Uncovering the lived experience of hospital administrators during the COVID-19 pandemic. Insights from a focus-group-based qualitative research project.

The COVID-19 pandemic has dramatically transformed organizational processes in healthcare institutions, more specifically, in France, in public hospitals. While it was known for years that French public hospitals were going through a crisis (Juven et al., 2019), research is scarce when it comes to hospital administrators, except in the field of administration sociology (Schweyer, 2006, 2018). Investigating their lived experience of the crisis seemed necessary to better assess their psychological needs and specificities and more fully understand how the pandemic hit French hospitals.

Our research started with a proposal from the CEO of a middle-sized French teaching hospital, who called us to help his team recall and write the story of their experience of the COVID-19 pandemic. Considering how little researchers know about hospital administrators in France, our research was exploratory and hypothesis-generating. We conducted 4 sessions of a semi-open focus group, once every three weeks between March and June ’21, completed by semi-directed individual interviews. Participation was voluntary; the administrators could enter the group and/or accept a semi-directed interview and/or both and/or none of these options. The focus group sessions and interviews were conducted on the field. The data collected is currently being thematically analyzed within an abductive framework relying on the systems psychodynamics paradigm (Petriglieri & Petriglieri, 2020).

In our presentation, we will detail how the group setting, according to what W.R. Bion demonstrated (Bion, 1999), enabled the emerging of unconscious feelings and representations among the participating administrators, which were too powerful and archaic to tolerate and were therefore projected onto the figures of the CEO and deputy CEO, who were not part of the group. We will show how the discourse of a generally lacking and malevolent management, which in previous works we called the fantasy of the “malicious institution” (Haliday, 2020), hid feelings of angst and helplessness, and how we decided to interpret such unconscious movements to keep the working group, and therefore the research, going.

Our main hypothesis points at the existence of “affective silos” between administrators, which are reinforced by the competitive spirit of their job and the organizational division of work. These affective silos which isolated administrators from their own feelings and from their colleagues’ were broken by the group setting, with participants being surprised to learn new things about their colleagues in the group and during the sessions.

These findings need to be discussed in the light of a few methodological limitations:
1°) The group explicitly asked for the CEO and deputy CEO to not participate. We will explain why we accepted such a request to maintain a good quality of collected data (i.e. a sincere as possible expression of feelings in the group), though it could be seen as reinforcing “the team”’s symptom (absence of feeling of togetherness, intense feelings of solitude in the job),
2°) The difference between research and consultancy was at times blurry, especially for the CEO and deputy CEO who wished to use the research to bring “the team” together,
3°) Finally, the idea that all hospital administrators, CEO and deputy CEO included, formed a “team”, was not to be taken for granted methodologically speaking. It actually turned out to be the most sensitive aspect of the research, determining a large part of the discussions in and in-between sessions 1 and 2.

Our experience points at the possibility of organizing supervision groups for hospital administrators, differing from – and therefore being complementary with – psychodynamic organizational consultancy.

Session schedule

5 MINS

Introduction

30 MINS

Paper presentation

20 MINS

Small group discussion; impressions of the paper and developing questions for the presenter

20 MINS

Discussion forum with the presenter; moderated for the speaker to elaborate their ideas

10 MINS

Discussion forum with the presenter; themes from the discussions

5 MINS

Break

30 MINS

Whole symposium open reflection discussion 

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