**3. Case studies of organisations confronting VUCA (volatile + uncertain + complex + ambiguous) conditions**

In this section we explore two cases where Agility and/or Innovation were missioncritical during a period of extreme disruption due to VUCA (volatile + uncertain + complex + ambiguous) conditions.

In March 2020 it became clear that the UK was about to experience a serious public health emergency caused by the rapid spread of Covid 19, then a new strain of coronavirus. At that time epidemiologists made predictions that up to a half a million premature deaths could occur in the UK with ice-rinks commandeered for use as temporary mortuaries and hospitals being unable to cope with the quantity of patients. The UK government moved to what was described as a 'wartime footing' and many initiatives took place to mitigate the effects of the pandemic, of which we will examine just two. First, was a fast-track programme to discover, develop, test, produce and deliver effective vaccines to protect populations against Covid 19 in about one-tenth

of the time generally allowed for this kind of task. Second, was the construction of a new emergency hospital in London that would have the facilities to cope with hundreds of patients with urgent and severe respiratory failure.

#### **3.1 Creating an effective vaccine against Covid 19**

The only effective long-term solution for a global viral pandemic is a safe and effective vaccine. In the case of the Covid 19 epidemic the need was urgent, but it quickly became clear that conventional pharmaceutical drug development processes would be unable to meet a tight deadline as, conventionally, drugs or vaccines will be in discovery or development for up to a decade before they are ready to be licenced as medicines.

The UK Government was quickly briefed on the likely disastrous social, individual and economic consequences of the pandemic and an ad hoc executive organisation was quickly established with access to almost unlimited funds and the power to define policies and commandeer resources. An early step in the UK was to establish the Vaccine Taskforce, which was announced on the 17th April 2020 [35] with the mission to "drive forward, expedite and co-ordinate efforts to research and then produce a coronavirus vaccine and make sure one is made available to the public as quickly as possible". This well-funded taskforce had the direct support of the UK Government to devise and deliver a strategy (that can be described as 'backing many horses in the same race') for directing and managing fast-tracked vaccine development.

It was quickly realised that the work to discover, invent, develop, test and manufacture at scale new vaccines at unprecedented speed would require extensive 'do-different' Innovation in multiple areas, including managerial processes, scientific discovery routines, intergroup-cooperation, trials management practises and preparation for constructing or upscaling vast, and largely robotic, production facilities. Innovation would be required in each of the 6P areas described in the previous section. As there was no certainty that a candidate vaccine would prove to be effective and safe in clinical trials multiple candidate vaccines were required to be developed.

Thanh et al. [36] provide deep insight into the scientific and technological challenges of this work programme when they observed that: "A striking feature of the vaccine development landscape for COVID-19 is the range of technology platforms being evaluated, including nucleic acid (DNA and RNA), virus-like particle, peptide, viral vector (replicating and non-replicating), recombinant protein, live attenuated virus and inactivated virus approaches". The development of Covid 19 vaccines quickly became an international effort with leading pharmaceutical companies providing resources and expertise so that 'many horses could be backed in the same race'.

Although one promising vaccine was being developed in the UK, the government took a decision to order supplies of different vaccine candidates before they had been certified for use from a range of international providers. Baraniuk [37] sheds light on the importance of speculative executive decision-making in this context when he observed that "(t)he UK's hefty vaccine orders were made in part thanks to the 2011 film Contagion. Health secretary Matt Hancock was spooked by the ending of the film, in which countries ravaged by a respiratory disease are left fighting for a limited number of vaccine doses. He insisted on ordering 100 million Oxford-AstraZeneca doses despite receiving advice to order a mere 30 million".

The Covid 19 vaccine developed by Pfizer and BioNTech was approved in about eight months after trials began. On the 8 December 2020 Grandmother Margaret Keenan became the first person in the world to receive the Pfizer COVID-19 jab in a hospital in the UK. The vaccine had been prepared four times more quickly than had ever been achieved before and in about a tenth of the time usually required for this kind of task.

Innovation was the core process driving the development of Covid 19 vaccines and it delivered the scientific breakthroughs, rapid upscaling of production facilities and other developments that enabled an effective and safe vaccine to be inoculated into millions of people within a timescale never previously accomplished. The scientific work of developing vaccines required interaction between multiple forms of 'do-better' and 'do-different' Innovation in each of the 6P areas (Product, Process, Position, Paradigm, Provisioning and Platform) that were described earlier. Although Innovation was central it depended on Requisite Agility to provide the conditions, and maintain ongoing support, that made this huge innovative endeavour possible. Agility was essential to establish, empower and drive the governance structure, acquire authority to create or deploy extensive and expensive resources, secure international cooperation, enrol pharmaceutical companies, provide funds, fast-tracked the building of production facilities and enable rapid clinical trials to be completed.

### **3.2 Building the Nightingale Hospital in 10 days**

In March 2020 it was decided by the Government Minister responsible for Health that an emergency hospital was needed in London as it was predicted that the existing hospitals could be overwhelmed by the numbers of seriously ill patients with Covid 19. London's emergency hospital was named after the nurse Florence Nightingale who had made huge contributions to the development of modern nursing techniques in the nineteenth century.

