Purpose – This study aims to explore the impact of power games and leadership dynamics on organizational learning and resilience within healthcare organizations during the COVID-19 pandemic. By examining power struggles and sensegiving practices across hierarchical levels in two Swedish hospitals, the study investigates how these dynamics affected decision-making, crisis management and adaptive responses in a high-pressure environment.

Design/methodology/approach – This qualitative study uses semi-structured interviews with key healthcare managers and personnel responsible for crisis management. A deductive analysis is applied using theoretical frameworks on organizational learning, power games and sensegiving. Three critical events are analyzed to illustrate the effects of power dynamics and leadership practices on learning and organizational adaptation.

Findings – The study finds that power games and unilateral sensegiving significantly disrupted communication, decision-making and organizational learning. Informal leadership structures emerged to address immediate challenges, yet tensions with formal management highlighted the need to integrate these emergent practices into formal structures.

Practical implications – This study highlights that effective pandemic crisis management in healthcare requires balancing formal authority with inclusive and adaptive practices. Key implications include grounding sensegiving in frontline input, adopting flexible “plan-to-plan” approaches, involving hospital-level managers in decision-making, prioritizing practical over political solutions and fostering service-oriented leadership that enables rather than controls.

Originality/value – This study contributes to understanding how leadership and power dynamics shape learning and resilience during healthcare crises. By combining the insights with organizational learning and the Plan-Do-Study-Act cycle, it provides a novel perspective on integrating formal and informal leadership to enhance crisis management.

The COVID-19 pandemic emphasized the importance of effective crisis management. This research aims to analyze and comprehend the lessons learnt at Swedish hospitals in implementing surge capacity during the pandemic to enhance preparedness for future pandemics. The study utilizes a mixed-methods approach, combining two qualitative case studies and a quantitative survey. Inductive, explorative, and deductive analysis methods based on framework of learning and dynamic capability have been employed. 

The distinction between a major accident and a pandemic is considerable. A pandemic lasts longer, with changing capacity requirements. Moreover, during a pandemic, information originates within hospitals, upon the admission of patients. The study identified innovative planning strategies, such as stepwise causality planning, for the organization to pursue common goals and material deliveries within an agreed-upon time consumption in an uncertain delivery situation. Internal staff mobility and support for specialized staff are critical for adapting capacity, with a high dependence on equipment, space, and systems. 

Crisis management during a pandemic needs to be distributed and adaptive. Plans must be constantly adjusted aligning to the reality of the crisis. Additionally, the study emphasizes the role of healthcare professionals in decision-making, as well as the importance of continuous learning. Allowing leaders with trust within the organization to lead and create openness within the organization, without power plays and with positive “storytelling,” establishes a secure environment where staff mobility can be enhanced.

This study highlights an effective crisis handling through dynamic action and openness to learning during the pandemic. However, it identifies shortcomings, including malfunctioning contingency plans, insufficient staff mobility, and undynamic crisis management, especially at the regional crisis management level.

COVID-19-pandemin har belyst nödvändigheten av effektiv krishantering under pandemier. Denna studie syftar till att förstå och analysera de lärdomar kring produktionsstyrning som uppstått under pandemin, då kapaciteten dagligen behövde styras och balanseras mot de olika vårdbehoven. Studien omfattar både kvalitativ forskning med två fallstudier och kvantitativ forskning genom en enkät. Induktiva, explorativa och deduktiva analysmetoder har använts, där den sistabaserades på ramverk kring lärande respektive dynamiska och statiska kapaciteter.

Skillnaden mellan en stor olycka och en pandemi är betydande. Pandemin varar längre och vårdbehovet förändras i vågor, till skillnad från en olycka som oftast är kort och plötslig. Vidare skiljer sig informationsflödet, där det i en pandemi uppstår på sjukhusen genom vårdgivarnas nätverk och när patienter anländer, medan det vid en olycka går direkt från räddningsledare till regionens krisledning. 

