The facilitating factors from table 1 indicates that management (like employees) were facing pressure regarding the innovation situation. As the project had taken longer time than anticipated, the situation seemed overwhelming. Moreover, the lack of resources (e.g. time) had placed pressure on managers to prioritize task which involved optimal operation of the new instruments and upholding service promises towards the primary health service (e.g. performing a rematch of the project part one). In effect, the challenges from the first part of the project seem to have created more operational work in part two of the project. The problems in part one may thus be one reason for why management is lacking capacity to develop the relations with employees. Moreover, lack of coherence between laboratories (see table 3) and gathering the laboratories to one community (see table 1) was mentioned. Consequently, the complex organizational structure and installing various analysis instruments at different locations at once, could have made dialogue and facilitating optimal learning of the new instruments more difficult.
Innovation adoption was argued to be socially deterministic, involving managerial action, human resources and skills (Webb and Pettigrew 1999). Moreover, not considering ideas from individuals of lower rungs may be a barrier to innovation (Yang and Konrad 2011). As innovation in this sense was in relation to innovation creativity, not being open to employees’ needs may awaken innovation resistance from negative emotions (e.g. toxic emotions) (Stachowicz-Stanusch, Amann et al. 2017). However, employees had strong opinions of the organization striving towards becoming a visionary (also stated in table 2). As this was mentioned to relate to “striving to be the best in the world, not just small changes”, it may indicate a wish and motivation towards putting in the work of becoming a leading actor (if the right resources are in place). As negative emotions regarding the continuation of the project was stressed on behalf of employees, resources may relate to a larger extent of being able to participate and being heard with regards to the project (e.g. more dialogue and transparency). Moreover, stressing managers economic focus, may mean a wish for closer relations (e.g. consensus with other actors within the organization) and being seen to a larger extent by management. Nevertheless, effects from part one of the project seem to have impacted part two negatively, changing work roles and workload on behalf of managers and employees alike.
The managers seem to be aware of the various frustrations and wanted to empower employees towards project continuation (willingness to change). However, the pressured situation seems to be a barrier for this purpose. In this way, the pivotal problem of Lean for innovation success is relevant in this case, as managers seem to be facing difficulty with balancing organizing styles (e.g. meeting economic measures as well as employee needs for innovation adoption).
Issues communicated at the workshop on behalf of the clusters “personnel and employee emotions”
Capacity pressure (time/instruments/new routines)
Employees do not have time to think about anything else but the new routines, employees are sick and do not have time to do the job they are intended to do.
Employees are burned out from working overtime and there is a bitterness from the previous project part 1.
Learning the new instruments have been slow (no use of VR or AR.)
As the new solution make it possible to free resources, there is still a need to hire more expensive competence.
A strong professional pride may be present.
Employees need to adapt routines to their own workday. There are too many tasks for each employee.
Employees have a locked mindset (e.g. what is in it for me?) One must consider the whole.
Employees are tired and unable to take risks in relation to continuation of the project (part two.)
The project loyalty is weakened.
Instruments do not work as expected. When instruments (automation line) do not work, this impact employees professional pride/honor negatively.
Feeling superfluous for lack of competence in relation to operating the new instruments (which are not working optimally) (e.g. wounded professional pride.)
Need to create motivation.
“We must believe in the solutions that provide better service to hospitalized patients”.
Resistance to changes/negative emotions.
Negative emotions are difficult to get rid of (stated to be inherited between employees). E.g. rumors between bioengineers of them not being allowed to perform certain tasks:
“We are not allowed to do …”.
(The managers want to know how to get out of this in a stronger manner.)
Striving to be the best in the world, not just small changes. Being a visionary is missing.
Get employees to see the opportunities in the project regarding safety delegates and employee representatives. “Is this enough? Where are the opportunities?”
Willingness to change. How to make employees think differently?
Feelings of organizational measures being handled too late.
Too much work pressure. This project (part two) is an opportunity to operate differently.
Distillation of input; not everything seems to show (information on behalf of employees).
Input from project meetings was filtered and in-dept arguments got lost.
Employee emotions from table 2 indicate a lack of motivation and burnout from negative experiences and aftermath of the first part of the project (the term burnout was mentioned within the interviews). As the first part involved issues regarding learning and operating the instruments and the new routines that followed, it seems to have awakened negative emotions on behalf of the laboratory employees, which continued into part two of the project. This included bitterness (from part one), reluctance to change, enhanced self-centeredness (e.g. “what’s in it for me?”) as well as feeling superfluous in relation to poorly operating instruments and the lack of instrument competence (impacting professional pride and organizational loyalty).
As involvement and participation should be done from the start by those who decide on a new solution to facilitate commitment and acceptance (Romme 2003), it seems that this has not been done in a timely manner. The decision to implement the new equipment and centralize some of the analysis to one location before considering employees (who directly work with the solution) needs from the start, might thus hinder innovation speed. This is because not feeling included or being able to participate with the decision from the start, may create a sense of reluctance towards the new solution. Negative rumors shared between employees may thus be the result of a disconnect (lack of dialogue) between management and employees which may keep the reluctance to change alive.
