International Journal for Quality in Health Care 2000; Volume 12, Number 6: pp. 457–458

Editorial

The learning health care organization

which have high frequency and intensity of communicationsThe concept of health care organizations, or indeed publicwhich are informal and open.service organizations, as learning organizations has not

In a health care context, there are essential transformationalemerged as a significant topic in the literature to date. Whilerequirements. Because this type of organization is embeddedit may be argued that private and public service organizationsin a larger system it has to adopt a systemic process approachare not qualitatively different, the latter function in a morewhich takes into account a variety of power relationships.complex environment, are generally more bureaucratic andIt must foster the learning of all of its members. Only aare slower to change. Contextual effects are critical in trans-collective learning process can enable the integration of allforming public service organizations and health care or-of the actors in the system. Consequently, an experientialganizations in particular. Context mediates the constructionlearning cycle has to be initiated and managed. This has toof meaning and provides guidance to socially acceptablebe designed into the transformation process.beliefs and attitudes.

The conditions that facilitate learning are:There are environmental, organizational and public sectorconstraints in transforming health care organizations (public). • prior identification and recognition of capabilities andThese organizations operate in a political and public context areas for improvement;and are part of a larger system. Historically they are usually

• a clear connection between the learning task and itsmonopolistic which influences their bureaucratic identity andpotential consequences;culture. They operate within public service constraints, e.g.

public and administrative law, which impact on their planning, • opportunity to practice new skills and competencies;financing, and human resource management practices. In

• performance feedback;addition, there has always been a strong presence of interestgroups. The scope for creating a learning organization through • a climate that encourages, facilitates and rewardsorganizational learning has to be considered in this context. learning.

The Learning Organization is an ideal towards whichOrganizational learning capacity has several dimensions.

organizations have to evolve in order to be able to respondThey include leadership commitment, individual, collective,

to various pressures identified. It is characterized in their structural and socio-cultural aspects. As previously stated,internal and external environments by the fact that individual organizational learning is both activity and process orientated.and collective learning are key elements. It is driven by a Learning activities encompass education and training, andcommunity of practitioners and is one of several strategic learning sources inside and outside of the organization. Theobjectives adopted to achieve the organization’s mission. creation of an environment which is conducive to learning

Organizational learning is not necessarily synonymous with may require the elimination or at least, significant reductionthe idea of the Learning Organization. It is the range of of obstacles to learning. Social, cultural, structural and politicalactivities and processes by which the organization eventually factors must be addressed and realigned. A positive attitudereaches the ideal of a Learning Organization. Primarily, it towards learning and self-development must be evident atis a transformational process to which the organizational top and middle management levels. The effectiveness of thestakeholders, individually and collectively, contribute their human resource development policies will only be dem-learning. It is an organizational change strategy that is currently onstrated in the manner in which they are operated in practice.treated as an important research topic by scholars. Of critical concern is how individuals deal with the interaction

The health care (or public service) organization as a learning between personal (psychological) and contextual (social) fac-organization results from a process of organizational change tors. Learning, as a human activity, has to be explored as aaimed at profound organizational transformation. To this end social as well as a psychological process.it requires cultural, structural and, especially, change in the The creation of a quality health care organization is achiev-organization’s relationship to its political environment. able when the task is refocused as the creation of a learning

The nature of learning and its contribution to innovation organization. This status is acquired through a systematicand change is influenced by the organization’s strategy, struc- change process. The adoption of a corporate strategy basedture, communication practices and its social context. Or- upon a shared core ideology of values and purpose marksganizational design affects learning in its various service the genesis of the journey. The design and implementationsystems and units. For example, a lateral, as opposed to the of appropriate structures that are conducive to learningtraditional vertical design, can recreate the organization as a are rooted in strategic objectives. As learning is a multi-person-centred entity. That type of structural change is, dimensional concept, its outcome may serve varying purposes.

Processes to unlearn the bureaucratic culture have to be puthowever, dependent upon highly effective, accountable teams

2000 International Society for Quality in Health Care and Oxford University Press 457

Editorial: de Burca

in place so that conversion learning can occur. All col- Further readinglaborators in converting to the new philosophy have to ‘buy-in’ and take relevant ownership and accountability. Only then Dixon N. The Organizational Learning Cycle. How we Can Learn Col-

will the commitment and actions of continuous improvement lectively. London: McGraw-Hill, 1994.Duncon RB, Weiss A. Organizational learning: implications forbecome identifiable. But that is not the end-state. Instead it

organizational design. In: Staw BT, ed., Research in Organizationalis the penultimate stage in a change process that graduallyBehaviour. Greenwich, CT: JA Press, 1979: pp. 76–123.creates a learning culture. That becomes the new corporate

Easterby-Smith M. Disciplines of organizational learning: con-or health care organization’s identity.tributions and critiques. Human Relations 1997; 50: 1085–1113.

Stiofan deBurcaEasterby-Smith M, Burgoyne J, Araujo L. (eds) Organizational LearningPresident, The European Society for Quality in Health Care

and the Learning Organization. London: Sage Publications, 1999Limerick, Ireland Kolb, DA. Experiential Learning. Englewood Cliffs, NJ; Prentice-

Hall, 1984.

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