Chapter 8 outlines several factors which determine the need for change in healthcare organizations (p. 146). Healthcare leaders addressing these factors must balance the larger change management process with an understanding of strategic management. Strategic management is concerned with operations, from financial planning, forecasting, and external planning (p. 158). A core part of developing strong strategic management is becoming a ‘learning organization,’ reducing bureaucratic structures and increasing agility.
For this week’s assignment, research the process and potentials of being a learning organization. Begin by reading “Building learning organizational culture during COVID-19 outbreak: a national study” (from your Instructional resources section). Do additional research to add to your discussion of the following questions:
What is the role of leadership in developing the change from a highly bureaucratic organization to a more agile learning organization?
What are the limitations and challenges for leadership in managing each stage of the force-field model during this kind of organizational change?
Chapter 7 of your textbook highlights one of the paradoxical challenges for leaders in healthcare. On one hand, addressing poor results from a culture audit or proactively shifting culture requires a leader who can “implement widespread cultural change in healthcare organizations as soon as possible” (p. 138). On another hand, one of the promising approaches to change, Evidence-Based Management (EBM), is notably “time-consuming to implement” (p. 138). After reading CH 7, this week’s additional readings (in your Instructional Resources), and watching the video (below), discuss the following questions:
How can Healthcare leaders balance the tensions between proactive and timely change with more systematic and slow-moving processes like EBM?
What unique challenges must leaders implementing EBM consider to develop employee trust and buy-in at different stages of the EBM process?
post an initial response of 500 words that includes at least one APA citation and the associated reference
Video link: https://www.youtube.com/watch?v=11WvOlncQRU
Chapter 7
The Process of Culture Development
in Healthcare Organizations
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Learning Objectives
• Discuss the importance of a strong, positive
culture in healthcare organizations
• Explain the process of culture development in
organizations
• Describe the various steps required to
perform a culture audit
• Understand the leader’s role in the
development and maintenance of a strong,
positive culture in a healthcare organization
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Culture Building
• Culture building consists of the leader’s activities related
to creating a strong working climate for employees.
• The climate is the attitude that workers have regarding
the work they do and the organization they perform that
work for.
• The best-run companies discover early in their
operations that having a strong culture allows them to
consistently outperform their competitors over time.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Defining Organizational Culture
• Culture represents the collection of behaviors exhibited
by members of the organization passed on to new
members as they become a part of the organization.
• The culture of the organization is considered a
permanent fixture because it does not change often or
easily.
• The need does exist, however, to ensure that the culture
remains in tune with the organization’s purpose and
values.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
How Culture Develops
• Group culture develops over a long period of time
through a trial-and-error process until the majority of
group members feel comfortable with the culture.
• When a business is first launched, the culture is given
life by the founder and his first few hires.
• As the company grows and becomes profitable, new
workers are hired and absorbed into the culture.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Building Organizational Culture
Healthcare organizations need to concentrate on
building a cultural foundation of excellence on five
elements:
• Shared values
• Empowerment
• Service excellence
• Rewards for success
• Culture change and market competitiveness
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
The Value of Culture in Healthcare
• Interest seems to be growing in
organizational culture as a potential
remedy for failing to keep up with the
ongoing technological changes in society
and industry.
• This interest in culture is due to the need
for dedicated employees who constantly
innovate the way products are made and
services are delivered.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
The Culture Audit
• A culture audit is a formal investigation of the
culture of an organization.
• The culture audit is a structural means to assess
the sentiments of organizational members using a
series of predetermined questions developed to
reveal meaningful clues about the existing culture.
• Although many outside experts are available to
help complete a culture audit, research conducted
by Schein (2004) indicates that leaders should
conduct their own audit of the current culture.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
The Building Blocks of a
Thick Healthcare Culture
• Significant research shows that strong, thick,
and positive cultures are directly related to
both short- and long-term success.
• Ledlow and Coppola (2011) make a
convincing argument that thick positive
cultures are often the result of employees
learning how to solve problems as a team.
• Another building block is the presence of a
learning environment in which all staff are
encouraged to educate themselves and grow
to meet future demands.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
The Results Pyramid
• According to Connors and Smith (2011), a
simple method for changing the culture of the
organization is the results pyramid.
• The results pyramid is a model of culture change
that concentrates on the most important parts of
the organization.
• Gaining an understanding of culture helps
leaders understand some of the irrational
behaviors practiced by people in a given
organization.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
The Leader’s Role in the
Improvement of Culture
• The healthcare leader must pay attention to building
a strong organizational structure every day through
her communication skills and by establishing trust
between the leader and followers.
• One step often overlooked by organizations eager to
achieve high performance is that leaders should
make certain that current culture cannot achieve the
desired or required results.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Implementing Cultural Change
in Healthcare Organizations
• Cultures that emphasize work and
coordination are associated with the
continuous improvement of quality in care
delivery.
• The goals of leadership in healthcare
organizations for the next several years will
be to reduce the costs of care and improve
the quality of services.
• These two important goals need to be
embedded into the culture of healthcare
organizations.
Copyright © 2018 Foundation of the American
College of Healthcare Executives. Not for sale.
Alonazi BMC Health Services Research
(2021) 21:422
https://doi.org/10.1186/s12913-021-06454-9
RESEARCH ARTICLE
Open Access
Building learning organizational culture
during COVID-19 outbreak: a national study
Wadi B. Alonazi
Abstract
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.
