A dynamic ontology of creativity and standardization in high-stakes work: Lessons from the bedside in intensive care units

Resolving how to be creative amid standardization is part of the professional work experience. Yet, few studies have examined how workers perceive the relationship between creativity and standardization, and how and why this may change. Nowhere is the tension between creativity and standardization more consequential than in hospital intensive care units, where decisions regarding this relationship have life-or-death outcomes. In this study, we conducted 60 in-depth interviews with intensive care unit professionals of differing roles, tenures, and specializations, in six intensive care units in a large hospital system in the North-East United States. Our inductive, grounded theory approach identified how professionals progress in their perceptions of mutuality between creativity and standardization: from conflicting, to ignoring, to embracing. These stages are also associated with emotions such as anger, cynicism, and joy. While most professionals advance through these stages as they gain latitude at work (either from advanced tenure, training status, or specialized knowledge), they can also fall back to earlier stages as they conflict with system-related standardization. We propose a model in which the integration of creativity and standardization in a professionals’ orientation to work is the foundation for work-related emotions. We elaborate on the process facilitators of harmonious creativity and standardization and the implications of our model for understanding individual creativity amid organizational and task-related standardization. This understanding provides a new way for professionals to resolve individual creative endeavors with organizational constraints to create well-being and effectiveness.

Questions:

• What is the best way to describe the relationship between creativity and standardization? Perceived mutuality? Balance? Dualism?
• Importance of context: this is a setting where the priority is saving lives, not creativity. The context shares features with some professional service industries, but also high-stakes industries where the outcomes are consequential and standardization is common, e.g., the military and aviation.
• How to integrate the role of emotions into the model?
• Ideas on describing mechanisms that explain how and when professionals shift between stages?
• How should we label the different “types” of creativity