A Qualitative Study on Civil-Military Cooperation in a Dutch Hospital During COVID-19

Introduction: During the COVID-19 outbreak, military personnel were deployed on an unprecedented scale to overwhelmed healthcare institutions. In the Netherlands too, military medical personnel were deployed to cope with the major patient influx. This study focuses on the civil-military cooperation at the Dutch University Medical Centre Utrecht (UMCU). We explore collaboration experiences and identify lessons for future collaboration.

Materials and Methods: A qualitative study was conducted based on a theoretical framework consisting of network theory, literature on emergent networks, and inter-organizational theory. Data were collected from semi-structured interviews with 34 participants; both civil and military personnel. An abductive thematic analysis was guided by five themes recovered from earlier research on civil-military cooperation. An ethical review and approval for non-medical research was obtained from the Research Ethics Review Committee Faculty of Science of the VU University Amsterdam (BETCHIE 2022.038).

Results: Military assistance at UMCU was perceived to be essential in the COVID-19 crisis and was characterized by its prolonged duration. Day-to-day obstacles arose and were overcome, including varying levels of medical skills and organizational culture differences. Yet, the prolonged duration of the deployment had a severe impact on the collaboration. The common goal became indistinct over time and the collaboration suffered from an ambiguous crisis definition and lacked a clear exit strategy. This uncertainty caused declining motivation amongst personnel.

Conclusions: Military medical support was highly appreciated, but crisis support lacked clearly defined phases to demarcate an end to the crisis, which also hampered the collaboration. Therefore, more attention to the different phases of the Emergency Management Cycle (EMC) is needed. Collaborative actions in the preparedness phase can familiarize partners in an early stage. Distinction between the response and recovery phase can provide transparency on the exit strategy.