Introduction: Providing high-quality care to every patient is challenging, particularly in critical care units (CCUs). However, this standard can be achieved through organizational learning. Unfortunately, the process of organizational learning in CCUs is not well understood. Objective: The objective of this study is to describe the developmental progression of a cardiac intensive care unit (CICU) to reach its current state of reliably excellent clinical performance. Methods: The method selected for this study was a learning history. A total of 43 individuals with experience working on the CICU participated in small group interviews. Participants included nurses, surgeons, unit clerks, administrators, nursing assistants, a pharmacist, a respiratory therapist, and an administrative assistant. Relevant artifacts, including unit performance data, were also gathered to complement interview data. Results: The CICU progressed through 4 distinct developmental stages to reach its current state. The CICU’s early development involved establishing psychological safety on the unit, which prepared the unit for increased accountability, improved performance, and the pursuit of reliability. Discussion/Conclusion: The findings validate the relationship between psychological safety and organizational learning, offer insight into how CCUs become high-reliability organizations, and provide clinical leaders with guidance for achieving high reliability in their organizations. The findings also help validate the American Association of Critical-Care Nurses position that a healthy work environment is essential to achieving clinical excellence. Critical care unit teams should use these findings as a framework for collective reflection and planning to achieve their desired future. Further research is needed to validate the applicability of these findings and to continue building the evidence base for organizational learning in hospital units.

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Aim To develop and test the Organizational Learning Instrument: Development Stages instrument, a measure of hospital units' readiness to engage in organizational learning. Design Cognitive interviewing, expert review and a quantitative, cross‐sectional survey. Methods Item development was informed by previous research on organizational learning. Content validity was assessed and strengthened using cycles of cognitive interviewing and expert review. The resulting instrument was distributed by email to all nurses providing direct patient care in inpatient units in 11 Magnet® hospitals. Data were collected in 2018. Intraclass correlations, using hospital unit as the grouping variable, indicated the need to use multilevel methods to analyse the survey data. Thus, coefficient omega and multilevel confirmatory factor analysis were used to estimate the instrument's reliability and construct validity, respectively. Results The Organizational Learning Instrument: Development Stages is a 35‐item survey comprised of four scales: Identity & Ownership, Team & Respect, Accountability & Support and Reliability & Sustainability. The expert review yielded scale‐level content validity scores from 0.90 to 1.0 and item‐level content validity scores from 0.86 to 1.0. Survey participants were 1212 nurses, working in 99 inpatient units, across 11 Magnet® hospitals. Intraclass correlations ranged from 0.113 to 0.158. Coefficient omega reliability for the four scales was 0.981–0.993. Standardized factor loadings for the 35 items were 0.699–0.961, with acceptable model fit statistics (comparative fit index = 0.980, Tucker–Lewis Fit Index = 0.979, and root mean squared error of approximation = 0.060). Conclusions These results indicate the instrument meets or exceeds generally accepted criteria for content validity, reliability and construct validity instrument, and is suitable for further use and testing. Impact Nurse administrators, managers and researchers now have a valid, reliable instrument to better foster and study organizational learning in hospital units. Advances in organizational learning are expected to improve a variety of patient, staff and organizational outcomes in hospital units.