Interprofessional collaboration mediates the relationship between perceived organizational learning and safety climate in hospitals: A cross-sectional study

BACKGROUND

Organizational learning (OL) and interprofessional collaboration (IPC) are said to enhance medical safety in hospitals, but the relationship between these variables has not been quantitatively tested.

OBJECTIVE

This study examines the mediating effects of IPC on the relationship between OL and safety climate (improvement, compliance, and patient/family involvement).

METHODS

An anonymous self-reporting questionnaire was administered to 1,495 healthcare workers from November 2021 to January 2022. The questions regarded the hospital's safety climate, OL, and IPC. A mediation analysis using structural equation modeling was conducted to examine the mediating role of IPC on the relationship between OL and the three safety climates. The indirect effect was estimated using 2,000 bootstrap samples.

RESULTS

Responses from 643 healthcare workers were analyzed. The direct effects of OL were 𝛽 = .74, 75 (p < .001) on improvement and involvement and 𝛽 = 0.1 (p > .05) on compliance. The indirect effects of IPC on improvement and involvement were 𝛽 = .14 (95%CI: .00 ∼ .06) and 𝛽 = .37 (95%CI: .04 ∼ .09), respectively.

CONCLUSION

This study determined the mechanisms that enhance a hospital's safety climate, demonstrating that IPC mediates the relationship between OL and improvement and patient/family involvement. However, OL and IPC are not related to compliance.

A practical tool for managing change: cross-sectional psychometric assessment of the safe surgery organizational readiness tool

BACKGROUND

Strengthening health systems through planned safety and quality improvement initiatives is an imperative to achieve more equitable, resilient, and effective care. And yet, years of organizational behavior research demonstrate that change initiatives often fall short because managers fail to account for organizational readiness for change. This finding remains true especially among surgical safety and quality improvement initiatives in low-income countries and middle-income countries. In this study, our aim was to psychometrically assess the construct validity and internal consistency of the Safe Surgery Organizational Readiness Tool (SSORT), a short survey tool designed to provide change leaders with insight into facility infrastructure that supports learning and readiness to undertake change.

MATERIALS AND METHODS

To demonstrate generalizability and achieve a large sample size ( n =1706) to conduct exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), a collaboration between seven surgical and anesthesia safety and quality improvement initiatives was formed. Collected survey data from health care workers were divided into pilot, exploration, and confirmation samples. The pilot sample was used to assess feasibility. The exploration sample was used to conduct EFA, while the confirmation sample was used to conduct CFA. Factor internal consistency was assessed using Cronbach's alpha coefficient.

RESULTS

Results of the EFA retained 9 of the 16 proposed factors associated with readiness to change. CFA results of the identified 9 factor model, measured by 28 survey items, demonstrated excellent fit to data. These factors (appropriateness, resistance to change, team efficacy, team learning orientation, team valence, communication about change, learning environment, vision for sustainability, and facility capacity) were also found to be internally consistent.

CONCLUSION

Our findings suggest that communication, team learning, and supportive environment are components of change readiness that can be reliably measured prior to implementation of projects that promote surgical safety and quality improvement in low-income countries and middle-income countries. Future research can link performance on identified factors to outcomes that matter most to patients.

The more ambidexterity the better? The moderating effect of organizational learning between high-performance HR practices and organizational performance

Objective

The objective of this study is to test the directly impact of high-performance HR practices on organizational performance, and the mediating effect of organizational ambidexterity empirically. Moreover, the moderating role of organizational learning in the relationship between ambidexterity and specialization in exploitation or exploration on firm performance has also been examined. Ultimately, we construct a moderated mediation model.

Methods

Questionnaires were distributed to the target enterprises mainly through the contacts of the research group members, the local management consulting association and the training opportunities for leaders. Finally, a total of 347 CEO questionnaire data were collected from Chinese SMEs. The sample cover Shanghai, Beijing, Chongqing, Jiangsu, Zhejiang, Guangdong, Henan, Sichuan and other eastern and central regions. SPSS 23.0 and AMOS 24.0 were used to analyze the data.

