How to design for resilience in the case of a Black Swan: The Danish Hospital System during the Covid-19 Pandemic

Abstract

Resilience is an organizational capability to recover from an environmental or technological shock. It is the capability to respond to unpredictable, “out of the blue” events such as COVID-19, technological disruptions, super system failures, financial crises, etc. This is different from the capability for accommodating strategic re-orientations, recovery of routines from trans-active memory, recognizing and incorporating garbage can model ideas, or improvisation, (Välikangas & Lewin, 2020).

On March 11 2020, Denmark closed down due to the Covid-19 pandemic, and the Danish hospitals, especially the emergency departments, faced an environmental shock. To respond to the shock hospitals activated their emergency response organization designed to deal with big accidents or other catastrophic scenarios. However, such an organization design did not work in the case of the pandemic and the hospital system was not at prepared for a pandemic. As such the Danish hospitals were facing a Black Swan scenario.

Black Swans are exceptionally unpredictable events with immense impacts on human society. They can be either positive (e.g. invention of the Internet and discovery of antibiotics) or negative Black Swans like the 2008 recession or the Covid-19 pandemic (Grandori, 2020; Taleb, 2010). What characterize Black Swans events are, that they are unimaginable or unimagined by certain actors in a certain context.

Using the information processing theory for organizational design (Burton and Obel, 2005 and Burton and Obel, 2018) the paper analyzes the organizational design response by five regional Danish hospitals.

The literature argues that resilience can be obtained by an appropriate design of the organization configuration, preparedness and planning, material resources, information management, security systems and redundancy, management processes, management practices, organizational culture, human capital and social networks and cooperation.

Based on written documents and semi-structured interviews with the management of the region, the management of the hospitals and heads of the emergency departments, we investigate the organizational changes made in the five hospitals located in the Central Jutland region in Denmark during the first wave of the Covid-19 Pandemic.

The paper concludes with a discussion of what we can learn with respect to organizing for resilience in the health sector and more generally how to design for a Black Swan event.