Learning: individual and organizational
The ultimate measure of clinical governance activities is the degree to which they contribute to organizational learning. Organizational learning occurs when the body of knowledge, competencies, and experiences within the organization is expanded.
This body comprises the contributions of individuals and teams within the organization but it is greater than the sum of its building blocks. The way that organizations learn and disseminate learning is a complex matter but it is essentially a social process. From a clinical governance perspective, learning is facilitated if a bionomic conception of quality is adopted. It is often said that learning is facilitated by systems thinking. This is true, but healthcare involves more than inanimate systems—it is highly dependent on human behaviour and relationships. For that reason, this author advocates a bio- nomic approach (3).Bionomic means ‘pertaining to ecology’. A bionomic approach to patient safety is based on principles and concepts of human ecology, and applies them to the healthcare system. The core attribute of an ecosystem is that of interdependence between living organisms and their environment, these constituent elements working together as a system; the individual organisms are in dynamic relationships with each other and with their surroundings. Interacting levels of organization range from the cellular level to the biosphere. Variety also exists within the ecosystem, but this biodiversity is strength rather than weakness.
The relevance of the bionomic approach to organizational learning is that it creates an environment in which relationships are valued and nurtured, experiences can be shared, ideas can flourish, new ideas are given a chance to germinate, and emphasis is placed on integration. Individuals take responsibility for quality of care and develop shared visions with other team members. Also, learning is transferred across teams, clinical areas, and institutions. A full account of organizational and individual learning is beyond the scope of this chapter but one example illustrates the transferability of learning. A ‘maternity dashboard’ was developed as a clinical governance tool for obstetric services and has been widely adopted in the United Kingdom (44). The concept of a dashboard has now been successfully adapted to emergency gynaecology where its implementation has been shown to generate improvements in patient management, service provision, and training (45).
Adoption and implementation of clinical governance as described in this chapter will create this learning environment. Lessons learned are shared with staff (‘Raise awareness’) and with service users (‘Involve service users’). The lessons inform the delivery of services (‘Design for quality’) through quality improvement (‘Apply QI methodology’). The ‘Learning’ is demonstrable by reference to quantitative and qualitative data (‘Collect and Analyse data’).