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COVID-19 experience in Morocco: Modelling the agile capabilities of Moroccan

Clinics

Conference Paper in IFAC-PapersOnLine · November 2021

DOI: 10.1016/j.ifacol.2021.10.008

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Fadoua Tamtam Amina Tourabi

Ecole Nationale des Sciences Appliquées - Agadir University Ibn Zohr - Agadir
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IFAC PapersOnLine 54-4 (2021) 44–49
COVID-19
COVID-19 experience
experience in
in Morocco:
Morocco:
COVID-19
Modelling the agile experience
capabilities in
of Morocco:
Moroccan Clinics
COVID-19
COVID-19 experience
experience in
in Morocco:
Modelling the agile
COVID-19
Modelling capabilities
experience in
the agile capabilities of Morocco:
of Moroccan
Moroccan Clinics
Morocco: Clinics
Modelling
Modelling the
the agile
agile capabilities
capabilities of
of Moroccan Clinics
Modelling the agileF. capabilities of Moroccan Clinics
Moroccan
Tamtam*. A. Tourabi** Clinics
F. Tamtam*. A. Tourabi**
F. Tamtam*. A. Tourabi**
*National School F.
F. Tamtam*.
of Applied A. Tourabi**
Sciences, Agadir, CO 80000
*National School F. Tamtam*.
of Applied A.
Tamtam*. A. Tourabi**
Tourabi**
Sciences, Agadir, CO 80000
MOROCCO*National (e-mail:
School fadoua.tamtam@gmail.com).
of Applied Sciences, Agadir, CO 80000
MOROCCO*National (e-mail:
School fadoua.tamtam@gmail.com).
of Applied Sciences, Agadir, CO 80000
**National School MOROCCO*National
of Applied
*National School
Sciences,
(e-mail:
School of Applied
Agadir, Sciences,
CO 80000
fadoua.tamtam@gmail.com).
of Applied Sciences, Agadir,
MOROCCO CO
CO 80000 (e-mail:
**National School MOROCCOof Applied Sciences,
(e-mail: Agadir, CO 80000Agadir,
fadoua.tamtam@gmail.com). MOROCCO 80000
(e-mail:
**National School MOROCCO
MOROCCOof Applied (e-mail:
Sciences, fadoua.tamtam@gmail.com).
Agadir,
a.tourabi@uiz.ac.ma)
(e-mail: CO 80000
fadoua.tamtam@gmail.com). MOROCCO (e-mail:
**National School of Applied a.tourabi@uiz.ac.ma)
Sciences, Agadir, CO 80000 MOROCCO (e-mail:
**National School of Applied Sciences,
Sciences, Agadir, CO 80000 MOROCCO (e-mail:
Agadir,
a.tourabi@uiz.ac.ma)
**National School of Applieda.tourabi@uiz.ac.ma) CO 80000 MOROCCO (e-mail:
a.tourabi@uiz.ac.ma)
a.tourabi@uiz.ac.ma)
Abstract: The COVID-19 pandemic posed multiple challenges to the healthcare sector. To be a leader
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satisfaction
individuals (Kodish
reaction;
(Kodishnew
reaction;
in: organizational new et
etandal.,
al., 1995);
1995); organizations
opportunities
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individual creation:
organizations
creation:
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2405-8963 Copyright
needed by Moroccan clinics, healthcare organizations should
should acquire
license.should acquire different
different agile
Copyright © 2018 IFAC2021 The Authors. This is an open access article under the CC BY-NC-ND
healthcare
healthcare organizations
organizations acquire different agile
agile
Copyright © 2018 IFAC
Copyright
Peer review©under
2018 responsibility
IFAC of International Federation of Automatic Control.
Copyright © 2018 IFAC
10.1016/j.ifacol.2021.10.008
Copyright © 2018 IFAC
Copyright
Copyright ©© 2018
2018 IFAC
IFAC
 F. Tamtam et al. / IFAC PapersOnLine 54-4 (2021) 44–49 45

