When Crises Hit, Shovel-Ready Ideas Can Get Greenlighted Quickly

In March 2020, as the world went into COVID-19 lockdown, Professor Julia DiBenigno got an email from another SOM Organizational Behavior faculty member. Her colleague had heard from a former SOM student who was now working at a hospital and wanted to know if researchers could support the healthcare workers somehow—for instance, by studying challenges that staff members faced and offering guidance on how to cope.‌

DiBenigno, lead author PhD student Elisabeth Yang, and their colleagues launched a project to interview frontline workers around the clock, providing a confidential outlet for employees to express concerns and share their stories of fear and stress. But to the researchers’ surprise, hospital staff members also started talking about “silver linings.” Organizational improvements that they’d long wanted to put in place were suddenly getting approved at lightning speed.‌

“People were making changes they had wanted to make for years, that were stalled for years, that now were suddenly being implemented in two days or a week,” DiBenigno says. Yang and DiBenigno realized that frontline workers’ ideas were being taken more seriously during the pandemic—and that many changes stuck around even after Covid cases waned. “Crises can open windows of opportunity for making change,” she says.‌

But not every idea was approved and retained long-term. By comparing successful and ultimately failed changes, Yang and DiBenigno identified several key practices that were necessary to push through changes and prevent them from falling by the wayside. For instance, laying the groundwork for ideas before the crisis and then quickly asking for full resources was critical.‌

The study suggests that traditional methods for bottom-up change, such as pilot projects and pursuing small wins, are still necessary in times of stability. But when an opportune moment arrives, frontline staff should throw out the traditional playbook, “go big, pitch your ideas, and ask for full funding,” DiBenigno says.

Frontline staff and managers often spot inefficiencies because they’re deeply enmeshed in day-to-day activities, but their proposed solutions frequently face resistance from above. Before the pandemic, “no one listened to us,” one staff member told the researchers. And new ideas can get mired in endless meetings and red tape. As one frustrated nurse described it, “There’s this whole ridiculous, dumb process… It goes through 25 freaking committees.”‌

That tendency toward stasis might evaporate temporarily during crises because leaders are “flooded with all these new problems they don’t know how to solve,” DiBenigno says. A hospital secretary noticed that when staff members proposed changes during the early months of the pandemic, managers immediately responded with comments such as “Let me make a phone call to [higher-level management] and we can see what we can do” or “That’s a great idea. Let’s run with it.”‌

Still, DiBenigno wondered if these ideas would stick. “I thought, oh, these changes might be getting implemented very quickly in this crisis moment, but they’ll quickly revert back,” she says. To find out what would happen, she and Yang tracked 33 desired changes from March 2020 to March 2022. In all, Yang and DiBenigno analyzed 213 interviews with physicians, nurses, and other staff at six hospital units.

The researchers found that 24 of the 33 changes were implemented, ranging from moving IV carts to buying new equipment to changing which staff members called patients’ families. Nine ideas failed to get approval. Of the 24 ideas that were initially executed, half of them stuck around after the worst of the crisis passed.‌

Next, DiBenigno and Yang investigated which factors distinguished the successful from the failed changes. First, they ruled out the possibility that the failed ideas weren’t any good. Those changes were often evidence-based practices that other hospitals had already adopted. “It wasn’t just about good and bad ideas,” DiBenigno says. “There’s something about the process.”‌

She and Yang identified two practices associated with initial approval. First, advocates needed to select a shovel-ready idea that could be jumpstarted based on pre-existing groundwork. For instance, if they wanted new equipment, they were most successful if they had already established relationships with vendors and drawn up plans for implementation.‌

Second, frontline staff needed to frame the idea as a solution to an urgent crisis-related problem. For example, some residents had long wanted to use portable ultrasound devices, which they felt were superior to stethoscopes. When the pandemic happened, they pointed out that the ultrasounds were easier to clean and didn’t require the doctor to get as close to the patient—a boon when hospitals were desperately trying to minimize infections of health care workers.‌

Next, DiBenigno and Yang identified three practices associated with helping an idea persist after the crisis. First, advocates needed to immediately ask for full funding, staff, and other resources required to sustain the change long-term. For instance, some nurses wanted to use a mobile app to improve the dispensing of medications; they quickly requested new iPhones for their unit and got the green light. However, their near-identical sister unit requested the same phones six months later but was denied. Meanwhile, an idea to centralize IV supply storage didn’t stick because the main advocate didn’t ask for funding to buy the necessary larger storage carts right away. By the time she did, in September 2020, the hospital had a capital expenditure freeze in place.‌

“Timing and speed are essential factors,” Yang says. “These windows of opportunity can be unexpectedly brief.”‌

The second important retention strategy was to shift framing the idea from a crisis-related solution to a change with long-term value. The portable ultrasounds, for instance, were retained partly because advocatesargued that they were also more efficient and easier to use for those in their program.‌

In contrast, an initially successful effort to add Amazon Echo Show video monitors to patient rooms failed to persist. Staff members had described the change as a “trial” and “proof of concept,” and the devices quickly fell out of use after case numbers dropped. That tentative language “may have locked in the idea that this was just for COVID,” DiBenigno says.‌

Finally, frontline staff need to weave the new practice into existing routines so they become “difficult or costly to undo” write Yang and DiBenigno. If the Echo Show monitors had been installed on permanent structures instead of being placed haphazardly,, they might have been kept in use. As it was, “they were just so easy to unplug and put in a closet,” DiBenigno says.‌

These lessons might extend to other situations that aren’t full-blown crises but still shake up the status quo. For instance, employees who want to advance sustainability initiatives could take advantage of a new CEO’s arrival to pitch big changes. Other disruptions could include the emergence of unfamiliar technologies or even being scrutinized in a government audit. ‌

“Anything that’s new and unexpected that creates new problems for the organization—that they don’t already have a good routine and way of solving—can create these openings,” DiBenigno says. The key is that the proposed idea needs to be a win-win solution that both addresses the current situation and has longer-term value.‌

While progress might seem agonizingly slow during the intervening years, advocates who stay vigilant for the right moment can seize the chance for their hard work to pay off. “The groundwork you lay during ‘normal’ times is not wasted effort,” Yang says. “Keep those valuable ideas in your back pocket and be ready to move swiftly and go big when the time comes.”‌