Understanding the influence of Learning

1
Understanding the influence of Learning
Development (LD) initiatives on Organisational
Learning (OL) within NHS Hospitals

• Shahida Choudhary
• Supervisors Dr. John Davies
• Professor John M. Sharp
• Research Centre for Organisational Excellence
  (COrE)
• Salford Business School
• University of Salford UK

2
Introduction

• Despite the amount of interest in the topic of
  OL, limited amount of good empirical research in
  area.
• Hence no consensus on the main characteristics
  necessary for the construction of a learning
  community.
• Study conducted within NHS

3
Literature Review

• The descriptive strand of Organisational Learning
  (OL) which involves the study of learning
  processes
• The prescriptive strand of the Learning
  Organisation (LO) which would focus on building
  an organisation that learns
• OL is the process by which organisations change
  their cultures and systems, to improve
  performance based on experience (Burgoyne, 1995)
  
• An LO is an organisation skilled at creating,
  acquiring and transferring knowledge and at
  modifying its behaviour to reflect new knowledge
  and insights (Garvin, 1993)

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Key Theoretical Issues(1)

• Individual learning
• All organisations are composed of individuals
  organisations can learn independent of any
  specific individual but not independent of all
  individuals.

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Key Theoretical Issues(2)

• Organisational Learning

Organisational learning can be identified by
studying the concrete structural and procedural
arrangements through which actions by members
that are understood to entail learning are
followed by observable changes in the
organisations pattern of activities.
Cook Yanow 1993
6
A three dimensional model of an LO
INDIVIDUAL
LEARNING
LEARNING
ORGANISATION
TEAM
ORGANISATION
LEARNING
LEARNING
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Need for Study

• Dominating factors for change in future of
  organisations is learning (Grieves, 2000)
• Gaps in OL LO theory scarceness of empirical
  studies
• Learning identified as a central concern for a
  modernised NHS
• The NHS currently invests over 2.5 billion a
  year on education and training for its staff
• Currently more than 15 different LD initiatives
  in NHS aimed at transforming future health care
• Moving the NHS towards an LO will require
  attention to the cultural values and structural
  mechanisms which facilitate OL (Nutley Davis,
  2001 Vassalou, 2001)

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Research Aim

• The aim of this research is to understand the
  influence of LD initiatives on OL within NHS
  acute trust hospitals

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Organisational Learning Mechanisms (OLMs)

• Processes structures that can create or improve
  learning opportunities and therefore contribute
  towards the development of a conducive learning
  environment

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Research Objectives(1)

• To comprehend OL LO concepts the process of
  OL relevant concepts in health care context
  the inhibitors of OL - to develop theoretical
  framework which depicts essential elements of OL
  influencing factors.
• To determine which OLMs exist in different wards
  in case study organisation.

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Research Objectives(2)

• To evaluate the perceived effectiveness of OLMs
  in different wards.
• To explore and understand the influence of
  various LD initiatives on OL in different wards.
• To determine the factors perceived to facilitate
  and/or inhibit OL in different wards.

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Research Questions(1)

• How do OLMs operate in different wards?
• How effective are these OLMs perceived to be in
  relation to OL?
• What factors are perceived to facilitate/inhibit
  OL in different wards?
• How do these factors affect the OLMs and the
  culture within which they operate?

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Research Questions(2)

• Why do these factors affect the OLMs and the
  culture within which they operate?
• How Why do various LD initiatives affect the
  OLMs in different wards?

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Research Methodology(1)

• Strongly inductive approach with an initial set
  of propositions which were developed into a
  proposed theoretical framework.
• Exploratory explanatory research what why
  how questions.
• Qualitative approach within Phenomenological
  paradigm.

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Research Methodology(2)

• Case Study strategy used (Yin, 2007)
• Two acute trust hospitals in North West
• Both hospitals employ 3000 staff
• Surgical Department in each hospital
• Cross-section of staff interviewed across
  functional groups
• Doctors, nurses, support staff

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Justification of Methodology

• Objective is rich, in-depth understanding of
  context of research.
• Multiple cases (2) to increase reliability
  robustness (Yin, 2007).
• Cross-comparison within between cases following
  replication logic (CollisHussey Yin, 2007).

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Methodology Data Collection

• General Surgery department
• Approx. 5 wards (each hospital)
• 20 interviews (each hospital)
• Document Review
• Observation

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Principles of data collection(1)

• Multiple sources of evidence used to triangulate
  data to minimise bias increase construct
  validity.
• Pre-interview activity, FGD conducted to pilot
  interview protocol.
• Interview protocol reviewed by supervisors 2
  LD professionals within hospitals to enhance
  validity reliability.

