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Technology use, cooperation, and organizational learning in patient safety reporting

Dissertation
Author: Pei-Ju Liu
Abstract:
Information technology has the potential to support cooperation and facilitate organizational learning. However, technology use, cooperation, and organizational learning are complex constructs that were often oversimplified and resulted in inconsistent findings in past studies. This study employed an innovative approach to building new knowledge about the use of technology in support of cooperative work and organizational learning in a health care setting. This study examined the use of the Patient Safety Network (PSN) within the University of Missouri Health Care (UMHC). The purpose of this study is to understand in what ways and to what extent health care practitioners at UMHC used the PSN and how it influenced cooperative work and contributed to organizational learning. Activity was used as the unit of analysis to examine members' actions and interactions surrounding a common patient safety activity that were recorded by the PSN. Follow-up surveys of perceived organizational learning were collected at the end of each patient safety activity. The findings of this study provide evidence that technology use and cooperation can be operationalized and examined in context and demonstrate how it can be done reliably. Three types of PSN technology use were found: Event Complexity, Appropriation of Reporting, and Appropriation of Resolution. The results show the importance of understanding the participation of different roles within a CSCW context and of considering task characteristics, such as event complexity. The degree of cooperation depended on how well the basic elements were met. The results indicate that at the time of the study, those using PSN show evidence of working cooperatively through the system, but in general are not scoring high on the indicators of cooperation. Additionally, the overall relationship between cooperation and organizational learning was found weak. Finally, the results show that factors of technology use impact levels of cooperation and perceived organizational learning. The overall cooperation was influenced by the levels of Appropriation of Reporting as well as by the interaction between the level of Event Complexity and Appropriation of Reporting. More specifically, the higher the Appropriation of Reporting, the higher the overall cooperation was found. Event Complexity reduced the effect of Appropriation of Reporting on the overall cooperation. The overall perceived organizational learning was influenced by the levels of Event Complexity and Appropriation of Resolution. More specifically, the higher the Event Complexity, the lower the overall perception of organizational learning. Extremely high and extremely low overall scores on Appropriation of Resolution had higher perceptions of organizational learning.

iv TABLE OF CONTENTS ACKNOWLEDGEMENTS................................................................................................ii TABLE OF CONTENTS...................................................................................................iv LIST OF ILLUSTRATIONS...........................................................................................viii LIST OF TABLES...............................................................................................................x ABSTRACT.....................................................................................................................xi ii Chapter 1.

INTRODUCTION....................................................................................................1 Overview....................................................................................................................1 Statement of the Problem...........................................................................................5 Purpose of the Study..................................................................................................5 Significance of the Study...........................................................................................6 Statement of the Research Questions.........................................................................7 Definition of Constructs.............................................................................................7 Chapter Summary......................................................................................................8 2.

LITERATURE REVIEW.........................................................................................9 Introduction................................................................................................................9 Organizational Learning............................................................................................9 Definitions of Orga nizational Learning.............................................................9 Development of Organizational Memory........................................................12 Multilevel and Dynamic Process of Organizational Learning.........................13 The Need for a Learning Organization............................................................15 Recent Attempts at Organiza tional Learning Measurement............................17

v Cooperation..............................................................................................................21 Definitions of Cooperation..............................................................................21 Cooperative Work in Organizations................................................................25 Recent Attempts at Measuring Cooperation....................................................30 Information Technology..........................................................................................32 Information Technology and Cooperative Work.............................................33 Research attempts at Computer-S upported Cooperative Work (CSCW)........35 Research attempts at Organizationa l Learning and Information Technology ……………………………………………………………………36 Research Challenges................................................................................................40 Patient Safety and Event Reporting in Health Care.................................................42 Chapter Summary....................................................................................................45 3.

METHODOLOGY..................................................................................................46 Introduction..............................................................................................................46 Context of the Study................................................................................................46 Implementation Site: University of Missouri Health Care .............................46 Statement of the Research Questions.......................................................................50 Methods....................................................................................................................51 Research Design...............................................................................................51 Unit of Analysis and Sample...........................................................................51 Data Collection................................................................................................52 Instruments.......................................................................................................53 Data Analysis...................................................................................................67 Chapter Summary....................................................................................................70 4.

RESULTS...............................................................................................................71

vi Introduction..............................................................................................................71 Data Screening and Analysis of Respondent Cases.................................................71 Data Screening.................................................................................................71 Descriptive Analysis of Respondent Cases......................................................72 Analysis of Response Rate...............................................................................74 Reliability and Validity Analysis of Instruments.....................................................77 Organizational Learning Survey......................................................................77 Cooperation Scoring Rubric Instrument..........................................................83 Analysis of Technology Use....................................................................................86 Research Question One: Descript ive Analysis of Technology Use.................87 Research Question One: Principle Co mponent Analysis of Technology Use ……………………………………………………………………88 Analysis of Cooperation and Organizational Learning...........................................93 Research Question Two: Descrip tive Analysis of Cooperation......................93 Research Question Three: Descriptive Analysis of Organizational Learning ……………………………………………………………………95 Research Question Four: Correlation Analysis for Cooperation and Organizational Learning............................................................................96 Multivariate Analysis of Variance (MANOVA) ....................................................97 Research Question Five: MANOVA Analysis of Cooperation by Technology Use.............................................................................................................97 Research Question Six: MANOVA Analys is of Organizational Learning by Technology Use.......................................................................................107 Analysis of Respondent Comments.......................................................................115 Chapter Summary..................................................................................................118 5.

