Robyn Fadden – host: | How useful, overhyped, or even detrimental are digital technologies in a crisis? What can be learned from experiences of crisis-driven technology use, both on an individual and organizational scale? Zoom came in to save the day when work went remote during the COVID-19 pandemic, online shopping and food delivery became even more normalized, even doctors’ appointments went online. For many, these digital technologies and even more specialized innovations provided a kind of utopian hope for large-scale societal change. In reality, the acceleration of digital innovation across sectors and the world has disrupted business as usual and exposed systemic challenges and inequalities. This is what Cambridge scholar Michael Barrett points out in his latest research examining the possibilities and limits of digital innovation. |
Robyn Fadden – host: | Welcome to Delve podcast. This podcast draws real-world insights from new management research at McGill’s Desautels Faculty of Management and beyond. If you’d like to listen to past episodes of this podcast, read feature articles and watch symposium videos, go to delve.mcgill.ca. For this episode of the Delve podcast, I’m your host Robyn Fadden. |
Robyn Fadden – host: | In December of 2022, noted management scholar Michael Barrett gave the Laurent Picard Distinguished Lecture at Desautels on the subject of rethinking digital innovation and crisis. He outlined his recent research that examines digital innovation in organizations and asks what happens with that innovation in a time of crisis, including at the beginning of the COVID-19 pandemic. Michael Barrett is currently Professor of Information Systems & Innovation Studies at Cambridge Judge Business School, where he is also the founder and Academic Director of Cambridge Digital Innovation. He is also Editor-in-Chief of the Information & Organization journal. After his lecture at Desautels, Professor Barrett sat down to discuss his findings with me on Delve podcast. |
Robyn Fadden – host: | Welcome to the Delve podcast, Professor Barrett. As a scholar, you’re immersed in digital innovation research, organizational strategy, and institutional change related to that. You’ve looked at the uses of AI, 3DP, telemedicine in hospitals, mobile payment services, clean energy, and technologies for climate resilience. Some organizations introduce new technologies before they’re perhaps equipped to do so, such as in a time of crisis. However, in an ideal situation, can organizations be fully prepared to introduce new technologies? Or should they always plan for some degree of the unexpected? |
Michael Barrett: | Well, one is never fully prepared for any eventuality, such as a crisis. But you’re absolutely right to say that there is what we might term a level of digital maturity of the organization, which may depend on the resources that they have, but not just the resources, but the mindset change that they have as to the possibilities and the potentialities of the new technology, and the actual practical pilots and ways of understanding and testing the limits and possibilities of the digital innovation. So, depending on the amount of work or that digital maturity, the resources, the capabilities, the readiness for change, and the infrastructure to deliver the technology, an organization will be less or more prepared, regardless of the eventuality. |
Robyn Fadden – host: | So then we have the crisis situation. So the same would apply if an organization is more prepared, they might be able to handle a crisis more easily through the use of digital assets. We see this in health care, for instance, and you’ve seen this in your research in healthcare management. |
Michael Barrett: | Yeah, absolutely. A wonderful example from our research is the work we’re doing in Israel, where the clinicians attached to the very large hospitals, again, well-resourced, do have both a readiness for change but also a proclivity to handling crisis. As we know, the nation of Israel is always in a state of readiness for critical issues and incidents. And that actually translates into other crises, such as healthcare, where they were the first in the world really to develop new capabilities, both on telemedicine to a combat what they would call the battle of the upper COVID-19. And also to reconfigure many parking lots, which they always have ready for in the state of war, into COVID units, something which other countries have done, but they were the first to do and very rapidly. And we attribute that in part to the psyche of the nation and the ability, therefore, to reconfigure very rapidly in times of crisis. |
Robyn Fadden – host: | That’s an interesting and somewhat contentious example – they’ve been used to crisis for such a long time that it’s almost a way of life, but they’ve also had the resources to harness crisis in many ways despite its obvious detriments. This is a good time to define what a crisis is, in relation to your most recent research, where you write that a crisis can be an opportunity for the organization, but not in all organizations or not all crises. |
Michael Barrett: | Maybe just to differentiate, there are different types of crises. There are different conditions of crisis, there are crises that that seem to be slow moving. So the change comes, but like climate change in a way, that’s perhaps never quick enough, and it’s long lasting. Then we have these very immediate crises that whether it has to do with a meltdown of the financial markets or otherwise, like a war, requires a very different recognition of the externalities that are affecting the crisis and the change as opposed to something which is more endogenous. |
