants, and pharmacy room officers, for their cooperation in providing information. Your contributions were invaluable for improving and developing the medical supply inventory management system at Phukhieo Chaleomphrakeit Hospital to make it more efficient and responsive to work demands. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 31 Mar 2025 ADD YOUR COMMENT Comment Author details Author details 1 Khon Kaen University, Nai Mueang, Khon Kaen, Thailand Praewchit Ritthaisong Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Nusaraporn Kessomboon Roles: Conceptualization, Project Administration, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information Faculty of Pharmaceutical Sciences, Khon Kaen University The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (3) version 3 Revised Published: 15 Apr 2026, 14:365 https://doi.org/10.12688/f1000research.159736.3 version 2 Revised Published: 09 Oct 2025, 14:365 https://doi.org/10.12688/f1000research.159736.2 version 1 Published: 31 Mar 2025, 14:365 https://doi.org/10.12688/f1000research.159736.1 Copyright © 2025 Ritthaisong P and Kessomboon N. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Ritthaisong P and Kessomboon N. Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.12688/f1000research.159736.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 09 Oct 2025 Revised Views 0 Cite How to cite this report: Rashid A. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r447435 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-447435 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 04 Feb 2026 Aamir Rashid , City University of New York (CUNY), New York, New York, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.189130.r447435 Thank you for your research on this interesting topic. While the manuscript is thoughtfully developed, a thorough reading has revealed several concerns that warrant critical attention. The manuscript relies on a single-site action research case ... Continue reading READ ALL Thank you for your research on this interesting topic. While the manuscript is thoughtfully developed, a thorough reading has revealed several concerns that warrant critical attention. The manuscript relies on a single-site action research case without a clearly articulated theoretical contribution beyond well-established Lean and VSM principles. While the operational improvements are quantified, the study remains confirmatory, reiterating known benefits of VSM rather than extending theory in healthcare operations or supply chain management. The research design lacks rigor in inference. Outcomes are framed as “expected” improvements based on future-state mapping rather than empirically validated post-implementation results, which weakens causal claims. The absence of longitudinal follow-up or comparative benchmarking limits internal validity and generalizability. Conceptually, “waste” is narrowly operationalized as time-based inefficiency, without engagement with inventory cost, service-level risk, or patient-safety trade-offs. This constrains the managerial and policy relevance of the findings. Moreover, the linkage between identified problems (shortages and expiries) and measured outcomes is indirect and insufficiently theorized. The manuscript’s scholarly positioning is modest. It draws heavily on applied healthcare and Lean literature but does not engage deeply with core supply chain, operations management, or inventory theory debates, limiting its contribution to a largely practice-oriented audience. The paper is suitable as a local applied case, but its contribution remains incremental rather than field-advancing. Methodologically, the study confuses process redesign with performance validation. Most reported improvements are expected or projected based on future-state mapping rather than empirically observed post-implementation outcomes. This undermines causal inference and weakens claims of effectiveness. The absence of a before–and–after comparison using realized data, or any counterfactual logic, is a major limitation. The action research design is under-specified. The roles of participants, decision authority, and potential bias introduced through participatory mapping are not critically discussed. The focus group process is described procedurally but not analytically, leaving uncertainty about how consensus was reached or how conflicting perspectives were handled. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Supply Chain Management I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rashid A. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r447435 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-447435 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 15 Apr 2026 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 15 Apr 2026 Author Response Dear Reviewer, We sincerely thank you for your careful and insightful review. Your comments have been extremely valuable in improving the scientific clarity, methodological transparency, and theoretical positioning of our ... Continue reading Dear Reviewer, We sincerely thank you for your careful and insightful review. Your comments have been extremely valuable in improving the scientific clarity, methodological transparency, and theoretical positioning of our manuscript. Below we address each concern in detail. Comment 1: Limited theoretical contribution beyond Lean/VSM principles Response: Thank you for this important comment. We clarified that the study aims to extend the application of VSM to hospital pharmaceutical inventory management within a resource-constrained healthcare context. Additional discussion has been incorporated to position the study within healthcare operations and implementation science, emphasizing contextual adaptation, multidisciplinary participation, and integration with medication safety and shortage prevention. Comment 2: Outcomes are projected rather than empirically validated Response: We agree that future-state mapping represents expected performance. The manuscript has been revised to clearly distinguish between “projected improvement” and “observed outcomes”. We removed causal wording and now describe the findings as process redesign potential. We also added a statement in the limitations that full effectiveness requires post-implementation monitoring and longitudinal evaluation. Comment 3: Narrow conceptualization of waste Response: Additional explanation has been inserted in the Discussion linking process delay to medication availability risk and service continuity in hospital pharmacy systems. Comment 4: Limited engagement with supply chain and inventory theory Response: Thank you for this insightful comment. We agree that the manuscript primarily presents an applied case study. To strengthen the scholarly positioning, we have revised the Discussion section to better connect the findings with inventory management and supply chain management concepts. Specifically, the study now highlights how VSM-based redesign supports inventory control through reduced replenishment intervals, improved inventory visibility, and sub-stock management. These elements relate to core inventory management principles Comment 5: Lack of before-after comparison and causal inference Response: Thank you for this important comment. We clarified that the study is a process design and improvement study rather than an effectiveness evaluation. Accordingly, claims of effectiveness have been moderated throughout the manuscript, and a limitation statement has been added to emphasize that causal impact requires evaluation after implementation using realized data. Comment 6: Action research roles and focus group analysis unclear Response: We added details describing participant roles, decision authority, and consensus process. We also described how disagreements were resolved using structured facilitation and iterative validation sessions to reduce bias. We believe these revisions significantly improve the rigor, transparency, and positioning of the manuscript. We are grateful for your constructive feedback which has strengthened the study. Kind regards, Praewchit Ritthaisong Dear Reviewer, We sincerely thank you for your careful and insightful review. Your comments have been extremely valuable in improving the scientific clarity, methodological transparency, and theoretical positioning of our manuscript. Below we address each concern in detail. Comment 1: Limited theoretical contribution beyond Lean/VSM principles Response: Thank you for this important comment. We clarified that the study aims to extend the application of VSM to hospital pharmaceutical inventory management within a resource-constrained healthcare context. Additional discussion has been incorporated to position the study within healthcare operations and implementation science, emphasizing contextual adaptation, multidisciplinary participation, and integration with medication safety and shortage prevention. Comment 2: Outcomes are projected rather than empirically validated Response: We agree that future-state mapping represents expected performance. The manuscript has been revised to clearly distinguish between “projected improvement” and “observed outcomes”. We removed causal wording and now describe the findings as process redesign potential. We also added a statement in the limitations that full effectiveness requires post-implementation monitoring and longitudinal evaluation. Comment 3: Narrow conceptualization of waste Response: Additional explanation has been inserted in the Discussion linking process delay to medication availability risk and service continuity in hospital pharmacy systems. Comment 4: Limited engagement with supply chain and inventory theory Response: Thank you for this insightful comment. We agree that the manuscript primarily presents an applied case study. To strengthen the scholarly positioning, we have revised the Discussion section to better connect the findings with inventory management and supply chain management concepts. Specifically, the study now highlights how VSM-based redesign supports inventory control through reduced replenishment intervals, improved inventory visibility, and sub-stock management. These elements relate to core inventory management principles Comment 5: Lack of before-after comparison and causal inference Response: Thank you for this important comment. We clarified that the study is a process design and improvement study rather than an effectiveness evaluation. Accordingly, claims of effectiveness have been moderated throughout the manuscript, and a limitation statement has been added to emphasize that causal impact requires evaluation after implementation using realized data. Comment 6: Action research roles and focus group analysis unclear Response: We added details describing participant roles, decision authority, and consensus process. We also described how disagreements were resolved using structured facilitation and iterative validation sessions to reduce bias. We believe these revisions significantly improve the rigor, transparency, and positioning of the manuscript. We are grateful for your constructive feedback which has strengthened the study. Kind regards, Praewchit Ritthaisong Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 15 Apr 2026 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 15 Apr 2026 Author Response Dear Reviewer, We sincerely thank you for your careful and insightful review. Your comments have been extremely valuable in improving the scientific clarity, methodological transparency, and theoretical positioning of our ... Continue reading Dear Reviewer, We sincerely thank you for your careful and insightful review. Your comments have been extremely valuable in improving the scientific clarity, methodological transparency, and theoretical positioning of our manuscript. Below we address each concern in detail. Comment 1: Limited theoretical contribution beyond Lean/VSM principles Response: Thank you for this important comment. We clarified that the study aims to extend the application of VSM to hospital pharmaceutical inventory management within a resource-constrained healthcare context. Additional discussion has been incorporated to position the study within healthcare operations and implementation science, emphasizing contextual adaptation, multidisciplinary participation, and integration with medication safety and shortage prevention. Comment 2: Outcomes are projected rather than empirically validated Response: We agree that future-state mapping represents expected performance. The manuscript has been revised to clearly distinguish between “projected improvement” and “observed outcomes”. We removed causal wording and now describe the findings as process redesign potential. We also added a statement in the limitations that full effectiveness requires post-implementation monitoring and longitudinal evaluation. Comment 3: Narrow conceptualization of waste Response: Additional explanation has been inserted in the Discussion linking process delay to medication availability risk and service continuity in hospital pharmacy systems. Comment 4: Limited engagement with supply chain and inventory theory Response: Thank you for this insightful comment. We agree that the manuscript primarily presents an applied case study. To strengthen the scholarly positioning, we have revised the Discussion section to better connect the findings with inventory management and supply chain management concepts. Specifically, the study now highlights how VSM-based redesign supports inventory control through reduced replenishment intervals, improved inventory visibility, and sub-stock management. These elements relate to core inventory management principles Comment 5: Lack of before-after comparison and causal inference Response: Thank you for this important comment. We clarified that the study is a process design and improvement study rather than an effectiveness evaluation. Accordingly, claims of effectiveness have been moderated throughout the manuscript, and a limitation statement has been added to emphasize that causal impact requires evaluation after implementation using realized data. Comment 6: Action research roles and focus group analysis unclear Response: We added details describing participant roles, decision authority, and consensus process. We also described how disagreements were resolved using structured facilitation and iterative validation sessions to reduce bias. We believe these revisions significantly improve the rigor, transparency, and positioning of the manuscript. We are grateful for your constructive feedback which has strengthened the study. Kind regards, Praewchit Ritthaisong Dear Reviewer, We sincerely thank you for your careful and insightful review. Your comments have been extremely valuable in improving the scientific clarity, methodological transparency, and theoretical positioning of our manuscript. Below we address each concern in detail. Comment 1: Limited theoretical contribution beyond Lean/VSM principles Response: Thank you for this important comment. We clarified that the study aims to extend the application of VSM to hospital pharmaceutical inventory management within a resource-constrained healthcare context. Additional discussion has been incorporated to position the study within healthcare operations and implementation science, emphasizing contextual adaptation, multidisciplinary participation, and integration with medication safety and shortage prevention. Comment 2: Outcomes are projected rather than empirically validated Response: We agree that future-state mapping represents expected performance. The manuscript has been revised to clearly distinguish between “projected improvement” and “observed outcomes”. We removed causal wording and now describe the findings as process redesign potential. We also added a statement in the limitations that full effectiveness requires post-implementation monitoring and longitudinal evaluation. Comment 3: Narrow conceptualization of waste Response: Additional explanation has been inserted in the Discussion linking process delay to medication availability risk and service continuity in hospital pharmacy systems. Comment 4: Limited engagement with supply chain and inventory theory Response: Thank you for this insightful comment. We agree that the manuscript primarily presents an applied case study. To strengthen the scholarly positioning, we have revised the Discussion section to better connect the findings with inventory management and supply chain management concepts. Specifically, the study now highlights how VSM-based redesign supports inventory control through reduced replenishment intervals, improved inventory visibility, and sub-stock management. These elements relate to core inventory management principles Comment 5: Lack of before-after comparison and causal inference Response: Thank you for this important comment. We clarified that the study is a process design and improvement study rather than an effectiveness evaluation. Accordingly, claims of effectiveness have been moderated throughout the manuscript, and a limitation statement has been added to emphasize that causal impact requires evaluation after implementation using realized data. Comment 6: Action research roles and focus group analysis unclear Response: We added details describing participant roles, decision authority, and consensus process. We also described how disagreements were resolved using structured facilitation and iterative validation sessions to reduce bias. We believe these revisions significantly improve the rigor, transparency, and positioning of the manuscript. We are grateful for your constructive feedback which has strengthened the study. Kind regards, Praewchit Ritthaisong Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Anantachoti P. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r422120 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-422120 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Feb 2026 Puree Anantachoti , Chulalongkorn University, Bangkok, Bangkok, Thailand Approved VIEWS 0 https://doi.org/10.5256/f1000research.189130.r422120 I am satisfied with the revisions made to the manuscript. Given ... Continue reading READ ALL I am satisfied with the revisions made to the manuscript. Given the improvements, I recommend that this manuscript be accepted for indexing. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Social pharmacy, Administrative pharmacy, Health and Pharmacy policy, Access to medicine, Regulatory Sciences I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Anantachoti P. