219 Building towards organizational resilience and complexity leadership developing and implementing solutions, which came in the form of collaborations, modified communication methods and monitoring and feedback. Collaborations The topic of collaborations was the most prominent theme found in the interviews and the document analysis. Approximately 30 internal and external initiatives were found, ranging from internal safety measures to national efforts like PCR testing and donor antibody monitoring and many international research projects. Respondents shared how some collaborations were pre-existing, but others were new, and collaborations were markedly increased through COVID-19. One key aspect at the beginning of the pandemic was the organic, bottom-up nature of the research collaborations. Overall, respondents stated how unique it was that employees quickly sought each other across the organization: “I collaborated with people that in the years before, [I] would never have collaborated with.” (Researcher7, 15 years). One document reviewed the quality of these collaborations, from those that were “more difficult” to “excellent” (the majority were good excellent; only one was deemed unsuccessful). From interviews, respondents shared how research collaborations were particularly rewarding, with quick data acquisition and many publications. Both the document analysis and interviews emphasized how joint collaborations with the Dutch government were of particular importance and success. Both the document analysis and interviews concurred that Sanquin’s multi-expertise knowledge base was the cornerstone as to why so many endeavors could successfully occur. However, while there were many positive aspects, challenges remained (Supplementary Table 1). Respondents shared how many of these challenges were rooted in the pre-existing structural and cultural organizational elements that came to the forefront as different departments worked together. Overall, while there was a clear, common goal and coordination, some groups still struggled with lack of governance and leadership issues, which caused delay and confusion. Communication methods Both the document analysis and interviews revealed how because most employees worked from home, communication patterns and venues were modified and increased. For internal purposes, respondents explained how this resulted in more frequent use of existing communication means while creating new ways of communication, such as the Help Hotline which provided COVID-19 work advice from Sanquin physicians for employees at a response rate of within 2 hours. Respondents
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