Michael Barrett: | Then the different images of crisis we’ve looked at in our research, to categorize them helpfully into crisis as opportunity versus crisis as disruption or crisis as exposure. And they are all images and vantage points, but they’re helpful to make sense of the crisis and to understand the different ways in which digital technologies might respond to those crises. It was Winston Churchill who said never waste a good crisis. And indeed, that would be the crisis opportunity. And how digital technologies we have seen in experimentation and the rapid innovation that becomes opportunities. The opportunities that we see through COVID are huge investments – in the UK that was over 140 million pounds in a short period of time into digital health, a sector that had relatively little investment as a category up to that point in time. So that’s a very good example of crisis as opportunity, rises as disruption, that whole sense of that any crisis will, as it suggests, disrupt work practices in ways that are very challenging to the routines and have a need for new ways of operating. It can happen to the organization also at the societal level. And so the way in which we’ve seen the digital response, we’ve all lived through it, it’s been phenomenal. We have seen how at scale, digital platforms allow us to really engage and do activities, whether it’s telemedicine, whether it’s learning opportunities through Zoom, whether it’s sales meetings through Zoom, so many things that we just knew was possible, but didn’t scale anywhere near that. But it was necessary in a time of disruption, and a need for continuity of services of care if it’s in a hospital setting. Of course, we do point out that we must always look at the tension and the critical issues, that they also might produce new risks in that these platforms are becoming increasingly indispensable. Over dependence on them can raise concerns for those that believe that indeed, what are the new possible surveillance, what are the new data that’s been collected for algorithms that may or may not be used in ways that that are supportive of the way of life and way of working that we’re used to. |
Michael Barrett: | And then lastly, I do find the crisis exposure really important, because it just sheds that spotlight with a crisis on those that are vulnerable in ways that we just may have sort of seen or had a sort of blind eye towards or not adequate attention to. And I think that’s really important to realize that it exposes the invisible work becoming visible, those that are in situations where they are perhaps not in the best situation in society, low economic conditions, socio-economic conditions. And the fact that we did see that many studies in the COVID [era], that there are increasing digital inequalities that have exacerbated the digital divide. And that is something which we argue is important as a moral imperative to us all to address. |
Robyn Fadden – host: | There’s a persistent utopian vision that digital innovation can solve all the world’s problems, but obviously so many of those problems – like poverty, homelessness, lack of access to health care – haven’t gone away despite the world’s technological leaps in the past 20 years. These socio-economic inequalities came into sharp relief during the COVID crisis. With that in mind, could you share how the organizations that you researched, especially hospitals, used technological innovation to help them manage in crisis. You have the example of the ophthalmology unit of a major London hospital, which introduced telemedicine during the COVID-19 pandemic to serve its patients, which included many older vulnerable patients. The hospital went from the tried-and-true slit lamp method of diagnosing eye problems in person to determining risk of eye problems through telemedicine, through video chat essentially. But even before the pandemic, you were drawn to look deeper at this hospital and how it functions – why was that? |
Michael Barrett: | We were drawn to it because we always look for where there is opportunity for learning at extremes often. So, where there are well-resourced hospitals or where there are resort areas where there’s exposure of not having an adequate digital infrastructure, we can learn the issues that needs to be raised. In this particular case, it is one of the leading hospitals for eye care in the world, well-resourced, and also with really an excellent infrastructure technologically, but also an ambition to be a really firm number-one digital hospital, meaning by that, developer of algorithms for diagnosing and eye care are at the forefront of the world in diagnosis and other areas. So we were drawn to them, and they were drawn to us to be honest. So there was a good marriage there. |
Michael Barrett: | And what that led to was, pre-COVID, looking at how these algorithms might be implemented for redesigning pathways to address the big challenges of many healthcare systems, including in the UK, have long wait times, and lack of expertise, human experts to address many, many patients, especially with an aging population, which is phenomenal, as you may know – in many developed countries, and even others, you will see in the next 10 to 15 years doubling of people over 65. So these vulnerable populations, with that comes more need for eye care. Looking at how they were addressing it through digital was really exciting. We ended up pivoting a little bit during COVID As many have because all the resources and the focus went towards continuity of care and using telemedicine to support it. |