The sense of dignity, community and meaning (Weisbord 1989) was argued to be affected in this matter (impacting commitment and solution acceptance). The findings seem to complement this literature. In terms of dignity, the fact that employees felt superfluous by not having enough instrument competence (slow learning progress due to work overload) and having a reduced sense of professional pride in relation to the instruments not working as expected (not trusting the instruments), it may reduce innovation speed. The same is relevant from having a locked mindset (e.g. “what is in it for me?”), as it may reduce employees’ ability to feel a sense of community and meaning with the innovation. Similarly, some input on behalf of employees from previous meetings were stated as “filtered” such that some project related arguments got lost. As ignoring input was stated to result in a lack of trust and uneasiness (Stachowicz-Stanuch, Amann et al. 2017), the organizational change phase (part two of the project) did not seem to firstly include employee’s needs. Hence, the sense of only being partly considered in the solution together with the feeling of input being “filtered”, may in this case be one reason for the negative response towards participating in the second part of the project. Limited organizational ability (Stachowicz-Stanuch, Amann et al. 2017) may thus relate to a reduced organizational innovation adoption progress from filtering feedback. Barriers to innovation speed may in this sense be the result of (1.) a combination of managers not having the capacity (due to a “rematch” of the project part one) to consider employee’s needs, and (2.) employees not feeling heard. Hence, the stressful experiences from the projects part one, results in managers having to address various negative consequences in the project’s part two. This postponement, together with a lack of employee participation due to prioritizing operational tasks (employees not feeling heard) may provide negative consequences for the pace of innovation speed.
Project groups were created to facilitate input towards the implementation from the start of the project (making necessary decisions and priorities, implementing measures and change routines). However, it seems that employees have been feeling unprioritized (management taking action on organizational measures too late and filtering employee inputs). As it is unclear what has been filtered, not feeling heard may contribute to negative emotions and a lacking sense of meaning towards an efficient continuation of the project (innovation speed). Not feeling heard and feeling overlooked is therefore understood as contributing factors for negative responses (e.g. defensiveness) towards the continuation of the project (e.g. innovation speed).
Management clearly state a wish to empower their employees. For this reason, this paper looks at how trust may rebuild and turn defensive responses towards a willingness to continue the project (e.g. positive responses) in relation to the innovation situation. In this sense, the insights from the first part of the paper (e.g. workshop and various project documents) have given relevant knowledge on issues which frame the laboratory service context (see table 1). Moreover, the issues are understood as contextual factors which might facilitate defensive responses and thus behavior towards the innovation.
To gain a deeper understanding of employee’s experiences with the new laboratory service situation, in-depth interviews were performed with key laboratory employees at each of the four laboratories. The next section involves these conversations and the assumingly defensive behaviors that derived from the told experiences (interviews). The interviews provided a basis for the NVivo analysis and consisted of Word frequency queries and Text search queries. Hence, the words most frequently mentioned from the interviews and its surrounding context (e.g. cues) of what was said on behalf of the laboratory employees. Three queries were performed: (1) on behalf of all codes made in NVivo which consisted of all interview questions, (2) on behalf of five chosen questions that particularly addressed needs, and (3) on behalf of one question addressing trust. The three words most frequently mentioned from all the interviews were time, answer and important. Additionally, the words important and time appeared in two of the other analyses. Therefore, an extra emphasis is placed on these words and its meaning. By performing these analyses, it was possible to focus the interview content to answer the research question and create trust mechanisms. The results from NVivo are presented in figure 2.
The trust mechanisms and themes are understood to be essential factors that impact employee trust generation towards management and the innovation (see table 3). Moreover, as part of the various trust mechanism themes, an assumption of facilitating factors for defensive behavior is created and is understood to impact trust in this context. The discussion is based on the trust mechanisms and trust mechanism themes, as well as facilitating factors that is understood to place barriers for trust generation (e.g. contribute to defensive behavior), and actual defensive behavior cues that derived from the results (see table 3). As defensive behavior is believed to reduce innovation speed in this paper, the insights provide a basis for how trust may impact innovation speed from defensiveness. To answer how trust may impact innovation speed, the next section will address defensive behavior and trust from the in-depth interviews.
Defensive routines are argued to involve reasoning (e.g. thoughts and cognitive rules) and action strategies which seek as protection to avoid embarrassment, pain or threats (Argyris 1991; Argyris 2002). For the purpose of this paper, an emphasis is placed on defensive routines (defensive strategies and reasoning) from what is told within the interviews. However, as defensive reasoning involves mental processes, only an assumption could be made of employees defensive reasoning. What is described as facilitating factors for defensive routines is thus understood as the responses from the interviews (involving emotion) which may impact defensive reasoning and strategies, consequently impacting trust generation and innovation speed negatively.
Bachmann and Zaheer (2008) mention self-interest seeking behavior resulting from detachment from routines. However, self-centered reasoning may in this case result from the combination of not feeling heard/overlooked by management (disconnect/lack of dialogue between managers and employees), as well as upholding professional pride. This, due to a lack of competence and/or the sense of being superfluous regarding operating instruments, which have resulted in a lack of loyalty towards the continuation of the project (see table 3).
