From bureaucracy to bedside teamwork: maintaining patient safety in COVID-19 care - staff experiences of COVID-19 care in a Swedish university hospital.

PURPOSE: This study aimed to describe healthcare staff’s experiences of planning and providing care for patients with COVID-19 at a university hospital in western Sweden. DESIGN: A qualitative content analysis was conducted based on 28 semi-structured interviews with healthcare staff at a university hospital in western Sweden. FINDINGS: One overarching category was identified: Togetherness to Maintain Patient Safety, comprising three subcategories: Managing Uncertainty and Fear of an Unknown Disease, Coping with High Workloads in an Unfamiliar Work Environment, and Collaborating with unfamiliar staff members. These themes illustrate how staff navigated the challenges of planning and delivering care during the pandemic. ORIGINALITY: Despite severe challenges, including high patient acuity, limited evidence-based knowledge, and resource constraints, staff successfully implemented ongoing improvements through a shared commitment to patient safety. Organizational flexibility and the reduction of hierarchical routines alleviated burdens on healthcare professionals, fostering collaboration and a person-centred approach to care. RESEARCH IMPLICATIONS: Collaboration among staff emerged as a central feature, supported by reduced bureaucracy and the use of continuous improvement methods, such as the plan–do–study–act cycle. PRACTICAL IMPLICATIONS: The study highlights the challenges created by the rapid onset of the COVID-19 pandemic, which profoundly affected healthcare working conditions. Staff collaboration, reinforced by less bureaucratic structures, facilitated continuous improvement and strengthened the commitment to delivering safe care under uncertain and demanding circumstances. SOCIAL IMPLICATIONS: Working together, supported by effective organizational and managerial leadership, was essential for adapting practices and safeguarding patient safety when evidence-based guidelines were limited. Standardized group introductions, divided into general routines and unit-specific practices, were identified as critical for reducing workload pressures on both permanent and redeployed staff.