Implementation challenges of electronic blood transfusion safety systems: Lessons from an international, multi-site comparative case study.

BACKGROUND: Severe transfusion reactions resulting from errors in matching the correct blood with the correct patient are considered never events. Despite the relative technical simplicity of barcode scanning for patient-blood bag matching, the adoption and universal application of this safety measure are by no means universal. This study highlights the logistical and institutional challenges associated with spreading, scaling up, and sustaining such IT-supported safety measures in healthcare. STUDY DESIGN AND METHODS: We report findings from a 5-year, prospective, multi-site case study conducted across one hospital in England and three hospitals in the Netherlands. Ethnographic methods, including interviews and observations, were used at each site to investigate the implementation of barcode scanning-supported safety pathways for blood transfusions. RESULTS: Significant variation was observed across the sites in the adoption and implementation of barcode scanning-supported safety pathways. Despite the potential for reducing transfusion errors, the introduction of this innovation was met with varying levels of success in different settings. DISCUSSION: This study highlights the critical role of inter-hospital learning and flexible system design in successfully implementing barcode scanning-supported safety pathways for blood transfusions. A more structured, national-level network for knowledge sharing could enhance the spread and sustainability of such innovations across healthcare settings.

Interactions between the context of a health-care organisation and failure: the situational impact of failure on organisational learning.

PURPOSE: This study aims to explore how health-care organisations learn from failures, challenging the common view in management science that learning is a continuous cycle. It focuses on understanding how the context of a health-care organisation and the characteristics of failure interact. DESIGN/METHODOLOGY/APPROACH: Systematically collected empirical studies that examine how health-care organisations react to failures, both in terms of learning and non-learning, were reviewed and analysed. The key characteristics of failures and contextual factors are categorised at the individual, team, organisational and global level. FINDINGS: Several factors across four distinct levels are identified as being susceptible to the situational impact of failure. In addition, these factors can be used in the design and development of innovations. Taking these factors into account is expected to stimulate learning responses when an innovation does not succeed. This enhances the understanding of how health-care organisations learn from failure, showing that learning behaviour is not solely dependent on whether a health-care organisation possesses the traits of a learning organisation or not. ORIGINALITY/VALUE: This review offers a new perspective on organisational learning, emphasising the situational impact of failure and how learning occurs across different levels. It distinguishes between good and bad failures and their effects on a health-care organisation's ability to learn. Future research could use these findings to study how failures influence organisational performance over time, using longitudinal data to track changes in learning capacity.

Organisational learning through a charitable trust-initiated project focusing on end-of-life care.

PURPOSE: We identify lessons from a project sponsored by a large charitable trust, which sought to build capability for end-of-life (EOL) care in Hong Kong through interdisciplinary and multi-agency collaboration. DESIGN/METHODOLOGY/APPROACH: An in-depth case study drawing on 21 in-depth interviews with diverse stakeholders was conducted. Lyman et al.'s (2018) model of organisational learning (OL) in healthcare settings was applied to analyse the relative emphasis on particular contextual factors and mechanisms, and to identify outcomes perceived to have been achieved. FINDINGS: Infrastructure such as materials for assessment and education received the most emphasis among the contextual factors and deliberate learning such as training sessions received the greatest attention among the mechanisms. While perceptions indicated that desired outcomes were being achieved in terms of social impact, there were relatively few mentions of "soft" factors such as enhanced motivation, leadership or OL skills among staff. ORIGINALITY/VALUE: This study extends the literature on how to create valuable social impact through OL. While prior studies have examined social impact in terms of solutions for social and environmental problems, ours is one of the few that examines how improvements are made to organisations' capability to deliver such impacts in the context of healthcare.

Organisational learning from the public health response to the COVID-19 pandemic: findings from a qualitative interview study.

System learning from major incidents is essential for enhancing preparedness for responding to future adverse events. Sharing learning not only stimulates further improvements, preventing the repetition of mistakes, but may also promote collaboration and the adoption of evidenced-based best practises. As part of a qualitative interview study designed to explore lessons learned, this paper describes the experiences and perspectives of 30 staff from the public health agency responsible for the national COVID-19 response in the United Kingdom. The focus of the interviews was on enabling factors and practises that worked well, as well as those that were more challenging, and which, if addressed, could improve responses to future infectious disease incidents. The interviews elicited valuable insights across various thematic areas that could inform emergency preparedness activities for future infectious disease outbreaks. The outcomes of this study, while integral for the UK agency responsible for public health, extend beyond organisational boundaries and contribute to a broader spectrum of activities aimed at facilitating global learning from the COVID-19 response.

