The assumption that a system will operate in a stable environment without risk is not realistic (Sales et al., 2018).

The assumption that a system will operate in a stable environment without risk is not realistic (Sales et al., 2018). Risk is widely classified into disruption and operational risks (Kleindorfer & Saad, 2005; Tang, 2006). Extreme uncertainty and the absence of synchronization between supply and demand are linked to operational risks while circumstances such as labor strikes, terrorist attacks, and natural calamities are related to disruption risks (Lockamy & McCormack, 2010). The probability of human injury or even death is high in disruptions such as multi-casualty disasters which brings about the challenge of increased pressure on healthcare. Healthcare institutions are required to become capable of understanding and adapting to environmental changes to mitigate such unexpected changes. These unexpected changes can affect the competitiveness, responsiveness and operating procedures of a firm significantly (Huang, Yen, & Liu, 2014), and for healthcare institutions, the economic well-being and reputation of the nation as well.

There is a growing need for healthcare institutions to develop responsiveness (Tolf, Nyström, Tishelman, Brommels, & Hansson, 2015; Vissers, Bertrand, & De Vries, 2001). However, the responsiveness of healthcare systems remains a complex, distinct and still not adequately investigated concept (Brinkerhoff & Bossert, 2013; Cleary, Molyneux, & Gilson, 2013; Gilson, Palmer, & Schneider, 2005; Siddiqi et al., 2009). Responsive healthcare systems anticipate and adjust to meet evolving requirements, exploiting opportunities to enhance access to effective interventions and to enhance health services (Hanefeld, Powell-Jackson, & Balabanova, 2017; Lodenstein, Dieleman, Gerretsen, & Broerse, 2013), ultimately resulting in improvements in outcomes of healthcare (Allotey, Davey, & Reidpath, 2014; Smith, Mossialos, Papanicolas, & Leatherman, 2009). A better understanding of healthcare responsiveness is particularly important for many nations with low and medium incomes such as Ghana, where economic and social development is rapidly advancing.

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Nevertheless, responsiveness always implies that a flexible central system exists (More & Babu, 2008). Flexibility is required to respond quickly to the rapidly changing unique patient needs and demands (Aronsson, Abrahamsson, & Spens, 2011; Peltokorpi, Torkki, & Lillrank, 2011). Flexibility remains an expensive and challenging capability to develop and incorporate in any system completely. Identifying the right flexibility capabilities to develop can efficiently improve responsiveness to meet changing needs and demands of healthcare patients (Aronsson et al., 2011; Peltokorpi et al., 2011). Moreover, flexible scheduling and resources can help healthcare institutions respond more effectively to their patients by better matching the variable demand for care with the supply of physical resources such as beds, pharmaceutical, people and space required (Chen, Zhou, Ma, & Pham, 2011; Laker, Froehle, Lindsell, & Ward, 2014). Researchers have asserted that flexibility can be proactively employed as well to create a competitive advantage for a business (Chang, Yang, Cheng, & Sheu, 2003; Ettlie & Penner-Hahn, 2008; D. M. Upton, 2008). Profitable flexibility applications have been demonstrated in various ways: by the National Bicycle Industrial Company (Moffat, 1990), and by the General Motors ‘ Lordstown factory experiment (Kasarda and Rondinelli, 1998). Flexibility is clearly of the utmost significance (J. H. M. Manders, Caniëls, & Ghijsen, 2017) to the responsiveness of healthcare institutions, the economy, patient satisfaction and yet significant amount of existing literature focuses on the manufacturing sector (Chang, Chen, Lin, Tien, & Sheu, 2006; Jack & Raturi, 2002; Koste, Malhotra, & Sharma, 2004), with little or no attention to the service sector..

However, understanding the impact of specific flexibility capabilities and their application is critical to organizations as flexibility is expensive to implement; hence any investment in flexibility based on wrongly considered competences might be (Gerwin, 2008; Narasimhan, Talluri, & Das, 2004). There is also a paucity of studies concerning flexibility capabilities relating to the operations of healthcare institutions. The quality of care and satisfaction with health facilities have been seen in most research as the perfect measure of assessing health systems performance. However, the WHO suggests responsiveness as a better measure of the performance of health systems (NB Valentine et al., 2003). Healthcare institutions are challenged by many sources of uncertainty in the supply chain and at an operational level. Though supply chain and operations flexibilities have the potential to promote the resilience and responsiveness of healthcare institutions, the scarcity of the literature in this respect makes this study worthwhile. As a result of limited literature at present, little knowledge exists on the extent to which supply chain and operations flexibilities individually promote responsiveness, or impact customer satisfaction, particularly within the service sector in Ghana.

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