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