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r422120 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-422120 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 16 Feb 2026 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 16 Feb 2026 Author Response Dear Reviewer, Thank you very much for your time and for carefully reviewing our manuscript. We sincerely appreciate your positive evaluation and your recommendation that the manuscript is suitable for ... Continue reading Dear Reviewer, Thank you very much for your time and for carefully reviewing our manuscript. We sincerely appreciate your positive evaluation and your recommendation that the manuscript is suitable for indexing. Your feedback has been very valuable in improving the clarity and quality of our work. We are grateful for your expertise and thoughtful assessment, and we hope our study will contribute to the field of hospital pharmacy operations and inventory management. Kind regards, Praewchit Ritthaisong Dear Reviewer, Thank you very much for your time and for carefully reviewing our manuscript. We sincerely appreciate your positive evaluation and your recommendation that the manuscript is suitable for indexing. Your feedback has been very valuable in improving the clarity and quality of our work. We are grateful for your expertise and thoughtful assessment, and we hope our study will contribute to the field of hospital pharmacy operations and inventory management. Kind regards, Praewchit Ritthaisong Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 16 Feb 2026 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 16 Feb 2026 Author Response Dear Reviewer, Thank you very much for your time and for carefully reviewing our manuscript. We sincerely appreciate your positive evaluation and your recommendation that the manuscript is suitable for ... Continue reading Dear Reviewer, Thank you very much for your time and for carefully reviewing our manuscript. We sincerely appreciate your positive evaluation and your recommendation that the manuscript is suitable for indexing. Your feedback has been very valuable in improving the clarity and quality of our work. We are grateful for your expertise and thoughtful assessment, and we hope our study will contribute to the field of hospital pharmacy operations and inventory management. Kind regards, Praewchit Ritthaisong Dear Reviewer, Thank you very much for your time and for carefully reviewing our manuscript. We sincerely appreciate your positive evaluation and your recommendation that the manuscript is suitable for indexing. Your feedback has been very valuable in improving the clarity and quality of our work. We are grateful for your expertise and thoughtful assessment, and we hope our study will contribute to the field of hospital pharmacy operations and inventory management. Kind regards, Praewchit Ritthaisong Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Sakulbumrungsil R. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r422121 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-422121 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Jan 2026 Rungpetch Sakulbumrungsil , Chulalongkorn University, Pathumwan, Thailand; College of Pharmacy Administration, Thailand, Thailand Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.189130.r422121 Thank you for the revised manuscript and the detailed responses to the previous review. The revisions have improved the clarity of the introduction and strengthened the overall narrative coherence. However, several issues remain that should be addressed before the manuscript ... Continue reading READ ALL Thank you for the revised manuscript and the detailed responses to the previous review. The revisions have improved the clarity of the introduction and strengthened the overall narrative coherence. However, several issues remain that should be addressed before the manuscript can be considered for indexing. 1. Clarification and Explicit Statement of Research Objectives The overarching aim of the study is to develop a new inventory management system. To ensure consistency across the manuscript, the research objectives should be stated explicitly and concisely. I recommend formulating them as follows: 1. To analyze the current inventory management workflow using Value Stream Mapping (VSM) in order to identify inefficiencies. 2. To design a future-state inventory management system based on the findings from the workflow analysis. Presenting the objectives clearly will improve alignment between the Introduction, Methods, and Conclusion sections. 2. Strengthen the Conclusion Section The conclusion should more clearly highlight two essential points: • The redesigned system is expected to improve efficiency based on the projected reductions in lead time and process time. • The actual impact of the redesigned system will depend on full implementation and subsequent monitoring, including follow-up evaluation and iterative improvement cycles. Explicitly acknowledging these points will strengthen the study’s implications and appropriately frame the scope of the current findings. 3. Inclusion of a Conceptual Workflow Figure To enhance reader understanding of the research process, please consider adding a conceptual figure summarizing the main steps of the study. A simple diagram illustrating the progression Current State → VSM Analysis → Redesign Process → Future State would provide a helpful visual overview of the methodology, particularly for readers who are less familiar with Lean or action research approaches. 4. Review for Grammatical Completeness and Coherent Sentence Structure To ensure readability and academic quality, I recommend that the authors conduct a thorough, manuscript-wide revision focusing on: • grammatical accuracy, • sentence completeness, • clarity and coherence of ideas, and • consistency in terminology across sections. A full-language review will help improve the overall clarity and professionalism of the paper. Overall Recommendation: Revisions Required This manuscript addresses an important issue in hospital pharmacy operations and offers a practical application of VSM within a real-world healthcare setting. With the additional revisions noted above, the manuscript will be further strengthened and more suitable for indexing. Competing Interests: No competing interests were disclosed. Reviewer Expertise: inventory management I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sakulbumrungsil R. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r422121 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-422121 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 15 Apr 2026 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 15 Apr 2026 Author Response Dear Reviewer, We sincerely thank you for your constructive comments and for recognizing the improvements made in the revised manuscript. Your suggestions have been very helpful in further strengthening the ... Continue reading Dear Reviewer, We sincerely thank you for your constructive comments and for recognizing the improvements made in the revised manuscript. Your suggestions have been very helpful in further strengthening the clarity and consistency of our work. Below we address each point in detail. Comment 1: Clarification of research objectives Response: The research objectives have now been explicitly stated in the Introduction section and aligned across the manuscript. The objectives are now presented as: (1) To analyze the current inventory management workflow using Value Stream Mapping (VSM) to identify inefficiencies, and (2) To design a future-state inventory management system based on the workflow analysis findings. Comment 2: Strengthening the conclusion section Response: The Conclusion has been revised to clearly distinguish between projected efficiency improvement and actual impact after implementation. We now explicitly state that the redesigned system is expected to improve efficiency based on reductions in lead time and process time, while acknowledging that real-world effectiveness depends on full implementation and continuous monitoring and improvement cycles. Comment 3: Addition of conceptual workflow figure Response: A conceptual workflow figure illustrating the research process (Current State → VSM Analysis → Redesign Process → Future State) has been added to the introduction section to improve reader understanding of the study design. Comment 4: Language and grammatical revision Response: The entire manuscript has undergone a comprehensive language review to improve grammatical accuracy, sentence structure, clarity of ideas, and consistency of terminology across all sections. We greatly appreciate your thoughtful feedback, which has significantly improved the quality and clarity of the manuscript. Kind regards, Praewchit Ritthaisong Dear Reviewer, We sincerely thank you for your constructive comments and for recognizing the improvements made in the revised manuscript. Your suggestions have been very helpful in further strengthening the clarity and consistency of our work. Below we address each point in detail. Comment 1: Clarification of research objectives Response: The research objectives have now been explicitly stated in the Introduction section and aligned across the manuscript. The objectives are now presented as: (1) To analyze the current inventory management workflow using Value Stream Mapping (VSM) to identify inefficiencies, and (2) To design a future-state inventory management system based on the workflow analysis findings. Comment 2: Strengthening the conclusion section Response: The Conclusion has been revised to clearly distinguish between projected efficiency improvement and actual impact after implementation. We now explicitly state that the redesigned system is expected to improve efficiency based on reductions in lead time and process time, while acknowledging that real-world effectiveness depends on full implementation and continuous monitoring and improvement cycles. Comment 3: Addition of conceptual workflow figure Response: A conceptual workflow figure illustrating the research process (Current State → VSM Analysis → Redesign Process → Future State) has been added to the introduction section to improve reader understanding of the study design. Comment 4: Language and grammatical revision Response: The entire manuscript has undergone a comprehensive language review to improve grammatical accuracy, sentence structure, clarity of ideas, and consistency of terminology across all sections. We greatly appreciate your thoughtful feedback, which has significantly improved the quality and clarity of the manuscript. Kind regards, Praewchit Ritthaisong Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 15 Apr 2026 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 15 Apr 2026 Author Response Dear Reviewer, We sincerely thank you for your constructive comments and for recognizing the improvements made in the revised manuscript. Your suggestions have been very helpful in further strengthening the ... Continue reading Dear Reviewer, We sincerely thank you for your constructive comments and for recognizing the improvements made in the revised manuscript. Your suggestions have been very helpful in further strengthening the clarity and consistency of our work. Below we address each point in detail. Comment 1: Clarification of research objectives Response: The research objectives have now been explicitly stated in the Introduction section and aligned across the manuscript. The objectives are now presented as: (1) To analyze the current inventory management workflow using Value Stream Mapping (VSM) to identify inefficiencies, and (2) To design a future-state inventory management system based on the workflow analysis findings. Comment 2: Strengthening the conclusion section Response: The Conclusion has been revised to clearly distinguish between projected efficiency improvement and actual impact after implementation. We now explicitly state that the redesigned system is expected to improve efficiency based on reductions in lead time and process time, while acknowledging that real-world effectiveness depends on full implementation and continuous monitoring and improvement cycles. Comment 3: Addition of conceptual workflow figure Response: A conceptual workflow figure illustrating the research process (Current State → VSM Analysis → Redesign Process → Future State) has been added to the introduction section to improve reader understanding of the study design. Comment 4: Language and grammatical revision Response: The entire manuscript has undergone a comprehensive language review to improve grammatical accuracy, sentence structure, clarity of ideas, and consistency of terminology across all sections. We greatly appreciate your thoughtful feedback, which has significantly improved the quality and clarity of the manuscript. Kind regards, Praewchit Ritthaisong Dear Reviewer, We sincerely thank you for your constructive comments and for recognizing the improvements made in the revised manuscript. Your suggestions have been very helpful in further strengthening the clarity and consistency of our work. Below we address each point in detail. Comment 1: Clarification of research objectives Response: The research objectives have now been explicitly stated in the Introduction section and aligned across the manuscript. The objectives are now presented as: (1) To analyze the current inventory management workflow using Value Stream Mapping (VSM) to identify inefficiencies, and (2) To design a future-state inventory management system based on the workflow analysis findings. Comment 2: Strengthening the conclusion section Response: The Conclusion has been revised to clearly distinguish between projected efficiency improvement and actual impact after implementation. We now explicitly state that the redesigned system is expected to improve efficiency based on reductions in lead time and process time, while acknowledging that real-world effectiveness depends on full implementation and continuous monitoring and improvement cycles. Comment 3: Addition of conceptual workflow figure Response: A conceptual workflow figure illustrating the research process (Current State → VSM Analysis → Redesign Process → Future State) has been added to the introduction section to improve reader understanding of the study design. Comment 4: Language and grammatical revision Response: The entire manuscript has undergone a comprehensive language review to improve grammatical accuracy, sentence structure, clarity of ideas, and consistency of terminology across all sections. We greatly appreciate your thoughtful feedback, which has significantly improved the quality and clarity of the manuscript. Kind regards, Praewchit Ritthaisong Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 31 Mar 2025 Views 0 Cite How to cite this report: Anantachoti P. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.175507.r391377 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v1#referee-response-391377 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Aug 2025 Puree Anantachoti , Chulalongkorn University, Bangkok, Bangkok, Thailand Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.175507.r391377 Dear Editor in Chief/ Corresponding Author, I have reviewed your manuscript titled "Application of Value Stream Mapping to Design and Develop an Inventory Management System in a Hospital." Overall, this study presented an interesting and relevant application of Value ... Continue reading READ ALL Dear Editor in Chief/ Corresponding Author, I have reviewed your manuscript titled "Application of Value Stream Mapping to Design and Develop an Inventory Management System in a Hospital." Overall, this study presented an interesting and relevant application of Value Stream Mapping (VSM) within a hospital setting. The action research approach, which focuses on solving a practical problem and sharing the experience, is highly valuable for other healthcare institutions that might consider applying VSM to their own inventory management challenges. The potential for practical impact is a significant strength of this manuscript. However, I found that the manuscript needs to be improved not only in writing style and conciseness, English language proofreading, but also strengthen the research methodology part. Detailed comments are provided below. Abstract 1. Introduction in the abstract captured only one side of the problem. As you mentioned “Insufficient drug reserves in hospitals ready for immediate use pose significant challenges in the management, procurement, and distribution of medications. Therefore, there is a critical need for improved resource management processes, ensuring a balanced and efficient medication reserve system. Lean Management is a systematic approach designed to eliminate waste, thereby reducing costs and enhancing efficiency, making it more effective than other management systems.” My issues are: 1.1 In the full manuscript, you are not only focused on insufficient, but also on over stockpiles too. 1.2 The information presented is contradicted. You started with insufficient drug reserve, but your next supporting sentence talked about elimination waste. 2. The objective was stated as “In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse managementsystem.” 2.1 Spelling managementsystem change to management system 2.2 The objective and results are not matched. The objective is to use the VSM as a framework to only analyzed the workflow process, but the result provide broader activities finally propose a solution. 3. Shortening the introduction, but described more key methodology part e.g. who are involved participants, their qualification, key variables of interest, method of data collection (focus group, in-depth interview, consensus method, Delphi method???) 4. Result part reflected that the key outcome is “work efficiency” which measuring by 1) number of steps in workflow and 2) type of work time reduction. This 2 key outcome were not at all mentioned in the introduction part. Similarly, the introduction mentioned about shortage and over stockpiles, but the result did not include them. 5. Conclusion “Design of work systems by those involved. This is a tool that helps reduce waste and has been developed collaboratively to make operations run more smoothly.” 5.1 This part should provide short summary to your objective. 5.2 First sentence is not a sentence. Please correct. Introduction 6. Please shorten the introduction. When reviewing the literature, please summarize, compare and contrast them instead of narratively describing each of them. 7. I would like to see you summarize key outcomes that align with the study's objectives stated in the introduction part. 8. Sequence of story telling in the introduction part may have to shuffle. May be talking about problems and problem solving (from literature review) first, then problem specific to your hospital (which is the gap of the study), then objective. 