Organizational learning during COVID-19: A qualitative study of nurses' experiences

Aim

The aim of this study is to test the validity of the Organizational Learning in Hospitals model in the context of the COVID‐19 pandemic.

Background

Organizational learning is especially crucial in circumstances of intense, complex, enduring change, as with the COVID‐19 pandemic. Nurse managers need additional guidance for fostering organizational learning under such circumstances. The Organizational Learning in Hospitals model may be a helpful resource but requires additional validation.

Methods

Semi‐structured interviews were conducted to gather 19 nurses' first‐hand experiences of organizational learning during the COVID‐19 pandemic. Data were analysed using deductive thematic analysis.

Results

Nurses' experiences of organizational learning generally aligned with the tenets of the model. Specifically, effective organizational learning occurred when the contextual factors and mechanisms portrayed in the model converged. Model and contrary cases illustrate this phenomenon.

Conclusions

This study validates and adds context to the model. It offers practical examples of the contextual factors and mechanisms of organizational learning. Leaders can use the model to guide their efforts to foster organizational learning.

Implications for Nursing Management

This study reaffirms the importance of nurse leaders' central role in organizational learning. Nurse leaders can use the Organizational Learning in Hospitals model, and the practical examples provided, to foster organizational learning during challenging times.

Resilience Competence Face Framework for the Unforeseen: Relations, Emotions and Cognition. A Qualitative Study

The high impact of unforeseen events in a globalized world accentuates the importance of a greater in-depth and broader understanding of resilient competencies that can promote performance. Traditional research has, however, paid relatively little attention to uncertainty and unpredictable conditions, including the particulate competence of the unforeseen, and how organizations can achieve degrees of resilience. Hence, the purpose of this study is to explore whether there are types of competence at the individual, social and organizational level that can enhance preparedness to face the unforeseen. The first aim was to explore how highly experienced professionals from different sectors and organizational levels describe and understand the nature and function of the unforeseen phenomenon. The second aim was to explore what resilient competencies can be beneficially applied in organizations to enhance performance irrespective of the scenario or event that occurs. The generic qualitative approach of this study employed semi-structured interviews. The purposive expert sample of 13 highly knowledgably Norwegian professionals with unique and extensive cross-sectorial experience of unforeseen events were selected. Ages ranged from 41 to 62 years (M = 48.92, SD = 6.94), length of professional experience and education ranging from 22 to 43 years. Thematic analysis of interview transcripts and the interpretation displayed six types of resilience competence: (1) General Preparedness, (2) Characteristics and Competence of the Individual, (3) Sound Relations, (4) Creative Behavior and Improvisational Skills, (5) The Ability to Reflect and Learn, (6) Emotion Efficacy. In addition, The Unforeseen was discerned as a complex phenomenon. These findings emphasize a cross-disciplinary perspective and provides integrative multilevel insight into the particulate competence of the unforeseen by introducing a framework that serves as a foundation for future research and as a tool for practitioners working in the field.

The role of organizational learning and resilience for change in building quality improvement capacity in primary care

BACKGROUND

The extent that organizational learning and resilience for the change process, that is, adaptive reserve (AR), is a component of building practice capacity for continuous quality improvement (QI) is unknown.

PURPOSE

The aim of the study was to examine the association of AR and development of QI capacity.

METHODOLOGY

One hundred forty-two primary care practices were evaluated at baseline and 12 months in a randomized trial to improve care quality. Practice AR was measured by staff survey along with a validated QI capacity assessment (QICA). We assessed the association of baseline QICA with baseline AR and both baseline and change in AR with change in QICA from 0 to 12 months. Effect modification by presence of QI infrastructure in parent organizations and trial arm was examined.

