Learning Organization

Senge (2006), describes a learning organization as a place where people are continually discovering how they create reality. The organization is focused on expanding its capacity for the future not merely surviving in it. Senge (2006) states that the characteristics of a learning organization, which include systems thinking, personal mastery, mental models, team learning

and shared vision, are relevant and present from the senior leaders to the managers and other constituents. In support of this premise, Crossan, Lane, and White (1999) describe

organizational learning as a dynamic process, creating tension through feed-forward and

feedback processes. Crossan et al. (1999) believe ideas flow from individuals to group and then to the organizational level while at the same time already learned actions flow back from the organizational level down to the individual. Understandably, a manager’s role in creating and transferring knowledge within this type of learning organization requires the ability to motivate, problem solve, support and train (Alipour et al., 2011). A learning organization is an

organization “skilled at creating, acquiring, and transferring knowledge, and at modifying its behaviour to reflect new knowledge and insights” (Garvin, 1993, p.4). Franco and Almeida (2011) lend further support to this task of leaders suggesting their role is to encourage knowledge sharing, support learning through tolerance of mistakes, create team learning and a shared vision, and empower people to enhance the commitment.

Learning organizations can be identified through policy, design, and application. For example, the National Health System (NHS) in Great Britain identified in official policy documents their goal to transform into a learning organization through a government ‘quality’ strategy by managing organizational culture in tandem with improved learning (Davies & Nutley, 2000). Practical application of these policy recommendations have, perhaps not

surprisingly, proven harder to achieve in practice (Gray & Williams, 2011). Under-reporting of incidences was acknowledged by the media and led to the first published death rates of all

hospitals in England in 2009. A new and heightened level of transparency for the general public, government, and hospital sectors was identified as one step towards hospitals becoming learning

organizations, yet areas of blame and surface learning have still been identified as areas in need of transformation (Davies & Nutley, 2000).

In the USA, Garvin, Edmondson, and Gino (2008), reported one example of a healthcare institution, the Children’s Hospitals and Clinics of Minnesota, that created a supportive learning environment for hospital employees via their “blameless reporting” policy. The Chief Operating Officer instituted a policy of “blameless reporting” to change the culture of blame and silence about errors in the organization. This change of wording from leadership ‘set the scene’ and provided a safe environment for all staff who worked together to understand safety, identify risks, and feel comfortable to report the errors (Garvin et al., 2008). Over time it was identified that this action yielded measurable reductions in preventable deaths and illnesses in the

institution.

In Canada, St. Joseph’s Healthcare Centre in London, Ontario demonstrates many aspects of a learning organization through application of its vision and mission. The Chief Executive Officer and Chair, Board of Directors describe their vision best as, “it calls us to listen, to reach across and beyond our teams, program and organizational boundaries, to continuously improve, to build strong relationships - to be our best. It offers clarity about

priorities and provides the space for annual review” (McLaughlin & Kernaghan, 2015, June 17). As described by Davies and Nutley (2000), “the key features of learning organizations relate less to the ways in which organizations are structured and more to the ways in which people within the organization think about the nature of, and the relationship between, the outside world, their organization, their colleagues, and themselves” (p.999).

A patient safety culture emphasizes a systems approach to dealing with errors. The overall assumption is that humans are fallible and errors will occur but the focus should by and

large be on what happened and not who did it (Goh et al., 2013). A learning organization

provides this environment through supportive open dialogue, member empowerment, and lack of blame (Goh et al., 2013; Sammer et al., 2010). In brief, the literature suggests: 1) that

managerial support for patient safety and organizational learning could facilitate a patient safety culture, 2) that a patient safety culture can have an impact on patient outcomes, and 3) that organizational learning can have a positive impact on patient safety culture (Goh et al., 2013). These integral relationships build on the intricacies of the framework provided and are the basis for this study’s current area of inquiry.

Chapter 3

Methodology

An exploratory mixed-method case study design was utilized to develop a deeper understanding on how and why leadership attributes impact a patient safety culture and patient safety outcomes in a hospital (Organization X) that formally claimed to be a learning

organization within their organizational documentation. For confidentiality purposes, the document created by Organization X is not listed in the references list. The overall guiding research question was: “how and why do leadership attributes impact a patient safety culture and patient safety outcomes in a learning organization?” This case study sought to clarify the impact between specific leadership attributes and a patient safety culture, as well as the impact between specific leadership attributes and patient safety outcomes through addressing the following research sub-questions:

1) What is front-line leadership’s role in creating a patient safety culture and preventing adverse events and ‘near misses’ in a healthcare-based learning organization?

2) What is nursing’s role in creating a patient safety culture and preventing adverse events and ‘near misses’ in a healthcare-based learning organization?

3) Is there a significant relationship between specific leadership attributes and a patient safety culture?

4) Is there a significant relationship between specific leadership attributes and adverse events or ‘near misses’?

5) In what ways do semi-structured interviews and additional sources provide further corroboration of the statistical findings between authentic leadership attributes and patient safety culture and patient safety outcomes, via an integrative mixed-methods analysis?

With limited relevant evidence in the current literature, a single case study can help determine whether the propositions are correct or some alternative set of explanations may be more relevant (Yin, 2014). Data collection in this study relied upon both qualitative and quantitative evidence to ensure that it captured leader and ‘follower’ perceptions on leadership attributes, patient safety culture, and patient safety outcomes. Those multiple sources of information were analyzed and triangulation of the data pursued (See Table 1). This case study was intended to provide a useful contribution to the knowledge and theory of leadership attributes in a hospital setting and the leadership impact on culture and patient outcomes. As well, this study was designed to provide a framework for further studies in the area of interest. In these ways, the research responds

favourably to Yin’s (2014) expectations for exploratory case studies. Table 1

Methodology Outline

Sub-questions: Measures Methodology of

Assessment What is leadership’s role in

creating a patient safety culture and preventing adverse events and ‘near misses’ in a healthcare- based learning organization?

 Semi-structured interviews with two nursing staff who completed the HSOPSC

 Open-ended comments of HSOPSC

 Modified constant comparative analysis

What is nursing’s role in creating a patient safety culture and preventing adverse events and ‘near misses’ in a healthcare- based learning organization?

 Semi-structured interviews with two nursing staff who completed the HSOPSC

 Open-ended comments of HSOPSC

 Modified constant comparative analysis

In what ways do semi-structured interviews and additional

qualitative sources provide further corroboration of the statistical findings between authentic leadership attributes and patient safety culture and patient safety outcomes, via an integrative mixed-methods analysis?

 Semi-structured interviews

 ALQ

 AEMS reporting on patient safety issues for one year period

 Organization document perusal

 HSOPSC

Is there a significant relationship between specific leadership attributes and a patient safety culture?

 Surveyed nursing staff using the HSOPSC

 Measure-to-measure and item-to-item inter- correlation matrices

 Significance and post- hoc powers of inter- correlations

Is there a significant relationship between specific leadership attributes and adverse events or ‘near misses’?

 Surveyed nursing staff using the HSOPSC

 Measure-to-measure and item-to-item inter- correlation matrices

 Significance and post- hoc powers of inter- correlations