Whether and how top management create flexibility in mental healthcare organizations: COVID-19 as a test case

Abstract

PurposeFlexibility is essential for healthcare organizations to anticipate the increasing internal and external dynamics. Mental healthcare organizations in the Netherlands face major policy reforms made by the government, increasing involvement from municipalities and gradual replacement of clinical care with outpatient care. Top management plays an important strategic role in creating this flexibility because they make important choices, give direction and structure the organization. To create flexibility, managers have to deal with complexity and paradoxes. In this study, the authors aim to contribute to the knowledge on how healthcare managers can create flexibility in their organizations.Design/methodology/approachThis is a qualitative empirical field study. In total, 21 managers of mental healthcare organizations participated in open in-depth interviews. The authors explored flexibility on three perspectives: organizational direction, structure and operations. The COVID-19 pandemic has provided an opportunity to explore flexibility. The authors asked participants to reflect on their organization's response to the pandemic.FindingsMost mental healthcare organizations create flexibility in an implicit way. Flexibility and resilience are closely linked mechanisms. Flexibility ensures a quick response while resilience provides the counterforce and rebound needed to adapt. Adaption ensures that healthcare professionals learn from their experiences and do not return completely to the way things were done before. The primary urge to survive ensured rapid and adequate responses to the COVID-19 pandemic. Whether this is a manifestation of flexibility remains difficult to conclude.Practical implicationsThe complexity theory offers some guidance in creating a flexible organization without losing consistency. Flexibility and resilience are closely linked mechanisms that antagonize and protect each other. With this insight, managers in mental healthcare can utilize the qualities and balance them without falling into the various pitfalls.Originality/valueIn this research, the authors are concerned with flexibility as a proactive attitude and capacity of organizations. By looking at the response of organizations to the COVID-19 crisis, the authors find out that responding to a disaster out of survival instinct is something else than flexibility. There is an interesting relationship between flexibility, resilience and adaptability, and they can balance each other.

Impact of COVID-19 on Management, Quality and Satisfaction of Health Organizations: A Case Study in a Portuguese Hospital

“…Important efforts should be implemented to protect health care professional wellbeing, enhancing their working conditions, and raising awareness about burnout. Proper utilization of financial and human resources are crucial for the sustainability of the health care system and the health care workforce, especially in crises (Yanez-Araque et al 2021 ; Van Gool et al 2022 ; WHO 2021 ).…”

“…To mitigate these hazards, a well-coordinated and comprehensive leadership that protects the health, safety, and wellbeing of health care workers should have been implemented. Measures for infection prevention and control, occupational health and safety, health workforce management and mental health and psychosocial support can reduce rates of work-related illness among health workers, absenteeism and less productivity (Van Gool et al 2022 ; WHO 2021 ).…”

Achieving high performance in healthcare institutions: a longitudinal perspective

“…Figure 3 shows the increase in average HPO scores and percentages improvement between the rst and second HPO diagnosis for the three nursing home care institutions. This gure shows that -despite a challenging few years caused by rising healthcare costs because of the aging of the Dutch population, continuing cost reduction pressure, technological developments demanding investments, increasing legislation, COVID-19, and increased turnover of healthcare professionals [35,36,37] -all three institutions increased their HPO scores, albeit modest for a three year period. Pre-COVID an average increase of between 0.3 and 0.5 points per year could be expected [20,21].…”