Table A3 Evidence supporting the...

Table A3

Evidence supporting the ambidexterity in the different phases of the adaptive cycle

Ambidexterity of MSF in adapting to the COVID-19 shocks
Ambidexterity phases	Timing of events ESC	Timing of events field
Phase A: A phase of high exploitation and low exploration	01/01/20–17/03/20	01/01/20–09/04/20
High Exploitation - ensuring continuity
Sources: 21 documents (18 meeting minutes, 2 internal newsletters, 1 public communication) 14 Respondents (R2, R3, R10, R14, R19, R21, R25, R29, R31, R32, R33, R36, R38, R40)
“The concern is not about supply per se but mainly on equitable allocation. The question is not only around shortages but how to deal with the shortage.” Minutes_ESCs_200228 “Of course, the first thing you do is look at your existing supplier base and see what you can still buy there and what you can secure there, because there you know, the quality of the product.” R26 “We put a rush on having available inventory in Dubai, in Merignac, and we prospected our suppliers.” R31 “Form sent to the 50 biggest suppliers for having a point of situation.” Minutes_ESC_200303 “The missions tried to push for international purchasing for too long. They should have switched to local procurement earlier.” R13 “At first, we had to make sure that regardless of the ongoing pandemic, the purchase of items was made according to the processes and respecting all medical matters, processes and all this.” R10
Low Exploration- investigating new options
Sources: 6 documents (5 meeting minutes, 1 internal newsletters) 14 Respondents (R8, R10, R14, R16, R19, R21, R25, R26, R31, R32, R33, R36, R38, R40)
“We kept some scan of the environment. We could try to anticipate some orders, and some new suppliers before the situation got all so surreal.” R32 “We were already looking for new suppliers early February. We were not in emergency mode yet, but we were feeling things started to get bigger, and we needed to prepare.” R36 “Mid-February, the procurement team started to explore contingency plans for potentially key articles.” R21 “We spent 3 or 4 weeks trying to organize the MSPP platform when we could sense market was tense. And then all sudden, we received 450 offers from suppliers, even though they were not manufacturing masks before.” R19 “We were securing inventory in the emergency stock.” R33 “I immediately secured 8/9 months of PPE for our regular TB projects […] because TB patients are long-term and extremely vulnerable.” R37 “At the very beginning, the MSPP wasn't mature enough to take over, it was just getting structured in case.” R25
Phase B: A shift to high exploration and low exploitation	19/03/20–03/06/20	10/04/20–19/07/20
High Exploration - investigating new options: COVID-19 taskforce and local procurement
Sources: 100 documents (75 meeting minutes, 21 newsletters, 3emails, 1 public communication) 39 respondents (R0, R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, R16, R17, R18, R19, R20, R21, R24, R25, R26, R28, R29, R30, R31, R32, R33, R35, R36, R37, R38, R39, R40, R41, R42)
“Regarding procurement, helplessness and frustration led to innovation.” R01 “We had to put quite a few things in place. It was not easy, we [ESC procurement team] were not used to working this way. But we managed.” R11 “We [regional supplier center] had to find new suppliers. We had suppliers, but their capacity was not adequate with our needs, so we had to identify new ones.” R12 “Normally we [ESC] ask for the European Quality Certificate and some of these new suppliers were only providing quality certificates from China. So, we had to was really a learning curve. It was this was the first time.” R17 “We had a lot of creative solutions.” R17 “All the procurement, all searching for new suppliers, it needs quite a lot of follow up, because the situation is very volatile, there is nothing taken for granted.” R32 “Besides the prioritization at ESCs, the two main things [to manage the crisis] was the taskforce and the local procurement authorization.” R16 “What helped us was the taskforce. […] We reorganized and coordinated in the procurement platform. This collaboration was never done like this before.” R17 “[April's priority 1] using alternative approaches such as local purchase, or production of key items, and calling all MSF sections to request or identify opportunities to secure donations or loans. Exploring innovative/alternative mitigating measures to minimise the impact of PPE shortages.” (Newsletter_intersection_1704) “We had to purchase on the Chinese