The role of connectedness for organisational learning in public healthcare : a Thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy, the University of Auckland

Abstract

The aim of this study was to examine how organisational learning can occur in a public healthcare organisation. In particular, focus is placed on how knowledge, once created, can be transferred between groups within an organisation. The reason for exploring this area is in response to recent reports and various scholarly papers that discuss ways to improve cost efficiency, quality, and accountability within Public healthcare organisations. These papers suggest that applying organisational learning practices and principles in a Public healthcare organisation may help moderate some of the barriers to improving these outcome measures. The literature on organisational learning , however, does not well address how knowledge can be created and transferred in an organisation made up of groups with such diverse worldviews. This in-depth study was conducted in a single New Zealand Public healthcare organisation. Fourteen focus groups were initially carried out across the organisation to generate statements regarding learning behaviours and strategies perceived and experienced. These statements were used to develop an 80-item survey instrument sent to all 4,680 employees. The survey measured how typically the learning behaviours and strategies were experienced, and how beneficial they were perceived to be for learning. Results from this survey were used as a basis for interviews with 33 employees, representing a range of professional groups and years of organisational experience. Results show there are specific behaviours and strategies that the study participants deem important in aiding organisational learning. Also, there are a number of factors that act as facilitators and barriers to the occurrence of such behaviours and strategies. These barriers and facilitators are presented within an integrated model of organisational learning in public healthcare. Within this model it is posited that organisational learning can occur in a Public healthcare organisation if opportunities are provided for interaction to occur in a safe place in which moments for learning can be recognised and relationships developed. This study contributes to the literature and body of knowledge in a number of ways. Firstly, it has extended previous work looking at organisational learning in Public healthcare by taking a wider look at the phenomena, and involving a complete organisation, rather than focusing on one or two sub-units. This approach has allowed the study to propose an integrated model of organisational learning in public healthcare. This model, and associated findings, indicate that theory explaining organisational learning in a public healthcare context needs to explicitly recognise that the diverse worldviews of the various groups present real tensions for interaction. Further, if theory is to aid in understanding how organisational learning might occur in such an environment, it needs to show how such tensions might be addressed. This study posits a way that such tensions might be addressed. Implications for the practitioner are that barriers to organisational learning may be moderated via developing structural arrangements to facilitate interaction; ensuring leaders model behaviours conducive to individuals feeling psychologically safe and valued, and using skilled facilitators to reduce domination and help individuals increase their understanding as to how each contributes to solving the issue or problem being faced.