Although Watts et al. (Reference Watts, Gray and Medeiros2021) provide insight into the unintended negative consequences of organizational interventions (i.e., “side effects”), the authors did not consider potential desirable consequences nor did they consider foreseeable effects. Extending their analysis, we present a typology of nonprimary organizational intervention effects that distinguishes between desirability and foreseeability. We define desirability as whether the effect is consistent (desirable) or not (undesirable) with the intended outcome of the intervention (Leslie, Reference Leslie2019). Foreseeability refers to whether existing theory can inform the nonprimary outcome of the intervention (foreseeable) or not (unforeseeable). Lending on our two-by-two typology that includes side effects (undesirable and unforeseeable), we identify three effects not otherwise considered by Watts et al. First, a happy accident occurs when an organizational intervention has a desirable but unforeseen consequence. Second, broadening is a desirable but foreseeable consequence. Finally, a trade-off occurs when the intervention has an undesirable albeit foreseeable consequence.
Our typology makes two contributions to the organizational interventions literature. First, whereas others have only considered the unintended or unforeseen consequences of organizational interventions (Leslie, Reference Leslie2019; Watts et al., Reference Watts, Gray and Medeiros2021), our typology integrates foreseeable consequences above and beyond the main effect. This is an important elaboration because organizations are complex, interdependent, social entities (Carpini et al., Reference Carpini, Parker and Griffin2017), and thus it can be expected that an intervention will affect not only the intended target but also related stakeholders and systems (Merton, Reference Merton1936). Additionally, implementing evidence-based interventions means there should be theoretical and empirical inputs that can help identify not only the desirable main but also potential secondary effects. Second, whereas side effects are construed as inherently undesirable (Watts et al.), we contend this perspective fails to consider desirable intervention outcomes beyond the main goals (Leslie, Reference Leslie2019; Merton, Reference Merton1936). Together, we provide a framework for assessing outcomes beyond the intended main effects and the negative unforeseen consequences.
Happy accident: Desirable and unforeseen consequence
The first category of our typology is happy accident, defined as the nonprimary, desirable, and unforeseen consequence of an organizational intervention. Although poorly understood due to a lack of existing theory (Leslie, Reference Leslie2019), happy accidents are likely to occur because organizations are complex and interdependent systems (Carpini et al., Reference Carpini, Parker and Griffin2017). Thus, an organizational intervention targeted at one outcome may have a positive effect on another. Documented cases of happy accidents are lacking but can be found in fields including economics and engineering. For example, a recent review of organizational environmental innovation initiatives suggests organizations benefit from the introduction of new environmentally friendly technologies but that their introduction also flows on to inform innovations in other areas and even shape government policy (Aldieri et al., Reference Aldieri, Carlucci, Vinci and Yigitcanlar2019).
An organizational intervention program involving the disability services sector in Western Australia provides an exemplar of the “happy accident” effect. Within a context of rapidly changing legislative policies and funding structures and increasing complex needs of clients there was a sectorwide imperative to develop capacity in designing innovative and adaptive services. Supported by the Disability Services Commission (a state government agency), disability services agencies were tasked with implementing positive behavior support (PBS), a service philosophy that is grounded in improving quality of life, safeguarding human rights, eliminating restrictive practices, and opening new opportunities for people with disabilities (Carr et al., Reference Carr, Dunlap, Horner, Koegel, Turnbull, Sailor, Anderson, Albin, Koegel and Fox2002). The research study adopted a longitudinal case-based approach to examine the process of change implementation in 18 service organizations over a period of 18 months.
The data revealed that as the change implementation progressed from the initial stages of growing awareness to the later stages of embedding change in organizational routines and processes, an unforeseen desirable outcome arose. As primary stakeholders, parents of children with disabilities were actively involved in working together with support workers from the service agencies to inform service design and delivery using PBS principles. Over time, as parents became more knowledgeable about the new changes and observed increasing levels of confidence and independence in their children, they became advocates of PBS implementation themselves. To that effect, several parents were involved in designing and delivering staff development training programs as a way of sharing their own insights and lived experiences. To this day, the training program Is There a Better Way? is a flourishing initiative whereby families and service providers engage in cocreating disability care and services in a “safe and non-judgemental space for collaborative reflection and problem solving” (Edwards et al., Reference Edwards, Soo and Greckhamer2016, p. 186). This exemplar reflects the unforeseen (thus “accidental”) nature of an outcome that was only realized through the benefit of time as primary stakeholders (i.e., parents) experienced positive results from the initial intervention. Through experimenting with innovative support services over time, faith and confidence in the importance of PBS principles created an unexpected group of change advocates who now represent a leading force in championing future change initiatives within the sector.