Results

The results revealed that high-performance HR practices had a positive effect on organizational performance and that organizational ambidexterity played a partially mediating role between high-performance HR practices and organizational performance. Further, organizational learning moderated the effects of organizational ambidexterity and organizational specificity on firm performance.

Discussion

This study provided valuable practical insights. On one hand, this study provides a concrete operational scheme for SMEs in China to realize organizational ambidexterity by integrating a series of HR practices such as employees' ability, motivation and opportunity. On the other hand, through organizational ambidexterity, firms can not only obtain organizational long-term performance by enhancing their new product R & D capabilities, that is, exploratory innovation, but also utilize their existing resources to improve and expand their existing products and services, that is, to achieve short-term performance by exploitative innovation.

Learning from patients: The impact of using patients' narratives on patient experience scores

BACKGROUND

Enthusiasm has grown about using patients' narratives-stories about care experiences in patients' own words-to advance organizations' learning about the care that they deliver and how to improve it, but studies confirming association have not been published.

PURPOSE

We assessed whether primary care clinics that frequently share patients' narratives with their staff have higher patient experience survey scores.

APPROACH

We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system. We used multilevel models to analyze survey data from patients about their experiences and from staff about exposure to useful narratives. We examined staff confidence in own knowledge as a moderator because confidence can influence use of new information sources.

RESULTS

Frequency of sharing useful narratives with staff was associated with patient experience scores for all measures, conditional on staff confidence in own knowledge ( p < .01). For operational measures (e.g., care coordination), increased sharing correlated with subsequently higher performance for more confident staff and lower performance or no difference for less confident staff, depending on measure. For relational measures (e.g., patient-provider communication), increased sharing correlated with higher scores for less confident staff and lower scores for more confident staff.

CONCLUSION

Sharing narratives with staff frequently is associated with better patient experience survey scores, conditional on confidence in knowledge.

PRACTICE IMPLICATIONS

Frequently sharing useful patient narratives should be encouraged as an organizational improvement strategy. However, organizations need to address how narrative feedback interacts with their staff's confidence to realize higher experience scores across domains.

Advancing ethics support in military organizations by designing and evaluating a value-based reflection tool

Military employees face all sorts of moral dilemmas in their work. The way they resolve these dilemmas-how they decide to act based on their moral deliberations-can have a substantial impact both on society and on their personal lives. Hence, it makes sense to support military employees in dealing with these dilemmas. Military organizations already support their personnel by adopting compliance-based approaches that focus, for instance, on enforcing moral rules. At the same time, however, they struggle to develop value-based approaches that could foster moral learning by improving employees' understanding of personal values, others' values, and their responsibility for others. Consequently, military employees are not adequately supported in their ethical decision-making when confronted with complex situations. To address this issue, drawing on a design research approach, we develop and evaluate the use of a value-based reflection tool to support military employees with their moral decision-making. The design and evaluation of the value-based reflection tool were informed by five semistructured interviews, notes on 45 joint reflection meetings with trainers, and evaluation notes of 755 participants. Our findings suggest the value-based reflection tool is a promising way to foster actors' moral competence in organizational settings by triggering the social mechanisms of reflection, empathy, and psychological safety. This study is the first to illustrate that value-based ethics support can complement compliance-based ethics support in a military organization. Furthermore, it demonstrates design research's potential to develop actionable knowledge for ethics support practices in organizations.

Putting the individual in the context of the organization: A Carnegie perspective on decision-making

The majority of decision research portrays decision-makers as largely decontextualized, separate from the institutional and social factors that influence their choosing. On the occasions when context is considered, it is rarely organizational, despite the prominence of organizations in people's lives. By contrast, the Carnegie perspective on decision-making emphasizes context, particularly that of organizations, as a central concern. We develop this contrast by first reviewing the limited role of context in neoclassical economic and psychological depictions of choice. Next, we present key elements of the organizational decision context in the Carnegie perspective: decision premises, standard operating procedures and decision rules, organizational structures, learning environments, and identity-situation interaction. We then consider the importance of interpretation to decision-making in context. In particular, rather than being given and clear, the meaning of decision context is often ambiguous and must be interpreted or constructed. The Carnegie perspective underscores the importance of this interpretive process to both decision-making and everyday life. We conclude by considering aspects of context that merit greater examination, as well as the implications for behavioral theorizing of acknowledging the contextualized nature of action.