capabilities (Aravindraj and Vinodh, 2014) which necessitate matrix (Sindhwani and Malhotra, 2017; Dhir and Dhir,
the need for defining and determining the appropriate ones. 2020). After we develop a final reachability matrix by using
transitivity (Sindhwani and Malhotra, 2017). This matrix
2.2 Identification of agile capabilities in healthcare helps to determine the level partitioning (Sindhwani and
organizations Malhotra, 2017) which will be presented later in a diagram
(Dhir and Dhir, 2020).
According to the definitions above, agility includes different
capabilities that lead to the continuity of organization The process of TISM presented in a step-by-step manner is
(Ghodrati and Zargarzadeh, 2013) in order to be better outlined below in detail.
prepared and perform successfully to the agile environment 3. MODELLING AGILE CAPABILITIES
(Ahmed et al., 2018). From the literature review, different
capabilities were identified and only those related to Our survey was done by administering a semi structured
healthcare organizations were shortlisted in Table 1. questionnaire to Moroccan healthcare experts, who work
Table 1. Agile capabilities identified for healthcare directly with patients of the COVID-19. Each Moroccan
organizations region is impacted differently by the pandemic, however, for
this study; the authors choose the southern region that is
Agile capability Description References
Organization Establishment of a clear
considered to be successful in this fight. A total of 40 experts
vision (C1) vision for the organization were chosen from COVID-19 background which includes
Organization Developed business practice doctors, nurses and senior physicians, for conducting
practices (C2) difficult to copy verification of capabilities, whereas 30 respondents were
Organization chosen for the validation of the final model to get a
Extent of centralization in
centralization
(C3)
organization statistically significant sample for the region.
Environment supportive of In order to aggregate these responses (Patri and Suresh,
Change changement, experimentation,
management improvement, learning and 2017), we choose the dominant value, for example ‘Yes’ was
(C4) innovation chosen as the aggregate response if the dominant response for
Cooperation Internal and external an interrelationship is ‘Yes’. Then, we analyze these
and cooperation to enhance interrelationships among agile capabilities by using TISM.
(Tsai et al., 2008) (Sahu,

collaboration competitiveness
(Sherehiy et al., 2007)

(C5) Step 1: Establishing and interpreting contextual

(Deksnys, 2018)

Healthcare
professionals
Knowledgeable and relationship between agile capabilities:
2013)

skills (C6) competent human resources The first step consists of modelling and finding a type of
Core contextual relationship between the identified capabilities
Existing strategies for
competencies and (Jena et al., 2017; Sindhwani and Malhotra, 2017). The
management of core
patients
management (C7) competence and patients contextual relationships are presented in an initial
Healthcare Effectiveness of service reachability matrix (Patil and Suresh, 2019) based on whether
service (C8) operations and Cost ‘element A influences/will help to achieve/help to enhance
Technology Appropriate and sufficient element B’ (Patri and Suresh, 2017; Sindhwani and Malhotra,
integration (C9) technological support 2017). If that is the case, then we defined the strength of
Performance Existence of continuum work
work (C10) evaluation system
relationship influencing (very strongly, strongly, moderately,
Mobilize a quick response to lightly) (Patil and Suresh, 2019). As it is recommended in
Quickness (C11) make the right decision the Patil and Suresh (2019) study, only very strongly ‘1’ or
first time strongly influencing ‘0’ relationships are considered. The
Flexible organizational initial reachability matrix for agile capabilities is presented in
Flexibility (C12) structures, practices,
workplace, strategies and Table 2 (Patil and Suresh, 2019).
people (C12) Table 2. Initial reachability matrix for agile capabilities
C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12
2.3 TISM methodology C1 1 0 0 0 0 1 1 0 1 0 0 1
C2 0 1 1 0 1 0 1 1 0 1 1 0
The TISM methodology is a revised version of the ISM C3 0 1 1 0 1 1 0 1 0 1 1 0
(interpretive structural modelling) approach. It is considered C4 0 0 0 1 0 0 0 0 0 0 0 0
as an advanced (Dhir and Dhir, 2020) and innovative C5 0 1 1 0 1 1 0 1 1 1 1 0
C6 0 0 0 1 0 1 0 0 1 0 0 0
technique (Jayalakshmi and Pramod, 2015). By combining C7 1 0 0 0 0 1 1 0 0 0 0 1
qualitative (Jayalakshmi and Pramod, 2015) and quantitative C8 1 0 0 0 1 0 0 1 0 0 0 1
(Patil and Suresh, 2019), TISM explains not only the C9 0 0 0 1 0 1 0 0 1 0 0 0
relationship between elements but also presents the reason for C10 1 1 1 0 0 0 0 1 0 1 1 1
its existence (Dhir and Dhir, 2020). C11 0 0 0 0 0 0 0 0 1 0 1 0
C12 1 0 0 0 0 0 1 0 0 0 0 1
To implement TISM, we identify firstly elements that could
be connected to each other (Sindhwani and Malhotra, 2017), The interpretation of agile capabilities’ relationships is done
then identify and present the mutual contextual relationship for “1” entries in the initial reachability matrix by explaining
between them (Dhir and Dhir, 2020) in an initial reachability how and in what way the agile capabilities influence each
46 F. Tamtam et al. / IFAC PapersOnLine 54-4 (2021) 44–49

