199 Something we must be proud of: team improvisation structural).9,25 For example, teams can improvise incrementally by adjusting SOPs, but they can improvise radically in times of crises,9,25 as seen in our study. Yet respondents’ lament that it was “going back to business as usual” alludes to the transition back to how things were. In Duchek’s organizational resilience framework, the third step is of “adaptation” in which lessons learned are translated into organizational change.14 In our study, the group “coped” (the second step) and incremental changes occurred, but there were no radical organizational permanent changes. Reasons include blood banking regulations and the need to revert back to “normal” change control procedures, how different phases of crises warrant different leadership styles and allowances for risk-taking (e.g., in the acute phase, risk-taking is necessary and allowed)26 and/or related to the organizational power and management structures and culture.10,14 This then leads to the consideration of what lessons can be learned regarding improvisation and innovation for non-crisis scenarios, which can be challenging for large bureaucratic organizations. It is notable to mention that though improvisation impacted the set routines and procedures, the safety and quality of the product were not affected, which is an important point as blood banking is rightly heavily regulated. As improvisation occurred, so did verbal risk assessments and failure models. These were discussed before any changes were made. In times of crises, it is common for trial and error to occur and return to risk-aversion when the period has passed. However, looking ahead, with such experiences behind us, one could take the lessons learned from CCP and apply them into Healthcare Failure Mode and Effects Analysis (HFMEA)27 thereby combining planning with improvisation. Planning is part of improvisation, which is not random moments of spontaneous brilliance but it is a skill that relies on pre-established rules, routines, and cultivation through training and practice.16 Therefore, improvisational training is needed during times of stability and peace16,28,29 for the biggest investment in training cannot occur during crises when it is ad hoc and rapid (as exemplified in this study). Improvisational training includes exercises in listening and communicating, using context-specific knowledge, in a safe context of shared responsibility where members can get out of their comfort zones.16,29 This could look like simulation training of multidisciplinary teams from different departments using scenarios from both crisis and non-crisis situations.8,29 Benefits include expanding employees’ (mental) capacities, character, and skillsets to prepare staff to better perform in times of uncertainty,8,28–30 and, equally important for non-crisis situations, boosting creativity communication, and engagement, among other benefits.31–33 Additionally, literature suggests that organizations can catalyze innovation by using the power of employee networks and creating adaptive spaces during crises.34–36 Doing so includes the benefits of crisis leadership37 and how team effi
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