Learning from patients: constructions of knowledge and legitimacy in hospital-based quality improvement programmes

ABSTRACT

Health services organisations are increasingly incorporating patient engagement strategies as a form of quality improvement. Such strategies take form in programmes where organisations partner with patients in order to learn from their experiences and thereby change how services are designed, delivered, and implemented. In this study, we examined the enactment of patient engagement programmes within an academic health science organisation in Canada. This was accomplished through an exploration of the various constructions of patient participants’ legitimacy, credibility, and expertise as manifesting through participation in the various practices associated with the programmes. Analysis was based on a selection of international, national, and organisational texts, as well as interviews with patient participants (n?=?20) and hospital staff members (n?=?6). Through this analysis, we argue that organisations are not learning from patients per se, but are learning from particular constructions of patient subjectivities in the form of patient advisers. We argue that if patient engagement programmes are premised upon opportunities to learn from patients, these programmes require a coherent theory of workplace learning. We suggest attention to the politics of knowledge production as a fruitful way to conceptualise how clinicians and administrators might learn from patients at the organisational level.     

Learning Organisationsreengineering schools for life long learning

It has taken some two decades for the concept of the learning organisation to achieve recognition as a powerful way of reengineering for life long learning. During this time, schools have been through a period of very rapid change but, paradoxically, many look less like learning organisations today than they may have before the introduction of the Education Reform Act. This paper examines some of the key ideas behind the learning organisation, explores why the concept is so powerful in contemporary contexts, identifies various types of learning organisations and suggests an analytical technique for relating styles of organisational learning to the environmental context. The paper concludes with an analysis of the implications of learning organisation concepts for schools and school leaders.     

Action research and organisational learning: a Norwegian approach to doing action research in complex organisations

The purpose of this article is to present a specific approach to the practice of action research ‘in complex organisations’. Clearly, there are many approaches to the challenge of doing action research in organisations; approaches that are, and also must be, quite context dependent and specific. But my purpose is neither to give an overview nor a recommendation of how action research is or should be done in complex organisations by different schools of action researchers around the world. The approach I will present has grown through practical experience accumulated over many years with doing action research in many different Norwegian organisations with organisational change and development as the specific objective. I will limit myself to an outline of this Norwegian context, and to how I and others have worked specifically with organisational learning both practically and theoretically within or in relation to a broad Norwegian or Scandinavian approach to action research and organisation development represented by many individuals.     

From silos to solutions: How one district is building a culture of collaboration and learning between school principals and central office leaders

Large urban school districts often struggle with hierarchy, fragmented processes and cultures whereby organisational silos between school and central office staff serve as a major barrier for reaching the desired strategic goals of improving student achievement. In addition, school district staff are undergoing change requiring leaders and staff in these organisations to adapt and build their capacity to support changing demands. However, little attention is paid to how to build the necessary systems and learning environments to support capacity building and leader development. This article reports on an action research study using mixed methods that reveal how central office leaders and school principals break down organisational silos to build a culture of learning using learning organisation principles. Using the Dimensions of the Learning Organization Questionnaire (DLOQ) short form, participants completed questions related to the school district's capacity for learning. Data from the survey and interviews outline key findings that illustrate how the learning organisation framework served as a model to create the organisational conditions and culture to enable support and cooperation for learning, capacity, change and improvement to occur. This action research case study is a look at one organisation's approach to addressing a gap in learning organisation research in the area of learning organisation interventions. In addition, it extends current research on schools as learning organisations with an example of data-informed change in one large school district in the southern United States.     

Exploring organisational learning in universities’ responses to a quality assurance reform: experiences from Ontario,Canada

Amidst the international movement toward establishing more rigorous external quality assurance, the recent quality assurance reform within the Ontario public university sector involves a shift of focus from external to internal quality assurance. This paper explores to what extent organisational learning was occurring at three comprehensive Ontario universities while they managed institutional change for assuring the quality of graduate programmes in response to the system-wide quality assurance reform. Drawing upon Senge’s framework for building a learning organisation, the study found that certain levels of organisational learning were taking place, albeit to different extent and in different pace, at the three Ontario universities during the initial years of transition. The findings also illustrate that institutional change and organisational learning are inextricably linked and that organisational learning is occurring as a result of the interactions between the organisational domain of action and the individual domain of learning.     

