The impact of COVID-19, the disease caused by SARS-CoV-2, has not only changed our lives and interactions as human beings but has had substantial consequences for health care systems worldwide [1]. Above all, hospitals must slow the spread of SARS-CoV-2 and further ensure a certain level of daily routine to maintain regular care and treatment of emergency patients. In addition to changes to clinical routines [2,3], this process involves adjustments in the way that clinicians work together.

Collaboration among hospital employees, particularly between physicians and interconnected medical departments, is essential for the overall diagnosis and treatment process [4-7]. Because the health care system is interdisciplinary in nature, goal-driven collaboration enhances the performance of services, quality of care, and patient outcomes [8-11]. Collaboration in hospitals can be defined as a professional alliance between health care specialists from multiple medical disciplines with diverse backgrounds and varying expertise, who jointly provide benefits for patients [12,13]. Although collaboration is considered to be a top priority in hospitals [14], some common issues are frequently experienced by clinicians [15]. Insufficient communication, including improper exchange of medical information, is a prevalent concern [16]. Clinicians manage their tasks in isolation with a lack of mutual understanding, which prevents the sharing of knowledge across departmental boundaries and inhibits collaboration between disciplines [17,18]. Furthermore, hospitals operate in complex clinical infrastructures, with a wide range of information systems containing different medical information; these systems are disconnected from each other and operated by multiple professionals [19,20]. Consistent presentation of medical data is lacking, and the retrieval of information stored across diversified systems is a time-consuming procedure [21,22].

In addition to existing collaborative challenges in hospitals [15], clinicians are being confronted with issues emerging from the COVID-19 pandemic [23]. Medical workers must not only examine individuals who are infected with the novel virus but must also respond to normal emergencies and patient cases. The required response involves substantial dedication and demands the implementation of diverse organizational arrangements as well as safety precautions [24]. Changes in surgery include decreasing the number of elective procedures to gain more capacity for emergency interventions [25]. Staff caring for patients with COVID-19 are separated from those caring for other patients, and postoperative visits are suspended and replaced by telephone calls to prevent in-hospital spread [3]. Furthermore, clinics are divided into multiple teams to prevent quarantine of an entire department, thus providing patient care in the case of infection. The underlying objective of reducing interpersonal communication compensates for any shortfall and maintains clinical operations. However, due to these necessary adjustments, collaboration in hospitals has changed significantly and has rapidly shifted toward virtual environments. Clinicians have started exchanging information using social media or instant messaging, and meetings are increasingly being conducted using applicable and available technology [3,26].

The integration of technologies into existing processes is a key component of the digital transformation [27,28] that improves cross-functional collaboration and coordination among individuals [29,30]. Digital transformation is defined as “a process that aims to improve an entity by triggering significant changes to its properties through combinations of information, computing, communication, and connectivity technologies” [30]. Therefore, digital transformation addresses changes associated with the introduction of new information technology (IT) in current organizational structures [31,32]. Because digital transformation is concerned with improving collaboration between individuals [30], it is closely linked to the computer-supported cooperative work (CSCW) research stream. CSCW determines how technology can increase group communication and work efforts [33]; thus, it is a vital component for understanding the dynamics of digital transformation [34] and associated changes of collaboration in practice [30].

In health care, digital transformation deliberately seeks to answer the question of how the quality of care and its related services can be improved with technology, as both rely on accurate, relevant, integrated and quickly accessible information [35,36]. For example, recent research examined how processes and digital infrastructure must be aligned to drive IT-enabled innovations [37] and whether advanced technologies, such as the Internet of Things (IoT) and artificial intelligence (AI) [38,39], can be integrated to empower caregivers to make evidence-based clinical decisions [28]. Extant research is further concerned with the potential of health information technology (HIT) to improve patient outcomes while reducing costs [40]. One example of HIT that is fundamentally transforming health services is electronic health records (EHRs), which digitally capture patients’ retrospective, concurrent, and prospective information to guide medical treatment [41]. In this realm, scholars are exploring how technology is creating smart hospitals [42], that is, clinical environments with optimized and automated processes based on technological advancements and intelligent facilities to introduce new capabilities and provide an ideal surrounding for patients [42-44].

