The Cost of Adaptability: Exploring the Dual Nature of Adaptive Capacity Through a Healthcare Case Study

ABSTRACT The capacity to adapt to surprising conditions by quickly changing existing ways of working is essential for organizations operating in complex and unpredictable environments. Yet empirical understanding of factors contributing to adaptive capacity remains limited and fragmented. This paper presents findings from a qualitative case study of a sudden internal flooding at a Swedish hospital, based on semi‐structured interviews. The flooding was caused by a rupture of a pressurized cooling water pipe, leading to water spreading from the fifth floor and cascading down to all floors below, resulting in substantial damage. The hospital demonstrated a strong capacity to stretch under pressure by relocating mobile equipment, redirecting patient flows, and transferring staff to a nearby hospital. We identify several factors enabling this adaptive capacity, relating to coordination, collaboration, commitment, networks, and trust. At the same time, the response was delayed due to limited preparedness and foresight, as well as tensions between bureaucratic processes and the need for rapid, flexible action. The paper thereby highlights that adaptability is essential for managing unexpected events but can also conceal structural vulnerabilities. The “cost of adaptability” thus refers to the price an organization pays when over‐relying on adaptability at the expense of preparedness and anticipation. To illustrate the dual nature of adaptability, we present a typology of four organizational archetypes based on their levels of adaptive and anticipatory capacities, describing both benefits and unintended side‐effects. The archetypes include organizations that are: Adaptable but structurally vulnerable; Well‐planned but inflexible; Brittle and shortsighted; and Resilient and sustainable.