Keywords: Learning organization, Culture, Knowledge‐share, COVID-19 outbreak
Correspondence: waalonazi@ksu.edu.sa
Health Administration Department, College of Business Administration, King
Saud University, PO Box 71115, 11587 Riyadh, Saudi Arabia
© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
Alonazi BMC Health Services Research
(2021) 21:422
Background
Having a primary role in restoring and maintaining
wellbeing, healthcare systems largely depend on organizations, people, and their competencies [1]. Particularly,
performance of healthcare systems varies based on the
structure, process and expected outcomes [2]. On a
micro level, healthcare organizations such as hospitals
and medical institutions remain at the nucleus of the
healthcare system regardless of the type of funding and
structure and the provided services to the general
population [1]. The key indicator of hospital performance
is the safe and consistent services provided to patients by
medical and non-medical staff [3]. Therefore, coordination
and communication within and between the teams is a
must to develop cohesive functioning essential to provide
high quality of medical care [4]. Healthcare organizations
are always bound to modify their functioning due to
dramatic changes in prevalence of diseases and pandemics
without compromising the quality of services [5]. Acquiring advanced technologies and creation and utilization of
contemporary knowledge can help healthcare organizations to perform well.
Learning organization is considered as a cumulative
phenomenon facilitating personal and professional
growth of individuals and teams. It also develops collective learning in an organization that leads to enhance
individual as well as organizational performance [6].
Indeed, learning organization improves the efficiency
and effectiveness of an organization through shared
knowledge [7]. An organization that practices continuous
learning of employees, bound to transform itself where employees continuously create, acquire, and share knowledge
is called learning organization [8]. Learning organization
and organizational learning has been used interchangeably
in previous literature. However, there is a thin line which
differentiates the two. According to Preskill and Torres
learning organization focuses on characteristics, principles,
and systems whereas organizational learning emphasizes on
the process of learning [9]. However, in each level,
individuals are the main agents that involve in learning
organization or organizational learning and bring substantial changes. Ultimately, organizational learning is a process
through which an organization develops new knowledge
and understands from routine experiences of the employees. Organizational learning has the potential to change
the behavior of employees and improve the organizational
capability on policy and practical levels [10].
Learning organization is the first step towards obtaining
dynamic knowledge that brings change among employees,
whereas in the context of a learning organization,
knowledge is acquired and shared among employees via a
system that develops capacity to improve performance
[10]. Generally, learning organization is influenced by
contextual factors such as culture. An organization that
Page 2 of 8
regards learning as absolutely critical for its business
success is considered well-equipped with knowledge
culture [11]. Organizational culture is the characteristic of an organization which manifests the sharing of
common values and beliefs among its employees [12].
Thus, learning organization culture develops skills
within an organization to create, acquire, and transfer
knowledge and enhance positive behavior to follow
new medical practice or guidelines [13].
As changing environment forces every healthcare
organization to enhance quality and safety, practice of
learning organization can improve the knowledge and
skills of medical staff and guide them to find better ways
to work effectively [14]. Collective learning among small
groups or teams could lead to standard performance of
healthcare organization through shared knowledge and
better understanding among teams [15]. In the context
of healthcare services, members of the teams may convert their knowledge in actions and later evaluate actions
on evidence based practice associated with contemporary guidelines [7]. Reay and others argued that in healthcare services, physicians and managers first choose the
correct knowledge from existing ones and adapt the
knowledge to solve problems and find solutions at hand.
This process can help in managing conflicts between
management and medical professionals. The process of
learning in healthcare is time consuming; yet it provides
the precise way to cope with medical crises [16].
Components of Health Learning Organization culture
The early studies on learning organization focused on
five factor model developed by Senge including systems
thinking, personal mastery, mental models, building a
shared vision, and team learning [17]. Gomes and Wojahn
conceptualized learning organization on the basis of four
components as experimentation, interaction, risk, and
dialogue, but concluded that learning organizations had
the capability to improve innovation performance [18].
Additionally, Halim and others included three components of learning organization as information acquisition,
information interpretation, and behavioral and cognitive
and initiated an imperative role of these factors in
innovation culture and performance [19].
In the context of healthcare organization, Leuven and
colleagues developed seven dimensions that measure
organizational learning in low resources healthcare
settings [4]. These seven dimensions are continuous
learning, dialogue and inquiry, team learning and collaboration, embedded systems, empowerment, systems
connections, and strategic leadership. Previous studies
on organizational learning in healthcare settings included
all top, middle, and lower level employees as part of the
study [4, 20, 21]. However, a little is focused on the
role of healthcare professionals during crisis to create
Alonazi BMC Health Services Research
(2021) 21:422
an environment of organizational learning. During
crisis, knowledge management is complex due to the
fact that various networks apply different strategies
like centralization and other organizational structure
like independency [22]. Therefore, the study excluded
the dimension of strategic learning in conceptualization of
strategic learning mainly focus on support of leadership
on learning and leadership models.
Promoting organizational learning during crisis
Creating, retaining, and transferring useful knowledge
are key elements when health institutions incorporate a
new model for corporate learning and development [23].
