Kalene Mears and Bret Lyman, College of Nursing

Introduction

The purpose of this study was to understand how a health system learns and adapts in order to progress and refine itself. Through this, we can gain a better understanding of how healthcare improves over time. Improving quality and safety in healthcare is a challenging task. Barriers to overall improvement can include organizational complexity, culture, and structure. The IOM recommends continuous system learning to achieve excellence, but little is known about how health systems actually learn. Through the use of Learning Histories, the complexities of how a system learns can be better understood. This method has been applied in other fields, but in this research project the method was explored in a healthcare setting.

Methodology

The healthcare unit focused on in this study was an intensive care unit well known for its excellence in clinical outcomes and patient care. The first step in obtaining the Learning History is to gather together the key members of the unit and have them determine the outcomes that make their unit exceptional. The outcomes agreed upon for this unit included patient experience, staff engagement, patient safety, unit-specific core measures, and unit specific clinical outcomes. Small group interviews were then recorded with any staff members who would volunteer to come in. There was high participation from the nurses on the unit and the data was able to reach saturation level. A number of other healthcare professionals associated with the unit also volunteered to participate allowing the perspectives of surgeons, patient care technicians, and managers to be accounted for. Relevant numerical data and artifacts from the unit was also collected and included in the history. Data was analyzed and the findings were validated with some of the initial key participants. This was then presented back to the unit in a staff meeting and a poster displaying key findings was gifted to them.

Results

This critical care unit has existed for over ten years now. During this time, it has experienced several eras of development, which have allowed it to have the reputation it now holds. Each era was characterized by stages of growth, which now continue to cycle and build on each other. The first era was a time when the unit was first created by bringing people together from other intensive care units in the hospital for a more specialized unit. This was a time when ownership and identity developed through good leadership examples. The next era was when a strong team developed when this group of nurses who were proud of their identity and were willing to work together for their patients. Third, accountability for performance expectations was increased and with this came additional support from programs and management to meet these expectations. Medicare’s increasing standards were an important source of accountability, which forced the unit to rise to the expectations. The last apparent phase was that of increasing reliability and sustainability on an ever changing. Though the last era never really ended, the other attributes continue to be continually developed.

Discussion

This unit demonstrates high performance and adaptability. The individual events and people who affected the unit may be different in other units, but perhaps the general eras of improvement to attain adaptability are consistent. Through more research, it’s possible to find a consistent pattern through the units, which could be utilized and adapted to what a unit needs as they work to be established and successful. The pattern of ownership and identity, teamwork and respect, accountability and support, and then reliability and sustainability may be a formula which can be seen in other established units and helpful in directing struggling units. Future research to confirm this theory should be conducted to confirm this theory and better identify an applicable model for health system learning.

Conclusion

The process of self-reflection was an overall positive experience on this unit. It gave the unit an opportunity to better understand why they are successful and put into conscious ideas the process they use to problem solve and what attributes are essential to keep them functional. From the research perspective, the result of this project were encouraging in finding an effective new approach to improve healthcare systems. When striving to improve an organization, it’s important to understand the underlying history and culture of the unit and working with that to effectively progress. A better appreciation for the process of growth and the importance of looking to the past for effective solutions in handling the future of the unit was gained through this project. As more research is conducted to build on findings in this field, the goal is to find an effective method of improving the healthcare system as a whole by improving individual units.