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Building capacity in the healthcare sector: A strengths-based approach for increasing employees' well-being and organisational resilience

Published online by Cambridge University Press:  09 July 2019

Yvonne Brunetto*
Affiliation:
Southern Cross University, Queensland, Australia
Tom Dick
Affiliation:
Southern Cross University, Queensland, Australia
Matthew Xerri
Affiliation:
Griffith University, Queensland, Australia
Ashley Cully
Affiliation:
Griffith University, Queensland, Australia
*
*Corresponding author. Email: yvonne.brunetto@scu.edu.au
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Abstract

This study uses Appreciative Inquiry (AI) as a lens for informing the process for building on employees' existing wellbeing within one Australian organisation, using the ‘discovery, dreaming, designing, and achieving destiny’ process. Using POSH as a theoretical framework, we worked with a large Not-For-Profit healthcare organisation as part of the ‘discovery’ phase to identify elements of what was positive, flourishing, and life-giving in the practices of their employees. During the ‘dreaming’ process, employees' wellbeing was identified as a strength. During the ‘designing’ phase, a training program was co-designed to build on employees' existing levels of wellbeing. This paper reports outcomes as part of the ‘achieving destiny component’ of the AI process. In particular, the outcomes show that employees' knowledge of, and ability to use positive emotions increased, which is a positive first step for increasing employees' wellbeing and organisational resilience.

Type
Research Article
Copyright
Copyright © Cambridge University Press and Australian and New Zealand Academy of Management 2019

Positivity is a growing area of interest for practitioners and researchers alike because it can provide a framework for improving employees' wellbeing and organisational resilience. Appreciative Inquiry (AI) is a type of action research that provides a process for examining whether an organisational initiative is consistent with the goals agreed upon jointly by organisational actors. AI uses a ‘strength-based approach to organisation development’ as the process for improving organisational effectiveness (Verleysen, Lambrechts, & Van Acker, Reference Verleysen, Lambrechts and Van Acker2014: 2). This means that AI begins from a premise that organisational members must jointly decide on their goals and identify their strengths and then collaboratively use and embrace a developmental positive initiative that builds on members' existing personal attributes as a means of increasing organisational capacity (Bushe, Reference Bushe2012). As such, the process is based on ‘principals of reasoning by which valid knowledge is obtained’ (O'Leary, Reference O'Leary2007: 162).

In this article, the authors intentionally situate AI as a type of methodological framework within the umbrella provided by Positive Organisational Scholarship in Healthcare (POSH) as ‘an alternative approach to studying [healthcare] organisations’ (Barker Caza & Caza, Reference Barker Caza and Caza2008: 21). We examine the positive processes and attributes of employees of a large Not-For-Profit (NFP) Queensland-based organisation that delivers a range of caring services, both residential and in the community (such as aged care, community care, and drug and alcohol support). Using a combination of qualitative and quantitative data collection strategies, we present empirical data that reveal intended and unintended effects associated with a positive orientation towards health service management – for the staff therein (employees and management) and the scholars involved. Indeed, this article uses the AI process and a POSH theoretical framework ‘to study triumphs and achievements because of their inherent appeal and allure … to reveal opportunities for capacity building’ (Dadich, Collier, Hodgins, & Crawford, Reference Dadich, Collier, Hodgins and Crawford2018: 1,206).

The reason for the organisation wanting to increase the wellbeing of carers is because of the growing importance of caring for vulnerable people in many OECD countries as is evident by the redistribution of health budgets and government resourcing to align better with the needs of the ageing population and other vulnerable groups (OECD, 2008). As a whole, the numbers in this group are growing, as are the demands for more skilled labour, suggesting that organisations will need to consider appropriate developmental initiatives consistant with their mission so as to better prepare their carers to cope. Presently, the political agenda is focused on developing adequate clinical and caring competencies in employees. On the other hand, Work Safe Australia (2013) identifies that the health and community service sector has the highest number of stress-related workers' compensation claims in Australia. POSH is a framework for validating the fact that there is also positive deviance in the Australian healthcare sector (Dadich et al., Reference Dadich, Collier, Hodgins and Crawford2018). Claims such as those by Work Safe Australia (2013) suggest that the emotional nature of caring work, and the expected level of emotional labour required to undertake the work, has led to high levels of mental exhaustion and burnout.

Mental health and wellbeing is a worldwide phenomenon, with evidence from the World Mental Health survey reveals that mental health disorders are common in all 28 participating countries (Kessler & Üstün, Reference Kessler and Üstün2004). Within Australia, from 2014 to 2015, 17.5% of the population reported having a mental or behavioural condition (Australian Bureau of Statistics [ABS], 2015). In the Australian caring sector, stress or a mental condition is among the most common work-related illnesses and injuries. For example, approximately one-fifth of the aged care workers reported perceiving high stress and/or work-related illnesses (Commonwealth Department of Health, 2017). Although poor mental health and wellbeing are prevalent throughout the world, there is limited evidence about the value of AI/POSH for generating organisational developmental initiatives, such as the holistic and strengths-based organisational development program trialled in the case in point, which could counter the negative impact of stress in the workplace.

As will be revealed, the AI process/POSH framework enabled the development of a program aimed at identifying and increasing the positive attributes of employees delivering care, so as to increase their wellbeing. AI provides a process for building on employees' strength using a ‘discovery, dreaming, designing, and achieving destiny’ process (Bushe, Reference Bushe2012). Using POSH as a framework, we worked with a large NFP healthcare organisation as part of the ‘discovery’ phase to identify elements of what was positive, flourishing, and life-giving in the practices of their employees (Cameron & Caza, Reference Cameron and Caza2004: 731). The process involved a collaborative engagement between the research team, the organisation, management, and employees spanning a 14-month period to identify strengths. During this phase, employees' strengths were identified. The dreaming phase involved a collaborative process amongst stakeholders to decide which employee strengths to grow and ‘employee's wellbeing’ was identified as a key priority. The designing phase involved developing an approach to building on employees' existing wellbeing so as to build organisational capacity by increasing the individual and combined emotional resilience of employees. Hence, the study is in line with AI action research (Bushe, Reference Bushe2012) and POSH principles (Barker Caza & Caza, Reference Barker Caza and Caza2008) and is also a response to calls for more quantitatively based studies using an AI framework because in the past, most AI papers have tended to be descriptive or anecdotal or qualitative in methods (Verleysen, Lambrechts, & Van Acker, Reference Verleysen, Lambrechts and Van Acker2014).