Studien har identifierat innovativa planeringsstrategier speciellt för pandemier, såsom en så kallad stegvis kausalitetsplanering som ger organisationen möjlighet att sträva efter samma mål, samt material leveranser mot en överenskommen timkonsumtion i en osäker leveranssituation. Den mest kritiska faktorn för att klara sjukhusvården under pandemin identifierades som intern personalrörlighet. Denna var avgörande för att förstärka avdelningar med utökat behov och därmed stödja uthålligheten för den specialiserade personalen som tjänstgjorde där. Vidare var personalförsörjningen och uthålligheten beroende av tillgänglighetenav skyddsutrustning, utrymme och funktionen i systemet.

En krisledning under en pandemi behöver vara både delegerande och adaptiv. Planer måste ständigt anpassas efter krisens realitet. Dessutom betonar studiens resultat betydelsen av vårdprofessionens medverkan i beslutsfattande, samt betydelsen av kontinuerligt lärande. Genom att låta ledare med uppbyggt förtroende i organisationen leda och skapa öppenhet, genom att undvika maktspel och främja positiv “storytelling”, skapas en trygg miljö som förbättrar personalens välmående och rörlighet.

Studien beskriver att krisen hanterades väl genom att organisationerna agerade dynamiskt och var öppen för lärande. Dock identifierades brister, såsom otillräckliga beredskapsplaner, bristande personalrörlighet och en odynamisk krisledning, särskilt på regionnivå. Resultatet från forskningen kan användas för att bygga bättre beredskap för pandemier i framtiden.

Introduction

This paper presents a structured review of the use of crisis management, specifically examining the frameworks of surge capacity, resilience, and dynamic capabilities in healthcare organizations. Thereafter, a novel deductive method based on the framework of dynamic capabilities is developed and applied to investigate crisis management in two hospital cases during the COVID-19 pandemic.

Background

The COVID-19 pandemic distinguishes itself from many other disasters due to its global spread, uncertainty, and prolonged duration. While crisis management in healthcare has often been explained using the surge capacity framework, the need for adaptability in an unfamiliar setting and different information flow makes the dynamic capabilities framework more useful.

Methods

The dynamic capabilities framework’s micro foundations as categories is utilized in this paper for a deductive analysis of crisis management during the COVID-19 pandemic in a multiple case study involving two Swedish public hospitals. A novel method, incorporating both dynamic and static capabilities across multiple organizational levels, is developed and explored.

Results

The case study results reveal the utilization of all dynamic capabilities with an increased emphasis at lower organizational levels and a higher prevalence of static capabilities at the regional level. In Case A, lower level managers perceived the hospital manager as brave, supporting sensing, seizing, and transformation at the department level. However, due to information gaps, sensing did not reach regional crisis management, reducing their power. In Case B, with contingency plans not initiated, the hospital faced a lack of management and formed a department manager group for patient care. Seizing was robust at the department level, but regional levels struggled with decisions on crisis versus normal management. The novel method effectively visualizes differences between organizational levels and cases, shedding light on the extent of cooperation or lack there of within the organization.

Conclusion

The researchers conclude that crisis management in a pandemic, benefits from distributed management, attributed to higher dynamic capabilities at lower organizational levels. A pandemic contingency plan should differ from a plan for accidents, supporting the development of routines for the new situation and continuous improvement. The Dynamic Capabilities framework proved successful for exploration in this context.

Purpose:

This study aims to explore the management learning during a long-term crisis like a pandemic. The paper addresses both what health-care managers have learnt during the COVID-19 pandemic and how the management learning is characterized.

Design/methodology/approach:

The paper is based on a qualitative case study carried out during the COVID-19 pandemic at two different public hospitals in Sweden. The study, conducted with semi-structured interviews, applies a combination of within-case analysis and cross-case comparison. The data were analyzed using thematic deductive analysis with the themes, i.e. sensemaking, decision-making and meaning-making.

