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 Organizational Learning Learning Over Time

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’

15. Edmonton Calgary Kamloops

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