Much of your recent work explores how people in lower-power roles can exert agency and influence in their organizations. How did you arrive at that research interest?
My interest came as a byproduct of doing lots of ethnographic studies and being blown away, over and over again, by the wisdom of people I was spending time with. Observing them in their day-to-day work, I saw they had insights they didn’t feel comfortable sharing, or stories about how they had tried to share process improvements that had gone nowhere.
In one of my first studies, on cross-occupational collaboration between nurses and nursing aides, I was dressed in scrubs shadowing a nursing aide. At the time, the hospital was implementing lean production processes to reduce cost and waste on the front lines. One of the recent changes they’d made was to buy cheaper plastic liners that go inside the pitchers that hold water for patients. So now the nursing aides had these flimsier liners that broke all the time, and they had to double up inside the pitchers, which means the cost-cutting measure might not have saved any money. But no one besides the nursing aides knew this was happening. Seeing these little inefficiencies and frustrations, I realized that so many ideas and insights are being left on the table and not acted on. There’s a lot of value for organizations to capture the experiences and frictions of people closest to the work.
People on the front lines experience lots of day-to-day inefficiencies and frictions. They still have to get the job done, so they create lots of workarounds—which might be amazing innovations that should scale across the organization.
In conjunction, I also saw a big disconnect with the leaders I engaged with. Being a leader, you have a bird’s-eye view of your organization compared to someone whose point of view comes from the vantage of their own department. But many leaders are so distanced from the day-to-day of basic operations. By doing these ethnographies, I realized that many leaders have a distorted view of their organization because they’re not directly connected to the front lines. They may have a bubble of “yes men” around them, or they may overindex on the perspectives of people close to them at the expense of other voices. One way I add value as an ethnographer is by serving as a confidential third party to whom employees speak candidly. I can anonymize those comments and report up to leaders on the wisdom of the front lines.
How do organizations benefit if employees on the front lines have avenues to voice their ideas and have them implemented?
People on the front lines experience lots of day-to-day inefficiencies and frictions. They still have to get the job done, so they create lots of workarounds—if they don’t have the right supplies or the right process, they find another way. These workarounds might actually be amazing innovations that should scale across the organization. But the local unit that figured it out is keeping quiet because technically the workaround is against the rule.
When you really want to know what people on the front lines have to say, you can empower them to solve their own problems, as opposed to having consultants or higher-level leaders impose a solution that might inadvertently create even more friction. Ideally, there would be a meeting of bottom-up and top-down approaches, where there’s a real connection between the solutions that workers can come up with and the higher levels that can support them with resources, advocate for them, and help scale things in a way frontline people might not be able to do on their own.
One way frontline solutions surface is through upward voice. Could you explain what that is and the context in which you studied it?
Upward voice is employees’ discretionary offering of ideas that improve group or organizational functioning in some way. It’s distinct from other forms of voice like labor, where people join together to have a greater voice in advocating for their interests, or ethical voice, where you’re speaking up about something, like whistleblowing.
In a project with coauthors at NYU and Harvard, we studied upward voice among staff within patient-centered medical homes, focusing on change teams—task forces charged with improving clinic operations—that included attending physicians, residents, nurses, medical assistants, secretaries, and even patients. What was interesting was that despite great intentions to incorporate the perspectives of those in lower-powered positions like the secretaries, nurses, and medical assistants, ideas from people in those roles tended to be dismissed or ignored when initially voiced. However, by studying these teams longitudinally—over years of meetings—we learned that some of those ideas did eventually lead to big changes. It just didn’t happen immediately, and it often happened via colleagues amplifying those ideas and cultivating them over time.
We documented several different voice cultivation pathways through which voiced ideas stay alive. One of the most interesting is what we call the catalyzing pathway, which is when a stalled or rejected idea gains new life after an external or environmental shock acts as a trigger to revive it. For example, one of the patients participating in this change team asked why patients had to fill out forms with the same information over and over again. That concern was dismissed by others on the team because it wasn’t coming from a staff member, and the patient ultimately quit the team out of frustration at not being heard. But a year or so later, when the team was facing issues related to patient dissatisfaction with the clinic, the team suddenly drew on the former patient team member’s ideas and started acting on them.
Does your research offer any ways that organizations might encourage or formalize upward voice?
