Organizational learning in hospitals: A realist review

Abstract

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.

Nurses' experiences of Organisational learning: A qualitative descriptive study

“…Qualitative descriptive studies are particularly well suited for generating rich descriptions of a phenomenon of interest, based on nurses’ experiences with that phenomenon (Kim, Sefcik, & Bradway, 2017). Generating rich descriptions of first‐hand experiences of organisational learning was critical to evaluating how well the Organisational Learning in Hospitals model (Lyman et al., 2019) aligns with those experiences. Additionally, qualitative descriptive studies do not necessarily require a clear theoretical framework, and the results can be used to inform additional theory development (Kim et al, 2017).…”

“…Additionally, qualitative descriptive studies do not necessarily require a clear theoretical framework, and the results can be used to inform additional theory development (Kim et al, 2017). This feature is important for the second purpose of the study – which involves exploring relationships among factors that have not been specified in detail in the Organisational Learning in Hospitals model (Lyman et al., 2019). Ethical approval was obtained through the authors’ university Institutional Review Board.…”

“…Research supports the link between organisational learning and positive patient outcomes, staff outcomes and organisational financial viability (Lyman, Jacobs, Hammond, & Gunn, 2019; Richter, 2013; Wang et al., 2014). Examples of positive patient outcomes associated with organisational learning include improved patient satisfaction scores and decreased surgical site infections, mortality, medication errors, patient pain scores, hospital length of stay, improved patient handoffs, increased error reporting and fewer central line‐associated bloodstream infections.…”

“…The Organisational Learning in Hospitals model (Figure 1; Lyman et al., 2019) is an evidence‐based theoretical representation of how organisational learning occurs in hospitals. Lyman et al suggest certain contextual factors are conducive to organisational learning (Table 1).…”

“…The primary purpose of this study was to explore how well the Organisational Learning in Hospitals model (Lyman et al., 2019) aligns with nurses’ first‐hand experiences with organisational learning. First‐hand experiences provide a valuable basis for examining and improving the model's validity.…”