Introducing the Learning Practice – I. The characteristics of Learning Organizations in Primary Care

Abstract

Characteristics of LPs include flatter team-based structures that prioritize learning and empowered change, involve staff and are open to suggestions and innovation. Potential benefits include: timely changes in service provision that are realistic, acceptable, sustainable, and owned at practitioner level; smoother interprofessional working; and fast flowing informal communication backed up by records of key decisions to facilitate permanent learning. Critical comment on potential pitfalls and practical difficulties highlights features of the present system that hinder development: tightly defined roles; political behaviours and individual-oriented support systems; plus the ongoing difficulties involved in tolerating errors (whilst people learn). This paper contributes to the wider quality improvement debate in the area in three main ways. First, by locating Government's desires to create health systems capable of learning within the theoretical and empirical evidence on LOs. Second, it suggests what an LP could be like and how its culture and structures might benefit both staff and patients in addition to meeting externally driven reforms and health priorities. Third, it extends the application of LO concepts to the health care sector locating the principles in bottom-up change.

Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health interventions to reduce alcohol-related harms: a qualitative case design using a cocreation approach

“…Where respondents placed their 'X' represents for them the resolution between the two competing anchors. Examples of a similar method being used in health-care research can be found in Rushmer et al, 56 190 it was agreed that full IRAS committee approval was not needed, as only professional staff were taking part in the research, in line with their professional roles. In Rosetown, research and development (R&D) approval was gained from six NHS trusts, and in Scotland R&D approval was granted from the host health board.…”

“…30 Tacit knowledge, previous experience and the influence of colleagues, however, have become recognised as powerful guiders of action. 21,32,52,[54][55][56] Boaz and Ashby 57 argue that in order to facilitate the development of evidence-based practice and policy, a broader conception of research quality is needed, which includes its fitness for purpose rather than just traditional academic measures of quality. On a more pragmatic level, it has been suggested that commissioners need three types of knowledge: knowledge from research ('evidence'), knowledge from data analysis (e.g.…”

Does the Utto Model of Technology Transfer Fit Public Sector Healthcare Services?

“…While emphasis on scientific knowledge and the division of the organization on functional specialisms has allowed the enhancement of patient care through practitioners gaining specialist skills; innovation has been impeded by rigidity; pecking orders; strict demarcation; tribalisism between staff; and departmental silos [Rushmer et al (2004)]. While the source of many innovations are based in the novel combination of diverse disciplines; the NHSs predominantly functionally based structure acts against such innovation.…”

Learning organisations: the challenge of finding a safe space in a climate of accountability

“…Theoretically the approach is sound and the characteristics of health care learning organisations are evidence based (Rushmer et al:2004a ).…”