Organizational Learning in Healthcare Contexts after COVID-19: A Study of 10 Intensive Care Units in Central and Northern Italy through Framework Analysis

The rapid spread of the SARS-CoV-2 virus has forced healthcare organizations to change their organization, introducing new ways of working, relating, communicating, and managing to cope with the growing number of hospitalized patients. Starting from the analysis of the narratives of healthcare workers who served in the intensive care units of 10 hospitals in Central and Northern Italy, this contribution intends to highlight elements present during the pandemic period within the investigated structures, which are considered factors that can influence the birth of organizational learning. Specifically, the data collected through interviews and focus groups were analyzed using the framework analysis method of Ritchie and Spencer. The conducted study made it possible to identify and highlight factors related to aspects of communication, relationships, context, and organization that positively influenced the management of the health emergency, favoring the improvement of the structure. It is believed that the identification of these factors by healthcare organizations can represent a valuable opportunity to rethink themselves, thus becoming a source of learning.

Looking Back, Looking Forward: A Study Protocol for a Mixed-Methods Multiple-Case Study to Examine Improvement Sustainability of Large-Scale Initiatives in Tertiary Hospitals

Background Hospitals invest extensive resources in large-scale initiatives to improve patient safety and quality at an organizational level. However, initial success, if any, does not guarantee longer-term improvement. Empirical and theoretical knowledge that informs hospitals on how to attain sustained improvement from large-scale change is lacking. Aim The proposed study aims to examine improvement sustainability of two large-scale initiatives in an Australian tertiary hospital and translate the lessons into strategies for achieving sustained improvement from large-scale change in hospital settings. Design and Methods The study employs a single-site, multiple-case study design to evaluate the initiatives separately and comparatively using mixed methods. Semi-structured staff interviews will be conducted in stratified cohorts across the organizational hierarchy to capture different perspectives from various staff roles involved in the initiatives. The output and impact of the initiatives will be examined through organizational documents and relevant routinely collected organizational indicators. The obtained data will be analyzed thematically and statistically before being integrated for a synergic interpretation. Implications Capturing a comprehensive organizational view of large-scale change, the findings will have the potential to guide the practice and contribute to the theoretical understandings for achieving meaningful and longer-term organizational improvement in patient safety and quality.

A success story of clinical debriefings: lessons learned to promote impact and sustainability

The COVID-19 crisis impacted emergency departments (ED) unexpectedly and exposed teams to major issues within a constantly changing environment. We implemented post-shift clinical debriefings (CDs) from the beginning of the crisis to cope with adaptability needs. As the crisis diminished, clinicians voiced a desire to maintain the post-shift CD program, but it had to be reshaped to succeed over the long term. A strategic committee, which included physician and nurse leadership and engaged front-line staff, designed and oversaw the implementation of CD. The CD structure was brief and followed a debriefing with a good judgment format. The aim of our program was to discover and integrate an organizational learning strategy to promote patient safety, clinicians' wellbeing, and engagement with the post-shift CD as the centerpiece. In this article, we describe how post-shift CD process was performed, lessons learned from its integration into our ED strategy to ensure value and sustainability and suggestions for adapting this process at other institutions. This novel application of debriefing was well received by staff and resulted in discovering multiple areas for improvement ranging from staff interpersonal interactions and team building to hospital wider quality improvement initiatives such as patient throughput.

Power, politics and improvisation: Learning during a prolonged crisis

The COVID-19 pandemic has caught most organizations off guard. They have had to adapt their operations rapidly, and with the pandemic persisting, continuously improvise. While such an external jolt to organizations might unsettle operations, it does not remove the fact that organizations are sites of power relations and political activity. In this article, we examine the influence of power and politics on learning from improvisation, through a qualitative longitudinal case study of an Australian university during COVID-19. We trace improvisations with the use of the social media platform WeChat, which was eventually adopted, after several changes in forms of improvisation, as part of the response to the COVID-19 pandemic. Our study contributes to the literature on learning from improvisation, and explains how different forms of improvisation morph into one another under the simultaneous influence of power relations and learning.

