Crisis management in institutional healthcare settings : From punitive to emancipatory solutions

Sometimes inefficient management of crises may lead to remedies that prove to be as problematic as the ills for which a solution is sought. Usually, this discrepancy arises from a limited analysis of the crisis, the objective of which is to preserve institutional legitimacy, regardless the roots of the failure. But the roots of a crisis may be found in profound organizational mechanisms generally permitting organizations to function normally on a daily basis. A more substantive investigation of the roots of the difficulties sometimes endangers the very legitimacy that the organization seeks to preserve. The case of the St. Charles Borromée Centre analysed in this article provides an excellent illustration of this. In basing ourselves on this case, we will show that crisis management interventions sometimes result in making organizations yet more vulnerable through not dealing with the heart of the vulnerabilities and through perpetuating a deeper state of ignorance about them. To do this, we rely on a twofold interpretation of the concept of vulnerability, seen as a process of organizational fragilization on one hand and of underestimation of the risk, on the other hand. More precisely, the case presented in this article aims to show that authoritarian and punitive bureaucratic responses are not only stigmatizing but also insufficient to compensate for the institutional vulnerabilities of organizations such as long-term care facilities. Certain propositions advanced in the literature such as "good caring treatment" programmes, similar to the humanist values promulgated by OD, prove to be more promising and liberating in that respect.