Introduction: Transformational and Transactional Management
COVID-19 pandemic had a significant effect on all the economic and social areas of society. Hospitals were among the first institutions to experience the need for change due to unexpected numbers of patients and the unknown methods of treating the new disease. Medical institutions experienced such issues as the lack of space, shortage of the necessary equipment, and the necessity for the personnel to work overtime in a stressful environment.
The management adjustment could be made through the transaction or transformation method. The former includes corporate restructuring and implementing the new technology through a formal and technical process without analyzing the corporate culture and people’s potential responses. The latter focuses on product reforming and charismatic leadership with a detailed explanation for the employees. Doctors follow the general guidelines but may also adjust their individual strategies when working directly with patients. They often lack time to consult with a team of specialists. Hospitals may follow the transaction or transformation strategy based on their needs, regulations, and experience.
Management Changes at the Start of COVID-19
China was the first state to experience the impact and consequences of the COVID-19 pandemic at the end of the last year. This country’s government is relatively authoritative, so the chosen management strategies for the hospitals were implemented through a transaction method supported administratively. Before the pandemic, medical personnel also had to follow numerous instructions instead of analyzing each patient’s case individually. China has developed digital technology, so a logical decision was to order the citizens to stay isolated in their households and perform most medical consulting through the Internet.
The mass media, authorities, and influencers started active propaganda to stand together against the new disease and meticulously follow the instructions. Leaders encouraged staying at home unless a patient’s state was critical (He et al., 2020, p. 89). While such a method seems militaristic and inconsiderate of the doctors’ opinions, providing emergency health services during the pandemic in a country with over a billion citizens could be the most effective strategy in this case.
Italian hospitals were among the first ones to experience the impact of the COVID-19 pandemic. They did not have many examples or models to follow and tried different strategies for the first time. Italian hospital management was transactional before the pandemic, but it was not efficient for the patients with Coronavirus this year. The management started incorporating transformational strategy and adjusting the system for extreme market change due to COVID-19.
The implementations included providing medical care for anyone in need, performing swab tests for all the patients with symptoms, and creating staff dedicated to the new virus treatment. Since medical personnel was not explicitly trained for COVID-19, the leaders started crisis unit meetings, advanced planning for personal protective equipment provision, and changed the standard operating procedures due to new conditions (Balduzzi et al., 2020, pp. 1901-1902). The healthcare system was altered to function during the crisis state.
The management also added psychological help for doctors and nurses and enhanced research work to potentially distinguish effective methods of treatment. Personnel was informed about the newest COVID-19 findings in the literature (Balduzzi et al., 2020, p. 1901). Hospitals started rescheduling transplantation procedures and practicing remote patient management when possible (Balduzzi et al., 2020). All the superior decisions were accepted and supported by medical workers, patients, and the general population as necessary in the given situation.
Management Problems and Adjustments
Both Chinese and Italian hospitals changed their strategies due to the various problems they have encountered over the first several weeks of COVID-19 spreading. Cases grew exponentially, the lack of resources to treat people effectively became evident, and the speed of recovery was slower than that of spreading (Neri et al., 2020, p. 505). While technology could be beneficial in informing the population about the preventive and treatment methods for illnesses, the pandemic caused people to spread fear and negativity through the available social media (Gao et al., 2020, p. 2). The psychological health of potential and actual patients required managerial support, so the government institutions started publishing daily updates on the COVID-19 situation and the latest news about treatment and prevention.
The initial strategy of separating the new Coronavirus patients and treating them with personnel dedicated strictly to such cases was insufficient. Swabbing every person suspected of having COVID-19 was not feasible and created an increased risk of contracting the virus during the procedure due to the number of people visiting hospitals (Balduzzi et al., 2020, p. 1904). Besides, many people with lung complications needed intensive care units and ventilation equipment (Remuzzi, A. and Remuzzi, G., 2020, p. 1225). The system could not support the necessary resources to contain the pandemic.
Chinese medical system became stricter regarding isolation by using cameras and tracking devices to control the population. Simultaneously, hospital management and healthcare professionals encouraged patients to stay at home if their symptoms were not severe to use the recourses for challenging cases. The propaganda of pride for being a doctor, nurse, or medical volunteer in China was meant to support the people treating patients. However, in reality, they were so exhausted and overworked that the strategy was not useful. The management style remained authoritative until the number of registered cases decreased significantly. Currently, hospitals in China function similarly to pre-COVID time, except for mandatory mask-wearing and Coronavirus testing.
Italian hospitals support the use of newly available technologies for more accurate diagnostics of lung problems. Artificial intelligence is currently trained with enough statistics to use for these purposes (Neri et al., 2020, p. 505). As Italy is still experiencing a large number of COVID-19 cases, the discipline measures to treat the population and protect the medical personnel had to become stricter. The used style is still transformational, but the process of following the procedures requires more discipline and less positive encouragement as highly contagious Coronavirus has to be treated diligently and without delays.
Methods of Comparison and Management Impact
In the context of this year’s pandemic, both transition and transformation management styles could be sufficient. However, the latter is more comfortable for the employees psychologically, which is crucial, considering they work in a stressful environment. Besides, radical cultural changes lead to technological progress and development of the medical sphere, both as a service and business. Chinese and Italian hospitals were among the first ones to experience the COVID-19 impact. However, their data helped medical institutions from other countries prepare and choose the preferred strategy when the pandemic spread further.
In reality, before COVID-19, most medical institutions already had a system in place that worked for both the patients and workers. Because of the Coronavirus infection, the world crisis made it possible to operate under pressure and make rational decisions, especially valuable managerial qualities. At the same time, since doctors and nurses are exhausted physically and psychologically, superiors have to analyze their abilities and resources, in the long run, to implement the changes effectively.
Managers have to consider the external factors, such as the COVID-19 pandemic, government financial support, the international situation with the disease spreading, and resources available. At the same time, medical personnel is the key internal force for hospitals. Effective managers have to consider the workers’ motivation, discipline, skills, and physical and mental state. COVID-19 crisis made leaders that can multitask and work in a stressful environment, especially valuable.
Remote work helps avoid unnecessary physical contact and the risk of catching the infection. Telemedicine has progressed significantly over the past decades and allows to the practice of efficient service for patients (Volterrani and Sposato, 2019, M54). However, it also leads to less control over the employees, and their activities cannot be checked by watching them directly. The medical field is rather specific, as often physical contact with the patient allows doctors to effectively diagnose the disease or injury. Experienced hospital personnel is highly valuable to the industry, especially during a crisis. It is the management’s responsibility to provide the maximal comfort and equipment for the doctors and nurses to be able to examine and treat the patients remotely. Also, this strategy saves space and other resources at hospitals.
Before the pandemic, most medical institutions used transactional management directed at effective maintenance since the financial flows and methods of working with clients were already established. In other words, the superiors had to be attentive and follow the approved procedures. However, over the past ten months, being stress-resistant and able to make decisions quickly became more critical for the superiors than supporting the existing networks within the hospitals. Crisis, lack of resources, and the need for innovation pushed medical institutions worldwide towards charismatic leadership with a strong vision.
Both transition and transformation methods can be useful in the hospital setting if controlled and adjusted according to the desired results. However, given the stressful environment associated with the COVID-19 pandemic and psychological pressure on personnel, profound cultural change through charismatic leadership seems more suitable. Thus, it would be more effective to use transformation management in modern hospital systems during pandemics as it emphasizes interpersonal communication.
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