Frameworks for Integrating Learning Analytics With the Electronic Health Record

The information systems designed to support clinical care have evolved separately from those that support health professions education. This has resulted in a considerable digital divide between patient care and education, one that poorly serves practitioners and organizations, even as learning becomes ever more important to both. In this perspective, we advocate for the enhancement of existing health information systems so that they intentionally facilitate learning. We describe three well-regarded frameworks for learning that can point toward how health care information systems can best evolve to support learning. The Master Adaptive Learner model suggests ways that the individual practitioner can best organize their activities to ensure continual self-improvement. The PDSA cycle similarly proposes actions for improvement but at a health care organization's workflow level. Senge's Five Disciplines of the Learning Organization, a more general framework from the business literature, serves to further inform how disparate information and knowledge flows can be managed for continual improvement. Our main thesis holds that these types of learning frameworks should inform the design and integration of information systems serving the health professions. An underutilized mediator of educational improvement is the ubiquitous electronic health record. The authors list learning analytic opportunities, including potential modifications of learning management systems and the electronic health record, that would enhance health professions education and support the shared goal of delivering high-quality evidence-based health care.

Learning Through Diversity: Creating a Virtuous Cycle of Health Equity in Health Care Organizations

In the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.

Foreign to all but fluent in many: The effect of multinationality on shock resilience

The sudden COVID-19 pandemic sent shockwaves through international markets. This paper studies the relation between multinationality and risk. While IB literature agrees that internationalization, in times of relative stability, increases systematic risk, we argue that internationalization also improves resilience against exogenous shocks. Leveraging the sequential COVID-waves as a unique empirical laboratory, we show that although multinationality causes liability of foreignness that increases systematic risk, it also generates an asset of multinationality that enhances shock resilience. Yet this advantage of internationalized firms gradually erodes as less internationalized firms learn about the shock and investors adapt their valuations to the post-shock reality.

Pathways for primary care practice adoption of patient engagement strategies

OBJECTIVE

To identify potential orderings of primary care practice adoption of patient engagement strategies overall and separately for interpersonally and technologically oriented strategies.

DATA SOURCES

We analyzed physician practice survey data (n = 71) on the adoption of 12 patient engagement strategies.

STUDY DESIGN

Mokken scale analysis was used to assess latent traits among the patient engagement strategies.

DATA COLLECTION

Three groupings of patient engagement strategies were analyzed: (1) all 12 patient engagement strategies, (2) six interpersonally oriented strategies, and (3) six technologically oriented strategies.

PRINCIPAL FINDINGS

We did not find scalability among all 12 patient engagement strategies, however, separately analyzing the subgroups of six interpersonally and six technologically oriented strategies demonstrated scalability (Loevinger's H coefficient of scalability [range]: interpersonal strategies, H = 0.54 [0.49-0.60], technological strategies, H = 0.42 [0.31, 0.54]). Ordered patterns emerged in the adoption of strategies for both interpersonal and technological types.

CONCLUSIONS

Common pathways of practice adoption of patient engagement strategies were identified. Implementing interpersonally intensive patient engagement strategies may require different physician practice capabilities than technological strategies. Rather than simultaneously adopting multiple patient engagement strategies, gradual and purposeful practice adoption may improve the impact of these strategies and support sustainability.

Is There a Missing Link? Exploring the Effects of Institutional Pressures on Environmental Performance in the Chinese Construction Industry

Although institutional pressures have huge strategic implications for organizational activities, this certainly does not mean that organizations under institutional pressures can improve environmental performance automatically. Institutional pressures are critical but not sufficient to affect environmental performance directly. Therefore, additional research is needed to explore the missing link between institutional pressures and environmental performance. Based on the "pressure-response-performance" framework, this study integrates perspectives of institutional theory and organizational learning to argue the mediating role of organizational learning in the relationship between institutional pressures and environmental performance. Data were collected via 268 valid questionnaires from construction firms located in Shanxi Province in central China. Hypotheses in the conceptual model were tested with structural equation modeling. Empirical results reveal that both coercive and mimetic pressures have significantly positive effects on organizational learning, whereas normative pressures have a non-significant effect on organizational learning. Besides that, organizational learning has a significantly positive effect on environmental performance. In addition, organizational learning partially mediates the relationship between coercive pressures and environmental performance and completely mediates the relationship between mimetic pressures and environmental performance. By exploring the mediating role of organizational learning, the article uncovers the missing link in the relationship between institutional pressures and environmental performance.