9. The objective stated in the last paragraph of the introduction is that“The objective of this study was to identify inefficiencies and challenges within the medical supply inventory management system, to reduce waste and optimize processes using Value Stream Mapping (VSM), and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness.” 9.1 I think your ultimate goal is to develop new inventory management system. But the process to reach the goal is that you 1) have to analyzed current workflow to identify problems and 2) use VSM as a framework and involve stakeholders to propose new management system. Your first and second objectives are just processes to reach your ultimate objective. Methodology 10. I understand that to answer the objective, there were many steps of work. Please make sure that for each step , you provide clear methodology elements e.g. 10.1 Study design Action research can be used as a study design as it’s a broad term. But for each specific step, you might use different design e.g. in-depth interview, focus group, consensus method etc. Please be more specific. 10.2 Sample - Qualification (eligibility criteria) -Number of samples (how many samples needed to ensure validity of answers) 10.3 Measurement - What outcomes were you seeking in each step. How did you measure it. These outcomes should reflect what you showed in the result section. Also, you measured work time, whether you interview to get the time, or you retrieve time from computer system? If many product items generate their own time, how would you calculate the reported time? - Some outcome may need to be operationalized e.g. waste As a reader, I’m not sure whether waste refers to expired over stockpiles. Since I did not see you measuring waste in terms of volume or value of products, but you measuring work time. I am not sure if you refer wasting time as waste or not. - What question guide do you use - Whether the questions valid 10.4 Data analysis What data analysis method were use? Results 11. The figure clearly portrait the workflow both current situation and proposed solution. But the color and the font size make it difficult to read. 12. Reporting style Under the “Value stream mapping” topic. Though understand that the Value stream mapping compose of 3 parts, but part 1 also showed in part 3. Part 2 is relevant to Figure 1. When putting together as result, you should summarized things that can be combined to make it short but still keep its clarity. 13. After table 1, there is a word “working period” come out of nowhere. Please consider deleting it. 14. Sub-topic Future work system I suggested paraphrase “Future work system “ to “proposed work system” Writing style. The result section is very long. You should synthesize first and laid down the content ที่ประมวลแล้ว in a clear and shorter version. I’m not sure whether this proposed work system came from researchers’ opinions or from the participants’ consensus? Please clarify both in the methodology and in the result. Discussion 15. In general, 1) do not repeat results in discussion and 2) make it short for each issue raised. 16. In the first discussion paragraph, please provide unique key findings or key strength of the study. 17. Many previous studies showed in discussion should be described in the introduction. When mentioned about previous studies, their findings should be compared or contrasted with your findings. 18. Limitation and suggestions (or recommendations) should be included under discussion section. Conclusion The conclusion should be the last part of the manuscript’s content. Ethics and consent You already mentioned about ethical approval at the very beginning of the methodology section. If this is the journal’s format, please delete the one in methodology section. It should not be redundant. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Social pharmacy, Administrative pharmacy, Health and Pharmacy policy, Access to medicine, Regulatory Sciences I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Anantachoti P. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.175507.r391377 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v1#referee-response-391377 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Oct 2025 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 09 Oct 2025 Author Response Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design ... Continue reading Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. Abstract 1. Introduction in the abstract captured only one side of the problem. As you mentioned “Insufficient drug reserves in hospitals ready for immediate use pose significant challenges in the management, procurement, and distribution of medications. Therefore, there is a critical need for improved resource management processes, ensuring a balanced and efficient medication reserve system. Lean Management is a systematic approach designed to eliminate waste, thereby reducing costs and enhancing efficiency, making it more effective than other management systems.” My issues are: 1.1 In the full manuscript, you are not only focused on insufficient, but also on over stockpiles too. 1.2 The information presented is contradicted. You started with insufficient drug reserve, but your next supporting sentence talked about elimination waste. Response: (Revised AbstractàIntroduction) 1.1We thank the reviewer for this important observation. In the revised abstract, we have modified the introduction to mention both insufficient reserves and overstockpiling as dual challenges 1.2We have rephrased the abstract to improve logical flow, presenting both shortage and overstock before linking to Lean Management and VSM 2. The objective was stated as “In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse managementsystem.” 2.1 Spelling managementsystem change to management system 2.2 The objective and results are not matched. The objective is to use the VSM as a framework to only analyzed the workflow process, but the result provide broader activities finally propose a solution. Response: (Revised Abstract) 2.1 Corrected as suggested. 2.2 We have revised the abstract objective to better align with the study’s scope and outcomes 3. Shortening the introduction, but described more key methodology part e.g. who are involved participants, their qualification, key variables of interest, method of data collection (focus group, in-depth interview, consensus method, Delphi method???) Response: (Revised Abstract -> method) As suggested, the abstract has been shortened, and key methodological details have been added. We briefly report the number and roles of participants, their qualifications, the main variables of interest, and data collection methods (focus groups discussion). 4. Result part reflected that the key outcome is “work efficiency” which measuring by 1) number of steps in workflow and 2) type of work time reduction. This 2 key outcome were not at all mentioned in the introduction part. Similarly, the introduction mentioned about shortage and over stockpiles, but the result did not include them. Response: (Revised Abstract -> Result) We appreciate this comment. The revised abstract now states that the study outcomes included workflow simplification (number of steps reduced) and time reduction. At the same time, references to shortages and overstock have been clarified as motivating problems, while results focus on the efficiency metrics that were directly measured. 5. Conclusion “Design of work systems by those involved. This is a tool that helps reduce waste and has been developed collaboratively to make operations run more smoothly.” 5.1 This part should provide short summary to your objective. 5.2 First sentence is not a sentence. Please correct. Response: (Revised Abstract -> conclusion) 5.1 We revised the abstract conclusion to briefly restate the objective and demonstrate how it was achieved. 5.2 Corrected to a complete sentence Introduction ( Revised Introduction) 6. Please shorten the introduction. When reviewing the literature, please summarize, compare and contrast them instead of narratively describing each of them. Response: We have shortened the introduction, synthesized related studies. 7. I would like to see you summarize key outcomes that align with the study's objectives stated in the introduction part. Response: We added a summary of the key outcomes in the introduction to ensure alignment between objectives and results. 8. Sequence of story telling in the introduction part may have to shuffle. May be talking about problems and problem solving (from literature review) first, then problem specific to your hospital (which is the gap of the study), then objective. Response: The introduction has been reorganized accordingly. 9. The objective stated in the last paragraph of the introduction is that“The objective of this study was to identify inefficiencies and challenges within the medical supply inventory management system, to reduce waste and optimize processes using Value Stream Mapping (VSM), and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness.” 9.1 I think your ultimate goal is to develop new inventory management system. But the process to reach the goal is that you 1) have to analyzed current workflow to identify problems and 2) use VSM as a framework and involve stakeholders to propose new management system. Your first and second objectives are just processes to reach your ultimate objective. Response: We thank the reviewer for this clarification. The objective has been revised to emphasize the ultimate aim: “to design and develop a new medical supply inventory management system that is efficient and effective by analyzing current inventory management processes to identify inefficiencies, applying Value Stream Mapping (VSM) as a framework for designing the new system, and improving processes to reduce waste and enhance system efficiency. Methodology 10. I understand that to answer the objective, there were many steps of work. Please make sure that for each step, you provide clear methodology elements e.g. 10.1 Study design Action research can be used as a study design as it’s a broad term. But for each specific step, you might use different design e.g. in-depth interview, focus group, consensus method etc. Please be more specific. 10.2 Sample - Qualification (eligibility criteria) -Number of samples (how many samples needed to ensure validity of answers) 10.3 Measurement - What outcomes were you seeking in each step. How did you measure it. These outcomes should reflect what you showed in the result section. Also, you measured work time, whether you interview to get the time, or you retrieve time from computer system? If many product items generate their own time, how would you calculate the reported time? - Some outcome may need to be operationalized e.g. waste As a reader, I’m not sure whether waste refers to expired over stockpiles. Since I did not see you measuring waste in terms of volume or value of products, but you measuring work time. I am not sure if you refer wasting time as waste or not. - What question guide do you use - Whether the questions valid 10.4 Data analysis What data analysis method were use? Response: 10.1 We clarified that Action Research served as the overarching design. Specific methods included focus group discussions for problem identification, and consensus-building workshops for system design. ( Revised methodology) 10.2 We added eligibility criteria and detailed the participant composition: pharmacists, pharmacy assistants, and warehouse staff (22 participants in total). ( Revised Participants) 10.3 We clarified that process time was measured and validated against electronic system data. Waste was defined as non–value-added time. Expired stock was acknowledged but not measured; instead, waste in this study referred to workflow inefficiencies. The question guide used in focus groups was reviewed by three experts to ensure content validity. (Revised Procedures and Data Collection, Outcomes and Measurements) 10.4 We revised the methodology to specify descriptive statistics for time data, comparative analysis of workflow steps, and thematic content analysis for qualitative inputs . ( Revised Data Analysis ) Results 11. The figure clearly portrait the workflow both current situation and proposed solution. But the color and the font size make it difficult to read. Response: Figure 1 was reformatted with larger fonts, clearer labels, for better readability. 12. Reporting style Under the “Value stream mapping” topic. Though understand that the Value stream mapping compose of 3 parts, but part 1 also showed in part 3. Part 2 is relevant to Figure 1. When putting together as result, you should summarized things that can be combined to make it short but still keep its clarity. Response: Reporting style under Value Stream Mapping is repetitive. Response: We have synthesized overlapping points, reduced redundancy, and reorganized subsections to maintain clarity and conciseness. ( Revised Result ) 13. After table 1, there is a word “working period” come out of nowhere. Please consider deleting it. Response: Deleted as suggested. 14. Sub-topic Future work system I suggested paraphrase “Future work system “ to “proposed work system” Writing style. The result section is very long. You should synthesize first and laid down the content ที่ประมวลแล้ว in a clear and shorter version. I’m not sure whether this proposed work system came from researchers’ opinions or from the participants’ consensus? Please clarify both in the methodology and in the result. Response: Subheading has been changed to “Proposed work system.” We also clarified that the design was primarily researcher-developed, with input and validation from participants through focus group consensus. (Revised Proposed work system) Discussion . (Revised Discussion) 15. In general, 1) do not repeat results in discussion and 2) make it short for each issue raised. Response: The discussion was revised to avoid repetition and concisely address each issue. 16. In the first discussion paragraph, please provide unique key findings or key strength of the study. Response: The first paragraph of the Discussion now highlights unique contributions 17. Many previous studies showed in discussion should be described in the introduction. When mentioned about previous studies, their findings should be compared or contrasted with your findings. Response: Relevant literature has been moved to the Introduction. In the Discussion, previous findings are explicitly compared and contrasted with our study’s outcomes. 18. Limitation and suggestions (or recommendations) should be included under discussion section. Response: We have merged the limitations and recommendations into the final part of the Discussion, highlighting potential resistance to change, IT requirements, and scalability. Conclusion The conclusion should be the last part of the manuscript’s content. Response: Corrected as suggested. Ethics and consent You already mentioned about ethical approval at the very beginning of the methodology section. If this is the journal’s format, please delete the one in methodology section. It should not be redundant. Response: Revised as suggested. Ethical approval is now presented only in the Ethics section. We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. Abstract 1. Introduction in the abstract captured only one side of the problem. As you mentioned “Insufficient drug reserves in hospitals ready for immediate use pose significant challenges in the management, procurement, and distribution of medications. Therefore, there is a critical need for improved resource management processes, ensuring a balanced and efficient medication reserve system. Lean Management is a systematic approach designed to eliminate waste, thereby reducing costs and enhancing efficiency, making it more effective than other management systems.” My issues are: 1.1 In the full manuscript, you are not only focused on insufficient, but also on over stockpiles too. 1.2 The information presented is contradicted. You started with insufficient drug reserve, but your next supporting sentence talked about elimination waste. Response: (Revised AbstractàIntroduction) 1.1We thank the reviewer for this important observation. In the revised abstract, we have modified the introduction to mention both insufficient reserves and overstockpiling as dual challenges 1.2We have rephrased the abstract to improve logical flow, presenting both shortage and overstock before linking to Lean Management and VSM 2. The objective was stated as “In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse managementsystem.” 2.1 Spelling managementsystem change to management system 2.2 The objective and results are not matched. The objective is to use the VSM as a framework to only analyzed the workflow process, but the result provide broader activities finally propose a solution. Response: (Revised Abstract) 2.1 Corrected as suggested. 2.2 We have revised the abstract objective to better align with the study’s scope and outcomes 3. Shortening the introduction, but described more key methodology part e.g. who are involved participants, their qualification, key variables of interest, method of data collection (focus group, in-depth interview, consensus method, Delphi method???) Response: (Revised Abstract -> method) As suggested, the abstract has been shortened, and key methodological details have been added. We briefly report the number and roles of participants, their qualifications, the main variables of interest, and data collection methods (focus groups discussion). 4. Result part reflected that the key outcome is “work efficiency” which measuring by 1) number of steps in workflow and 2) type of work time reduction. This 2 key outcome were not at all mentioned in the introduction part. Similarly, the introduction mentioned about shortage and over stockpiles, but the result did not include them. Response: (Revised Abstract -> Result) We appreciate this comment. The revised abstract now states that the study outcomes included workflow simplification (number of steps reduced) and time reduction. At the same time, references to shortages and overstock have been clarified as motivating problems, while results focus on the efficiency metrics that were directly measured. 5. Conclusion “Design of work systems by those involved. This is a tool that helps reduce waste and has been developed collaboratively to make operations run more smoothly.” 5.1 This part should provide short summary to your objective. 5.2 First sentence is not a sentence. Please correct. Response: (Revised Abstract -> conclusion) 5.1 We revised the abstract conclusion to briefly restate the objective and demonstrate how it was achieved. 5.2 Corrected to a complete sentence Introduction ( Revised Introduction) 6. Please shorten the introduction. When reviewing the literature, please summarize, compare and contrast them instead of narratively describing each of them. Response: We have shortened the introduction, synthesized related studies. 