Responding to knowledge disruptions: doctors dealing with the pandemic

Our research is based on an in-depth investigation of how certain physicians dealt with the Covid-19 pandemic in Italy in 2020. (The first cases of Covid in a Western country were detected in Italy.) We carried out our study in one of the biggest hospitals in Milan, in the region of Lombardy, a research-intensive teaching hospital with 600 beds. This hospital was converted into a medical center specialized in Covid-19, intaking patients from all over the region, and the physicians who worked there were the among the first to experience and respond to the knowledge interruption triggered by the Covid-19 pandemic in their workplace.

To reconstruct the complex social context that doctors found themselves working in during the initial outbreak of the pandemic, we triangulated the different sources of primary and secondary data.

• 81 semi-structured interviews. With the help of the Human Resources Department, we recruited and interviewed 74 physicians, who represented nearly 80% of the total number of doctors who worked during the first wave of Covid-19. Thanks to these interviews, we were able not only to reconstruct the main changes that occurred in the hospital, but also to assess the role played by doctors as they responded to the pandemic.

• Internal communications and archival materials from the organization. To study how the actions of the physicians were integrated in the broader community of medical professionals, we collected scientific materials (273 articles) on Covid-19 produced over time by doctors at this hospital, as well as their video presentations at medical conferences (15 videos).

We moved iteratively through the data, the emerging theories, and the literature, following a gradual abstraction approach that consisted of four steps:

1. First, we analyzed Covid-19 as a disruption of professional knowledge, and bracketed our data along a timeline based on the impact of uncertainty on physicians’ inferences.
2. Then we systematically codified the emotional dynamics of the professionals linked to the knowledge interruption created by Covid-19.
3. Next, we analyzed and categorized the responses of professionals and the motivating mechanism.
4. Finally, we clarified the relationships between constructs, and based on these, built our models.

Our inductive analysis of the responses of Italian physicians brought to light not only the fact that they lacked the specialized knowledge they needed to diagnose and treat their patients, but also that they were experiencing negative epistemic emotions (emotions associated with knowledge and knowledge processes), along with a sense of moral duty as professionals (to treat patients). To compensate for the ineffectiveness of their knowledge-based work, the doctors utilized and prioritized a series of service-oriented practices, leaning into the collaborative and humanistic side of their work.

Our work describes the ways in which professionals responded to knowledge interruptions that arose from societal challenges that were so complex as to undermine the adequacy of their knowledge base. This study contributes to the literature on professions and organizations in two ways.

1. We conceptualize a distinctive category of knowledge disruptions, extending prior theory. Specifically, we draw connections between knowledge interruptions and the emotional dynamics that professionals experience, introducing epistemic emotions and revealing their importance in the context of professional failure.

2. We discover the micro-dynamics professionals can leverage to respond to knowledge interruptions that stem from a situation of total uncertainty. Prior literature which focused the cognitive practices of expanding knowledge and strategies of jurisdictional defense. In contrast, we assert that collaborative and humanistic work practices, very different from traditional knowledge-based approaches, can empower professionals to come up with alternative answers that are actionable and constructive.

When professionals have no way to use knowledge-based strategies to mitigate the uncertainty generated by knowledge disruptions, they experience strong negative epistemic emotions. Yet in such a scenario, they seem to be driven by a higher sense of moral duty, and they embrace collaborative and humanistic service-oriented work practices (poles apart from their usual knowledge-centric approach). These practices are inspired by the need to fulfill their professional role of service, rather than by an understanding of professionalism anchored on knowledge and rationality.