Opportunities for organizational learning and innovation: A nonprofit case study during COVID-19 in Hong Kong

COVID-19 has created unprecedented challenges and uncertainty for the nonprofit sector. Drawing from a case study of a community-based service delivery nonprofit organization in Hong Kong, this research note examines the impact of COVID-19 on this organization's daily operations, identifies its organizational coping strategies in response to the challenges it faced, and outlines key organizational learning resulting from its experience of dealing with the pandemic. With reference to the narrative development process framework, this study found that the customary social service delivery model was inadequate in meeting the emergent needs identified in the community. This realization served as a catalyst for the organization to employ socially innovative coping strategies to continue safeguarding the well-being of vulnerable population groups. As a result, a new paradigm of service delivery leveraging on neighborhood support networks and cross-sector collaborations was developed. Factors that would enable nonprofits to enhance their adaptive capacity in the face of future public health crises are discussed, with particular attention drawn to the usefulness of adopting a narrative development process in guiding organizations' collective actions.

The Role of Relational Embeddedness in Enhancing Absorptive Capacity and Relational Performance of Internationalized SMEs: Evidence From Mainland China

The social network in the organizational learning process is a critical knowledge source to realize superior performance. The purpose of this study is to examine the relationship between relational memory, relational embeddedness, and absorptive capacity, and their impact on the relational performance of small and middle enterprises (SMEs). This study empirically verifies the research framework from 223 Chinese internationalized SMEs. The results confirm previous studies that indicate positive correlations among relational embeddedness, relational memory, and absorptive capacity. The results also indicate that relational embeddedness and relational memory have positive effects on relational performance. The findings show that relational memory plays a mediating role in the relationship between relational embeddedness, absorptive capacity, and relational performance.

Unveiling the Role of Cross-Cultural and Cognitive Differences in Organizational Learning Mechanism of Technology-Acquiring Cross-Border Mergers and Acquisitions: Evidence From Emerging Market Enterprises

In recent years, cross-border mergers and acquisitions (M&As) of emerging market enterprises (EMEs) have increased rapidly, and many cross-border M&A have been conducted in the United States, Western Europe, and other developed countries. This new type of technology-acquiring cross-border M&A has several unique features. In particular, the cross-cultural differences between the home country and the host country and the cognitive differences between emerging markets and developed markets pose a huge challenge to the organizational learning of technology-acquiring cross-border M&A of enterprises from emerging markets. Based on this, the present study innovatively constructs an integrated theoretical model to explore the role of cross-cultural and cognitive differences in the organizational learning mechanism of technology-acquiring cross-border M&A in emerging markets. In this study, the partial least squares structural equation model (PLS-SEM) was used in an empirical study of 240 Chinese technology-acquiring cross-border M&A enterprises, and it was found that cultural and cognitive differences play an important role in technical ability and learning performance. The study also found that the interaction of cross-cultural differences between the home and host countries and the cognitive differences between the emerging and developed markets promoted the learning performance of cross-border M&A in the emerging markets. Based on the integration theory of cultural differences, cognitive differences, and technical ability, this paper unveils the role of cross-cultural and cognitive differences in organizational learning mechanisms of technology-acquiring cross-border M&A.

Challenges of Medical Error Reporting in Mizan-Tepi University Teaching Hospital: A Qualitative Exploratory Study

Background

Medical error is defined as “an act of omission or commission in planning or execution that contributes or could contribute to an unintended result”. It is a serious public health problem that can pose a threat to patient safety and if managed it can be an opportunity to an organizational learning. This study aimed to assess the challenges of error reporting.

