Organizational Learning in a Cardiac Intensive Care Unit

Abstract

Introduction: Providing high-quality care to every patient is challenging, particularly in critical care units (CCUs). However, this standard can be achieved through organizational learning. Unfortunately, the process of organizational learning in CCUs is not well understood. Objective: The objective of this study is to describe the developmental progression of a cardiac intensive care unit (CICU) to reach its current state of reliably excellent clinical performance. Methods: The method selected for this study was a learning history. A total of 43 individuals with experience working on the CICU participated in small group interviews. Participants included nurses, surgeons, unit clerks, administrators, nursing assistants, a pharmacist, a respiratory therapist, and an administrative assistant. Relevant artifacts, including unit performance data, were also gathered to complement interview data. Results: The CICU progressed through 4 distinct developmental stages to reach its current state. The CICU’s early development involved establishing psychological safety on the unit, which prepared the unit for increased accountability, improved performance, and the pursuit of reliability. Discussion/Conclusion: The findings validate the relationship between psychological safety and organizational learning, offer insight into how CCUs become high-reliability organizations, and provide clinical leaders with guidance for achieving high reliability in their organizations. The findings also help validate the American Association of Critical-Care Nurses position that a healthy work environment is essential to achieving clinical excellence. Critical care unit teams should use these findings as a framework for collective reflection and planning to achieve their desired future. Further research is needed to validate the applicability of these findings and to continue building the evidence base for organizational learning in hospital units.

Psychological Safe Environment: A Concept Analysis

“…Psychologically safe learning environments promote learning (Lyman et al, 2017) and contribute to patient safety (Dieckmann & Krage, 2013;Salas, Wilson, Burke, & Priest, 2005). Based on this concept analysis, there is direction on how to create a psychologically safe learning environment for simulation in the health professions and literature to support the need to do so.…”

“…Fowler and Rigby (1994) argued that students experienced distrust and anxiety during experiential learning activities as they perceived the facilitators as lacking in skills and expertise to provide for the psychological safety of participants. Psychological safety in the health care environment is linked to participants engaging in self-correcting behaviors, as they do not believe they will be punished for mistakes (Aranzamendez, James, & Toms, 2015;Lyman, Ethington, King, Jacobs, & Lundeen, 2017;Tucker & Edmondson, 2003). In studies that addressed psychological safety in simulation, researchers found that increased stress impairs knowledge recall and decreases clinical performance during simulation (Harvey, Bandiera, Nathens, & LeBlanc, 2012), whereas psychological safety is associated with a decrease in anxiety in stressful situations (Ignacio et al, 2015).…”

Nurses' experiences of Organisational learning: A qualitative descriptive study

“…Organisational learning (Senge, Ross, Smith, Roberts, & Kleiner, 1994; Singer & Vogus, 2013) is a promising approach for improving health care systems and patient outcomes (Fan et al., 2016; Filice et al., 2013; Lyman, Ethington, King, Jacobs, & Lundeen, 2017; Lyman, Shaw, & Moore, 2017; Nembhard, Alexander, Hoff, & Ramanujam, 2009; Rangachari et al., 2014). The concept of organisational learning arose from a confluence of work in the fields of psychology, systems thinking and organisational behaviour (Rebelo & Gomes, 2008).…”

Organizational learning in hospitals: A realist review

“…Organizational learning is linked to better patient outcomes, improved job satisfaction, reduced costs and other benefits (Fan et al, 2016;Lees et al, 2016;Lyman, Ethington, King, Jacobs, & Lundeen, 2017;Lyman, Shaw, & King, 2017;Rangachari et al, 2014;Sadeghifar et al, 2014;Syed & Samreen, 2015). However, the lack of a middlerange theory of organizational learning in hospitals leaves researchers and clinical leaders with little guidance for advancing research and practice in this field.…”