Transformational Changes within Learning Healthcare Organizations


Health care organizations in the concept of learning organizations have not been widely embraced, in many health institutions across the globe and in literature. This has been attributed to the complex environment especially in the public service organizations, in contrast to private service organizations. It has been argued qualitatively that the public and service organizations are not different, but the former function is much slower to change and bureaucratic in regard to transformational changes. However, changes in health care service and delivery is essential for the learning healthcare organization.


















The learning organization can be described as an ideal in regard to how healthcare organizations, evolve so as to respond effectively towards various pressures in the work environment, and institutionalizing standards and principles that guide changes for improving the overall performance of the organization. Moreover, contextual effects play a crucial part in the transformational changes within a learning healthcare organization. Context acts as a platform in providing guidance to the attitudes and beliefs socially acceptable in the working environment. However, in the transformational changes in healthcare organizations face various constraints such as organizational, environmental and public sector, while the latter affecting transformations in public health care organizations.

In addition, public and administrative law impacts planning, human resource management practices, and financing which are crucial factors to transforming organizations. Despite such constraints, the concept of learning organization once implemented, will function towards enhancing both the inputs and outputs in quality service delivery, to patients while ensuring optimization of the organization’s resources.  The learning organization is also characterized by collective and individual elements, which are key elements in the whole process of transformational changes in a health care organization. This concept can be adopted by practitioners, as one of the many objectives in achieving the mission of the organization.

Consequently, the aim of this study is to evaluate health care organizations that have instituted transformational changes, with the aim of promoting learning organizations. In addition, various issues and challenges that arise with implemented transformational changes will be focused on and the outcomes of the changes.


Transformational Changes within Learning Healthcare Organizations

Organizational learning is ideal in the range of processes and activities that eventually lead to the aspect of learning organization. The two terms are not essentially synonymous as one process leads to the other. Primarily, the process of transformational changes in a healthcare organization involve individuals, stakeholders and collectively towards learning (Nolan, 2007 p.45). Overall, the nature of learning in an organization coupled with its innovation and contribution to change is affected by the organization’s structure, its social context, strategy and communication practices.

The organization in focus is Robert Wood Johnson Foundation (RWJF), which has been committed to enhancing health care and health for all Americans. Central to the organization’s mission, is to ensure that patients receive high-quality care from a professional cadre of physicians and nurses. Transformational changes at the health institution were influenced by the need to reform its organizational culture, with the aim of improving the overall provision of quality care, for its patients and also enhancing the human resource management practices, in recruiting and retaining a competitive and competent nursing workforce.

Moreover, deaths related to errors in the hospital procedures and the issue of nursing shortages compounded the need, for the institution to adopt transformational changes. Changes in the organizational culture was key in the organizational learning process, so as to instill elements and processes comprising of individual and collective attitudes and behaviors, towards an effective organizational culture that would foster growth and development in healthcare provision. The organization realized that organizational culture influenced, the outcomes and satisfaction of the patients treated at the institution (Spann, 2005 p.24). More so, learning organization concept was suggested by the organization’s management while involving the nursing workforce. Leadership at the organization in realizing the need to change was an essential, component in driving the transformational changes for the overall achievement of goals and objectives for the institution. The transformational changes took the process of eliminating preventable deaths at the hospital, due to overstay of patients at the facility without follow-up in treatment.

Additionally, institution of these changes enabled RWJF to identify those areas, which were lacking in nursing professionalism and working systematically to improve best practices, and consequently enhance patient service and safety. The time frame for the transformational changes was to take approximately six months through training, workshops and education episodes that would promote learning of the organization’s impeding changes, to enhance organizational culture and working attitudes towards accomplishing the mission of the institution (Grol, 2007 p.120). Moreover, financial resources were important in driving the transformational changes, and recruiting a competent nursing workforce towards eliminating staff shortages, that led to cases of unwarranted deaths and long stays before service in the organisation.

Finances were from government grants and from the organization’s shareholders in disbursing funds, which were crucial to upgrading the institution, providing a conducive learning atmosphere that would support organizational learning. Although, there were several constraints such as unsupportive attitude from the workforce through the changes, the final outcomes resulted to the organization’s responsiveness, quality, professional decision making, a focused purpose and effective structure factors in fostering change and continuous improvement.

The Flinders Medical Centre (FMC) located in Southern Australia, has been on the process of redesigning their clinical processes and projects, with the aim of to local conditions and requirements of patients visiting the facility for medical treatment. The organization undertook principles in organizational learning in implementing and sustaining changes, in the overall operation efficiency of the health care provision for patients. Some of the issues that led to embracing of change were dissatisfaction with working conditions at the facility, which led to patient dissatisfaction of services provided and consequently low performance of the institution (Denham, 2005 p.42). The leadership by the senior management and the chief executive in the transformational change process, was essential in setting standards for driving the change process and service delivery.

Through organization learning while challenging and engaging the staff, to ‘stretch goals’ in the aspect of personal and collective ambitions towards achievement of objectives, was much significant in setting learning organizations parameters, which would lead to acceptable solutions simultaneously ensuring that organizational strategies are implemented. The implementation of strategic changes was encompassed within a span of five months coupled with, reward success and monitor performance in the achievement of transformational changes in service delivery, to improve patient satisfaction. Staff members were also involved in the transformation program in order to succeed, through setbacks and resistance in the change process (Wang, 2006 p.601). The FMC management encountered challenges through the resistance of change through the workforce, compounded by sound utilization of budgets to foster changes in the whole process.

Moreover, these problems gradually subsided with the senior managers keeping the momentum and resilience, in transformational change and organization learning. Engaging the clinical leaders also proved to be effective, in ensuring commitment and engagement of clinicians through the changing clinical practice and care delivery system. Financial resources were available through government resources and support from reform processes from the National Health Service, located in the United Kingdom. Consequently the outcomes from the change process and learning organizations resulted, to persistence and flexibility in service delivery, sustainability, standard work, maintenance and continuous improvement.



Transformational changes in health care improvement through learning organizations, is significant in improving the health standards and service delivery of health care to patients. Moreover, implementation and sustainability of these changes provides a competent platform, for effective patient treatment, monitoring and personalized services. Heath care management has a key role in ensuring that the entre workforce is, involved in the whole transformational change to effectively organizational learning changes.














Denham, C.R. (2005). Patient safety practices: leaders can turn barriers into accelerators. Journal of Patient Safety. Volume 1, Issue 1. pp. 41-55.
Grol, R.P. & Bosch, M.C. (2007). Planning and studying improvement in patient care:The use of theoretical perspectives. The Milbank Quarterly. Volume 85, Issue 1. pp. 93-138.
Nolan, T.W. (2007). Execution of strategic improvement initiatives to produce system-level results. Cambridge, Mass: Institute for Healthcare Improvement.
Spann, J. (2005). Charting Nursing’s Future. Princeton, NJ: The Robert Wood Johnson Foundation
Wang, M.C. & Harrison, M. (2006). Redesigning health systems for quality: Lessons from emerging practices. Journal on Quality and Patient Safety. Volume 32, Issue 11. pp. 599-611

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