Learning culture is a prominent theory in healthcare, especially as systems press forward to become “learning systems” (Harrison and Shortell 2021; Dy et al. 2015; Ashok et al. 2018; Institute of Medicine (IOM) 2013). Ideally, continuous learning is occurring throughout the Inner Setting with visible evidence of engaged process improvement (including historical evidence of previous change initiatives (Breimaier et al. 2015)), use of data to inform change, and the necessary relational environment (Miake-Lye et al. 2020; Lapré and Nembhard 2011; Amy C Edmondson 2012). Shared values, beliefs, and norms around psychological safety, continual improvement, and using data to inform practice (Institute of Medicine (IOM) 2013; Harrison and Shortell 2021; Lapré and Nembhard 2011; Guise, Savitz, and Friedman 2018) support and enable employee skill development through increased experience implementing innovations (Breimaier et al. 2015). This culture creates a collective learning mindset (Amy C Edmondson 2012) and increases the setting’s absorptive capacity for new knowledge and methods (T. Greenhalgh, Robert, et al. 2004).
The original CFIR (Laura J. Damschroder et al. 2009) learning climate construct has been moved under Culture in the updated CFIR (Laura J. Damschroder, Reardon, Widerquist, et al. 2022) because of the lack of agreement on culture versus climate concepts. As with the other Culture subconstructs, Learning-Centeredness can be assessed as a broad Inner Setting culture or as a specific micro-system climate.
The original CFIR (Laura J. Damschroder et al. 2009) elaborated on this construct, stating that learning-centeredness manifests through several behaviors and perceptions: a) leaders express their own fallibility and need for team member assistance and input; b) team members feel that they are essential, valued, and knowledgeable partners in implementation; c) individuals feel psychologically safe to try new methods; and d) there is sufficient time and space for reflective thinking and evaluation (Klein, Conn, and Sorra 2001; J. Leeman, Baernholdt, and Sandelowski 2007; Nembhard and Edmonson 2006).
The degree to which an organization demonstrates “learning” will vary across sub-groups, and manifestations of these attributes may have a stronger influence than a general measure of learning in the setting more broadly (A. C. Edmondson, Bohmer, and Pisana 2001). The literature on team learning has emphasized the setting’s role in creating the climate to enable learning and fostering collaboration within and between cross-disciplinary teams (Amy C. Edmondson 2002) (also Inner Setting: Relational Connections and Implementation Process: Teaming).
There is no agreement on precisely how to operationalize this construct but some generalizations can be made. In a positive learning climate, individuals are not constrained by failure and psychological safety is promoted. Psychological safety has predicted engagement in quality improvement work (Nembhard and Edmonson 2006). Having the time and space for reflective thinking and evaluation (see Implementation Process: Reflecting and Evaluating) is another important characteristic, at least in part, because it promotes learning from past successes and failures to inform future implementations (A. C. Edmondson, Bohmer, and Pisana 2001; C. D. Helfrich et al. 2007). Developing a culture that promotes learning is a “core property” that health care organizations need for on-going quality improvement (Ferlie and Shortell 2001 p287). A learning culture is an important contributor for increasing absorptive capacity for new knowledge: the ability of an organization to fully assimilate innovations (T. Greenhalgh, Robert, et al. 2004). Greenhalgh et al. include learning organization culture within their concept of absorptive capacity of new knowledge along with existing knowledge and skills (tacit and explicit), and within proactive leadership (T. Greenhalgh, Robert, et al. 2004).