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Qual Saf Health Care 12:313-316 doi:10.1136/qhc.12.4.313
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How can healthcare organisations enhance their capacity to learn?

  1. Tom Smith
  1. Research Associate, Judge Institute of Management, Cambridge University, Cambridge CB2 1AG, UK ts271@cam.ac.uk
      • What is the influence of culture on the ability of health services to learn?

      • Why do hospitals fail to learn from errors?

      • How will advances in technology such as telemedicine help to spread learning?

      These and other questions are raised in the papers outlined below.

      Learning about culture

      Organizational culture is often used to explain extraordinary organizational performance. In fact, the term “safety culture” has recently emerged in the healthcare literature to describe the set of assumptions and practices necessary for healthcare organizations to provide optimal care. More and more, the benefits of shared culture are talked about in health care. But, as noted in the first paper below, shared “norms and assumptions can also be a source of danger if they blind the collective to vital issues or factors important to performance that lie outside the bounds of organizational perception. Cultural blind spots can lead an organization down the wrong path, sometimes with dire performance consequences. This was the case at the Bristol Royal Infirmary (BRI).

      What can we learn about the role of culture in health care from Bristol? ▸

      Karl Weick is one of the most respected academic figures in organisational behaviour. He is the author of Sensemaking in Organizations (1995) and a former editor of Administrative Science Quarterly. His paper is focused on the question: “Why did Bristol Royal Infirmary continue to perform pediatric cardiac surgeries for almost 14 years (1981–95) in the face of poor performance?”.

      “The working definition of culture used in the BRI inquiry was ‘those attitudes, assumptions, and values which condition the way in which individuals and the organization work’. The BRI board of inquiry variously referred to the BRI as a provider-oriented culture, a culture of blame, a club culture, a culture of fear, an oral culture, a culture of justification, a culture …

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