During crisis, medical institutions take a few effective
staff in formal committee to accelerate the process ahead
of other activity, projecting the less risky roads. Building
health protocols, ensuring its effectiveness, as well as
revealing the practice among healthcare professionals
was a major goal to deal with COVID-19. Again, what
promotes organizational learning is the nature of the
emergency, which is in this case a pandemic issue [24].
Though the Saudi government issued instructions to
lockdowns, self-isolation, and social distancing, such instructions were initiated based on international learning
system, mostly from the World Health Organization
(WHO), as well we as the internal experience [25].
However, MOH has taken effective steps in almost each
hospital to prevent the spread of the viruses. The MOH
initiated on online medical consultations and many
activities to learn from this anise. Figure 1 shows the
number of new, infected, and death cases in Saudi Arabia during the study period.
Page 3 of 8
period to be privatized with less power of the government [5]. Almost two-thirds of health provisions are
funded by the government, under the regulation of
the Ministry of Health. Semi-government agencies like
Ministry of Defense, Ministry of Guard and Ministry
of Interior contribute also in funding their health
settings [26]. Despite such services by the government,
private sector and university hospitals contribute slightly
in operating the Saudi healthcare system. Again, social reform is an integral part to effective health improvement
[27]. As the government is under heavy transition periods
by the new health leadership, it is expected the funding
portion is flipped within decades [5, 28]. As a result of
each provision having different entities and priorities, a
chasm now may exist between knowledge and practice
within each entity [29].
Having several healthcare providers, the learning
organization culture of each entity across the country
has not been well-studied [30]. However, learning
organization is necessary to implement the strategies
that could benefit the organization. In addition, working
productivity is also dependent on improved working
efficiency and environment that are by products of
organization learning [31]. Understanding learning
organization culture in such contexts would enhance the
resilience of the Saudi system and may enable it to
better absorb the adverse effects of the economic and
political shocks, especially under such transition periods.
Methods
This is a cross-sectional study where the overriding objective
was to explore some domains associated with building effective organization learning culture during crisis.
Saudi healthcare system
In Saudi Arabia, the healthcare system is at cross
roads where the old publicly funded system, regulated
mainly by the government, is now under transition
Tool
Consisting of 21 items, the abbreviated form of Dimensions of Learning Organizations Questionnaire (DLOQ)
Fig. 1 Infected, recovery, and mortality cases during the study period in Saudi Arabia
Alonazi BMC Health Services Research
(2021) 21:422
Page 4 of 8
developed by Marsick and Watkins [32] and Leuve was
utilized in this study. The purpose of using this tool was
simply because it possessed construct validity and sound
reliability. Three adequate measurement items (individual, group, and organization) for each dimension included in this study.
Data Collection
During March to September 2020, data were collected
from four major healthcare providers including Ministry
of Health (MOH), Teaching University Hospital (TUH),
Semi Government (SGH), and Private Hospitals (PH).
During partial lockdown, an on line survey was sent to
some corporate communication departments to liaise
the survey, after obtaining the IRB. The unit of analysis
was the first line of healthcare workers who directly deal
with COVID-19 cases. The judgmental sampling method
was used to identify the eligible respondents and data
were collected through electronic mails.
Procedure and sampling
This study used G*power software to calculate the minimum sample size as recommended by Hair and others
for PLS-SEM analysis and found minimum sample of
146 was adequate as maximum six predictors pointing at
one endogenous variable [33]. Medium effect size and
0.95 power of the model were set for calculation. The
sample size of 1131 of the study satisfied the condition
of minimum sample size.
Measurement
All items of the constructs were adapted from the
existing literature and were slightly modified to fulfill
the objective of the study [4, 32]. All the items were
measured on a five-point Likert scale that ranged from
(1) strongly disagree to (5) strongly agree.
Results
Out of 1500 assigned emails, only 1131 responses
returned as they were used for final data analysis. In
regard to learning environment, government, and semigovernment healthcare settings tend to provide better
learning environment than private hospitals. As, from
the total respondents of government, 95.6 %; semigovernment, 96.1 %; and university hospitals, 94.3 %
responded that the hospital in which they work is a real
learning organization. However, in case of private hospitals 88.9 % of the total respondents confirmed that the
hospital is a learning organization as shown in Table 1.
The representation of the respondents was almost
equally distributed from all four categories regarding
their work nature in the hospitals i.e., government hospitals
(24.2 %), university hospitals (21.6 %), semi-government
hospitals (29.4 %), and private hospitals (24.8), as shown in
Table 2.
As shown in Table 3, teaching university hospital
(TUH) indicated the highest level in building learning
organization among the rest, with the highest level in effective system connection and the lowest in continuous
learning process. The lowest level in building learning
organization was the private Health Hospitals (PH), in
the highest score of system connections and the lowest
in building internal continues learning and equally building the culture of learning (M = 3.13, and M = 2.95,
respectively).
In Table 4, a correlation matrix was constructed to
measure the strength between the intrinsic and extrinsic
variables when building effective learning organization
during crisis.
A multiple linear regression (MLR) was constructed to
model the linear relationship between the explanatory
variables and building effective organizational culture in
the assigned settings. As shown in Table 5, a significant
regression equation was found (F (6, 1124) = 168.730,
p < .0005, R2 = 0.471).
