## 5 Discussion
In addition to the challenges identified in construct development, the research has also underscored the need for empirical studies validating the current theoretical constructs of agility. This study has cataloged 21 empirical investigations of agility constructs within the healthcare sector. This observation aligns with the findings of prior authors. There is a pressing need to explore alternative agility models, but equally important is the validation of the existing theoretical dimensions underpinning agility. Despite the limited research on this subject matter, it remains possible to draw meaningful conclusions regarding agility in healthcare that can enhance the replicability and validity of agility models. When it comes to instrument adoption and the development of the selected empirical studies, one of the important observations is the need for replicability of the questionnaires used. Most papers (17 out of 21) created their own questionnaires. Among the four agility constructs identified in this review, only [PERSON] and [PERSON]'s Organizational Agility questionnaire demonstrates robust validity. Two authors have replicated this instrument, and four others have cited it as part of their questionnaires. In the supply chain agility construct, the questionnaires appear to replicate and support the dimensions established in [PERSON] and [PERSON]'s theoretical construct [47]: responsiveness, proactivity, equipment, realignment, and customization. However, researchers should conduct further investigations to validate these dimensions, as the number of studies (three out of five) is still relatively limited. In the context of workforce agility, [PERSON] and [PERSON]'s three-dimensional questionnaire [61] is used in [PERSON] et al. 's study [60], but the other two papers on workforce agility employed different questionnaires. Therefore, it is advisable to consider using more robust and validated questionnaires, such as the aggregated model for workforce agility \begin{table}
\begin{tabular}{c c} \hline
**Construct Level** & **Definition** \\ \hline Organizational Agility & Capability of organizations of any size to sense and respond to changes and uncertainties in a prompt manner. \\ Workforce Agility & Capability of employees to sense and respond in a timely manner to changes in their medical work environment and their patients’ needs. \\ Supply Chain Agility & Capability of supply chain members to sense and respond in a timely manner to changes in the healthcare industry and patient needs. \\ Treatment Agility & Capability of healthcare organizations to ensure quick adaptability and responsiveness during treatment to patient needs. \\ \hline \end{tabular}
\end{table} 
Table 14: Levels of agility in healthcare—multi-dimensional model proposal. proposed by [PERSON] and [PERSON] [15]. However, it is worth noting that this model has not yet been tested in healthcare settings. As for treatment agility, this construct is still in its early stages of development, with no replication observed for the questionnaires used. However, dimensions like \"speed of treatment\" and \"accommodations\" are included in two of the three studies [44; 48], and [PERSON] and [PERSON]'s questionnaire [56] serves as a valuable reference for treatment agility. This emerging construct warrants further research and the development of more robust questionnaires. Table 15 summarizes the recommended instruments for each of the four agility levels. Figure 7 provides a comprehensive summary of the agility models explored in the questionnaire-based studies, categorizing the corresponding latent variables into predictors and responders for each of the four agility constructs. The figure also groups the latent variables listed in Tables 10-13 based on their themes and associates them with the respective agility construct. It is important to note that this analysis excluded latent variables listed as mediators and moderators.