By Dr Maria Quinlan, Research Lead, ARCH
To paraphrase Tolstoy, “all happy organisations are alike; each unhappy organisation is unhappy in its own way.” The ability for healthcare organisations to innovate is a fundamental requirement for adopting and sustainably scaling digital health solutions. If an organisation is unhappy, for example if it is failing to communicate openly and honestly, if staff feel overworked and that their opinion isn’t valued, it stands to reason that it will have trouble innovating and handling major complex transitions.
When we analyse examples of digital-health innovations which have been successfully piloted and scaled within healthcare organisations there is a consistent set of what we might term ‘happy’ organisational characteristics which enable such innovation to be successfully adopted. They include factors such as clear leadership and direction; staff who are given clear objectives and who are empowered to meet them in the manner they see fit; an ability to organise cross-functional clinical project teams and to define transparent project governance; the investment of time and other resources of people and money; as well as meaningful two-way communication across the organisation .
Happy organisations foster happy workers
What these factors combine to achieve is happy, engaged workers – and happy workers are more effective, compassionate, and less likely to suffer burnout . Clear objectives, praise, a sense that your voice matters – these can seem like fluffy ‘soft’ concepts and yet they are found over and over to be central to providing the right context within which new digital health innovations can flourish. Classic ‘high involvement’ management techniques – for example empowering team members to make decisions and not punishing them for every misstep are found to be key . As Don Berwick of the Institute of Healthcare Improvement (IHI) says, people who feel joy in work are “not scared of data”, rather “joy is a resource for excellence” 
Managing what Sigal Barsade, Professor of Management at Wharton calls the ‘emotional’ culture of an organisation is a very important concept – especially in the healthcare environment which expects so much of staff . Healthcare workers face pressures which many of us working in other fields can’t really comprehend, a recent systematic review found that clinicians have higher rates of suicidal ideation than the general population, with a high prevalence of burnout, psychiatric morbidity and depression linked to excessive workload . Attempting to introduce innovative new ways of working within such constrained environments can be challenging to say the least. Exhausted workers, those with little time in their day for reflection, or those who work in organisations which fear failure are less likely to innovate .
Taking the emotional temperature of an organisation
So it is important that we take the emotional temperature of any healthcare organisation that we wish to deploy a new digital health solution within. It is vital to know what you are getting into – if it’s a hornet’s nest of unhappy workers and ineffective leadership, this will no doubt impact on the successful adoption of any new way of providing care. As Barker et al (2016) in a recent article in the journal Implementation Science put it, “rapid scale up with not occur in an unreceptive environment… the design of the intervention needs to be closely attuned to the social beliefs and health system practices”. Thus it is key that we have some understanding of the health organisations’ culture and social systems at the outset of any implementation project. But how can a healthcare organisation or a company trying to scale a new service do this in practice? There are many simple and effective methods for gauge how ‘happy’ and by corollary how innovation-ready an organisation is .
- Assessing an organisations’ adaptive reserve 
Drawing from their work researching healthcare organisations ability to handle complex transitions in the US, Jaen et al (2010) developed a 23-item scale measure for what they term ‘adaptive reserve’. Adaptive reserve is an internal capability for change which includes being agile; capable of continuous learning; and being adept at self-assessment, reflection and improvisation. The Adaptive Reserve questionnaire asks staff to rate their organisation according to a variety of statements which include statements such as; ‘we regularly take time to consider ways to improve how we do things’ and ‘this organisation is a place of joy and hope’.
- Sitting down and talking with staff
Through the use of methods such as video-ethnography, photo-voice, and informal focus-groups – people working in health care organisations are asked their opinion – we ask what’s working well; what would they do differently, how they think the new digital health solution should be implemented?
The IHI suggest beginning with the simple act of asking staff “what matters to you?”, and following that with the more challenging tasks of really listening to the answers and then acting upon the feedback . This echoes models of collective leadership which have been gaining traction within healthcare in recent years , and is another way of assessing the emotional temperature of an organisation.
At a minimum we can do what the IHI do in their own Boston office, provide a simple tool for capturing whether people had a good day or a bad day in work.
By using a combination of these methods we can get a clearer understanding of how to successfully deploy new digital health solutions within the complex collaborative systems which healthcare organisations are. Taking the time to do this at the beginning of any deployment is vital to the success of any implementation.
 Lippa, J et al (2015) What Health Care Leaders Need to Do to Improve Value for Patients Harvard Business Review December 2015; Barsade, S. and O’Neill, O. (2016) Manage Your Emotional Culture Harvard Business Review January-February 2016
 Barsade, S. and O’Neill, O. (2016) Manage Your Emotional Culture Harvard Business Review January-February 2016
 Oskrochi, Y. et al (2015) Beyond the Body: A Systematic Review of the Nonphysical Effects of a Surgical Career Surgery 159 (2)
 Gino, F. and Staats, B. (2015) Why Organisations Don’t Learn Harvard Business Review November 2015; Mate, K., and Rakover, J. (2016) Four Steps to Sustaining Improvement in Health Care Harvard Business Review November 2016
 Jaen et al (2010) Methods for Evaluating Practice Change Toward a Patient-Centered Medical Home, Annals of Family Medicine, Vol. 8(1)
 IHI (2016) Restoring Joy in Work for the Healthcare Workforce, Healthcare Executive Sept/Oct 2016
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