Methods

Explorative qualitative cross-sectional study was conducted. The study was conducted among healthcare providers in Mizan-Tepi University Teaching Hospital. The study participants were selected purposely based on the patient contact hour and had served in this hospital for long period of time. Twenty-one in-depth interviews were undertaken. From each wards, three in-depth interviews were held. Case team leaders and other healthcare providers were identified and interviewed. The data were analyzed thematically.

Results

Twenty-one healthcare providers were recruited for this study. Majority of the participants, 12 (57.1%) were nurses and midwives and as to marital status, 18 (85.7%) were married. Challenges for reporting medical errors were identified as perceived lack of confidentiality of the medical errors, perceived punitive measures, lack of good reporting system, perceived fear of losing acceptance, lack of learning culture from errors, information asymmetry, mass-media publication of medical errors, avoidance of conflict and attitude of health professionals.

Conclusion

There were system and individual related challenges for reporting of medical errors. Healthcare managers should enhance medical error reporting for organizational learning by addressing these system and individual factors.

Influence of Organizational Learning and Dynamic Capability on Organizational Performance of Human Resource Service Enterprises: Moderation Effect of Technology Environment and Market Environment

This study aims to explore the influence of organizational learning and dynamic capability on organizational performance of human resource service enterprises with the moderating role of technology environment and market environment. Data were gathered from 360 human resource service enterprises, and applied the hierarchical linear regression method and structural equation model to test the hypotheses. We found that organizational learning has a significantly positive impact on resource integration capability, as well as has a significantly positive impact on resource reconfiguration capability of human resource service enterprises. Resource integration capability and resource reconfiguration capability have a significantly positive impact on organizational performance. Moreover, results indicated that the resource integration capability and resource reconfiguration capability partially mediate in the relationship between organizational learning and organizational performance. Furthermore, technology environment and market environment have positive moderation effect between resource integration capability and organizational performance of human resource service enterprises, as well as have positive moderation effect between resource reconfiguration capability and organizational performance of human resource service enterprises. The current study contributes to a better understand the impact mechanism of organizational learning on organizational performance from the perspective of organizational learning theory and dynamic capability theory. In addition, this study provides implications for human resource service enterprises and managers to improve organizational performance.

Developmental stages associated with organizational learning in hospitals: An instrument development study

AIM

To develop and test the Organizational Learning Instrument: Development Stages instrument, a measure of hospital units' readiness to engage in organizational learning.

DESIGN

Cognitive interviewing, expert review and a quantitative, cross-sectional survey.

METHODS

Item development was informed by previous research on organizational learning. Content validity was assessed and strengthened using cycles of cognitive interviewing and expert review. The resulting instrument was distributed by email to all nurses providing direct patient care in inpatient units in 11 Magnet® hospitals. Data were collected in 2018. Intraclass correlations, using hospital unit as the grouping variable, indicated the need to use multilevel methods to analyse the survey data. Thus, coefficient omega and multilevel confirmatory factor analysis were used to estimate the instrument's reliability and construct validity, respectively.

RESULTS

The Organizational Learning Instrument: Development Stages is a 35-item survey comprised of four scales: Identity & Ownership, Team & Respect, Accountability & Support and Reliability & Sustainability. The expert review yielded scale-level content validity scores from 0.90 to 1.0 and item-level content validity scores from 0.86 to 1.0. Survey participants were 1212 nurses, working in 99 inpatient units, across 11 Magnet® hospitals. Intraclass correlations ranged from 0.113 to 0.158. Coefficient omega reliability for the four scales was 0.981-0.993. Standardized factor loadings for the 35 items were 0.699-0.961, with acceptable model fit statistics (comparative fit index = 0.980, Tucker-Lewis Fit Index = 0.979, and root mean squared error of approximation = 0.060).

CONCLUSIONS

These results indicate the instrument meets or exceeds generally accepted criteria for content validity, reliability and construct validity instrument, and is suitable for further use and testing.

IMPACT

Nurse administrators, managers and researchers now have a valid, reliable instrument to better foster and study organizational learning in hospital units. Advances in organizational learning are expected to improve a variety of patient, staff and organizational outcomes in hospital units.

