Understanding the influence of Learning & Development (L&D) initiatives on Organisational Learning (OL) within N

1. Understanding the influence of Learning & Development (L&D) initiatives on Organisational Learning (OL) within NHS Hospitals Shahida Choudhary Supervisors: Dr. John Davies Professor John M. Sharp Research Centre for Organisational Excellence (COrE) Salford Business School University of Salford UK Management & Management Science Research Institute

2. Introduction • Despite the amount of interest in the topic of OL, limited amount of good empirical research in area. • Hence no consensus on the main characteristics necessary for the construction of a learning community. • Study conducted within NHS Management & Management Science Research Institute

3. Literature Review • The descriptive strand of Organisational Learning (OL) which involves the study of learning processes • The prescriptive strand of the Learning Organisation (LO) which would focus on building an organisation that learns • OL is the process by which organisations change their cultures and systems, to improve performance based on experience (Burgoyne, 1995) • An LO is an organisation skilled at creating, acquiring and transferring knowledge and at modifying its behaviour to reflect new knowledge and insights (Garvin, 1993) Management & Management Science Research Institute

4. Key Theoretical Issues…(1) • Individual learning: “All organisations are composed of individuals;… organisations can learn independent of any specific individual but not independent of all individuals”. Management & Management Science Research Institute

5. Key Theoretical Issues…(2) • Organisational Learning: “Organisational learning can be identified by studying the concrete structural and procedural arrangements through which actions by members that are understood to entail learning are followed by observable changes in the organisation’s pattern of activities”. Cook & Yanow 1993 Management & Management Science Research Institute

6. A three dimensional model of an LO INDIVIDUAL LEARNING LEARNING ORGANISATION ORGANISATION TEAM LEARNING LEARNING Management & Management Science Research Institute

7. Need for Study • Dominating factors for change in future of organisations is ‘learning’(Grieves, 2000) • Gaps in OL & LO theory – scarceness of empirical studies • Learning identified as a central concern for a modernised NHS • The NHS currently invests over £2.5 billion a year on education and training for its staff • Currently more than 15 different L&D initiatives in NHS aimed at transforming future health care • Moving the NHS towards an LO will require attention to the cultural values and structural mechanisms which facilitate OL (Nutley & Davis, 2001; Vassalou, 2001) Management & Management Science Research Institute

8. Research Aim The aim of this research is to understand the influence of L&D initiatives on OL within NHS acute trust hospitals Management & Management Science Research Institute

9. Organisational Learning Mechanisms (OLMs) • Processes & structures that can create or improve learning opportunities and therefore contribute towards the development of a conducive learning environment Management & Management Science Research Institute

10. Research Objectives…(1) • To comprehend OL & LO concepts & the process of OL; relevant concepts in health care context & the inhibitors of OL - to develop theoretical framework which depicts essential elements of OL & influencing factors. • To determine which OLMs exist in different wards in case study organisation. Management & Management Science Research Institute

11. Research Objectives…(2) • To evaluate the perceived effectiveness of OLMs in different wards. • To explore and understand the influence of various L&D initiatives on OL in different wards. • To determine the factors perceived to facilitate and/or inhibit OL in different wards. Management & Management Science Research Institute

12. Research Questions…(1) • How do OLMs operate in different wards? • How effective are these OLMs perceived to be in relation to OL? • What factors are perceived to facilitate/inhibit OL in different wards? • How do these factors affect the OLMs and the culture within which they operate? Management & Management Science Research Institute

13. Research Questions…(2) • Why do these factors affect the OLMs and the culture within which they operate? • How &Why do various L&D initiatives affect the OLMs in different wards? Management & Management Science Research Institute

14. Research Methodology…(1) • Strongly inductive approach – with an initial set of propositions which were developed into a proposed theoretical framework. • Exploratory & explanatory research – ‘what’ ‘why’ & ‘how’ questions. • Qualitative approach within Phenomenological paradigm. Management & Management Science Research Institute

15. Research Methodology…(2) • Case Study strategy used (Yin, 2007) • Two acute trust hospitals in North West • Both hospitals employ 3000+ staff • Surgical Department in each hospital • Cross-section of staff interviewed across functional groups: • Doctors, nurses, support staff Management & Management Science Research Institute

16. Justification of Methodology • Objective is rich, in-depth understanding of context of research. • Multiple cases (2) to increase reliability & robustness (Yin, 2007). • Cross-comparison within & between cases following replication logic (Collis&Hussey; Yin, 2007). Management & Management Science Research Institute

17. Methodology: Data Collection • General Surgery department • Approx. 5 wards (each hospital) • 20 interviews (each hospital) • Document Review • Observation Management & Management Science Research Institute

