THE IMPACT OF MANAGING GOVERNMENT HEALTHCARE SYSTEMS DURING CRISIS PERIODS ON DECISION-MAKING PROCESSES, LEADERSHIP, AND BURNOUT AMONG HEALTHCARE SYSTEM MANAGERS: A QUALITATIVE STUDY

Abstract

Public healthcare systems have faced increasingly complex realities in recent decades, characterized by the growing frequency and intensity of crises, including pandemics, national emergencies, extraordinary healthcare demands, resource shortages, and persistent systemic challenges. These situations require healthcare system managers to operate in environments characterized by high levels of uncertainty, time pressure, and the need to make decisions with broad implications for patients, employees, and the overall functioning of healthcare organizations (World Health Organization [WHO], 2020). Managing healthcare systems during crisis periods is not based solely on operational management capabilities but requires an integration of effective leadership, organizational flexibility, adaptive capacity, and rapid decision-making under conditions of incomplete and constantly changing information. Research in crisis management emphasizes that the ability of healthcare systems to cope with unexpected events depends significantly on managers’ ability to lead change, maintain organizational communication, and develop systemic resilience (Boin et al., 2016). Despite extensive knowledge regarding healthcare leadership and burnout among healthcare professionals, a research gap remains regarding the experiences of healthcare system managers who occupy key positions in decision-making and organizational management during crisis periods. In particular, there is limited understanding of how increased managerial demands influence decision-making processes, leadership styles, and burnout levels among senior healthcare managers. The aim of this study is to examine the impact of managing government healthcare systems during crisis periods on decision-making processes, leadership, and burnout among healthcare system managers. The study is based on a qualitative interpretive approach (Interpretivist Approach) using semi-structured in-depth interviews with 30 managers within the public healthcare system, including hospital managers, department directors, nursing managers, and senior healthcare executives. Data analysis using thematic analysis identified five major themes: decision-making under conditions of uncertainty, adaptive leadership during crisis periods, managerial and emotional responsibility burden, organizational support as a protective resource, and burnout alongside the development of professional resilience. The findings contribute to understanding the relationship between job demands and organizational resources according to the Job Demands–Resources Model (JD-R), which suggests that high workload and insufficient resources may increase burnout, whereas organizational support and professional resources may strengthen coping abilities and resilience (Bakker & Demerouti, 2017). This study provides theoretical and practical contributions to the field of healthcare systems management by emphasizing the need to develop crisis leadership capabilities, strengthen managerial support mechanisms, and establish organizational policies that promote resilience and protect the professional well-being of healthcare system managers.