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Cited by 102Healthcare Quality and ManagementHealth Policy Implementation ScienceOrganizational Learning and Leadership

Sustainability of healthcare improvement: what can we learn from learning theory?

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Hovlid, Einar, Bukve, Oddbjørn, Haug, Kjell, Aslaksen, Aslak Bjarne, von Plessen, Christian·2012·BMC Health Services Research
DOI 10.1186/1472-6963-12-235PMC PMC3532388
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Abstract

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 increase resistance to later initiatives to improve care. Quality improvement relies on changing the clinical system yet factors that influence the sustainability of quality improvements are poorly understood. Theoretical frameworks can guide further research on the sustainability of quality improvements. Theories of organizational learning have contributed to a better understanding of organizational change in other contexts. To identify factors contributing to sustainability of improvements, we use learning theory to explore a case that had displayed sustained improvement. METHODS: Førde Hospital redesigned the pathway for elective surgery and achieved sustained reduction of cancellation rates. We used a qualitative case study design informed by theory to explore factors that contributed to sustain the improvements at Førde Hospital. The model Evidence in the Learning Organization describes how organizational learning contributes to change in healthcare institutions. This model constituted the framework for data collection and analysis. We interviewed a strategic sample of 20 employees. The in-depth interviews covered themes identified 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 this knowledge to how the entire clinical pathway could be improved. In this way they developed a revised and deeper understanding of their clinical system and its interdependencies. They became increasingly aware of how different elements needed to interact to enhance the performance and how their own efforts could contribute. CONCLUSIONS: The improved understanding of the clinical system represented a change in mental models of employees that influenced how the organization changed its performance. By applying the framework of organizational learning, we learned that changes originating from a new mental model represent double-loop learning. In double-loop learning, deeper system properties are changed, and consequently changes are more likely to be sustained.

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  • Failure to sustain is detrimental to improvement efforts in general because staff, patient and public opinion of improvement initiatives declines and enthusiasm for future programmes is lost.

    “This has also been shown to be detrimental to improvement efforts in general as staff, patient and public opinion of improvement initiatives declines and enthusiasm for engaging in future programmes is lost [9, 10].”

    From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [9]

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1 of the 68 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Cilliers P Complexity and postmodernism: understanding complex systems 1998 Routledge, London

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Authors
Hovlid, E., Bukve, O., Haug, K., Aslaksen, A. B., & von Plessen, C.
Affiliations
  • Høgskulen i Sogn og Fjordane (NO)
  • University of Bergen (NO)
  • Haukeland University Hospital (NO)
Corresponding author
Hovlid, Einar
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2012-08-03
Volume
12
Issue
1
Pages
235-235
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/1472-6963-12-235
PMC
PMC3532388
OpenAlex
W2101420408
Cited by
101
References
68
Citations by year
2026: 3 · 2025: 4 · 2024: 5 · 2023: 10 · 2022: 11 · 2021: 11 · 2020: 11 · 2019: 5 · 2018: 7 · 2017: 6 · 2016: 11 · 2015: 6 · 2014: 8 · 2013: 3
FWCI
8.84
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders
Norges Forskningsråd
Topics
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Organizational Learning and Leadership
Keywords
sustainability of quality improvement, organizational learning, learning organization, double-loop learning, mental models, elective surgery, healthcare quality improvement, organizational change
MeSH terms
Hospitals, General, Humans, Learning, Models, Theoretical, Norway, Organizational Innovation, Quality Assurance, Health Care, Program Evaluation, Critical Pathways, Quality Improvement

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