245 General Discussion Kim et al. analyzed written text of 30 healthcare employees in various hospitals in Ohio focusing on Human Resources (HR)-driven initiatives.54 Like Chapter 6, this study occurred as the pandemic was unfolding in the Spring of 2021, but differences lay in the implementation of adaptive HR practices or policies that supported employees throughout the pandemic and the emergence of new leaders from middle management who developed group cohesiveness. They separate top and middle management and assess individual resilience over time.54 Karreinen and colleagues interviewed primary healthcare leaders in Finland to evaluate their perceptions of local resilience and on the role of leadership in building resilience to continue serving the population during crises.55 Their results provide a more holistic approach by addressing the broader context of primary healthcare, e.g., the importance of building collaborations and consensus amongst different stakeholders at the regional level. Their findings echo the broader issues related to Sanquin’s role in regional, national, and international contexts during the pandemic. The authors find that “embracing uncertainty” (Karreinen et al., p. 9) is vital and discuss how complexity leadership is needed for resilience in crises.55 Furthermore, three of these studies 53,54,56 sought to find the interactions or mechanisms between individual, team, and organizational resilience, and two posited new theoretical frameworks.53,54 Gröschke and colleagues quantitatively analyzed a broadly-disseminated survey of medical, administrative, and service staff in several German hospital.56 They found that individual and organizational resilience and team efficacy are interrelated. Their results showed that hospitals that had good leadership, preparation, and learning culture (i.e., had organizational resilience) had the largest impact on individual and organizational transformation; hence, if employees perceived their organizations to be resilient, it was easier for employees to be resilient.56 In comparing Kaltenbrunner et al. and Kim et al.’s frameworks of the interconnections between the individual, team/managerial, and organizational levels, both include similar traits of individual resilience. Both emphasize the need for top or middle managers to have consideration and care for their employees and have increased communication. They also posit that employees undergo crisis simulations and further training in crisis contexts and develop an adaptive culture.53 With regards to leadership, Kim distinguishes between the activities of top management and middle management: the former’s is to clarify mission, vision, and strategies, whereas the latter’s is to interpret top management’s decisions and act as counselors or coaches.54 Kim’s model is the most multi-level and interactional of the two, and posits how improvisation, paired with deliberate changes of HR practices, is a necessary part of operational resilience.54
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