Actions targeting the integration of peer workforces in mental health organisations: a mixed-methods systematic review.

BACKGROUND: Lived experience workforces are one of the fastest growing emerging disciplines in Australian mental health service settings. Individuals with lived and living experience of mental distress employed in mental health services, often referred to as peer or lived experience workers, are widely considered essential for mental health recovery and reform. Despite vast growth of this workforce, concerns remain over the widespread integration of peer workforces to align with recommended movement of healthcare services toward greater recovery-orientated and person-centered practices. Previous research has identified barriers for peer work integration including a lack of clear role definition, inadequate training, and poor supportive organisational culture. Stigma, discrimination and a lack of acceptance by colleagues are also common themes. This systematic review seeks to identify organisational actions to support integration of peer workforces for improved mental health service delivery. METHOD: A systematic search was conducted through online databases (n = 8) between January 1980 to November 2023. Additional data were sourced from conference proceedings, hand searching grey literature and scanning reference lists. Qualitative data was extracted and synthesised utilising narrative synthesis to identify key themes and findings reported adhere to PRISMA guidelines. The review protocol was registered with Prospero (CRD: 42,021,257,013). RESULTS: Four key actions were identified: education and training, organisational readiness, Structural adjustments, resourcing and support and, demonstrated commitment to peer integration and recovery practice. CONCLUSIONS: The study identifies actions for mental health service organisations and system leaders to adopt in support of integrating peer and lived experience workforces in service delivery.

The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis.

AIMS AND METHOD: Serious incident management and organisational learning are international patient safety priorities. Little is known about the quality of suicide investigations and, in turn, the potential for organisational learning. Suicide risk assessment is acknowledged as a complex phenomenon, particularly in the context of adult community mental health services. Root cause analysis (RCA) is the dominant investigative approach, although the evidence base underpinning RCA is contested, with little attention paid to the patient in context and their cumulative risk over time. RESULTS: Recent literature proposes a safety-II approach in response to the limitations of RCA. The importance of applying these approaches within a mental healthcare system that advocates a zero suicide framework, grounded in a restorative just culture, is highlighted. CLINICAL IMPLICATIONS: Although integrative reviews and syntheses have clear methodological limitations, this approach facilitates the management of a disparate body of work to advance a critical understanding of patient safety in adult community mental healthcare.

Systemic Reflections on Knowledge Transfer Comment on "Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis".

The systemic failure of organisational learning should not come as a surprise - after all every system delivers exactly what it is designed for. Knowledge management/transfer is a property of the organisational system rather than a particular technique. Hence, knowledge management/transfer is about the contextual framing in which learning focused on understanding can occur. Looking through a system lens any research field can be defined as a complex adaptive organisation, and its culture determines if and how learning and knowledge transfer (or shared learning) can occur. Creating and maintain a learning culture requires leadership that perpetuates continuous dialogues to achieve tacit and explicit knowledge exchange.

Flipped Learning 4.0. An extended flipped classroom model with Education 4.0 and organisational learning processes.

This article integrates two visions on the creation of knowledge by students: an academic vision where the person who creates knowledge uses high-level cognitive abilities and, therefore, acquires deeper learning, and an organisational learning vision, where the creation of knowledge adds value to the organisation and the individuals who work in this matter. It starts from a validated flipped classroom model and then adds procedures and cycles of knowledge that make it an active methodology, in such a way that it simultaneously supports organisational learning, using cooperative competencies characteristic of Education 4.0. This proposed hybrid model has been applied online during confinement due to the COVID-19 pandemic and, subsequently, in dual mode (students partly in person and the rest online at the same time) and face-to-face mode. The evidence of this research shows that the creation of knowledge by the students, cooperatively and with an organisational learning perspective, has repercussions for improvements in their academic performance by producing deeper learning. In addition, the development of cooperative skills is observed to create and manage a large amount of helpful knowledge for them and other students in their learning process.