RESULTS

Mean QICA increased from 6.5 to 8.1 (p < .001), and mean AR increased from 71.8 to 73.9 points (p < .001). At baseline, there was a significant association between AR and QICA scores: The QICA averaged 0.34 points higher (95% CI [0.04, 0.64], p = .03) per 10-point difference in AR. There was a significant association between baseline AR and 12-month QICA-which averaged 0.30 points higher (95% CI [0.02, 0.57], p = .04) per 10 points in baseline AR. There was no association between changes in AR and the QICA from 0 to 12 months and no effect modification by trial arm or external QI infrastructure.

CONCLUSIONS

Baseline AR was positively associated with both baseline and follow-up QI capacity, but there was no association between change in AR and change in the QICA, suggesting AR may be a precondition to growth in QI capacity.

PRACTICE IMPLICATIONS

Findings suggest that developing AR may be a valuable step prior to undertaking QI-oriented growth, with implications for sequencing of development strategies, including added gain in QI capacity development from building AR prior to engaging in transformation efforts.

Leading Organizational Learning

Description A learning organization engages their teams to garner a commitment to learning and leverage organizational knowledge thereby positioning themselves better for future innovation. Organizations that focus on interrelated learning at the individual, group or team and organizational levels are optimally positioned to maximize organizational competitiveness in dynamic, competitive environments. A leader's responsibility is to devote more effort to guide the organization's continuous development, members, and themselves. Through constant learning, the organization can leverage learning to create competitive strategies while cultivating transformative opportunities. However, successful learning outcomes are not the product of any individual or leader, and instead, the collective work of all involved. Leaders focused on organizational learning realize the dynamic nature of operating a business in a competitive environment and encourage members to seek feedback, new educational opportunities, open communication, and innovative problem-solving strategies, the combination of which enable the collective organization to not just survive but thrive.

Learning and Collaboration during Crisis: A Novel University-Community Partnership to Manufacture Medical Personal Protective Equipment

Research on crisis management focuses on pre-planning for disasters in order to understand potential barriers. However, one significant barrier to crisis response is that organizations may come together in unplanned configurations during crisis response. This means that significant opportunities exist for understanding the process by which individuals learn, collaborate, and create new systems during crises. In this case report, we present the case of face shield production by a university, academic medical center, and community partners during the supply chain collapse of the early COVID-19 pandemic with the aim of identifying the relationships that formed during the COVID-19 response, so that this case of relationship formation and participant experiences might inform similar disaster response challenges in the future. Thirteen participants responded to an in-depth questionnaire designed to simulate an asynchronous in-depth interview. Respondents reported on the activities of 80 individuals from 38 units/organizations, providing insight into communication challenges and resolutions. Responses were analyzed using thematic analysis, highlighting roles and relationships among participants. The findings grant insight into the experience of learning from crisis response efforts, responding to recent calls for social scientific work on COVID-19 responses.

Learning Platforms for Implementing Formative Interventions to Promote the Health and Safety of Workers in Brazil

Formative intervention methodologies, such as the Change Laboratory (CL), are increasingly being used in work environments. However, the learning process entailed in the application of these methodologies has received insufficient attention and may be facilitated through the use of learning platforms. We examined the development of learning and training strategies for implementing formative interventions, drawing on the experiences of a research group focusing on workers' health. Information obtained from individuals involved in CL formative activities was analyzed and interpreted using Cultural-Historical Activity Theory and the theory of expansive learning. The process of learning to implement formative interventions unfolded gradually, beginning with the interventionists' initial exposure to abstract concepts that they subsequently internalized via various mediations and applied in concrete situations. Four key interventionist training strategies used to foster collective learning were identified: (1) promoting dialogues and exchange of experiences, (2) creating environments for continuous learning and permanent discussion (seminars and post-graduate courses and the use of communication technologies), (3) creating spaces for experimentation and the practical application of concepts (case studies and participation in interventions), and (4) the use of the double stimulation method during training programs.