Once the decision had been taken to build the emergency hospital the UK government had to decide what 'practice of action' or 'means' could achieve this demanding and urgent task. Interestingly, the construction task was not delegated to the normal planning groups who were accustomed to take several years to construct a new hospital. Rather an empowered ad hoc organisation was constructed with the hands-on help of military officers who had the capabilities to deliver fast-track complex work programmes. The importance of 'can-do' competencies provided by the military was explained by a member of the project management team [38] in the following way: "(m) uch of the success so far is due to the collaboration with the military, whose leadership approach to clarity of task, clarity of mission, delegation of responsibility, execution and compassion is impressive to see". Watts and Wilkinson provided additional insight into 'can-do' competencies in their interview with a chief medical officer of a Nightingale Hospital, who observed that "(t)hey (the military) will take your wish list and provide you with a solution… And if you have forgotten something or made an error, they are not phased at all: the attitude is one of problem solving not blame… They are very good at just making it happen; they don't go away and debate it and have committee meetings… They take the instruction and operationalise that for you at great speed".

Many actions were implemented within days of the government decision to go ahead. The Excel Centre in London was leased, vast funds were allocated, specialist architects instructed to design a new 4000 bed hospital, military planners tasked to act as project integrators, construction companies with proven competences were hired and hundreds of specialist workers were recruited. This required multiple rapid, decisive, integrated, funded and aligned actions to fulfil a design brief that [39] would "repurpose, with minimal new construction techniques, an exhibition centre into a hospital". Notice that 'minimal new construction techniques' were specified.

#### *Untangling the Relationship between Innovation and Agility DOI: http://dx.doi.org/10.5772/intechopen.112557*

It was considered that there would not be time to embark on Innovation Initiatives. Those defining how the constructors of the Nightingale Hospital should operate had taken a decision similar to that already adopted by National Aeronautics and Space Administration (NASA), which was to strive to avoid undertaking any innovative endeavours during an actual space mission.

The Cfes construction company was selected as a principal contractor in the Nightingale Hospital project. Rob Doubtfire, Managing Director of Cfes, described the hectic pace of being a key actor in this agility-orientated endeavour [40]. Doubtfire received a phone call on Friday evening the 20th of March and he attended a briefing at Excel Centre the next day. One day later, on Sunday, Cfes designers gathered to plan the transformation of the conference centre into specialist hospital and employees started work, on site, on the next day. From then on teams from the UK's National Health Service (NHS), the military, specialist architects and many subcontractors worked 16 to 18-hour shifts for nine days until the new hospital was ready to be handed over. The members of these aligned groups were totally dedicated with some sleeping in the temporary headquarters project office. Importantly, almost unlimited funds were made instantly available and government ministers took a close and proactive interest in maintaining rapid but considered progress.

Agility, not Innovation, was the dominant modality of action. Agile Capability was targeted at: (i) developing a resolute political will to get it done; (ii) making adequate funds available; (iii) assigning military personnel to provide the organisational expertise required to coordinate a large, complex and urgent project, (iv) ensuring that only experienced professionals were hired, (v) developing a culture that total dedication was expected, (vi) ensuring that workers were empowered, (vii) limiting innovation that was only sanctioned if existing capabilities were unavailable and (viii) maintaining a 'wartime spirit'. As the task of building of the Nightingale Hospital was undertaken there were relatively minor Innovation Initiatives that were 'do-better', rather than 'do-different', in Process, Provisioning and Platform. These were supportive rather than mission critical.

#### **3.3 Learning from the cases**

When we review the cases outlined in the previous section it is important to note that data collected in one context cannot provide reliable generalizations although it can be used to develop hypotheses or to identify research questions. A limitation of our study was that the data available were secondary and the expertise of informants could not be checked, although the records of the UK Government's Health and Social Care Committee, which has the power to take evidence under oath and to compel witnesses to attend, provided a valuable means to cross-check data and added veracity to the dataset.

Using of the Litmus Tests (see Sections 2.1.3 and 2.2.5) shows that the development of Covid 19 vaccines and the construction of the Nightingale Hospital benefitted from Innovation and/or Agility at different phases of these grand projects. At times the relationship between the two instruments was complex with Innovation being nested within Agility or Agility providing resources to increase the probability that Innovation would be successful.

#### *3.3.1 Relevance of structural functionalism to the construct of Dynamic Capabilities*

Whether reviewed separately or interactively it is helpful to describe Innovation and Agility as providing 'functions' that serve to facilitate or enable progress towards an overall goal. The term 'functions' needs explanation as we are using the term as it was defined in a sociological perspective known as Structural Functionalism. This conceptual framework is now rarely used for large-scale social analyses but, as Potts et al. [41] explain: "structural-functional approaches are highly useful and practical when used as a foundation for systemic analysis of real-world, multi-layered, complex planning systems".

Structural Functionalism views a social system as an organism with multiple 'organs' each of which makes a distinctive contribution to the wellbeing of the whole. If an organ helps a social system to survive over time, remain healthy, achieve desired outcomes, withstand shocks and adapt to changing conditions then is described as 'functional'. If an organ hinders the social system's ability to survive over time, withstand shocks or adapt to changing conditions then it is 'dysfunctional'.

From a theoretical perspective, viewing Innovation and Agility as providing (sociological) functions provides a useful, perhaps novel, perspective on Dynamic Capabilities that were originally identified largely using economic theoretical lenses. In recent literature [42]. Dynamic Capabilities have been described as being actualised by 'micro-foundations'. If micro-foundations are also defined as functions, then their role in systematic analysis can be understood more comprehensively.