Mechanisms of organisational learning in hospitals: An instrument development study.

AIM: To develop a valid, reliable research instrument to measure mechanisms associated with organisational learning in hospitals. BACKGROUND: A valid, reliable instrument for measuring mechanisms of organisational learning would enable nurse leaders and researchers to improve health care through facilitation and study of organisational learning. METHODS: The Organizational Learning in Hospitals model was used as a framework to develop the Organizational Learning Instrument-Mechanisms. Cognitive interviews and expert reviews were used to refine and evaluate item-level and scale-level content validity. The instrument was distributed by email to a random sample of nurses working in inpatient hospitals in Utah (n = 1253). Confirmatory factor analysis was used to assess construct validity, and coefficient alpha was used to assess internal reliability. RESULTS: Item-level content validity scores were .88 to 1.0, and scale-level content validity was .98 (maximum score = 1.0). Standardized factor loadings were .539-.956, with model fit statistics as follows: comparative fit index (CFI) = .975, Tucker-Lewis index (TLI) = .973 and root mean square error of approximation (RMSEA) = .059. Coefficient alpha scores were .77-.95 for the instrument's five factors. CONCLUSIONS: Initial testing indicates the Organizational Learning Instrument-Mechanisms has adequate levels of reliability, content validity and construct validity. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital leaders and researchers may begin using this instrument to improve and study the mechanisms of organisational learning in hospital units.

Ensuring the quality and quantity of personal protective equipment (PPE) by enhancing the procurement process in Northern Ireland during the coronavirus disease 2019 pandemic: Challenges in the procurement process for PPE in NI.

This article outlines the purchasing process for personal protective equipment that was established for Health and Social Care in Northern Ireland in response to the outbreak of coronavirus disease 2019. The Business Services Organisation Procurement and Logistics Service, who are the sole provider of goods and services for Health and Social Care organisations, was faced with an unprecedented demand for personal protective equipment in response to the coronavirus disease 2019 pandemic. The usual procurement process was further complicated by changing messages within guidelines which resulted in confusion and anxiety when determining whether or not a product would meet the required safety guidance and was therefore suitable for purchase. In order to address these issues in a rapidly changing and escalating scenario the Department of Health asked the Business Services Organisation Procurement and Logistics Service to work with the Medicines Optimisation Innovation Centre to maximise the availability of personal protective equipment whilst ensuring that it met all requisite quality and standards. A process was implemented whereby the Medicines Optimisation Innovation Centre validated all pertinent essential documentation relating to products to ensure that all applicable standards were met, with the Business Services Organisation Procurement and Logistics Service completing all procurement due diligence tasks in line with both normal and coronavirus disease 2019 emergency derogations. It is evident from the data presented that whilst there were a significant number of potential options for supply, a large proportion of these were rejected due to failure to meet the quality assurance criteria. Thus, by the process that was put in place, a large number of unsuitable products were not purchased and only those that met extant standards were approved.

Exploring the relationship between organisational silence and organisational learning in nurses: A cross-sectional study.

AIMS: To assess the organisational silence and learning levels among nurses of a university hospital and explore the relationship between the socio-demographics, organisational silence and learning. BACKGROUND: Organisational learning is an active process needed for improving organisational performance, and silence has a devastating impact on an organisation's capacity to learn. METHODS: A cross-sectional quantitative design was applied using two tools: the organisational silence and the organisational learning scales. Over 3 months, data were collected from 724 nurses. The data were then analysed using suitable statistical methods. RESULTS: The organisational silence level is moderate. The organisational learning level is predominantly moderate. The association between the two scales is a weak negative correlation, yet statistically significant. The multiple regression analysis was better in predicting organisational learning scores. CONCLUSIONS: There is a highly statistically significant negative weak correlation between overall organisational silence and overall organisational learning. More researchers are invited to implement of interventions to promote speaking-up behaviours and organisational learning in nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders can create a work atmosphere that encourages and promotes open communication among nurses and other health care team members, likewise, creating an environment conducive to translating experiences into organisational learning.

A threat rather than a resource: why voicing internal criticism is difficult in international organisations.

