Leveraging local knowledge for crisis management: a practice-based approach to managing uncertainty in healthcare during COVID-19.

Background/aim: Crises like the COVID-19 pandemic are inherently uncertain, dynamic and generate broader consequences on organisations, challenging traditional crisis management approaches. Conventional approaches often neglect the mechanisms and processes frontline practitioners enact in their local practices to adapt effectively. This study explores how healthcare professionals (HPs) at a university hospital centre developed and mobilised local knowledge to rapidly respond to the evolving conditions of the COVID-19 pandemic.

Methods: We conducted an interpretive single case study at a designated COVID-19 university hospital in Montreal, Canada. Over 6 months (April to September 2020), we collected data through 49 virtual interviews with healthcare practitioners, minutes from an operational crisis unit and organisational records such as protocols and clinical algorithms. Our analysis focused on identifying spaces and mechanisms that facilitated the creation, testing and translation of local knowledge across different clinical units, leading to rapid organisational adaptation.

Results: The study reveals that frontline HPs enacted new mechanisms forming three types of spaces-reflective, experimental and translational-that bypassed existing organisational structures of knowledge development. These spaces enabled the rapid development and translation of local knowledge, fostering dynamic organisational responses to the evolving crisis.

Conclusion: By highlighting the critical role of local knowledge and the processes supporting its integration, this research offers valuable insights into improving crisis management practices. It emphasises frontline practitioners' improvised and flexible organising processes that enable a more global capacity to leverage local knowledge for the effective adaptation in unprecedented crisis situations.