Learning Organizational Culture in Greek Public Hospitals

(1) Background: A learning organizational culture is crucial to the safety of patients and the quality of public health care. The aim of this study was to assess the learning organizational culture and capacity of Greek public hospitals. (2) Materials and Methods: A cross-sectional analysis was carried out in six public general hospitals and stratified sampling was used as the sampling technique. A total of 480 questionnaires were distributed to health care professionals and 380 valid questionnaires were returned (78% response rate). The comprehensive form of the Dimensions of Learning Organization Questionnaire (DLOQ), which was adapted and translated into Greek, was used for data collection in this survey. (3) Results: The level of learning organizational culture and capacity in the health units are very low. All seven dimensions of the learning organizational instrument are lower than the theoretically neutral median (3.0). Health care employees believe that the hospital’s existing culture and management practices do not foster and contribute to continuing learning, which is the fundamental aspect of self-development, department development and performance improvement. (4) Conclusions: Greek public hospitals need to adopt different types of leadership practices and culture in order to be able to facilitate organizational learning. Organizational learning (OL) is based on collaborative working, a culture that encompasses learning as participation in the organizational work practice. This transformation of culture should take place at all levels of learning to enhance results.

The Relationship Between Leadership Behaviors and Volunteer Commitment: The Role of Volunteer Satisfaction

Despite the relative scarcity of studies on the impact of leadership styles on satisfaction and commitment of volunteers within non-profit organizations, this relationship plays a crucial role in fostering sustained volunteerism and volunteers' well-being. A questionnaire was administered to more than 200 volunteers involved in delivering social services in non-profit organizations from Central and Northern Italy. The questionnaire contained the Volunteer Satisfaction Index, the sub-scale on Affective Commitment of the Organizational Commitment Scale, and two sub-scales of the Key Leadership Behaviors, namely: Helping people to grow and lead, and Enabling learning and innovation. Socio-demographic data were collected as well. Findings revealed that leaders' actions oriented toward the enablement of learning and innovation have an effect on volunteers' affective commitment, through the full mediation of volunteer satisfaction. Leaders' actions oriented toward the growth and empowerment of volunteers, instead, did not show significant relationships with volunteer satisfaction and affective commitment.

Lioutas E, De Rosa M, Papadaki-Klavdianou A. Extension and Advisory Organizations on the Road to the Digitalization of Animal Farming: An Organizational Learning Perspective

Agricultural digitalization emerged as a radical innovation, punctuating the gradual evolution of the agrifood sector and having the potential to fundamentally restructure the context within which extension and advisory organizations operate. Digital technologies are expected to alter the practice and culture of animal farming in the future. To suit the changing environmental conditions, organizations can make minor adjustments or can call into question their purposes, belief systems, and operating paradigms. Each pattern of change is associated with different types of organizational learning. In this conceptual article, adopting an organizational learning perspective and building upon organizational change models, we present two potential change and learning pathways that extension and advisory organizations can follow to cope with digitalization: morphostasis and morphogenesis. Morphostatic change has a transitional nature and helps organizations survive by adapting to the new environmental conditions. Organizations that follow this pathway learn by recognizing and correcting errors. This way, they increase their competence in specific services and activities. Morphogenetic change, on the other hand, occurs when organizations acknowledge the need to move beyond existing operating paradigms, redefine their purposes, and explore new possibilities. By transforming themselves, organizations learn new ways to understand and interpret contextual cues. We conclude by presenting some factors that explain extension and advisory organizations' tendency to morphostasis.

Eco-Efficiency and Private Firms' Relationships with Heterogeneous Public Stakeholders in China

Private firms have been struggling to simultaneously achieve both environmental and economic goals. The concept of eco-efficiency captures the extent to which firms gain competitiveness through environmental management. Based on stakeholder salience theory and organizational learning theory, this study proposes that relationship with public stakeholders can hinder or promote private firms' eco-efficiency. Our findings showed that firm eco-efficiency is reduced by a relationship with the government but is enhanced by relationships with non-governmental organizations (NGOs). This study also found that the effects on eco-efficiency of a firm's relationship with public stakeholders are contingent on firm size. The findings of this study shed light on the organizational learning perspective of eco-efficiency and multi-stakeholder management by theoretically and empirically differentiating the effects on firm eco-efficiency of relationships with the government and NGOs.