We can estimate the model to build effective learning
organization during COVID-19 crisis, knowing the values
for the six variables, by using the regression model:
SL = 0.340 + 0.152 (CL) + 0.096 (DI) + 0.100 (TC) +
0.180 (ES) + 0.136 (EM) + 0.235 (SC).
All six variables are significant predictors of learning
organization. P-values < 0.05 and even 0.01 for all the
variables. The result explained that the internal system
and connections were superior, compared to other
methods. As shown, the R2 value for learning organization
culture of 0.475 suggests that 47.5 % of the variance of
Table 1 Responses about the possibility of having organization as a place of learning
Hospital Typea
Is this hospital
considered a
learning
organization?
Male
Female
MOH
TUH
SGH
PH
%
n=244
%
n=333
%
n=280
%
n=1131
%
Yes
131
48
121
50
174
52
141
50
567
50.1
No
7
2
7
3
8
2
16
6
38
3.4
Yes
131
48
109
45
146
44
108
39
494
43.7
No
5
2
7
3
5
2
15
5
32
2.8
MOH Ministry of Health, TUH Teaching University Hospital, SGH Semi-governmental Hospital, PH Private Hospital
a
Overall
n=274
Alonazi BMC Health Services Research
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Page 5 of 8
Table 2 The demographic characteristics of the participants and their career background
The nature of the
respondents’ work
Hospital Typea
MOH
TUH
n=274
Yes
Clinical
Administrative
Both
No
Clinical
Administrative
Both
SGH
PH
%
n=244
%
n=333
%
n=280
%
M
49
18
77
32
62
19
62
22
F
42
15
74
30
42
13
49
18
M
62
23
33
14
94
28
71
25
F
68
25
27
11
74
22
50
18
M
20
7.3
11
4.5
18
5.4
8
2.9
F
21
7.7
8
3.3
30
9
9
3.2
M
2
0.7
5
2
2
0.6
9
3.2
F
0
0
6
2.5
1
0.3
8
2.9
M
5
1.8
2
0.8
4
1.2
4
1.4
F
4
1.5
1
0.4
3
0.9
5
1.8
M
0
0
0
0
2
0.6
3
1.1
F
1
0.4
0
0
1
0.3
2
0.7
MOH Ministry of Health, TUH Teaching University Hospital, SGH Semi-governmental Hospital, PH Private Hospital, Y Yes, N No, M Male, F Female
a
learning organization culture can be explained by six independent variables. The structural model represents the assumed relationship between some variables [33]. The
results revealed that continuous learning, dialogues and
inquiry, team learning and collaboration, embedded systems, empowerment, and systems connections all have
significant positive relationship with learning organization
culture.
Discussion
The aim of the study was to examine the factors influencing building effective learning organization culture in
various healthcare. Having theoretical and practical implications, this study bridges the gap in literature on
learning organization culture in healthcare settings. Besides, study findings guide top management of the hospitals and policy makers to develop policies and guidelines
based on organization learning that create cohesive work
environment among various departments of hospitals to
provide quality services to patients. Becoming a learning
organization is complex and provider-based specific. Unlike process and outcomes indicators, the structural indicators have influence on formulating effective health
learning organization culture [34].
First, structural indicators including system connections, embedded system and team work were reported to
have a major influence on learning organization. Indeed,
the structural components of the health organization
have the strongest relationship in formulating health
learning organization culture. Systems connections explain that an organization must observe a problem from
different aspects and encourage employees to engage
across the organization and with outside environment to
bring solutions [17]. Unlike European health settings,
hospitals in Asian countries, generally, lack practice of
engaging the general population to develop new ideas
and learning [35, 36].
Collaboration with community welfare organizations,
local health agencies, and health consultants can bring
advanced knowledge to hospitals and guide in
Table 3 Results of descriptive analysis including the mean of each setting
Latent Construct/Item
MOH
(n = 275)
TUH
(n = 244)
SGH
(n = 333)
PH (n = 280)
Continuous Learning (CL)
3.12
4.11
4.37
2.95
Dialogue and Inquiry (DI)
3.00
4.37
4.27
3.03
Team Learning and Collaboration (TC)
3.16
4.35
4.32
3.02
Embedded Systems (ES)
3.27
4.38
4.25
3.00
Empowerment (EM)
3.01
4.35
4.27
3.05
Systems Connections (SC)
3.15
4.42
4.26
3.13
Learning Organization Culture (SL)
3.07
4.38
4.26
2.95
Over all
3.11
4.34
4.29
3.02
Alonazi BMC Health Services Research
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Page 6 of 8
Table 4 Correlation matrix to measure the strength between the intrinsic and extrinsic variables
Domain/ Statistical Value
SL
SL
1
P
CL
DI
TC
ES
EM
SC
Sig.
CL
DI
TC
ES
EM
SC
a
P
0.507a
Sig.
0.000
P
0.523a
0.547a
Sig.
0.000
0.000
P
0.535a
0.483a
0.580a
Sig.
0.000
0.000
0.000
P
0.539a
0.472a
0.523a
0.592a
Sig.
0.000
0.000
0.000
0.000
P
0.540a
0.486a
0.548a
0.587a
0.526a
Sig.
0.000
0.000
0.000
0.000
0.000
P
0.572a
0.487a
0.553a
0.565a
0.505a
0.584a
Sig.
