3. Methods
3.1. The context of research, a pluralistic context in
crisis
The subject of organizational transformation within a hospital requires
a thorough examination of its complex nature, which is influenced by the
numerous professionals working there, the directives of the supervisory
authorities, and the expectations of patients38. The
structural and cultural specificities of hospitals pose challenges to
transformation initiatives. In France, recent legislative reforms aimed
at modernizing and transforming the healthcare system have faced
difficulties. However, due to the recent health crisis, obstacles to
collaboration and transformation within and between organizations were
eliminated to adapt hospital organizations and operating
methods5,6. A crisis can be seen as a time of learning
and can disrupt established ways of thinking39.
Our research focuses on two French public university hospitals, with a
capacity of over 1,500 beds and more than 8,000 professionals each.
These hospitals provide care and treatment to patients suffering from
the Sars-Cov-2 virus and operate under the supervision of the Regional
Health Agency. They are financed by the French Health Insurance. The
hospitals are typical pluralistic organizations40. The
field of study for this research is the intricate nature of
organizational transformation within the hospital, influenced by the
multitude of professionals working there, the directives of the
supervisory authorities, and the expectations of the
patients38.
The objective of this study is to examine the process of organizational
transformation and, more particularly, the mechanisms of interaction
within pluralistic organizations. The context provided offers a suitable
foundation for this exploration.
3.2. Data sources and
analysis
Our research aimed to elucidate the interactional mechanisms that
underpin the process of organizational transformation in hospitals,
which has been propelled and imposed by the recent health crisis. Guided
by the inquiry ”What are the internal and external interactional
mechanisms that are involved in the dynamics of organizational
transformations in hospitals?”, our investigation pursued a
comprehensive and exploratory perspective 42.
To collect data, we employed semi-structured interviews as our primary
mode of data gathering, complemented by periods of observation and
documentary analysis. Our data collection spanned an observation period
from October 2020 to July 2021, followed by interviews with
professionals involved in the care organization and management of
Sars-Cov-2 patients from September 2021 to December 2022.
We developed our sample based on two criteria that considered both the
vertical and horizontal divisions of labor: the professional category,
which distinguishes between paramedics, medical professionals, and
administrative professionals, and the hierarchical level, which
differentiates between operational professionals, middle managers, and
top management, including board members. A total of 28 interviews were
conducted between September 2021 and December 2022 (refer to Table 1).
Table 1. Interviews conducted