Browsing by Division "CHC - Center for Health Care"

This paper seeks to explain why a both/and approach can lead to a vicious cycle instead of a virtuous one as paradox literature suggests. The study draws on data from a longitudinal process study of how a hospital navigated the paradox of treating patients during the COVID-19 pandemic with a both/and approach that resulted in reduced treatment capacity. By analyzing the events unfolding over time, I use a circular logic and induce a systemic model to explain how and why a both/and approach can lead to a vicious cycle. The explanation lies in two feedback loops, which are the effects of a both/and approach on resource scarcity and on affective conflicts among organizational members. The proposed model advances existing explanations on why a both/and approach can lead to a vicious or a virtuous cycle. The model underscores a shift in paradox scholarship to a processual understanding that accounts for effects on the conditions that surface paradox. These insights help organizations tap the creative potential of paradox and avoid the outcome irony that aiming to balance contradictory demands reduces the possibility to do so over time.

During the COVID-19 pandemic, hospitals and their members had to handle multiple paradoxes that surfaced as permanent contradictions between different expectations. Informed by systems theory, the analysis of the data from a longitudinal process study of a hospital managing the pandemic focuses on the relationship between the expectation of treating COVID-19 and all other patients, which illustrates the organizing paradox of part-whole tensions. The analysis shows the three-dimensionality of this paradox. In the factual dimension, there are different alternatives to choose from. The social dimension involves balancing between centralized decision-making of a few actors and broad participation to ensure acceptance. Timewise, managing the pandemic requires to consider the current situation and the future developments. This three-dimensionality characterizes the practical challenge of dealing with an extreme situation such as the pandemic, the onset of which, its intensity, its dynamic and its duration cannot be predicted. In addition to this practically relevant reconstruction, the theoretical contribution for the English-speaking literature on paradoxes in organizations lies in expanding its focus from one to the three dimensions thereby enlarging the explanatory scope of paradox theory.

Based on the introduction process of lean management in the emergency department of a Swiss hospital, which required a parallel change of organization and management, the article analyzes the decision-making practice in highly in highly complex organizations and reflects on the differences between a purpose-driven and a system-rational system-rational understanding of management

This paper explores how members of a subordinate unit navigate a so-called pragmatic paradox. It is a situation in which actors find themselves lacking agency to navigate paradoxical demands. Drawing on a longitudinal case study I investigate how the studied nursing department regains agency by establishing third spaces. Third spaces are settings of social interactions, in which actors can enunciate, reflect, and address contradictory issues. The proposed process model explains the establishment of third spaces. This process of how actors can regain agency advances current approaches to navigate pragmatic paradoxes. Furthermore, the paper contributes to relating cognitive approaches with social interaction within the paradox lens. In addition, the paper complements literature on third spaces which tend to focus on their internal dynamics by explaining the emergence and maintainance of third spaces over time.