From reliability to pragmatism: Hospital management in the context of radical uncertainty

The COVID-19 pandemic presented a scenario of radical uncertainty that hospitals had to manage. Two strands of research can illuminate this management. The first puts forward the high-reliability organization (HRO) principles that the hospital sector has applied for two decades. The second is based on pragmatism and underscores experimental, trial-and-error strategies appropriate for radical uncertainty. This strategy, utilized primarily in the political governance of crises, can be applied in hospital management as well. The results of our qualitative research into French hospitals (109 online interviews over 2020–2021) highlight the importance of pragmatic rationality in crisis management based on organizing collective inquiries. This concept of pragmatic rationality questions the notion of reliability, sticking to pre-existing performance standards not applicable in such contexts. It invites to propose the concept of high pragmatic organization based on five principles that partially integrate those of an HRO.