Background

This study uses Positive Organisational Scholarship (POS) as a theoretical lens for examining how to increase positivity within organisations using an AI action research approach. AI has been used previously in change programs for building resilience and positivity using the ‘discovery, dreaming, designing, and achieving destiny’ approach (Bushe, Reference Bushe2012). AI preceded POS and is now perceived by some to be a type of POS because they both similarly study positive phenomena with the aim of increasing organisational capacity and improving performance (Bushe, Reference Bushe2012; Donaldson & Ko, Reference Donaldson and Ko2010). According to Dutton, Glynn, and Spreitzer (Reference Dutton, Glynn and Spreitzer2007), POS research comprises three key aspects: (1) the topic must be capacity enhancing, (2) the process must build on a platform of existing strengths, and (3) the focus must be capability creating for employees and the organisation as a whole. POS researchers acknowledge that both positive and negative outcomes can result concurrently from such attempts (Dutton, Glynn, & Spreitzer, Reference Dutton, Glynn and Spreitzer2007). Fredrickson and Losada (Reference Fredrickson and Losada2005) suggest a positivity ratio of approximately three positive to one negative condition should result in flourishing.

Far from a facile optimism, the POSH approach is essentially applying POS specifically to healthcare contexts, in part, to counter the dominance of the tendency to focus predominantly on negative stories and catastrophise the healthcare sector in Australia. As explained by Dadich et al. (Reference Dadich, Collier, Hodgins and Crawford2018), POSH recognises that a research space is shaped and limited by the language we use, the tone of our enquiry, by the accretions of academic ‘disciplines’ because it frames the nature and substance of ideas we use to think about opportunities. Dadich et al. reinforce the salience of these emergent approaches to ‘health service management research, where reports of poor care, adverse events, and disrespectful behaviors can be readily sourced’ (Dadich et al., Reference Dadich, Collier, Hodgins and Crawford2018: 1206).

Together, the AI action research processes and POSH principles inform the goals and research design for a collaborative and holistic emotional resilience program aimed at enhancing carer's wellbeing. The next section provides the theoretical justification for the empirical research embedded in the collaborative program.

The components of the collaborative program

The initiative involved a holistic program which aimed to build employees' personal resources so as to enhance their well-being. One such personal attribute is Psychological Capital (PsyCap) which comprises four parts: hope, optimism, self-efficacy, and resilience. Luthans, Youssef, and Avolio (Reference Luthans, Youssef and Avolio2007: 3) define PsyCap as:

‘an individual's positive psychological state of development and is characterised by: (1) having confidence (self-efficacy) to take on and put in the necessary effort to succeed at challenging tasks; (2) making a positive attribution (optimism) about succeeding now and in the future; (3) persevering towards goals and, when necessary, redirecting paths to goals (hope) in order to succeed; and (4) when beset by problems and adversity, sustaining and bouncing back and even beyond (resilience) to attain success’.

PsyCap is a positive attribute because those with high levels tend to have a natural buffer against stress and as a consequence have high wellbeing and high workplace performance (Story, Youssef, Luthans, Barbuto, & Bovaird, Reference Story, Youssef, Luthans, Barbuto and Bovaird2013). PsyCap is also important because it predicts positive safety outcomes for healthcare workers (Brunetto, Xerri, Trinchero, Farr-Wharton, Shacklock, & Borgonovi, Reference Brunetto, Xerri, Trinchero, Farr-Wharton, Shacklock and Borgonovi2016) as well as increased wellbeing and reduced turnover (Brunetto, Rodwell, Shacklock, Farr-Wharton, & Demir, Reference Brunetto, Rodwell, Shacklock, Farr-Wharton and Demir2016). Hence, we co-designed a series of engagements to leverage employee's existing PsyCap and wellbeing to further improve employee wellbeing using the PERMA framework (Seligman, Reference Seligman2011) and Emotional Resilience (Reivich, Seligman, & McBride, Reference Reivich, Seligman and McBride2011).

The justification for building on existing employee wellbeing was because of the degree to which carers engage in emotional labour. Employees engage in emotional labour every time they regulate their emotional expression/reactions to create an ‘official’ observable display (i.e., facial and body) to meet the requirements of their role. The ‘regulation and expression’ masks the real feelings, sometimes of sadness for the patient, or anger for the dementia patient who is screaming obscenities, and at other times, hiding the panic that the incident with a client has unearthed in the carer's memories of past patients (Seligman, Reference Seligman2011). When employees undertake emotional regulation frequently, the chances of mental exhaustion and burnout are higher (Grandey, Reference Grandey2000), and consequently this may lead to an erosion of employee wellbeing (Chau, Dahling, Levy, & Diefendorff, Reference Chau, Dahling, Levy and Diefendorff2009).

Whilst the organisation had identified that their employees had some PsyCap and some wellbeing, research suggests emotional labour needs high levels of personal resources to help them cope with difficult and stressful situations (Luthans & Youssef–Morgan, Reference Luthans and Youssef–Morgan2017; Avey, Reference Avey2014). On the other hand, PsyCap is developmental and therefore those employees with lower PsyCap can be upskilled via specific programs (Luthans, Avery, & Patera, Reference Luthans, Avery and Patera2008). The development of PsyCap focuses on building ‘hope’ among employees as a starting point using specific exercises. For example, Luthans, Avery, and Patera (Reference Luthans, Avery and Patera2008) successfully delivered an online training program for the development of PsyCap for 364 participants from multiple backgrounds such as manufacturing, service, sales, and government, of which the treatment group comprised 187 participants and the control group comprised 177 participants. For example, the development of ‘hope’ involved an exercise where participants identify a goal and work through specific steps including (a) identifying potential roadblocks and (b) develop flexible routes to achieve their goals in response to those roadblocks.

