Dimensions of Learning Organizations Questionnaire (DLOQ) in a low-resource health care setting in Nepal

Organizational attributes that contribute to the learning & improvement capabilities of healthcare organizations: a scoping review

BACKGROUND

This study aims to explore and identify the organizational attributes that contribute to learning and improvement capabilities (L&IC) in healthcare organizations. The authors define learning as a structured update of system properties based on new information, and improvement as a closer correspondence between actual and desired standards. They highlight the importance of learning and improvement capabilities in maintaining high-quality care, and emphasize the need for empirical research on organizational attributes that contribute to these capabilities. The study has implications for healthcare organizations, professionals, and regulators in understanding how to assess and enhance learning and improvement capabilities.

METHODS

A systematic search of peer-reviewed articles published between January 2010 and April 2020 was carried out in the PubMed, Embase, CINAHL, and APA PsycINFO databases. Two reviewers independently screened the titles and abstracts and conducted a full-text review of potentially relevant articles, eventually adding five more studies identified through reference scanning. Finally, a total of 32 articles were included in this review. We extracted the data about organizational attributes that contribute to learning and improvement, categorized them and grouped the findings step-by-step into higher, more general-level categories using an interpretive approach until categories emerged that were sufficiently different from each other while also being internally consistent. This synthesis has been discussed by the authors.

RESULTS

We identified five attributes that contribute to the L&IC of healthcare organizations: perceived leadership commitment, open culture, room for team development, initiating and monitoring change, and strategic client focus, each consisting of multiple facilitating aspects. We also found some hindering aspects.

CONCLUSIONS

We have identified five attributes that contribute to L&IC, mainly related to organizational software elements. Only a few are identified as organizational hardware elements. The use of qualitative methods seems most appropriate to understand or assess these organizational attributes. We feel it is also important for healthcare organisations to look more closely at how clients can be involved in L&IC.

TRIAL REGISTRATION

Not applicable.

Building learning organizational culture during COVID-19 outbreak: a national study

Background

Hospitals and healthcare institutions should be observant of the ever-changing environment and be adaptive to learning practices. By adopting the steps and other components of organizational learning, healthcare institutions can convert themselves into learning organizations and ultimately strengthen the overall healthcare system of the country. The present study aimed to examine the influence of several organizational learning dimensions on organization culture in healthcare settings during the COVID-19 outbreak.

Methods

During COVID-19 crisis in 2020, an online cross-sectional study was performed. Data were collected via official emails sent to 1500 healthcare professionals working in front line at four sets of hospitals in Saudi Arabia. Basic descriptive analysis was constructed to identify the variation between the four healthcare organizations. A multiple regression was employed to explore how hospitals can adopt learning process during pandemics, incorporating several Dimensions of Learning Organizations Questionnaire (DLOQ) developed by Marsick and Watkins (2003) and Leufvén and others (2015).

Results

Organizational learning including system connections (M = 3.745), embedded systems (M = 3.732), and team work and collaborations (M = 3.724) tended to have major significant relationships with building effective learning organization culture. Staff empowerment, dialogues and inquiry, internal learning culture, and continuous learning had the lowest effect on building health organization culture (M = 3.680, M = 3.3.679, M = 3.673, M = 3.663, respectively). A multiple linear regression was run to predict learning organization based on the several variables. These variables statistically significantly predicted learning organization, F (6, 1124) = 168.730, p < .0005, R² = 0.471, (p < .05).

Discussion

The findings concluded that although intrinsic factors like staff empowerment, dialogues and inquiry, and internal learning culture, revealed central roles, still the most crucial factors toward the development of learning organization culture were extrinsic ones including connections, embed system and collaborations.

Conclusions

Until knowledge-sharing is embedded in health organizational systems; organizations may not maintain a high level of learning during crisis.

Learning Organizational Culture in Greek Public Hospitals

(1) Background: A learning organizational culture is crucial to the safety of patients and the quality of public health care. The aim of this study was to assess the learning organizational culture and capacity of Greek public hospitals. (2) Materials and Methods: A cross-sectional analysis was carried out in six public general hospitals and stratified sampling was used as the sampling technique. A total of 480 questionnaires were distributed to health care professionals and 380 valid questionnaires were returned (78% response rate). The comprehensive form of the Dimensions of Learning Organization Questionnaire (DLOQ), which was adapted and translated into Greek, was used for data collection in this survey. (3) Results: The level of learning organizational culture and capacity in the health units are very low. All seven dimensions of the learning organizational instrument are lower than the theoretically neutral median (3.0). Health care employees believe that the hospital’s existing culture and management practices do not foster and contribute to continuing learning, which is the fundamental aspect of self-development, department development and performance improvement. (4) Conclusions: Greek public hospitals need to adopt different types of leadership practices and culture in order to be able to facilitate organizational learning. Organizational learning (OL) is based on collaborative working, a culture that encompasses learning as participation in the organizational work practice. This transformation of culture should take place at all levels of learning to enhance results.