0.000
0.000
0.000
0.000
0.000
0.000
1
1
1
1
1
1
Correlation is significant at the 0.01 level (2-tailed)
implementing strategies to overcome challenges faced by
the hospitals. Team learning is a situation where individuals think together, share experiences, knowledge and
skills to do the things in better way [17]. Hospital management and policy makers could promote a culture of
engagement of employees within an extrinsic-intrinsic
environment and share new knowledge across the
organization for continuous learning. Acquired knowledge incorporated from outsiders but embedded in the
working systems, practices, and structures can be used
and shared to improve performance [32]. In healthcare
settings, the learning acquired from the new knowledge
should be deep rooted and become part of daily operations of the hospitals.
Empowerment, dialogue and inquiry, internal and
continues learning philosophy were also positively
related to learning organization culture. Empowerment
is a process in which employees of every level take part
in collective decision making and accountability. This
practice develops motivation among employees to acquire new knowledge so that they can take better
decisions [32]. However, in healthcare settings empowering every employee to a level where s/he becomes a part
of collective decision making is a huge challenge.
Healthcare systems all across the world are predominantly governed by bureaucracy and hierarchical structure
with set rules and operating procedures and left no
room for many employees to be a part of decision making [37, 38]. Employees, both medical and non-medical,
remain excluded in decision-making but bound to implement the instruction and guidelines with high perfection. Policy makers and top administration must ensure
the inclusion of hospital employees of every level in collective decision making so that they can also become
part of learning and contribute to growth of healthcare
system. Dialogues and inquiry are the reasoning skills to
express views and the capacity to listen and inquire
about the views of others [32]. Logical reasoning and dialogues open space for critical thinking and bring logical
and appropriate solutions to different situations.
Continuous learning was also found strongly related to
learning organization culture. In healthcare services,
Table 5 Summary of MLR analysis for variables predicting building effective leaning organizational culture
Model
Unstandardized Coefficients
Standardized Coefficients
Beta
t
Sig.
3.179
0.002
B
Std. Error
Constant
0.340
0.107
CL
0.152
0.028
0.151
5.459
0.000
DI
0.096
0.031
0.094
3.117
0.002
TC
0.100
0.032
0.097
3.099
0.002
ES
0.180
0.029
0.177
6.119
0.000
EM
0.136
0.031
0.134
4.427
0.000
SC
0.235
0.031
0.224
7.545
0.000
Alonazi BMC Health Services Research
(2021) 21:422
skills and knowledge can easily be outdated due to
evolvement of technology and procedures. Therefore,
medical and non-medical staffs must engage in continuous learning for their self-satisfaction and overall quality
of healthcare services. However, researchers argued that
continuous learning at individual level is important but
not sufficient to improve performance unless and until
not embedded in systems [32]. Hospital management
may ensure that learning is not limited to individuals
only and installed as part of systems so that teams and
individuals can use it uninterruptedly.
Internal learning indicators were among the least important aspects to develop culture of learning in hospitals and healthcare institutions. However, in most of the
Asian work settings expressing views openly and freely is
unwelcoming among colleagues and superiors. This is
again mainly due to bureaucracy and hierarchical nature
of functioning in healthcare systems [22]. Giving voice
to every individual to express their reasoning and logical
thinking in healthcare institutions will open space to
bring in new ideas and contribute to the culture of
learning. Providing satisfactory services to patients requires team work and involves teams and individuals of
different expertise. Patient visits to hospitals usually
come in contact with employees work in different medical and non-medical departments. Employees that come
in contact with patients should receive new knowledge
and instill it into the working systems. However, many
developing healthcare systems face the problem of
communication and coordination gap between different
departments of the hospital [4, 39]. A culture should be
developed within the hospital where systems ingrained
with new knowledge are well connected so that learning
can be shared across the organization to enhance service
quality.
Contextually, caution should be given to generalize the
study findings in healthcare systems of other developing
countries due to situational and cultural differences. Furthermore, the use of non-probability sampling to collect
the data due to the unavailability of sampling frame is
another limitation of the study [5]. Future studies should
utilize similar variables and test their relationships in different healthcare settings and compare the findings of
this study and observe the effect of situational factors
and culture on learning organizational culture.
The findings of this current study and the existing
body of evidence have approved that there are some
associations between effective learning organization and
certain extrinsic organizational practices. Indeed, embedded system like linkage of medical episodes, in medical
and non-medical fields, have shown a positive impact
among the sample in increasing knowledge-environment.
Addition, building strong reliable health information
system, especially for decision making throughout the
Page 7 of 8
hospital would increase the chances of knowledge transfer
among health practitioner. The absence of building health
learning organization may promote ineffective performance within a holistic healthcare system.
Conclusions
Learning culture can become a guiding tool for organizations to improve skills and knowledge of individuals
and teams and develop a culture to work together and
deliver quality services. Policy makers and the top leadership should work towards creating a sense of shared
purpose among medical and non-medical staff at middle
and lower level management. Well-connected systems
embedded with learning culture will help to build effective relationships, coordinated actions and the reflections
that strengthen the desirable practices in healthcare
while correcting structures, procedures, and assumptions. In simple, leaderships of healthcare organizations
can create a continuous learning environment.
