Organizational learning and leadership in healthcare settings

¶ … organizational learning through the lens of leadership. The article notes that leadership must deal with an increased amount of conflict in the health care setting. The authors note that leaders must have adaptive systems to help manage change and conflict in their organizations, and the authors then highlight eight leadership tasks. The article has value in the sense that it talks a bit about how a lot of health care leadership relates to managing conflict. There is a high level of interdependency in health care these days, and conflict arises from that. Leaders need to have specific skills to manage conflict in the workplace, and ensure that everybody is pulling in the same direction. Overall, it\'s not the greatest source, but that is because the conflict angle is a poor fit for the topic of having a culture of learning in health care.

Vassalou (2001) examines the nature of the learning organization, and how the concept is applied to health care in Europe. The author proposes recommendations to health care organization to eliminate structural barriers to learning. The paper is valuable for two reasons. First, it highlights that health care organizations (at the time at least) have barriers to being learning organizations. Understanding what these barriers are is important for knowing how to remove them. The author\'s recommendations for removing the barriers also make a valuable contribution to the final paper.

Dowd, S. (2000) examines the nature of the learning organization, and how health care organizations are becoming learning organizations. The core concept of the learning organization is that the organization itself does the learning, rather than individual people. So knowledge is documented and passed through the organization, and is retained by it, rather than simply existing in the silo of a single individual. There is value in understanding some of the drivers of the transition to becoming a learning organization, including technology that makes it easier for organizations to maintain and transfer knowledge.

Senge & Sterman (1990), in this paper, discuss the idea of organizational learning. This paper is one of the earlier ones on the subject, and as such is valuable for tracing the development of the concept. They set out a clear definition of organizational learning as \"the process whereby shared understandings and strategies change,\" specifically with reference to developing flexibility within the organization to learn and adapt to new circumstances. An essential article to understanding the base concept of organizational learning, though this is not specifically focused on health care.

Carroll & Edmonson (2002) discuss the role that being a learning organization plays in health and safety. They point out that while a learning organization is beneficial for all facets of health care, the field of health care is evolving rapidly. There are many new innovations -- drugs, equipment and techniques -- and the learning organization must be able to master these in order to maintain its superiority with respect to patient outcomes. The authors point out the leadership is a key element in fostering organizational learning. Such learning can only come when there is complete buy-in from all levels of the organization, and that management in particular has a unique role in building relationships that allow for higher levels of organizational learning. This article is highly valuable for the way it puts the concept of organizational learning into the health care context.

Literature Review

The literature on the importance of having a culture of learning organization in health care begins with an outline of the concept of the learning organization. This concept was fleshed out in the late 1980s and early 1990s by management theorists, and was intended to be adopted by a wide range of organizational types. The underlying principle, as described by Senge & Sterman (1990), is that organizations have to be able to adapt to changing circumstances. They defined organizational learning as a \"process whereby shared understandings and strategies change.\" There are several key elements to that that Senge and Sterman identify. Key is that the understandings are shared throughout the organization, which implies that there are means by which this can occur.

The role of management and leadership also needs to be understood, because any time something is shared throughout the organization, it is essential that leadership is involved. Carroll and Edmondson (2002) note that in health care, all levels of leadership must contribute to the development of the learning organization. This means that information must flow freely through the different levels, and that everybody in the organization needs to be dedicated to a constant state of learning. Leadership plays a critical role in facilitating this.

Dowd argues that health care organizations are becoming learning organizations. One of the reasons why this is the case is that there has been a greater emphasis on technology, which has allowed organizations to store and transfer more knowledge than they have ever been able to before. Furthermore, the pace of change in the world has increased, and this has forced health care organizations to become more adaptable. In retrospect, Dowd was right. Not only have health care organizations had to adapt to HIPAA, but since Dowd\'s article there has been the aging of the baby boomers and the passage of the Affordable Care Act as two more things that have forced health care organizations to be more adaptable in order to thrive.

Vassalou offers a somewhat contrary opinion. There are many barriers to organizational learning in the health care field, many of which Vassalou outlines. It is important for managers and leaders in health care to understand these barriers and to respond by finding ways to overcome these barriers. This is how organizational learning is enhanced.

Anderson and Mcdaniel make clear that the leaders of healthcare organizations need to have adaptive systems. That is to say, organizational learning is not a one-off, nor is it an ad hoc process. Organizational learning, in contrast, is a systemic process and one of the major roles of leadership when it comes to this learning is to build out the systems that will allow the organization to consistently have a high level of adaptability.

Fraser and Greenhalgh (2001) point out that managing complexity is a key element in designing a learning organization. Complexity is one of the issues that is driving the need for modern health care organizations to constantly learn and adapt to new circumstances. Furthermore, it is important for those organizations to understand the complexities of their environments in order for that adaptation process to be successful. Begun, Zimmerman and Dooley (2002) expand on this idea, describing how health care organizations have become complex systems. Everybody within the health care organization has a specialized role, but there is also a high degree of interdependency between these roles. As such, the organization is highly complex, and the role of leadership is to understand the complex system and ensure that it is able to adapt to changing circumstances without a corresponding lag in safety, patient outcomes or staff satisfaction.