Findings:

The COVID-19 pandemic was characterized by uncertainty and a need for continuous learning among the managers at the case hospitals. The learning process that arose was circular in nature, wherein trust played a crucial role in facilitating the flow of information and enabling the managers to get a good sense of the situation. This, in turn, allowed the managers to make decisions meaningful for the organization, which improved the trust for the managers. This circular process was iterated with higher frequency than usual and was a prerequisite for the managers’ learning. The practical implications are that a combined management with hierarchical and distributed management that uses the normal decision routes seems to be the most successful management method in a prolonged crisis as a pandemic.

Practical implications:

The gained knowledge can benefit hospital organizations, be used in crisis education and to develop regional contingency plans for pandemics.

Originality/value:

This study has explored learning during the COVID-19 pandemic and found a circular process, “the management learning wheel,” which supports management learning in prolonged crises. © 2024, Ritva Rosenbäck and Ann Svensson.

The COVID-19 pandemic has disrupted global supply chains and caused widespread shortages of healthcare supplies. This mixed-methods study examined the management of supply shortages in Swedish hospitals during the COVID-19 pandemic. The key findings are that the shortage of supplies was initially severe owing to low regional and national contingency inventory levels, a lack of knowledge of supply chain management, and cost-saving measures. The perceived consequences of the shortage of personal protective equipment persisted in emergency and inpatient departments, in the later waves. Although pharmaceutical shortages later decreased, hospital managers were disappointed that they persisted. This study also highlights the effectiveness of consensus-based hourly supply agreements between service organisations and unit managers, which makes the prioritisation of the limited supply more dynamic. Despite these challenges, hospitals were able to adapt to the supply chain disruptions caused by the pandemic; however, the results emphasise the importance of preparedness for future pandemics.

BACKGROUND: In pandemics, it is critical to find a balance between healthcare demand, and capacity, taking into consideration the demands of the patients affected by the pandemic, as well as other patients (in elective or emergency care). The purpose of this paper is to suggest conceptual models for the capacity requirements at the emergency department, the inpatient care, and intensive care unit as well as a model for building staff capacity in pandemics.

METHODS: This paper is based on a qualitative single case study at a middle-sized hospital in Sweden. The primary data are collected from 27 interviewees and inductively analyzed.

RESULTS: The interviewees described a large difference between the immediate catastrophe scenario described in the emergency plan (which they had trained for), and the reality during the COVID-19 pandemic. The pandemic had a much slower onset and lasted longer compared to, for example, an accident, and the healthcare demand fluctuated with the societal infection. The emergency department and inpatient care could create surge capacity by reducing elective care. Lower inflow of other emergency patients also helped to create surge capacity. The number of intensive care beds increased by 350% at the case hospital. At the same time, the capacity of the employees decreased due to infection, exhaustion, and fear. The study contributes to knowledge of conceptional models and key factors affecting the balance between demand and capacity.

CONCLUSION: The framework suggests conceptual models for balancing surge capacity during a pandemic Health care practitioners need to provide assumptions of the key factors to find the balance between the demand and capacity corresponding to the reality and maintain the delivery of high-quality healthcare services.

Staff management challenges in the healthcare system are inherently different during pandemic conditions than under normal circumstances. Surge capacity must be rapidly increased, particularly in the intensive care units (ICU), to handle the increased pressure, without depleting the rest of the system. In addition, sickness or fatigue among the staff can become a critical issue. This study explores the lessons learned by first- and second-line managers in Sweden with regard to staff management during the COVID-19 pandemic. A mixed-methods approach was used, with preliminary qualitative interview (n = 38) and principal quantitative questionnaire (n = 272) studies, based on principal component and multiple regression analyses. The results revealed that the pandemic created four types of challenges relating to staff management: staff movement within hospitals; addition of external staff; addition of hours for existing staff through overtime and new shift schedules; and avoidance of lost hours due to sickness or fatigue. Furthermore, the effects of these managerial challenges were different in the first wave than in later waves, and they significantly differed between the ICU and other units. Therefore, a greater proactive focus on staff management would be beneficial in future pandemic situations.