In contrast, in this project, only healthcare workers were involved. They differ from other employees because they are expected to engage in emotional labour regularly, and therefore have a greater need to understand how emotions impact their wellbeing as well as those around them. An important contribution of this research is that it builds on the work of Verleysen, Lambrechts, and Van Acker (Reference Verleysen, Lambrechts and Van Acker2014) who argued that the way forward for enhancing PsyCap is to firstly explain and use processes which increases employees' understanding about how positive emotions work so as to develop a basis from which positive individual resources such as optimism and self-efficacy can grow. Adding to the complexity, particular sectors – in this case the caring sector – appear to attract a type of employee with a specific mix of personal resources usually characterised by clarity around basic psychological needs and uncertainty regarding pathways and contingencies for meeting them: a mix that can result in low coping skills for some (Barsade & O'Neill, Reference Barsade and O'Neill2014). As a result, some employees will not be able to cope as well as other employees. Although employees high in psychological resources can reduce the negative influence of stressors, the long-term impact of emotional labour without adequate organisational support will be detrimental to employee and organisational outcomes alike.

The difference between emotional labour and other labour is the degree to which employees have to present a different emotion to the patient/client compared to the emotions they are experiencing, which over time can compromise their wellbeing (Chau et al., Reference Chau, Dahling, Levy and Diefendorff2009). Hence, unlike PsyCap training for employees working outside the healthcare sector, an important component of this collaborative development program involved discussing with participants the importance of self-awareness and the interaction of ‘thoughts–emotions–actions’ as per the Verleysen, Lambrechts, and Van Acker (Reference Verleysen, Lambrechts and Van Acker2014) approach. During the ‘discovery’ and the ‘dreaming’ stages, these discussions were geared towards supporting the employees to reflect on their own practice as a stimulus for new insights. Building on the employees' heightened self-awareness, during the ‘achieving destiny’ (AD) stage we were able to direct the engagements towards focusing on the nexus between emotional regulation and its impact on wellbeing using the Seligman (Reference Seligman2011) wellbeing framework. According to Seligman (Reference Seligman2011), as mentioned, employee wellbeing is based on PERMA – comprising the extent to which individuals are well positioned in terms of (a) Positive Emotions, (b) Engagement (in life, work), (c) Relationships, (d) Meaning (of life), and (e) Accomplishment. Whilst there are multiple definitions of wellbeing, the definition used by Seligman is that it is separate from physical, job-related, mental, and/or social wellbeing, and instead captures elements of hedonic wellbeing (life satisfaction, feelings, emotions) and eudaimonic wellbeing (living life according to one's values) (Forgeard et al., Reference Forgeard, Jayawickreme, Kern and Seligman2011). As such, employee wellbeing captures both tangible and intangible aspects of wellbeing. Additionally, previous research about employee's wellbeing suggests that it is a barometer of organisational wellbeing (Brunetto et al., Reference Brunetto, Xerri, Trinchero, Beattie, Shacklock, Farr-Wharton and Borgonovi2018). This is important because there is a growing body of evidence that PsyCap is positively associated with employees' wellbeing (Avey, Reichard, Luthans, & Mhatre, Reference Avey, Reichard, Luthans and Mhatre2011; Siu, 2013). Avey et al. (Reference Avey, Reichard, Luthans and Mhatre2011: 21) proposed that when employees have high PsyCap, they are more likely to be flexible in considering different perspectives to achieve their stated goals, as well as being more likely to appraise situations and circumstances in more positive, opportunistic and adaptive ways. Consequently, this is likely to enhance their wellbeing.

Alternatively, Reivich, Seligman, and McBride (Reference Reivich, Seligman and McBride2011) proposed six building blocks (competencies) to foster resilience, which essentially forms the foundation of PsyCap and wellbeing because it begins with ways of increasing self-awareness. In aged care, the ability to cope with the emotions of clients/patient is paramount and because clients are often frail, the expectation is that all employees will cope well, and whilst many do, this project provided a pathway for further growth in this area. For example, many carers are expected to at one moment cope with the death of a resident, and in another moment be able to energetically welcome another resident – all with minimal time to cope with personal grief. Hence, employee resilience is an important skill for aged care employees to acquire. The foundations of resilience proposed by Reivich, Seligman, and McBride (Reference Reivich, Seligman and McBride2011: 27) are:

  1. (a) ‘self-awareness – identifying one's thoughts, emotions, and behaviors, and patterns in each that are counterproductive;

  2. (b) self-regulation – the ability to regulate impulses, thinking, emotions, and behaviors [sic] to achieve goals, as well as the willingness and ability to express emotions;

  3. (c) optimism – noticing the goodness in self and others, identifying what is controllable, remaining wedded to reality, and challenging counterproductive beliefs;

  4. (d) mental agility – thinking flexibly and accurately, perspective taking, and willingness to try new strategies;

  5. (e) character strengths – identifying the top strengths in oneself and others, relying on one's strengths to overcome challenges and meet goals, and cultivating a strength approach in one's unit; and

  6. (f) connection – building strong relationships through positive and effective communication, empathy, willingness to ask for help, and willingness to offer help’.

