The application of organizational slack to hospital system responsiveness during the COVID-19 pandemic

The COVID-19 pandemic placed intense pressure on individual hospitals and hospital systems. While no hospital could have predicted the exact needs required to respond to the crisis, there may be certain organizational characteristics or hospital system types that were better prepared to respond effectively. In this article, we propose a conceptual model for effectiveness of health system organizational response to COVID-19, using the theoretical foundation of organizational slack which is defined as the "excess" accumulated resources that do not contribute to that organization's immediate production function. We first define and describe the contributors of organizational slack, such as accumulated social capital or financial health. We then describe the benefits of organizational slack such as the ability to be more innovative or having more operational flexibility. Next, we discuss the application of organizational slack during the pandemic to adapt operations, redeploy staff and/or supplies and to manage any technological pivots (e.g., the rapid escalation of telehealth). Finally, we address the ways that hospital system structures may moderate the relationship between the benefits and applications of organizational slack. The COVID-19 pandemic placed unique pressures on hospitals as the crisis was sustained and will most likely transform future operations and care delivery. Through the lens of organizational slack, we can better understand the optimal ways to respond to future crises.