Figure 4. Organizational transformation: a dynamic multi-actor and
cross-level process
In the process of organizational transformation, middle managers and
professionals in the field are considered social actors with a high
level of knowledge 43, which they have acquired
through their practical experiences and real-life situations and have
transformed into reflexivity. This knowledge, both tacit and explicit,
is a source of knowledgeability and develops
capability43. According to
Giddens43, social actors activate and put knowledge
into action in a form of reflexivity, which involves critical reflection
on their own practices and actions. This practical knowledge, a source
of skills, guides actions and is a source of power.
Organizational changes are influenced by inter-professional and
inter-hierarchical interactions that shape the structure and actions of
the organization. This complexity arises from three factors: the
systemic and multi-level nature of the phenomenon, the social systems
regulating hospital operations, and the processual character of the
phenomenon. As such, organizational change must be approached as a
systemic, social, and processual phenomenon, rather than a simple
replacement of sanction systems with experimentation.
5.2. Limitations and prospects
The limitations of the research presented in this study are primarily
related to methodology and may limit the generalizability of the
findings. The study’s unique nature and contextual and organizational
specificities may render the results subject to interpretation.
Therefore, replicating this study in different types of establishments
with various statuses or geographical locations would be of interest.
Additionally, while the organizational transformations described in this
research were implemented to address a health emergency and met with
minimal resistance, the transference of these mechanisms beyond the
crisis context warrants further investigation.
Despite these limitations, this study has opened new avenues for
research, particularly in the areas of strategic management of
healthcare organizations and decision-making in uncertain environments,
which align with current strategy as practice. The study demonstrates
how power has shifted and been delegated in response to the need for a
high level of responsiveness, transforming the hospital from a
traditional professional bureaucracy to an adhocratic bureaucracy.
Another promising area for investigation is the examination of
transformation from the perspective of knowledge management and the
mobilization of intra- and extra-organizational knowledge. Dhanaraj and
Parkhe44 argue that value and innovation will be
minimal if the specialized knowledge of each network member remains
largely confined within its organizational boundaries.