In summary, we integrated principles of PsyCap, resilience, and wellbeing to create a holistic approach as part of the ‘AD’ part of the action research plan (Bushe, Reference Bushe2012) to provide experiences likely to build knowledge and skills that carers could use to transform their personal resources so as to encourage and facilitate them building on their existing wellbeing. The AD program included experiences to enable the development of evidence-based techniques aimed at making visible the quotidian ‘wins’ of day-to-day emotional caring work (Chau et al., Reference Chau, Dahling, Levy and Diefendorff2009). The holistic and strengths-based AD development program builds on employees' awareness of their own practices, and as such, can be applied to other types of employees, as it honours and validates the existing strengths of workers.

Process and Results

Participants

The participants taking part in the AD program included employees from five different departments working in a large NFP Queensland-based organisation that delivers a range of caring services, both residential and in the community (such as aged care, community care, and drug and alcohol support). Participation was voluntary; however, many had been involved in giving feedback about the organisation's strengths from the first phase of the project and were therefore committed to the program. Employees comprised nurses (RNs, ENs), social workers, allied health professionals (physiotherapists, occupational therapists, social workers), carers (Certificate III and IV), Assistants in Nursing (AINs), drug and alcohol officers, etc. In particular, 46 had a Certificate III and 19 had Certificate IV in aged care or AINs; 19 had degrees (mostly in nursing [RNs], but also in Psychology, Physiotherapy, and Social Work) and seven had diplomas in Nursing (ENs), Health Science, Community Services, and Health Services. Participants nominated specific days to participate in the program. We then grouped employees into groups of 10 or 15 employees.

In total, 98 participants engaged in the program. In terms of gender, 94 were female and four were male. The sample reflected the Australian ageing health workforce with 44 Baby Boomers (born before 1967), 41 Generation X (born between 1967 and 1982), and 13 Generation Y (born after 1983). The education qualification includes 43 with ‘Certificate III’ or less in aged care, 19 with ‘Certificate IV’ in aged care, 19 with an undergraduate degree, and 17 with higher degrees (postgraduate degree or multiple degrees/diplomas). All employees had been in the organisation for 5 or less years and nine employees had been in the organisation 1 year or less. Additionally, within the sample (n = 98), 20 randomly selected employees were tested at four points – mainly from the last four groups. In particular, all participants in the last four groups were invited to undertake more intensive surveying and the first five to volunteer from each group were included. Of the sample that agreed, all were females, 12 were Baby Boomers, five were Generation X, and three were Generation Y. As well, seven had Certificate III or less, one had certificate IV, seven had an undergraduate degree, and four had postgraduate qualifications.

Discovery and dreaming

The research team was invited by the large NFP healthcare organisation to work together over a 14-month period to identify strengths and opportunities on which to build the capacity of the workforce. Following established AI methods, we used a four-process approach involving ‘discovery, dreaming, designing, and achieving destiny’ as part of their change program for building resilience and positivity in the workplace (Bushe, Reference Bushe2012). For the first two processes, we used POSH as a framework to empirically identify elements of what was positive, flourishing, and life-giving in the practices of their employees (Cameron & Caza, Reference Cameron and Caza2004: 731). These two processes occurred over a period of 12 months using multiple day-long activities to collaboratively conceive a new mission with key principles of strengths and positivity underlying their purpose and process. It was during the third stage – the designing stage, that discussions with the key members of the organisation in conjunction with the organisational development unit revealed that employees' existing understanding of how their basic psychological needs were met was useful as a basis for providing a platform of knowledge and skills about emotions as a way of increasing organisational resilience against the stresses involving in the caring sector. In the fourth stage of the AI process (AD), the organisational development unit and the research team designed a series of qualitative and quantitative data collection strategies to assess the impact of the AI/POSH process. As part of AD, a holistic and strengths-based organisational development program aimed at increasing the positive attributes of employees delivering care, so as to increase their wellbeing, was co-developed and trialled.

Designing and Achieving Destiny

The (AD) program comprised 9 h of intra- and interpersonal enquiry and development for the 98 participants. It began with a pretest at the start of the first day followed by one 6 h session (with two breaks). A further 3 h session followed at least a week apart and mostly a few weeks apart. The AD program began by providing information, skills development, and group exercises on self-awareness, which involved understanding emotions, how to regulate them, and the connection between emotions and actions. In particular, the three-part session began on day 1 with the introduction of key concepts, followed by scenarios for problem-based role-playing in groups, and reflections – some based on the Seligman (Reference Seligman2011) framework and some based on the Reivich, Seligman, and McBride (Reference Reivich, Seligman and McBride2011) framework. This was followed by information sharing, skills development, and more scenarios so as to capture the skills required for different situations (angry clients/patients with dementia/sad clients, etc.) and group exercises to explore daily experiences, embodied, and contextual specificities and to understand the link between emotions-actions and relationships as a lead into understanding the PERMA framework.

The second day comprised a 3 h session beginning with reporting to the participant group about how successful and useful (or not) the new skills were in the workplace (based on the incidents they had experienced when testing their new skills). In some cases, the participants brainstormed about ways of addressing tricky situations. Hence, group learning based on each other's experiences occurred. In other participant groups, the group moved quickly to the next part of the program which involved skill development exercises for building PsyCap – focusing primarily on building hope and optimism (as per Luthans, Avery, & Patera, Reference Luthans, Avery and Patera2008). The remaining time was used to build on participant's knowledge and skills about the use of positive language. This allowed some participants the opportunity to teach other participants different ways of addressing difficult situations. Further knowledge and skills were also promoted as additional ways of transforming challenging scenarios into encounters that will likely achieve conflict resolution. The last task involved integrating the cornerstones for developing PsyCap (focusing firstly on building hope and finishing with developing greater resilience) as a means of ensuring high wellbeing. All participants undertook a post-test at the completion of the 9 h. Additionally, as stated, 20 participants were surveyed after 3 h, at the end of the first day, at the start of the second day, and upon completion of the AD program.