This study demonstrated the usefulness of implementation of organizational learning practices based on
several dimensions that can lead to transfer hospitals
and healthcare institutions into learning organization
during crisis.
Abbreviations
SA: Saudi Arabia; MOH: Ministry of Health; TUH: Teaching University Hospital;
SGH: Semi-governmental Hospital; PH: Private Hospital; CL: Continuous
Learning; DI: Dialogue and Inquiry; TC: Team Learning and Collaboration;
ES: Embedded Systems; EM: Empowerment; SE: Systems Connections;
SL: Learning Organization Culture; MLR: Multiple Leaner Regression
Acknowledgements
The author extends his appreciation to the Deanship of Scientific Research,
King Saud University and the Research Center at the College of Business
Administration for supporting this project.
Author's contributions
W.A wrote the whole manuscript. The author(s) read and approved the final
manuscript.
Authors' information
Wadi is an Associate Professor in the Department of Health Administration,
King Saud University.
Funding
Not externally funded.
Availability of data and materials
All data are available based on academic purposes through the
corresponding author (waalonazi@ksu.edu.sa).
Declarations
Ethics approval and consent to participate
This study has been performed in accordance with the Declaration of
Helsinki and was approved by an appropriate ethics committee in Ministry of
Health (General Directorate of Health Affairs IRB A-220), Riyadh, Saudi Arabia.
No consent form was used, as replying to the online survey implied
agreement to participate. The committee in the General Directorate of
Health Affairs approved this procedure.
Consent for publication
Not Applicable.
Alonazi BMC Health Services Research
(2021) 21:422
Competing interests
The author declares that he has no financial or personal relationships that
may have inappropriately influenced him in writing this article.
Page 8 of 8
23.
Received: 22 December 2020 Accepted: 23 April 2021
24.
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EVIDENCE BASED LEADERSHIP IN THE
HEALTHCARE ORGANIZATION
by Scott K. Edinger, Joseph R. Folkman and John H. Zenger
It’s been a long day; in a long month, in one of the toughest
years in recent memory. The CEO just finished reviewing
the last quarter’s results and while they were satisfactory,
there is a tremendous pressure to improve upon those
results. Patient care measures need to improve, bottom
line performance isn’t where it needs to be, and you were
just told that over the next two quarters your toughest
regional competitor is going to be expanding and hiring.
So now, on top of it all you have to worry about retaining
your best people.
As the Chief Human Resources Officer of this regional
healthcare system, you are struggling to find innovative
ways to address what seems like a paradoxical challenge:
•
providing high quality and affordable care
•
simultaneously improving patient satisfaction and implementing operational efficiencies and cost controls.
At times it feels like an impossible set of objectives. That
pretty much sums up the issues faced by many Human
Resource executives today. Add to that the marketplace
reality of an aging workforce in the healthcare industry
that threatens a very real shortage of talent to fill key roles
and the job isn’t getting any easier.
It’s hardly a revelation to point out that today’s healthcare
industry faces dramatic change, but when you consider:
•
Healthcare reform
•
Increased regulation ( Joint Commission standards,
accreditation reviews)
10 Pioneer Drive, Suite 105 | Kitchener, ON N2P 2A4
•
Retaining talent with a shrinking pool of incoming
talent (Physicians, pharmacists, (RN’s, radiology tech’s,
and even hospital administration.)
•
Increase in standards for quality care and patient
satisfaction metrics
•
More consumer choices for healthcare
•
Complexity of Medicare reimbursements on the rise
It becomes clear that U.S. healthcare organizations face
a number of serious matters and sometimes competing
priorities. And of course, all are essential to the success of
the organization.
With those kinds of challenges to address, there simply
is not a silver bullet solution. Yet there is one variable,
very much in your control, which has a measurable and
powerful impact in addressing all of them. That variable
is the effectiveness of your leaders. Now more than ever,
it is vital that health care organizations develop leaders
who perform at a high level (read: not just good, but great)
who are able to carry out these missions and inspire those
around them to do the same.
In this paper, we will highlight how leaders in healthcare
organizations can be developed with an eye on producing
positive outcomes to the above mentioned organizational
issues. Broadly, we have studied tens of thousands of leaders
to determine what characteristics best differentiate extraordinary leaders from their average and poor counterparts.
We analyzed a detailed subset of those leaders that came
PHONE
519.748.1044
FAX
519.748.5813 www.clemmergroup.com
a strategic partner of
from the healthcare industry to discover the key differences
that make leading the healthcare organization unique.
With those datasets there are a handful of conclusions that
will help any healthcare organization address these challenges with leaders who are prepared to make a difference.
FIRST, A BROAD LOOK.
In healthcare, it’s no secret that the implementation of
evidence based medicine is a crucial practice. In the same
spirit, evidence based leadership development is needed
to ensure that the development of leaders is grounded in
real data and not just opinion or the popular ideas of the
time. When we look at the key leadership competencies
that separate excellent from average leaders, there is an
empirically defined set of competencies highlighting
what makes a great leader. Based on our research involving well over 25,000 leaders, we have concluded that
the extraordinary leaders are not characterized by the
absence of any weaknesses but rather, by the presence of
a handful of profound strengths. That is, all leaders have
some weaknesses (after all, they are human) yet the best
leaders have a few areas of expertise that reach the 90th
percentile (our criteria for extraordinary performance)
in terms of their effectiveness The good news for mere
mortals who are responsible for leading teams, divisions,
or entire organizations is that developing 3-5 profound
leadership strengths has an enormous impact on organizational performance. Those that make the greatest
FOCUS ON
RESULTS
•
Drives for
Results
•
Establishes
Stretch Goals
•
LEADING
CHANGE
•
Develops
Strategic
Perspective
•
Champions
Change
•
Connects the
Group to the
Outside World
Takes Initiative
Copyright © 2010 Zenger Folkman.
difference for leaders are illustrated in the Extraordinary
Leader Model below.
