Interactions Cas 1 Cas 2 Cas 3
Operational professionals – Middle management
- Effective interactions have been fostered between professionals and middle management in the relevant field. - In collaboration with operational professionals, middle management have formulated guidelines pertaining to flow organization and have assessed the necessary resources.: ”Top management gave us the green light” (hygienist nurse). - Middle management implemented planning and control activities: ”We tried to organize activities on the basis of the protocols and flows we had decided on” (head of intensive care unit). - The middle management collaborates closely with operational experts to convey regulations. - Undoubtedly, extensive communication activities are undertaken. A multitude of communication avenues are employed, including regular briefings, conferences, and online platforms such as intranets and messaging applications. - Middle management personnel have been deployed to guarantee the implementation of protocols.
- The process of compartmentalization was carried out in collaboration with middle management, technical services, and hygienic nurses.: ”We defined the rules for dressing, undressing, cleaning, etc.” (hygienist nurse); ”We defined the circuit with the other managers” (Care manager, Medicine Department).
Operational professionals – Top management
- Top management has allocated resources in response to the needs and demands expressed by professionals in the field.
- Senior executives were physically present in the operational site, and there was ongoing communication among different levels of the organizational hierarchy: ”for the first 6 weeks, I was out in the field all the time” (Director of care); ”the medical solidarity, the caregiver solidarity, it was something extraordinary” (Director of care). - Human Resources Direction has put in place training courses to effectively manage patients on non-invasive ventilation.: ”we put together a team with specific skills. Then we had to recruit, yes, a lot” (Medical Director). - The top management swiftly stepped in to augment resources: ”We kept a close eye on resources, and closely monitored the absenteeism rate” (Human Resources Director). - The establishment of formal rules was entrusted to operational specialists by the highest echelons of management. - Physicians have elected to cease all planned activities prior to any decision being made by administrative authorities or the government, with the objective of allocating human and material resources towards the treatment of individuals afflicted with the Sars-Cov-2 virus. - The need for logistical management necessitated that logisticians assume a pivotal role in spearheading the process of transformation: ”we had a lot of freedom to reorganize the department’s incoming and outgoing circuits” (safety manager).
Middle management – Top management
- The relationship between middle managers and top management has been established. - Middle management became actively involved in crisis management prior to top management’s involvement: ”So I didn’t wait for meetings, or for people who had no idea what was really going on in the field to manage something” (head of intensive care unit). - The anesthetist-intensive care physician, who is part of the crisis unit, routinely provides updates from their field assignments: ”We shared our information to justify our decisions, which nobody dared to discuss at the time”. - Middle management informed top management of the necessary and desired transformations, ask for the necessary resources and materials to be made available, and worry about a definite shortage. Director of care then takes a more global view in terms of available resources and skills: ”We made sure that the professionals mobilized in the ICU had the skills to deal with an intubated patient” (Director of Care); ”Before the ARS asked us to, we decided to suspend scheduled activities to concentrate our resources on Covid” (Medical Director). - Resources were a decisive factor in managing the transformations: ”for PPE11Personal Protection Equipment , we took stock, checked with our suppliers and tried to find other suppliers” (Administrative Director).
- Top management define the new organization with middle management.
- Middle and top management meet on a regular basis to adapt the organization of the department, its capacity to receive patients, the resources allocated, etc. : ”something that has also been done in the past. We had daily briefings and debriefings with the head of care, meeting every day at 8:30 in the morning and then again in the evening. We took stock of everything that had happened the day before. What could we do about it, how could we improve the situation?” (Care Manager, Medicine Department) - Top management coordinated with other hospitals in the area: ”So we should have an idea of the flows to size the number of beds that were needed, and also be able to dispatch them between hospitals. So I think it was a really important nation” (internal auditor).