145 Mapping opportunities and threats for the future demand of red blood cells in the Netherlands the system17). This was described in a previous publication in which we identified historical trends and its drivers, main sources of uncertainty (there termed “transformational factors”), and expectations of future RBC trends through a literature review and semi-structured interviews with 44 (inter)national blood transfusion experts. We found a strong historical trend of decreased demand for RBCs, due to drivers such as lowered transfusion thresholds, surgical techniques and pharmacologic agents, and organizational changes. With regards to the future, experts expected that RBCs would increase (17%), decrease (45%), decrease but stabilize (12%), or stabilize as is (7%), with various transformational factors to support each trend (e.g., improved surgical techniques will reduce RBC demand).4 In Step 2, we invited a subset of experts from Step 1 living in or around the Netherlands to participate along with new experts, such as Dutch clinicians and Sanquin employees. We gathered experts from various blood transfusion or closely related fields, and divided them into two heterogeneous groups for half-day interactive sessions. Authors V.M. and E.R. moderated these sessions while P. L.S. was the note-taker. During these sessions, building upon Step 1 results, experts were asked to propose any additional STEEPL drivers, and the organizational implications thereof for Sanquin’s medium-term (15–20 year) strategy. The process was supported by MeetingSphere, an online collaborative platform (MeetingSphere GmbH), notable for its tools of anonymous brainstorming, rating of ideas, and automatic measurement reports, and used among government institutions, corporations, and universities.19 The ses sions began with an introduction of the topic (Step 0), the platform, and the initial set of drivers from Step 1. These drivers were evaluated on clearness and completeness. Next, experts were asked to anonymously brainstorm opportunities and threats that would impact future RBC demand. These were clustered through consensus under drivers. A new driver that arose was “Sanquin’s blood supply organization” which was perceived as an important driver by experts although this is an internal force, differing from the other external drivers. Next, these drivers were ranked anonymously on importance and uncertainty. Ranking was ascending, so that the higher the score, the more important or more uncertain that particular driver was perceived to be. Following the sessions, given the large number of drivers, opportunities, and threats, authors M. J., K. v. d. H., and P. L. S. assessed the results and consolidated them accordingly until they became 10 final drivers, hereafter called “themes.” In Step 2b, experts were sent a three-question survey using Qualtrics XM (Qualtrics, LLC) in which they were asked to rank the 10 themes in terms of importance and uncertainty (Supplementary). The rank values of the themes were placed on a matrix of uncertainty and importance with 1 being the least important/uncertain and
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