Emotional tension was described to rise in organizations with many levels of authority (Whyte 1949). In this sense, activity coordination was stressed as important in times of business growth. For this purpose, as employees were feeling burned out due to the changes in routines, it seems that there is a need to compensate activities to regain emotional balance. As negative rumors were present and stressed to be inherited between employees (see table 2), the sense of not being allowed to do certain activities might have contributed to transferring tension between employees and units (Whyte 1949), collectively “slowing down” (e.g. hindering) innovation speed.
From the in-depth interviews, negative responses portraying tension regarding the new situation resulted in one noticeable (key) defensive strategy: Taking responsibility. Moreover, this strategy contained various subcategories of defensive routines (e.g. defensive strategies and reasoning). As the interview results are categorized into what is assumed as mechanisms impacting trust creation, an explanation of the defensive routines will be performed for each trust mechanism (availability, predictability and proximity and one question of trust) (see table 3). In this matter, taking responsibility firstly involved self-interest seeking behavior (Bachmann and Zaheer 2008), and separated activity/group attention (Bohm and Nichol 1996; Fulmer and Keys 1998) as it seemed to include focusing attention towards something/someone else (e.g. the primary health service), professional pride and seeking meaning. Moreover, the sense of feeling responsible was stated to facilitate self-criticism (Tetlock, Skitka et al. 1989, Schillemans and Smulders 2015). Nevertheless, similar results could be drawn from the workshop, as well as the individual interviews. The three subcategories of defensive routines subject to responsibility will be discussed and addressed with relevant trust literature as follows.
Focusing attention as a result of responsibility
As no additional resources had been added regarding the organizational change, the employees who had extra tasks did not have time to do this, nor inform the primary health service regarding routine errors. Employees were therefore afraid that bad habits would be formed.
"We have been working routine-based almost every day, so bioengineering tasks within pre-analysis are not as prioritized. We have cut down on what we have been able to do (...) so we have not been able to consult the primary health service for the last 2 years. We have hardly been able to hold a course. I have worked overtime to be able to order items and have them available, so it's a very unbearable situation. There are limits to how much you can handle. And then we have always said how important it is that we act on these things (...) that we have an updated laboratory handbook, that we hold courses, get to travel and inform and that we are active in relation to these things.”
Since employees were mentioned to have told management about these challenges and made suggestions for solutions, it seemed that some employees did not feel heard or prioritized. It also indicates that employees may have felt discouraged, as management had waited to handle the challenges they were facing. Moreover, working over-time might demonstrate a presence of pressure to reach analysis goals. At the same time, new knowledge needed to be acquired on behalf of handling the new instruments and routines.
“Here, in the pre-analysis section, we have not had a lot of opportunities in the past few years because of new instruments and training. There are also key employees in other sections who have been busy with the new implementation. Of course, they also need time for that (...) however this comes at the expense of others, and we have a pace every day that is totally irresponsible because of the new things that are constantly coming up.”
"The fact that they start something this intense and don't realize the consequences (...) and we have tried to tell them with tears in our eyes, with meetings and the possibilities we have, but it seems like saving today and carrying out “fire extinguishing” is the thing.»
Employees who were not directly involved with the new instruments did not feel prioritized. Hence, employees might have felt frustration and a lack of control (uncertainty) from not feeling supported in relation to the new situation. Moreover, it may be the sense of not being able to be sufficiently available towards the primary health service. In the light of this, it seems that activity coordination and compensating activities (Whyte 1949) on behalf of employees have not been fully undertaken (e.g. providing more resources). Therefore, it had raised concern (emotional tension) towards management and the innovation (disconnect/detachment from management). Consequently, resulting in self-interest-seeking reasoning in terms of enhanced responsibility (defensive strategy) towards the primary health service. Employees were thus directing focus away from the innovation efforts (e.g. redirecting loyalty). As refocusing group attention was associated with dialogue and shared mindsets, it is in this case linked to the act of redirecting attention (e.g. loyalty) from self-interest and disconnect with management, and the innovation due to the tense situation.
Professional pride and seeking meaning as a precondition for responsibility
The innovation situation led some employees to be afraid of not being able to use their education and what they were trained for. In this way, employees seemed to perform self-protection (Argyris, 1985) regarding work titles by demonstrating clear boundaries of what their job really was all about.
“On behalf of us employees, it has been said that we would be given more time to work with quality-related tasks, and that [employees] who have administrative positions would be given more time to work with their subject. However, this requires that they do not move positions to [area]. This is what we fear. I have said this to the management as well that this will be the consequence. I can't personally see how we are supposed to handle this with the present volume even with an automation. It may work (...) because we want to keep the employees’ we have here in order to maintain the service to hospital patients.”
"We are [profession] to analyze blood tests, which is why we have chosen this profession. It's something about maintaining an interesting position for everyone so we don't lose staff or get in trouble with the recruitment."
"When the primary health service samples are delivered to [hospital] maybe 95% of what gets delivered there is [type of analysis]. Is it then appropriate that joint sampling is under another department? How should we do this? What should we do with the staff?”
