5. Discussion
The discussion aims to delve into the research’s salient contributions,
while simultaneously grappling with its constraints and potential future
trajectories.
5.1. Research contributions
The research emphasizes the mechanisms that facilitate the development
of a social structure and social systems in pluralistic organizations
and govern individual and collective actions that regulate the process
of organizational transformation.
These relationships, initially based on power, communication, and
sanctions 35, evolve and modify social systems.
The ongoing health crisis has significantly disrupted the traditional
social order and power dynamics within pluralistic organizations38,40. As the situation continues to evolve, middle
management has seized power, which was originally delegated by top
management who now admit they have limited control over the situation on
the ground. This power grab is supported by several factors, including
middle management’s organizational and business expertise, as well as
their knowledge of the reality on the ground. With this newfound power,
middle management is able to define rules and strategies that address
the challenges faced by professionals in the field. Inter-professional
interactions between middle managers from different disciplines are
strong, based on the expertise of each, which contributes to the
development of a new organizational structure. This process requires
recognizing and combining everyone’s expertise. The interactional
mechanisms associated with this structure rely on communication
supported by top management, who establish spaces for multi-professional
and inter-hierarchical exchange. The collective dynamic is facilitated
by the creation of forums for exchange, such as crisis cells, and a
shared perception, based on field data, of a situation calling for
transformation. The synergy between individual actions and collective
dynamics is essential for driving organizational transformations.
Middle management is the linchpin of social systems and the founder of
social structure. They are both builders and catalysts of
transformation. This capacity is based on inter-professional
relationships founded on trust, and on a presence between professionals
that provides access to information and to realities on the ground.
Social systems are typically constructed through the coordinated efforts
of middle managers and field professionals, who span a variety of
professional disciplines. These individuals possess a deep understanding
of the practical realities on the ground and possess the expertise
necessary to devise effective organizational strategies for delivering
care and related services. They are responsible for designing and
continually refining procedures to ensure optimal functioning. This
capacity is made possible by the confidence that top management has in
these middle managers, who are regularly updated on the information and
instructions communicated by supervisory authorities. The actions of
individuals and groups have a recursive impact on the structure, with
the return-to-equilibrium phase being temporary and giving way to
increased agility. The external environment influences structural
adjustment through both top-down and bottom-up communication and access
to information, leading to a mechanism of joint regulation between
structure and activities. Procedures may emerge from field practices,
but the allocation of resources and skills is determined within the
structure. This implies an appropriate allocation of resources and
skills, with the structure and activity interacting and intertwining to
enable a high degree of agility.
However, this agility is supported by planning and control mechanisms
based on trust and transparency between parties. Therefore, this
research suggests that organizational transformations within pluralistic
organizations should be understood as a processual, systemic, and
multi-level (figure 4).