Leading from the Frontline: Autonomy and Improvisation in a Hospital During Times of Crisis
Bibliographic record
Abstract
How organizations coordinate a unified response under system-wide disruption impacting multiple units in different ways is a crucial question for healthcare organizations today. To address this question, we report on a qualitative field study of a frontline hospital over the course of the 2020-2022 COVID-19 pandemic. Our findings reveal that such crises require multiple extended coordinated response processes where central coordinators assign new work, prioritize resources, and modulate the autonomy and improvisational ability of multiple organizational sub-units to mount organization-wide responses. We contribute to healthcare management and coordination research by offering a process model for coordinating responses to broad-scale disruption that leverages local knowledge and resourcefulness of experienced hospital personnel under conditions of disruption, and allows for standardization and refinement as disruptions are resolved or normalized.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.012 | 0.021 |
| Scholarly communication | 0.006 | 0.005 |
| Open science | 0.002 | 0.009 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".