These comments may indicate that employees felt a great deal of uncertainty about an unclear situation where some of the premises for the change and cooperation was not known. The answers also indicate that there was doubt and fear associated with the new centralization by moving relevant positions to one location. In this sense, redirecting loyalty towards the primary health service seemed to be a defensive strategy by taking control of the situation from responsibility. Hence, with a lack of managerial support and task direction, employees were protecting professional pride (and the sense of feeling superfluous) from creating work related meaning. Redirecting attention in this way may thus be a result of tension from not feeling heard by management. “Clinging to the remnants of joy of work” (Donald 1959) may in this case involve protecting and defending various work-related tasks towards the primary health service which seemed more meaningful and manageable. Therefore, taking responsibility seem to be the result of seeking meaning (professional pride) and gaining control of the unclear situation. Hence, in this case, self-interest-seeking behavior may be described as self-interest-seeking reasoning, due to it involving thought processes which seem to somewhat justify and manage the overwhelming situation by creating meaning. This type of reasoning may guide (come before) responsible behavior (defensive strategies) (see table 3). Consequently, as defensive routines are described to hinder learning in organizations (Argyris and Schön 1974; Argyris and Schön 1996), it may hinder innovation speed by redirecting attention (e.g. loyalty) from self-interest-seeking reasoning.
An important factor is that mixed messages were mentioned as a defensive routine (Argyris 1986). As employees were told that the innovation would free time to perform favored tasks, the fact that this had not happened, may have impacted defensive responses. Moreover, unlearning was stressed as important for change, and could involve learning anxiety from routines being embedded in personal or group identity (Schein 2010). For the hospital case, giving up old habits may be more difficult with uncertainty (a lack of clarity with the innovation) and a sense of not being fully supported or competent (instruments). Maneuvering (craving compensation for efforts to change/change is in our own interest) (Schein 2004; Schein 2010) may thus in this case mean that innovation speed (e.g. change) relies on clarity in relation to what benefits the innovation could bring regarding employee needs to create mastering and meaning.
As part of feeling responsible, it was stated as important that the primary health service “did things in the right way”. This involved procedures and routines before the blood samples were sent to the laboratory.
“The more things arrive in the way we want it, the more right it gets. It simplifies our job and make things go faster.”
“If they do not fulfill our desires for quality, they are perceived as unserious, and one does not really dare to trust that they are doing things right. It's important to remember that it doesn't help how much we control our machines if a lot of mistakes are made before the tests arrive."
Being available thus involved more contact with the primary health service to provide the right conditions to enhance work related predictability from doing things right (e.g. comply with the laboratories’ wishes for quality and agreed deadlines to avoid mistakes).
"We have accepted that we will never be able to provide as good service as [competitor] on such data technical things because we are governed by [company] and all the agreements etc., so instead we must highlight what is our advantage."
Being a member of “Quality assurance” was stated to provide assurance (e.g. predictability) in that routines would be performed in the right manner. However, uncertainty towards own performance and not being in the position to make decisions seemed to impact employees’ sense of pride in being portrayed as a skilled employee. As a result, the employees became more aware of their own strengths and weaknesses. Hence, they attempted to communicate their strengths by identifying factors that distinguished them from their competitors, namely proximity to the hospital and the patient. One employee pointed out a personal but important case for maintaining test samples (especially when it was cold outside) during transportation.
"What is most important to me is that we handle this properly because there are many different delivery vehicles (...) and it is important that we have proper routines to be able to catch any mistakes made by others (...) and that things are not destroyed, because there is a patient behind every glass we get. It is not just for everyone to come and take new tests. For the last 15 years I have been trying to come up with a solution. This has been a cause close to my heart.”
This seems to provide evidence that employees took responsibility and were loyal towards their customers by defending their position from justifying strengths. Justifying weaknesses from strengths in the context of responsibly may therefore be a type of coping strategy (Tetlock, Skitka et al. 1989; Greiling and Spraul 2010). However, a sense of both excitement and loneliness from the lack of recognition and support from management (in a cause that was perceived as important) was present. Adhering to and taking responsibility for personal causes, despite a lack of compliance, may thus provide evidence for employees' need to make sense of the situation, mean something, and be seen. Furthermore, persistence may indicate hope. Hope in that they would achieve their goals and prove their abilities, if only they were given the chance.
The fact that employees participated in regular meetings without feeling heard (e.g. from the sense of information being filtered) may indicate a sense of voicelessness. As defensive silence was stated to be a result of a fear of speaking up (Dyne, Ang et al. 2003), innovation speed and thus organizational capability may in this case be reduced from voicelessness from a lack of participation. As a result, attention and loyalty could have been redirected away from the innovation due to a defensive act of responsibility.
For the question from the interview addressing trust (see table 3), accuracy was stated as essential. Hence, to fulfill the laboratory’s wishes for quality and provide confidence in procedures being followed, a partner should perform their job in a responsible manner (e.g. follow agreements and be a “Quality assurance” member). The fact that having a good dialogue with the customer was mentioned as important, and should primarily start from the hospital division, builds on the argument of employees feeling responsible for the situation. Looking at the findings of (Ringen and Holtskog 2013) where Customer requirement correlated with motivation, this study indicate similar findings. This is because customer requirements, in this case, the need to be responsible for the primary health service, seems to be considered as a primary and thus important activity on behalf of the employees. Meaning creation, professional pride and redirecting responsibility/attention towards the primary health service thus seems to be a defensive response towards managers and the innovation motivated by the responsibility towards the primary health service suddenly not being regarded as a primary activity.
