Learning from experience in a national healthcare system : organisational dynamics that enable or inhibit change processes

Abstract

Healthcare organisations are seeking to advance safety and quality in a changing environment. They are also facing growing demands and obligations to identify and spread the use of best practices in the services that they provide. However, it has been shown that the dissemination and adoption of best practices can encounter several difficulties such as resistance to adjust to new clinical, organisational and interpersonal routines and the need to modify procedures to be context sensitive and applicable. On the other hand, numerous examples abound in which individuals and teams in healthcare organisations were shown to exhibit creativity and leadership and consequently the capability to improve quality and engender organisational growth. This study researched the organisational dynamics that either foster or inhibit the system change needed for the ongoing organisational development of the major acute general public hospital in Malta: Mater Dei Hospital (MDH). The researcher sought to elucidate whether and to what extent MDH is adopting and applying appropriate learning practices so that knowledge acquired and generated within the organisation is retained, disseminated, managed and applied. Malta is the main island of a small archipelago in the Mediterranean with a total population of just over 430,000. This study utilized two major research methods: an action research arm and an in-depth interview approach. The former was achieved through the documentation and interpretation of a practitioner-researcher experience working within a multi-disciplinary hospital group. The Patient Safety and Quality Improvement Team (PaSQIT) was set up to promote and implement projects that raise the profile of and increase the standards for patient safety and quality care at MDH. Data collection and analysis were guided by the grounded theory paradigm to ‘ground’ the research process and product in the data. These processes were operated within a constructivist and informed grounded theory approach, wherein the researcher is allowed to be mindful and sensitive to the extant literature and to critically adopt pre-existing knowledge in the analysis judged in terms of relevance, fit, and utility. Another extensive literature review was conducted nearer to the end of the data collection and analysis processes to elicit existent knowledge that can challenge or corroborate the original findings of this research. This research affirmed the high potential and capabilities of the hospital workforce. This potential is nonetheless susceptible to be affected and gradually transformed by identified organisational and external forces into a workforce that is highly territorial, cynical and showing lack of ‘ownership’ of the organisational vision and objectives. The results led to the generation of a theoretical framework that depicts a vicious circle that needs to be broken to allow the desired organisational development and learning. The report presents a number of recommendations to help counteract these forces and break the cycle. The theoretical framework that was generated from the findings of this research is the key outcome of this study. This framework provides a visualization of the identified and interconnected enabling and hindering factors and a practical schematic on which corrective activities can be designed, implemented and monitored. Although this framework has a specific relevance for MDH, this additional knowledge can be used and inspire other organisations operating within comparable conditions. Finally, this research can be a source for stimulation for future studies that compare and follow-up these findings over time at MDH or in organisations working in similar, different or contrasting situations.