How do teachers learn together? A study of school-based teacher learning in China from the perspective of organisational learning

Studies of professional development have examined the influence of school-based approaches on in-service teacher learning and change but have seldom investigated teachers’ job-embedded learning processes. This paper explores the dynamic processes of teacher learning in school-based settings. A qualitative comparative case study based on the framework of organisational learning was conducted to analyse the ways that 17 teachers from two school-based communities in a secondary school in Shanghai, China, experienced learning through various learning activities. The findings showed that the two group teachers had actively developed implementation-oriented and experimentation-oriented processes of learning. The former process is referred to as exploitation learning. Exploitation learning helps teachers by creating a stable environment to learn the existing knowledge and norms of practice of a school organisation. The latter process is referred to as exploration learning. Exploration or exploratory learning provides a platform for new knowledge construction aimed at improving existing practices in a more radical way. Teachers’ perceptions of and participation in school-based learning activities shape their learning experiences in different ways. Specifically, the support of school leaders is necessary to promote teachers’ exploratory learning in school-based settings. However, the leadership strategies that best support teachers’ learning require further investigation.     

How can organisations learn: an information systems development perspective

This article sets out to argue that organisations can learn but that they cannot do so in their own right without infrastructural support. This article further examines the notion that individuals in organisations also require the cognitive participation of the organisation itself as a learning entity to learn. The close reliance and affiliation required between individuals and organisations to enable their learning from one another are discussed. In continuation of this, specific examples are provided through the industry sector of information systems development (ISD) projects to illustrate of how organisations can learn. Finally, the question of how one identifies organisational learning is analysed. Following on from the ISD and its use in the analogy of organisational learning, the article discusses an organisational empirical research project currently being undertaken by the authors, which utilises blogs. Though there are many potential organisational learning connotations associated with blogs, they could be perceived as a type of information system. The ongoing research being undertaken with the company using the blogs will attempt to identify indicators of learning at the individual, group and organisational levels. The significance of the issues explored in this article lies in the fact that it addresses an ISD approach to study how an organisation learns, and why this perspective is useful towards understanding the process of organisational learning. This article contributes to the organisational learning debate through an illustrative industry example of ISD projects. In doing so, we wish to argue that though individual learning can occur in ISD projects, the collective nature of projects primarily engenders the interpretive aspect of organisational learning. We further believe that it is the interactive nature of an ISD project that allows an organisation to learn in tandem with project members as exemplified through the stages of a project life cycle. We feel that this article contributes to the ISD and organisational learning literature in terms of linking both concepts together.     

Comparative learning in partnerships: control,competition or collaboration?

This paper examines the quality and development of relations between organisations and the ways in which these are informed by incidental learning experiences in two projects. The paper conceptualizes instances of inter‐organisational learning (IOL) applying theories such as principal‐agent, prisoners' dilemma and women's place in community development. The main results are (a) that IOL can be used to maintain and modify relations of control and dominance in partnership hierarchies; (b) that IOL serves as a spin‐off of horizontal relationships and can be increased or reduced in the competition between partners for resources and identity; and (c) that IOL at the community level, when delivering outsiders' intervention, can be promoted by involving local authorities and operating within the existing household hierarchy. The paper shows that the influential role of individuals, beyond organisational boundaries, becomes critical through social networks and the establishment of trust‐based relations and resistance to learning as consequences of personal conflict. However, structural constraints in the aid system, such as asymmetric access to resources, expertise, knowledge, status and networks, ultimately determine the quality of funding management schemes and the emergence of an environment that stimulates mutual individual learning, which in turn may lead to organisational learning and inter‐organisational learning.     

Total Quality Management,the Learning Organisation and Post‐compulsory Education

Abstract

The turbulence confronting educational Institutions In the United Kingdom has led to the suggestion that any attempt to respond using established management principles and processes is likely to be dysfunctional. Total quality management (TQM) has been advanced as a strategy that will enable educational institutions adapt to the greater market orientation and transform them into learning organisations. The paper identifies the key principles of TQM, critically reviewing the literature that examines their application in education and focusing on the post‐compulsory sector. Secondly, selected linkages between the key principles and other approaches to the study of organisational behaviour, including aspects of open systems theory, leadership, teamworking, training and staff development, and organisational culture, are examined. The concept of the learning organisation is outlined and its relationship with TQM examined. The paper concludes that TQM treats organisational change issues in educational institutions and the concept of the learning organisation as unproblematic, Ignoring Issues of power, authority, resistance to change and double‐loop learning.     

