They’re only human after all: Examining the central role of staff in hospitals’ response to dynamic environments

Context
Hospitals face unprecedented uncertainty and increasing difficulty in preparing for and responding to shocks. At the same time, workforce challenges are intensifying, as growing numbers of staff report diminished health and well-being and an increasing intention to leave the profession. These internal and external pressures threaten both staff and hospital functioning. To remain viable in dynamic environments, hospitals must strengthen their capacity to cope with uncertainty while safeguarding staff well-being and retention. This dissertation accordingly examines how hospitals can build the capabilities needed to deal with today’s dynamic environment with an emphasis on learning how to better support the workforce.

Methods
Empirical studies were conducted across Dutch hospitals and span the period before, during, and after the COVID-19 pandemic (i.e., a prolonged shock). The dissertation includes two mixed-methods studies and a multiple case study examining organizational and staff responses to the pandemic (763 pages of internal documents, 635 minutes of video material, 194 newspaper articles, 274 survey respondents, and 72 interviews across five hospitals). Additionally, a quantitative study analyzed the relationship between slack (i.e., excess) resources and staff absenteeism and turnover across all Dutch hospitals between 2017–2021 (342 hospital-year observations). A longitudinal qualitative study explored persistent post-shock challenges (40 interviews across four hospitals). Lastly, a multiple case study examined the role of team leaders in supporting staff in the post-pandemic period (23 interviews across three hospitals). Together, these studies enable an integrated analysis of how organizational, leadership, and system-level conditions shape workforce well-being and hospitals’ capacity to cope with uncertainty.

Results
Hospitals’ capacity to cope with shocks and ongoing uncertainty was strongly contingent on staff health, availability, and commitment. Staff commitment was undermined by competing demands, limited opportunities for recovery, energy depletion, and a perceived lack of appreciation and support. Despite widespread recognition of mental health risks, staff support strategies were often generic and reactive rather than proactive and tailored to individual needs, contributing to low utilization of (psychosocial) support. Quantitative analyses demonstrate that slack resources significantly reduce turnover during stable periods and significantly lower absenteeism during shocks. Three persistent challenges extend beyond the pandemic: structural workforce constraints amid increasing care demands, the need for organizational collaboration in competitive contexts, and the importance of inclusive leadership within predominantly top-down structures. Team leaders emerged as key actors in supporting staff through a both-and approach that balances staff needs with managerial demands, yet their capacity to do so was frequently constrained by limited trust, autonomy, and support from higher management.

Discussion
This dissertation demonstrates that the workforce lies at the core of hospitals’ ability to cope with today’s dynamic environment. It therefore calls for “the centrality of humanity” in healthcare organizations. That is, recognizing that organizational functioning fundamentally depends on the sustained availability of healthy staff, who should not merely be treated as ‘resources’ but as individuals with intrinsic human needs that should be met. Responsibility for staff well-being should primarily reside at the organizational level rather than staff. Team leaders can act as critical intermediaries in protecting staff well-being, but only when granted sufficient trust, autonomy, and support from higher management. At the organizational level, slack resources constitute a key resilience mechanism, enabling hospitals to retain staff during stable periods and buffer against absenteeism during shocks. At the system level, financing and governance structures should be adapted to enable sustained investment in staff, facilitate organizational collaboration, and strengthen resilience.