Organizational Learning in a Cardiac Intensive Care Unit: A Learning History.
BACKGROUND
Providing high-quality care to every patient is challenging, particularly in critical care units (CCUs). However, this standard can be achieved through organizational learning. Unfortunately, the process of organizational learning in CCUs is not well understood.


OBJECTIVE
The objective of this study is to describe the developmental progression of a cardiac intensive care unit (CICU) to reach its current state of reliably excellent clinical performance.


METHODS
The method selected for this study was a learning history. A total of 43 individuals with experience working on the CICU participated in small group interviews. Participants included nurses, surgeons, unit clerks, administrators, nursing assistants, a pharmacist, a respiratory therapist, and an administrative assistant. Relevant artifacts, including unit performance data, were also gathered to complement interview data.


RESULTS
The CICU progressed through 4 distinct developmental stages to reach its current state. The CICU's early development involved establishing psychological safety on the unit, which prepared the unit for increased accountability, improved performance, and the pursuit of reliability.


CONCLUSIONS
The findings validate the relationship between psychological safety and organizational learning, offer insight into how CCUs become high-reliability organizations, and provide clinical leaders with guidance for achieving high reliability in their organizations. The findings also help validate the American Association of Critical-Care Nurses position that a healthy work environment is essential to achieving clinical excellence. Critical care unit teams should use these findings as a framework for collective reflection and planning to achieve their desired future. Further research is needed to validate the applicability of these findings and to continue building the evidence base for organizational learning in hospital units.
Bret Lyman, PhD, RN, is an assistant professor at the College of Nursing in Brigham Young University, Provo, Utah. Kalene M. Ethington, BS, RN, is a registered nurse in the intensive care unit at Mountain View Hospital, Payson, Utah. Carly King is a nursing student and a research assistant at the College of Nursing in Brigham Young University, Provo, Utah. Jonathan D. Jacobs is a nursing student and a research assistant at the College of Nursing in Brigham Young University, Provo, Utah. Hayley Lundeen, BSN, RN, CCRN, CSC, CMC, is a registered nurse in the cardiac intensive care unit at Utah Valley Regional Medical Center, Provo.
Bret
B
Lyman
Kalene M
KM
Ethington
Carly
C
King
Jonathan D
JD
Jacobs
Hayley
H
Lundeen
D002309:Cardiology / Q000193:education*; D006302:Health Services Research; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D017146:Models, Organizational; D015279:Organizational Culture; D010564:Personnel, Hospital / Q000193:education*