However, the increasing application of technology also serves as a basis for enhancing information exchange and collaboration in hospitals [15,45-47]. Collaborative visioning promotes joint decision-making and helps to overcome related issues frequently experienced by clinicians [48]. Communication is improved as information is presented transparently for involved experts. For example, central platforms coordinate the diffusion of reports and information exchange among participants [29,49]. The free transfer of medical information across departmental boundaries further establishes a closer alignment with collaborators from other departments, which dissolves silo thinking [50,51]. In addition, the introduction of standards simplifies complex clinical infrastructures and contributes to a feasible exchange of medical data between detached HIT systems; it also assists clinicians in gathering information more quickly [28].

In summary, the technological capacity for enhancing information exchange and collaboration focusing on patient outcomes is widely available [45-47]. Digital transformation and associated technologies are essential to facilitate the exchange of information among clinicians across organizational boundaries, as new forms of collaborative work drive operational performance [15,30,31]. However, in their complex clinical environments, hospitals traditionally struggle to adopt new technologies [19,20], especially when aligning IT-enabled transformations with existing infrastructure [52]. Agarwal et al [17] stated that “an IT-enabled transformation of health care is just beginning, and it cannot happen too fast.” However, the present situation of the COVID-19 pandemic is confronting hospitals with the urgent need to identify valid solutions while maintaining a sufficient level of collaboration and complying with the legal requirements of social distancing. Radical actions and restrictions are unavoidable for hospitals; however, they involve profound implications. Habitual collaboration is altered instantly, with no or only partial consideration of possible influencing factors such as available resources or security and data protection. Furthermore, the entire process of integrating technologies is likely to be faster during a crisis than under normal conditions, as people are conducting sense-making on a different level [53,54]. Disruptive technologies that are being applied to combat the COVID-19 pandemic are replacing traditional communication in health care teams [55] and are fundamental for sustained collaboration in hospitals. The ongoing pandemic is therefore creating a pressing need to rethink collaboration between clinicians; however, research on how digital transformation advocates collaboration in hospitals during a crisis is still lacking. We argue that this topic is of great interest to researchers and practitioners because virtual collaboration in hospitals will increase even further in the near future and persist for a long time. Thus, our research is guided by the following question: How is digital transformation driving collaboration among clinicians in a time of crisis?

We report the unique findings of an exploratory case study of a German hospital, in which we observed the introduction of an IT system to enhance collaboration among physicians during the COVID-19 pandemic. Our results are based and on 16 generalized semistructured interviews with physicians from various departments. We explain how clinicians worked together before the ongoing crisis, what has changed as a result of the pandemic, how the introduction of an IT system ensured effective collaboration, and how the digital transformation should continue to transform hospital operations.

We aim to increase our understanding of how digital transformation can improve collaboration among clinicians in the subject hospital and other hospitals. Moreover, it will demonstrate how the proposed IT improvements can ensure accurate, safe, and effective patient care not just for future crises but for daily operations. Researchers will be able to use our key lessons to understand the difference between a regular installation and one made out of necessity, along with their advantages and disadvantages. Practitioners will be able to understand how our recommendations help to ensure goal-driven collaboration and how hospitals can benefit from them. We hope to guide decision makers who want to introduce IT to improve collaboration between clinicians and stimulate additional research in this important field by expanding the body of knowledge.

The German health care system is a highly developed sector in which the health of the population and life expectancy has continuously risen [56]. In the fight against SARS-CoV-2, wide-ranging countermeasures were backed by the German government and introduced at an early stage. A crisis taskforce was convened on February 27, 2020, and the first nationwide restrictions on public access were adopted on March 22 [57]. There is no evidence that the system was overburdened, as only 60% of the total of 33,051 intensive care beds were in use [58]. However, the new restrictions undoubtedly influenced hospitals and the ways in which their employees interacted with each other. To determine how collaboration between clinicians changed during the COVID-19 pandemic, we observed the introduction of an IT system at a large German hospital during the period from March 24 to April 24, 2020.

