Consolidating circular economy, resilience and sustainability indicators for healthcare supply chain modelling

Analytical and simulation-based models rely on explicitly defined indicators to specify objectives, constraints, and outputs, shaping the trade-offs models reveal and the decisions they support. While supply chain modelling has traditionally prioritised efficiency, cost, and service level, disruption risks and environmental and social pressures have increased interest in circular economy, resilience, and sustainability (CERS). However, CERS indicators remain fragmented and are rarely operationalised in an integrated manner within modelling. This gap is particularly salient in healthcare supply chains (HSCs), where system complexity, societal criticality, and disruptions intensify trade-offs between CERS objectives. This study investigates how CERS objectives are operationalised in HSC modelling and explores their perceived importance in practice. A multi-method research design was adopted. First, a scoping review of 135 papers, indexed in Web of Science and Scopus, synthesised how CERS indicators are embedded in objectives, performance indicators, constraints, and experimental parameters in HSC models. Second, a healthcare-focused expert elicitation, including interviews and a rating exercise, interpreted and prioritised literature-derived indicators. The review identified 102 literature-derived indicators and 17 additional practice-informed indicators. Findings highlight imbalance in indicator coverage and identify potential trade-offs, with economic indicators dominating and social-related indicators underrepresented despite their practical significance. The study consolidates findings into a modelling-aligned CERS framework and illustrates how selected indicators can support modelling studies and trade-off analysis. The framework provides a structured basis for developing integrated CERS-informed HSC models.