market, and it was totally new for us. We didn't know either the US norms or the Chinese norms. I was all new for us.” R25 “We had never done a collaboration between one purchase from one ESC and one QA from another OC, and it worked really well.” R25 “So, from the moment we restructured, one ESC takes care of that item, the other ESCs takes care of that item, and we mix the teams of QA and purchaser, it really helped having a global mindset to purchase for all the OCs. It was a little long to put into place, because normal each purchaser and QA only work for their supply center.” R33 “We developed quite a few new tools to cope with the covid orders.” R37 “We also implemented, that never happened before, inspections before transfer of goods. We had to do it with all the new suppliers.” R25
Low Exploitation - ensuring continuity: maintaining relationships with long-time suppliers
Sources: 54 documents (41 meeting minutes, 13 newsletter) 27 respondents (R2, R3, R4, R6, R7, R10, R12, R14, R15, R16, R17, R18, R19, R21, R24, R25, R26, R29, R30, R31, R32, R33, R36, R37, R38, R40, R41)
“[April's priority 2] Securing essential supplies in the long term, by engaging in high-level negotiations with existing and new supply partners.” (Newsletter_intersection_1704) “From the beginning, we put in the orders to the ESC. Where there was a massive delay, I was asking update to the taskforce […] Those orders are shipped now. So, we knew that for these first six months we would have to monitor with the local procurement and the local stocks.” R34 “We are still focusing on suppliers' reliability, identification of manufacturers and manufacturing sites, as well as quality.” R04 “We had to remind everyone that procurement is still done a certain way. The field could purchase locally, but they had to follow the validation process. And international procurement was handled only by the ESCs, the field was not allowed to purchase in China.” R06 “We tried to maintain the quality validation process as much as possible. Exceptions were drawn, if we were sure about the manufacturer, if it was a manufacturer with a long medical supply experience.” R17 “So this time when there was a massive lack of stock everywhere worldwide […] we still tried to pull the orders all together to make like joint orders.” R32 “We didn't lower our standards. It was a high stake. We could have, but I don't think it would have been a good idea, because the only thing it would have done would be to have purchased fully useless materials at very high prices.” R31 “When constraints in Europe increased, we increased inventory in [this ESCs' warehouse in] Dubai. […] It's always worked well in Dubai.” R31 “My financial authorized was increase, but over [certain amount] purchases still had to validated by the administration council.” R19 “We didn't disturb the normal ordering process or procedure or for items that were not linked to COVID. They [ESC] still had the capacity to prepare those for us.” R14 “We asked MSF Logistique to prepare as much as possible from everything from our regular cargoes, the ones that we place for regular operations. For the COVID's related for regular mission and of course or the emergency we purchased locally.” R07
Phase C: Back to high exploitation low exploration	04/06/20 - onwards	20/07/20 - onwards
High Exploitation - ensuring continuity
Sources: 36 documents (29 meeting minutes, 7 newsletter) 10 respondents (R2, R6, R7, R12, R14, R19, R21, R33, R36, R38, R40)
“In June/July, we were back to normal supply from ESCs, and we kept the new suppliers if needed.” R12 “So June, […] we were negotiating with the suppliers and the buyers as well, negotiating huge quantities. Because [before the crisis] one mask costs like ten cents. And during the crisis it was costing like three euros. So, there was this financial game that we know that it works like this. And the buyers were fighting for that.” R17 “In July, the suppliers were validated, we were back to the normal way of validating them and had a sufficient supplier base.” R25 “We need to really to follow up to have good relations with suppliers are good terms, commercial terms and where they can take some my responsibilities.” R32
Low Exploration - investigating new options
Sources: 4 documents (3 meeting minutes, 1 newsletter) 8 respondents (R5, R19, R21, R25, R33, R36, R38, R40)
“We will continue to explore the possibility for new suppliers for oxygen concentrators in the region [Latin America].” R05 “So June, we were still validating new suppliers.” R17 “We are sourcing already for the second wave.” R33

