Managers' Experience of the Response of the Health System to the Covid-19 Pandemic for Inpatient Geriatric Care: Lessons About Organisation and Resilience.

Background: Effective management of crises is a major challenge for healthcare organisations and their managers. Research suggests that to respond to evolving and unpredictable crises, such as the Covid-19 pandemic, an organisation needs the capability to continually adapt to the changing situation using relevant knowledge. However, there are few empirical studies using an organisational resilience perspective to understand how a health system responds to this type of crisis. This study aimed to describe managers' perspectives on what influenced the response to the Covid-19 pandemic in the Region Stockholm healthcare system for older people.

Methods: Data collection was conducted through in-depth semi-structured interviews with assistant managers (n = 3) and managers of inpatient geriatric services outside of acute care hospitals (n = 8), managers of three acute care hospitals (n = 3); and the crisis management team for geriatric services (n = 3). Data was analysed using qualitative content analysis.

Results: Crisis management of geriatric care in the Stockholm healthcare system during the Covid-19 pandemic's first 15 months was influenced by a combination of service specific aspects, 'Internal flexible responses', collaborative aspects, 'Coordination within the system', and governance aspects 'Adaptive steering'.

Conclusions: This study contributes to empirical knowledge about organisational resilience. Managers' responses are facilitated when the governance allow them more flexibility in their internal responses and enable their cross-organisational collaboration. A coordinating function across healthcare services is an important enabler in a crisis when the function has well-established, trustful prior collaborations with the services.