To provide a contextual background that facilitates understanding for employee defensive reasoning and behavior (reactions) within the hospital case and the innovative environment (and how trust may address this), the innovation implementation and employee involvement situation will be discussed. The first part of the discussion explains the project environment. Hence, it involves insights made from given project reports and documents, as well as notes made from participating in a project workshop at the hospital in the fall of 2019. The second part of the discussion involves analysis of the in-depth interviews that followed.
Background- framing the problem
To increase automation and collaboration internally and with the primary health service, the hospital division invested in new automated laboratory instruments in each of their laboratories. The organizational innovation in this case thus relates to employee experience with the implementation of the new way of performing laboratory analysis. The innovation is twofold and emphasizes a new way of working (automation/instruments/centralization) as well as innovation adoption of the new work situation.
The innovation implementation project resulted in a shift in laboratory equipment and work processes at the hospital laboratories. Employees at the hospital laboratories that was not part of the centralization, thus performed other and fewer analyses. Hence, the new implementation situation had an impact on work routines and workload.
Various milestones were created for different purposes throughout the project. Relevant for this paper, is the milestones involving implementation of new analytical equipment, which responsibility was transferred to another project. A main emphasis thus revolves around employees’ experiences with the implementation situation.
Positive implementation factors for the purpose of the laboratory employees related to dialogue meetings and the creation of project groups for the different laboratories to complete the project. Hence, one employee from each project group would act as a messenger between division management and the employees. In this matter, employees would be able to provide input regarding the project. From the hospital decision note (2017) (involving laboratory employee feedback), the choice of a new work model (instruments) was based on estimated consequences for service, quality, staff and finances. However, consequences for employees related to more time to perform various routines. The step-by-step (2-3-year period) development of the laboratory service was stated to start with equipment replacement, followed by a centralization and automation of tests. However, the step-by-step introduction in addition to factors related to the board decision process had postponed the goal of having equipment in operation by 2017.
The first project milestone involved innovation implementation tasks related to acquisition of laboratory instruments and organizational development. However, from the project report, the organizational development part seems to have started with patient and primary health service needs, the skills needed to meet these needs as well as appropriate work allocation and organization in the new workflow.
At the workshop it was mentioned that the first part of the project involved implementing the instruments at the hospital laboratories. The second part of the project involving the organizational change (transportation and logistics of the samples) had just started with an estimated finish in spring 2021. From this insight, an assumption is made that the decision to implement the new instruments took place before considering employee’s needs. The instrument implementation was stated to ensure efficient and safe routine operation of all new equipment with good plans for training. Supplier training services on behalf of employees was thus stated to be included in the instrument procurement. However, it is unsure whether the training of employees had taken place before, during or after the instrument implementation. As some employees stated a lack of instrument competence, that learning of the new instruments had been slow (see table 2), and that some employees within the interviews had been busy the last years with training, it seems that the instrument training had not been optimal (not done before the implementation). In the light of this, the concept of involvement became relevant. As measures were performed to inform and include employees in the implementation (meetings, project groups, consequence measures), the possibility to participate seems to have involved giving inputs regarding an already decided implementation plan.
Several issues on behalf of the employees appeared at the workshop. For the purpose of this paper, three clusters were relevant: Personnel, employee emotions and management. From the employee’s utterances at the workshop, there seemed to be tension due to unresolved issues, uncertainties and negative emotions regarding the new work situation. Input on behalf of the employees is stated in table 2.
As a focus is placed on the employee experiences in this paper, some input points stressed by managers and employees on behalf of one of the clusters management have been gathered (see table 1). Gathering points on behalf of both management and employees seek to form a comprehensive picture of the hospital situation. In this sense, including insights on behalf of management seeks to provide perspective regarding the implications made. Moreover, the points served as an important starting point for the employee interviews that followed.
Table 1
Issues communicated at the workshop on behalf of the cluster “management”
Facilitating factors for employee response
|
Capacity pressure (time/economy/instruments)
|
Management
|
Part one of the project has not gone well. To little capacity as all equipment was changed at once.
Part two of the project is related to the success of part one:
“We should have been up and running the production in the spring of 2019, we are behind! How can we boost this timewise?”
New automated instruments have not performed well. Part two is about collecting and transporting the blood samples (reducing transportation times.)
Management is pressured economically.
Economically focused.
Little time and capacity to be a leader (a lot of administrative work due to e.g. sick employees.)
Managers feel like organizers.
Managers have many different tasks: Adjusting what has been tough for the employees (project part one), consider customer needs, enhance service (response times) and gather the laboratory to one community.
Tiresome process for management with lacking resources and various project related challenges (too many projects are connected to each other.)
|
Opportunities
Change for the better (strengthen bonds/relations)
|
Achieving closeness (bonds) to employees (hindered due to a lack of time.)
Get rid of negative emotions (help employees.)
Revitalize enthusiasm (towards entering a new project.)
Being a visionary (stated as important.)
The hospital need help to address the workflow in each laboratory (transferring labor, job safety and shifts need to match.)
|
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 was lacking capacity to develop the relations with employees. Moreover, lack of coherence between laboratories (see figure 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. 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.
Next, insights on behalf of the cluster’s personnel and employee emotions will be discussed (see table 2).