Understanding what leadership competencies make the
greatest difference is more than just a useful exercise—it’s
essential to understanding how the best leaders make the
greatest impact. Even more essential is having a clear picture
of the impact these competencies have on organizational
outcomes. In our work, we have not only measured leadership competencies but have taken it a step further to measure
the impact that leadership effectiveness has on organizations.
From turnover, profitability, customer satisfaction, employee
engagement, and even likelihood of avoiding unionization,
we have measured the impact that leaders have in driving
better results in all of these areas.The trends are clear—better
leaders equal better results. Taking it a step further, extraordinary leaders drive extraordinary results.
One of the measures we have aggregated in the healthcare
industry is the frequently discussed measure of employee
engagement. Recognizing that engaged employees and
teams are considerably more productive, have more positive interactions with patients, and are more committed to
doing whatever it takes to get the job done well, we know
engagement has a strong influence on the success of the
organization in almost every area. The graph below shows
the impact that leaders in healthcare organizations have on
the engagement levels of the people they lead.
CHARACTER
•
Displays High
Integrity and
Honesty
INTERPERSONAL
SKILLS
PERSONAL
CAPABILITY
•
Communicates •
Powerfully and
Prolifically
Technical/
Professional
Expertise
•
Inspires and
Motivates
Others to High
Performance
•
Solves
Problems
and Analyzes
Issues
•
Builds
Relationships
•
Innovates
•
•
Develops
Others
Practices SelfDevelopment
•
Collaboration
and Teamwork
2
a strategic partner of
A picture—or graph in this case—is clearly worth 1000 words.
SECOND, A DEEP LOOK.
In order to determine what makes the greatest difference for healthcare leaders as well as what is most important to
those who they lead we conducted the following analysis which yielded some interesting conclusions.
The juxtaposition of this data allows us to get a glimpse at what leadership strengths are most critical in the unique healthcare
environment, as well as what allows healthcare leaders to stand out among their peers.
1.
Compare and contrast
the top 10% of healthcare
l e a d e r s ve r s u s to p
leaders of other sector
in our global database.
2. Compare and contrast
the top 10% of healthcare
l e a d e r s ve r s u s t h e
bottom 10% of healthcare
leaders.
3. Analyze data on what
is most requested by
subordinates, “If my
leader did this it would
have the greatest
impact” (Illustrates what
is needed in the eyes of
those being led)
Copyright © 2010 Zenger Folkman.
3
a strategic partner of
When we look at the common themes in this data it
is clear that there are a handful of leadership traits that
are critical to success in the healthcare arena, and as you
would expect, some of these traits, regardless of your field
of choice, are non-negotiable.
an industry, few can rival healthcare regarding the
criticality of technical expertise in determining the
success of leaders. The ability to analyze issues, solve
problems, and see beyond the horizon is how this
manifests every day.
Developing Others. The requirements of managed
4. Display High Integrity and Honesty. In earlier
1.
care have increased the workload of everyone in the
healthcare industry, even if only in a peripheral way.
Because of that, it is easy to understand why the ability
to develop the skills of others is critical to a leader’s
success. Improving productivity reduces stress and
there is no better way to boost productivity than to
teach someone how to effectively do a job independently. That includes improving one’s own abilities and
is closely tied to self-development, also of significance,
as well. And of course, the number one skill required
to do this well is providing feedback and coaching in
a productive way.
2. Collaboration and Teamwork. In most organiza-
tions, people work together for common goals. In
the healthcare organization, people work together
to save lives—perhaps a common goal of the highest
order—so it is no wonder that the ability to work
cross-functionally with others is so powerful and so
important. I was at a client’s facility last year and was
amazed at the attention given to the many transition
points of patients to ensure that there was always a
consistent staff presence to ensure nothing slipped
through the cracks. That requires a tremendous
amount of anticipation of client need and an ability
to work collaboratively with others to fulfill that need.
Anyone who has ever been victim to an unwanted
“blind transfer” in a call center knows what we are
talking about. That won’t work in healthcare and great
leaders in this environment know how crucial it is to
get the patient what they need.
