Competing institutional logics in hospital management during the COVID-19 pandemic – lessons for the future

Abstract

Hospitals had to adapt quickly when the COVID-19 pandemic broke out in January 2020. This article analyses the organisation of the crisis management efforts of Oslo University Hospital (OUH). The analysis is based on theories that organising is a process of sensemaking, especially in the face of unexpected events. Crises stress test organisations and can highlight important decision patterns and otherwise hidden underlying logics. Theories of emergency and crisis management distinguish between anticipation and resilience. In the analyses of the OUH case, two different emergency logics, planned and ad hoc was identified. The different logics create tension in priorities and the choice of problems and solutions during the pandemic. The analysis was based on 19 in-depth interviews that took place in three clinics at OUH between December 2020 and November 2021, as well as internal audits and documents from OUH and published works. The analysis of OUH show that the resilient, ad hoc emergency logic was mostly present in the first phase of the pandemic and allowed flexibility and fast centralised decision-making. This process-based organising is particularly suitable to tackle crises but face difficulties in normal operations. To learn from past crisis management experiences and develop robust hospitals for the future, a greater awareness of the relationship between different emergency logics and sensemaking in crises is needed.