7. I would like to see you summarize key outcomes that align with the study's objectives stated in the introduction part. Response: We added a summary of the key outcomes in the introduction to ensure alignment between objectives and results. 8. Sequence of story telling in the introduction part may have to shuffle. May be talking about problems and problem solving (from literature review) first, then problem specific to your hospital (which is the gap of the study), then objective. Response: The introduction has been reorganized accordingly. 9. The objective stated in the last paragraph of the introduction is that“The objective of this study was to identify inefficiencies and challenges within the medical supply inventory management system, to reduce waste and optimize processes using Value Stream Mapping (VSM), and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness.” 9.1 I think your ultimate goal is to develop new inventory management system. But the process to reach the goal is that you 1) have to analyzed current workflow to identify problems and 2) use VSM as a framework and involve stakeholders to propose new management system. Your first and second objectives are just processes to reach your ultimate objective. Response: We thank the reviewer for this clarification. The objective has been revised to emphasize the ultimate aim: “to design and develop a new medical supply inventory management system that is efficient and effective by analyzing current inventory management processes to identify inefficiencies, applying Value Stream Mapping (VSM) as a framework for designing the new system, and improving processes to reduce waste and enhance system efficiency. Methodology 10. I understand that to answer the objective, there were many steps of work. Please make sure that for each step, you provide clear methodology elements e.g. 10.1 Study design Action research can be used as a study design as it’s a broad term. But for each specific step, you might use different design e.g. in-depth interview, focus group, consensus method etc. Please be more specific. 10.2 Sample - Qualification (eligibility criteria) -Number of samples (how many samples needed to ensure validity of answers) 10.3 Measurement - What outcomes were you seeking in each step. How did you measure it. These outcomes should reflect what you showed in the result section. Also, you measured work time, whether you interview to get the time, or you retrieve time from computer system? If many product items generate their own time, how would you calculate the reported time? - Some outcome may need to be operationalized e.g. waste As a reader, I’m not sure whether waste refers to expired over stockpiles. Since I did not see you measuring waste in terms of volume or value of products, but you measuring work time. I am not sure if you refer wasting time as waste or not. - What question guide do you use - Whether the questions valid 10.4 Data analysis What data analysis method were use? Response: 10.1 We clarified that Action Research served as the overarching design. Specific methods included focus group discussions for problem identification, and consensus-building workshops for system design. ( Revised methodology) 10.2 We added eligibility criteria and detailed the participant composition: pharmacists, pharmacy assistants, and warehouse staff (22 participants in total). ( Revised Participants) 10.3 We clarified that process time was measured and validated against electronic system data. Waste was defined as non–value-added time. Expired stock was acknowledged but not measured; instead, waste in this study referred to workflow inefficiencies. The question guide used in focus groups was reviewed by three experts to ensure content validity. (Revised Procedures and Data Collection, Outcomes and Measurements) 10.4 We revised the methodology to specify descriptive statistics for time data, comparative analysis of workflow steps, and thematic content analysis for qualitative inputs . ( Revised Data Analysis ) Results 11. The figure clearly portrait the workflow both current situation and proposed solution. But the color and the font size make it difficult to read. Response: Figure 1 was reformatted with larger fonts, clearer labels, for better readability. 12. Reporting style Under the “Value stream mapping” topic. Though understand that the Value stream mapping compose of 3 parts, but part 1 also showed in part 3. Part 2 is relevant to Figure 1. When putting together as result, you should summarized things that can be combined to make it short but still keep its clarity. Response: Reporting style under Value Stream Mapping is repetitive. Response: We have synthesized overlapping points, reduced redundancy, and reorganized subsections to maintain clarity and conciseness. ( Revised Result ) 13. After table 1, there is a word “working period” come out of nowhere. Please consider deleting it. Response: Deleted as suggested. 14. Sub-topic Future work system I suggested paraphrase “Future work system “ to “proposed work system” Writing style. The result section is very long. You should synthesize first and laid down the content ที่ประมวลแล้ว in a clear and shorter version. I’m not sure whether this proposed work system came from researchers’ opinions or from the participants’ consensus? Please clarify both in the methodology and in the result. Response: Subheading has been changed to “Proposed work system.” We also clarified that the design was primarily researcher-developed, with input and validation from participants through focus group consensus. (Revised Proposed work system) Discussion . (Revised Discussion) 15. In general, 1) do not repeat results in discussion and 2) make it short for each issue raised. Response: The discussion was revised to avoid repetition and concisely address each issue. 16. In the first discussion paragraph, please provide unique key findings or key strength of the study. Response: The first paragraph of the Discussion now highlights unique contributions 17. Many previous studies showed in discussion should be described in the introduction. When mentioned about previous studies, their findings should be compared or contrasted with your findings. Response: Relevant literature has been moved to the Introduction. In the Discussion, previous findings are explicitly compared and contrasted with our study’s outcomes. 18. Limitation and suggestions (or recommendations) should be included under discussion section. Response: We have merged the limitations and recommendations into the final part of the Discussion, highlighting potential resistance to change, IT requirements, and scalability. Conclusion The conclusion should be the last part of the manuscript’s content. Response: Corrected as suggested. Ethics and consent You already mentioned about ethical approval at the very beginning of the methodology section. If this is the journal’s format, please delete the one in methodology section. It should not be redundant. Response: Revised as suggested. Ethical approval is now presented only in the Ethics section. We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn Competing Interests: The authors declare no competing interests. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Oct 2025 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 09 Oct 2025 Author Response Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design ... Continue reading Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. Abstract 1. Introduction in the abstract captured only one side of the problem. As you mentioned “Insufficient drug reserves in hospitals ready for immediate use pose significant challenges in the management, procurement, and distribution of medications. Therefore, there is a critical need for improved resource management processes, ensuring a balanced and efficient medication reserve system. Lean Management is a systematic approach designed to eliminate waste, thereby reducing costs and enhancing efficiency, making it more effective than other management systems.” My issues are: 1.1 In the full manuscript, you are not only focused on insufficient, but also on over stockpiles too. 1.2 The information presented is contradicted. You started with insufficient drug reserve, but your next supporting sentence talked about elimination waste. Response: (Revised AbstractàIntroduction) 1.1We thank the reviewer for this important observation. In the revised abstract, we have modified the introduction to mention both insufficient reserves and overstockpiling as dual challenges 1.2We have rephrased the abstract to improve logical flow, presenting both shortage and overstock before linking to Lean Management and VSM 2. The objective was stated as “In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse managementsystem.” 2.1 Spelling managementsystem change to management system 2.2 The objective and results are not matched. The objective is to use the VSM as a framework to only analyzed the workflow process, but the result provide broader activities finally propose a solution. Response: (Revised Abstract) 2.1 Corrected as suggested. 2.2 We have revised the abstract objective to better align with the study’s scope and outcomes 3. Shortening the introduction, but described more key methodology part e.g. who are involved participants, their qualification, key variables of interest, method of data collection (focus group, in-depth interview, consensus method, Delphi method???) Response: (Revised Abstract -> method) As suggested, the abstract has been shortened, and key methodological details have been added. We briefly report the number and roles of participants, their qualifications, the main variables of interest, and data collection methods (focus groups discussion). 4. Result part reflected that the key outcome is “work efficiency” which measuring by 1) number of steps in workflow and 2) type of work time reduction. This 2 key outcome were not at all mentioned in the introduction part. Similarly, the introduction mentioned about shortage and over stockpiles, but the result did not include them. Response: (Revised Abstract -> Result) We appreciate this comment. The revised abstract now states that the study outcomes included workflow simplification (number of steps reduced) and time reduction. At the same time, references to shortages and overstock have been clarified as motivating problems, while results focus on the efficiency metrics that were directly measured. 5. Conclusion “Design of work systems by those involved. This is a tool that helps reduce waste and has been developed collaboratively to make operations run more smoothly.” 5.1 This part should provide short summary to your objective. 5.2 First sentence is not a sentence. Please correct. Response: (Revised Abstract -> conclusion) 5.1 We revised the abstract conclusion to briefly restate the objective and demonstrate how it was achieved. 5.2 Corrected to a complete sentence Introduction ( Revised Introduction) 6. Please shorten the introduction. When reviewing the literature, please summarize, compare and contrast them instead of narratively describing each of them. Response: We have shortened the introduction, synthesized related studies. 7. I would like to see you summarize key outcomes that align with the study's objectives stated in the introduction part. Response: We added a summary of the key outcomes in the introduction to ensure alignment between objectives and results. 8. Sequence of story telling in the introduction part may have to shuffle. May be talking about problems and problem solving (from literature review) first, then problem specific to your hospital (which is the gap of the study), then objective. Response: The introduction has been reorganized accordingly. 9. The objective stated in the last paragraph of the introduction is that“The objective of this study was to identify inefficiencies and challenges within the medical supply inventory management system, to reduce waste and optimize processes using Value Stream Mapping (VSM), and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness.” 9.1 I think your ultimate goal is to develop new inventory management system. But the process to reach the goal is that you 1) have to analyzed current workflow to identify problems and 2) use VSM as a framework and involve stakeholders to propose new management system. Your first and second objectives are just processes to reach your ultimate objective. Response: We thank the reviewer for this clarification. The objective has been revised to emphasize the ultimate aim: “to design and develop a new medical supply inventory management system that is efficient and effective by analyzing current inventory management processes to identify inefficiencies, applying Value Stream Mapping (VSM) as a framework for designing the new system, and improving processes to reduce waste and enhance system efficiency. Methodology 10. I understand that to answer the objective, there were many steps of work. Please make sure that for each step, you provide clear methodology elements e.g. 10.1 Study design Action research can be used as a study design as it’s a broad term. But for each specific step, you might use different design e.g. in-depth interview, focus group, consensus method etc. Please be more specific. 10.2 Sample - Qualification (eligibility criteria) -Number of samples (how many samples needed to ensure validity of answers) 10.3 Measurement - What outcomes were you seeking in each step. How did you measure it. These outcomes should reflect what you showed in the result section. Also, you measured work time, whether you interview to get the time, or you retrieve time from computer system? If many product items generate their own time, how would you calculate the reported time? - Some outcome may need to be operationalized e.g. waste As a reader, I’m not sure whether waste refers to expired over stockpiles. Since I did not see you measuring waste in terms of volume or value of products, but you measuring work time. I am not sure if you refer wasting time as waste or not. - What question guide do you use - Whether the questions valid 10.4 Data analysis What data analysis method were use? Response: 10.1 We clarified that Action Research served as the overarching design. Specific methods included focus group discussions for problem identification, and consensus-building workshops for system design. ( Revised methodology) 10.2 We added eligibility criteria and detailed the participant composition: pharmacists, pharmacy assistants, and warehouse staff (22 participants in total). ( Revised Participants) 10.3 We clarified that process time was measured and validated against electronic system data. Waste was defined as non–value-added time. Expired stock was acknowledged but not measured; instead, waste in this study referred to workflow inefficiencies. The question guide used in focus groups was reviewed by three experts to ensure content validity. (Revised Procedures and Data Collection, Outcomes and Measurements) 10.4 We revised the methodology to specify descriptive statistics for time data, comparative analysis of workflow steps, and thematic content analysis for qualitative inputs . ( Revised Data Analysis ) Results 11. The figure clearly portrait the workflow both current situation and proposed solution. But the color and the font size make it difficult to read. Response: Figure 1 was reformatted with larger fonts, clearer labels, for better readability. 12. Reporting style Under the “Value stream mapping” topic. Though understand that the Value stream mapping compose of 3 parts, but part 1 also showed in part 3. Part 2 is relevant to Figure 1. When putting together as result, you should summarized things that can be combined to make it short but still keep its clarity. Response: Reporting style under Value Stream Mapping is repetitive. Response: We have synthesized overlapping points, reduced redundancy, and reorganized subsections to maintain clarity and conciseness. ( Revised Result ) 13. After table 1, there is a word “working period” come out of nowhere. Please consider deleting it. Response: Deleted as suggested. 14. Sub-topic Future work system I suggested paraphrase “Future work system “ to “proposed work system” Writing style. The result section is very long. You should synthesize first and laid down the content ที่ประมวลแล้ว in a clear and shorter version. I’m not sure whether this proposed work system came from researchers’ opinions or from the participants’ consensus? Please clarify both in the methodology and in the result. Response: Subheading has been changed to “Proposed work system.” We also clarified that the design was primarily researcher-developed, with input and validation from participants through focus group consensus. (Revised Proposed work system) Discussion . (Revised Discussion) 15. In general, 1) do not repeat results in discussion and 2) make it short for each issue raised. Response: The discussion was revised to avoid repetition and concisely address each issue. 16. In the first discussion paragraph, please provide unique key findings or key strength of the study. Response: The first paragraph of the Discussion now highlights unique contributions 17. Many previous studies showed in discussion should be described in the introduction. When mentioned about previous studies, their findings should be compared or contrasted with your findings. Response: Relevant literature has been moved to the Introduction. In the Discussion, previous findings are explicitly compared and contrasted with our study’s outcomes. 18. Limitation and suggestions (or recommendations) should be included under discussion section. Response: We have merged the limitations and recommendations into the final part of the Discussion, highlighting potential resistance to change, IT requirements, and scalability. Conclusion The conclusion should be the last part of the manuscript’s content. Response: Corrected as suggested. Ethics and consent You already mentioned about ethical approval at the very beginning of the methodology section. If this is the journal’s format, please delete the one in methodology section. It should not be redundant. Response: Revised as suggested. Ethical approval is now presented only in the Ethics section. We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. Abstract 1. Introduction in the abstract captured only one side of the problem. As you mentioned “Insufficient drug reserves in hospitals ready for immediate use pose significant challenges in the management, procurement, and distribution of medications. Therefore, there is a critical need for improved resource management processes, ensuring a balanced and efficient medication reserve system. Lean Management is a systematic approach designed to eliminate waste, thereby reducing costs and enhancing efficiency, making it more effective than other management systems.” My issues are: 1.1 In the full manuscript, you are not only focused on insufficient, but also on over stockpiles too. 1.2 The information presented is contradicted. You started with insufficient drug reserve, but your next supporting sentence talked about elimination waste. Response: (Revised AbstractàIntroduction) 1.1We thank the reviewer for this important observation. In the revised abstract, we have modified the introduction to mention both insufficient reserves and overstockpiling as dual challenges 1.2We have rephrased the abstract to improve logical flow, presenting both shortage and overstock before linking to Lean Management and VSM 2. The objective was stated as “In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse managementsystem.” 