The organisational impact of undertaking a professional doctorate: Forming critical leaders

Research on the impact of professional doctorates on students and their organisations has reported contested outcomes. We undertook a study to develop a causal explanation of how organisational change may, or may not, result from participation in a Doctor of Education programme (EdD). Drawing on critical realist perspectives, the research found that all the doctoral students shared professional concerns with their work colleagues. In some cases, however, this sharing fostered social relations that supported both collective meta-reflexivity and a performative collective reflexivity, and that resulted in organisational change. Variation in the students’ impact on their organisations was further connected to their organisational roles, and to the extent to which their agency aligned with organisational agendas or other external regulatory and normative systems. Strictly limited, or no, organisational change was, however, evident where collective reflexivity was seen to be restricted or to involve contestation. The article concludes that there is significant value to gain by conceiving learning on a professional doctorate not simply in terms of personal growth, but also in terms of mastering a discourse that crosses both research and professional practice and developing the capacity to draw others into that discourse in an organisationally relevant and yet critical fashion.     

The influence of organisational identification on employee attitudes and behaviours in multinational higher education institutions

In order to operate effectively and efficiently, most higher education institutions depend on employees performing extra-role behaviours and being committed to staying with the organisation. This study assesses the extent to which organisational identification and employee satisfaction are antecedents of these two important behaviours. Key objectives of the research were to identify possible antecedents of organisational identification and to discover whether the consequences of organisational identification vary among the employees of multinational universities at home and foreign campuses. We developed a model that was tested using structural equation modelling, which assesses the influences of organisational identification on employee satisfaction, extra-role behaviours and turnover intentions. All of the paths in our model were significant, but employee identification, satisfaction and extra-role behaviours were lower at foreign branches than at the home campuses of universities, and turnover intentions were higher. These results suggest that higher education institutions need to implement different human resource strategies at home and foreign branches, with a focus on improving organisational identification at the foreign subsidiaries.     

Creating and using knowledge: an analysis of the differentiated nature of workplace learning environments

This paper argues that contemporary workplaces give rise to many different forms of knowledge creation and use, and, as a consequence to different forms of learning and pedagogical approaches. Some of these are utilised to the benefit of the organisation and employees (though not, necessarily, in a reciprocal manner), but others are buried within everyday workplace activity. The discussion builds on earlier work where it was argued that organisations differ in the way they create and manage themselves as learning environments, with some conceptualised as ‘expansive’ in the sense that their employees experience diverse forms of participation and, hence, are more likely to foster learning at work. By studying the way in which work is organised (including the organisation of physical and virtual spaces), this research is suggesting that it is possible to expose some of this learning activity as well as to identify examples where new (or refined) knowledge has been created. In this regard, it is argued that it is important to break down conceptual hierarchies that presuppose that learning is restricted to certain types of employee and/or parts of an organisation and to re‐examine knowledge as applied to the workplace. The conclusion focuses on how such an approach, and in particular the use of a productive system analysis, is strengthening the concept of expansive and restrictive learning environments.     

Responding to the technological imperative: the experience of an open and distance education institution

This paper examines the key impact that technology is having on shaping and, indeed, fusing the worlds of work both outside and inside tertiary institutions. The transformation of organisations by technology creates key challenges for tertiary institutions which are identified. One tertiary institution's attempts to engage with these challenges is illuminated through case study research. The institution in question, Deakin University, is a major open and distance education organisation in Australia. In grappling with the technological imperative, issues of leadership, management and organisational change come to the fore. Leadership in dynamically evolving organisations committed to the use of educational technologies in a range of diverse teaching‐learning contexts is an enormously complex and difficult task. The complexities, ambiguities and difficulties of leadership in such an environment are illuminated in this paper through the presentation of a set of eight interconnected issues which reveal some of the experiences of people within the University who are attempting to manage educational change and technological innovation.     

Quality as sense-making

Sense-making is a process of engaging with complex and dynamic environments that provides organisations and their leaders with a flexible and agile model of the world. The seven key properties of sense-making describe a process that is social and that respects the range of different stakeholders in an organisation. It also addresses the need to account for the history and context of the organisation while also acting to change that context. This paper describes a conception of quality framed by sense-making. It explores the possible insights and guidance it can provide to leaders and others seeking a model aligning quality with forward-looking organisational change and capable of reflecting the complex relationships between educational organisations and their diverse stakeholders. Quality as sense-making flows from a recognition that education is too complex and too important to be defined by a small number of qualities relevant to a privileged group of stakeholders, or by limited performance indicators such as financial efficiency, instead it is experienced through an on-going conversation challenging complacency and the status quo.     

