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While high-impact events such as natural disasters and infectious disease pandemics have increased significantly in recent decades, we know little about how hospitals effectively organize and respond to surges, or sudden, unanticipated escalations in treatment needs. To address this gap, we conducted a longitudinal study of five multi-hospital health care systems in the U.S., as they experienced and worked through surges in demand associated with the COVID-19 pandemic. We discover a variety of organizational-level tactics that hospitals engage to effectively manage surge capacity, defined as a hospital's ability to manage surges that challenge or exceed present capacity to treat patients. We organize these tactics into an emerging, conceptual framework explaining three dimensions of hospital surge capability: overseeing capacity management efforts, managing capacity supply and managing capacity demand. We conclude that effective surge capability involves the dynamic adaptation of capacity at the hospital level, which is accomplished through the organizing of various surge response tactics. These tactics fit together to provide hospitals a strategic approach to surge management. We contribute to the surge management literature by developing a framework to explain effective surge response that extends beyond the accumulation of adequate space, staff, stuff, and structures and that addresses surges in demand at the hospital, as opposed to response unit (e.g., an Emergency Department) or community-wide levels. [ABSTRACT FROM AUTHOR]

The aim of this symposium is to explore the concept of organizational resilience and ask what it means to organize resiliently. Researchers on four separate projects will present emerging empirical findings on how organizations in Africa, Europe, and North America organized in the face of significant adversities during Ebola and COVID-19 pandemics. The presentations included in this symposium promise to further understandings of organizational resilience by exploring how organizations emergently adjust in the face of unprecedented and long-lasted crisis and adversity. The projects also explore how capability endowments, including routines, staff, and other resources are made to work together in novel ways in response to dynamic unfolding situations. The role of temporal dynamics in resilience is also taken up by several projects. Kathleen Sutcliffe, a well-known expert on the topic of organizational resilience, will lead a group discussion not only of the four presentations, but also of her own thoughts about how future work could advance theory and practice of organizational resilience. * Towards a Diachronic Perspective on Coordinating in Crises: Enacting Temporal Elasticity * Presenter: Lisa Harborth; U. of Hamburg * Organizational Resilience as a Function of Emergent Coordination: The Integration of Critical Care i * Presenter: McKenzie Lloyd-Smith; Bayes Business School (formerly Cass) * A Cornerstone of Organizational Resilience: Balancing Formal and Informal Practices During Crisis * Presenter: Tuna Cem Hayirli; Harvard Business School * Presenter: Masha Kuznetsova; -* Presenter: Paul Biddinger; Harvard Medical School * Presenter: Elizabeth Bambury; Harvard T.H. Chan School of Public Health * Presenter: Mariam Krikorian Atkinson; Harvard U. * Modes of Adjustment: There's More Than One Way to Organize Resiliently * Presenter: Brian Hilligoss; U. of Arizona * Presenter: Jeff Larson; U. of Arizona * Presenter: Alden Lai; New York U. * Presenter: Elena Maria Wong; U. of Arizona * Presenter: Matthew John DePuccio; Rush U. [ABSTRACT FROM AUTHOR]