{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:22:02Z","timestamp":1789568522573,"version":"build-2803163510"},"reference-count":64,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Centre for Clinical Research S\u00f6rmland, Uppsala University Sweden","award":["Grant No. DLL-940876"],"award-info":[{"award-number":["Grant No. DLL-940876"]}]},{"name":"Regional Research Council in Mid Sweden","award":["Grant No.RFR-939378"],"award-info":[{"award-number":["Grant No.RFR-939378"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,2,14]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to explore how emergency department (ED) organisations and clinicians adapted to altered prerequisites during the first wave of the COVID-19 pandemic, the processes involved and the consequences. In addition, we examined how the ordinary state affected resilient performance during this period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This qualitative study involved inductive thematic analysis of semi-structured interviews and narratives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Three hospital-based EDs, one county and two rural hospitals, located in two Swedish regions were studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 12 participants, 80% of whom were women, were recruited. The participants included two physicians, three registered nurses, three assistant nurses and four nursing managers working at the three EDs before and during the first pandemic wave.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overarching theme \u2018anchored in the eye of the storm\u2019 emerged. This theme suggests that resilient performance during the pandemic was facilitated by ordinary adaptive capacity in the ED. A thematic map and seven main themes with a total of 25 subthemes explain the process. The ordinary state of conditions in the ED was challenged with the emergence of the COVID-19 pandemic. Altered prerequisites were perceived partly as a new reality in addition to business as usual. The adaptations included organise to regain control and developing new strategies to manage the situation, mainly by initiatives among clinicians. The consequences included perceived strain and frustration and partially impacted quality of care. However, an increased sense of cohesion among clinicians and enhanced knowledge were also noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>During the pandemic, a partially new reality was experienced, although work also continued largely as business as usual based on experiences of crowding, established preparedness plans and ordinary adaptive capacity. Despite dealing with a previously unknown patient group, the experience of working with critically ill patients and establishing structured work processes proved advantageous and facilitated resilient performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094591","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T16:56:00Z","timestamp":1741020960000},"page":"e094591","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Anchored in the eye of the storm: a qualitative study of resilient performance during the COVID-19 pandemic in Sweden in the context of the emergency department"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0681-9768","authenticated-orcid":false,"given":"Ann-Sofie","family":"K\u00e4llberg","sequence":"first","affiliation":[{"name":"Dalarna University School of Health and Welfare, Falun, Sweden"},{"name":"Department of Emergency Medicine, Falun Hospital, Falun, Sweden"},{"name":"Center for Clinical Research Dalarna, Falun, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"G\u00f6ras","sequence":"additional","affiliation":[{"name":"Department of Caring Sciences, Department of Occupational Health and Psychology, University of Gavle, Gavle, Sweden"},{"name":"Department of Anesthesia and Intensive Care, Falun Hospital, Falun, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Berg","sequence":"additional","affiliation":[{"name":"Dalarna University School of Health and Welfare, Falun, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petronella","family":"Bjurling-Sj\u00f6berg","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research S\u00f6rmland, Uppsala University, Uppsala, Sweden"},{"name":"Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden"},{"name":"Department of Patient Safety, Region S\u00f6rmland, Nykoping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"2025121514323240000_15.3.e094591.1","doi-asserted-by":"crossref","DOI":"10.3390\/jpm12081295","article-title":"Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems","volume":"12","author":"Filip","year":"2022","journal-title":"J Pers Med"},{"key":"2025121514323240000_15.3.e094591.2","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph20217019","article-title":"From Threatening Chaos to Temporary Order through a Complex Process of Adaptation: A Grounded Theory Study of the Escalation of Intensive Care during the COVID-19 Pandemic","volume":"20","author":"G\u00f6ras","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"2025121514323240000_15.3.e094591.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12873-021-00464-w","article-title":"Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge","volume":"21","author":"Jachetti","year":"2021","journal-title":"BMC Emerg Med"},{"key":"2025121514323240000_15.3.e094591.4","article-title":"Strategies to Measure and Improve Emergency Department Performance: A Review","volume":"16","author":"Mostafa","year":"2024","journal-title":"Cureus"},{"key":"2025121514323240000_15.3.e094591.5","doi-asserted-by":"crossref","unstructured":"Plsek PE , Greenhalgh T . 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