I have another blog post on the CCIO website – the contents of which may remind readers here of this and this and also this – so here is the Greatest Hits version:
Morale, adaptive reserve and innovation
On the ARCH (Applied Research in Connected Health) website, research lead Dr Maria Quinlan recently wrote a post called Happy Organisations and Happy Workers – a key factor in implementing digital health.
In the opening paragraph, Dr Quinlan invokes Anna Karenina:
To paraphrase Tolstoy, “all happy organisations are alike; each unhappy organisation is unhappy in its own way.” The ability for healthcare organisations to innovate is a fundamental requirement for adopting and sustainably scaling digital health solutions. If an organisation is unhappy, for example if it is failing to communicate openly and honestly, if staff feel overworked and that their opinion isn’t valued, it stands to reason that it will have trouble innovating and handling major complex transitions.
The whole post is a fascinating read, with implications for team functioning beyond the implementation of digital health and indeed beyond healthcare itself. Dr Quinlan cites research on what makes a happy worker;
What these factors combine to achieve is happy, engaged workers – and happy workers are more effective, compassionate, and less likely to suffer burnout. Clear objectives, praise, a sense that your voice matters – these can seem like fluffy ‘soft’ concepts and yet they are found over and over to be central to providing the right context within which new digital health innovations can flourish. Classic ‘high involvement’ management techniques – for example empowering team members to make decisions and not punishing them for every misstep are found to be key. As Don Berwick of the Institute of Healthcare Improvement (IHI) says, people who feel joy in work are “not scared of data”, rather “joy is a resource for excellence”
Dr Quinlan goes on to describe the high rates of burnout and emotional exhaustion among healthcare workers. Unfortunately this is a phenomenon that has been consistent in survey after survey. Not only does poor morale compromise the introduction of innovation, it also causes direct human suffering and compromises what an organisation is trying to achieve.
The concept of “adaptive reserve” is an important one, especially in the context of reforms and innovations being introduced into already pressured environments:
Adaptive reserve is an internal capability for change which includes being agile; capable of continuous learning; and being adept at self-assessment, reflection and improvisation. The Adaptive Reserve questionnaire asks staff to rate their organisation according to a variety of statements which include statements such as; ‘we regularly take time to consider ways to improve how we do things’ and ‘this organisation is a place of joy and hope’.
There is sometimes an urge to reform or innovate our way out of the situation healthcare finds itself in, and yet the concept of Adaptive Reserve suggests that this is inverting how reform and innovation work; there needs to be not just systematic space and infrastructure for it to happen, but psychological space among staff.
A related blog post on the ARCH website by Dr Marcella McGovern on the blame culturethat exists within many organisations, and particularly in the Irish health care context is worth reading. Dr McGovern uses Melvin Dubnick’s framework of “prejudicial blame culture” to describe how systems focused on blame stifle initiative and responsibility.
Google recently completed Project Aristotle, a study of what makes a successful team. Far and away the most important factor is “psychological safety” – “Can we take risks on this team without feeling insecure or embarrassed?” Focusing on technological fixes in the absence of a sense of psychological safety is a recipe for innovations to fail and for morale to decrease further. Can technology, in and of itself, foster psychological safety? My inclination is to say no, that psychological safety is much more about interpersonal relationships within a team and a system. What technology may be able to do – in a positive sense – is help facilitate team communication.
Of course, this also has to be carefully thought through. Evgeny Morozov’s “To Solve Everything, Click Here” is a fascinating and at times rather frustrating book which takes a searching look at technology in the modern world. Morozov is against both the excessive hype of technological utopians and the excessive gloom of technological pessimists. He strongly decries what he calls “solutionism”:
“solutionism.” … has come to refer to an unhealthy preoccupation with sexy, monumental and narrow-minded solutions – the kind of stuff that wows audiences at TED Conferences – to problems that are extremely complex, fluid and contentious. These are the kind of problems that, on careful examination, do not have to be defined in the singular and all-encompassing ways that “solutionists” have defined them; what’s contentious then, is not their proposed solution but their very definition of the problem itself. Design theorist Michael Dobbins has it right: solutionism presumes rather than investigates the problems that it is trying to solve, reaching “for the answer before the questions have been fully asked.” How problems are composed matters every bit as much as how problems are resolved.
The problems of healthcare are truly “extremely complex, fluid and contentious” and any honest attempt to solve them must engage with this complexity. Can judicious innovation help foster psychological safety within a team, and thereby not only create happiness among health workers but also help them achieve the organisational goals they are engaged in meeting?
A Medical Education 