The impact of organizational learning culture, workforce diversity and knowledge management on innovation and organization performance: A structural equation modeling approach

BACKGROUND: Innovation is founded as a strong contributor to the formulation of competitive strategy and enhance organizational performance. Different organizations dropped drastically from the competition by not innovating their products and services. PURPOSE: To analyze the relationship of an organizational learning culture, workforce diversity and knowledge management with innovation and organizational performance, this topic is also has become an important topic in the field of management. With a few exceptions, however, the literature has focused on different business and small and medium-size enterprise, but this study intends to bridge this gap by testing the framework in educational institutes. METHODS: A quantitative research method is used to test the conceptual framework. The data was collected from Malaysian, and Thailand private sector universities; a closed-ended questionnaire was administrated to collect the data. Data is analyzed through statistical software SMART-PLS RESULTS: Findings of the study reveal that the exogenous variables knowledge management, organization learning culture, and workforce diversity has a significant and positive relationship with endogenous variable innovation and further innovation has a significant and positive association with organization performance. CONCLUSION: This study reveals that workforce diversity, knowledge management and organizational learning culture play a vital role to bring the innovation which further enhances the organization performance. Due to current pandemic COVID-19, educational institutes required more innovative process of teaching and operation, a learning culture, knowledge management systems and diverse workforce can play a vital role in the educational institute innovation process.

Identifying organisational capability of hospitals amid the new healthcare reform in China: a Delphi study

OBJECTIVE

Since China launched its nationwide systemic healthcare reform in 2009, policies such as the elimination of drug markups and the reform of medical insurance payments have forced some hospitals into a crisis threatening their survival. Both public and private hospitals have been building and strengthening their capacity to achieve sustainable development. However, the existing research has not provided a comprehensive evaluation tool required to support this effort. Therefore, this study develops an organisational capability evaluation index system to help public and private hospitals assess their current conditions.

DESIGN

The Delphi method was used to construct a hospital organisational capability evaluation index system in conjunction with the boundary value method and an analytic hierarchical process. Then, a questionnaire survey was administered in 55 hospitals (32 non-profit and 23 for-profit hospitals), and Cronbach's α and a factor analysis were used to verify the index system's reliability and validity.

SETTING AND PARTICIPANTS

A literature review and semistructured interviews with 23 hospital managers and scholars clarified the definition of hospital organisational capability and formed an indicator pool. Additionally, 20 hospital directors were selected from public and private hospitals to participate in two rounds of the Delphi consultation.

RESULTS

The Delphi consultation resulted in an index system including 12 primary and 40 secondary indicators demonstrated to be reliable and valid. The three indicators with the largest weights were 'regulation capability' (0.251), 'decision-making capability' (0.121) and 'executive capability' (0.105).

CONCLUSION

This study constructed an index system based on theoretical and practical considerations, and is expected to be applied to quantitatively evaluate the organisational capability of both public and private hospitals in China, and support their adaptation to external environmental changes.

Validation of Dimensions of Learning Organization Questionnaire (DLOQ) in health care setting in Greece

Background: In health care systems the organizational learning is a continuous process to improve actions through better knowledge and detect or correct errors. This study examines the validity and reliability of the Dimensions of Learning Organization Questionnaire in addition to the applicability of the instrument in a Greek health care cultural context. Design and methods: A cross-sectional study was carried out in 6 general hospitals of Attica and the sampling scheme was the stratified sampling. Questionnaires were distributed to 487 healthcare professionals and 380 valid questionnaires were returned. The research tool used in this survey is the extensive form of DLOQ, which has been adapted and translated into Greek language. Data analysis was carried out with SPSS 25. Results: Three leading experts of the health sector examined the face validity assessment of the translated DLOQ and stated that it is characterized by high face validity. As regard construct validity of the DOLQ throughout Multitrait-Multimethod Matrix, was proved that all the variables of the same factors are statistically significantly correlated (p<0.001), and their correlation coefficients have moderate to high power ranging between 0.563 and 0.798. Moreover, the discriminant validity was demonstrated as certain correlation coefficients between variables of different factors were found to be higher than of certain correlation coefficients between variables of the same factors. The internal consistency among the items of the DOLQ range between 0.842 and 0.977 and they are considered to be good to excellent. Conclusions: Our results confirmed that DLOQ is a valuable tool in measuring Learning Organizational in Greek public hospitals.

Are our 'UHC systems' learning systems? Piloting an assessment tool and process in six African countries

BACKGROUND

If there is one universal recommendation to countries wanting to make progress towards Universal Health Coverage (UHC), it is to develop the learning capacities that will enable them to 'find their own way' - this is especially true for countries struggling with fragmented health financing systems. This paper explores results from a multi-country study whose main aim was to assess the extent to which UHC systems and processes at country level operate as 'learning systems'.

METHOD

This study is part of a multi-year action-research project implemented by two communities of practice active in Africa. For this specific investigation, we adapted the concept of the learning organisation to so-called 'UHC systems'. Our framework organises the assessment around 92 questions divided into blocks, sub-blocks and levels of learning, with a seven scale score in a standardised questionnaire developed during a protocol and methodology workshop attended by all the research teams. The study was implemented in six francophone African countries by national research teams involving researchers and cadres of the ministries involved in the UHC policy. Across the six countries, the questionnaire was administrated to 239 UHC actors. Data were analysed per country, per blocks and sub-blocks, by levels of learning and per question.

