Institutional Attributes Associated With Innovation and Improvement: Results of a Multisite Study

Abstract

Background To date, no studies have explored why some teaching hospitals and health systems appear to offer a more fertile environment for innovation and improvement in the learning environment. As a consequence, little is known about the role of organizational attributes and culture in fostering innovation and improvements in settings where residents learn and participate in care, though these have been studied extensively in the general literature on organizations. Aims The goals of our study entailed (1) gathering ground-level observations on processes and common attributes; (2) disseminating this information for adoption and adaptation; and (3) exploring whether the current accreditation model may present barriers to institution- and program-level innovation. Methods We conducted a qualitative study of 4 institutions, successful in innovation and improvement in their learning environment, and sought to replicate the findings with a second group of 5 institutions. Results Three themes emerged from the interviews and site visits of the participants in the alpha phase: (1) a structure and culture that promote integration and inclusion; (2) a recognition of the value of resident education to the institution; and (3) a learning organization rooted in the extensive use of data and ongoing change, improvement, and innovation. Conclusions Some of the concepts identified in our small sample of “innovative” institutions could be relatively easily adopted or adapted by others that seek to enhance innovation and improvement in the learning environment. In contrast, the structural factors that characterized 3 of the 4 alpha participants, particularly the organization and compensation of faculty, may not be generalizable to many other institutions.

Organisational learning in hospitals: A concept analysis

“…Ford & Angermeier, ; Gagnon et al, ; Gibson & Campbell, ; Thompson, ), (b) collectively reflecting on past experiences (e.g. Edmondson, , Lipshitz & Popper, ), (c) intentionally obtaining, developing, and sharing knowledge and skills (Nembhard & Tucker, ; Vashdi, ), (d) making important information or behaviours resistant to loss by incorporating them into the organisation's policies, processes and/or culture (Davis, ; Nes & Moen, ), and (e) team members demonstrating leadership by initiating, facilitating and/or sustaining improvements (Filice et al, ; Philibert et al, ).…”

“…and (e) team members demonstrating leadership by initiating, facilitating and/or sustaining improvements (Filice et al, 2013;Philibert et al, 2010).…”

Organizational learning in hospitals: A realist review

“…Established standards for interpersonal conduct can also encourage respectful interactions (Dupree, Anderson, McEvoy, & Brodman, 2011). When psychologically safe relationships exist in an organization, incidents and errors are more likely to be reported (Crofts, 2006;Tucker, 2003;Turner, Ramsay, & Fulop, 2013), while connections within and among organizations can foster innovation and organizational learning (Philibert et al, 2010;Ugurluoglu, Ugurluoglu Aldogan, & Dilmac, 2013).…”

“…Infrastructure was identified as a contextual factor of organiza- infrastructure is necessary to support critical aspects of organizational learning (Philibert et al, 2010), such as person-to-person interactions (Carlton Jones & Roddie, 2016;Gregory, Hopwood, & Boud, 2014;Nilsen, 2011;Vashdi, Bamberger, Erez, & Weiss-Meilik, 2007). In contrast, organizational learning is impaired when an organization's goals and its available resources are misaligned (Souba, Way, Lucey, Sedmak, & Notestine, 2011).…”

“…Subsequently, improved outcomes positively influence both the contextual factors and mechanisms associated with organizational learning. For example, positive financial outcomes (Tucker, 2003;van Veen-Berkx et al, 2015) can support additional investments in infrastructure (Philibert et al, 2010) and positive team outcomes (Babich et al, 2016;Brunetto, Shacklock, Teo, Farr-Wharton, & Nelson, 2015) can lead to more interaction and deliberate learning.…”