Title: Organizational learning in health care
Description: Organizations that learn - consistently improving their processes and products by integrating new insights and knowledge - perform well in a changing environment. This premise has led to much theorizing about effective processes for promoting organizational learning. However, little empirical research has followed to guide organizations such as those in health care that have a need and desire to learn in order to overcome performance problems and absorb rapidly-changing knowledge. This dissertation aims to advance empirical research on organizational learning by examining the improvement efforts of health care organizations involved in quality improvement "collaboratives," organized programs in which teams from multiple institutions work to improve care around a specific topic. Using survey, archival, interview and observation data from participants in four collaboratives sponsored by the Institute for Healthcare Improvement, I first assess which features of collaboratives matter most for learning. I find that access to faculty experts knowledgeable about the specified topic and achieving improvement matters most. Second, I capitalize on the existence of collaboratives to investigate interorganizational learning in health care, a process that has received scant attention in the organizational learning and health care management literatures. I propose and test a model of intraorganizational learning activity (ILA). Results show that team, organizational, collaborative and task characteristics all influence the use of ILA, which increases organizational improvement. Notably, collaborative identification and team functioning play important mediating and moderating roles, respectively.

Finally, I address the observation that engagement in improvement work beyond collaborative teams is necessary, and that barriers to collaboration for intraorganizational learning exist. I focus on one barrier: the differential status accorded to those in different professions. Survey data collected from another collaborative, Vermont Oxford Network, reveal that profession-derived status is positively associated with psychological safety - a key antecedent of engagement in improvement efforts. Moreover, results show leader inclusiveness - words and deeds exhibited by leaders that invite and appreciate others' contributions - helps overcome inhibiting effects of status differences. Together, the findings offer insight into antecedents of and strategies for fostering intra- and inter-organizational learning, and ultimately improvement, in health care.