Table 1 A roadmap for the implementation of organisational change during a healthcare crisis, based on qualitative research conducted in 2021 among 26 nurses at the University Hospital in Krakow, Poland.
Phase of implementation of organisational change | |
|---|---|
Expected results | COVID-19 pandemic, obtained results |
Preparedness for crises | |
Functioning of an employee | |
BM: Concerns regarding lack of information, personal situation, change implementation | Anxiety, uncertainty, concerns related to the admission of the first patient and entering the zone where the COVID-19 infected patients are located |
The functioning of a team/organization | |
JM: Planning process, systems & manuals; training simulations (e.g. establishing ownership within the process, resources allocation, testing, live simulations) | Employees recognized the uncertainty and preparations as “organisational chaos” due to the reorganisation of wards and the fluctuating introduction of procedures. The issue was the frequent changes in clear procedures rather than the procedures themselves |
Crisis prevention | |
The functioning of an employee | |
BM: Concerns regarding personal situation, the way change is introduced, long-term consequences of the change | Denial was absent; only shock and mobilisation were reported, alongside awareness of the situation’s severity. Concerns about crisis management continued, such as frequent procedural changes, and respondents felt unsupported by expected figures like infection prevention nurses and doctors |
The functioning of a team/organization | |
JM: Early warning, scanning; Issue & risk management, emergency response (e.g. audits, social forecasting, prioritisation, strategy development, training) | Respondents highlighted the lack of support from an infection prevention nurse and emphasized the need for a safety standard due to high nurse turnover and disconnection among staff in the Covid-19 zone |
Late deployment / post-crisis management | |
The functioning of an employee | |
BM: Concerns regarding long-term consequences of the change, scope of cooperation in implementation phase | Withdrawal, adaptation, no acceptance of the existing situation. The emergence of routine, focus on work and patients, reduced concerns regarding the knowledge one has |
The functioning of a team/organization | |
JM: Recovery, business resumption; post-crisis issue impact; evaluation & modification (e.g., operational recovery, media scrutiny, root cause analysis) | Resolving current problems faster and reorganising work toward a more efficient functioning. The feeling of growing conflicts among the nurses (the former ‘unity in the face of danger’ disappears) |
Consolidating the positive effects of change/ crisis incident management | |
The functioning of an employee | |
BM: Concerns regarding cooperation in the implementation of the change and about the possibility of improving the effects of the change | Anti-infection procedures are deemed useful and worth promoting. Acceptance surfaces, previously absent. Internalization happens: mask-wearing and hand hygiene are emphasized as essential standards. Negative statements are neutralized with counteracting elements |
The functioning of a team/organization | |
JM: Crisis recognition; system activation response; crisis management (e.g. transition from emergency, objective assessment, effective mechanism of call out, damage mitigation, stakeholder management, media response) | Statements on work organization, disinfectants supply, and procedure validity. Concerns about fatigue, post-COVID duty division, current working hours, and feeling unappreciated |