Ambidexterity of MSF in adapting to the COVID-19 shocks
Ambidexterity phases	Timing of events ESC	Timing of events field
Phase A: A phase of high exploitation and low exploration	01/01/20–17/03/20	01/01/20–09/04/20
High Exploitation - ensuring continuity
Sources: 21 documents (18 meeting minutes, 2 internal newsletters, 1 public communication) 14 Respondents (R2, R3, R10, R14, R19, R21, R25, R29, R31, R32, R33, R36, R38, R40)
“The concern is not about supply per se but mainly on equitable allocation. The question is not only around shortages but how to deal with the shortage.” Minutes_ESCs_200228“Of course, the first thing you do is look at your existing supplier base and see what you can still buy there and what you can secure there, because there you know, the quality of the product.” R26“We put a rush on having available inventory in Dubai, in Merignac, and we prospected our suppliers.” R31“Form sent to the 50 biggest suppliers for having a point of situation.” Minutes_ESC_200303“The missions tried to push for international purchasing for too long. They should have switched to local procurement earlier.” R13“At first, we had to make sure that regardless of the ongoing pandemic, the purchase of items was made according to the processes and respecting all medical matters, processes and all this.” R10
Low Exploration- investigating new options
Sources: 6 documents (5 meeting minutes, 1 internal newsletters) 14 Respondents (R8, R10, R14, R16, R19, R21, R25, R26, R31, R32, R33, R36, R38, R40)
“We kept some scan of the environment. We could try to anticipate some orders, and some new suppliers before the situation got all so surreal.” R32“We were already looking for new suppliers early February. We were not in emergency mode yet, but we were feeling things started to get bigger, and we needed to prepare.” R36“Mid-February, the procurement team started to explore contingency plans for potentially key articles.” R21“We spent 3 or 4 weeks trying to organize the MSPP platform when we could sense market was tense. And then all sudden, we received 450 offers from suppliers, even though they were not manufacturing masks before.” R19“We were securing inventory in the emergency stock.” R33“I immediately secured 8/9 months of PPE for our regular TB projects […] because TB patients are long-term and extremely vulnerable.” R37“At the very beginning, the MSPP wasn't mature enough to take over, it was just getting structured in case.” R25
Phase B: A shift to high exploration and low exploitation	19/03/20–03/06/20	10/04/20–19/07/20
High Exploration - investigating new options: COVID-19 taskforce and local procurement
Sources: 100 documents (75 meeting minutes, 21 newsletters, 3emails, 1 public communication) 39 respondents (R0, R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, R16, R17, R18, R19, R20, R21, R24, R25, R26, R28, R29, R30, R31, R32, R33, R35, R36, R37, R38, R39, R40, R41, R42)
“Regarding procurement, helplessness and frustration led to innovation.” R01“We had to put quite a few things in place. It was not easy, we [ESC procurement team] were not used to working this way. But we managed.” R11“We [regional supplier center] had to find new suppliers. We had suppliers, but their capacity was not adequate with our needs, so we had to identify new ones.” R12“Normally we [ESC] ask for the European Quality Certificate and some of these new suppliers were only providing quality certificates from China. So, we had to was really a learning curve. It was this was the first time.” R17“We had a lot of creative solutions.” R17“All the procurement, all searching for new suppliers, it needs quite a lot of follow up, because the situation is very volatile, there is nothing taken for granted.” R32“Besides the prioritization at ESCs, the two main things [to manage the crisis] was the taskforce and the local procurement authorization.” R16“What helped us was the taskforce. […] We reorganized and coordinated in the procurement platform. This collaboration was never done like this before.” R17“[April's priority 1] using alternative approaches such as local purchase, or production of key items, and calling all MSF sections to request or identify opportunities to secure donations or loans. Exploring innovative/alternative mitigating measures to minimise the impact of PPE shortages.” (Newsletter_intersection_1704)“We had to purchase on the Chinese market, and it was totally new for us. We didn't know either the US norms or the Chinese