other (Sindhwani and Malhotra, 2017). An example of the C5 1* 1 1 1* 1 1 1* 1 1 1 1 1* 12

C6 0 0 0 1 0 1 0 0 1 0 0 0 3
interpretation of relationship between C1 with other
C7 1 0 0 1* 0 1 1 0 1* 0 0 1 6
capabilities is depicted in Table 3. C8 1 1* 1* 1** 1 1* 0 1 1* 1* 1* 1 11
Table 3. Interpretation of C1 relationship with other C9 0 0 0 1 0 1 0 0 1 0 0 0 2
capabilities C10 1 1 1 0 1* 1* 0 1 1* 1 1 1 10
C11 0 0 0 0 0 1* 0 0 1 0 1 0 3
In what way C1 will
Agile Paired comparison C12 1 0 0 1** 0 1* 1 0 0 0 0 1 5
influence/enhancethe other
capability of capability
capability?

Dependence
C1: Establishment of a clear vision for the organization
Healthcare 8 5 5 9 5 11 6 5 10 5 6 8
organization visionis Organization gives employee a
influencing glimpse of the vision but its
C1-C6 finalization needs to be developed
healthcare
professionals skills byemployees

Healthcare Communication of organizational Step 3: Partitioned reachability matrix

organization visionis vision helps to involve healthcare
influencing professionals in a continuous Level partition of the final reachability matrix is based
C1-C7
management of its improvement process in order to mainly on the three sets: reachability set in which we
core competencies achieve a competitive advantage presented the row elements of final reachability matrix, the
Management of core column elements are presented in the antecedent set and the
competenciesis Healthcare organizations
influencing are adopting managerial methods common ones are presented in the intersection set (Patil and
C7-C1
healthcare that goes with organization's Suresh, 2019; Vaishnavi et al., 2019).
organization vision mission, culture, or values
Table 5. Partitioned reachability matrix
Health services
management is The availability of healthcare delivery
influencing accelerates the process of finalizing
C8-C1