Michael Barrett: | Some of the very interesting projects had to be put on one side on the shelf a little bit – the redesign of the pathways through AI and doing pilots in that area, the focus had to be how do we keep care going, how does, therefore, telemedicine allow for ophthalmology to be continued. And that was our focus during COVID, which was really an eye opener on seeing how having talked to the senior doctors and AI technology specialists in the organization not even two months before, they had clearly said, and this is true across much of the world, perhaps that it would be five to 10 years before those pilots that we had seen in December of 2019, which looked quite revolutionary at the time around telemedicine could be possible within the you know, within their hospital, which is one of the leading hospitals in the world. And then to see and witness firsthand through the research and expansion of the pilots. And the launch of them. And the scale up within three months to 10,000 video consultations just was mind blowing to them and for us as well. And what we learned through that though was the way in which it’s not that the telemedicine had changed. It remained the same technology, but the risk landscape within which the introduction of the technology was being introduced was changing in a way that led to a lot more openness for certain conditions by a much larger percentage of the clinicians to provide the care—and in doing so to adjust their procedures and approaches to delivering the care that was sensitive to keep the risks and the potential harm, minimized as to how they saw it before the crisis. But it was a surprise to all, including the clinicians, many of whom I had no expectation or intention of delivering care through the telemedicine because why would you if you feel that your profession largely involves a physical examination around a slit lamp with the person beside you, and that that is the best way of making a judgment and a diagnosis, then that was the focus only: why would you change? Why would you change? |
Robyn Fadden – host: | A health care center or hospital is a place where risk is tangible, more tangible to the general population than in other areas since it’s something we all relate to, our health, our quality of life and the risks to it, such as harm and death. How did your research define risk in relation to new digital technologies and understanding and weighing risk? And why is it important, especially to decision makers at an organization such as a hospital to understand that risk is socially constructed? You did both quantitative research and qualitative research to show that risk is more of an ecology, a series of relationships, rather than a more easily quantifiable measure. |
Michael Barrett: | It’s a good question. And it’s a challenge in a healthcare setting. Healthcare understands better than many, as you say, both do no harm to patients is the oath the doctor takes, so frontline physicians and allied health clinicians, more generally health professionals have an understanding of risk from that point of view, and are therefore, especially with regulation and the consequences, which can be life threatening, does limit, or at least makes that decision of balance of harm and benefit, a delicate one. There might be more of a resistance or a willingness to do no harm, even if there’s great benefit, potentially. So that’s what we might explain simply as somebody be more conservative. Now that we say we’re conservative, why it’s important to unpack these words, in the different contexts, in a tightly regulated context, like healthcare – it is important to protect the patient, and the professional socialization of a doctor, doing no harm, is a very strong impetus for not taking risks that are seen to be risks. |
Michael Barrett: | Our usual way of thinking of digital innovation may center on what’s the value, of showing the value. And indeed, that is very important. And you show the value also by implementing it effectively. But the challenge becomes that its value for whom, if you like, is one issue. And this whole sense of the risk that you’re willing to take becomes a risk related to the uncertainty that it provides. Especially and only if it’s of value to a particular, what we call objects at risk, or humans in this case. And so it’s that balance of understanding the nature of the industry, the risk of the risk landscape. That and the changing risk landscape, which we see very clearly in a crisis of a COVID-19, where you do have a new ecology emerging, of the extent to which this COVID risk, which was impacting the user journey of elderly people who might be vulnerable, therefore, life threatening to come in to do a physical examination. Even if that is the preferred and the best way, clinically, the patient was now at risk and at harm. So it left an opening in that risk ecology for the telemedicine, the same technology to be seen it as less risky, and doing less harm for the patient than if you ask them to come in to the site or to the emergency for a physical examination. |
Robyn Fadden – host: | And then, since we’re talking about an organization and all the moving parts and people within it, an additional factor to the patients and their experience is the particular clinicians, nurses, and other kinds of health care practitioners themselves and their experiences of this technology. |
Michael Barrett: | Absolutely. And that’s really important. Some might refer to it as the subject position, the way in which, particular in this case, young, pregnant ophthalmologists, who were at risk were required by the Royal College to not be on the front line. This was challenging for them as was for many people in healthcare settings who wanted to contribute, who wanted to stay at the front line. How could they do that? They could do that by championing and developing on the telemedicine virtual platforms, which they were critical as key actors to scale the platform. |