norms. I was all new for us.” R25“We had never done a collaboration between one purchase from one ESC and one QA from another OC, and it worked really well.” R25“So, from the moment we restructured, one ESC takes care of that item, the other ESCs takes care of that item, and we mix the teams of QA and purchaser, it really helped having a global mindset to purchase for all the OCs. It was a little long to put into place, because normal each purchaser and QA only work for their supply center.” R33“We developed quite a few new tools to cope with the covid orders.” R37“We also implemented, that never happened before, inspections before transfer of goods. We had to do it with all the new suppliers.” R25
Low Exploitation - ensuring continuity: maintaining relationships with long-time suppliers
Sources: 54 documents (41 meeting minutes, 13 newsletter) 27 respondents (R2, R3, R4, R6, R7, R10, R12, R14, R15, R16, R17, R18, R19, R21, R24, R25, R26, R29, R30, R31, R32, R33, R36, R37, R38, R40, R41)
“[April's priority 2] Securing essential supplies in the long term, by engaging in high-level negotiations with existing and new supply partners.” (Newsletter_intersection_1704)“From the beginning, we put in the orders to the ESC. Where there was a massive delay, I was asking update to the taskforce […] Those orders are shipped now. So, we knew that for these first six months we would have to monitor with the local procurement and the local stocks.” R34“We are still focusing on suppliers' reliability, identification of manufacturers and manufacturing sites, as well as quality.” R04“We had to remind everyone that procurement is still done a certain way. The field could purchase locally, but they had to follow the validation process. And international procurement was handled only by the ESCs, the field was not allowed to purchase in China.” R06“We tried to maintain the quality validation process as much as possible. Exceptions were drawn, if we were sure about the manufacturer, if it was a manufacturer with a long medical supply experience.” R17“So this time when there was a massive lack of stock everywhere worldwide […] we still tried to pull the orders all together to make like joint orders.” R32“We didn't lower our standards. It was a high stake. We could have, but I don't think it would have been a good idea, because the only thing it would have done would be to have purchased fully useless materials at very high prices.” R31“When constraints in Europe increased, we increased inventory in [this ESCs' warehouse in] Dubai. […] It's always worked well in Dubai.” R31“My financial authorized was increase, but over [certain amount] purchases still had to validated by the administration council.” R19“We didn't disturb the normal ordering process or procedure or for items that were not linked to COVID. They [ESC] still had the capacity to prepare those for us.” R14“We asked MSF Logistique to prepare as much as possible from everything from our regular cargoes, the ones that we place for regular operations. For the COVID's related for regular mission and of course or the emergency we purchased locally.” R07
Phase C: Back to high exploitation low exploration	04/06/20 - onwards	20/07/20 - onwards
High Exploitation - ensuring continuity
Sources: 36 documents (29 meeting minutes, 7 newsletter) 10 respondents (R2, R6, R7, R12, R14, R19, R21, R33, R36, R38, R40)
“In June/July, we were back to normal supply from ESCs, and we kept the new suppliers if needed.” R12“So June, […] we were negotiating with the suppliers and the buyers as well, negotiating huge quantities. Because [before the crisis] one mask costs like ten cents. And during the crisis it was costing like three euros. So, there was this financial game that we know that it works like this. And the buyers were fighting for that.” R17“In July, the suppliers were validated, we were back to the normal way of validating them and had a sufficient supplier base.” R25“We need to really to follow up to have good relations with suppliers are good terms, commercial terms and where they can take some my responsibilities.” R32
Low Exploration - investigating new options
Sources: 4 documents (3 meeting minutes, 1 newsletter) 8 respondents (R5, R19, R21, R25, R33, R36, R38, R40)
“We will continue to explore the possibility for new suppliers for oxygen concentrators in the region [Latin America].” R05“So June, we were still validating new suppliers.” R17“We are sourcing already for the second wave.” R33

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