Education And Debate

Developing learning organisations in the new NHS

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7240.998 (Published 08 April 2000) Cite this as: BMJ 2000;320:998
  1. Huw T O Davie, reader in health care policy and management (hd@st-and.ac.uk),
  2. Sandra M Nutley, senior lecturer in public sector management
  1. Department of Management, University of St Andrews, St Andrews, Fife KY16 9AL
  1. Correspondence to: H T O Davies
  • Accepted 11 November 1999

The government's quality strategy represents a bold blueprint for the new NHS. It embodies the view that managing the organisational culture in tandem with improved learning (albeit overseen by close external monitoring) will deliver substantial gains in performance. The avowed aim is “to create a culture in the NHS which celebrates and encourages success and innovation … a culture which recognises … scope for acknowledging and learning from past mistakes.”1

Although learning is something undertaken and developed by individuals, organisational arrangements can foster or inhibit the process. The organisational culture within which individuals work shapes their engagement with the learning process. More than this, there are serious questions about whether and how the organisation can harness the learning achieved by its individual members. Thus, although continuing professional development has long been a part of the NHS, evidence from other sectors suggests that learning needs to take a more central role. Organisations that position learning as a core characteristic have been termed “learning organisations,”24 and this concept is an important one in the context of organisational development.5

This paper explores organisational learning and the characteristics of the organisational cultures needed to underpin this learning. We have drawn on existing publications in this area and have used informal synthesis to summarise the key elements of learning organisations and relate these to recent developments in the NHS. Our aim is to encourage the transference of some of these ideas to the NHS.

Summary points

The national quality strategy for the new NHS highlights lifelong learning as a way of improving health care

Learning is something achieved by individuals, but “learning organisations” can configure themselves to maximise, mobilise, and retain this learning potential

Learning occurs at different levels—single loop learning is about incremental improvements to existing practice; double loop learning occurs …

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