Self-criticism as a result of responsibility
As a result of the innovation and the new routines, the hospital division’s laboratories had a strong wish for change, in relation to being given more time to provide better laboratory service towards meeting primary health service’s needs. In this case, an employee on behalf of one of the hospital laboratories took the blame for a lack of presence.
“…and then there is the doctor's office visits that are far too rare. That is because I do not allocate my time properly. I am very much into routines. I wish I could have been out more, but at the same time, it is busy out there too. You must do something there to go there. You don't go there just to go there. This is where “Quality assurance” comes in. We should have been more out (…) but we have to find the right balance."
Blaming was stated as a form of defensiveness (Noonan and Argyris 2007). However, for this case, some employees took the blame on themselves by feeling responsible. “Quality assurance” seemed to act as a relief and security for the lack of presence on behalf of the hospital employees. However, the fact that some employees took responsibility for the lack of dialogue with the primary health service shows the extent to which employees felt great responsibility towards external partners for decisions taken. This also seemed to result in frustration with the present work situation. Moreover, there was some disagreement between the laboratories, regarding their own service performance. As most employees felt that they offered good professional knowledge and quality towards the primary health service (in some cases faster responses than the competitor), it was mentioned that they prioritized patients at the hospital first. Employees thus felt that they could provide better service. One employee took the blame for not listening properly and not understanding the primary health service needs. In this case, self-criticism related to better performance according to response times and spending less time transporting samples. Those who were critical of their own performance also believed the primary health service would choose the competitor, due to better service and response times. The current regional solutions were therefore considered to be an impediment for being present.
“I want us to change to be able to provide more services, but some issues are placed at a level that we have no control over. Then there is no use. I am not skeptical, I welcome it, and we should focus on it because that is what the world is like, but our hands and feet are a little bit bound, and it is a little frustrating, but that is how it is. Someone should really ask [company] what they really think about the laboratory services, why is it like this? is it really a competitive situation?”
The primary task of the hospital division's employees was mentioned to relate to counseling and producing test results (referred to as time-consuming). Moreover, it was mentioned that the hospital had different resource conditions than their competitors and was bound by regional agreements. In the light of this, as the hospital was stated to have enough resources (experience and expertise), it had not been possible to make use of it. The fact that employees knew that the hospital had enough resources, but still did not feel prioritized (without understanding why), may indicate a sense of frustration due to the sense of being treated differently (e.g. unfairly). Moreover, knowledge and dissemination of the primary health service needs were mentioned to take time as it mainly took place through IT solutions (e.g. journal systems) managed by other actors. In this way, employees were dependent on others. The new routines therefore seemed to have left employees feeling powerless and frustrated by not knowing the premise for the new situation.
"There are many ways to see all the changes in the hospital, but part of the idea is that we will be given some resources to provide more holistic solutions and services outwards instead of just thinking locally (…) try to tailor things. Things take time, communication is time-consuming and there is a continuous amount of focus and work. It's not something you do one day in the month. In that case, we always need to have the resources available. This is what we are hoping for when we are now automating and centralizing operations (...) that someone can work even if are they not physically here or there (...) that it is possible to be able to be available and provide the outgoing service that we have, but on which we do not have sufficient continuity.”
The laboratory employees felt hopeful with the new laboratory situation. At the same time, they expressed skepticism and concern that the new situation would not live up to the resources required to perform optimally towards the primary health service. Having time and space to explain blood sample routines and treatment was mentioned as important, however, there was disagreement among the hospital laboratories about whether they should themselves be responsible for the primary health service (not a service center). In any case, they wished that this was looked upon as an important task.
Decisions and judgements were described as being made from accountability anticipations (e.g. expectations of having to justify beliefs) (Lerner and Tetlock 1999; Greiling and Spraul 2010) and being accountable enhanced self-criticism and defensive bolstering (Tetlock, Skitka et al. 1989; Greiling and Spraul 2010). In this way, being accountable was stressed as both positive and negative for learning (Schillemans and Smulders 2015). However, as the employees in this case did not seem to be accountable for the lack of dialogue with the primary health service, they might have felt responsible due to the pressured situation. In this way, it may be possible that employees were taking responsibility due to not knowing managers’ expectations as well as the uncertainty towards own performance.
The next section will discuss how variations of trust may impact innovation speed, by reducing defensive routines.
Increasing innovation speed from trust
For the purpose of trust, this concept was stated to be multifaced (Wang and Vassileva 2005) involving expectations or behaviors (Singh and Sirdeshmukh 2000) and could vary depending on time and context (Rousseau, Sitkin et al. 1998). Understanding what type of trust is present is therefore relevant. To overcome defensive routines and facilitating change, acquiring an awareness of the mechanisms driving trust and tension on behalf of the employees have therefore been important to know how innovation speed may be increased.