RESULTS

The study confirms the feasibility and relevance of adapting the learning organisation framework to UHC systems. All countries scored between 4 and 5 for all the sub-blocks of the learning system. The study and the validation workshops organised in the six countries indicate that the tool is particularly powerful to assess weaknesses within a specific country. However, some remarkable patterns also emerge from the cross-country analysis. Our respondents recognise the leadership developed at governmental level for UHC, but they also report some major weaknesses in the UHC system, especially the absence of a learning agenda and the limited use of data.

CONCLUSION

Countries will not progress towards UHC without strong learning systems. Our tool has allowed us to document the situation in six countries, create some awareness at country level and initiate a participatory action-oriented process.

Investigating the dimensions of learning organizations questionnaire (DLOQ) in a Romanian private ophthalmology organization

Private ophthalmology organizations are knowledge-based institutions that need to adapt to changes from both external and internal environments. To ease the organization's survival, a learning process is required at different levels: individual, team, group, and to the organization itself, triggering a learning organization (LO) transformation. The aim of this research was to assess the relevance and efficiency of the Dimensions of the Learning Organization Questionnaire (DLOQ) in a private ophthalmology organization from Bucharest, Romania. The DLOQ was translated from English into Romanian and administered to 113 nurses and physicians working in the private ophthalmology organization. The DLOQ includes the following dimensions: Continuous learning, Dialogue and inquiry, Team learning and collaboration, Embedded systems, Empowerment, Systems connections and Strategic Leadership. Data was analyzed using central tendency indicators, such as the mean and standard deviation for quantitative variables, as well as the frequency, for qualitative variables. To be able to determine the comparison between the DLOQ dimensions' scores and the professions of the respondents, several Mann-Whitney U tests were performed. The DLOQ's internal consistency and its measurement validity were assessed using the Cronbach's alpha coefficient values and the Confirmatory Factor Analysis, respectively. The findings of the DLOQ implementation revealed that it is generally suitable to be used in the ophthalmology context. However, among the DLOQ dimensions, the Strategic Leadership dimension had to be removed, due to cultural and socio-demographic factors. No significant variations across professions and dimensions were registered. Although the DLOQ was developed for company settings, this study demonstrated that it could be successfully applied in health care as well. The DLOQ dimensions may provide valuable insights and understanding regarding the objective where further efforts should be directed. Also, through appropriate care management strategies, this instrument may contribute to the strengthening of the health care system, and particularly to the implementation of LO orientation in other medical specialties.

Scoping literature review on the Learning Organisation concept as applied to the health system

ᅟ: There is growing interest in the use of the management concept of a 'learning organisation'. The objective of this review is to explore work undertaken towards the application of this concept to the health sector in general and to reach the goal of universal health coverage in particular. Of interest are the exploration of evaluation frameworks and their application in health.

METHOD

We used a scoping literature review based on the York methodology. We conducted an online search using selected keywords on some of the main databases on health science, selected websites and main reference books on learning organisations. We restricted the focus of our search on sources in the English language only. Inclusive and exclusive criteria were applied to arrive at a final list of articles, from which information was extracted and then selected and inserted in a chart.

RESULTS

We identified 263 articles and other documents from our search. From these, 50 articles were selected for a full analysis and 27 articles were used for the summary. The majority of the articles concerned hospital settings (15 articles, 55%). Seven articles (25%) were related to the application of the concept to the health centre setting. Four articles discussed the application of the concept to the health system (14%). Most of the applications involved high-income countries (21 articles, 78%), with only one article being related to a low-income country. We found 13 different frameworks that were applied to different health organisations.

CONCLUSIONS

The scoping review allowed us to assess applications of the learning organisation concept to the health sector to date. Such applications are still rare, but are increasingly being used. There is no uniform framework thus far, but convergence as for the dimensions that matter is increasing. Many methodological questions remain unanswered. We also identified a gap in terms of the use of this concept in low- and middle-income countries and to the health system as a whole.

An Insight into Health Care Setup in National Capital Region of India using Dimensions of Learning Organizations Questionnaire (DLOQ)- A Cross-Sectional Study

INTRODUCTION

Over the past decades India, though being a developing country has progressed in multiple sectors but has not shown a substantial qualitative progress in healthcare. To be able to evaluate learning organization in a healthcare setup would thrust millennium development goals and infuse continuous learning model into health sector.

AIM

To assess health care context using the Dimensions of the Learning Organization Questionnaire (DLOQ) in a health care setting in National Capital Region of India.

MATERIALS AND METHODS

DLOQ proforma were distributed among 315 employees at all levels of the hospital. Data was analysed using SPSS software version 19.0 and was subjected to quantitative analysis and non-parametric tests.

RESULTS

The Kruskal-Wallis test indicated a significant difference between the means of the different professions where as Mann-Whitney tests compared the relation between each of the profession and a significant difference (p < 0.05) was noted, except dimension "systems connection".

CONCLUSION

The results provided sufficient inputs about the multidimensional learning organization capacity of a health care setting in a rapidly developing country.