All 98 participants completed a survey comprising a quantitative and qualitative component at Time 1 (before day 1) and Time 2 (after day 2). The study included a qualitative component as one approach to verify the impact of the AD program. The quantitative variables were collected using validated scales and a 6-point Likert scale where ‘1’ = strongly disagree and ‘6’ = strongly agree. PsyCap was measured using the four subscales from Luthans, Vogelgesang, and Lester (Reference Luthans, Vogelgesang and Lester2006) and was operationalised as a second order, latent variable, comprising four sub-dimensions of PsyCap (efficacy, hope, resilience, and optimism). Employee wellbeing was measured using a 4-item scale developed by Brunetto, Farr-Wharton, and Shacklock (Reference Brunetto, Farr-Wharton and Shacklock2011). In addition, the post-test included two open-ended questions requiring a written word response. The questions: (1) ‘What is the most important knowledge and/or skills you have learnt from the program’, (2) ‘Based on what you have learnt, what skills can you use in the workplace’.

To gain more information about how resilience builds PsyCap, we surveyed 20 participants in depth – using both a quantitative and a qualitative component. This part of the study involved participants completing questions relating to: (a) Knowledge of Emotions, (b) Recognition and use of Positive Emotions, (c) Recognition and use of Negative Emotions, and (d) Active use of positive engagement strategies. Each measure was developed and tested using an EFA to determine the validity of the measures.

Data analysis and results

To examine the impact of the AD program, we examined all of the quantitative and qualitative data. In particular, the sequential mixed-methods design was used where the quantitative data are dominant and the qualitative data are supplementary either supporting, negating, or explaining the quantitative findings (Creswell & Plano Clark, Reference Creswell and Plano Clark2011). We used SPSS v.25 to examine whether PsyCap and employee wellbeing change from Time 1 (before the AD program) to Time 2 (post-AD program) for the sample of 98. We then examined the responses to the qualitative questions – both the responses from the 98 surveys as well as the responses collected at four time points to capture the micro changes in understanding about emotions and the link between emotions, PsyCap, and wellbeing.

An analysis of variance (ANOVA) between Time 1 and 2 revealed PsyCap and employee wellbeing were not significantly different when comparing before and after the AD program. This, however, makes sense when one considers a tenant of conservation of resource theory, that is, resource gains beget further resource gains, so that those with higher resources are better placed to take advantage of resource gains when compared to their counterparts who lack adequate resources (Hobfoll, Reference Hobfoll2011). In the context of this study, PsyCap is an important personal resource (Luthans, Youssef, & Avolio, Reference Luthans, Youssef and Avolio2007), and those with more PsyCap have more personal resources to buffer against stress-producing events, such that their resource gains beget further resource gains to them (Hobfoll, Reference Hobfoll2011). Therefore, the pretest scores were divided into two groups (a) Group 1 (n = 51), capturing those with high PsyCap and (b) Group 2 (n = 47), capturing those with lower levels of PsyCap.

Figure 2 shows the findings of an ANOVA, and indicates that those with high PsyCap (Group 1) perceived a significant increase in their PsyCap (F = 5.772, p < .05) from Time 1 to Time 2. Additionally the findings from the data collected over four time points (see Figure 1), depicting the average PsyCap, knowledge of emotions, use of positive emotions, and control of negative emotions, show that while PsyCap incrementally increased from Time 1 to Time 4, the knowledge, use, and control of emotions sharply increased from Time 1 to Time 2, and then mostly incrementally improved from Time 2 to Time 4.

Figure 1. The impact of training on PsyCap, knowledge, use of, and control of negative emotions N = 20

Figure 2. Carers divided into those with higher PsyCap (top line) and those with lower PsyCap (lower line)

Qualitative data were analysed using Yin (Reference Yin2011) five phases (compiling, disassembling, reassembling, interpreting, and concluding) to identify the emerging themes. In response to the qualitative question: ‘What is the most important thing you learnt from the training?’, the two strongest emerging themes were ‘Awareness of Emotions’ (26 responses) and ‘Self-regulation of Emotions’ (20 responses), which are two of the foundational skills for achieving emotional resilience (e.g., see Table 2) (Seligman, Reference Seligman2011). In response to the qualitative research question that asked ‘What skills can I use in the workplace’, there was one significant emerging theme, which was ‘Self-Regulation of Emotions’ (68 responses).

As stated above, the AI process enabled the development of an AD program aimed at building on carer's knowledge and skills about emotions as a way of identifying and increasing their positive attributes. In particular, because understanding and regulating emotions is the first step in building positive attributes, the emprical research embedded in the AD program examined employees' capacity to further develop their knowledge, and use of positive cognitions and emotions in the workplace. This knowledge and skills are the basis of giving carers greater skills to reduce the stress caused by negative emotions (particularly anger and sadness) and a basis for building PsyCap and wellbeing (Seligman, Reference Seligman2011).

Additionally, an analysis of the quantitative data from the 20 participants identified that the biggest gain from the AD program was the increase in the knowledge of, and use of positive emotions (see Figure 1). This was further supported in the qualitative component of the study, with Table 4 showing the responses of 20 participants to the question ‘What is the most important thing you have learnt in the training’. The responses related to their increased knowledge, use, and control of emotions. Also, in relation to the usability of the skills learnt, the emerging themes were ‘the power of being positive’ and ‘dealing with difficult and angry people, and sadness’ (see Table 5).

Discussion

This study used an Al process informed by a POSH lens for examining the outcomes of an organisational development program (especially the ‘AD’ element of that program) aimed at increasing the positive attributes of carers, so as to increase their wellbeing. As stated in the Results section, the initiative emerged from extensive consultative discussions within the organisation to identify their perceived strengths and then the development of a co-designed action plan to build on those existing strengths. The organisation aimed to build on employee's existing wellbeing so as to increase organisational resilience in line with an emergent organisational mission developed as a part of the AI program. As such the initiative fits within an AI framework that perceives developmental initiations as the result of extensive consultation to jointly determine a way forward for building on existing strengths to achieve its mission – augmenting employee wellbeing and organisational resilience (Bushe, Reference Bushe2012).