Broadening: Desirable and foreseen consequence
The second category in our typology is broadening, defined as the nonprimary, desirable, and foreseeable consequence of an organizational intervention. The broadening effect is similar to positive spill over (Leslie, Reference Leslie2019) because benefits beyond the immediate outcomes are generated; however, we posit broadening is foreseeable when the intervention is evidence based, representing a unique effect. Broadening is likely because attitudinal and behavioral outcomes related to the primary target of organizational interventions may share the same mechanisms. For example, diversity training programs may enhance minority representation as well as increase ethical decision making that is unrelated to diversity because the program emphasizes social justice and perspective taking.
An example of the broadening effect comes from an intervention involving the surgical teams from three tertiary hospitals. Specifically, a preoperative multidisciplinary team briefing intervention (herein referred to as “briefings”) was introduced. Briefings are short 3- to 5-minute meetings that occur before a nonemergency operating room team commences their list (a predetermined list of patients) that involves surgeons, anaesthetists, nurses, and support staff. Briefings are opportunities for team members to introduce themselves, codevelop a “big picture” overview of the day, review individual cases including any equipment requirements, and ask questions (Carpini et al., Reference Carpini, Flemming and Parker2015). The briefing intervention was in response to growing evidence suggesting near misses, complications, and even mortality could often be related to communication failures. Investigations as to the underlying causes of these seminal events often highlight hierarchical structures and a general reluctance to speak up as major contributors (Lingard et al., Reference Lingard, Regehr, Cartmill, Orser, Espin, Bohnen, Reznick, Baker, Rotstein and Doran2011). Organizational psychology research has identified psychological safety—the “perceptions of the consequences of taking interpersonal risks in a particular context”—as an important antecedent of speaking up (Edmondson & Lei, Reference Edmondson and Lei2014, p. 24). Therefore, the research team sought to examine the influence of briefings on engendering psychological safety among surgical teams as a means of enhancing communication and patient safety because briefings are expected to help create group norms of respectful information sharing and speaking up. The intervention involved training staff on how to conduct high-quality briefings.
As intended, the briefing intervention did increase reported levels of psychological safety among operating room teams when compared with a preintervention baseline. Notably, there was also an increase in patient safety communication and specifically speaking-up behavior (Parker et al., Reference Parker, Rommohan, Griffin, Flemming, Hamdorf, Leung, Fruhen, Carpini and Yam2016–Reference Parker, Rommohan, Griffin, Flemming, Hamdorf, Leung, Fruhen, Carpini and Yam2018). In addition to the desired effect, the briefing intervention enhanced team members’ identification with their workplace. For example, one surgical fellow stated, “Before, I felt just like a contract laborer doing my job, but the briefing helped me to express and connect with my workplace a lot better.” This finding, although not the intended intervention outcome, was desirable and foreseeable given psychological safety is positively related to trust and information sharing, all of which can contribute to team members’ feeling like they are collaborating in a shared goal (Edmondson & Lei, Reference Edmondson and Lei2014).
Trade-off: Undesirable and foreseen consequence
The third category of our typology is trade off, which we define as the nonprimary, undesirable, and foreseen consequence of an organizational intervention. Industrial and organizational psychology scholars and practitioners have long been aware of the potential trade-offs associated with various interventions. For example, well-being interventions may require trade-offs such as increasing employee autonomy through job enrichment at the potential cost of physical well-being (Grant et al., Reference Grant, Christianson and Price2007). Trade-offs are distinct from the “backfire” effect identified by Leslie (Reference Leslie2019) because the latter is defined by an intervention having the opposite effect on the primary outcome, such as when a diversity intervention increases awareness of individual differences instead of engendering cohesion. Trade-offs are also distinct from side effects (Watts et al., Reference Watts, Gray and Medeiros2021) because trade-offs are undesirable yet foreseeable outcomes of organizational interventions. Whereas prior research has focused almost uniquely on the potential trade-offs for focal employees, we expand this perspective to consider other stakeholders—namely, the researchers themselves.
