No man is an island: management of the emergency response to the SARS-CoV-2 (COVID-19) outbreak in a large public decentralised service delivery organisation

Abstract

Background We wanted to better understand whether and how agility can be achieved in a decentralised service delivery organisation in Sweden. The pandemic outbreak of SARS-Cov-2 (Covid-19) provided an opportunity to assess decentralisation as a strategy to improve the responsiveness of healthcare and at the same time handle an unpredictable and unexpected event. Methods Data from in-depth interviews with a crisis management team (n = 23) and free text answers in a weekly survey to subordinated clinical directors, i.e. unit managers, (n = 108) were scrutinised in a directed content analysis. Dynamic capabilities as a prerequisite for dynamic effectiveness, understood as reaching strategic and operative effectiveness simultaneously, were explored by using three frameworks for dynamic effectiveness, dynamic capabilities and delegated authority in a decentralised organisation. Results Unpredictable events, such as the pandemic Covid-19 outbreak, demand a high grade of ability to be flexible. We find that a high degree of operational effectiveness, which is imperative in an emergency situation, also is a driver of seeking new strategic positions to even better meet new demands. The characteristics of the dynamic capabilities evolving from this process are described and discussed in relation to decentralisation, defined by decision space, organisational and individual capacity as well as accountability. We present arguments supporting that a decentralised management model can facilitate the agility required in an emergency. Conclusions This study is, to our knowledge, the first of its kind where a decentralised management model in a service delivery organisation in healthcare is studied in relation to crisis management. Although stemming from one organisation, our findings indicating the value of decentralisation in situations of crisis are corroborated by theory, suggesting that they could be relevant in other organisational settings also.

“Local cooperation has been the cornerstone”: facilitators and barriers to resilience in a decentralized health system during COVID-19 in Finland

“…This decentralized the implementation of prevention measures to regional and local authorities. Aligned with previous literature, the findings in this article highlight that this decentralization impacted overall resilience in the health system in both positive and negative ways, and that key components to operational effectiveness in decentralized health systems include high levels of autonomy and trust (Ohrling et al. , 2022; Capano and Lippi, 2021).…”

Rapid implementation of remote digital primary care in Stockholm and implications for further system-wide implementation: practitioner’s and manager’s experience of the Always Open mobile application

“…Later in the pandemic, more on-line education and guidance was available to them, but there was no formal implementation strategy and support to enable them to take up use of the CDCS in their everyday practice. In addition, the healthcare organization had achieved significant management decentralization and management flexibility for unit managers over a period of 14 years [ 24 , 32 , 33 ]. There may be significant differences to other primary care service in the competencies to use the CDCS and flexibility afforded to unit managers in their take up of digital services.…”

“…Clinical managers, also called service delivery unit-managers, in SLSO have a large degree of delegated managerial authority that matches their accountability for budgets, for managing employee performance and satisfaction, and for actions taken by the unit. Otherwise, the organization is a typical line-management public bureaucracy structure with value- and trust-based governance [ 32–34 ].…”

Lessons from COVID-19 pandemic response by a non-government organisation in Bangladesh: Emergence of a framework to guide emergency response in low- and middle-income countries (LMICs).

“…Quick and accessible communication channels such as group chats and calls using platforms like WhatsApp can help in creating direct and instant access to the management and receiving important decisions quickly. Such a communication strategy has been described by others as an effective way of decentralisation of the administrative processes as well as a means to monitor the organisation's activities (29)(30)(31)(32). In addition, as highlighted by SF's experience, it helps in gaining real time insights of the implementation process of the response plan on the ground by the organisation's leadership.…”