Developing Hospital Resilient Supply Chain Scenario through Cross-Impact Analysis Method
Authors: khademi Jolgeh Nejad Afsaneh , Ahmadi Kahnali Reza , Heyrani Ali 
Published: April 2022

Background and Objectives The hospital and its supply chain must be resilient in the critical situations. Developing scenario is an important tool for planning and decision-making process in these situations. Therefore, this study intended to develop possible scenarios for hospital supply chain resilience. Material and Methods This research study is applied in terms of purpose and is based the scenario method and the probabilistic trends approach. The participants of the study were 14 experts from two hospitals who were selected through a purposeful sampling method. The data obtained in the first phase of the semi-structured interviews, were coded and analyzed through using MAXQDA Software. In the next phase, the cross impact analysis questionnaire was used to develop the scenario and the analysis of the data was performed through Scenario Wizard software. Results The results of combining 35 states for 12 factors affecting hospital resilience which also included all possible future states, showed that 7 scenarios with high adaptation and 467 scenarios with poor adaptation can be considered. Strong scenarios were divided into three groups of scenarios as "optimistic", "intermediate" and "pessimistic" based on similarity and degree of desirability. Conclusion The Findings revealed that the strength of the impact of unfavorable states was more than that of favorable states. Therefore, for the resilience of the hospital supply chain, it is necessary to pay more attention to unfavorable scenarios to provide the necessary preparation to face those states, and with proper planning, the desired states can be achieved. Extended Abstract Background and Objectives The complexity and intensity of environmental fluctuations combined with unexpected accidents and dangers have increased the probability of hospital supply chain disruptions. The hospital and its supply chain must be intelligent to resist unforeseen events, so that in different situations, there is no work stoppage in their activities. Scenarios are an important tool for improving the planning and decision-making process in these situations. The purpose of this paper is to develop a scenario for hospital supply chain resilience. Material and Methods This research is based on the scenario method, and it is applied in terms of purpose. In addition, in the category of normative scenarios and based on the probabilistic modified trends (PMT) school. The Participants were 14 experts from two hospitals who were purposefully selected. The data obtained in the first phase from interviews, were coded and analyzed through MAXQDA Software. In the second phase, based on the participants' viewpoints, the possible states of each of the identified factors in the previous stage were defined, and the cross impact questionnaire was designed. The cross impact questionnaire is in the form of a matrix in which respondents determine the effect of each state on other states. Finally, cross impact analysis method and Scenario Wizard software were used to compile the scenario and compatibility coefficients and total impact score indices were used to examine compatible scenarios. Results Based on analysis results of the semi-structured interviews, 30 drivers of hospital supply chain resilience were identified. These factors were clustered in the form of 12 main components including: "staff preparedness and accountability in the event of a disaster", "safety of infrastructure and equipment", "recovery of infrastructure after disaster", "cooperation and participation of various organizations and communication systems among them", "support systems and potential hospital capacity", "coordination and flexibility of suppliers", "planning and management of disaster", "nature of accidents", "government policies", "sanctions on drugs and equipment", "people's culture at the time of the accident", and "funding". The output of Scenario Wizard software showed 7 strong scenarios that were divided into three groups of scenarios as "Optimistic", "pessimistic" and "interstitial" based on their rank and degree of desirability. The Optimistic scenarios include ideal resilient and hard resilient scenarios, the interstitial scenarios comprise high-capacity and troublesome challenging scenarios, and the pessimistic scenarios consist of vulnerable, defenseless and fragmented scenarios. Conclusion The results showed that the strength of the impact of undesirable situations was more than that of desirable situations. Hence, for the resilience of the hospital supply chain, it is necessary to pay more attention to undesirable scenarios in comparison to desirable ones in order to provide the necessary preparation to face those situations and to reach the desirable situations through proper planning. Practical Implications of Research Due to the challenges of traditional planning in the face of the future, in this study, the scenario developing approach was used as a tool to improve the efficiency and effectiveness of planning in the hospital supply chain. Managers and planners can substitute alternative futures for a single future and plan to take advantage of favorable future situations and avoid or reduce the effects of unfavorable future situations to be better prepared to face the future. Ethical Considerations In the present study, all ethical considerations have been observed based on the recommendations and regulations. Conflict of Interest The authors stated that there is no conflict of interest. Aknowledgment This article is based on the result of Afsaneh Khademi-Jolgehnejad’s Master thesis submitted to the University of Hormozgan and received approval code Under 11130.Authors are grateful to the consultants of the Clinical Research Development Center of Shahid Mohammadi Hospital and Bandar Abbas Children's Hospital for their cooperation and guidances.