An illustrative example of the trade-off effect as a function of organizational intervention comes from recent work within the Western Australia local government context. Australian local governments, headed by chief executive officers (CEOs), manage vast public asset portfolios and key activities (e.g., waste management and infrastructure) while often juggling competing demands from various stakeholders. For example, there are many documented instances of ratepayers acting uncivilly toward CEOs both at work (e.g., yelling in council meetings) and in the community (e.g., vandalizing personal property) when ratepayers believe their needs have not been met. Therefore, it is not entirely surprising that these CEOs report levels of psychological distress almost three times the national average (Timming et al., Reference Timming, Notebaert and Carpini2019). To address CEOs’ high levels of psychological distress, a resilience training program was developed and introduced as a short-term intervention while research was undertaken to identify system and policy interventions for more systemic change.
The primary intention of the resilience program was to equip CEOs with cognitive and behavioral strategies to mitigate the personal negative effects of ratepayer-enacted incivility. The program was rolled out and garnered media attention that emphasized the program goals of helping CEOs respond to incivility. Once the intervention became public knowledge, an undesirable yet foreseeable effect was that ratepayer-instigated incivility rose sharply. Specifically, ratepayer-instigated incivility directed at the CEOs intensified and the research team itself also became new targets. Acts of researcher-directed incivility began with disparaging emails and phone calls, followed by complaints to the dean and university research ethics committee. Although the complaints were dismissed, the intensification of incivility was foreseen. Indeed, consistent with an organizational systems perspective of incivility that emphasizes the underlying social network—that is, a “ set of actors and the set of ties representing some relationship … between actors” (Miner et al., Reference Miner, Diaz, Wooderson, Mcdonald, Smittick and Lomeli2018, p. 331)—the researchers anticipated backlash from certain ratepayer groups because of the affiliation with their primary targets of incivility, the CEOs. Additionally, the research findings that ratepayer incivility was a major concern also put the researchers at odds with the instigators. This case example highlights the importance of considering multiple stakeholders, including the practitioners themselves, when assessing organizational intervention trade-offs.
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Although Watts et al. (Reference Watts, Gray and Medeiros2021) provide insight into the unintended negative consequences of organizational interventions (i.e., “side effects”), the authors did not consider potential desirable consequences nor did they consider foreseeable effects. Extending their analysis, we present a typology of nonprimary organizational intervention effects that distinguishes between desirability and foreseeability. We define desirability as whether the effect is consistent (desirable) or not (undesirable) with the intended outcome of the intervention (Leslie, Reference Leslie2019). Foreseeability refers to whether existing theory can inform the nonprimary outcome of the intervention (foreseeable) or not (unforeseeable). Lending on our two-by-two typology that includes side effects (undesirable and unforeseeable), we identify three effects not otherwise considered by Watts et al. First, a happy accident occurs when an organizational intervention has a desirable but unforeseen consequence. Second, broadening is a desirable but foreseeable consequence. Finally, a trade-off occurs when the intervention has an undesirable albeit foreseeable consequence.
Our typology makes two contributions to the organizational interventions literature. First, whereas others have only considered the unintended or unforeseen consequences of organizational interventions (Leslie, Reference Leslie2019; Watts et al., Reference Watts, Gray and Medeiros2021), our typology integrates foreseeable consequences above and beyond the main effect. This is an important elaboration because organizations are complex, interdependent, social entities (Carpini et al., Reference Carpini, Parker and Griffin2017), and thus it can be expected that an intervention will affect not only the intended target but also related stakeholders and systems (Merton, Reference Merton1936). Additionally, implementing evidence-based interventions means there should be theoretical and empirical inputs that can help identify not only the desirable main but also potential secondary effects. Second, whereas side effects are construed as inherently undesirable (Watts et al.), we contend this perspective fails to consider desirable intervention outcomes beyond the main goals (Leslie, Reference Leslie2019; Merton, Reference Merton1936). Together, we provide a framework for assessing outcomes beyond the intended main effects and the negative unforeseen consequences.
