Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units

by Anita L. Tucker, Ingrid M. Nembhard & Amy C. Edmondson

Overview — How do hospital units, as complex service organizations, successfully implement best practices? Practices involve people and knowledge; people must apply knowledge to particular situations, so changing practices requires changing behavior. This study is a starting point for healthcare organizations to improve work practices. The researchers drew from literature on best practice transfer, team learning, and process change and developed four hypotheses to test at highly specialized hospital units that care for premature infants and critically ill newborns. Key concepts include:

  • Organizations must set up project teams to investigate and implement new practices. Project teams are important for creating organizational change.
  • There is a strong positive relationship between "learn-how" and implementation success.
  • "Learn-how" makes new practices work in a specific context, and psychological safety encourages people to participate in this disruptive process.

Author Abstract

This paper contributes to research on organizational learning by investigating specific learning activities undertaken by improvement project teams in hospital intensive care units and proposing an integrative model to explain implementation success. Organizational learning is important in this context because medical knowledge changes constantly, and hospital care units must learn if they are to provide high quality care. To develop a model of how improvement project teams promote essential organizational learning in health care, we draw from three streams of related research - best practice transfer (BPT), team learning (TL), and process change (PC). To test the model's hypotheses, we collected data from 23 neonatal intensive care units seeking to implement new or improved practices. We first analyzed the frequency of specific learning activities reported by improvement project participants and discovered two distinct factors: learn-what (activities that identify current best practices) and learn-how (activities that operationalize practices in a given setting). We then conducted general linear model analyses and found support for three of our four hypothesis. Specifically, a high level of supporting evidence for a unit's portfolio of improvement projects was associated with implementation success. Learn-how was positively associated with implementation success, but learn-what was not. Psychological safety was associated with learn-how, which was found to mediate between psychological safety and implementation success.

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