Level
healthcare theorganization's missions Agile Reachability Antecedent Intersection
organization vision capabilities set set set
Healthcare
organization visionis One of the most important mission of
influencing its the organization in today’s agile Iteration 1
C1-C9 environment is the use of
technological 1,3,4,5,6,7,8,
ability technologicalsystems C4 4 4 I
9,12
Work evaluation Iteration 2
system is influencing Effectiveness of work performance 1,2,3,5,6,7,8,
C10-C1 healthcare provides the direction to take the C6 6,9 6,9 II
appropriate decision 9,10,11,12
organization vision
1,2,3,5,6,7,8,
C9 6,9 6,9 II
Healthcare 9,10,11
organization vision is A clear organization vision serves to Iteration 3
C1-C12 influencing be informed by flexibility readiness of
organizational and the organization and its human 1,2,3,5,7,8,10
resources C1 1,7,12 1,7,12 III
individual flexibility ,12
Organizational and C11 11 2,3,5,8,10,11 11 III
individual flexibility In today’s environment, flexibility can 1,2,3,5,7,8,10
is influencing change the organization vision when
C12 1,7,12 1,7,12 III
C12-C1 healthcare ,12
it’s needed
organization vision Iteration 4
C2 2,3,5,8,10 2,3,5,8,10 2,3,5,8,10 IV
C3 2,3,5,8,10 2,3,5,8,10 2,3,5,8,10 IV
Step 2: Formation of final reachability matrix and
C5 2,3,5,8,10 2,3,5,8,10 2,3,5,8,10 IV
transitivity check
C8 2,3,5,8,10 2,3,5,8,10 2,3,5,8,10 IV
The final reachability matrix is obtained with the help of
C10 2,3,5,8,10 2,3,5,8,10 2,3,5,8,10 IV
transitivity check (Patil and Suresh, 2019; Vaishnavi et al.,
2019). An example of the first and second level transitivity is
showed below for ‘0’ entries in the initial reachability matrix Step 4: Development of agile capabilities digraph
(Patil and Suresh, 2019). 1* or 1** is entered if there is a From the final reachability and partitioned matrixes and level
transitivity; otherwise, ‘0’ remains in the final reachability partitions, we created the digraph (Fig. 1) by classifying all
matrix (Table 4) (Patil and Suresh, 2019; Vaishnavi et al., the agile capabilities according (Jena et al., 2017). In the
2019). digraph, we have drawn only the directed and transitive links
Table 4. Final reachability matrix for agile capabilities (Jena et al., 2017).
The digraph is placed in ascending order where the
Driving

capabilities eliminated in the first iteration (Level I) are

power

C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12

placed on the top position and the ones eliminated in the last
C1 1 0 0 1* 0 1 1 0 10 0 1 5 iteration (Level IV) occupy the bottom position (Patri and
C2 1* 1 1 0 1 1* 1 1 1* 1 1 1* 11 Suresh, 2017; Patil and Suresh, 2019).
C3 1* 1 1 1* 1 1 1* 1 1* 1 1 1* 12
C4 0 0 0 1 0 0 0 0 00 0 0 1
 F. Tamtam et al. / IFAC PapersOnLine 54-4 (2021) 44–49 47

flexibility requirement at different levels: individually,

Fig. 1. Agile capabilities digraph.
Level IV Capabilities: 2, 3, 5, 8 and 10
Enabler 2 influences third-level capability 7 and 11;
developed business practice that distinguish a firm in the
marketplace would improve the management of its core
competencies and patients and increase the speed of decision
making. Also it influences fourth-level capability 3; more
people participate on development of business practices more
they will be able to participate in decision making. In the
same level, Capability 2 influences capability 5, 8 and 10;
participation in developing business practices enhance
cooperation and improve service and performance
effectiveness.
Level III Capabilities: 1, 7, 12 and 11
Capability 1 influences third-level capability 7; management
of core competence and patients would require a clear
organizational vision to adopt the most appropriate strategies
for it. Also, organization vision helps in the fulfilment of
organizationally and strategically. Capability 1 influences the
second and first-level; it helps to update human resources
skills internally and to monitor changes externally. For
capability 11, technology uses and development of
employees’ skills is done quickly in the organization. Level II
Capabilities: 6 and 9
In a reciprocal relationship, developed professionals skills
increase the technology integration easily and vice versa
advanced technology needs a competent, knowledgeable and
empowered people. These capabilities help to monitor
changes effectively. New changes require a skilled people
able to control environment using technology.
Level I Capability: 4
The first-level I contains only one capability which is
capability 4. Change management influences the overall
agility of the organization. Environmental changes oblige
organizations and individuals working within them to be
agile.
4. TISM Validation
Our model was validated by using quantitative analysis of
TISM linkages. There were 24 linkages and each link was
validated by using a T-test on SPSS 16.0 software. 30
questionnaires were distributed to doctors and researchers
and a total of 24 questions were developed for each linkage.
To analyze responses, the links with a significance level less
than 0.05 was accepted and others were rejected (C1-C7 ; C7-
C6 ; C11-C6 ; C6-C4).

