198 Chapter 5 5.4 Discussion This study sought to evaluate which elements of team improvisation were present in the early-stage CCP group of Sanquin’s Blood Bank during the acute pandemic phase in Spring 2020. We found that elements of expertise, memory, teamwork quality, real-time information and communication, and experimental culture were strongly present. The element of training was present to a lesser degree. The crisis situation created an “opportunity window”21 for impacts and changes in conventional methods and protocolization as employees found themselves needing fast availability of a new product in the midst of urgency, pressure, and the unknowns. The elements of team improvisation were activated, catalyzing the group’s strengths of expertise, memory, teamwork quality, and real- time information to form a strong mental model of teamwork. These findings correlate with other literature which explored healthcare organizations’ responses to COVID-19.10,22 Wiedner et al. found that key drivers of urgency (in which “normal practices cannot continue and formal regulatory practices become limiting”), resource scarcity, and collective identity (increased cooperation and social bonding that overcome organizational silos) contribute towards organizational innovation.22 However, authors state that junior, less-experienced staff allow for more innovative ideas,22 which is the opposite of our case study as the composition of the CCP group was of senior, very experienced staff. This is probably due to the latter’s collective transactive memory, a diverse past collection of declarative and procedural knowledge of the organization’s systems, structure, strategy, culture, rules, and procedures.16,23,24 This in combination with the aforementioned strong mental model, trust and safety within the group, allowed the group to improvise effectively and quickly, overcoming lengthy blood bank processes. Such elements are supported in the literature.16,23,24 Furthermore, the crisis allowed for a temporary experimental culture in which control was loosened, autonomy was heightened, and errors were allowed—expected, even—for improvisation to occur. Workarounds in protocols were found and the new digital intake form became a permanent feature of Sanquin’s intake process. Top-down leadership changed to enabling leadership to keep efforts moving forward. Respondents admitted how refreshing this cultural change was compared to the slowness and backward- ness of the “traditional” environment. This correlates to Lloyd-Smiths’ study of the characteristics of a resilient healthcare organization’s response to COVID-19 includes sacrificing existing routines and processes,10 which is a common finding in crisis management and improvisational literature.9,16,25 Furthermore, this literature also describes how improvisation occurs on multiple levels (i.e., the individual, interpersonal, and organizational) or degrees (i.e., minor, bounded, and
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