Happy accident: Desirable and unforeseen consequence
The first category of our typology is happy accident, defined as the nonprimary, desirable, and unforeseen consequence of an organizational intervention. Although poorly understood due to a lack of existing theory (Leslie, Reference Leslie2019), happy accidents are likely to occur because organizations are complex and interdependent systems (Carpini et al., Reference Carpini, Parker and Griffin2017). Thus, an organizational intervention targeted at one outcome may have a positive effect on another. Documented cases of happy accidents are lacking but can be found in fields including economics and engineering. For example, a recent review of organizational environmental innovation initiatives suggests organizations benefit from the introduction of new environmentally friendly technologies but that their introduction also flows on to inform innovations in other areas and even shape government policy (Aldieri et al., Reference Aldieri, Carlucci, Vinci and Yigitcanlar2019).
An organizational intervention program involving the disability services sector in Western Australia provides an exemplar of the “happy accident” effect. Within a context of rapidly changing legislative policies and funding structures and increasing complex needs of clients there was a sectorwide imperative to develop capacity in designing innovative and adaptive services. Supported by the Disability Services Commission (a state government agency), disability services agencies were tasked with implementing positive behavior support (PBS), a service philosophy that is grounded in improving quality of life, safeguarding human rights, eliminating restrictive practices, and opening new opportunities for people with disabilities (Carr et al., Reference Carr, Dunlap, Horner, Koegel, Turnbull, Sailor, Anderson, Albin, Koegel and Fox2002). The research study adopted a longitudinal case-based approach to examine the process of change implementation in 18 service organizations over a period of 18 months.
The data revealed that as the change implementation progressed from the initial stages of growing awareness to the later stages of embedding change in organizational routines and processes, an unforeseen desirable outcome arose. As primary stakeholders, parents of children with disabilities were actively involved in working together with support workers from the service agencies to inform service design and delivery using PBS principles. Over time, as parents became more knowledgeable about the new changes and observed increasing levels of confidence and independence in their children, they became advocates of PBS implementation themselves. To that effect, several parents were involved in designing and delivering staff development training programs as a way of sharing their own insights and lived experiences. To this day, the training program Is There a Better Way? is a flourishing initiative whereby families and service providers engage in cocreating disability care and services in a “safe and non-judgemental space for collaborative reflection and problem solving” (Edwards et al., Reference Edwards, Soo and Greckhamer2016, p. 186). This exemplar reflects the unforeseen (thus “accidental”) nature of an outcome that was only realized through the benefit of time as primary stakeholders (i.e., parents) experienced positive results from the initial intervention. Through experimenting with innovative support services over time, faith and confidence in the importance of PBS principles created an unexpected group of change advocates who now represent a leading force in championing future change initiatives within the sector.
Broadening: Desirable and foreseen consequence
The second category in our typology is broadening, defined as the nonprimary, desirable, and foreseeable consequence of an organizational intervention. The broadening effect is similar to positive spill over (Leslie, Reference Leslie2019) because benefits beyond the immediate outcomes are generated; however, we posit broadening is foreseeable when the intervention is evidence based, representing a unique effect. Broadening is likely because attitudinal and behavioral outcomes related to the primary target of organizational interventions may share the same mechanisms. For example, diversity training programs may enhance minority representation as well as increase ethical decision making that is unrelated to diversity because the program emphasizes social justice and perspective taking.
An example of the broadening effect comes from an intervention involving the surgical teams from three tertiary hospitals. Specifically, a preoperative multidisciplinary team briefing intervention (herein referred to as “briefings”) was introduced. Briefings are short 3- to 5-minute meetings that occur before a nonemergency operating room team commences their list (a predetermined list of patients) that involves surgeons, anaesthetists, nurses, and support staff. Briefings are opportunities for team members to introduce themselves, codevelop a “big picture” overview of the day, review individual cases including any equipment requirements, and ask questions (Carpini et al., Reference Carpini, Flemming and Parker2015). The briefing intervention was in response to growing evidence suggesting near misses, complications, and even mortality could often be related to communication failures. Investigations as to the underlying causes of these seminal events often highlight hierarchical structures and a general reluctance to speak up as major contributors (Lingard et al., Reference Lingard, Regehr, Cartmill, Orser, Espin, Bohnen, Reznick, Baker, Rotstein and Doran2011). Organizational psychology research has identified psychological safety—the “perceptions of the consequences of taking interpersonal risks in a particular context”—as an important antecedent of speaking up (Edmondson & Lei, Reference Edmondson and Lei2014, p. 24). Therefore, the research team sought to examine the influence of briefings on engendering psychological safety among surgical teams as a means of enhancing communication and patient safety because briefings are expected to help create group norms of respectful information sharing and speaking up. The intervention involved training staff on how to conduct high-quality briefings.