Voicing criticism seems to be a difficult task for employees in international organisations (IOs), as numerous anecdotes in the literature suggest. This observation is alarming, since internal criticism is an indispensable resource for organisational learning processes. So why are IOs apparently not using this resource to its full potential? The present article is the first to provide a comprehensive answer to this question by combining insights from organisation theory with an empirical case study of the UN Secretariat. My general argument is that 'criticism from within' is ambivalent. It can be a resource for, but also a threat to IOs: internal criticism can endanger an IO's external reputation as well as destabilise the organisation from within. Based on this theoretical understanding, I identify and empirically examine three specific reasons for the UN Secretariat's weak criticism culture: (1) Criticism is suppressed due to a widespread fear of leaks resulting from external pressures. (2) Criticism is avoided as a strategy of self-protection in the face of (inevitable) failures. (3) Constructive criticism is difficult to express in settings where organisational hypocrisy is necessary.

Cross-cultural adaptation and validation of the strategic learning assessment map for Chinese nursing organisation: A cross-sectional study.

AIM: To translate the Strategic Learning Assessment Map into Chinese and validate it in Chinese nursing organisations. BACKGROUND: Nursing is the largest occupational organisation in the health sector and its adaptation and innovation are important for the realisation of sustainable development goals. Organisational learning is critical in cultivating the adaptive and innovative abilities of organisations, but there is limited research on its measurement. Although the Strategic Learning Assessment Map is a widely acknowledged organisational measurement instrument, it has not yet been adapted and validated in China. DESIGN: A cross-sectional study design was used. METHODS: The Chinese version of the Strategic Learning Assessment Map was generated through forward-backward translation and was tested with a convenience sample of 2745 nurses from 7 administrative regions of mainland China. The internal consistency, content validity, structural validity and theoretical framework were examined. RESULTS: Results validated the theoretical framework and showed excellent content validity, convergent validity and fitness of the measurement model; only discriminant validity was not satisfactory. Cronbach's α values for the overall scale and its subscales ranged from 0.97 to 0.99. CONCLUSIONS: The Chinese version of the Strategic Learning Assessment Map is a reliable organisational learning instrument for Chinese nursing organisations.

Leadership assumptions on implementation of patient involvement methods.

BACKGROUND: From 2014 to 17, a large-scale project, 'The User-involving Hospital', was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders' assumptions concerning implementation of patient involvement methods in a hospital setting. METHODS: Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns' seven stages of interview research. RESULT: The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: "The health care professionals' roles in the implementation process" and "The leaders' own roles in the implementation process". CONCLUSION: The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

Advancing quality culture in health professions education: experiences and perspectives of educational leaders.

The concept of quality culture has gained increased attention in health professions education, drawing on insights that quality management processes and positive work-related attitudes of staff in synergy lead to continuous improvement. However, the directions that guide institutions from quality culture theory to educational practice have been missing so far. A prospective qualitative case study of three health professions education programmes was conducted to explore how a quality culture can be enhanced according to the experiences and perspectives of educational leaders. The data collection was structured by an appreciative inquiry approach, supported with vignette-based interviews. A total of 25 participants (a selection of course coordinators, bachelor coordinators and directors of education) reflected on quality culture themes to learn about the best of what is (Discover), envision positive future developments (Dream), identify actions to reach the desired future (Design), and determine how to support and sustain improvement actions (Destiny) within their own educational setting. The results are presented as themes subsumed under these four phases. The experiences and perspectives of educational leaders reveal that peer learning in teams and communities, attention to professional development, and embedding support- and innovation networks, are at the heart of quality culture enhancement. An emphasis on human resources, (inter)relations and contextual awareness of leaders stood out as quality culture catalysts. Educational leaders are therefore encouraged to especially fuel their networking, communication, coalition building, and reflection competencies.

Relationships between the components of nurse managers' transformational leadership and organisational learning subprocesses in a hospital ward: A cross-sectional study.