Additionally, the study addresses a call by Verleysen, Lambrechts, and Van Acker (Reference Verleysen, Lambrechts and Van Acker2014) for more quantitative studies using an AI framework. The study complements the body of AI/POSH research by adding to the work of Verleysen, Lambrechts, and Van Acker (Reference Verleysen, Lambrechts and Van Acker2014) because similarly to that study, this study also was based on the belief that PsyCap can only develop once participants understand how basic psychological needs have been met. Consistent with this approach, the findings from this study also show that the developmental program was successful in building on employee's emotional capacity by developing their existing strengths. Hence, the study found that the wellbeing (Seligman, Reference Seligman2011) and resilience frameworks (Reivich, Seligman, & McBride, Reference Reivich, Seligman and McBride2011) were useful as a basis for providing a platform of knowledge and skills about emotions. The findings suggest that the AD program was successful in raising the participant's emotional self-awareness, and giving them coping options to increase their control of emotions. In turn, these building blocks formed the basis for developing carers' wellbeing and emotional resilience (Reivich, Seligman, & McBride, Reference Reivich, Seligman and McBride2011; Seligman, Reference Seligman2011). All employees, even those with low PsyCap showed qualitatively and quantitatively (see Tables 2–5, Figures 1 and 2) that they have gained new skills in recognising the impact of their emotions on themselves and those around them (and how to control them) during the program. Hence, this part of the AD program was successful. Recognition and control of emotions are the foundations for increasing resilience (Reivich, Seligman, & McBride, Reference Reivich, Seligman and McBride2011) and PsyCap (Verleysen, Lambrechts, & Van Acker, Reference Verleysen, Lambrechts and Van Acker2014). Therefore, the program was successful in achieving the first step towards building the wellbeing of carers.

However, unlike the Luthans, Avery, and Patera (Reference Luthans, Avery and Patera2008) study, Table 1 shows that only those with higher PsyCap experienced an increase in PsyCap. There was also a slight increase in wellbeing for those with higher PsyCap. The qualitative findings confirm that employees felt more aware of their emotions and more confident to self-regulate their emotions in the workplace after training. In the absence of a control group, the qualitative findings confirm and provide insight into why those high in PsyCap increased their PsyCap between Time 1 and Time 2. Namely, those high in PsyCap are better equipped to take advantage of the developmental program because they possess the personal resources that can be used as a foundation for further resource development. Applying the principle of COR theory that resource gain begets further research gain (Hobfoll, Reference Hobfoll2011), such a result is expected because those high in personal resources are better equipped to take advantage of potential future gains.

Table 1. ANOVA of wellbeing and PsyCap from T1 to T2

On the other hand, those with lower PsyCap did not perceive an increase in PsyCap, suggesting a need to further examine how POSH can be directed towards building employee's personal resources such as PsyCap. Verleysen, Lambrechts, and Van Acker (Reference Verleysen, Lambrechts and Van Acker2014) provided an initial study showing that basic psychological needs form the basis of building PsyCap. This study adds further evidence that PsyCap does not develop in a vacuum. Avey (Reference Avey2014) identified that authentic leadership predicts PsyCap, which suggests that organisations can positively impact employees' wellbeing by using the right positively-oriented tools. This study contributes new information about how awareness and control of emotions provide the initial building blocks for building PsyCap, and empirically shows the impact of the processes used by one large organisation delivering care. Further empirical studies are required to test this premise.

There are several limitations to consider when examining the results and conclusions. First, whilst the initial two phases ‘discovery’ and ‘dreaming’ involved a consultative approach involving multiple organisational stakeholders, the ‘designing’ phase was limited to the selected senior managers, organisational learning employees, and the researchers, and the ‘AD’ phase (Bushe, Reference Bushe2012) involved a relatively low sample size (n = 98) across only five departments. Second, to further validate the AD program, it is important that further studies include a control group and further testing at a later date to provide deeper insights about the nexus between understanding and controlling emotions and psychological states, such as PsyCap, and increased wellbeing. Additionally, the relatively low number of professionals has compromised the researchers' ability to gain greater insight by dividing the groups not only based on low and high PsyCap but also possibly based on their work roles or professions. Also future studies could be further enriched by a stronger focus on qualitative analysis of the employees' perspectives. Finally, while the collaboration was intentionally designed to stimulate positive affect, we did not empirically examine the contagion effect or the influence of positive/negative affect on employee PsyCap and wellbeing.

A key contribution of this study is the use of the AI process for building organisational resilience, including the empirical testing of the AD program in an Australian NFP organisation that delivers caring services. The AD program was designed to test whether the engagement activities fostered employee's knowledge of and use of positive coping mechanisms, so as to develop carer's personal resource – PsyCap, as a way of building on their existing wellbeing. This is important because, for example, approximately one-fifth of aged care workers perceive stress or a mental condition leading to work-related illnesses and injuries (Commonwealth Department of Health, 2017). Our study shows that the AD program was somewhat successful in increasing the wellbeing of employees, although it was more successful for those with higher PsyCap. Such findings are in line with the conservation of resources theory, which stipulates that those with adequate resources will be able to draw upon those resources to further develop resources and conserve against resource loss (Hobfoll, Reference Hobfoll2011). Additionally, the findings of PsyCap outcomes are different from the research undertaken by Luthans, Avery, and Patera (Reference Luthans, Avery and Patera2008). One explanation could be that Luthans, Avery, and Patera did not use work with organisations that employ emotional labour. Emotional labour differs from other employees because of the long-term impact of having to present a different emotion to clients/patients compared with the emotions they are really experiencing (such as having to hide their anger or sadness) (Chau et al., Reference Chau, Dahling, Levy and Diefendorff2009). The lesson for managers from the AD program is that employees' PsyCap and wellbeing do not exist in a vacuum; instead, especially for emotional labour, there are basic building blocks (namely self-awareness and control of emotions) that provide the scaffolding for employees to build on their existing PsyCap and wellbeing.