2.1 Spelling managementsystem change to management system 2.2 The objective and results are not matched. The objective is to use the VSM as a framework to only analyzed the workflow process, but the result provide broader activities finally propose a solution. Response: (Revised Abstract) 2.1 Corrected as suggested. 2.2 We have revised the abstract objective to better align with the study’s scope and outcomes 3. Shortening the introduction, but described more key methodology part e.g. who are involved participants, their qualification, key variables of interest, method of data collection (focus group, in-depth interview, consensus method, Delphi method???) Response: (Revised Abstract -> method) As suggested, the abstract has been shortened, and key methodological details have been added. We briefly report the number and roles of participants, their qualifications, the main variables of interest, and data collection methods (focus groups discussion). 4. Result part reflected that the key outcome is “work efficiency” which measuring by 1) number of steps in workflow and 2) type of work time reduction. This 2 key outcome were not at all mentioned in the introduction part. Similarly, the introduction mentioned about shortage and over stockpiles, but the result did not include them. Response: (Revised Abstract -> Result) We appreciate this comment. The revised abstract now states that the study outcomes included workflow simplification (number of steps reduced) and time reduction. At the same time, references to shortages and overstock have been clarified as motivating problems, while results focus on the efficiency metrics that were directly measured. 5. Conclusion “Design of work systems by those involved. This is a tool that helps reduce waste and has been developed collaboratively to make operations run more smoothly.” 5.1 This part should provide short summary to your objective. 5.2 First sentence is not a sentence. Please correct. Response: (Revised Abstract -> conclusion) 5.1 We revised the abstract conclusion to briefly restate the objective and demonstrate how it was achieved. 5.2 Corrected to a complete sentence Introduction ( Revised Introduction) 6. Please shorten the introduction. When reviewing the literature, please summarize, compare and contrast them instead of narratively describing each of them. Response: We have shortened the introduction, synthesized related studies. 7. I would like to see you summarize key outcomes that align with the study's objectives stated in the introduction part. Response: We added a summary of the key outcomes in the introduction to ensure alignment between objectives and results. 8. Sequence of story telling in the introduction part may have to shuffle. May be talking about problems and problem solving (from literature review) first, then problem specific to your hospital (which is the gap of the study), then objective. Response: The introduction has been reorganized accordingly. 9. The objective stated in the last paragraph of the introduction is that“The objective of this study was to identify inefficiencies and challenges within the medical supply inventory management system, to reduce waste and optimize processes using Value Stream Mapping (VSM), and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness.” 9.1 I think your ultimate goal is to develop new inventory management system. But the process to reach the goal is that you 1) have to analyzed current workflow to identify problems and 2) use VSM as a framework and involve stakeholders to propose new management system. Your first and second objectives are just processes to reach your ultimate objective. Response: We thank the reviewer for this clarification. The objective has been revised to emphasize the ultimate aim: “to design and develop a new medical supply inventory management system that is efficient and effective by analyzing current inventory management processes to identify inefficiencies, applying Value Stream Mapping (VSM) as a framework for designing the new system, and improving processes to reduce waste and enhance system efficiency. Methodology 10. I understand that to answer the objective, there were many steps of work. Please make sure that for each step, you provide clear methodology elements e.g. 10.1 Study design Action research can be used as a study design as it’s a broad term. But for each specific step, you might use different design e.g. in-depth interview, focus group, consensus method etc. Please be more specific. 10.2 Sample - Qualification (eligibility criteria) -Number of samples (how many samples needed to ensure validity of answers) 10.3 Measurement - What outcomes were you seeking in each step. How did you measure it. These outcomes should reflect what you showed in the result section. Also, you measured work time, whether you interview to get the time, or you retrieve time from computer system? If many product items generate their own time, how would you calculate the reported time? - Some outcome may need to be operationalized e.g. waste As a reader, I’m not sure whether waste refers to expired over stockpiles. Since I did not see you measuring waste in terms of volume or value of products, but you measuring work time. I am not sure if you refer wasting time as waste or not. - What question guide do you use - Whether the questions valid 10.4 Data analysis What data analysis method were use? Response: 10.1 We clarified that Action Research served as the overarching design. Specific methods included focus group discussions for problem identification, and consensus-building workshops for system design. ( Revised methodology) 10.2 We added eligibility criteria and detailed the participant composition: pharmacists, pharmacy assistants, and warehouse staff (22 participants in total). ( Revised Participants) 10.3 We clarified that process time was measured and validated against electronic system data. Waste was defined as non–value-added time. Expired stock was acknowledged but not measured; instead, waste in this study referred to workflow inefficiencies. The question guide used in focus groups was reviewed by three experts to ensure content validity. (Revised Procedures and Data Collection, Outcomes and Measurements) 10.4 We revised the methodology to specify descriptive statistics for time data, comparative analysis of workflow steps, and thematic content analysis for qualitative inputs . ( Revised Data Analysis ) Results 11. The figure clearly portrait the workflow both current situation and proposed solution. But the color and the font size make it difficult to read. Response: Figure 1 was reformatted with larger fonts, clearer labels, for better readability. 12. Reporting style Under the “Value stream mapping” topic. Though understand that the Value stream mapping compose of 3 parts, but part 1 also showed in part 3. Part 2 is relevant to Figure 1. When putting together as result, you should summarized things that can be combined to make it short but still keep its clarity. Response: Reporting style under Value Stream Mapping is repetitive. Response: We have synthesized overlapping points, reduced redundancy, and reorganized subsections to maintain clarity and conciseness. ( Revised Result ) 13. After table 1, there is a word “working period” come out of nowhere. Please consider deleting it. Response: Deleted as suggested. 14. Sub-topic Future work system I suggested paraphrase “Future work system “ to “proposed work system” Writing style. The result section is very long. You should synthesize first and laid down the content ที่ประมวลแล้ว in a clear and shorter version. I’m not sure whether this proposed work system came from researchers’ opinions or from the participants’ consensus? Please clarify both in the methodology and in the result. Response: Subheading has been changed to “Proposed work system.” We also clarified that the design was primarily researcher-developed, with input and validation from participants through focus group consensus. (Revised Proposed work system) Discussion . (Revised Discussion) 15. In general, 1) do not repeat results in discussion and 2) make it short for each issue raised. Response: The discussion was revised to avoid repetition and concisely address each issue. 16. In the first discussion paragraph, please provide unique key findings or key strength of the study. Response: The first paragraph of the Discussion now highlights unique contributions 17. Many previous studies showed in discussion should be described in the introduction. When mentioned about previous studies, their findings should be compared or contrasted with your findings. Response: Relevant literature has been moved to the Introduction. In the Discussion, previous findings are explicitly compared and contrasted with our study’s outcomes. 18. Limitation and suggestions (or recommendations) should be included under discussion section. Response: We have merged the limitations and recommendations into the final part of the Discussion, highlighting potential resistance to change, IT requirements, and scalability. Conclusion The conclusion should be the last part of the manuscript’s content. Response: Corrected as suggested. Ethics and consent You already mentioned about ethical approval at the very beginning of the methodology section. If this is the journal’s format, please delete the one in methodology section. It should not be redundant. Response: Revised as suggested. Ethical approval is now presented only in the Ethics section. We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn Competing Interests: The authors declare no competing interests. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Sakulbumrungsil R. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.175507.r394960 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v1#referee-response-394960 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Aug 2025 Rungpetch Sakulbumrungsil , Chulalongkorn University, Pathumwan, Thailand; College of Pharmacy Administration, Thailand, Thailand Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.175507.r394960 This manuscript presents a valuable case study in the hospital inventory management. It offers a solid contribution to the field of lean operations improvement. The methodology is sound and the transformation plan is logically constructed. The outcomes, particularly the improvements in ... Continue reading READ ALL This manuscript presents a valuable case study in the hospital inventory management. It offers a solid contribution to the field of lean operations improvement. The methodology is sound and the transformation plan is logically constructed. The outcomes, particularly the improvements in lead time, process time, and activity ratio, are well-documented. Areas for Revision 1. Introduction and Literature Review The research problem and study objectives should be clearly stated at the beginning of the introduction. Currently, these are embedded within a long narrative, which may obscure the purpose of the study. Since the manuscript integrates the introduction and literature review, it is recommended to present the study objectives early, before detailing the literature. The literature review is lengthy and contains some repetition, particularly in the sections discussing international applications of VSM. To enhance clarity and conciseness, consider summarizing similar case studies in a comparative table or highlighting the key findings, settings, and outcomes. Clarify the novelty of your study compared to existing Thai studies. What distinguishes your approach, IT integration, Kanban system, etc.? 2. Methods Include a brief summary of participant demographics (e.g., number and roles of pharmacists, warehouse staff, assistants) to improve transparency and understanding of the context. Specify the data collection timeframe and duration of each research phase (e.g., planning, implementation, observation) more clearly to help readers understand the study period and process scope. 4. Results In Table 2, it would be helpful to clearly distinguish between processing time and waiting time for each step to better align with the result in the table 3. Consider replacing the labels “current” and “future” states with “before” and “after”, as the new system has already been implemented. This will more accurately reflect the temporal progression and outcomes of the intervention. 5. Discussion Expand on the sustainability and scalability of the improved system. How will the hospital ensure long-term adoption, staff training, regular data updates, and system evaluation? Address how the IT infrastructure and human resources will support ongoing use. Compare findings more clearly to previous Thai studies and global case studies, emphasizing what this study adds. 6. Limitations The limitations are thorough, but consider adding commentary on potential resistance to change in healthcare environments when implementing new IT systems. 7. Conclusion The conclusion is appropriate but consider emphasizing: Practical policy implications (e.g., how this model can inform regional hospital networks). The feasibility of replication in other small-to-mid-sized hospitals. The importance of continued monitoring through Lean cycles (e.g., annual PDSA reviews). Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: inventory management I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sakulbumrungsil R. Reviewer Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.175507.r394960 ) The direct URL for this report is: https://f1000research.com/articles/14-365/v1#referee-response-394960 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 01 Oct 2025 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 01 Oct 2025 Author Response Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design ... Continue reading Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. 1. Introduction and Literature Review The research problem and study objectives should be clearly stated at the beginning of the introduction. Currently, these are embedded within a long narrative, which may obscure the purpose of the study. Since the manuscript integrates the introduction and literature review, it is recommended to present the study objectives early, before detailing the literature. The literature review is lengthy and contains some repetition, particularly in the sections discussing international applications of VSM. To enhance clarity and conciseness, consider summarizing similar case studies in a comparative table or highlighting the key findings, settings, and outcomes. Clarify the novelty of your study compared to existing Thai studies. What distinguishes your approach, IT integration, Kanban system, etc.? Response: We appreciate this valuable suggestion. In the revised manuscript, we have restructured the introduction to state the research problem and study objectives explicitly at the beginning, ensuring that the study purpose is clearly presented before the literature review, highlighting the key findings, contexts, and outcomes for clarity and conciseness. We have also added integration of IT systems, the application of the Kanban method, and the comprehensive VSM-based redesign. ( Revised introduction) 2. Methods Include a brief summary of participant demographics (e.g., number and roles of pharmacists, warehouse staff, assistants) to improve transparency and understanding of the context. Specify the data collection timeframe and duration of each research phase (e.g., planning, implementation, observation) more clearly to help readers understand the study period and process scope. Response: We have added a concise description of participant demographics, including the number and roles of pharmacists, pharmacy assistants, and warehouse staff involved. In addition, the revised Methods section specifies the timeframe of data collection and provides details on the duration of each research (Revised introduction Method , Participants, VSM tool involves five steps,) 4. Results In Table 2, it would be helpful to clearly distinguish between processing time and waiting time for each step to better align with the result in the table 3. Consider replacing the labels “current” and “future” states with “before” and “after”, as the new system has already been implemented. This will more accurately reflect the temporal progression and outcomes of the intervention. Response: Table 2 has been revised to clearly separate processing time and waiting time for each step, which aligns with the results presented in Table 3. Moreover, we have replaced the labels “current” and “future” states with “before” and “after,” to more accurately reflect the temporal progression and outcomes following the intervention. 5. Discussion Expand on the sustainability and scalability of the improved system. How will the hospital ensure long-term adoption, staff training, regular data updates, and system evaluation? Address how the IT infrastructure and human resources will support ongoing use. Compare findings more clearly to previous Thai studies and global case studies, emphasizing what this study adds. Response: We have expanded the Discussion section to address sustainability and scalability. We also added a more explicit comparison between our findings, previous Thai studies, and global case studies, highlighting how our integrated e-Kanban–VSM approach with IT support provides a distinctive contribution ( Revised Dicussion, Sugestion ) 6. Limitations The limitations are thorough, but consider adding commentary on potential resistance to change in healthcare environments when implementing new IT systems. Response: We have included additional commentary on the potential resistance to change in healthcare environments when implementing new IT-based systems. This provides a more balanced view of the challenges in applying our approach.