Arno Adriaan Gerbrand Bakkeren
Crises confront decision makers with persistent, interdependent demands that intensify under conditions of urgency, uncertainty, distributed authority, and public scrutiny. They must act rapidly while exercising judgment, coordinate centrally while preserving local discretion, and stabilize operations while remaining attentive to consequences that may emerge later and elsewhere. Drawing on paradox theory, crisis governance, and research on decision making in extreme contexts, this dissertation examines how such tensions become governable in practice. Its overarching research question is: How do decision makers navigate paradoxical tensions in crisis response? The dissertation develops a cross-level account spanning the response system, the central–local interface, and concrete decision episodes. The first study examines crisis response at the system level through a systematic review of 211 empirical studies published between 1993 and 2025 in management and public administration journals. It develops the Extreme Context Response System (ECRS) model, which links response mechanisms to operational and environmental outcomes and to feedback channels characterized by different temporal latencies. The review identifies recurring patterns in how consequences unfold over time. Operational outcomes tend to stabilize before environmental outcomes become visible; feedback travels through partially distinct channels; and time pressure concentrates attention on immediate operational priorities. Where environmental feedback is weak, delayed, or politically muted, operational primacy can displace risks and contribute to later environmental extremes. The second study examines hybrid crisis governance at the central–local interface during the Dutch public-health response to COVID-19. It focuses on the relationship between a central coordinating body and 25 regionally autonomous Municipal Health Services. The analysis identifies three coupled coordination mechanisms: a decision ledger, an exception interface, and a synchronized cadence. These mechanisms preserve decisions and their rationales, provide a bounded route for surfacing locally unworkable directions, and establish recurring moments for coordination, adjustment, and reconsideration. Together, they sustain accountability, predictable timing, and shared understanding while keeping central direction and local discretion jointly workable across levels. The third study examines concrete decision episodes in which leaders experienced paradoxical demands as undecidable. Drawing on interviews with all 25 regional public-health leaders, internal organizational documents, and field-based involvement, the study shows how leaders relied on ethical consideration when protocols, categories, and formal authority did not fully settle what should be done. Four recurring domains emerged: allocative prioritization, rule interpretation, temporal sequencing, and cross-audience alignment. Across these domains, leaders weighed duties, procedures, anticipated consequences, and audience expectations in order to render action defensible under uncertainty and scrutiny. These studies interconnect and conceptualize crisis governance as a cross-level process in which consequences, coordination, and ethical accountability remain connected over time. The integrated argument is that paradoxical tensions remain navigable when later consequences remain visible, cross-level tensions remain revisable, and difficult action remains defensible while response is still unfolding. The dissertation contributes to research on extreme contexts, crisis governance, and organizational paradox by connecting temporal, organizational, and ethical dimensions of crisis response. It further identifies practical design principles for response systems that preserve visibility of delayed consequences, support adaptation across interfaces, and sustain accountable decision making under pressure.