In this case, trust seeks to increase innovation speed (adoption). As redirecting attention and loyalty (an outcome of taking self-inflicted responsibility) is understood to be a defensive strategy that reduces innovation speed, finding the right trust mechanism that reduces emotional tension, the sense of disconnect, enhances work-related meaning and focuses attention on the innovation is important. What is described as trust mechanisms and trust mechanism themes (see table 3) are from the interviews and analysis understood to be important factors that impact employees’ experiences and thus emotions (e.g. tension) towards the laboratory service. However, it is important to keep in mind the complex multi-location laboratory structure (e.g. lack of coherence) and the challenges with the instruments, which in this case seems to have placed barriers for the management and employee dialogue and connection. Nevertheless, how the various trust mechanism themes and tension creating mechanisms may impact trust, and reverse defensive routines in this context, will be explained next.
Trust was stated to be associated with expectations of being heard, of positive responses or from receiving innovation benefits (Clegg, Unsworth et al. 2002). Furthermore, it was stressed to link to the probability of beneficial actions (Gambetta 1988). Not being able to be sufficiently available towards the primary health service, not feeling heard, prioritized or been given enough resources (compensate activities) to perform all the needed tasks, are therefore understood as tension creating mechanisms. These have thus enhanced uncertainty towards the innovation and the way management have handled the situation (e.g. “saving today” “not realizing consequences” “carrying out fire extinguishing”). Redirecting attention and loyalty away from the innovation might in this sense be impacted from employees being able to foresee negative consequences of management decisions. As employees might feel they are in a better position (proximity to the primary health service/competence) to know what is best for their customers, not being considered may place a barrier to trust generation.
As the tension has been physically experienced by the employees over time (e.g. burnout), discouragement have been formed from not feeling heard (e.g. experienced negative responses from management). The combination of having communicated needs, and the sense of important issues being filtered and addressed at a later point, may thus have framed future expectations towards management in a way that has limited the belief that the innovation is beneficial (disconnect) (benefits are less likely to happen). This belief may thus have contributed to employees finding their own ways by taking responsibility (defensive strategy/action) from self-interest e.g. professional pride (defensive reasoning). This, to reduce tension in terms of directing attention towards what is perceived as important (proximity to the primary health service), and which provide benefits (in this case work related meaning e.g. professional pride/feeling superfluous/competent/personal causes and situational control). Attention and loyalty, which are perceived as conditions for trust generation, are in this way directed towards the primary health service, by making sure they were doing things the right way (responsibility as a defensive strategy for self-protection) (Probst and Büchel 1997). For this reason, as learning anxiety (Schein 2010) could hinder innovation speed, due to a lack of clarity and having to give up old habits and identities, innovation speed may be enhanced from trust by communicating innovation benefits towards employees from the start of the innovation implementation. This is because enhanced clarity/performance certainty, innovation understanding and training as well as feeling heard, may limit employees need to cope, hold on to what is familiar/manageable (e.g. previous routines) and having to justify and compensate for their experienced and assumed weaknesses. However, innovation speed is only assumed to be enhanced if mixed messages (Argyris 1986) are avoided in this case. This is because tension was created by not having experienced the told benefits (e.g. being given more time for favored tasks) during the project part one. As this was one of the original ideas with the innovation (communicated in meetings), challenges and the uncertainty with part one of the project had made this benefit difficult to comply. Consequently, addressing this issue at a later point in time had triggered defensive responses regarding the innovation situation. Hence, time seems to be an important dimension in this case in terms of tension creation, and a factor which may impact when a message becomes mixed and when defensive reasoning starts. Knowing this boundary is meaningful for message consistency/predictability, which is understood as significant for trust and innovation speed in this case. Moreover, creating a space for employee participation where employees feel heard is understood as essential to reduce negative rumors and self-interest-seeking reasoning and tension. In this way, trust generation is understood to start when tension creating mechanisms are reversed (taking action) by management (see table 3). The amount of tension creating mechanisms addressed might thus state something about the level of trust generated between management and employees, impacting the probability for innovation adoption. As defensive reasoning is connected to defensive strategies/action, reversing tension creating mechanisms may impact selfless reasoning to trust (e.g. over-ruling defensive self-interest-seeking reasoning) due to positive expectations of management facilitating innovation benefits. Hence, defensive reasoning may be looked upon as part of the process to trust management and the innovation. In this way, trust may be perceived as an outcome of employees selfless reasoning, due to the act of reducing emotional tension (tension creation mechanisms), disconnect, and defensive reasoning towards management and the innovation. In this way, the defensive strategy of responsibility may, from trust, be redirected back towards the innovation (alter the sense of proximity towards the innovation), consequently increasing innovation speed. However, it is important to keep in mind that finding the right balance for trust depend on various factors (e.g. change in organizational structure, management availability and needs). Hence, as the tension creating mechanisms are assumed as essential for trust generation in this case, they might vary in importance and change between employees at different points in time.
