From Close Cooperation to Its Unravelling: A Political View of the COVID Crisis Management in Hospitals

Abstract In France, the first wave of the COVID-19 pandemic was marked by intense cooperation between hospitals and a high level of job satisfaction, both of which declined in subsequent waves. How can these dynamics be explained? This paper demonstrates that the collective mobilisation cannot be accounted for solely by an injection of financial resources and the strength of a shared professional ethos; it claims instead that relations of cooperation must be understood as relations of power. Drawing on a qualitative study in 14 French hospitals (139 interviews), it shows that the initial wave created conditions and mechanisms that greatly enabled cooperation, but which then waned with ensuing waves. The paper argues that cooperation is related to three types of relationships that had improved during the first wave: those between healthcare professionals, between healthcare staff and top hospital management, between healthcare professionals, patients and their families. It identifies the mechanisms behind these relationships, respectively: the suspension of competition between doctors and departments, the greater autonomy given to healthcare professionals in management decision-making, and the absence of patients’ families, which enabled caregivers to reassert their professional authority. Conditions conducive to cooperation were no longer present during subsequent waves, making cooperation more difficult.