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.

Aim To provide a clear definition and description of organisational learning in hospitals. Background Organisational learning is a promising strategy nurse managers, and leaders can use to improve organisational performance. A clear definition and description of organisational learning is necessary to advance theory, research and practice in this field. Methods Walker & Avant's method was used to conduct a concept analysis of organisational learning in hospitals. Data sources included 147 empirical studies, 16 review articles, three dictionary entries and three book chapters. Results Organisational learning occurs when experiences are translated into positive changes in the organisation's collective knowledge, cognition and actions. Organisational context plays a key role in the learning process. Other manifestations of the concept are identified. Conclusions This concept analysis provides a clear definition of organisational learning and a description of its defining attributes, antecedents, empirical referents and consequences. Implications for Nursing Management Nurse managers and leaders can improve patient and organisational outcomes by creating an environment conducive to translating experiences into organisational learning. Further research is needed to continue advancing the science of organisational learning in hospitals.