156 Chapter 4 on experts’ ranking of importance and uncertainty: (1) precision medicine, (2) blood supply organization, and (3) disruptive events. Two of these (precision medicine and disruptive events) are external uncontrollable drivers, while one (blood supply organization) refers to Sanquin’s internal milieu, such as its structure and culture. Precision medicine, ranked with moderate-high importance and low uncertainty, can be considered the “critical planning issue” —a “given” that should be incorporated in all future scenario plots.20 Experts emphasized the imminence of such a trend already happening in healthcare,21 and the continual progression toward full embracing of precise/personalized medicine, which is already present within transfusion practice.22,23 Including this theme into future strategic planning or decision- making would not be too difficult as it would include continuing and strengthening what is already being done with key stakeholders and partnerships with local and international research initiatives, while proactively seeking new opportunities for precision (transfusion) medicine. The blood supply organization had the most concentrated size reflecting experts’ strong concordance of its moderate-high importance and moderate-high uncertainty. According to scenario principles, it can be considered the “critical scenario driver,” that is a driving force in differentiating future scenarios and essential for success in future planning.20 However, given that this theme is internal, that is, within Sanquin’s system and by definition, “controllable,” (as one can choose leaders, whereas one cannot choose what disruptive event will occur next), it is interesting that experts would choose this with greater urgency compared to the other external drivers. Perhaps it reflects a perception that the blood supply organization is the most critical factor in the future success of itself. Many experts highlighted that the organization’s traditional, hierarchical culture and methods impede progress, and in order for Sanquin to continue and even thrive into the future, organizational changes as outlined in Table 4.3 are crucial. Hence, the key elements of effective leadership, innovative attitude, strong collaboration, and communication with action could not be overstressed for future viability. In recent years, the blood bank has taken steps to address some of these issues such as by developing a strategy for 2019–2024 with the core values of responsibility, innovation, and connection and the aims of (1) garnering a sufficient donor database, (2) delivering high-quality blood products for a good price, and (3) internationally leading through research and innovation, all using digitalization initiatives.24 Several of the steps to reach the three-fold aim in the strategy align with the mitigating measures in Table 4.3. Interestingly, in our results, experts did theorize the possibility of a major threat such as a pandemic or emerging disease (disruptive events) but ranked it as least important and most uncertain, one to “monitor and reassess”20 At the time of con-
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