Background:
Changes that improve the quality of health care should be sustained. Falling back to old,unsatisfactory ways of working is a waste of resources and can in the worst case increaseresistance to later initiatives to improve care. Quality improvement relies on changing theclinical system yet factors that influence the sustainability of quality improvements are poorlyunderstood. Theoretical frameworks can guide further research on the sustainability of qualityimprovements. Theories of organizational learning have contributed to a better understandingof organizational change in other contexts. To identify factors contributing to sustainability ofimprovements, we use learning theory to explore a case that had displayed sustainedimprovement.
Methods:
Forde Hospital redesigned the pathway for elective surgery and achieved sustained reductionof cancellation rates. We used a qualitative case study design informed by theory to explorefactors that contributed to sustain the improvements at Forde Hospital. The model Evidencein the Learning Organization describes how organizational learning contributes to change inhealthcare institutions. This model constituted the framework for data collection and analysis.We interviewed a strategic sample of 20 employees. The in-depth interviews covered themesidentified through our theoretical framework. Through a process of coding and condensing,we identified common themes that were interpreted in relation to our theoretical framework.
Results:
Clinicians and leaders shared information about their everyday work and related thisknowledge to how the entire clinical pathway could be improved. In this way they developeda revised and deeper understanding of their clinical system and its interdependencies. Theybecame increasingly aware of how different elements needed to interact to enhance theperformance and how their own efforts could contribute.
Conclusions:
The improved understanding of the clinical system represented a change in mental models ofemployees that influenced how the organization changed its performance. By applying theframework of organizational learning, we learned that changes originating from a new mentalmodel represent double-loop learning. In double-loop learning, deeper system properties arechanged, and consequently changes are more likely to be sustained.