Hospital Supply Chain Bottlenecks: An Integrative Analytical Framework for Moroccan Public Emergency Departments[La supply chain hospitalière face aux goulots d'étranglement : un cadre analytique intégratif pour les services d'urgences publics marocains]

Context: Moroccan public hospital emergency departments face growing tension between increasing healthcare demand and organizational processes still governed by first-come, first-served rules, indifferent to patient clinical severity. This mismatch generates structural congestion phenomena that are organizational in nature, not capacitary. Gap: Despite substantial international literature on emergency department crowding, research specific to the Moroccan public hospital context remains scarce and fragmented (El Fakir et al., 2016). No integrative analytical framework explicitly articulates, for this context, managerial focusing theories, mathematical queuing models, process mapping tools and the hospital supply chain perspective. Objective and framework: This article proposes an integrative framework combining four complementary theoretical corpora: the Theory of Constraints (TOC), queuing theory, Lean-BPM tools (Value Stream Mapping and Business Process Management) and the hospital supply chain perspective. Empirical application and main result: This framework is applied to the Emergency Department of Mohammed Ben Abdallah Hospital in Mohammedia, based on 323 consecutive days of observation and 85,486 admissions (June 2024-April 2025). The analysis reveals a structural bottleneck at the care stage: 59.29 minutes of waiting for 9.21 minutes of treatment, yielding a ratio of 6.4, the mathematical signature of the dominant system constraint. Contribution: The article makes a theoretical contribution (an integrative model of four corpora), a methodological contribution (a reproducible four-step approach: process diagnosis, constraint identification, variability modeling, future state design) and a managerial contribution (operational prescriptions achievable at constant resources for Moroccan public emergency departments).