Leaders can try to foster climates where it’s psychologically safe for people at all ranks to speak their minds, especially given that status hierarchies are pervasive in organizations and have powerful effects. For example, a leader might choose to start a meeting by saying, “I want to hear from the most junior person first.” Or they might issue an anonymous survey before a meeting so everyone can say what they think without bringing rank into it.
Once leaders ask for those ideas, they need to be willing to remove roadblocks, advocate with those above, and genuinely partner with the front lines in implementing them. Sometimes I see leaders who want to empower those on the front lines, but they don’t want to implement any of the ideas that come up. That completely shuts down the conversation and future offering of ideas.
Let’s say you’re an employee at an organization that doesn’t value upward voice. How could such an employee draw on the voice cultivation pathways you documented to increase the chances that others might hear and implement their ideas?
One of the pathways we identified was called “exemplifying.” That’s when you go out and show the idea has legs, perhaps by doing a small pilot on your own time—putting it out into the world.
Then you can echo and amplify others’ ideas. One implication of this project that I really like is that it decenters the idea of the heroic voicer and highlights how others can help great ideas take off, with many different people contributing to the implementation of an idea. As an employee, you can think about which of your peers’ good ideas you can back, so that when they bring something up and it gets ignored you can agree with them or refer back to it to lend legitimacy to their argument.
One inspiring takeaway from this study is that if you have something you really believe in, you should just say it, even if it’s risky or unpopular, because the idea can take on a life of its own afterward. Even if it goes nowhere in the moment, someone else might pick it up or it might become relevant a year later. Once it’s said, no one can unhear it.
Have you observed lower-power experts draw on tactics besides upward voice?
For two and a half years, I studied mental health clinicians working for the U.S. Army to treat active-duty soldiers suffering from mental health conditions like PTSD. As members of the Army’s peripheral medical function, these providers held very little formal power and often had difficulty getting the commanders of the soldiers they treated to follow recommendations that were important for soldiers’ recoveries—for example, sitting out a stressful training exercise. So I was intrigued to discover that some providers had managed to establish very influential relationships in which commanders regularly followed their advice. What I found was that those providers did not rely solely on their medical expertise as a source of authority. Rather, they built influential relationships through a process I call “rapid relationality.”
The first phase of this process is all about “getting in”: How do you gain basic access to your assigned commander so that they return your emails or calls? One successful tactic included setting up meet-and-greets as soon as they were assigned to a unit; this ensured that their first meetings with commanders were all about making a case for their value, rather than asking for something. The next set of strategies involved “proving oneself,” or demonstrating a commitment to the Army in ways that had nothing to do with medical expertise. I talked to providers who did pushups with the unit or made a point of skipping lunch and staying late to meet with commanders. The final set of tactics involved utilizing relational expertise to communicate in ways that were culturally resonant for commanders—for instance, learning military terminology and styles of communication. The most successful providers not only built these relationships but did so rapidly, before conflicts arose that destroyed their window of opportunity to establish influence.
The ideal state is constant interplay between the top and bottom of an organization, where you’re creating an organizational culture that allows people on the front lines to innovate and share ideas, while leaving room for managers to help scale up the right ones.
In another paper from this larger study, I identified organizational design facets that enabled rapid relationality by assigning providers to work with a manageable number of commanders and units, so that everyone could learn each other’s names (as opposed to a pooling system of working with all soldiers across an Army post, where those personal relationships would not be feasible). At the same time, I recommended that mental health providers avoid cooptation pressures by maintaining close ties to their fellow clinician peers.
You studied a hospital during the early months of COVID and found that frontline employees were able to implement their ideas much more quickly and easily than under normal circumstances. What did you learn about how that happened?
We were talking to hospital workers, mainly frontline physicians and nurses, when COVID hit. We were surprised to find people telling us about “silver linings”—long-held ideas they suddenly had the freedom to try with less red tape. What we found is that the ideas that got off the ground and stuck around had to be “shovel-ready,” meaning they were premeditated in some way. The person with the idea had already made some progress or worked out the logistics, such as identifying a potential vendor. Then, when COVID created a changing environment with all these new problems, managers were more open to hearing from the front lines. A person with a shovel-ready idea was well-positioned to say, “I have this ready-made solution for you” and to receive the green light to implement that change with less pushback. We tracked dozens of change ideas that had been desired pre-COVID to see which ones were implemented and which ones endured nearly two years later and identified a set of tactics associated with rapidly getting your shovel-ready idea off the ground, and also implementing it in a way that helped it endure beyond the post-crisis period.