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Principles of data collection(2)

• Case study record created (notes, documents,
  transcripts, results tables, narratives etc.)
  to minimise errors bias increase reliability.
• Chain of evidence maintained (when reporting
  results, parts of interview transcripts, results
  tables, documents cited) to increase
  reliability robustness.

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Data Analysis

• Interviews fully transcribed (same day).
• E-mailed to interviewees for verification.
• Pattern-matching enhanced internal validity
  whereby empirically based pattern compared with
  predicted one (theoretical framework).
• Explanation building.
• Cross-case synthesis used to increase external
  validity.

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Case Study Findings(1)
Hospital LD Initiatives OLMs
A 18 35
B 21 23
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LD Initiatives

• Agenda for Change
• Improving Working Lives
• Investors In People
• Continuing Professional Development
• Critical Care Programme
• CRiSP (Care of the Critically ill Surgical
  Patients) Course
• Essence of Care
• Link Nursing
• Leadership at Point of Care

• ANTT
• Management Courses
• Nursing Degrees
• LEO (Leadership management course)
• NVQs
• Junior Doctors Training Scheme
• Appraisal Training

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OLMs

• Doctors daily rounds
• Grand weekly rounds
• Nurse rotation programme
• Patient reviews
• Shadowing
• Staff networking
• Multi-disciplinary meetings
• Nurse hand-overs
• Mentoring
• Work delegation
• Reflection in/after surgery
• Review of medical records
• Periodic review
• Medical staff meetings
• Nursing staff meetings
• Ward manager meetings
• Evidence-based practice

• Monthly nurse team briefs
• Video training
• Staff room tea breaks
• Test results analysis
• Clinical audits
• Journal club
• Induction training
• Study days
• Market days
• Introduction of computer records
• Conferences
• Staff appraisals
• X-ray meetings
• Weekly teaching sessions
• Tacit learning
• Incident reporting
• Link nursing

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Findings(contd)

• Infrequent opportunity for OLM engagement leads
  to ineffective LD implementation.
• Inhibitors staff shortages demanding work
  patterns low staff morale apathy poor
  communication information sharing poor
  leadership lack of management support

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Findings(contd)

• Instead of having positive affect, some LD
  initiatives perceived to be an administrative
  burden (e.g. AfC).
• Individually each LD initiative has merits but
  concurrent plethora perceived to have
  counter-productive effect.
• Random implementation of LD initiatives without
  synchronisation.

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Findings(contd)

• A strong commitment to LD- staffs access to
  time and support an issue.
• An abundance of potential opportunities, but
  clear indications that staff need more support to
  participate in a proactive approach to LD.
• Underlying support structures for LD perceived
  to be weak inappropriate (fragmented
  communication information sharing
  individualism lack of holistic approach towards
  LD).

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Originality Contributions to Knowledge

• First step towards theory building relating to OL
  within UK NHS. Contributions to body of knowledge
  on how OL is influenced by LD initiatives OLMs
  within NHS context.
• Theoretical frameworks developed bring together
  different OLM categories, LD initiatives and
  simultaneously incorporate categorise the main
  inhibitors of OL within the two hospitals studied.

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Contributions to Knowledge (contd)

• Production of two in-depth case studies of
  efforts of two hospitals to enhance LD
  initiatives, OLMs related learnoing processes.
• Previous studies on OL LO mainly undertaken in
  different cultural contexts from that of UK NHS,
  a contribution to literature has been made.

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Contributions to Knowledge (contd)

• Contribution to knowledge by summarising,
  highlighting categorising main inhibitors to OL
  within the two hospitals. Some unique inhibitors
  identified within UK NHS context.

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Limitations

• Findings restricted to 2 cases.
• Lack of literature on OLMs particularly in health
  care.
• During data collection access to wards restricted
  to interview times - observations hence
  restricted too.
• Access denied to interview night staff.

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Recommendations for further Research

• Further research into the relationship between
  levels of OL the implementation of LD
  initiatives OLMs.
• Further investigation into inter-relationships
  between learning, performance productivity.
• Unlearning identified as critical factor for OL
  to take place. Process of learning, unlearning
  relearning needs further research.
• Theoretical framework employed as a basis for
  further research with other hospitals and wards.

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Operational Recommendations

• It is important that health care practitioners
  promote the cause of LD initiatives such as CPD,
  AfC, IWL etc.
• Create excitement for LD activities by clearly
  linking participation to greater autonomy and
  career advancement
• Other personal benefits, such as increased
  self-esteem and greater feeling of competence
  need to be highlighted
• It is crucial that organisations acknowledge the
  benefits to the participant, the patients and the
  health care institution, by providing greater
  levels of support to individuals engaged in LD
  activities.