Why postmortems fail

Most high-profile disasters are followed by demands for an investigation into what went wrong. Even before they start, calls for finding the missed warning signs and an explanation for why people did not "connect the dots" will be common. Unfortunately, however, the same combination of political pressures and the failure to adopt good social science methods that contributed to the initial failure usually lead to postmortems that are badly flawed. The high stakes mean that powerful actors will have strong incentives to see that certain conclusions are-and are not-drawn. Most postmortems also are marred by strong psychological biases, especially the assumption that incorrect inferences must have been the product of wrong ways of thinking, premature cognitive closure, the naive use of hindsight, and the neglect of the comparative method. Given this experience, I predict that the forthcoming inquiries into the January 6, 2021, storming of the US Capitol and the abrupt end to the Afghan government will stumble in many ways.

Lessons in Failure: Applying an Organizational Learning Framework to Understanding Attitudes Towards Failure in Development

This paper applies an organizational learning framework to explore attitudes towards failure in the water, sanitation and hygiene (WASH) development sector. It draws on 35 key-informant interviews, contextualized by organizational theory and existing scholarship on failure in development, to understand the challenges faced by WASH practitioners in identifying failure, analyzing failure, and deliberate experimentation. Through interrogating past and present initiatives for publicizing failure in development, this paper digs deeper into the successes, obstacles, and lessons learnt from mainstreaming failure into organizational practices. It then synthesizes these findings to advance a 3-tier conceptual map for organizations to build an enabling environment for learning from failure in development.

Determinants of Overall Perception of Radiation Safety Among Radiologic Technologists

PURPOSE

To examine the determinants of radiation safety culture among radiologic technologists in the United States. The specific aims were to report descriptive statistics related to radiation safety culture determinants and examine relationships between specific determinants of radiation safety culture and overall perception of radiation safety (OPRS).

METHODS

Radiologic technologists working in radiography, mammography, and computed tomography were identified using the American Society of Radiologic Technologists membership database. The researcher implemented a quantitative cross-sectional design using the Radiation Actions and Dimensions of Radiation Safety (RADS) survey instrument, which contained the study's determinants and OPRS variable, to guide hypotheses testing. Descriptive statistics were used to report RADS survey item outcomes, and Pearson correlation and multiple linear regression tests were conducted to analyze the hypothesis.

RESULTS

A total of 425 radiologic technologists completed the survey. Ten variables significantly correlated with OPRS. The variables of leadership actions (β = .402; P < .001), teamwork across imaging stakeholders (β = .304; P = .011), organizational learning (β = .121; P = .007), and questioning attitude (β = .110; P = .001) predicted OPRS, with leadership actions being most important in the model.

DISCUSSION

The correlation between OPRS scores and the 10 determinants suggests that each variable is a relevant determinant of radiation safety culture among radiologic technologists in the United States. The outcomes establish key priorities and provide an actionable foundation to facilitate a positive radiation safety culture in medical imaging.

CONCLUSION

The study presented a unique examination of OPRS determinants among American radiologic technologists. Findings can be used to support clinically-oriented interventions in improving radiation safety culture.

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.

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.

Learning from implementation setbacks: Identifying and responding to contextual challenges

Introduction

We address organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. The redesign was expected to improve care efficiency, prevention, and continuity. In response to setbacks, redesign and system leaders used understanding of context to plan system-wide changes, as well as program adjustments. Doing so enhanced the redesign's prospects and contributed to system learning.

Methods

We conducted a 33-month, mixed-methods study. Qualitative data included quarterly calls with the redesign leaders and 63 activity log entries. There were three site visits; 73 interviews with practice leaders, providers, and medical assistants. Data analysis used categories from an implementation research framework; these were refined and then expanded inductively using log reports, debriefings with change leaders, and documents. Quantitative analysis used system operational data on chronic care, prevention, efficiency, productivity, and patient access.

Results

Redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics. Interviews reported that team redesign was leading to improvements in chronic care and prevention and eased provider burden. Besides making small adjustments to cope with setbacks, redesign and system leaders engaged in more thorough organizational learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health.

Conclusions

This case points to benefits for both health care researchers and change practitioners of paying closer attention to how context affects implementation of organizational change, and to opportunities and conditions for learning from setbacks during change.