Trust was argued as an expectation of others not acting opportunistically (Bradach and Eccles 1989; McEvily, Perrone et al. 2003), in self-centered ways (Madhok 2006), or exploiting each other’s vulnerabilities (Sabel 1993). However, believing the opposite would facilitate actors to create safeguards to protect themselves against this loss (Madhok 2006). As the employees had sensed a lack of support from management over time, and seemed to not know all the premises for the innovative change, defensive reasoning and strategies may be a result of employees safeguarding themselves from believing that the experienced behavior would continue into the next part of the project. Moreover, as fear and doubt were associated with the instrument centralization, it impacted expectations of having a meaningful and manageable (e.g. have competence, use education, gain enough resources) workday negatively. As trust is stated to involve risk (Barney and Hansen 1994; McEvily, Perrone et al. 2003), an assumption is made that the sense of risk/loss (e.g. lack of meaning, benefits, professional pride, control) with adopting the innovation might trigger defensive routines on behalf of employees (focusing attention away from the innovation). Defensive routines may thus be a type of safeguard that creates meaning, reducing the sense of risk with continuing the project. However, as it may make the situation more bearable for the employees, it does not mean that the goal of innovation adoption is reached. Nevertheless, the operating cost (Madhok 2006) of not considering the tension creating mechanisms (see table 3) may in this case involve reducing the pace of innovation speed from defensive routines (e.g. safeguards). In this case, trust is assumed to be generated by reducing tension creating mechanisms as a result of trust mechanism themes (see table 3) ahead of the innovation implementation. By feeling heard, supported and gaining the needed resources to be available, it may enhance employees’ beliefs of being supported in the future (e.g. delayed reciprocity) (McEvily, Perrone et al. 2003). Moreover, expectations of support, clarity and meaning with the new situation may provide a sense of acceptability and uncertainty tolerance (McEvily, Perrone et al. 2003). As predictability was understood to be important for the employees, employees “cognitive map” (in this case reasoning to trust) may be guided by expectations of being heard/supported. In this sense, “Quality assurance” seems to act as an additional source which may impact predictability and trust.
A trusted source was stated to enhance the sense of usefulness and relevance, thus speeding up responsiveness and learning (McEvily, Perrone et al. 2003). Consequently, trust might enhance the tolerance for the laboratory situation being uncertain, in this way, directing attention and loyalty (e.g. acceptance) towards the innovation. Speeding up might in this sense involve reduced tension and enhanced sense of connection (dialogue) with management, which might limit defensive routines. Moreover, self-criticism is assumed to link to uncertainty towards own and others performance, and a lack of control (e.g. feeling powerless and frustrated) due to a lack of resources given to perform optimally regarding the innovation. As the employees wished the tasks towards the primary health service was looked upon as important (being given resources), expectations of being supported in this matter seems to be limited. Being critical and directing the blame on oneself could therefore be the result of taking responsibility from uncertainty tolerance being low. As being accountable enhanced self-criticism (Tetlock, Skitka et al. 1989, Schillemans and Smulders 2015), the fact that employees took responsibility (self-inflicted responsibility) on such a high level when they were not expected too, show the value of communicating expectations and needs for innovation speed.
In terms of the sense of disconnect between management and employees, trust was mentioned to involve the dimension of affective and cognitive factors which provides different outcomes (McAllister 1995, Chae 2016). For this case, affective trust seems to link to and impact cognitive trust. Affective trust is relevant due to the emotional tension and defensive reasoning cues being present, as well as the need for management to meet these needs (addressing tension creating mechanisms). By meeting these needs, innovation speed is assumed to be increased. This is because emotional bonds (Chua, Morris et al. 2012) may be created (e.g. from two-way communication), facilitating understanding and positive attitudes (e.g. selfless reasoning) towards management intentions (Chua, Morris et al. 2012) with the innovation. However, as cognitive trust was stressed to involve resources and perceived expertise and confidence in the abilities of others (reliability) (Chua, Morris et al. 2012), the lack of affective trust in this case as a result of tension creating mechanisms, seems to have impacted employees cognitive trust negatively towards management’s ability to manage the new situation. However, as identifying and describing the type of trust seen as most important was proposed (McEvily, Perrone et al. 2003), trust in this case is assumed to start with action (Singh and Sirdeshmukh 2000) (e.g. involvement/participation) on behalf of management decisions. Trust in this case for innovation speed is therefore assumed to start with the amount of emotional tension creating mechanisms reversed by management (being considered and being given a voice by management) in relation to the innovation implementation. Managerial action thus frames expectations and willingness to adopt the innovation in this case. However, the laboratory structure (organizing style) as well as the pressured situation for management (see table 1) seems to have created distance between managers and employees. This, in addition to the hospital being mentioned to be governed by others and various agreements, thus play an important part in relation to managers availability and being able perform acts of trust.
The paper findings indicate that innovation implementation decisions have been made without sufficiently consultation and regard of the employees’ knowledge and experience.
A more traditional approach to management and change seems in this way to have impacted employees negatively. Consequently, the organization style in this case seems not to be consistent with the traditional Norwegian work life model. Furthermore, we argue that trust is an important factor for Lean organization to enhance innovation speed. However, as trust creation is highly complicated, it is hard to break it down and analyze it. As a result, trust in this case may be understood as a consequence of positive emotions employees may develop based on organizational characteristics (e.g. management decisions, atmosphere, communication/dialogue and participation/involvement). From this view, trust is understood as reflexive in this case, modified from a reactive response to the experienced organization style.
