185 Something we must be proud of: team improvisation 5.1 Introduction Since 2020, the ongoing COVID-19 pandemic has profoundly impacted societies around the world, affecting health organizations who have borne the burden of caring for the ill.1 Blood establishments (BEs) worldwide have grappled to respond to subsequent impacts and changes to blood supply and demand, shortages of materials and staffing, and other issues in the supply chain.2–6 In organizational and crisis management literature, “the ability of organizations to respond to external threats, such as COVID-19, is linked to the notion of resilience,”7 of which improvisation is considered a key component.8 Organizational improvisation (OI) is the “conception of unhindered action as it unfolds, by an organization or its members, often (yet not exclusively) in response to an unexpected interruption or change of activity” (p. 4).9 In times of crises, it has been described as using creativity to “create order from chaos”10 and requires “immediate action that cannot be addressed using preapproved, ‘safe’ routines and solutions” (p. 4).9 Within BE organization and management, the quality of blood products, particularly aspects of safety and availability, are of paramount importance. This has historically led to a strict system of processes and procedures, and a well-defined organization, staff, and culture of how things are done. However, the COVID-19 crisis challenged these elements as it forced staff to produce a new product in sufficient quantities in a rapid timeframe. Improvisation needed to occur. This is exemplified by the collection of convalescent plasma (CCP), plasma taken from recovered COVID-19 patients to use as a treatment option for diseased patients.11 In 2020, this initiative was catalyzed by many BEs worldwide,3,5,6,12 including at Sanquin Blood Supply Foundation, the Dutch national blood bank legally tasked as the sole provider of blood products in the Netherlands. Sanquin rapidly sprang to action in March 2020 to first form the early-stage CCP group to collect CCP for clinical studies, and later, as part of nationwide collection effort for hyperimmunoglobulins.2 Based on our previous work, we found that disruptive events (including a global pandemic) are an important theme that would impact blood product demand so that BEs should become more adaptive, flexible, and be open to change.13 These elements are important in resilience, and the pandemic was the perfect opportunity to study these elements in action through the singular and collective actions of the teams that undertook COVID-19 activities. Due to the CCP project being one of the first and most spotlighted projects in the organization,2 it was a unique opportunity to study team improvisation within this group. To our knowledge, while there now exists many examples of CCP projects within the literature, there have not yet been case studies on the internal dynamics of such projects, and/or studies on team impro-
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