Ensuring resilience in a Critical Care Unit: a dynamic approach of slacking processes[Maintenir la fiabilité en situation extrême : une approche dynamique du slack organisationnel]

Numerous organizations face extreme situations whose consequences may be locally catastrophic, if not at the entire society level. Due to these potential consequences, these organizations have to produce and maintain a high degree of reliability during their operations and to develop resilience. But if organizational literature underlines the crucial role of slack in resilience and reliability, few things are said about the concrete ways by which organizational actors are creating and using this slack. Thus, in this paper, our goal is to study these processes in extreme situations at an intra-organizational level. With this aim, we led an ethnographic study in a French critical care unit during 14 months to observe how slack is created and consumed to face extreme situations. Our results are twofold. Firstly, we show the dynamics of the processes of creation and consumption over time in the potentially critical situation. In these situations, we underline the existence of tipping points where the organization stabilize or, on the contrary, face a real critical situation. Secondly, we shed light on two kinds of production and consumption processes: some are official and planned by the organization; others are unofficial and ad hoc depending on the situation. Both of them are useful to manage critical situations in healthcare and enable to articulate theoretically the roles of slack, the practices of slack (what we call ‘slacking' processes) and the roles of actors in these processes.