Policy learning and crisis policy-making: quadruple-loop learning and COVID-19 responses in South Korea

This study aims to analyze how the Korean government has been effective in taming COVID-19 without forced interruptions (i.e. lockdowns) of citizens' daily lives. Extending the theory of organizational learning, we propose the quadruple-loop learning model, through which we examine how a government can find solutions to a wicked policy problem like COVID-19. The quadruple-loop learning model is applied to explain how the Korean government could effectively tame COVID-19 in the initial stage through its agile as well as adaptive approach based on effective interactions of backstage (time, target, and context) and frontstage of policy processes mainly focusing on the initial stage until the highest alert level was announced. Based on the Korean case, this study also examines critical factors to effective learning organizations such as leadership, information and transparency, as well as citizen participation and governance.

How Psychological Safety Affects Team Performance: Mediating Role of Efficacy and Learning Behavior

This article examines the mechanisms that influence team-level performance. It investigates psychological safety, a shared belief that the team is safe for interpersonal risk taking and a causal model mediated by learning behavior and efficacy. This model hypothesizes that psychological safety and efficacy are related, which have been believed to be same-dimension constructs. It also explains the process of how learning behavior affects the team's efficacy. In a study of 104 field sales and service teams in South Korea, psychological safety did not directly affect team effectiveness. However, when mediated by learning behavior and efficacy, a full-mediation effect was found. The results show (i) that psychological safety is the engine of performance, not the fuel, and (ii) how individuals contribute to group performance under a psychologically safe climate, enhancing team processes. Based on the findings, this article suggests theoretical and methodological implications for future research to maximize teams' effectiveness.

Using Safety-II and resilient healthcare principles to learn from Never Events

OBJECTIVES

Conduct a secondary analysis of root cause analysis (RCA) reports of Never Events to determine whether and how Safety-II/resilient healthcare principles could contribute to improving the quality of investigation reports and therefore preventing future Never Events.

DESIGN

Qualitative and quantitative retrospective analysis of RCA reports.

SETTING

A large acute healthcare Trust in London.

PARTICIPANTS

None.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

Quality of RCA reports, robustness of actions proposed.

RESULTS

RCA reports had low-to-moderate effectiveness ratings and low resilience ratings. Reports identified many system vulnerabilities that were not addressed in the actions proposed. Using a Safety-II/resilient healthcare lens to examine work-as-done and misalignments between demand and capacity would strengthen analysis of Never Events.

CONCLUSION

Safety-II/Resilient Healthcare concepts can increase the quality of RCA reports and focus attention on prospectively strengthening systems. Recommendations for incorporating Safety-II concepts into RCA processes are provided.

New graduate registered nurses' experiences with psychological safety

AIM

The purpose of this study was to gain insight into new graduate registered nurses' experiences with psychological safety.

BACKGROUND

Organizational learning allows acute care hospitals to consistently provide high-quality patient care. Psychological safety is critical for organizational learning. New graduate nurses in particular need to feel psychologically safe as they transition into professional nursing practice. Understanding new graduate registered nurses' experiences of psychological safety can guide leaders and others to create work environments that foster psychological safety and organizational learning.

METHOD

Semi-structured interviews were conducted with 13 newly graduated registered nurses working in inpatient hospital settings. Interviews were analyzed using thematic analysis.

RESULTS

Four primary themes featured prominently in the new graduate nurses' experiences of psychological safety: building credibility, making personal connections, feeling supported and seeking safety.

CONCLUSION

Understanding these themes will help nursing education programmes, nurse managers, nurse colleagues and new graduate registered nurses foster psychological safety and create environments conducive to organisational learning.