Self-awareness and control of emotions are especially important for those carers who perceive a high contagion effect (Petitta, Jiang, & Härtel, Reference Petitta, Jiang and Härtel2016). This is because those who are affected by contagion are drawn to, and are more affected by either positive or negative emotions (sadness, anger), and consequently, are more likely to be, respectively, positively or negatively affected in terms of stress. Barsade and O'Neill (Reference Barsade and O'Neill2014) explain that those employees susceptible to negative contagion are likely to have had a dysfunctional childhood, and when negative events occur at work, it affects them more because of a high level of emotional contagion, especially compared to those with high PsyCap and low emotional contagion. It seems likely that AD program aimed at building on existing wellbeing for carers must be mindful that this group is over-represented in those claiming stress-related workers compensation claims, and therefore, a more intensive AD program may be necessary for some. Future research should consider this claim.

There are two implications emerging from the AD phase. The first implication for organisations is that they could be more selective in screening for contagion effect at the recruitment stage, especially because this group is over-represented in the number of stress-related workers compensation claims from the community sector (Work Safe Australia, 2013). Second, the AD program was not designed to overcome issues related to negative emotional contagion. Whilst the contagion effect is established in research, no previous research has identified the type of development initiative likely to be successful in building individual attributes for those identified with low PsyCap, although the need to build better coping options is evident in the qualitative findings (see Tables 25). Hence, future research should consider ways of tailoring an AD program specifically designed to build personal resources for those with high contagion. Additionally, assuming that in any organisation that provides caring services, a sizeable number of the carers are likely to have higher levels of contagion (Petitta et al., Reference Petitta, Jiang and Härtel2016), an important strategy for building on their existing wellbeing is to target a more intensive front-end self-awareness component during the AD program to build on their existing lower levels of personal resources.

Table 2. ‘The most important thing that I learnt from doing this training is …’ (N = 98)

Note. Each example uses a direct quote.

Table 3. Based on what you have learnt in the training, what skills can you use in the workplace? (n = 98)

Note. Each example uses a direct quote.

Table 4. Qualitative responses to the question ‘What is the most important thing you learnt from the training?’ (n = 20)

Note. Each example uses a direct quote.

Table 5. Useability of learnt skills (n = 20)

Note. Each example uses a direct quote.

Conclusion

This study was part of an AI/POSH change program for building resilience and positivity in the workplace (Bushe, Reference Bushe2012). This study builds on existing research by Verleysen, Lambrechts, and Van Acker (Reference Verleysen, Lambrechts and Van Acker2014) and Dadich et al. (Reference Dadich, Collier, Hodgins and Crawford2018) by testing the impact of an AD phase which integrates the work of Luthans, Avery, and Patera (Reference Luthans, Avery and Patera2008), Seligman (Reference Seligman2011), and Reivich, Seligman, and McBride (Reference Reivich, Seligman and McBride2011). The AD phase identified the important role of ensuring appropriate self-awareness and control of emotions as an important basic building block of building on existing strengths (wellbeing). Hence, to increase the capability and resilience of the whole workforce and improve organisational effectiveness, it is important to further develop knowledge and skill development about self-awareness and control of emotions as a step towards building wellbeing for emotional labour.

Author ORCIDs

Yvonne Brunetto, 0000-0001-7219-0817; Tom Dick, 0000-0002-9809-6308.

