title: Institutional attributes associated with innovation and improvement: results of a multisite study.
abstract: BACKGROUND
  To date, no studies have explored why some teaching hospitals and health systems appear to offer a more fertile environment for innovation and improvement in the learning environment. As a consequence, little is known about the role of organizational attributes and culture in fostering innovation and improvements in settings where residents learn and participate in care, though these have been studied extensively in the general literature on organizations.
  
  
  OBJECTIVE
  The goals of our study entailed (1) gathering ground-level observations on processes and common attributes; (2) disseminating this information for adoption and adaptation; and (3) exploring whether the current accreditation model may present barriers to institution- and program-level innovation.
  
  
  METHODS
  We conducted a qualitative study of 4 institutions, successful in innovation and improvement in their learning environment, and sought to replicate the findings with a second group of 5 institutions.
  
  
  RESULTS
  THREE THEMES EMERGED FROM THE INTERVIEWS AND SITE VISITS OF THE PARTICIPANTS IN THE ALPHA PHASE: (1) a structure and culture that promote integration and inclusion; (2) a recognition of the value of resident education to the institution; and (3) a learning organization rooted in the extensive use of data and ongoing change, improvement, and innovation.
  
  
  CONCLUSIONS
  Some of the concepts identified in our small sample of "innovative" institutions could be relatively easily adopted or adapted by others that seek to enhance innovation and improvement in the learning environment. In contrast, the structural factors that characterized 3 of the 4 alpha participants, particularly the organization and compensation of faculty, may not be generalizable to many other institutions.
authors: Ingrid
authors: I
authors: Philibert
authors: Mary Joyce
authors: MJ
authors: Johnston
authors: Laura
authors: L
authors: Hruska
authors: Jane A
authors: JA
authors: Shapiro
authors: Paul
authors: P
authors: Friedmann
authors: Paul B
authors: PB
authors: Gardent
authors: Paul B
authors: PB
authors: Batalden
authors: David C
authors: DC
authors: Leach