4. Results
4.1. Presentation of the transformations
studied
The study’s central findings are based on three significant
organizational modifications. The first of these modifications involves
the reorganization of the intensive care unit, which has resulted in an
increase in capacity and separate management of patients with and
without the Sars-Cov-2 virus. The second transformation pertains to the
reorganization of patient reception in the emergency department through
the establishment of a screening platform. The last transformation
involves the isolation of an infectious diseases department into a
dedicated service called ”Covid” for the care of infected patients. The
department of infectious diseases was designated as the reception
department for Covid patients.
4.2. Cross-level interactions, blurred inter-hierarchical
boundaries
In the first case, the middle manager’s regular communication with his
Italian colleagues enabled him to anticipate the arrival of the virus in
France and alert his superiors: ”I absolutely had to organize
something about it, so I warned my management. They told me it was never
going to happen, and a month later, there it was ” (head of intensive
care unit). In the second case, the initiation of the transformation was
prompted by the admission of patients exhibiting symptoms that were
indicative of Covid-19, by operational professionals: ”There were
patients arriving with severe coughs and hyperthermia, and we
immediately had to adapt the flow so that they didn’t come into contact
with healthy patients ” (Nurse 2). In the third case, the department
implemented strict regulations governing entry and exit, which
ultimately limited the interaction between professionals working within
the department. Throughout these times, professionals consistently
emphasized the importance of maintaining access to information and
communication.: ”we always had the latest information, which was a
great help, and enabled us to be very proactive ” (Head of nosocomial
infection prevention unit); ”the crisis unit was quickly set up,
and I was part of it with my partner, so it was reassuring too, because
we had all the parties involved, the pharmacy, the biomedical unit, and
we could really discuss things live, and communication was very good.
The most important thing when you’re managing critical events is to be
able to talk to all the different positions, so that everyone hears the
same thing ” (Director of Care). In terms of logistics, numerous
alterations were encountered, particularly the establishment of parallel
circuits for all individuals, goods, and materials arriving and
departing the department.
The inter-hierarchical interactions identified in the various cases are
shown in Table 2.
Table 2. Inter-hierachical interactions