AIMS: To investigate the association between the five components of nurse managers' transformational leadership and each process of organisational learning in a hospital ward. BACKGROUND: Elucidating the components of nurse managers' transformational leadership that promote organisational learning is needed. METHODS: In 2018, 591 self-report questionnaires from two hospitals in Japan were analysed, using the measurement scale for Organizational Learning Subprocesses and Multifactor Leadership Questionnaire. Hierarchical linear modelling was conducted using the wards' mean scores of five components of transformational leadership and five subprocesses of organisational learning. RESULTS: None of the transformational leadership components were significantly associated with information acquisition, but all five were significantly positively associated with information distribution and information integration. Only some of the five components showed a significant association with information interpretation and organisational memory. CONCLUSION: Transformational leadership may be effective to promote the four organisational learning processes other than information acquisition. IMPLICATIONS FOR NURSING MANAGEMENT: A nurse manager should exercise leadership other than transformational leadership, or use other strategies to promote information acquisition. However, particular behaviours of transformational leadership, such as intellectually stimulating behaviours and personal considerations, could be effective in promoting the understanding of information among the members and establishing new routines.

React and act: a qualitative study of how nursing home leaders follow up on staff-to-resident abuse.

BACKGROUND: Elder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse. METHODS: A qualitative explorative design was used. The sample comprised 43 participants from two levels of nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews were conducted with 28 care managers, and individual interviews took place with 15 nursing home directors. The constant comparative method was used for the analyses. RESULTS: Nursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows: 1) on an individual level, leaders performed investigations and meetings, guidance, supervision, and occasionally relocated staff members; 2) on a group level, feedback, openness, and reflection for shared understanding were strategies leaders used; and 3) on an organisational level, the main solutions were to adjust to available resources, training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that were taken. CONCLUSIONS: Nursing home leaders need to be clear about how they should follow up incidents of elder abuse on different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that acknowledge that incidents of elder abuse in patient care arise not only from the actions of individuals but also from the complex everyday life of which they are a part and in which they operate.

Understanding integrated care at the frontline using organisational learning theory: A participatory evaluation of multi-professional teams in East London.

Integrated care has been proposed as an organising principle to address the challenges of the rising demand for care services and limited resources. There is limited understanding of the role of learning in integrated care systems. Organisational Learning (OL) theory in the guise of 'Learning Practice' can offer a lens to study service integration and reflect on some of the challenges faced by multi-professional teams in developing a learning culture. The study presents findings from two qualitative evaluations of integrated care initiatives in three East London boroughs, England, undertaken between 2017 and 2018. The evaluations employed a participatory approach, the researcher-in-residence model, to coproduce findings with frontline staff working in multi-professional teams in community care. Thematic analysis was undertaken using an adapted version of the 'Learning Practice' framework. The majority of learning in the teams was single loop i.e. learning was mainly reactive to issues that arise. Developing a learning culture in the three boroughs was hindered by the differences in the professional and organisational cultures of health and social care and challenges in developing effective structures for learning. Individual organisational priorities and pressures inhibited both the embedding of learning and effective integration of care services at the frontline. Currently, learning is not inherent in integrated care planning. The adoption of the principles of OL optimising learning opportunities, support of innovation, managed risk taking and capitalising on the will of staff to work in multidisciplinary teams might positively contribute to the development of service integration.

Nurses' experiences of Organisational learning: A qualitative descriptive study.

AIM: To explore the validity of and expand upon a model of organisational learning in hospitals. BACKGROUND: Organisational learning is a positive change in an organisation's collective knowledge, cognition and/or action, leading to improved hospital performance. A current model offers an evidence-based, theoretical representation of organisational learning in hospitals, yet the intricacies of organisational learning in clinical practice are not fully understood. Additional guidance is needed to effectively foster and study organisational learning. METHOD: Semi-structured interviews were used to gather 15 first-hand experiences of organisational learning from 14 nurses. Data were analysed via deductive thematic analysis. RESULTS: Organisational learning was more effective when aligned closely with the model and less effective when alignment was poor. The nurses' experiences illustrate relationships among elements of the model and underscore the importance of leadership and psychological safety in organisational learning. CONCLUSION: This study helps validate the model and offers new insights into organisational learning. Additional research is needed to explore the role of leadership and psychological safety in organisational learning. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can use the Organisational Learning in Hospitals model to evaluate organisational learning. Nurse managers have the opportunity to develop effective leadership practices designed to cultivate psychological safety within their teams.