Adapting despite “walls coming down”: Healthcare providers’ experiences of COVID-19 as an implosive adaptation

Abstract

Introduction: The COVID-19 pandemic has been a daunting exercise in adaptation for healthcare providers. While we are beginning to learn about the challenges faced by teams during the COVID-19 pandemic, what remains underexplored are the strategies team members used to adapt to these challenges. The goal of this study is therefore to explore how healthcare providers navigated and adapted to on-the-ground challenges imposed by COVID-19. Methods: We interviewed 20 healthcare workers at various hospitals in Ontario, who provided care as part of clinical teams during the COVID-19 pandemic. Data were collected and analyzed following Constructivist Grounded Theory principles including iteration, constant comparison and theoretical sampling. Results: Participants’ accounts of their experiences revealed the process of ‘implosive adaptation’. The ‘reality check’, the ‘scramble’ and the ‘pivot’ comprised this process. The reality check described the triggers, the scramble detailed the challenges they went through and the pivot prescribed the shifting of mindset as they responded to challenges. These stages were iterative, rather than linear, with blurred boundaries. Discussion: According to our participants, not all adaptations have to be successful during a crisis. The language of reality check, scramble and pivot provides a framework for teams to talk about and make sense of their approaches to crisis, even beyond the COVID-19 pandemic.