Excerpts from interviews illustrating the principal findings
| Theme | Subtheme | Interview excerpts |
| Exceptional mobilisation | Ambivalent feelings: stress and pride | ‘There were sick colleagues, there were accidents, a lot of pressure. But overall, we managed to keep the shop running’. ‘It was very stressful. I found it exciting in organisational terms, medically too. I admit that it was very interesting to get involved. We had a real sense of our profession. It was also fascinating to organise’. |
| An unusual degree of internal solidarity | ‘The hospital has become a living space again. It’s a bit weird saying that. (…) We needed to feel that we were useful and we didn't want to leave colleagues on their own’. ‘There really was a kind of momentum that I've never known, a collective momentum of the people involved in COVID-19’. | |
| Task delegation and coordination | ‘There were surgeons who came in as reinforcements for COVID-19 teams saying, “I am willing to help, if we have to do stretcher work, I will!”. An extremely effective spontaneous collaboration’. ‘I was extremely surprised by the quality of care provided by my non-intensive care colleagues, who found themselves with frankly borderline patients, patients who should have been taken care of, in intensive care or in continuous care, with large doses of oxygen’. | |
| External help | ‘We had a lot of volunteers, especially clinical staff’. ‘I have been in touch with the director of the nursing school several times, letting her know about the situation and that it was a real need, that it wasn’t just to complain. The trainers arrived, they saw what was happening and they even worked at the weekend. They were there at weekends’. | |
| Reappearance of tensions at the end of the first wave | ‘At the end of May, it went back to a bit of everyone for themselves again. We’ve gone back to being the same again. I thought that we had had a bit of an impact on each other’s mentality, but no! It lasted four or 5 weeks. By the end of May, beginning of June, it was everyone for themselves again, pettiness’. ‘Some non-COVID services resumed scheduled activity before others, which made some sense. This created a bit of tension about when to resume scheduled activity. (…) The resumption of the hospital’s polypathology activity was a bit complicated, with some tensions’. | |
| Crisis management | APHP was effective at coordinating the opening of intensive care beds and purchasing key equipment | ’The main role (that the APHP crisis unit) played was to organise the increase in intensive care bed capacity, and therefore to open beds at an ever faster rate, with all that that implies: human resources, ventilators, etc…’. ‘Ordering several million gowns at once has more of an impact than ordering 10 000. It’s the same for ventilators. For stocks that were in short supply, APHP made the purchases directly. It then made it possible to dispatch equipment afterwards, according to the needs of the hospitals’. |
| A lot of autonomy was granted to local level | ‘Basically, we realised very quickly that care was local and that we would have to organise ourselves locally, even if there was central co-ordination’. ‘It was never that easy in the hospital. It was discussed in the local crisis unit, a decision was made in the crisis unit. This decision was not discussed or debatable once it was made. Afterwards, it was just logistics’. | |
| Deviations from central orders | ‘We turned a blind eye to the generalisation of mask-wearing. I have no regrets because I think it helped us a lot’. ‘The management of visits too, where we deviated a little. (…) the doctors knew that they could give authorisations to certain families, when the situation was really too difficult. (…) I think we have to trust collective intelligence a bit’. | |
| Relationships between hospital managers and healthcare professionals | Tensions during the phase of alert | ‘In terms of administration, hospital group and hospital, the same thing, with a lag that was a bit stressful and painful to manage for a good week. They hit a bit late, a week behind schedule (…) We fell back on grotesque discussions that we used to have, outside of the health crisis. It created a bit of tension’. ‘We have argued this before, but we were very surprised, there was really a discrepancy between the medical and paramedical position and the administration position, which was: “No, everything is going to be fine!” There was really a difference in the discourse’. |
| Strong cooperation during the first wave | ‘It was going well (between management and health professionals). There was never any refusal from the administration concerning requests (…) for equipment, for organisation that we were going to put in place. Management adhered and followed completely’. ‘What has changed is this famous crisis committee, that was a time when people met. It’s something that got a bit lost’. | |
| The feeling that these smooth relations between managers and health professionals will not last | ‘It’s a well-functioning crisis committee. We all had a bad time with the end of lockdown and the reappearance of all those who had served no purpose, except to hide during the crisis, and who came back to tell us how to do it, when we were on the verge of exhaustion! That, frankly, was the old world order to the power of 10!’. ‘Has the routine organisation left traces? It doesn’t feel like it yet’. |
APHP, l’Assistance Publique Hôpitaux de Paris.