( Revised Limitation) 7. Conclusion The conclusion is appropriate but consider emphasizing: Practical policy implications (e.g., how this model can inform regional hospital networks). The feasibility of replication in other small-to-mid-sized hospitals. The importance of continued monitoring through Lean cycles (e.g., annual PDSA reviews). Response: We highlight the feasibility of replicating this system in other small- to mid-sized hospitals and stress the importance of ongoing monitoring using Lean cycles, such as annual PDSA reviews, to ensure continuous improvement. (Revised Suggestion) We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. 1. Introduction and Literature Review The research problem and study objectives should be clearly stated at the beginning of the introduction. Currently, these are embedded within a long narrative, which may obscure the purpose of the study. Since the manuscript integrates the introduction and literature review, it is recommended to present the study objectives early, before detailing the literature. The literature review is lengthy and contains some repetition, particularly in the sections discussing international applications of VSM. To enhance clarity and conciseness, consider summarizing similar case studies in a comparative table or highlighting the key findings, settings, and outcomes. Clarify the novelty of your study compared to existing Thai studies. What distinguishes your approach, IT integration, Kanban system, etc.? Response: We appreciate this valuable suggestion. In the revised manuscript, we have restructured the introduction to state the research problem and study objectives explicitly at the beginning, ensuring that the study purpose is clearly presented before the literature review, highlighting the key findings, contexts, and outcomes for clarity and conciseness. We have also added integration of IT systems, the application of the Kanban method, and the comprehensive VSM-based redesign. ( Revised introduction) 2. Methods Include a brief summary of participant demographics (e.g., number and roles of pharmacists, warehouse staff, assistants) to improve transparency and understanding of the context. Specify the data collection timeframe and duration of each research phase (e.g., planning, implementation, observation) more clearly to help readers understand the study period and process scope. Response: We have added a concise description of participant demographics, including the number and roles of pharmacists, pharmacy assistants, and warehouse staff involved. In addition, the revised Methods section specifies the timeframe of data collection and provides details on the duration of each research (Revised introduction Method , Participants, VSM tool involves five steps,) 4. Results In Table 2, it would be helpful to clearly distinguish between processing time and waiting time for each step to better align with the result in the table 3. Consider replacing the labels “current” and “future” states with “before” and “after”, as the new system has already been implemented. This will more accurately reflect the temporal progression and outcomes of the intervention. Response: Table 2 has been revised to clearly separate processing time and waiting time for each step, which aligns with the results presented in Table 3. Moreover, we have replaced the labels “current” and “future” states with “before” and “after,” to more accurately reflect the temporal progression and outcomes following the intervention. 5. Discussion Expand on the sustainability and scalability of the improved system. How will the hospital ensure long-term adoption, staff training, regular data updates, and system evaluation? Address how the IT infrastructure and human resources will support ongoing use. Compare findings more clearly to previous Thai studies and global case studies, emphasizing what this study adds. Response: We have expanded the Discussion section to address sustainability and scalability. We also added a more explicit comparison between our findings, previous Thai studies, and global case studies, highlighting how our integrated e-Kanban–VSM approach with IT support provides a distinctive contribution ( Revised Dicussion, Sugestion ) 6. Limitations The limitations are thorough, but consider adding commentary on potential resistance to change in healthcare environments when implementing new IT systems. Response: We have included additional commentary on the potential resistance to change in healthcare environments when implementing new IT-based systems. This provides a more balanced view of the challenges in applying our approach.( Revised Limitation) 7. Conclusion The conclusion is appropriate but consider emphasizing: Practical policy implications (e.g., how this model can inform regional hospital networks). The feasibility of replication in other small-to-mid-sized hospitals. The importance of continued monitoring through Lean cycles (e.g., annual PDSA reviews). Response: We highlight the feasibility of replicating this system in other small- to mid-sized hospitals and stress the importance of ongoing monitoring using Lean cycles, such as annual PDSA reviews, to ensure continuous improvement. (Revised Suggestion) We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn Competing Interests: The authors declare no competing interests. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 01 Oct 2025 Praewchit Ritthaisong , Khon Kaen University, Nai Mueang, Thailand 01 Oct 2025 Author Response Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design ... Continue reading Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. 1. Introduction and Literature Review The research problem and study objectives should be clearly stated at the beginning of the introduction. Currently, these are embedded within a long narrative, which may obscure the purpose of the study. Since the manuscript integrates the introduction and literature review, it is recommended to present the study objectives early, before detailing the literature. The literature review is lengthy and contains some repetition, particularly in the sections discussing international applications of VSM. To enhance clarity and conciseness, consider summarizing similar case studies in a comparative table or highlighting the key findings, settings, and outcomes. Clarify the novelty of your study compared to existing Thai studies. What distinguishes your approach, IT integration, Kanban system, etc.? Response: We appreciate this valuable suggestion. In the revised manuscript, we have restructured the introduction to state the research problem and study objectives explicitly at the beginning, ensuring that the study purpose is clearly presented before the literature review, highlighting the key findings, contexts, and outcomes for clarity and conciseness. We have also added integration of IT systems, the application of the Kanban method, and the comprehensive VSM-based redesign. ( Revised introduction) 2. Methods Include a brief summary of participant demographics (e.g., number and roles of pharmacists, warehouse staff, assistants) to improve transparency and understanding of the context. Specify the data collection timeframe and duration of each research phase (e.g., planning, implementation, observation) more clearly to help readers understand the study period and process scope. Response: We have added a concise description of participant demographics, including the number and roles of pharmacists, pharmacy assistants, and warehouse staff involved. In addition, the revised Methods section specifies the timeframe of data collection and provides details on the duration of each research (Revised introduction Method , Participants, VSM tool involves five steps,) 4. Results In Table 2, it would be helpful to clearly distinguish between processing time and waiting time for each step to better align with the result in the table 3. Consider replacing the labels “current” and “future” states with “before” and “after”, as the new system has already been implemented. This will more accurately reflect the temporal progression and outcomes of the intervention. Response: Table 2 has been revised to clearly separate processing time and waiting time for each step, which aligns with the results presented in Table 3. Moreover, we have replaced the labels “current” and “future” states with “before” and “after,” to more accurately reflect the temporal progression and outcomes following the intervention. 5. Discussion Expand on the sustainability and scalability of the improved system. How will the hospital ensure long-term adoption, staff training, regular data updates, and system evaluation? Address how the IT infrastructure and human resources will support ongoing use. Compare findings more clearly to previous Thai studies and global case studies, emphasizing what this study adds. Response: We have expanded the Discussion section to address sustainability and scalability. We also added a more explicit comparison between our findings, previous Thai studies, and global case studies, highlighting how our integrated e-Kanban–VSM approach with IT support provides a distinctive contribution ( Revised Dicussion, Sugestion ) 6. Limitations The limitations are thorough, but consider adding commentary on potential resistance to change in healthcare environments when implementing new IT systems. Response: We have included additional commentary on the potential resistance to change in healthcare environments when implementing new IT-based systems. This provides a more balanced view of the challenges in applying our approach.( Revised Limitation) 7. Conclusion The conclusion is appropriate but consider emphasizing: Practical policy implications (e.g., how this model can inform regional hospital networks). The feasibility of replication in other small-to-mid-sized hospitals. The importance of continued monitoring through Lean cycles (e.g., annual PDSA reviews). Response: We highlight the feasibility of replicating this system in other small- to mid-sized hospitals and stress the importance of ongoing monitoring using Lean cycles, such as annual PDSA reviews, to ensure continuous improvement. (Revised Suggestion) We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. 1. Introduction and Literature Review The research problem and study objectives should be clearly stated at the beginning of the introduction. Currently, these are embedded within a long narrative, which may obscure the purpose of the study. Since the manuscript integrates the introduction and literature review, it is recommended to present the study objectives early, before detailing the literature. The literature review is lengthy and contains some repetition, particularly in the sections discussing international applications of VSM. To enhance clarity and conciseness, consider summarizing similar case studies in a comparative table or highlighting the key findings, settings, and outcomes. Clarify the novelty of your study compared to existing Thai studies. What distinguishes your approach, IT integration, Kanban system, etc.? Response: We appreciate this valuable suggestion. In the revised manuscript, we have restructured the introduction to state the research problem and study objectives explicitly at the beginning, ensuring that the study purpose is clearly presented before the literature review, highlighting the key findings, contexts, and outcomes for clarity and conciseness. We have also added integration of IT systems, the application of the Kanban method, and the comprehensive VSM-based redesign. ( Revised introduction) 2. Methods Include a brief summary of participant demographics (e.g., number and roles of pharmacists, warehouse staff, assistants) to improve transparency and understanding of the context. Specify the data collection timeframe and duration of each research phase (e.g., planning, implementation, observation) more clearly to help readers understand the study period and process scope. Response: We have added a concise description of participant demographics, including the number and roles of pharmacists, pharmacy assistants, and warehouse staff involved. In addition, the revised Methods section specifies the timeframe of data collection and provides details on the duration of each research (Revised introduction Method , Participants, VSM tool involves five steps,) 4. Results In Table 2, it would be helpful to clearly distinguish between processing time and waiting time for each step to better align with the result in the table 3. Consider replacing the labels “current” and “future” states with “before” and “after”, as the new system has already been implemented. This will more accurately reflect the temporal progression and outcomes of the intervention. Response: Table 2 has been revised to clearly separate processing time and waiting time for each step, which aligns with the results presented in Table 3. Moreover, we have replaced the labels “current” and “future” states with “before” and “after,” to more accurately reflect the temporal progression and outcomes following the intervention. 5. Discussion Expand on the sustainability and scalability of the improved system. How will the hospital ensure long-term adoption, staff training, regular data updates, and system evaluation? Address how the IT infrastructure and human resources will support ongoing use. Compare findings more clearly to previous Thai studies and global case studies, emphasizing what this study adds. Response: We have expanded the Discussion section to address sustainability and scalability. We also added a more explicit comparison between our findings, previous Thai studies, and global case studies, highlighting how our integrated e-Kanban–VSM approach with IT support provides a distinctive contribution ( Revised Dicussion, Sugestion ) 6. Limitations The limitations are thorough, but consider adding commentary on potential resistance to change in healthcare environments when implementing new IT systems. Response: We have included additional commentary on the potential resistance to change in healthcare environments when implementing new IT-based systems. This provides a more balanced view of the challenges in applying our approach.( Revised Limitation) 7. Conclusion The conclusion is appropriate but consider emphasizing: Practical policy implications (e.g., how this model can inform regional hospital networks). The feasibility of replication in other small-to-mid-sized hospitals. The importance of continued monitoring through Lean cycles (e.g., annual PDSA reviews). Response: We highlight the feasibility of replicating this system in other small- to mid-sized hospitals and stress the importance of ongoing monitoring using Lean cycles, such as annual PDSA reviews, to ensure continuous improvement. (Revised Suggestion) We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn Competing Interests: The authors declare no competing interests. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 31 Mar 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 3 (revision) 15 Apr 26 Version 2 (revision) 09 Oct 25 read read read Version 1 31 Mar 25 read read Rungpetch Sakulbumrungsil , Chulalongkorn University, Pathumwan, Thailand; College of Pharmacy Administration, Thailand, Thailand Puree Anantachoti , Chulalongkorn University, Bangkok, Thailand Aamir Rashid , City University of New York (CUNY), New York, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Rashid A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Feb 2026 | for Version 2 Aamir Rashid , City University of New York (CUNY), New York, New York, USA 0 Views copyright © 2026 Rashid A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for your research on this interesting topic. While the manuscript is thoughtfully developed, a thorough reading has revealed several concerns that warrant critical attention. The manuscript relies on a single-site action research case without a clearly articulated theoretical contribution beyond well-established Lean and VSM principles. While the operational improvements are quantified, the study remains confirmatory, reiterating known benefits of VSM rather than extending theory in healthcare operations or supply chain management. The research design lacks rigor in inference. Outcomes are framed as “expected” improvements based on future-state mapping rather than empirically validated post-implementation results, which weakens causal claims. The absence of longitudinal follow-up or comparative benchmarking limits internal validity and generalizability. Conceptually, “waste” is narrowly operationalized as time-based inefficiency, without engagement with inventory cost, service-level risk, or patient-safety trade-offs. This constrains the managerial and policy relevance of the findings. Moreover, the linkage between identified problems (shortages and expiries) and measured outcomes is indirect and insufficiently theorized. The manuscript’s scholarly positioning is modest. It draws heavily on applied healthcare and Lean literature but does not engage deeply with core supply chain, operations management, or inventory theory debates, limiting its contribution to a largely practice-oriented audience. The paper is suitable as a local applied case, but its contribution remains incremental rather than field-advancing. Methodologically, the study confuses process redesign with performance validation. Most reported improvements are expected or projected based on future-state mapping rather than empirically observed post-implementation outcomes. This undermines causal inference and weakens claims of effectiveness. The absence of a before–and–after comparison using realized data, or any counterfactual logic, is a major limitation. The action research design is under-specified. The roles of participants, decision authority, and potential bias introduced through participatory mapping are not critically discussed. The focus group process is described procedurally but not analytically, leaving uncertainty about how consensus was reached or how conflicting perspectives were handled. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Supply Chain Management I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 15 Apr 2026 Praewchit Ritthaisong, Khon Kaen University, Nai Mueang, Thailand Dear Reviewer, We sincerely thank you for your careful and insightful review. Your comments have been extremely valuable in improving the scientific clarity, methodological transparency, and theoretical positioning of our manuscript. Below we address each concern in detail. Comment 1: Limited theoretical contribution beyond Lean/VSM principles Response: Thank you for this important comment. We clarified that the study aims to extend the application of VSM to hospital pharmaceutical inventory management within a resource-constrained healthcare context. Additional discussion has been incorporated to position the study within healthcare operations and implementation science, emphasizing contextual adaptation, multidisciplinary participation, and integration with medication safety and shortage prevention. Comment 2: Outcomes are projected rather than empirically validated Response: We agree that future-state mapping represents expected performance. The manuscript has been revised to clearly distinguish between “projected improvement” and “observed outcomes”. We removed causal wording and now describe the findings as process redesign potential. We also added a statement in the limitations that full effectiveness requires post-implementation monitoring and longitudinal evaluation. Comment 3: Narrow conceptualization of waste Response: Additional explanation has been inserted in the Discussion linking process delay to medication availability risk and service continuity in hospital pharmacy systems. Comment 4: Limited engagement with supply chain and inventory theory Response: Thank you for this insightful comment. We agree that the manuscript primarily presents an applied case study. To strengthen the scholarly positioning, we have revised the Discussion section to better connect the findings with inventory management and supply chain management concepts. Specifically, the study now highlights how VSM-based redesign supports inventory control through reduced replenishment intervals, improved inventory visibility, and sub-stock management. These elements relate to core inventory management principles Comment 5: Lack of before-after comparison and causal inference Response: Thank you for this important comment. We clarified that the study is a process design and improvement study rather than an effectiveness evaluation. Accordingly, claims of effectiveness have been moderated throughout the manuscript, and a limitation statement has been added to emphasize that causal impact requires evaluation after implementation using realized data. Comment 6: Action research roles and focus group analysis unclear Response: We added details describing participant roles, decision authority, and consensus process. We also described how disagreements were resolved using structured facilitation and iterative validation sessions to reduce bias. We believe these revisions significantly improve the rigor, transparency, and positioning of the manuscript. We are grateful for your constructive feedback which has strengthened the study. Kind regards, Praewchit Ritthaisong View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Rashid A. Peer Review Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r447435) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-447435 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Anantachoti P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Feb 2026 | for Version 2 Puree Anantachoti , Chulalongkorn University, Bangkok, Bangkok, Thailand 0 Views copyright © 2026 Anantachoti P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I am satisfied with the revisions made to the manuscript. Given the improvements, I recommend that this manuscript be accepted for indexing. Competing Interests No competing interests were disclosed. Reviewer Expertise Social pharmacy, Administrative pharmacy, Health and Pharmacy policy, Access to medicine, Regulatory Sciences I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 16 Feb 2026 Praewchit Ritthaisong, Khon Kaen University, Nai Mueang, Thailand Dear Reviewer, Thank you very much for your time and for carefully reviewing our manuscript. We sincerely appreciate your positive evaluation and your recommendation that the manuscript is suitable for indexing. Your feedback has been very valuable in improving the clarity and quality of our work. We are grateful for your expertise and thoughtful assessment, and we hope our study will contribute to the field of hospital pharmacy operations and inventory management. Kind regards, Praewchit Ritthaisong View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Anantachoti P. Peer Review Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r422120) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-422120 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Sakulbumrungsil R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Jan 2026 | for Version 2 Rungpetch Sakulbumrungsil , Chulalongkorn University, Pathumwan, Thailand; College of Pharmacy Administration, Thailand, Thailand 0 Views copyright © 2026 Sakulbumrungsil R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the revised manuscript and the detailed responses to the previous review. The revisions have improved the clarity of the introduction and strengthened the overall narrative coherence. However, several issues remain that should be addressed before the manuscript can be considered for indexing. 1. Clarification and Explicit Statement of Research Objectives The overarching aim of the study is to develop a new inventory management system. To ensure consistency across the manuscript, the research objectives should be stated explicitly and concisely. I recommend formulating them as follows: 1. To analyze the current inventory management workflow using Value Stream Mapping (VSM) in order to identify inefficiencies. 2. To design a future-state inventory management system based on the findings from the workflow analysis. Presenting the objectives clearly will improve alignment between the Introduction, Methods, and Conclusion sections. 2. Strengthen the Conclusion Section The conclusion should more clearly highlight two essential points: • The redesigned system is expected to improve efficiency based on the projected reductions in lead time and process time. • The actual impact of the redesigned system will depend on full implementation and subsequent monitoring, including follow-up evaluation and iterative improvement cycles. Explicitly acknowledging these points will strengthen the study’s implications and appropriately frame the scope of the current findings. 3. Inclusion of a Conceptual Workflow Figure To enhance reader understanding of the research process, please consider adding a conceptual figure summarizing the main steps of the study. A simple diagram illustrating the progression Current State → VSM Analysis → Redesign Process → Future State would provide a helpful visual overview of the methodology, particularly for readers who are less familiar with Lean or action research approaches. 4. Review for Grammatical Completeness and Coherent Sentence Structure To ensure readability and academic quality, I recommend that the authors conduct a thorough, manuscript-wide revision focusing on: • grammatical accuracy, • sentence completeness, • clarity and coherence of ideas, and • consistency in terminology across sections. A full-language review will help improve the overall clarity and professionalism of the paper. Overall Recommendation: Revisions Required This manuscript addresses an important issue in hospital pharmacy operations and offers a practical application of VSM within a real-world healthcare setting. With the additional revisions noted above, the manuscript will be further strengthened and more suitable for indexing. Competing Interests No competing interests were disclosed. Reviewer Expertise inventory management I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 15 Apr 2026 Praewchit Ritthaisong, Khon Kaen University, Nai Mueang, Thailand Dear Reviewer, We sincerely thank you for your constructive comments and for recognizing the improvements made in the revised manuscript. Your suggestions have been very helpful in further strengthening the clarity and consistency of our work. Below we address each point in detail. Comment 1: Clarification of research objectives Response: The research objectives have now been explicitly stated in the Introduction section and aligned across the manuscript. The objectives are now presented as: (1) To analyze the current inventory management workflow using Value Stream Mapping (VSM) to identify inefficiencies, and (2) To design a future-state inventory management system based on the workflow analysis findings. Comment 2: Strengthening the conclusion section Response: The Conclusion has been revised to clearly distinguish between projected efficiency improvement and actual impact after implementation. We now explicitly state that the redesigned system is expected to improve efficiency based on reductions in lead time and process time, while acknowledging that real-world effectiveness depends on full implementation and continuous monitoring and improvement cycles. Comment 3: Addition of conceptual workflow figure Response: A conceptual workflow figure illustrating the research process (Current State → VSM Analysis → Redesign Process → Future State) has been added to the introduction section to improve reader understanding of the study design. Comment 4: Language and grammatical revision Response: The entire manuscript has undergone a comprehensive language review to improve grammatical accuracy, sentence structure, clarity of ideas, and consistency of terminology across all sections. We greatly appreciate your thoughtful feedback, which has significantly improved the quality and clarity of the manuscript. Kind regards, Praewchit Ritthaisong View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Sakulbumrungsil R. Peer Review Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.189130.r422121) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-365/v2#referee-response-422121 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Anantachoti P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Aug 2025 | for Version 1 Puree Anantachoti , Chulalongkorn University, Bangkok, Bangkok, Thailand 0 Views copyright © 2025 Anantachoti P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Editor in Chief/ Corresponding Author, I have reviewed your manuscript titled "Application of Value Stream Mapping to Design and Develop an Inventory Management System in a Hospital." Overall, this study presented an interesting and relevant application of Value Stream Mapping (VSM) within a hospital setting. The action research approach, which focuses on solving a practical problem and sharing the experience, is highly valuable for other healthcare institutions that might consider applying VSM to their own inventory management challenges. The potential for practical impact is a significant strength of this manuscript. However, I found that the manuscript needs to be improved not only in writing style and conciseness, English language proofreading, but also strengthen the research methodology part. Detailed comments are provided below. Abstract 1. Introduction in the abstract captured only one side of the problem. As you mentioned “Insufficient drug reserves in hospitals ready for immediate use pose significant challenges in the management, procurement, and distribution of medications. Therefore, there is a critical need for improved resource management processes, ensuring a balanced and efficient medication reserve system. Lean Management is a systematic approach designed to eliminate waste, thereby reducing costs and enhancing efficiency, making it more effective than other management systems.” My issues are: 1.1 In the full manuscript, you are not only focused on insufficient, but also on over stockpiles too. 1.2 The information presented is contradicted. You started with insufficient drug reserve, but your next supporting sentence talked about elimination waste. 2. The objective was stated as “In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse managementsystem.” 2.1 Spelling managementsystem change to management system 2.2 The objective and results are not matched. The objective is to use the VSM as a framework to only analyzed the workflow process, but the result provide broader activities finally propose a solution. 3. Shortening the introduction, but described more key methodology part e.g. who are involved participants, their qualification, key variables of interest, method of data collection (focus group, in-depth interview, consensus method, Delphi method???) 4. Result part reflected that the key outcome is “work efficiency” which measuring by 1) number of steps in workflow and 2) type of work time reduction. This 2 key outcome were not at all mentioned in the introduction part. Similarly, the introduction mentioned about shortage and over stockpiles, but the result did not include them. 5. Conclusion “Design of work systems by those involved. This is a tool that helps reduce waste and has been developed collaboratively to make operations run more smoothly.” 5.1 This part should provide short summary to your objective. 5.2 First sentence is not a sentence. Please correct. Introduction 6. Please shorten the introduction. When reviewing the literature, please summarize, compare and contrast them instead of narratively describing each of them. 7. I would like to see you summarize key outcomes that align with the study's objectives stated in the introduction part. 8. Sequence of story telling in the introduction part may have to shuffle. May be talking about problems and problem solving (from literature review) first, then problem specific to your hospital (which is the gap of the study), then objective. 9. The objective stated in the last paragraph of the introduction is that“The objective of this study was to identify inefficiencies and challenges within the medical supply inventory management system, to reduce waste and optimize processes using Value Stream Mapping (VSM), and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness.” 9.1 I think your ultimate goal is to develop new inventory management system. But the process to reach the goal is that you 1) have to analyzed current workflow to identify problems and 2) use VSM as a framework and involve stakeholders to propose new management system. Your first and second objectives are just processes to reach your ultimate objective. Methodology 10. I understand that to answer the objective, there were many steps of work. Please make sure that for each step , you provide clear methodology elements e.g. 10.1 Study design Action research can be used as a study design as it’s a broad term. But for each specific step, you might use different design e.g. in-depth interview, focus group, consensus method etc. Please be more specific. 10.2 Sample - Qualification (eligibility criteria) -Number of samples (how many samples needed to ensure validity of answers) 10.3 Measurement - What outcomes were you seeking in each step. How did you measure it. These outcomes should reflect what you showed in the result section. Also, you measured work time, whether you interview to get the time, or you retrieve time from computer system? If many product items generate their own time, how would you calculate the reported time? - Some outcome may need to be operationalized e.g. waste As a reader, I’m not sure whether waste refers to expired over stockpiles. Since I did not see you measuring waste in terms of volume or value of products, but you measuring work time. I am not sure if you refer wasting time as waste or not. - What question guide do you use - Whether the questions valid 10.4 Data analysis What data analysis method were use? Results 11. The figure clearly portrait the workflow both current situation and proposed solution. But the color and the font size make it difficult to read. 12. Reporting style Under the “Value stream mapping” topic. Though understand that the Value stream mapping compose of 3 parts, but part 1 also showed in part 3. Part 2 is relevant to Figure 1. When putting together as result, you should summarized things that can be combined to make it short but still keep its clarity. 13. After table 1, there is a word “working period” come out of nowhere. Please consider deleting it. 14. Sub-topic Future work system I suggested paraphrase “Future work system “ to “proposed work system” Writing style. The result section is very long. You should synthesize first and laid down the content ที่ประมวลแล้ว in a clear and shorter version. I’m not sure whether this proposed work system came from researchers’ opinions or from the participants’ consensus? Please clarify both in the methodology and in the result. Discussion 15. In general, 1) do not repeat results in discussion and 2) make it short for each issue raised. 16. In the first discussion paragraph, please provide unique key findings or key strength of the study. 17. Many previous studies showed in discussion should be described in the introduction. When mentioned about previous studies, their findings should be compared or contrasted with your findings. 18. Limitation and suggestions (or recommendations) should be included under discussion section. Conclusion The conclusion should be the last part of the manuscript’s content. Ethics and consent You already mentioned about ethical approval at the very beginning of the methodology section. If this is the journal’s format, please delete the one in methodology section. It should not be redundant. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Social pharmacy, Administrative pharmacy, Health and Pharmacy policy, Access to medicine, Regulatory Sciences I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 09 Oct 2025 Praewchit Ritthaisong, Khon Kaen University, Nai Mueang, Thailand Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. Abstract 1. Introduction in the abstract captured only one side of the problem. As you mentioned “Insufficient drug reserves in hospitals ready for immediate use pose significant challenges in the management, procurement, and distribution of medications. Therefore, there is a critical need for improved resource management processes, ensuring a balanced and efficient medication reserve system. Lean Management is a systematic approach designed to eliminate waste, thereby reducing costs and enhancing efficiency, making it more effective than other management systems.” My issues are: 1.1 In the full manuscript, you are not only focused on insufficient, but also on over stockpiles too. 1.2 The information presented is contradicted. You started with insufficient drug reserve, but your next supporting sentence talked about elimination waste. Response: (Revised AbstractàIntroduction) 1.1We thank the reviewer for this important observation. In the revised abstract, we have modified the introduction to mention both insufficient reserves and overstockpiling as dual challenges 1.2We have rephrased the abstract to improve logical flow, presenting both shortage and overstock before linking to Lean Management and VSM 2. The objective was stated as “In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse managementsystem.” 