Table 2
Issues communicated at the workshop on behalf of the clusters “personnel and employee emotions”
Employee response
|
Capacity pressure (time/instruments/new routines)
|
Personnel
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Employee emotions
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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 Virtual Reality (VR) or Augmented Reality (AR) technology.)
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 employees 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.)
|
Opportunities
|
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.
|
Hidden input
|
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 1987) 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. In effect, 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. Filtering employee feedback may thus be a barrier to innovation adoption as it excludes important information (e.g. needs/suggestions) on behalf of the employees, slowing down innovation progress. 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. 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 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 are understood to be essential factors that impact employee trust generation towards management and the innovation (see figure 3). Moreover, as part of the various trust mechanisms, 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, as well as facilitating factors that is understood to place barriers for trust generation (e.g. contribute to defensive behavior) (see figure 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 sections will address defensive routines and trust from the in-depth interviews.
Defensive routines
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 figure 3).
Emotional tension may rise in organizations where a compensation for new activities are not provided (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, proximity and one question of trust) (see figure 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). The lack of dialogue with management thus seem to impact employees´ attention towards something/someone else (e.g. the primary health service), professional pride and seeking meaning. Moreover, the sense of feeling responsible facilitated self-criticism (Tetlock, Skitka et al. 1989, Schillemans and Smulders 2015). The four 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.
" 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.”
Some employees did not feel heard or prioritized. The answer indicates that employees may have felt discouraged and pressured to reach analysis goals, as management had waited to handle the challenges they were facing. At the same time, new knowledge needed to be acquired on behalf of handling the new instruments and routines.
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. 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 attention and loyalty) from self-interest and disconnect with management, and the innovation.
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 regarding work titles by demonstrating clear boundaries of what their job really was all about.
"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."
Employees felt a great deal of uncertainty about an unclear situation where some of the premises for the change and cooperation was not known. 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. 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. This is because it involves 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 figure 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.
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 and passionate cause over the last 15 years for maintaining test samples (especially when it was cold outside) during transportation. Employees therefore 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 defensive reasoning. 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. In this way, 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 (involuntary silence). Innovation speed and thus organizational capability may in this case be reduced from voicelessness and a lack of participation.
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 (wished this was perceived as an important task). In this case, some employees were self-critical (blaming themselves) for feeling responsible for the lack of presence. One employee took the blame (self-criticism) for not listening properly and not understanding the primary health service needs.
“…and then there is the doctor's office visits that are far too rare. That is because I do not allocate my time properly.”
The employees knew that the hospital had enough resources. However, the fact that they did not feel prioritized (without understanding why) may have provided frustration due to the sense of being treated differently (e.g. unfairly).
“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.”
Nevertheless, the current regional solutions were considered to be an impediment for being present.
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 (lack of dialogue/disconnect towards management). Not knowing the preconditions for change, uncertain environments and tension may frame anticipations of management and/or the innovation which limit positive expectations (e.g. Clegg, Unsworth et al. 2002) with regards to the innovation (e.g. needs not being met). As not knowing might make it harder to create expectations of what might happen in the future, it seems that this uncertainty had impacted actors to enhance defensive routines. The responsible strategy may act as a defensive mechanism to protect (e.g. a sense of risk reduction from believing that the experienced behavior would continue into the next part of the project) and gain control regarding the unclear situation. Hence, a defensive strategy from anticipations may be self-inflicted responsibility in relation to neutral anticipations from uncertainty and disconnect towards the innovation/management. In this sense, justifying weaknesses from strengths in the context of responsibly might be a form of defensive bolstering. Nevertheless, as responsibility (defensive strategy) is positive towards tasks related to the primary health service, it does not contribute to innovation speed (e.g. redirecting attention).
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 vary depending on degree and setting. 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 has 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 (see figure 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. For this reason, as trust initiatives (e.g. trust mechanisms) is understood to impact emotions and defensive routines and thus the ability to trust, there exist a connection between the three variables trust, emotion and defensive routines (see figure 3). 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.
How the various trust 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. 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 had been physically experienced by the employees over time (e.g. burnout), discouragement had 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 had limited the belief that the innovation was 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, innovation speed may be enhanced from trust by communicating innovation benefits towards employees from the start (e.g. Romme 2003) 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 being given more time 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. Time therefore 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.
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 figure 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.
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 may be guided to trust by expectations of being heard/supported (reasoning to trust). Consequently, trust might enhance the tolerance for the laboratory situation being uncertain, 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, limiting 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 seemed to be limited. Being self-critical 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 (facilitating positive attitudes e.g. selfless reasoning) towards management intentions with the innovation. Managerial action thus frames expectations and willingness to adopt the innovation.
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). In this case, 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. Moreover, the fact that the hospital was mentioned to be governed by others (e.g. government level) and various agreements, play an important part in relation to managers ability to perform acts of trust. 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. Moreover, as reducing tension creating mechanisms may make the situation more bearable for the employees, it does not mean that the goal of innovation adoption is reached.
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 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, 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 impact innovation understanding and 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 defensive routines.
As trustful actions by management is assumed to link to positive expectations from selfless reasoning, facilitating resources (compensating activities, avoiding postponing problems and 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.