Paper Outline

• Introduction

• Overview of the concept of learning organizations

• Brief history of that concept

• How the concept applies to health care organizations

• Role of organizational culture in the learning organization

• Overview of Learning Organization

• Fundamental premise

• History of the concept

• Different roles

• Leadership in the Learning Organization

• The importance of organizational structure

• The importance of organizational culture

• How leaders influence culture

• Culture in the Learning Organization

• How culture influences organizational learning

• What cultures are successful in org. learning

• How can such a culture be fostered

• Organizational Culture in Health Care

• What is the traditional culture in health care?

• Is this culture conducive to organizational learning?

• What transformations need to be undertaken in order to improve the way that health care organizations respond to a changing environment

• The Changing Environment

• External forces influencing the health care environment

• Legislation

• Technological Change

• Aging population

• Industry consolidation

• Internal forces influencing the health care environment

• Immigrant workers

• Diversity

• Adaptability

• Education

• How the internal and external forces tie together to create a rapidly-changing environment

• Healthcare\'s Relationship to Change

• How has healthcare traditionally dealt with change?

• Has this been successful in the past?

• Health care\'s struggles to adapt to the 21st century

• How the learning organization and culture better prepares health care

• Conclusions

• Health care orgs are becoming more adaptable

• Move toward learning organizations is stronger

• Leadership at all levels plays a key role

• Culture is critical

• Leadership influences culture

• Culture drives adaptability and thirst for knowledge

• Postscript

• Areas for future study

• How can health care orgs continue to improve their cultures to be learning orgs and manage a rapidly-changing environment

Introduction

The concept of the learning organization began in management study in the late 1980s and early 1990s. It gained currency at the time because of its emphasis on encouraging the organization to be ready for a more rapidly-changing world, a message that resonated in management circles because the world was changing rapidly at the time. Computers were starting to become more common in businesses, and the United States had just signed its first trade agreement, a sign of things to come. The Eastern Bloc was crumbling, remaking the world order on top of all this. These external forces were combining to bring about a more rapid pace of change to the world, and to organizations, than had been seen for decades. As a result, organizations and management theorists started to conceptualize how organizations could better equip themselves for such changes. One of these conceptualizations was the learning organization.

Senge and Sterman defined organizational learning as \"process whereby shared understandings and strategies change,\" the implication being that a learning organization is one that employs such a process. The pace of external change has only increased, to the point where even more stable industries such as health care had to increase their ability to adapt -- HIPAA, electronic medical records, technological advancement in procedures and medicines, and finally the ACA have assured that rapid pace of change is the new norm in health care, too. Management literature has ever since emphasized the need for organizations to become learning organizations in order that they continue to thrive in such an environment (Garvin, Edmondson & Gino, 2008).

As the concept has been developed, the different elements of the learning organization have been explored. One key element is organizational culture. The premise is that organizational culture has to be oriented towards being adaptable, that a culture too rigid will struggle to ever become a learning organization. Culture can be an inhibitor to organizational learning, and therefore it is critical that the leader of any health care organization that wishes to be engage in a high level of organizational learning will need to place significant emphasis on building a flexible culture, just as a baseline that will permit the organization to improve its adaptability (Chang & Lee, 2007).

Overview of Learning Organizations

The fundamental premise of the learning organization is that it must be capable of adapting to a rapidly-changing environment. That the environment today is rapidly changing scarcely needs to be said, but the reality that companies need to adapt quickly to change is perhaps less universally-accepted. Garvin (1993) highlights how an organization can position itself to adapt quickly: \"A learning organization is skilled at creating, acquiring, and transferring knowledge, and at modifying its behavior to reflect new knowledge and insights.\" The building blocks of the learning organization therefore are the different aspects of the organization that encourage it to perform these tasks with respect to information.

Everybody is involved in the creation of a learning organization. Leadership plays a critical role because leaders define the structure and culture of the organization, and set the tone by being adaptable themselves. That relates to the second part of the definition of a learning organization, \"modifying its behavior to reflect new knowledge and insights.\" But the other members within an organization, outside of leadership, also play a key role. It is the larger body of employees at an organization that maintain its culture, and their participation in the acquisition and absorption of key information is essential. They need to be oriented, from a cultural perspective, towards learning. So culture is one of the most important components of the learning organization, regardless of industry.

Organizational Culture in Health Care

Health care has long been a conservative industry. It has been able to adapt to new medicines and procedures, but in terms of being genuinely adaptable to change, there is little doubt that health care has struggled. While the entire rest of American business is digital, many in health care struggle with the concept of electronic health records, as one example. In that sense, adaptability might not be the best trait of many health care organizations. This has consequences for transforming them into learning organizations, because the baseline culture in many health care firms is one that does not encourage a high rate of organizational learning.

