Pharmacists’ collective phronesis during the Pandemicracy
Abstract
During spring 2020, as the Corona epidemic turned into a pandemic, we got access to follow a hospital pharmacy. In our ethnographic study we examined how pharmacists quickly had to re-organize by transferring wards pharmacies, re-organizing the hospital into different zones, and setting up designated Covid-19-wards. The work to prepare and tackle the pandemic situation that unfolded was synchronized among care professionals. There was a constant shortage of materials and drugs, and the pharmacists faced challenges they had not seen before. It was no longer possible to press a button and wait for market deliveries. Instead, pharmacists had to turn to proven knowledge and combine it with forgotten methods in a search for practical solutions by reviving tried and trusted pharmacy craftsmanship. Using the WHO recipe, they could secure the stock of hand sanitizer, searching for necessary components in the local community and in other parts of the hospital. By finding ways to tap sterile water from the water system in the dialysis department they could also secure access to the sterile water which was needed to moisten the lungs of ventilator patients. When they were in danger of running out of the anesthetic Propofol, they initiated a collaboration with nurses and doctors in the Intensive Care Units to invent solutions to the life-threatening shortage of anesthetics on the market.
In the revival of the pharmacists’ knowledge in securing stocks of drugs and medical products, there was a sense of excitement combined with determination to succeed and the satisfaction of succeeding. This everyday creativity we view as an expression of professional judgment, which has been suppressed in an economically over-rationalized organizational world. The Swedish philosopher Jonna Bornemark (2018) has pointed out how staff in interpersonal professions (such as care and education) feel that they no longer perform the work they have been trained for but have been transformed into ‘hyperrational’ slightly remote-controlled cogs in the wheel, where creativity is taken hostage by governing documents and chained by financial concepts such as ‘business goals, results, efficiency, governance and customers.’
In the midst of the pandemic we point in this paper to how the pharmacists and their health care professional colleagues were able to let go of the economical rational logic and give more space to the professionals’ experience, judgment, empathy, ethics and creativity, allowing these qualities to be a guide to coping with the problems that unfolded. This is interpreted as a collective phronesis (Bornemark, 2020); an organizational orchestration of professional judgment consisting of handling embodied knowledge, asking ethical questions, and an ability to act despite the paradoxes and dilemmas that unfold (Bornemark, 2020).
The pharmacist’s strong sense of professional judgment, we view as based on awareness of what the consequences of their potential non-action might be, and an ability to focus on their organization’s main mission (Bornemark, 2018). Relating to professional judgment an ability to act under uncertainty emerged. The hospital pharmacists balanced risks, and when necessary circumscribed rules and norms and to develop solutions that addressed concrete problems, often in collaboration with others (Weick et al., 2005; Maitlis & Sonenschein, 2010). Their professional judgment, combined with practical agency, enabled pharmacists, as a marginalized profession, to play an increasingly important role in an organization in crisis.
In this paper we will, based on observations and interviews conducted with hospital pharmacists from May 2020 – Dec 2020), analyse collective phronesis as a concept that can help us understand the role of organizational orchestration of judgement, and a collectively enacted entrepreneurial behavior. This behavior seemed to be triggered by the pandemicracy, an extreme situation that necessitated a modification of rules.
