Praiseldy Langi Sasongko

157 Mapping opportunities and threats for the future demand of red blood cells in the Netherlands ducting Step 3 in January 2020, no one could have anticipated the rapidity of COVID19 that would ensue and its drastic, global consequences. Therefore, this theme is currently a prominent driver in transfusion medicine and many other fields as well.25-27 In scenario development, this driver is considered a “wild card,” a very-high impactful, rapidly moving event that is disruptive, beyond the control of any group or individual, wide in scope and directly affects the human condition (previous examples include terrorist attacks and the SARS epidemic).28 With regards to its impact on RBC demand in the Netherlands, however, demand decreased in the acute pandemic phase simultaneous to an influx of new donor registrations29 so that RBC inventory remained stable overall in 2020 (written communication). However, shortages of blood products have occurred,30-32 particularly in low- to middle-income countries,33,34 simultaneous to increasing demand for COVID-19 convalescent plasma.33,35 For Sanquin, COVID-19 has been a catalyst for opportunities. This crisis paradoxically unlocked several mitigating actions from our results regarding the blood supply organization, societal context, and change in perceptions releasing a momentum of unprecedented, interconnected organizational changes within Sanquin and catalyzing (inter)national initiatives.36-39 Overall, these short-term changes have been positive; however, these qualities are also equally important outside of crisis times in adapting to changes in future demand, whatever they may be. An organization must learn from a crisis to affect change.40 As illustrated by the scenario approach and the current pandemic, a different paradigm is needed to assess and plan for future uncertainties, including future “wild cards.” There needs to be room for flexibility, adaptability, and continual learning. Instead of having fixed policies, management could monitor important drivers and intentionally make adaptations to polices over time as knowledge is gained (“monitor and adapt”)41 using tools such as the dynamic adaptive planning (DAP)42 or dynamic adaptive policy pathways (DAPP).43 The former embraces the fact that in an ever-changing world, fixed policies are likely to fail and thus, a flexible plan needs to adopt and adapt dynamically to the changing circumstances through learning mechanisms.42 The latter assesses the dynamic interactions within the system over time and identifies under which conditions a policy will fail.43 Therefore, management could use one of these tools in combination with our results to make adaptive policy changes regarding RBC demand. For example, management could prioritize and monitor advances in precision medicine, RBC replacements, and the aging population in disruptive events and use DAP or DAPP to explore adaptive strategies that would embrace the opportunities and mitigate the threats of these themes. From our results, we see that opportunities remain for a BE to provide tailored transfusion services for patients, offer specialized types of blood products, be an integral part of (inter)national collaborations, and even use

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