The Learning Practice Inventory: diagnosing and developing Learning Practices in the UK.

BACKGROUND AND SETTING: This paper outlines the development of a diagnostic tool to help Primary Care general practitioner (GP) Practices diagnose the extent to which they are developing effective techniques for collective learning and if their Practice culture supports innovation. This project is undertaken by the University of St Andrews and NHS Education for Scotland. METHODS: Based on Learning Organization and Organizational Learning theory, and using a modified Behaviourally Anchored Rating Scale, the Learning Practice Inventory (LPI) identifies attitudes, behaviours, processes, systems and organizational arrangements associated with being a Learning Practice. The LPI is a self-assessment, fixed-choice, survey-feedback tool that surveys all Practice members. RESULTS: The survey-feedback tool empowers Practice members to view, assess and prioritize the developments they wish to make collectively to Practice life. The LPI assumes complexity and non-linearity in change processes, used longitudinally it tracks the impact of change on Practice life through time. Practitioners and Practices involved in its development give favourable feedback on the tool, and its potential usefulness. DISCUSSION: This contributes to our wider understanding in three main ways: first, it applies the ideas of Learning Organizations and Organizational Learning to health care settings. Second, as a practical advance, the tool assumes complexity, non-linearity and systemic knock-on effects during change in Primary Care. Third, it offers practitioners who work together the opportunity to share knowledge and learning in practical ways helping them to change by themselves and for themselves and their patients.

Clinical governance and the learning organization.

AIM: This paper compares and contrasts clinical governance and organizational learning. BACKGROUND: Clinical governance represents one of the most significant policy developments in recent years. It places on all health care delivery organizations a statutory duty to develop the systems, standards and processes necessary to improve health care quality and manage risk. At the same time, many health care organizations are seeking new ways in which learning can be retained and deployed more widely within the organization (organizational learning). KEY ISSUES: Both approaches emphasize cultural changes as essential underpinnings to quality improvement. However, the two approaches also differ fundamentally in their logic of action. Clinical governance is essentially 'top down', being built around formal standards, established procedures, and regular monitoring and reporting. In contrast, organizational learning emphasizes 'bottom up' changes in values, beliefs and motivations in such a way that learning and change are prioritized. The challenge for managers and practitioners lies in seeking a creative tension between these two contrasting styles of organizational change.