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