Thoughts and opinion from the wards
How Learning Organizations can Improve Healthcare Quality
There is growing demand for quality healthcare and political push for cost reduction as new technologies necessitate appropriate adjustment. Hunter (2007) asserts the poor quality of services at public facilities especially in low-income countries is responsible for increasing calls for reforms. Medical errors, prescription mistakes, misdiagnosis are other issues that have necessitated evaluation of healthcare for safety and quality in recent times (Davies & Nutley, 2000). I believe if learning organizations are created in the healthcare industry, these issues may be resolved.
Increasing demand for Quality and Safety
Davies & Nutley (2000) alludes to the increasing demand for quality healthcare in developed world particularly in the United Kingdom and the US, and propose that an organizational change is the key to achieve quality improvement. This organizational change will promote excellence by learning from the past, and apply useful principles of learning organization from other industries.
Organizations that promote learning as a central culture are referred to as learning organizations. This type of learning goes beyond personal development and continuous professional development. It is a culture that acknowledges the importance of continuous learning for all cadres and specialties of staffs resolves emerging problems with lessons from the past and promotes innovative thinking that guarantees quality healthcare delivery. Easterby-Smith (1990) proves that the 'ability to learn rapidly from experiences' is responsible for the success of many Japanese companies. This can be applied to healthcare.
Learning Organizations in Healthcare
A notable example of this structural reform is the introduction of culture of learning organization for the new NHS. This implies that healthcare providers need to embrace learning from simple errors and common mistakes to improve healthcare. Healthcare managers in the NHS need to utilize the ‘learning potential’ in individuals to achieve safety and quality in service delivery to clients and patients (Davies and Nutley, 2000).
The demand for safety and quality in healthcare should make doctors can learn from prescription errors. However, this has not been happening because many prescribing errors are not discovered. Even when they are found, the prescriber is not informed. This lack of feedback is a reflection of poor organizational culture which precludes active learning. In a Nigerian teaching hospital where I once worked, there is no forum for doctors and pharmacists to meet and resolve issues about prescription error when it occurs. When a pharmacist perceives a prescription error, [s]he can write her professional opinion at the back of the prescription sheet and request the patient goes back to see the doctor who issued the prescription. The doctor writes an appropriate response to justify the prescription or reviews it in view of the professional advice.
Risks of Applying Learning Organizations in Healthcare
Edmondson (2004) argues that healthcare organizations that have adopted organizational learning are rare. Lack of vision by managers at all levels and ineffective communication with different segments of the healthcare team are some of the factors responsible. There is fear that learning organizations may expose wrong practice with attendant punishment for offenders. It may also contribute to increasing litigations against healthcare workers. If learning is not well-managed, patients or their relatives may become aware of these mistakes, and sue the offender and/or the hospital. This is reason why medical mistakes are covered up.
The application of learning organization in healthcare holds great prospects. A semblance of this practice exists in teaching hospitals in Nigeria but it is restricted to departments or faculties. Different departments hold clinical meetings to evaluate cases, and learn from mistakes and improve on healthcare. In my medical practice, I have seen that this type of learning is a very useful tool to train juniors. It also improves quality.
If experience is the best teacher, learning from mistakes must be a great practice. Healthcare managers must create a compelling vision that is well communicated to staff. They need to design a practical framework that protects staff and the hospital during the learning process and create a suitable environment to promote this useful culture (Edmondson, 2004).
Davies, H.T.O. & S.M. Nutley (2000) 'Organisational culture and quality of health care', Quality Health Care, 9(1), pp. 111-119
Davies, H.T.O. & S.M. Nutley (2000) 'Developing learning organisations in the new NHS', British Medical Journal, 320: 998
Dean, B. (2002) 'Learning from prescribing errors', Quality and Safety in Health Care, 11(3): 258-260
Easterby-Smith, M. (1990) ‘Creating a Learning Organisation’, Personnel Review, 19(5), pp. 24 – 28
Edmondson, A.C. (2004) 'Learning from failure in health care: frequent opportunities, pervasive barriers', Quality and Safety in Health Care, 13(2), pp. 3-9.
Hunter, D.J. (2007) Managing for Health. Routledge, Abingdon, England.
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