155 Mapping opportunities and threats for the future demand of red blood cells in the Netherlands events or an adaptive strategy for changing legislation. Further, the existence of a key legal personnel communicating visionary guidance in changing legislation was another aspect of this. External communication to different groups of the society was emphasized, from educational campaigns for the general public along with political actions like lobbying in changing perceptions and societal context, to informing and inviting donors to partake in emergency actions in a disruptive event (Table 4.3). Additionally, having strong internal and external collaboration were heavily emphasized throughout all discussions. Ideas of the former included creating multidisciplinary research teams and improved inter/intra-departmental and divisional collaboration in blood supply organization, while ideas for external collaboration were many. These included continual (inter)national research partnerships regarding RBC improvements or RBC replacements, being aware of and incorporating key stakeholders’ perspectives, values, and needs in blood supply organization, precision medicine, and societal context, and preparing to extend services or products abroad in commercialization/open EU market (Table 4.3). In fact, the latter theme emphasizes that international cooperation or competition may change Sanquin’s current mentality of being a monopoly in the Netherlands and force Sanquin to be sensitive to market/ demand changes and improve their competitive edge. Of course, many of these mitigating measures were intertwined, such as the need for both effective communication and collaboration as parts of the mechanism building blocks of an effective strategy or even daily way of working. Furthermore, these are all key components in the public’s perceptions of Sanquin to build trust which is critically important to support all blood bank activities (change in perceptions, Table 4.3). 4.4 Discussion This study sought to map key categories of opportunities and threats with mitigating potential risks for the Netherlands by using a scenario approach. In traditional scenario approach, full scenarios (i.e., plausible storylines of possible futures) are created; instead, we used its qualitative methodology to identify 10 main themes consisting of drivers that would impact future RBC demand to provide input for strategic decision-making. The positioning of the themes on the matrix further reflects how they can be incorporated into strategic planning accordingly: that is, drivers with high importance and low uncertainty should be incorporated in all scenarios (“critical planning issues”) while those that are highly important and highly uncertain are the driving forces that differentiate scenarios (“critical scenario drivers,” “important scenario drivers”).20 Therefore, we found three that were particularly notable based
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