144 Chapter 4 4.2 Materials and methods Setting Sanquin is an umbrella organization composed of several divisions in the Netherlands. Sanquin’s activities are composed of the Sanquin Blood Bank (the not-forprofit organization that, by law, is the sole blood bank of the country), Research and Lab Services, and a privatized division of Reagents, Diagnostics, Innovation, and Plasma Products.16 Study design For the overall scenario approach, we employed an iterative four-step qualitative methodology, illustrated below (Figure 4.1). Figure 4.1 Overview of scenario development process In Step 0, the specification of the blood bank system, its outcome of interest, and relevant time horizon were set through discussions. In doing this, Sanquin’s system was clarified in (1) defining the boundaries of the forces inside and outside Sanquin’s system regarding RBC demand, and (2) defining its structure, such as the elements that affect or influence the outcomes of interest, the stakeholders involved, and the interrelationships thereof.17 Step 1 defined the sets of external forces that may affect RBC demand: uncontrollable “drivers” (i.e., developments in society, technology, economics, ecology, politics, and legal [STEEPL]),18 and controllable “drivers,” (i.e., forces within the control of the actors in the policy domain that affect the structure and performance of
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