18. Principles of data collection…(1) • Multiple sources of evidence used to triangulate data – to minimise bias – increase construct validity. • Pre-interview activity, FGD conducted to pilot interview protocol. • Interview protocol reviewed by supervisors & 2 L&D professionals within hospitals to enhance validity & reliability. Management & Management Science Research Institute

19. Principles of data collection…(2) • Case study record created (notes, documents, transcripts, results tables, narratives etc.) – to minimise errors & bias – increase reliability. • Chain of evidence maintained (when reporting results, parts of interview transcripts, results tables, documents cited) – to increase reliability & robustness. Management & Management Science Research Institute

20. Data Analysis • Interviews fully transcribed (same day). • E-mailed to interviewees for verification. • Pattern-matching enhanced internal validity whereby empirically based pattern compared with predicted one (theoretical framework). • Explanation building. • Cross-case synthesis used to increase external validity. Management & Management Science Research Institute

21. Case Study Findings…(1) Management & Management Science Research Institute

22. Agenda for Change Improving Working Lives Investors In People Continuing Professional Development Critical Care Programme CRiSP (Care of the Critically ill Surgical Patients) Course Essence of Care Link Nursing Leadership at Point of Care ANTT Management Courses Nursing Degrees LEO (Leadership management course) NVQs Junior Doctors Training Scheme Appraisal Training L&D Initiatives Management & Management Science Research Institute

23. Doctor’s daily rounds Grand weekly rounds Nurse rotation programme Patient reviews Shadowing Staff networking Multi-disciplinary meetings Nurse hand-overs Mentoring Work delegation Reflection in/after surgery Review of medical records Periodic review Medical staff meetings Nursing staff meetings Ward manager meetings Evidence-based practice Monthly nurse team briefs Video training Staff room tea breaks Test results analysis Clinical audits Journal club Induction training Study days Market days Introduction of computer records Conferences Staff appraisals X-ray meetings Weekly teaching sessions Tacit learning Incident reporting Link nursing OLMs Management & Management Science Research Institute

24. Findings…(contd) • Infrequent opportunity for OLM engagement leads to ineffective L&D implementation. • Inhibitors: staff shortages; demanding work patterns; low staff morale; apathy; poor communication & information sharing; poor leadership; lack of management support Management & Management Science Research Institute

25. Findings…(contd) • Instead of having positive affect, some L&D initiatives perceived to be an administrative burden (e.g. AfC). • Individually each L&D initiative has merits; but concurrent plethora perceived to have counter-productive effect. • Random implementation of L&D initiatives without synchronisation. Management & Management Science Research Institute

26. Findings…(contd) • A strong commitment to L&D- staff’s access to time and support an issue. • An abundance of potential opportunities, but clear indications that staff need more support to participate in a proactive approach to L&D. • Underlying support structures for L&D perceived to be weak & inappropriate (fragmented communication & information sharing; individualism; lack of holistic approach towards L&D). Management & Management Science Research Institute

27. Originality & Contributions to Knowledge • First step towards theory building relating to OL within UK NHS. Contributions to body of knowledge on how OL is influenced by L&D initiatives & OLMs within NHS context. • Theoretical frameworks developed bring together different OLM categories, L&D initiatives and simultaneously incorporate & categorise the main inhibitors of OL within the two hospitals studied. Management & Management Science Research Institute

28. Contributions to Knowledge …(contd) • Production of two in-depth case studies of efforts of two hospitals to enhance L&D initiatives, OLMs & related learnoing processes. • Previous studies on OL & LO mainly undertaken in different cultural contexts from that of UK NHS, a contribution to literature has been made. Management & Management Science Research Institute

29. Contributions to Knowledge …(contd) • Contribution to knowledge by summarising, highlighting & categorising main inhibitors to OL within the two hospitals. Some unique inhibitors identified within UK NHS context. Management & Management Science Research Institute

30. Limitations • Findings restricted to 2 cases. • Lack of literature on OLMs particularly in health care. • During data collection access to wards restricted to interview times - observations hence restricted too. • Access denied to interview night staff. Management & Management Science Research Institute

31. Recommendations for further Research • Further research into the relationship between levels of OL & the implementation of L&D initiatives & OLMs. • Further investigation into inter-relationships between learning, performance & productivity. • “Unlearning” identified as critical factor for OL to take place. Process of learning, unlearning & relearning needs further research. • Theoretical framework employed as a basis for further research with other hospitals and wards. Management & Management Science Research Institute

32. Operational Recommendations • It is important that health care practitioners promote the cause of L&D initiatives such as CPD, AfC, IWL etc. • Create excitement for L&D activities by clearly linking participation to greater autonomy and career advancement • Other personal benefits, such as increased self-esteem and greater feeling of competence need to be highlighted • It is crucial that organisations acknowledge the benefits to the participant, the patients and the health care institution, by providing greater levels of support to individuals engaged in L&D activities. Management & Management Science Research Institute