264 Summary Chapter 4 builds on the work described in Chapter 2. Scenario sessions were conducted to take the transformational factors found in Chapter 2 and categorize them into 10 main themes, ranked by respondents in terms of importance and uncertainty. Experts ranked the top three most important themes to be the blood supply organization, precision medicine, and red blood cell replacements; the top most uncertain theme was “disruptive events.” Subsequently, focus groups were organized to find the opportunities, threats, and mitigating measures per theme for Sanquin. For example, regarding the blood supply organization, opportunities included leadership placement, and strengthening collaborations with hospitals and external companies; threats included lack of (clearly communicating) a vision or strategy or a rigid organizational structure. Mitigating measures included stimulating an innovative mentality amongst the leadership of Sanquin and having an agile, flexible organizational structure with enhanced communications and collaborations between divisions and departments. Furthermore, Chapter 4 shifts the thesis from the external factors that may affect the future demand of RBCs and Ig (Part I) to the internal organizational factors (Part II), thereby moving the focus from scenario development to organizational resilience. As the COVID-19 pandemic occurred at the end of data collection for Chapter 4, it was an opportunity to see a main result (disruptive events, ranked as the most uncertain theme) happen in “real time” and observe how Sanquin “coped” and “adapted” (the second and third stages of resilience). Thus, Part II describes Sanquin’s actions immediately at the onset of the COVID-19 pandemic (prelude to Chapters 5 and 6) and specific organizational initiatives throughout the pandemic (Chapters 5-6). Hence, Chapter 5 uses interviews and an internal document analysis to assess which elements of improvisation in the early-group convalescent plasma (CCP) project contributed towards successful teamwork and organizational resilience. It was found that the elements of expertise and memory, teamwork quality, experimental culture, and real-time information and communication enabled them to improvise well. Many specific examples of improvisation are given. The discussion argues how improvisation is possible without impacting the safety and quality of the product, and incorporating improvisation within the organization’s practices and culture has beneficial effects. As the CCP group was only one example of a COVID-19 initiative, Chapter 6 provides a broad overview of the other organizational initiatives that were present. By combining a document analysis of 150 internal and external reports, interviews
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