The hospital decided to introduce and provide Microsoft Teams (Microsoft Corporation) throughout the clinic. It was necessary to maintain collaboration between physicians, including those who were working from home, during the pandemic. Furthermore, restricted personal contact was needed to slow the spread of the virus. Microsoft Teams is a collaboration platform with features such as chatting, video calls, and file sharing. It can be used by many devices, such as personal computers, notebooks, tablets, and smartphones [59]. In response to the COVID-19 outbreak, Microsoft decided to offer the Teams software for free to help individuals stay connected [60].

Additionally, several organizational changes were initiated by the hospital. The departments were split into two different teams and worked in a weekly rotation to ensure that if one team was contaminated with the virus, the second team would be able to continue working and providing appropriate patient care. Furthermore, all elective procedures were reduced to a minimum, and only urgent surgeries were performed. However, the most crucial action was the minimization of any face-to-face exchanges between clinicians.

As presented in Figure 1, the case study preceded the implementation and test phase conducted by the hospital’s IT department. The decision to implement the corresponding emergency concept, including the rollout of Microsoft Teams, was made on March 17 by the hospital management. On March 24, the software was installed on the employees’ computers. Installation was followed by a week-long test phase during which additional hardware, such as cameras, microphones, and speakers, was installed. Because Microsoft Teams had not been used in the clinic before, clinicians had little or no knowledge of how to use the system. We provided advice and tips exclusively remotely, as visits to the hospital were forbidden to prevent the virus from infecting other patients and spreading. Finally, the first formal meeting and the official start of our support took place on April 1.

After the new system was introduced, we conducted 16 semistructured interviews with physicians. The interviews were designed to provide “questioning guided by identified themes in a consistent and systematic manner” [61]. We developed a guide containing relevant questions in advance. Our goal was to make the guidelines as comprehensive as possible because physicians are typically available for a limited time, especially during a crisis. The guide was divided into chapters, with initial questions and subsequent follow-up questions (see Table 1).

Because we were interested in the meaning of the experts’ substantive statements and not in their linguistic habitus or expressions, which are not necessary for understanding the context, nor in their physical gestures or facial expressions, we decided to paraphrase the interviews instead of conducting verbatim transcriptions. The analysis of the interviews was based on the recommendations in the qualitative assessment of content analysis by Schilling [28]. Paraphrasing the data reduced the volume by removing unnecessary words to form short, concise sentences. We listened carefully to the interview recordings and paraphrased the content of the physicians’ statements. Next, we generalized and reduced the content to better understand and interpret the meaning of the statements [62]. The subsequent categorization was guided by the recommendations of Mayring [29] for an organization of data derived from the material itself. This inductive category formation approach described the data without predefined criteria, leading to an unbiased “understanding of the material in terms of the material” [63].

The physicians were aged between 25 and 42 years (mean 32.2 years, SD 4.4), with 9 female and 7 male experts, and their tenures ranged from 0.5-17 years (mean 4.3 years, SD 4.4). Of the participants, 3 were senior physicians and 13 were resident physicians from 3 different clinics. The interviews were conducted using Microsoft Teams, with which the physicians were by then familiar. The interviews lasted between 9:04 and 28:25 minutes and were recorded, analyzed, and deleted once the evaluation was finished to protect the privacy of the participants. An overview of our sample is outlined in Table 2. The results yielded novel insights on how physicians collaborate with the assistance of technology during a pandemic. They broadened our view on collaboration among physicians in hospitals.

This section describes the level of collaboration between clinicians before the crisis, what has changed because of the pandemic, and how it should be organized in the future. Excerpts from the German interviews have been translated into English for the reader’s convenience. For the purpose of anonymization, the numbering of the interviewees does not correspond to the order of the interviewees as depicted in Table 2.

Figure 2 summarizes the results.

In this section, we present the most relevant insights gained from our case study. We explain general key lessons learned and offer recommendations on how digital transformation can improve collaboration. Our goal is to guide hospitals and their decision makers who want to embrace digital transformation for collaborative purposes.