Does providing short cycle feedback produce organisational learning?

Organisational learning is essential for innovation and effectiveness (Franco & Almeida 2011); especially in healthcare where organisational learning can directly improve the quality of care provided to patients. Incident reporting is a common governance tool within healthcare (Mahajan 2010) and feedback from incident reporting has the potential to facilitate individual and organisational learning that could lead to enhanced practices (Levitt & March 1988). Furthermore, the identification and resolution of problems encountered in the course of one’s work is a method for achieving organisational learning (Tucker & Edmondson 2003); in practical terms, incorporating lessons learnt into the organisation’s ‘memory’ by way of governance processes, policies and systems. However, little research has explicitly examined the potential for incident reporting to foster organisational learning or the mechanisms through which this might occur. The purpose of this study was to examine whether providing short cycle feedback through an incident reporting system produced organisational learning. Specifically, the study investigated whether the short cycle feedback system would facilitate single-loop organisational learning, which is defined as learning to identify errors and develop ameliorating strategies to prevent their recurrence (Argyris & Schon 1978). Single loop learning was measured as i) an improvement in incident reporting rates; ii) a decrease in actual incidents; and, iii) a decrease in the severity of incidents. This research was conducted over 2 Stages. Stage 1 involved a longitudinal study conducted over 5 phases and undertaken in 2 wards (study and control) within a major metropolitan hospital in south-west Sydney. During Phase 1, a pre-intervention questionnaire was administered to staff in the control ward and study ward to evaluate staff members’ attitudes towards incident reporting and feedback. In Phase 2, verbal querying was used to collect data on observed and reported incidents in order to quantify incident underreporting. During Phase 3, staff in the study ward received a short cycle feedback intervention that aimed to produce and provide feedback from an incident report to the reporting staff member within a 72 hour timeframe. A senior nurse provided feedback in a formative, consultative manner, which was delivered face-to-face to the incident reporter. During Phase 4, the short cycle feedback intervention was withdrawn and underreporting continued to be measured via verbal querying. During Phase 5, a post-intervention questionnaire was administered to staff in the control ward and study ward to evaluate staff members’ attitudes towards incident reporting and feedback. The feedback intervention and comparisons between pre-intervention and post-intervention questionnaires demonstrated an improvement in staff members’ perception regarding the utility of incident reporting systems and that short cycle feedback facilitated learning outcomes. Expected results, such as a reduction in incident severity and actual incidents, were equivocal. Consequently, during Stage 2 of the study a focus group was conducted with members of the hospital’s senior management team to critique the results and develop strategies to promote feedback mechanisms within the organisation. Focus group participants commented on the virtues of the study and recommended strategies to enhance medical staff participation and expand the feedback specialist role to improve engagement of after-hours and weekend staff. The focus group determined that these strategies, in conjunction with a replication study at a larger Hospital and across multiple specialties, would strengthen the findings from Stage 1. The study concluded that short cycle feedback did facilitate single loop learning, evidenced by changes in staff attitudes, knowledge and behaviour regarding incident reporting and clinical practices. The study also found that short cycle feedback produced 3 additional forms of learning: double-loop organisational learning, triple-loop organisational learning, and vicarious learning. Double loop learning was evidenced by new values regarding incident reporting utility. Triple loop learning was observed by a further understanding of incident reporting as a tool within a learning continuum system. Vicarious learning was demonstrated via a change in skills and behaviours of participants that did not directly receive short cycle feedback but learnt vicariously about its value. Hence, the research demonstrated that short cycle feedbac