Organizational logics in time of crises: How physicians narrate the healthcare response to the Covid-19 pandemic in Swedish hospitals.

BACKGROUND: The COVID-19 pandemic has challenged healthcare organizations and puts focus on risk management in many ways. Both medical staff and leaders at various levels have been forced to find solutions to problems they had not previously encountered. This study aimed to explore how physicians in Sweden narrated the changes in organizational logic in response to the Covid-19 pandemic using neo-institutional theory and discursive psychology. In specific, we aimed to explore how physicians articulated their understanding of if and, in that case, how the organizational logic has changed during this crisis response. METHODS: The empirical material stems from interviews with 29 physicians in Sweden in the summer and autumn of 2020. They were asked to reflect on the organizational response to the pandemic focusing on leadership, support, working conditions, and patient care. RESULTS: The analysis revealed that the organizational logic in Swedish healthcare changed and that the physicians came in troubled positions as leaders. With management, workload, and risk repertoires, the physicians expressed that the organizational logic, to a large extent, was changed based on local contextual circumstances in the 21 self-governing regions. The organizational logic was being altered based upon how the two powerbases (physicians and managers) were interacting over time. CONCLUSIONS: Given that healthcare probably will deal with future unforeseen crises, it seems essential that healthcare leaders discuss what can be a sustainable organizational logic. There should be more explicit regulatory elements about who is responsible for what in similar situations. The normative elements have probably been stretched during the ongoing crisis, given that physicians have gained practical experience and that there is now also, at least some evidence-based knowledge about this particular pandemic. But the question is what knowledge they need in their education when it comes to dealing with new unknown risks.

Physicians’ experiences of work, support and leadership during the first wave of the COVID-19 pandemic: stories from Swedish hospitals

IntroductionPositive work engagement can increase in times of hard pressures, and especially when organisational resources are at place. Nevertheless, such hard pressure as the COVID-19 pandemic on care processes is not seen in modern times in Sweden. Inherent unpredictability of a pandemic together with the initial lack of reliable scientific data have posed major challenges to healthcare professional.ObjectiveThe aim of this study is to describe hospital-based physicians experiences of work, support and leadership in the health organisation they worked in during the first wave of the COVID-19 pandemic.MethodsA total of 25 physicians from different clinical units, and different hospitals in Sweden were interviewed between July and October of 2020. Interviews were transcribed verbatim and analysed using a qualitative content analysis as described by Graneheim, Lindgren and Lundman (2017). Analysis was inspired by a system approach sorting experiences on micro, meso and macro levels. ResultsPreliminary results show that physicians experienced on micro level physicians struggled to keep their health and control over their work situation. On meso level, physicians described trust in and support from first line managers. However, organisational and health service leadership were lacking. Physicians led the transition from regular to pandemic care, which was perceived as positive.ConclusionsHealth service organisation can learn from the physicians’ experience both in preparation for the next crisis and the importance of including medical professions in the organisation of care.