Operational professionals – Middle management
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- 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).
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- 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.
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- 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).
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Operational professionals – Top management
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- Top management has allocated resources in response to the needs and
demands expressed by professionals in the field.
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- 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).
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- 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).
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Middle management – Top management
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- 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).
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- Top management define the new organization with middle
management.
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- 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).
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