Stakeholder Perspectives on the Adaptability of Hospital Drug Formularies to Disease Patterns: A Modified Q-Methodology Study in Vietnam

Background Hospital drug formularies function within Complex Adaptive Systems (CAS), where the alignment between drug supply and disease patterns is critical for patient care and cost-effectiveness. However, measuring this adaptability is challenging due to conflicting priorities among stakeholders and a lack of standardized assessment tools. Objectives This study aims to analyze the perspectives of three key stakeholder groups-clinical providers, non-clinical service providers, and policymakers-to develop a consensus-based set of indicators for monitoring the adaptability of drug formularies in Vietnam. Methods We employed a modified Q-methodology approach involving 69 experts (20 non-clinical, 28 clinical, and 21 policymakers). A Q-set of 92 indicators across 9 criteria was developed. Participants evaluated these indicators using a 5-point Likert scale to determine levels of consensus and discordance, rather than a forced-distribution sort, to assess the absolute importance of adaptability metrics. Results The analysis revealed high consensus across all groups regarding the importance of "Usage adaptation" and "Storage adaptation". However, significant discordance was observed in criteria related to "Ensuring drug availability," "Appropriate procurement" and "Outputs and outcomes". Notably, non-clinical providers prioritized proactive ordering, whereas clinical experts emphasized output results. Conclusion The study proposes a management framework that monitors drug list adaptability across four levels: non-adaptive, passive, active, and advanced adaptive. Successful adaptability requires enhanced collaboration between specialized teams and a shift from efficiency-based to resilience-based performance metrics.