IMPLICATIONS FOR NURSING MANAGEMENT

All members of the health care team involved in the new graduate registered nurses' transition to practice have a role in fostering psychological safety. Additional research is needed to better understand psychological safety and how to foster it.

Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation

Introduction

Organizations and systems that deliver health care may better adapt to rapid change in their environments by acting as learning organizations and learning health systems (LHSs). Despite widespread recognition that multilevel forces shape capacity for learning within care delivery organizations, there is no agreed-on, comprehensive, multilevel framework to inform LHS research and practice.

Methods

We develop such a framework, which can enhance both research on LHSs and practical steps toward their development. We draw on existing frameworks and research within organization and implementation science and synthesize contributions from three influential frameworks: the Consolidated Framework for Implementation Research, the social-ecological framework, and the organizational change framework. These frameworks come, respectively, from the fields of implementation science, public health, and organization science.

Results

Our proposed integrative framework includes both intraorganizational levels (individual, team, mid-management, organization) and the operating and general environments in which delivery organizations operate. We stress the importance of examining interactions among influential factors both within and across system levels and focus on the effects of leadership, incentives, and culture. Additionally, we indicate that organizational learning depends substantially on internal and cross-level alignment of these factors. We illustrate the contribution of our multilevel perspective by applying it to the analysis of three diverse implementation initiatives that aimed at specific care improvements and enduring system learning.

Conclusions

The framework and perspective developed here can help investigators and practitioners broadly scan and then investigate forces influencing improvement and learning and may point to otherwise unnoticed interactions among influential factors. The framework can also be used as a planning tool by managers and practitioners.

Clinician engagement in research as a path toward the learning health system: A regional survey across the northwestern United States

Introduction:

Increased research engagement of frontline, community-based clinicians could result in greater research relevancy, increased likelihood of implementation into practice, and improved health care for patients. Establishment of learning health systems within health-care organizations may facilitate this process.

Methods:

In 2016, the U.S. Northwest Participant and Clinical Interactions Network conducted a region-wide survey in four community-based health systems to identify barriers to clinician involvement in research and understand clinician interest and levels of engagement.

Results:

Survey responses indicated broad interest in research’s value to patients (77% of respondents), contribution to clinical evidence (79%), and fulfillment of intellectual curiosity (77%). Engagement was not always correlated with interest. Top barriers included time (65%), support (34%), and getting started (32%).

Conclusion:

In community health systems in the northwestern United States, clinician interest in research exists but with several significant barriers. Leveraging the learning health system movement may be one way to increase focus on research and address identified barriers.

Arabic Version of Learning Organization Survey Short-Form: Hospital Pharmacy Settings

Objective: The objective of this study was to assess the psychometric properties of a translated Arabic version of the Learning Organization Survey (LOS-27) and to use this to evaluate staff perceptions about the organizational learning process in Kuwaiti hospital pharmacies. Setting: This study adopted a cross-sectional survey of the pharmacy employees in 6 hospital pharmacies in Kuwait. Results: The results indicated that the internal consistency of all composites was more than 0.7, except for one. All item loadings for the construct measurements were above 0.7. The standardized root mean square residual (SRMR) score showed a good fit with a value of 0.08. The intercorrelation among composites ranged from 0.34 to 0.68. Conclusions: The results indicate that the Arabic translation of the LOS-27 questionnaire has adequate levels of reliability and validity in comparison with the original US survey results. The overall average positive rate of composites was 64%. Therefore, the findings suggest that the hospital pharmacy staff surveyed in Kuwait were moderately positive in their perceptions about organizational learning in their organizations.

Human Factors in Health(care) Informatics: Toward Continuous Sociotechnical System Design

Developing structures and processes for continuous sociotechnical system design is key to sustaining human factors (HF) knowledge in the context of rapid health care changes and technological innovations. Two research studies illustrate how to embed HF in organizational learning processes and structures. We need to develop innovative HF methods for continuous sociotechnical system design.