Practical implications for innovation speed
Enhancing technology (medical instruments and equipment) is essential to increase blood analysis efficiency and in this way meet patient needs in better ways. For urgent and critical hospital situations (e.g. the Covid-19 situation), we argue that speed is an important element for innovation implementation success. Moreover, as urgent situations often involve making fast decisions, technical knowledge, achieving common objectives and professional responsibility, place a special emphasis on the importance of the ability to trust management.
Successful innovation implementation in organizations requires managers that take action towards enhancing the connection with their employees. As this case have shown, negative rumors, self-interest seeking reasoning and tension are factors which might reduce innovation speed. Creating a social environment by facilitating a space for employee participation where employees feel heard and supported (e.g. empowered), is therefore essential. This involves providing positive responses to employee’s needs (tension creating mechanisms), which may frame employees’ positive expectations of the innovation being beneficial.
Reducing the sense of loss and focusing attention on the innovation can be done by providing meaning and protecting employees’ professional pride. Therefore, managers should provide enough information for the reasons and consequences for innovation implementation (information regarding resources, competence, being able to use education). Being available for the employees as well as facilitating the needed resources for employees to feel available (e.g. proximity) towards the primary health service, may thus produce positive emotions and a sense of predictability. This might impact future expectations of being supported (from positive reasoning to trust), consequently limiting employees from performing safeguards (e.g. defensive routines).
As trustful actions by management is assumed to link to positive expectations from selfless reasoning, facilitating resources (taking action) may limit employees’ sense of uncertainty and lack of control (towards own competence, the context and customer needs). This might reduce self-inflicted responsibility and self-criticism, shifting the focus towards the innovation. In the light of this, facilitating transparency and dialogue of expectations and needs towards communicative tasks
involving the primary health service might reduce the disconnect between managers and employees. In effect, reducing the sense of having to manage tasks and take responsibility alone (self-inflicted responsibility) may impact positive expectations of managers decision-making abilities.
Overview of results: Trust and defensive mechanisms
Results from the workshop (part 1 of the paper)
Results from the interviews (part 2 of the paper)
Predictability and proximity
One question about trust:
“To be able to trust a partner, what do you see as important factors? Why?".
Trust mechanism themes
Lack of resources.
Uncertainty towards primary health service needs/own performance.
Powerlessness (decisions are made by others.)
Feeling unprioritized and not knowing preconditions for change.
Following appointments (procedures.)
Being a “Quality assurance” member (safety/security/routines.)
Better dialogue with the primary health service.
Uncertainty about own performance.
Highlighting own benefits (proximity to patient/hospital.)
Personal (passionate) causes (maintenance of samples.)
Accuracy (following procedures/agreements.)
A partner should care for their job.
Being a “Quality assurance” member (security/safety.)
Fulfilling the laboratory's wishes for quality.
Facilitating factors for defensive routines (tension creating mechanisms)
Lack of dialogue and not feeling heard/overlooked.
Not open to employee needs.
Distillation of input/ filtering information.
Lack of participation.
Poorly operating instruments.
Lack of instrument competence.
Impacting professional pride negatively.
Burnout/lack of motivation.
Skepticism (solution not freeing enough time.)
Hope with the new solution (gain enough time to inform.)
Sense of lacking presence (towards the primary health service.)
Frustration with work situation (burnout/working overtime.)
Not feeling heard (needs.)
Not feeling good enough (performance.)
Afraid of bad habits forming.
Pressure to meet goals.
Lack of coherence between laboratories.
Conflicting attitudes (we can do this if we get enough resources.)
Lack of communication with management.
Sense of competitors being better.
Tension from having to do what is being told (lacking resources to do it all.)
Dependent on others.
Lack of time/resources.
Not being a member of “Quality assurance”.
Not complying with quality standards “routines done in the right way" (avoid mistakes.)
Need more contact with the primary health service.
Disconnect (with managers/customers.)
Lacking guiding information.
Others are better equipped (service and support.)
Lack of resources.
Lack of support from management.
Uncertainty with the new situation.
Lack of resources (time.)
Lack of support from management (needs.)
Locked mindset/self-centeredness “what’s in it for me?” (seeking meaning, professional pride, lack of loyalty) (e.g. devotion.)
Self-interest-seeking behavior (“What is in it for me?)
Rumors spreading between employees/units “we are not allowed to do…”
(Prioritizing important tasks, seeking meaning/justifying lack of time on other tasks.)
(Self-criticism: Taking the blame, ownership,
loyalty towards the primary health service.)
(Taking control, canalizing frustration towards management through the primary health service.)
Compensating/justifying advantages/professional pride.)
Loyalty towards the primary health service.
Taking responsibility (Doing things right, taking control.)
Mechanisms enhancing innovation speed
Facilitate space for employee participation.
Make sure employees feel heard and supported (being given a voice.)
Provide positive responses to needs (e.g. tension creating mechanisms.)
Provide meaning (communicate innovation benefits/reasons/consequences.)
Enhance the sense of availability and proximity by providing enough resources (manager-employee and employee-customer) (impacting expectations of support/limiting defensive routines.)
Protect professional pride (reduce the sense of loss with participating in the innovation.)
Timing is essential for given messages (timing triggers defensive responses.)
Having a third actor to compensate for service tasks.