Organizational Learning and Knowledge Utilization

1. Organizational Learning and Knowledge Utilization Trish Reay U. Alberta KU07 Stockholm Sweden August 17, 2007

2. Thinking from an organizational perspective� KU is a process of using knowledge Why is this valuable? (individual/ organizational/ societal) Different organizations; different reasons Profit driven: Ability to use knowledge well = competitive advantage Not for profit: Ability to use knowledge well = better achievement of organizational goals Similarity: using knowledge well contributes to better organizational performance

3. �Learning in� vs �Learning by� organizations

4. Thinking organizationally� Following on from Dopson (2007) How can we improve KU (in health care settings)? Organizational Learning provides a framework Organization uses knowledge to meet goals Dynamic (not static) process Managerial actions (or lack of action) important Helpful concept from strategy literature: Dynamic capabilities Behaviour change is intermediate step

5. Overview of today�s presentation: Knowledge Utilization Organizational Learning Dynamic Capabilities Research findings from Calgary Health Region study (Pablo et al. 2007) Preliminary findings from Primary Health Care Innovation study (Reay et al.) Conclusions

6. Knowledge Utilization What�s the problem?

7. Why take an Organizational Perspective? Need large scale utilization to gain desired changes based on (research) evidence Need ongoing dynamic processes to respond to new evidence over time Both individual and organizational learning are critical Focus on organizational learning brings different concepts to the foreground

8. Organizational Learning Productive organizational learning: �conscious and critical process of reflection intended to produce new perceptions, goals, and/or behavioral strategies� (Lipshitz et al. 2007) Detection & correction of error; discovery & exploitation of opportunity Includes insight and action Learning is a cyclical process Note: �learning by� rather than �learning in� organizations.

9. Organizational Learning Productive organizational learning must take place within the context of everyday activities Criterion: learning results in organizational action based on valid knowledge. Different contexts = different learning process Organizational structures (roles, functions, procedures) (OLMs) Organizational culture Psychological safety & organizational commitment Leadership/ Management Factors outside managerial control E.g. Risk associated with making mistakes

10. Organizational Learning Mechanisms OLMs Fundamental building blocks of organizational learning �Concrete observable entities that provide a means for observing and specifying where and when organizational learning occurs� (Lipshitz et al. 2007) E.g. standard review (debrief) all major events Managerial role/ responsibilities

11. Managerial role in organizational learning Critical Persuading others (influencing their hearts and minds) that learning & associated behavior changes are essential for own performance/ well-being and that of the organization. Channels of influence: Instituting OLMs Maximize tolerance for failure Give consistent messages that learning has high priority Allocating time and attention

12. Dynamic Capabilities as OLM Definition: Organizational and strategic routines by which firms achieve new resource configurations. (Eisenhardt & Martin, 2000) Concept from for-profit strategy literature Goal is to out-perform competitors Internal resources provide competitive advantage In dynamic markets (e.g. high tech 1990s) managers had to respond quickly Successful ones developed dynamic capabilities that enabled sustained competitive advantage.

13. So, what does this have to do with healthcare? Dynamic capabilities facilitate the use of organizational resources in a way that maximizes organizational performance. Knowledge is an important resource Performance is how well the organization meets its goals � which may or may not be profit.

14. Pablo, Reay, Dewald & Casebeer (2007) Study of Organizational Change in Primary Health Care in Calgary Health Region (CHR) Publicly funded system Mid 1990s budget cuts and also expectation of improved services (doing more with less) CHR chose to focus strategy on Primary Health Care Dynamic capability of �learning through experimenting�

16. Reforming Primary Health Care Goal: To support continuous improvement in response to evolving conditions and new research findings. CHR believed that it could improve health services and organizational performance through strategic efforts focused on �front line�. Committee established to oversee, encourage and coordinate efforts of front line change agents (usually resourced with external grants). Our research: meeting observations; interviews with key individuals; tracking events

17. Innovation projects Developing inter-professional teams (2) Altering home care services for elderly Team based, home focused model for diabetic clients Developing PHC services in community with few physicians Establishing specialized PHC for children

18. Strategic approach: Based on development of dynamic capabilities Learning through experimenting Stages: Identifying the dynamic capability Enabling the dynamic capability Managing the ongoing tensions

19. 1. Identifying the dynamic capability Organizational leaders searched for recognized and culturally appropriate ways of improving performance. �Learning through experimenting� held value and was respected by physicians and other health care workers.

20. 2. Enabling the dynamic capability At all organizational levels, individuals used a supportive style of leadership based on encouraging and developing work relationships built on trust. Managers (particularly at mid levels) developed ways to re-socialize the work relationships between physicians and other health professionals.

21. 3. Managing the ongoing tensions Managers (particularly at mid levels) tried to balance individual initiative and organizational control. Managers restricted some experimenting by: Eliminating some �experimenting� where outcomes already known. (trying to avoid NIH syndrome) Managers found ways to modify organizational structures when physicians faced roadblocks to participating in �learning through experimenting� initiatives.

22. What�s important about KU here? Organizational Goal: to improve delivery of services and health of population served. Knowledge as a resource �Using knowledge well� was equivalent of strategic advantage. Focused on dynamic capability (learning through experimenting) to work toward goal. Positive organizational initiative Requires cooperation from most organizational members Hope for intertwining of KU in everyday action.

23. Organizational Learning in PHC Innovation Current study (Reay, Golden-Biddle, Casebeer & Hinings) Following 10 PHC innovation sites in 6 RHAs Finding new ways to provide PHC Special funding arrangements Multi-disciplinary Engage family physicians with RHA providers Qualitative, longitudinal research; interviews with key individuals How do organizations learn to provide better PHC?

24. Preliminary �findings� Best available knowledge will always be changing Developing dynamic capabilities that encourage �bounded� searching for evidence, but also demand a �do something� approach. Routines, roles, procedures that use knowledge to work toward organizational goals. Two OLMs seem to stand out: Managerial role is critical: Variation across sites System for managing resources matters: Variation across sites

25. Putting it all together� Productive organizational learning perspective highlights �different� components of KU. �Developing dynamic capabilities� may be an attractive organizational strategy for advancing KU. Knowledge as a resource (not an expense) Learning is a dynamic process �best knowledge� is always changing Urgent vs. Important Where does KU fit?

26. References: Dopson, S. 2007. A view from organizational studies. Nursing Research, 56 (4S): 72-77. Eisenhardt K. & Martin, J. 2000. Dynamic capabilities: What are they? Strategic Management Journal, 21: 1105-1121. Lipshitz, R., Friedman, V.J. & Popper, M. 2007. Demystifying Organizational Learning. Thousand Oaks: Sage. Pablo, A., Reay, T., Dewald, J. & Casebeer, A. 2007. Identifying, enabling and managing dynamic capabilities in the public sector. Journal of Management Studies, 44(5): 687-708. www.business.ualberta.ca\hos