Elisabeth Yang’s research while affiliated with Yale-New Haven Hospital and other places

Environmental jolts can trigger more conducive conditions for driving change in organizations. However, punctuated equilibrium theories of organizational change concentrate on top managers’ implementation of de novo radical changes after jolts. Existing research has not examined frontline-driven, incremental change efforts during these periods of disrupted stasis, despite the value of frontline change ideas. We develop a process model to explain how and when those on an organization’s front lines can leverage a jolt to opportunistically implement long-desired change ideas in ways that promote their retention. We conducted a two-year qualitative field study at a hospital during the Covid-19 pandemic, examining the trajectories of 33 premeditated change ideas raised by frontline staff. By comparing ideas that persisted to become part of normal operations with those that failed to be selected or retained, we identified practices and conditions that promoted the selection and retention of frontline change ideas. Our study suggests that frontline change advocates can seed the long-term retention of “shovel-ready” ideas—as opposed to de novo ideas—after a jolt by rapidly and opportunistically deploying a novel set of practices before the brief window of opportunity created by lessened constraints and increased managerial receptivity closes. Prior theories of change largely assume frontline-driven change to be slow and continuous, proceeding in a one-off fashion; we explain how and when frontline change can instead occur in rapid, opportunistic bursts. This study advances theories of punctuated equilibrium and bottom-up change in organizations by unearthing an alternative way that change can be intentionally accomplished in organizations. Supplemental Material: The online appendix is available at https://doi.org/10.1287/orsc.2021.15120 .

Predictive models may be particularly beneficial to clinicians when they face uncertainty and seek to develop a mental model of disease progression, but we know little about the post-implementation effects of predictive models on clinicians' experience of their work. Combining survey and interview methods, we found that providers using a predictive algorithm reported being significantly less uncertain and better able to anticipate, plan and prepare for patient discharge than non-users. The tool helped hospitalists form and develop confidence in their mental models of a novel disease (Covid-19). Yet providers' attention to the predictive tool declined as their confidence in their own mental models grew. Predictive algorithms that not only offer data but also provide feedback on decisions, thus supporting providers' motivation for continuous learning, hold promise for more sustained provider attention and cognition augmentation.

Background The COVID-19 pandemic has exposed front-line healthcare workers to unprecedented risks and stressors threatening both physical and mental health. Prior work in the military has found that team identification, or the sense that one was a part of a team, can help reduce stress and prevent burnout during prolonged stress. Methods We conducted repeated cross-sectional surveys embedded within emergency department workflow to understand whether team identification was associated with reduced reports of stress and burnout among front-line workers. Results During the 10-week study which spanned the first wave of COVID-19, 327 of 431 (76%) front-line healthcare workers responded to at least one round of the survey. Higher team identification was associated with significantly less work stress ( B =−0.60, 95% CI −0.84 to to -0.40, p<0.001) and burnout ( B =−12.87, 95% CI −17.73 to -8.02, p<0.001) in cross-sectional analyses. Further evidence of the protective effect of team identification for work stress ( B =−0.36, 95% CI −0.76 to 0.05, p=0.09) and burnout ( B =−13.25, 95% CI −17.77 to -8.73, p<0.001) was also found in prospective longitudinal evidence. Conclusion This work suggests work team identification is a key buffering factor against feelings of stress and burnout. Efforts to promote team identification may offer a promising way for leaders to support front-line healthcare workers’ well-being during the COVID-19 pandemic. These results can inform ongoing COVID-19 operational and quality improvement initiatives.