2.1 Spelling managementsystem change to management system 2.2 The objective and results are not matched. The objective is to use the VSM as a framework to only analyzed the workflow process, but the result provide broader activities finally propose a solution. Response: (Revised Abstract) 2.1 Corrected as suggested. 2.2 We have revised the abstract objective to better align with the study’s scope and outcomes 3. Shortening the introduction, but described more key methodology part e.g. who are involved participants, their qualification, key variables of interest, method of data collection (focus group, in-depth interview, consensus method, Delphi method???) Response: (Revised Abstract -> method) As suggested, the abstract has been shortened, and key methodological details have been added. We briefly report the number and roles of participants, their qualifications, the main variables of interest, and data collection methods (focus groups discussion). 4. Result part reflected that the key outcome is “work efficiency” which measuring by 1) number of steps in workflow and 2) type of work time reduction. This 2 key outcome were not at all mentioned in the introduction part. Similarly, the introduction mentioned about shortage and over stockpiles, but the result did not include them. Response: (Revised Abstract -> Result) We appreciate this comment. The revised abstract now states that the study outcomes included workflow simplification (number of steps reduced) and time reduction. At the same time, references to shortages and overstock have been clarified as motivating problems, while results focus on the efficiency metrics that were directly measured. 5. Conclusion “Design of work systems by those involved. This is a tool that helps reduce waste and has been developed collaboratively to make operations run more smoothly.” 5.1 This part should provide short summary to your objective. 5.2 First sentence is not a sentence. Please correct. Response: (Revised Abstract -> conclusion) 5.1 We revised the abstract conclusion to briefly restate the objective and demonstrate how it was achieved. 5.2 Corrected to a complete sentence Introduction ( Revised Introduction) 6. Please shorten the introduction. When reviewing the literature, please summarize, compare and contrast them instead of narratively describing each of them. Response: We have shortened the introduction, synthesized related studies. 7. I would like to see you summarize key outcomes that align with the study's objectives stated in the introduction part. Response: We added a summary of the key outcomes in the introduction to ensure alignment between objectives and results. 8. Sequence of story telling in the introduction part may have to shuffle. May be talking about problems and problem solving (from literature review) first, then problem specific to your hospital (which is the gap of the study), then objective. Response: The introduction has been reorganized accordingly. 9. The objective stated in the last paragraph of the introduction is that“The objective of this study was to identify inefficiencies and challenges within the medical supply inventory management system, to reduce waste and optimize processes using Value Stream Mapping (VSM), and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness.” 9.1 I think your ultimate goal is to develop new inventory management system. But the process to reach the goal is that you 1) have to analyzed current workflow to identify problems and 2) use VSM as a framework and involve stakeholders to propose new management system. Your first and second objectives are just processes to reach your ultimate objective. Response: We thank the reviewer for this clarification. The objective has been revised to emphasize the ultimate aim: “to design and develop a new medical supply inventory management system that is efficient and effective by analyzing current inventory management processes to identify inefficiencies, applying Value Stream Mapping (VSM) as a framework for designing the new system, and improving processes to reduce waste and enhance system efficiency. Methodology 10. I understand that to answer the objective, there were many steps of work. Please make sure that for each step, you provide clear methodology elements e.g. 10.1 Study design Action research can be used as a study design as it’s a broad term. But for each specific step, you might use different design e.g. in-depth interview, focus group, consensus method etc. Please be more specific. 10.2 Sample - Qualification (eligibility criteria) -Number of samples (how many samples needed to ensure validity of answers) 10.3 Measurement - What outcomes were you seeking in each step. How did you measure it. These outcomes should reflect what you showed in the result section. Also, you measured work time, whether you interview to get the time, or you retrieve time from computer system? If many product items generate their own time, how would you calculate the reported time? - Some outcome may need to be operationalized e.g. waste As a reader, I’m not sure whether waste refers to expired over stockpiles. Since I did not see you measuring waste in terms of volume or value of products, but you measuring work time. I am not sure if you refer wasting time as waste or not. - What question guide do you use - Whether the questions valid 10.4 Data analysis What data analysis method were use? Response: 10.1 We clarified that Action Research served as the overarching design. Specific methods included focus group discussions for problem identification, and consensus-building workshops for system design. ( Revised methodology) 10.2 We added eligibility criteria and detailed the participant composition: pharmacists, pharmacy assistants, and warehouse staff (22 participants in total). ( Revised Participants) 10.3 We clarified that process time was measured and validated against electronic system data. Waste was defined as non–value-added time. Expired stock was acknowledged but not measured; instead, waste in this study referred to workflow inefficiencies. The question guide used in focus groups was reviewed by three experts to ensure content validity. (Revised Procedures and Data Collection, Outcomes and Measurements) 10.4 We revised the methodology to specify descriptive statistics for time data, comparative analysis of workflow steps, and thematic content analysis for qualitative inputs . ( Revised Data Analysis ) Results 11. The figure clearly portrait the workflow both current situation and proposed solution. But the color and the font size make it difficult to read. Response: Figure 1 was reformatted with larger fonts, clearer labels, for better readability. 12. Reporting style Under the “Value stream mapping” topic. Though understand that the Value stream mapping compose of 3 parts, but part 1 also showed in part 3. Part 2 is relevant to Figure 1. When putting together as result, you should summarized things that can be combined to make it short but still keep its clarity. Response: Reporting style under Value Stream Mapping is repetitive. Response: We have synthesized overlapping points, reduced redundancy, and reorganized subsections to maintain clarity and conciseness. ( Revised Result ) 13. After table 1, there is a word “working period” come out of nowhere. Please consider deleting it. Response: Deleted as suggested. 14. Sub-topic Future work system I suggested paraphrase “Future work system “ to “proposed work system” Writing style. The result section is very long. You should synthesize first and laid down the content ที่ประมวลแล้ว in a clear and shorter version. I’m not sure whether this proposed work system came from researchers’ opinions or from the participants’ consensus? Please clarify both in the methodology and in the result. Response: Subheading has been changed to “Proposed work system.” We also clarified that the design was primarily researcher-developed, with input and validation from participants through focus group consensus. (Revised Proposed work system) Discussion . (Revised Discussion) 15. In general, 1) do not repeat results in discussion and 2) make it short for each issue raised. Response: The discussion was revised to avoid repetition and concisely address each issue. 16. In the first discussion paragraph, please provide unique key findings or key strength of the study. Response: The first paragraph of the Discussion now highlights unique contributions 17. Many previous studies showed in discussion should be described in the introduction. When mentioned about previous studies, their findings should be compared or contrasted with your findings. Response: Relevant literature has been moved to the Introduction. In the Discussion, previous findings are explicitly compared and contrasted with our study’s outcomes. 18. Limitation and suggestions (or recommendations) should be included under discussion section. Response: We have merged the limitations and recommendations into the final part of the Discussion, highlighting potential resistance to change, IT requirements, and scalability. Conclusion The conclusion should be the last part of the manuscript’s content. Response: Corrected as suggested. Ethics and consent You already mentioned about ethical approval at the very beginning of the methodology section. If this is the journal’s format, please delete the one in methodology section. It should not be redundant. Response: Revised as suggested. Ethical approval is now presented only in the Ethics section. We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn View more View less Competing Interests The authors declare no competing interests. reply Respond Report a concern Anantachoti P. Peer Review Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.175507.r391377) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-365/v1#referee-response-391377 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Sakulbumrungsil R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Aug 2025 | for Version 1 Rungpetch Sakulbumrungsil , Chulalongkorn University, Pathumwan, Thailand; College of Pharmacy Administration, Thailand, Thailand 0 Views copyright © 2025 Sakulbumrungsil R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript presents a valuable case study in the hospital inventory management. It offers a solid contribution to the field of lean operations improvement. The methodology is sound and the transformation plan is logically constructed. The outcomes, particularly the improvements in lead time, process time, and activity ratio, are well-documented. Areas for Revision 1. Introduction and Literature Review The research problem and study objectives should be clearly stated at the beginning of the introduction. Currently, these are embedded within a long narrative, which may obscure the purpose of the study. Since the manuscript integrates the introduction and literature review, it is recommended to present the study objectives early, before detailing the literature. The literature review is lengthy and contains some repetition, particularly in the sections discussing international applications of VSM. To enhance clarity and conciseness, consider summarizing similar case studies in a comparative table or highlighting the key findings, settings, and outcomes. Clarify the novelty of your study compared to existing Thai studies. What distinguishes your approach, IT integration, Kanban system, etc.? 2. Methods Include a brief summary of participant demographics (e.g., number and roles of pharmacists, warehouse staff, assistants) to improve transparency and understanding of the context. Specify the data collection timeframe and duration of each research phase (e.g., planning, implementation, observation) more clearly to help readers understand the study period and process scope. 4. Results In Table 2, it would be helpful to clearly distinguish between processing time and waiting time for each step to better align with the result in the table 3. Consider replacing the labels “current” and “future” states with “before” and “after”, as the new system has already been implemented. This will more accurately reflect the temporal progression and outcomes of the intervention. 5. Discussion Expand on the sustainability and scalability of the improved system. How will the hospital ensure long-term adoption, staff training, regular data updates, and system evaluation? Address how the IT infrastructure and human resources will support ongoing use. Compare findings more clearly to previous Thai studies and global case studies, emphasizing what this study adds. 6. Limitations The limitations are thorough, but consider adding commentary on potential resistance to change in healthcare environments when implementing new IT systems. 7. Conclusion The conclusion is appropriate but consider emphasizing: Practical policy implications (e.g., how this model can inform regional hospital networks). The feasibility of replication in other small-to-mid-sized hospitals. The importance of continued monitoring through Lean cycles (e.g., annual PDSA reviews). Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise inventory management I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 01 Oct 2025 Praewchit Ritthaisong, Khon Kaen University, Nai Mueang, Thailand Title: Author Response to Reviewers Dear Reviewers , We sincerely thank you for your careful reading, constructive comments, and valuable suggestions on our manuscript “Application of value stream mapping to design and develop an inventory management system in a hospital.” We have revised the manuscript accordingly. Below, we provide a point-by-point response. 1. Introduction and Literature Review The research problem and study objectives should be clearly stated at the beginning of the introduction. Currently, these are embedded within a long narrative, which may obscure the purpose of the study. Since the manuscript integrates the introduction and literature review, it is recommended to present the study objectives early, before detailing the literature. The literature review is lengthy and contains some repetition, particularly in the sections discussing international applications of VSM. To enhance clarity and conciseness, consider summarizing similar case studies in a comparative table or highlighting the key findings, settings, and outcomes. Clarify the novelty of your study compared to existing Thai studies. What distinguishes your approach, IT integration, Kanban system, etc.? Response: We appreciate this valuable suggestion. In the revised manuscript, we have restructured the introduction to state the research problem and study objectives explicitly at the beginning, ensuring that the study purpose is clearly presented before the literature review, highlighting the key findings, contexts, and outcomes for clarity and conciseness. We have also added integration of IT systems, the application of the Kanban method, and the comprehensive VSM-based redesign. ( Revised introduction) 2. Methods Include a brief summary of participant demographics (e.g., number and roles of pharmacists, warehouse staff, assistants) to improve transparency and understanding of the context. Specify the data collection timeframe and duration of each research phase (e.g., planning, implementation, observation) more clearly to help readers understand the study period and process scope. Response: We have added a concise description of participant demographics, including the number and roles of pharmacists, pharmacy assistants, and warehouse staff involved. In addition, the revised Methods section specifies the timeframe of data collection and provides details on the duration of each research (Revised introduction Method , Participants, VSM tool involves five steps,) 4. Results In Table 2, it would be helpful to clearly distinguish between processing time and waiting time for each step to better align with the result in the table 3. Consider replacing the labels “current” and “future” states with “before” and “after”, as the new system has already been implemented. This will more accurately reflect the temporal progression and outcomes of the intervention. Response: Table 2 has been revised to clearly separate processing time and waiting time for each step, which aligns with the results presented in Table 3. Moreover, we have replaced the labels “current” and “future” states with “before” and “after,” to more accurately reflect the temporal progression and outcomes following the intervention. 5. Discussion Expand on the sustainability and scalability of the improved system. How will the hospital ensure long-term adoption, staff training, regular data updates, and system evaluation? Address how the IT infrastructure and human resources will support ongoing use. Compare findings more clearly to previous Thai studies and global case studies, emphasizing what this study adds. Response: We have expanded the Discussion section to address sustainability and scalability. We also added a more explicit comparison between our findings, previous Thai studies, and global case studies, highlighting how our integrated e-Kanban–VSM approach with IT support provides a distinctive contribution ( Revised Dicussion, Sugestion ) 6. Limitations The limitations are thorough, but consider adding commentary on potential resistance to change in healthcare environments when implementing new IT systems. Response: We have included additional commentary on the potential resistance to change in healthcare environments when implementing new IT-based systems. This provides a more balanced view of the challenges in applying our approach.( Revised Limitation) 7. Conclusion The conclusion is appropriate but consider emphasizing: Practical policy implications (e.g., how this model can inform regional hospital networks). The feasibility of replication in other small-to-mid-sized hospitals. The importance of continued monitoring through Lean cycles (e.g., annual PDSA reviews). Response: We highlight the feasibility of replicating this system in other small- to mid-sized hospitals and stress the importance of ongoing monitoring using Lean cycles, such as annual PDSA reviews, to ensure continuous improvement. (Revised Suggestion) We sincerely appreciate your time, effort, and valuable feedback, which have helped us improve the quality of our manuscript. We hope that the revised version meets your expectations, and we remain open to further suggestions. Sincerely, Praewchit and Nusaraporn View more View less Competing Interests The authors declare no competing interests. reply Respond Report a concern Sakulbumrungsil R. Peer Review Report For: Application of value stream mapping to design and develop an inventory management system in a hospital [version 2; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :365 ( https://doi.org/10.5256/f1000research.175507.r394960) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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