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.