Managers' experiences in leading healthcare workers in hospital departments during a pandemic: a qualitative study

The COVID-19 pandemic exposed critical weaknesses within the healthcare sector in many countries, and intensifying pressure on managers and healthcare workers was immediate. Managers were faced with increased pressure during the pandemic related to difficult prioritizations and severely disrupted daily operations. Therefore, a deeper understanding of managers' similar and different experiences during pandemics is necessary. Our aim of this study was to explore the experiences of managers' in leading HCWs at two major Swedish hospitals during the COVID-19 pandemic. Further, to describe their applied managerial approaches and strategies, and comparing the experiences of managers overseeing units caring for COVID-19 patients with those managing units not involved in COVID-19 patient care, to identify both differences and similarities in their crisis management practices.

A qualitative research design involving thematic analysis was applied during the COVID-19 pandemic. Data used in this study were from the open-ended questions in a web-based survey; 376 managers were included.

Managers´ experiences in leading HCWs resulted in four themes: (1) centralised crisis management, (2) managing daily operative work, (3) dynamics of managerial support, and (4) new insights into learning and development, accompanied by 13 subthemes. Their experiences in leading HCWs caring for COVID-19 patients or not varied, and managers need to recognize these variations in strategies to provide effective and crucial support to HCWs during challenging times. Managers also appreciated certain hospital operations during the pandemic, while identifying areas for improvement within the organisation.

Acknowledging diverse needs among managers is important, especially given the diverse conditions in departments caring for COVID-19 patients versus others. Managers play a critical role in centralised crisis management, ensuring daily operative work, providing managerial support to healthcare workers, and fostering a culture of continuous learning and development. These insights highlight the importance of effective management and the dynamics of managerial support during pandemic crises, which directly impact patient safety. These results contribute to the ongoing improvement of healthcare organisations in addressing unforeseen challenges, such as pandemics and broader existential crises, by emphasizing the managerial perspective on crisis response.