Organizational learning in hospitals: A realist review

AIM

To establish a middle-range theory of organizational learning in hospitals.

DESIGN

A realist review of the literature, conducted according to established standards for realist and meta-narrative evidence syntheses. Middle-range theory development was performed according to Smith and Liehr's recommendations.

DATA SOURCES

Two comprehensive scientific databases and six discipline-focused databases spanning health care, life sciences, business, sociology, and psychology were searched from inception to 12 May 2016.

REVIEW METHODS

Citations meeting the inclusion criteria were appraised using the Mixed Methods Appraisal Tool. Data extraction was guided by a focus on the contextual factors, mechanisms, and outcomes associated with organizational learning.

RESULTS

The initial search yielded 2,332 citations, 147 of which were ultimately included in the review. The included citations were generally of high quality. Reviewed evidence indicates certain aspects of organizational context can be conducive to mechanisms of organizational learning, leading to a range of positive organizational outcomes.

CONCLUSION

This review updates and expands on a previous review of the literature on organizational learning in hospitals, refines the concept of organizational learning in hospitals, and provides a middle-range theory of organizational learning in hospitals.

IMPACT

This updated review provides a strong evidence base for future work on the topic of organizational learning in hospitals. The refined concept of organizational learning makes it possible to develop reliable, valid research instruments that better reflect of the full scope of organizational learning. Finally, the middle-range theory guides researchers and clinical leaders as they advance the science and practice of organizational learning.

Learning from experience in a National Healthcare System: organizational dynamics that enable or inhibit change processes

OBJECTIVE

To study the organizational dynamics that either enable or inhibit the changes needed by the system for the ongoing organizational development of the major acute general public hospital in Malta.

SETTING

The main public acute general hospital in Malta. Malta is the main island of a small archipelago in the Mediterranean with a total population reaching around 460 000.

DESIGN AND PARTICIPANTS

This qualitative study utilized two major research methods: action research and in-depth interviews. Data collection and analysis were guided by the grounded theory paradigm and operated within a constructivist and informed grounded theory approach. The action research was conducted through the documentation and interpretation of a practitioner-researcher experience working within a multi-disciplinary hospital team consisting of up to 15 members from different healthcare professional groups. The in-depth interviews involved 25 interviewees using theoretical sampling techniques.

RESULTS

The findings affirmed the high potential and capabilities of the hospital workforce. This potential is nonetheless susceptible to be affected and gradually transformed by identified organizational and external forces into a workforce that is highly territorial, cynical and showing lack of 'ownership' of the organizational vision and objectives. The organizational culture, structures, systems and leadership as well as external factors that were frequently rooted at the national level were identified as strong impacting and underlying factors.

CONCLUSIONS

A theoretical framework was generated depicting a vicious circle that needs to be broken to enable the desired organizational development and learning. This additional knowledge can be used by and inspire other organizations operating within comparable conditions.

Application of the safety through organizational learning methodology for the post analysis of an adverse event during a search and rescue operation

Experiences show that during the investigation of accidents, focusing on the direct causes of the event and thus ignoring other facts that also contributed to the event from the background is a recurring problem. In this article we set out to present the lessons learnt from applying a novel approach using the safety through organizational learning (event analysis) methodology for the analysis of an occupational accident. We used this method to analyse a fatal accident during a search and rescue operation, where the victim was one of the members of the search and rescue team. Our analysis also reviewed some contributing factors, which had not been identified by the previously conducted official investigation. As part of our method, we reflected on these factors by specifying concrete management measures, thus laying the foundations of organizational learning.

Trust, Money, and Power: Life Cycle Dynamics in Alliances Between Management Partners and Accountable Care Organizations

Policy Points Accountable care organizations (ACOs) form alliances with management partners to access financial, technical, and managerial support. Alliances between ACOs and management partners are subject to destabilizing tension around decision-making authority, distribution of shared savings, and conflicting goals and values. Management partners may serve either as trainers, ultimately breaking off from the ACO, or as central drivers of the ACO. Management partner participation in ACOs is currently unregulated, and management partners may receive a significant portion (in some cases, majority) of shared savings.

