Organizational logics in time of crises: How physicians narrate the healthcare response to the Covid-19 pandemic in Swedish hospitals

BACKGROUND: The COVID-19 pandemic has challenged healthcare organizations and puts focus on risk management in many ways. Both medical staff and leaders at various levels have been forced to find solutions to problems they had not previously encountered. This study aimed to explore how physicians in Sweden narrated the changes in organizational logic in response to the Covid-19 pandemic using neo-institutional theory and discursive psychology. In specific, we aimed to explore how physicians articulated their understanding of if and, in that case, how the organizational logic has changed during this crisis response. METHODS: The empirical material stems from interviews with 29 physicians in Sweden in the summer and autumn of 2020. They were asked to reflect on the organizational response to the pandemic focusing on leadership, support, working conditions, and patient care. RESULTS: The analysis revealed that the organizational logic in Swedish healthcare changed and that the physicians came in troubled positions as leaders. With management, workload, and risk repertoires, the physicians expressed that the organizational logic, to a large extent, was changed based on local contextual circumstances in the 21 self-governing regions. The organizational logic was being altered based upon how the two powerbases (physicians and managers) were interacting over time. CONCLUSIONS: Given that healthcare probably will deal with future unforeseen crises, it seems essential that healthcare leaders discuss what can be a sustainable organizational logic. There should be more explicit regulatory elements about who is responsible for what in similar situations. The normative elements have probably been stretched during the ongoing crisis, given that physicians have gained practical experience and that there is now also, at least some evidence-based knowledge about this particular pandemic. But the question is what knowledge they need in their education when it comes to dealing with new unknown risks.