Standard operating procedures design for resilient performance during healthcare crises: the role of work-as-done

Healthcare institutions are complex systems subjected to outcome variabilities and disruptions. As such, resilient performance (RP) is paramount to providing the system's functionality under crises, approximating the gap between the work-as-imagined (WAI) and the work-as-done (WAD). Resources for action to support RP include Standard Operating Procedures (SOPs), usually interpreted as part of the WAI. We aim to discuss the role played by the WAD in the SOP design as a resource for action during the COVID-19 pandemic. This study is part of a broader research project and used content analysis from previous interviews. Three examples illustrate the findings related to SOP design as a resource for action and the implementation of COVID-19 patient prone maneuver: (i) case of a hospital that did not have the prone maneuver SOP in place; (ii) case of a hospital that expanded the use of prone maneuver to awake patients and patients without mechanical ventilation, generating a new SOP; and (iii) use of the checklist created during the COVID-19 pandemic for the prone maneuver. Conclusions state that designing and implementing SOPs based on insights from the WAD is a consistent approach to alleviate the gap with the WAI, contributing to RP to cope with healthcare crises while supporting safe and efficient work for employees, patients, and the organization.