How can employers apply this research outside times of crisis?
So much of the change management literature is about carefully planning step-by-step, multi-year change processes with a traditional change management toolkit. We’re bringing a little more attention to moments where you could drop your tools and go bigger and faster than you otherwise would. The paper’s practical guidance is to always be laying the groundwork for the ideas that you care about, using traditional change management tools, during stable times. At the same time, you should be ready to capitalize on shifts in your environment, and to demonstrate that your ideas can solve the problems those shifts create, and be ready to move fast and go big to seize a brief window of opportunity for the change to be swiftly implemented and in ways that help it endure.
This model of opportunistic change is quite realistic for how things work in organizations, which are inherently political entities. It’s not necessarily optimal; we shouldn’t have to wait for pandemics for good frontline ideas to be implemented. But for frontline change agents, it should be part of their toolkit to monitor the environment for favorable moments to go a little quicker and bigger.
What about organizations themselves? How can they balance the need to effect change with some of the systems and safeguards that constitute the red tape?
The ideal state is one of constant interplay and connection between the top and bottom of an organization, where you’re creating the space and an organizational culture that allows people on the front lines to innovate and share ideas, while leaving room for managers to screen ideas and help scale up the right ones. An organization has limited resources, and it can’t do everything that everyone wants to do. A good manager needs to let people experiment and then evaluate those experiments in an equitable way.
Many organizations are grappling with this tension as they’re figuring out how to get real value from AI. Traditional organizational approaches to implementing new technologies are often top-down and driven by centralized IT departments. Yet IT departments are often removed from the daily work of those on the front lines, who may better understand where AI makes sense and where it doesn’t. Organizations can benefit from frontline experimentation with AI, where the front lines find good AI use cases, managers assess those use cases, and IT supports use cases that should be scaled up. AI is an especially good example of where involving the front lines from the start can add greater value.
Have you seen any good examples of that constant interplay?
In a different paper I’m working on with a former doctoral student, Elisabeth Yang, we’re examining how experienced frontline staff can serve as “voice conduits” between leadership and those on the front lines. Such roles are especially valuable if there’s low psychological safety on the front lines and staff feel afraid to speak up to authority holders on their teams.
This was the case in the hospital studied, where there was a disconnect between frontline bedside nurses best positioned to notice early warning signs in their patients and the providers with the authority to make decisions about their patients’ care. We found that experienced frontline nurses outside those care teams were able to serve as voice conduits, creating an outside voice channel to elicit concerns from frontline bedside nurses and then elevate the most pressing ones to providers. Operating outside the chain of command of these care teams, the experienced nurses could raise frontline concerns upwardly with less potential backlash and help prompt timely action. We’ve been taken by the power of this role, which was developed by a senior nurse manager at the hospital where it was introduced. We think many organizations would benefit from putting their most experienced and expert frontline staff in an organization-wide role like this so that more people can benefit from them.
How often do organizations act on the findings you present?
I’ve been lucky enough to hear about some positive changes from my observations and feedback. In one of the hospitals where I studied nursing aides early on, I mentioned casually to a manager that aides are the face of the hospital; I documented that they spend about 90% of their time in patient rooms, whereas it’s more like 50% for nurses with more paperwork and medication tasks. I remember that the manager’s jaw dropped, because the hospital didn’t see nursing aides that way. They’re not paid or trained very well; they might have a different range of capabilities or experience levels. But they’re dressed the same as nurses, and a patient might not know the difference. Basic ethnographic insights from spending time on the front lines can shift how managers and leaders think. In this case, it prompted this organization to think about providing better training and pay, and creating a path to becoming a nurse for these nursing aides whose importance had been overlooked.
A lot of the situations you describe are ones in which status hierarchies, politics, or inertia hamper the functioning of an organization. How does organizational behavior help people navigate that reality?
I study how people are managing where they are, rather than where we wish they were. It’s important to document the challenges people are facing on the front lines and how they manage to be heard and get things done, sometimes against the odds. Textbooks on organizational strategy and decision-making are often so different from people’s reality. Organizational behavior takes seriously the messy, informal dynamics that go into running and living inside an organization, rather than assuming that the formal org chart represents how decisions are made. The optimal solution may not be the politically viable one, and there are so many workarounds, networks, and relationships that determine how things really get done. We need to design guidance for managers and leaders that accounts for these real social, political, and cultural dynamics they face. Otherwise we’re not preparing them for the realities of organizational life.
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