Implications of a Learning Organisation for Social Justice in Poverty Stricken Communities: A Theoretical Perspective

Abstract

The term “social justice” cuts across disciplines and theoretical orientations. Critical theory underpinned the study reported on in this article. Many South African schools, particularly in poverty stricken communities, still experience insurmountable economic and social injustices despite progress since the apartheid regime. The injustices manifest in poverty, inequalities and unequal distribution of educational resources, impacting on the achievement gap. While social justice is a concern in the literature, South African literature has little on how to apply the concept of a learning organisation to reclaim a commitment to social justice. The article argues that schools perceived as learning organisations are sites of social and political struggle that can promote and encourage human rights to fundamental freedoms for all, without discrimination. This requires progressive teachers and critical thinking by students to transform dehumanising social milieus into communities of participation embodying the values of progress and human emancipation.     

The Learning Company

The learning company is an organisation which facilitates the learning of all of its members and continuously transforms itself in order to meet its strategic goals. The paper introduces the concept of the learning company and examines its relevance in modern industrial society. A study of Director‐level personnel in eight large public and private sector organisations in the United Kingdom provides support for the concept. Following a discussion of the learning company as an organisational transformation, guidelines for designing learning companies are proposed.     

The relationship between the school as a learning organisation and staff outcomes: A case study of Wales

Does the school as a learning organisation affect staff outcomes? This article examines the relationship between the school as a learning organisation and staff job satisfaction and the school's responsiveness to staff needs using a purposefully designed “Schools as Learning Organisations Survey” completed as part of an OECD study in Wales. A positive and significant relationship is found between the school as a learning organisation and both job satisfaction of staff—that is school leaders, teachers and teaching support staff—and the school's responsiveness to staff needs. The article proposes ways of realising these outcomes and identifies areas for further research. Policy makers, school staff and other stakeholders in education and other public sectors internationally can use these findings as supporting evidence in recommending people to develop their organisations into learning organisations, given the potential benefits for employees and the organisation at large.     

Learning to Produce Knowledge - the Contribution of Mentoring

This paper is a discussion of mentoring in the context of knowledge productivity in organisations. Links are made between the perspective of organisations as knowledge productive, the theory of situated learning and the developmental strategy of mentoring as a basis for arguing that mentoring has a distinctive contribution to make to organisations whose success is dependent upon being knowledge productive. Learning at work is conceptualised in terms of a corporate curriculum, an inclusive concept which recognises the diverse ways in which people learn in an organisational environment. In particular, learning in and through a mentoring relationship is viewed as contributing to a person's ability to be knowledge productive.     

Implementing Peer Learning Across Organisations: The development of a model

Peer learning can be implemented by individual teachers within an organisation or can be implemented across an organisation by a central implementer. In this article, it is argued that the types of approach required in these two forms of implementation are very different and whilst the former is dealt with in the literature on peer learning, the latter has been largely unconsidered. The article reports how a review of the literature on organisational change was used to develop a model of how to implement peer learning across organisations. It describes how this model was used to guide the implementation of peer learning across a UK further education college. The results of a pilot study into the model's effectiveness in this context are reported. These results suggest that the model appeared to be a useful guide to the implementation of peer learning across an organisation and, as such, is worthy of further investigation in other contexts.     

Organisational learning approaches to school leadership and management: teachers' values and perceptions of practice

In this article, we report results of a survey of 1,397 teachers in 26 primary and 17 secondary schools in England as part of the Learning How to Learn project. We consider how school self-evaluation can be understood within an organisational learning frame. Factor analysis of teachers' responses helped us identify 4 dimensions of organisational learning approaches to school leadership and management. Comparisons were made between teachers' perceptions of school leadership and management practices and the values they placed on those practices. We discuss the usefulness of analysing values-practice gaps for furthering understanding of organisational learning approaches to school leadership and management. Analysis of gaps between teachers' values and practices reveals significant inconsistencies between perceptions of current practices and values across a broad spectrum of school leadership and management practices. Perceptions of practice were significantly behind the values that teachers place on each of the 4 dimensions of practice.