Crisis and Crystallisation: Identifying system change opportunities

Michele Mastroeni

Co-researchers: Kassie Miedema, Oliver Jones, and Quinn Davidson

During the COVID-19 pandemic response period of 2020, military forces in various countries were mobilised to help in the response—from providing logistical support to civilian health providers to directly providing care to citizens. COVID-19 highlighted the securitisation of domestic disaster relief and/or large-scale disease responses framed as security concerns (Malik et al., 2021; Erickson et al., 2022). In France, the language was overtly martial: “we are at war,” stated French President Macron on March 16, 2020, and the French military committed to the “fight” (Pasquier, 2021; European External Action Service, 2020). This language demonstrates a crisis perception, effectively cutting through debate and dialogue regarding what action to take and spurring mobilisation to contain COVID and its impacts. In Canada, while the language used by the government was less martial, the Canadian Armed Forces (CAF) was nonetheless activated during COVID with both Operation Laser (treatment and care efforts) and Operation VECTOR (support to provinces for distribution of vaccines) (Veteran Affairs Canada, 2022). The call-up signalled a crisis, a break in the system, and, more importantly, a crystallisation of objectives unique to crisis situations.

The CAF response provides an empirical springboard from which we engage in the debate on values and their impact on the framing of health innovation, governance, and how crisis opens the door to institutional change. The starting place for this talk is a discussion of institutions, the framing of values and value, and their impact on the pricing of innovation, the innovation process and stakeholder behaviour, which includes Mazzucato’s call for a re-evaluation of value as applied to health innovation, and an orientation towards a “mission” to spur more effective coordination of stakeholders and the “entrepreneurial state’s” leadership (Mazzucato et al., 2020; Mazzucato & Roy, 2019). Next, a summary of military engagement in response to COVID-19 and the empirical example of the CAF’s engagement is examined. The discussion extends to how policymakers and other stakeholders in the innovation system can explore the reframing of institutions and values to remove bottlenecks and obstacles to health innovation.

The complexity of innovation governance is challenging in stable times, and during a crisis, the constantly changing nature and uncertainty of the environment increases the complexity. Through the example of Operation Laser (Government of Canada, 2023), the crisis also presents an opportunity for governance initiatives: identifying system limitations and planning for system change, clarifying societal objectives and creating a minimal consensus for action based on societal values. Even without a crisis, the lessons brought forward are useful for considering long-term change as they raise key questions:

• How do you change risk perception?
• How do you identify and communicate common values and facilitate discussions of further discovery of these if needed?
• How do you bring people along, keep the changes moving forward into the long term, and maintain them beyond any single stakeholder’s time-consuming effort (e.g., a government term)

Whether working for long-term change or starting without a crisis, change requires the identification of societal values and objectives along with the stakeholders who will be the impacted actors (cooperative or conflictive). Therefore, developing a crisis or change management philosophy that can be translated to effective governance has to be designed with these key elements in mind, called the S3.

Stakeholders: This involves identifying and charting all stakeholders in the problem space who may be directly or indirectly impacted by a crisis, a problem demanding attention, or change initiatives/innovation being planned.

Systems: Mapping systems, a common practice for innovation governance, allows for a strong understanding of how actors interact with each other, the nature and extent of that interaction, or their interaction with other system elements (e.g. institutions, resources).

Stories: These are the narratives that support change and governance efforts, introduce reactions to a crisis, or communicate the justification for mission and change.

These elements stem from design and are applicable to a wide variety of social and policy issues (e.g., Martin and Martin, 2009; Bason et al., 2020; Archipelago of Design, 2022). They lay the foundations for understanding and operationalising action for complex problems.

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