Organization ready to manage changes C4

Change
management

Availability of
highly competent C6 The integration of health
information technology C9
professionals Healthcare Quick response technology
Technology
professional integration
skills

Increased flexibility
to respond quickly to
C1 Maximizing value for C7 Core various healthcare C12 C11
patients competencies system needs Flexibility
Organization Quickness
and patients
vision Organization management
practices Organization practices
influence health requires high capacity of rapid
adaptation Individual
professionals'
Centralized Patient’s performance
performance and
organization can cooperation increases flexible
the quality of Performance
focus on the working
patient’s services enhancement
fulfilment of
Cooperation Flexibility in needs speed
its vision
decisions occur more quickly healthcare Patient satisfaction
Quick implementation environments
of decisions improves the
service quality
Improving performance
Mutual Mutual access to
C3 C5 C8
Organization

influence influence healthcare

Performance
practices

Organization Cooperation Healthcare Improving

between between services
centralization and service
C2

work

organization centralized service quality

C10

collaboration through
practices and organization structured through
centralization and cooperation performance
cooperation management

Fig. 2. Validated TISM

48 F. Tamtam et al. / IFAC PapersOnLine 54-4 (2021) 44–49
5. CONCLUSIONS
Our purpose is to create a practical model for agile
capabilities in order to help healthcare organizations to
cope with environmental uncertainties, in particular the
COVID-19 crisis. Based on the literature review, twelve
agile capabilities related to healthcare sector have been
identified: organization vision; practices; centralization,
change management , cooperation, management of
employees skills; core competencies; patients; healthcare
service, technology integration, performance work,
quickness and flexibility. The empirical study has shown
that the main key capability (named the major driving
force) is change management which would help the clinic
to create cooperation, better understanding of
organizational and employee skills towards agility and act
quickly. Also, studying each change required helps to
improve the quality and variety of services provided to
patients and to manage costs effectively. New changes
adjust the organization vision, practices, centralization and
technology integration in order to perform effectively and
flexibly.
Our paper contributes; firstly, to the literature that
examines the impact of COVID-19 on healthcare
organizations, secondly many studies identified agile
capabilities for manufacturing organizations; however this
study focused on the identification of those needed in
healthcare sector which has not been explored in the
literature. The practical implications of our study are:
allowing healthcare professionals to focus attention on the
most significant agile capabilities, i.e. focusing on the top
most first-level capability, and the rest according to their
levels. From the above findings, healthcare organization
will be interested in evaluating the proposed capabilities to
improve its agility implementation. Also, the
methodological aspect of our article is helpful for theorists
and practitioners in studying COVID-19 management.
The two limitations of this paper is the lack of TISM
validity because it is based on opinions of experts (Dhir
and Dhir, 2020), those participating in the survey.
However, there are many alternative ways to validate TIS
model as exploratory and confirmatory factor analysis and
structural equation modelling. Also, the study focuses
mainly on hospital of single region. It can be extended to
other regions in order to have an overview on the COVID-
19 impact on Moroccan health system. In fact, I expect
that healthcare professionals should plan an effective
strategy for proper measurement of the main agile
capability “Change management” depending on the
COVID-19 situation in each region. That’s our future
work.
ACKNOWLEDGEMENTS
The authors acknowledge the financial support of the
National Centre for Scientific and Technical Research
(CNRST) under the Excellence Research Scholarships
Program.
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