Robyn Fadden – host: | Again showing that risk is related to a series of relationships in the organization as well as its wider social touchpoints. |
Michael Barrett: | Social construction, but in a series of relations, which are ongoing, dynamic and are shaping our riskscape or a landscape within which new actions with technology might be made more affordable. |
Robyn Fadden – host: | Is risk managed differently in an organization that has been changed by such a major crisis, than in an organization that hasn’t had to alter itself or its activities to a major degree due to crisis? |
Michael Barrett: | We’re trying to get to that in the research through understanding the recalibration of the services, that journey that the hospital is, because they have gone through COVID, they have made adjustments, in this case to telemedicine based services, they have changed around that, they’ve done risk work activities to enable, whether it’s through increased safety netting or rely more on history practices, or being careful as to designating it as a triage service. These are all ways in which they’ve been able to work with and scale telemedicine. Now through that experience of the crisis, they’ve developed capabilities, if you like, and sharpened capabilities around through those risks, work activities, as to how to work with risk. |
Michael Barrett: | Now, I should emphasize as clinicians, as we said earlier, and other healthcare professionals, especially on the frontline, it’s part of their DNA to be handling risk. But what the crisis does it seems to open up new avenues and develop new capabilities of managing risk – which, after the crisis, and we’re following that up now as to what’s retained, what is seen as perhaps too risky or what could be expanded upon with this new additional risk capability to move forward to offer perhaps care in other conditions, or to combine technologies with, let’s say telemedicine and AI together, because one is at a different level of readiness, risk-wise to deal with a more complex array, an ensemble of technologies in providing care, with the hope of providing more care, better care for more people because of the looming desperate crisis we have in healthcare. |
Robyn Fadden – host: | And that crisis has endured and expanded but also become more of a focus for governments, policy makers and citizens as well. A crisis like COVID-19 has a temporary timespan and so is perhaps easier to see solutions to, but a longer-term crisis is entrenched and its solutions more murky. Yet in your research and theories of risk and technologies, there’s the sense of learning more about solutions to long-term crisis. And what you’ve just talked about could be applied to different areas outside of health care, couldn’t they? |
Michael Barrett: | I really do believe they can. But like all research, which is more qualitatively oriented, we have to be specific as to the boundary conditions and the kinds of things that may be generalizable, what we often refer to as analytical generalizability, as opposed to statistical generalizability, which you would try to do in a quantitative study. But I do believe the principles, the ideas, the insights that we’re learning around the changing risk-scape and risk ecology, then how we consider and designate those as a social construction of what risk objects are and how they get translated, are very helpful regardless of the industry. We do have to account for where the boundary conditions come in, whether it okay if it’s a regulated industry, maybe similar to health care but very different – could be the farm industry, could be air traffic control, you name it, they may share more commonalities of how we think about the journey and the concepts and how they might be valuable. But still, outside of regulated industries, I think it tells us more about more generally how we organize for risk, especially with digital innovation, the principles. But the context is king or queen, in the sense of how we think through with the principles and the ideas, what are the insights and the learnings that we can get across multiple sectors. But I would definitely encourage not being restricted to a single sector, but to sensitively appropriate the ideas and the concepts in ways that are so sensitive to the context but are willing to be bold, and experiment and see the opportunities for insights from this work more widely. |
Robyn Fadden – host: | And really, that also is one of the hallmarks of digital innovation as we know it, willing to be bold and willing to iterate. As Professor Barrett points out, his research on digital innovation, crisis, and risk has wider implications beyond the particular sites, such as hospitals, that he and his colleagues ventured into and studied in depth. Both adoption of new technologies and understanding risk, while on the surface seem clinical and quantitative, take place within organizations that are inherently social, where the real lives of people are in constant flux and absolutely matter to the bigger picture of whether crisis can be turned into opportunity. |
Robyn Fadden – host: | Our guest today on the Delve podcast was Cambridge professor Michael Barrett, discussing research that he outlined in the recent Laurent Picard Distinguished Lecture at Desautels on the subject of rethinking digital innovation and crisis. You can find out more about this research in an article at delve.mcgill.ca. Thank you for listening to the Delve podcast, produced by Delve, the thought leadership platform of the Desautels Faculty of Management at McGill University. You can follow DelveMcGill on Facebook, LinkedIn, Twitter and Instagram. And subscribe to the DelveMcGill podcast on your favourite podcasting app. |