References

Australian Bureau of Statistics (ABS). (2015). National Health Survey: First results, 2014–2015 (catalogue no. 4364.0.55.001). Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument.Google Scholar
Avey, J., Reichard, R., Luthans, F., & Mhatre, K. (2011). Meta-analysis of the impact of positive psychological capital on employee attitudes, behaviors, and performance. Human Resource Development Quarterly, 22, 127151.CrossRefGoogle Scholar
Avey, J. B. (2014). The left side of psychological capital new evidence on the antecedents of psycap. Journal of Leadership & Organisational Studies, 21(2), 141149.CrossRefGoogle Scholar
Barker Caza, B., & Caza, A. (2008). Positive organisational scholarship: A critical theory perspective. Journal of Management Inquiry, 17, 2133. doi: 10.1177/1056492607305907.CrossRefGoogle Scholar
Barsade, S, & O'Neill, O (2014). What's love got to do with it? A longitudinal study of the culture of companionate love and employee and client outcomes in the long-term care setting. Administrative Science Quarterly, 59(4), 551598.CrossRefGoogle Scholar
Bushe, G. R. (2012). Foundations of appreciative inquiry: History, criticism and potential. AI Practitioner, 14(1), 820.Google Scholar
Brunetto, Y., Farr-Wharton, R., & Shacklock, K. (2011). Using the Harvard HRM model to conceptualise the impact of changes to supervision upon HRM outcomes for different types of Australian public sector employees. International Journal of Human Resource Management, 22(3), 553573.CrossRefGoogle Scholar
Brunetto, Y., Rodwell, J., Shacklock, K., Farr-Wharton, R., & Demir, D. (2016). The impact of individual and organisational resources on nurse outcomes and intent to quit. Journal of Advanced Nursing, 72(12), 30933103.CrossRefGoogle Scholar
Brunetto, Y., Xerri, M., Trinchero, E., Beattie, R., Shacklock, K., Farr-Wharton, R., & Borgonovi, E. (2018). Comparing the impact of management on public and private sector nurses in UK, Italy and Australia. Public Management Review, 20(4), 525544.CrossRefGoogle Scholar
Brunetto, Y., Xerri, M., Trinchero, E., Farr-Wharton, R., Shacklock, K., & Borgonovi, E. (2016). Public-private sector comparisons of nurses’ work harassment using SET: Italy and Australia. Public Management Review, 18(10), 14791503.CrossRefGoogle Scholar
Cameron, K. S., & Caza, A. (2004). Contributions to the discipline of positive organisational scholarship. American Behavioral Scientist, 47, 731739. doi:10.1177/0002764203260207.CrossRefGoogle Scholar
Chau, S. L., Dahling, J. J., Levy, P. E., & Diefendorff, J. M. (2009). A predictive study of emotional labour and turnover. Journal of Organisational Behavior, 30, 11511163.CrossRefGoogle Scholar
Commonwealth Department of Health. (2017). 2016 National Aged Care Workforce Census and Survey – the aged care workforce, 2016. Canberra, Australia.Google Scholar
Creswell, J. W., & Plano Clark, V. L. (2011). Designing and conducting mixed methods research (2nd ed.). Thousand Oaks, CA: Sage, (pp. 8182).Google Scholar
Dadich, A., Collier, A., Hodgins, M., & Crawford, G. (2018). Using positive organisational scholarship in healthcare and video reflexive ethnography to examine positive deviance to new public management in healthcare. Qualitative Health Research 28(8). doi:10.1177/1049732318759492.CrossRefGoogle Scholar
Donaldson, S., & Ko, I. (2010). Positive organisational psychology, behavior, and scholarship: A review of the emerging literature and evidence base. The Journal of Positive Psychology, 5(3), 177191.CrossRefGoogle Scholar
Dutton, J., Glynn, M., & Spreitzer, G. (2007). Positive organisational scholarship. Encyclopedia of Positive Psychology, 2, 737741.Google Scholar
Forgeard, M. J. C, Jayawickreme, E., Kern, M. L., & Seligman, M. E. P. (2011). Doing the right thing: Measuring wellbeing for public policy. International Journal of Wellbeing,, 1(1), 79106.Google Scholar
Fredrickson, B., & Losada, L. (2005). Positive affect and the complex dynamics of human flourishing. American Psychologist, 60(7), 678686.CrossRefGoogle ScholarPubMed
Grandey, A. (2000). Emotional regulation in the workplace: A new way to conceptualize. Journal of Occupational Health Psychology, 5(1), 95110.CrossRefGoogle ScholarPubMed
Hobfoll, S. E. (2011). Conservation of resource caravans and engaged settings. Journal of Occupational and Organizational Psychology, 84(1), 116122.CrossRefGoogle Scholar
Kessler, R. C., & Üstün, T. B. (2004). The world mental health (WMH) survey initiative version of the world health organisation (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93121.CrossRefGoogle Scholar
Luthans, F., Avery, J., & Patera, J. (2008). Experimental analysis of a web-based training intervention to develop positive psychological capital. Management Department Faculty Publications. (Paper 135). Retrieved from http://digitalcommons.unl.edu/managementfacpub/1357.Google Scholar
Luthans, F., Vogelgesang, G., & Lester, P. (2006). Developing the psychological capital of resiliency. Human Resource Development Review, 5(1), 2544.CrossRefGoogle Scholar
Luthans, F., Youssef, C. M., & Avolio, B. J. (2007). Psychological capital: Developing the human competitive edge. New York: Oxford University Press.Google Scholar
Luthans, F., & Youssef–Morgan, C. M. (2017). Psychological capital: An evidence-based positive approach. Annual Review of Organisational Psychology and Organisational Behaviour, 4, 339366.CrossRefGoogle Scholar
OECD (2008). Growing unequal poverty and incomes over 20 years growing unequal? https://www.oecd.org/els/soc/growingunequalincomedistributionandpovertyinoecdcountries.htm.Google Scholar
O'Leary, Z. (2007). The social science jargon buster. London: Sage.CrossRefGoogle Scholar
Petitta, L., Jiang, L., & Härtel, C. (2016). Emotional contagion and burnout among nurses and doctors: Do joy and anger from different sources of stakeholders matter? Stress and Health, 33, 358369.CrossRefGoogle ScholarPubMed
Reivich, K., Seligman, M., & McBride, S. (2011). Master resilience training in the U.S. Army. American Psychologist, 66(1), 2534.CrossRefGoogle ScholarPubMed
Seligman, M. (2011). Flourish: A visionary new understanding of happiness and well-being. NY: Free Press.Google Scholar
Story, J. S., Youssef, C. M., Luthans, F., Barbuto, J. E., & Bovaird, J. (2013). Contagion effect of global leaders' positive psychological capital on followers: Does distance and quality of relationship matter? The International Journal of Human Resource Management, 24(13), 25342553.CrossRefGoogle Scholar
Work Safe Australia. (2013). The Australian workplace barometer: Report on psychosocial safety climate and worker health in Australia, Safe Work Australia. Retrieved from https://www.safeworkaustralia.gov.au/.../the-australian-workplace-barometer-report.p.Google Scholar
Verleysen, B., Lambrechts, F., & Van Acker, F. (2014). Building psychological capital with appreciative inquiry: Investigating the mediating role of basic psychological need satisfaction. The Journal of Applied Behavioral Science, 51(1), 1035.CrossRefGoogle Scholar
Yin, R. (2011). Qualitative research from start to finish. New York: Guilford Press.Google Scholar
Figure 0

Figure 1. The impact of training on PsyCap, knowledge, use of, and control of negative emotions N = 20

Figure 1

Figure 2. Carers divided into those with higher PsyCap (top line) and those with lower PsyCap (lower line)

Figure 2

Table 1. ANOVA of wellbeing and PsyCap from T1 to T2

Figure 3

Table 2. ‘The most important thing that I learnt from doing this training is …’ (N = 98)

Figure 4

Table 3. Based on what you have learnt in the training, what skills can you use in the workplace? (n = 98)

Figure 5

Table 4. Qualitative responses to the question ‘What is the most important thing you learnt from the training?’ (n = 20)

Figure 6

Table 5. Useability of learnt skills (n = 20)