Davies, Nutley & Mannion (2000) point out that health care management also does not tend to borrow much knowledge from other industries, a contributing factor in the staid culture that fails to promote a rapid pace of change. The traditional culture in health care, therefore, is not conducive to organizational learning because it does not encourage learning from all sources, focuses too much on centralized decision-making and does not offer pathways for organizational learning. Even if one part of an organization innovates, it is often too disconnected from other parts of the organization to bring the whole organization into the new way of thinking.

Thus, there are transformations that need to be undertaken in order to bring about the sort of organizational cultural change that will create learning organizations out of today\'s health care organizations. Davies, Nutley and Mannion (2000) note that organizations can only loosely chart the course for a culture. They can create the myths and the core values that incorporate learning. By ensuring that the organization knows where it needs to be, in terms of culture, leadership creates the conditions whereby management can gradually affect culture change. Gaining buy-in from different levels within the organization flows from having leadership buy-in and the appropriate resources dedicated to bringing about a change in the organizational culture.

The Changing Environment of Health Care

There are a number of forces driving change in health care, which makes the case for greater attention to organizational learning. The legislative environment is complex and changing. The ACA is the latest in a series of significant measures that is influencing the legislative environment, but noteworthy is that there are provisions in the ACA that have not been rolled out consistently across the country. This sort of complexity emanating from the political environment means that health care organizations need to be adaptable depending on how the winds of political change are blowing.

Moreover, the pace of technological change is increasing at a rate much faster than has been traditional in health care. New drugs, new medical devices, procedures and information technology are all changing the way that health care is administered. Traditional models of health care are dying out, and new models are being introduced. An organization needs to have a culture of learning in order to ensure that its members keep pace with this rapid pace of technological change.

The structure of the industry is changing as well. There is a move towards different sorts of business models. Health care firms are seeking ways to consolidate operations in order to save money. Despite rapidly-escalating costs associated with health care, the reality is that the economic environment for health care providers is anything but certain. Health care is becoming commoditized, a process that encourages consolidation. Such trends challenge health care organizations to maintain their own sense of identity and adapt to what are rather jarring changes.

Add to all of these changes the demographic reality. Baby boomers are entering their retirement years, creating a sharply rising demand for health care. This is a challenge for health care providers as it stretches their existing capacity. There are demographic shifts in terms of increasing diversity of the people who receive health care, as well as those who give it, again presenting a few unique challenges that maybe most health care managers did not think about historically (Fiscella, et al., 2000).

Internal Challenges in Healthcare

The key to building a positive culture that promotes organizational learning is to understanding the existing culture in health care and what barriers that might present, and how to overcome those barriers. In many areas, there is a shortage of quality workers, which creates all manner of problems. First, understaffed facilities do not have the time to dedicate to learning because too often they are simply putting out fires. Further, Workers tend to move more in such an environment, because there is competition for their services. Even if the shortages are alleviated by importing workers, those workers come from different cultures and may be even more resistant to an organizational learning culture than the mainstream culture (Kuehn, 2007).

Increased diversity presents a challenge in the sense that not everybody comes from the same cultural baseline. Where some cultures might be highly adaptable, it cannot be assumed that all are. And individual people might behave different from their expectations based on culture, but the point is more that with a greater diversity of thought there are going to be people who are not as adaptable because that is how they have been raised.

To foster a greater sense of adaptability is one of the challenges for a health care organization that wants to build adaptability into its organizational culture, it is important emphasize adaptability and education. Adaptaibility means having a certain openness to new ideas, being willing to change how things are done on the basis of evidence, and ensuring that all processes are subject to period review to ensure that things are being done in the best possible way. The point is to get the organization to a point where it is comfortable, and does not fear change.

Beyond that, education is important. This is not a matter of finding workers with a specific degree of formal education, but building internal processes that encourage education, finding pathways internally for moving information around so that the people in the company have the highest possible knowledge. Internal and external forces come together to produce a rapidly-changing environment, but internal forces that foster a higher degree of education and openness will also help to prepare the organization to have a culture that encourages organizatioanal learning and adaptability.

Culture of a Learning Organization

A learning organization has a specific culture, one that is built on a certain openness, a willingness to adapt and ultimately one that is built on. Leadership first needs to signal that it is important for the organization to be adaptable. The leaders in the organization can scan the environment and easily understand that the pace of change in health care is much faster than it has ever been. This means that, simply, in order to thrive or even survive the modern health care organization must be a learning organization. The issue is that the people within the organization have their own jobs, and are worried about those. They are not worried about the macro-level issues their bosses have to think about..So leadership has to set the tone -- they know what is at stake. But it is more than just paying lip service to being a learning organization. Leadership actually has to do it. They have to set out the tone for the culture, define how they will guide the organization to become a learning organization and then will need to ensure that the adequate resources are in place to make it happen.