CONTEXT

Accountable care organizations (ACOs) are a prominent payment and delivery model. Though ACOs are often described as groups of health care providers, nearly 4 in 10 ACOs partner with a management company for services such as financial investment, contracting, data analytics, and care management, according to recent research. However, we know little about how and why these partnerships form. This article aims to understand the reasons providers seek partners, the nature of these relationships, and factors critical to the success or failure of these alliances.

METHODS

We used qualitative data collected longitudinally from 2012 to 2017 at 2 ACOs to understand relationships between management partners and ACO providers. The data include 115 semistructured interviews and observational data from 7 site visits. Two coders applied 48 codes to the data. We reviewed coded data for emergent themes in the context of alliance life cycle theory.

FINDINGS

Qualitative data revealed that management partners brought specific skills and services and also gave providers confidence in pursuing an ACO. Over time, tension between providers and management partners arose around decision-making authority, distribution of shared savings, and conflicting goals and values. We observed 2 outcomes of partnerships: cemented partnerships and dissolution. Key factors distinguishing alliance outcome in these 2 cases include degree of trust between organizations in the alliance; approach to conflict resolution; distribution of power in the alliance; skills and confidence acquired by the ACO over the life of the alliance; continuity of management partner delivery on promised resources; and proportion of savings going to the management partner.

CONCLUSIONS

The diverging paths for ACOs with management partners suggest 2 different roles that management partners may play in ACO development. In some cases, management partners may serve as trainers, with the partnership dissolving once the ACO gains skills and confidence to work alone. In other cases, the management partner is a central driver of the ACO and unlikely to break off.

The learning history: A research method to advance the science and practice of organizational learning in healthcare

AIMS

This paper presents a discussion of the learning history research method, including a description of how to conduct a learning history. Suggested applications of the method in research and clinical practice are also provided.

BACKGROUND

Organizational learning has been linked to improved clinical performance and other positive outcomes in healthcare. Yet, the theoretical guidance available to researchers and clinical leaders who study and strive to foster organizational learning is sparse. Studying how organizational learning occurs in the healthcare context is a critical step toward addressing this knowledge gap. The learning history, a participatory research method, is specifically designed for studying the organizational learning process. Thus, it is precisely suited for the work of developing a theoretical foundation for organizational learning in healthcare.

DESIGN

Discussion paper.

DATA SOURCES

This discussion paper is based on relevant literature and the authors' experiences conducting learning histories.

IMPLICATIONS FOR NURSING

Researchers can use learning histories to develop a better understanding of and a theoretical foundation for organizational learning in healthcare. Leaders in clinical practice can use learning histories to foster learning and improvement in their organizations.

CONCLUSION

Learning histories are a promising approach to advancing the science and practice of organizational learning.

Wrestling with the complexity of evaluation for organizations at the boundary of science, policy, and practice

Boundary organizations are situated between science, policy, and practice and have a goal of supporting communication and collaboration among these sectors. They have been promoted as a way to improve the effectiveness of conservation efforts by building stronger relationships between scientists, policy makers, industry, and practitioners (Cook et al. 2013). Although their promise has been discussed in theory, the work of and expectations for boundary organizations are less defined in practice. Biodiversity conservation is characterized by complexity, uncertainty, dissent, and tight budgets, so boundary organizations face the challenging task of demonstrating their value to diverse stakeholders. We examined the challenges boundary organizations face when seeking to evaluate their work and thus aimed to encourage more productive conversations about evaluation of boundary organizations and their projects. Although no off-the-shelf solution is available for a given boundary organization, we identified 4 principles that will support effective evaluation for boundary organizations: engage diverse stakeholders, support learning and reflection, assess contribution to change, and align evaluation with assumption and values.