As intended, the briefing intervention did increase reported levels of psychological safety among operating room teams when compared with a preintervention baseline. Notably, there was also an increase in patient safety communication and specifically speaking-up behavior (Parker et al., Reference Parker, Rommohan, Griffin, Flemming, Hamdorf, Leung, Fruhen, Carpini and Yam2016–Reference Parker, Rommohan, Griffin, Flemming, Hamdorf, Leung, Fruhen, Carpini and Yam2018). In addition to the desired effect, the briefing intervention enhanced team members’ identification with their workplace. For example, one surgical fellow stated, “Before, I felt just like a contract laborer doing my job, but the briefing helped me to express and connect with my workplace a lot better.” This finding, although not the intended intervention outcome, was desirable and foreseeable given psychological safety is positively related to trust and information sharing, all of which can contribute to team members’ feeling like they are collaborating in a shared goal (Edmondson & Lei, Reference Edmondson and Lei2014).
Trade-off: Undesirable and foreseen consequence
The third category of our typology is trade off, which we define as the nonprimary, undesirable, and foreseen consequence of an organizational intervention. Industrial and organizational psychology scholars and practitioners have long been aware of the potential trade-offs associated with various interventions. For example, well-being interventions may require trade-offs such as increasing employee autonomy through job enrichment at the potential cost of physical well-being (Grant et al., Reference Grant, Christianson and Price2007). Trade-offs are distinct from the “backfire” effect identified by Leslie (Reference Leslie2019) because the latter is defined by an intervention having the opposite effect on the primary outcome, such as when a diversity intervention increases awareness of individual differences instead of engendering cohesion. Trade-offs are also distinct from side effects (Watts et al., Reference Watts, Gray and Medeiros2021) because trade-offs are undesirable yet foreseeable outcomes of organizational interventions. Whereas prior research has focused almost uniquely on the potential trade-offs for focal employees, we expand this perspective to consider other stakeholders—namely, the researchers themselves.
An illustrative example of the trade-off effect as a function of organizational intervention comes from recent work within the Western Australia local government context. Australian local governments, headed by chief executive officers (CEOs), manage vast public asset portfolios and key activities (e.g., waste management and infrastructure) while often juggling competing demands from various stakeholders. For example, there are many documented instances of ratepayers acting uncivilly toward CEOs both at work (e.g., yelling in council meetings) and in the community (e.g., vandalizing personal property) when ratepayers believe their needs have not been met. Therefore, it is not entirely surprising that these CEOs report levels of psychological distress almost three times the national average (Timming et al., Reference Timming, Notebaert and Carpini2019). To address CEOs’ high levels of psychological distress, a resilience training program was developed and introduced as a short-term intervention while research was undertaken to identify system and policy interventions for more systemic change.
The primary intention of the resilience program was to equip CEOs with cognitive and behavioral strategies to mitigate the personal negative effects of ratepayer-enacted incivility. The program was rolled out and garnered media attention that emphasized the program goals of helping CEOs respond to incivility. Once the intervention became public knowledge, an undesirable yet foreseeable effect was that ratepayer-instigated incivility rose sharply. Specifically, ratepayer-instigated incivility directed at the CEOs intensified and the research team itself also became new targets. Acts of researcher-directed incivility began with disparaging emails and phone calls, followed by complaints to the dean and university research ethics committee. Although the complaints were dismissed, the intensification of incivility was foreseen. Indeed, consistent with an organizational systems perspective of incivility that emphasizes the underlying social network—that is, a “ set of actors and the set of ties representing some relationship … between actors” (Miner et al., Reference Miner, Diaz, Wooderson, Mcdonald, Smittick and Lomeli2018, p. 331)—the researchers anticipated backlash from certain ratepayer groups because of the affiliation with their primary targets of incivility, the CEOs. Additionally, the research findings that ratepayer incivility was a major concern also put the researchers at odds with the instigators. This case example highlights the importance of considering multiple stakeholders, including the practitioners themselves, when assessing organizational intervention trade-offs.