3. Solve Problems and Strategic Perspective.
While these two are not exactly the same, there are
some natural linkages between these two abilities and
both were significant in terms of differentiating the
best healthcare leaders from their average and poor
counterparts. In short, this is all about how value is
created for patients; diagnoses, solutions, and looking ahead to address future issues. Add to this the
importance of resolving conflicts and constructively
challenging the status quo as a means to driving that
value (two specific behaviors that healthcare leaders
tended to outperform leaders from other sectors,)
and it is easy to see why this has such an impact. As
Copyright © 2010 Zenger Folkman.
studies, we have highlighted that this competency is
the foundation for extraordinary leadership. While
necessary, however, in and of itself it is in most cases,
not sufficient. All of us have known people with a lot
of character that are not great leaders. In order to be
a great leader, people must be willing to follow, and
people won’t follow someone who they don’t trust to
act in their best interests at least part of the time. I’m
not talking about lying, cheating, stealing, and other
unsavory behaviors—while these are clearly breaches
of integrity and honesty. In the majority of cases, it
is not this kind of bad behavior that gets in the way
of a leader. More often than not, it is a failure to do
little things that erodes peoples view of integrity and
honesty; saying one thing and doing another or what
many call “not walking the talk,” not following through
on commitments, and most of all in healthcare, not
looking out for the best interests of the patient and the
team. This is not to say that rational self-interest isn’t
appropriate and that displaying integrity and honesty
is entirely about self-sacrifice. Rather, doing what we
say we will do, and behaving in a way consistent with
organizational and dare I say, “human” values is what
makes a powerful difference for those we lead.
5. Inspire and Motivate. If there is a strength among
all leaders that makes the greatest difference it is the
ability to inspire and motivate others to high performance. In our book The Inspiring Leader, we highlight
our research proving that this characteristic was the
single most powerful differentiator of great leaders,
had the most significant impact on the engagement
of employees, and not surprisingly, was rated by direct
reports as the most important competency of their
leader. There is a message in that data. If you are going to be an effective, if not extraordinary leader, then
this is one area that requires your attention. There are
many ways that leaders inspire and motivate, and a
thorough discussion of them is beyond the scope of
this article. Suffice it to say, that in order for leaders
to increase productivity, drive efficiency, and improve
the quality of care in their organization, they must
find a way to inspire those they work with. Doing so
creates a connection to purpose, increases energy to
accomplish more, and fosters a culture of achievement.
4
a strategic partner of
CONCLUSION
The CHRO of a regional hospital system said this best
in a recent discussion over dinner as we talked about
succession planning. She lamented about the recent loss
of an ICU manager. The lament was there not because
of the specific turnover—that will happen everywhere.
Rather, it was because the organization knew the retirement/departure was known to be imminent 18 months
prior. Because there had not been effective leadership
development or succession planning past the top level,
the organization will now have to recruit a replacement.
That will take at least 9 months to a year and will cost
approximately $100,000 in recruiting and projected
overtime costs due to lost productivity. Add to that the
increased organizational and individual stress and strain
and it becomes even more significant. Multiply scenarios
like this one over the course of an entire organization
and the costs of not developing leaders creates spiral of
negative consequences felt by everyone from the CEO
to your patients.
Developing leaders is not a panacea—far from it. There
are many factors that are involved in the success of any
well run organization, particularly in the healthcare arena.
Yet the impact that leaders have on all of those factors,
from patient care, adherence to standards, effective decision making, engagement and effort put forth by staff,
and plenty of others. So much so that it should at the
very least be given appropriate consideration as a key
priority for the organization. After all, if building more
effective leaders, which is one of just a few variables you
have a great deal of control over, can impact all of these
areas, isn’t it worth a shot? No pun intended.
ZENGER | FOLKMAN
Extraordinary Performance. Delivered.
We specialize in leadership and performance development that directly drives an organization’s profitability. Founded on pioneering,
empirical research using 360-degree assessments and other surveys, we’ve built one of the world’s largest collections of leadership
research data – hundreds of thousands of feedback surveys on tens of thousands of managers.
Using powerful techniques that focus on building strengths using implementation tools and personalized coaching, our approach
lifts the performance of leaders, coaches and individual contributors in the differentiating competencies shared by those who are
among the world’s most successful people. Our proven, practical methods create a clear picture of how leadership drives profit and
the ways to put it to work within organizations.
If you are interested in discussing how your organization can increase profit through extraordinary leadership, please contact
Zenger Folkman. We welcome the opportunity to talk with you about how your organization can develop extraordinary leaders
who have the competencies to maximize profits for your organization!
Scott K. Edinger works with hundreds of leaders each year on developing leadership talent in their business and addressing the
challenges of organizational change. He is a frequent keynote speaker at national meetings, and has contributed to publications
such as Selling Power and Sales and Marketing Management.
Joe Folkman, Ph.D., is a frequent keynote speaker and conference presenter, a consultant to some of the world’s most successful organizations, and the author or co-author of six books. His research has been published in The Wall Street Journal’s National
Business Employment Weekly, Training and Development, and Executive Excellence.
John H. “Jack” Zenger, D.B.A., was inducted into the Human Resources Development Hall of Fame in 1994 and received
the Thought Leader Award from his industry colleagues in 2005. He is the author or co-author of seven books on leadership and
teams, and is considered one of the most authoritative voices on improving organizational performance and developing leadership.
THE CLEMMER GROUP
Stronger People. Stronger Organizations.
The CLEMMER Group is Zenger Folkman’s Canadian Strategic Partner. Jim Clemmer was co-founder of The Achieve
Group (which became Canada’s largest leadership training firm) when they worked with Jack Zenger’s previous company,
Zenger Miller.
CONTACT US
phone 519.748.1044
Copyright © 2010 Zenger Folkman.
email service@clemmergroup.com
internet www.clemmergroup.com
5
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