DISCUSSION AND CONCLUSION...................................................................120 Introduction............................................................................................................120

vii Discussion..............................................................................................................121 Measurement Challenge.................................................................................121 Technology Use for Patient Safety Reporting and Resolution......................123 Cooperation during Event Reporting.............................................................126 Perceived Organizational Learning for Patient Safety...................................130 The Influence of Cooperation on Organizational Learning...........................131 The Effects of Technology Use on Cooperation............................................132 The Effects of Technology Use on Organizational Learning........................137 Limitation...............................................................................................................140 Recommendation...................................................................................................142 APPENDIX A.

USE OF PSN FOR PATIENT SAFETY REPORTING AND RESOLUTION...144 B.

EXAMPLE OF A PATIENT SAFETY REPORT................................................151 C.

COOPERATION RUBRIC FOR EVALUATING A PSR...................................153 D.

COOPERATION CODE BOOK FOR EVALUATING A PSR..........................157 E.

ORGANIZATIONAL LEARNING SURV EY ADAPTED FROM GOH & RICHARDS (1997)..........................................................................................165 F.

EMAIL NOTIFICATION FOR A RESOLV ED REPORT WITH SURVEY URL …………………………………………………………………………..168 G.

ORGANIZATIONAL LEARN ING ONLINE SURVEY.....................................170 H.

EXAMPLE OF TECHNOLOGY USE OF A PATIENT SAFETY REPORT.....172 I.

EXAMPLES OF DETAILED USERS’ ACTIONS IN ACTION IN PSN...........174 REFERENCES................................................................................................................177 VITA........................................................................................................................... .....188

viii LIST OF ILLUSTRATIONS Figure Page 2.1 Organizational Learning Process.............................................................................14 2.2 Five Dimensions of Orga nizational Learning Survey.............................................19 2.3 Relationship between the two research streams.......................................................37 3.1 Steps for Developing a Theoretically Valid Protocol..............................................55 3.2 Graphic Representation of Coordination Mechanism for Patient Safety Reporting ……………………………………………………………………………58 4.1 Graphic of CFA Results...........................................................................................79 4.2 Interaction between Event Complexity and Appropriation of Reporting on Social Skills..................................................................................................................102 4.3 Estimated Marginal Means of Social Sk ills per level of Appropriation of Reporting …………………………………………………………………………..103 4.4 Estimated Marginal Means of Social Skills per level of Event Complexity.........104 4.5 Estimated Marginal Means of Positiv e Interdependence per level of Event Complexity.........................................................................................................102 4.6 Graphic of the Three-Way Interaction among Event Complexity, Appropriation of Resolution, and Appropriation of Reporti ng on Clarity of Mission and Vision (CMV)................................................................................................................111 4.7 Estimated Marginal Means of Transfer of Knowledge (TOK) per level of Event Complexity.........................................................................................................113 4.8 Estimated Marginal Means of Transf er of Knowledge (TOK) per level of Appropriation of Resolution..............................................................................114 5.1 Direct and Positive Effect of Ap propriation of Reporting on Cooperation...........133

ix 5.2 Moderation Effect of Event Complexity on the Relationship between Appropriation of Reporting and Cooperation....................................................134 5.3 Direct and Positive Effect of Event Co mplexity on Positive Interdependence.....135 5.4 Direct and Negative Eff ect of Event Complexity on Organizational Learning.....138 5.5 Direct and Negative Effect of Appropriation of Resolution..................................138

x LIST OF TABLES Table Page 2.1 Definitions of Organizational Learning in Past Research........................................10 3.1 Characteristics of Univers ity of Missouri Health Care............................................47 3.2 Data Collection Methods.........................................................................................52 3.3 User Actions within Each PSR................................................................................54 3.4 Example of Coordination Mechanism fo r Patient Safety Reporting With the PSN ……………………………………………………………………………57 3.5 Factors and Indicators of Cooperation in PSRs.......................................................62 3.6 Data Analysis Strategies..........................................................................................68 4.1 Description of Cases for This Study........................................................................74 4.2 Overall Response Rates...........................................................................................75 4.3 Analysis of Characteristics for Valid Cases and Target Sample.............................76 4.4 Reliability Analysis for Organizational Learning Survey.......................................77 4.5 Construct Reliability and Validity Analysis for Five Factors in the Organizational Learning Survey...................................................................................................81 4.6 Construct Reliability and Validity Analys is for the Latent Factor Organizational Learning...............................................................................................................83 4.7 Factor Structure and Loadings for Cooperation Indicators......................................86 4.8 Descriptive Statistics for Technology Use Indicators..............................................87 4.9 Correlation Matrix for PSN Technology Use Indicators.........................................89 4.10 KMO and Bartlett's Test........................................................................................90

xi 4.11 Sums of Squared Loadings for Co mponents Extracted in PSN Technology Use…………………………………………………………………………….. . 91 4.12 Loadings and Structure of Components in PSN Technology Use.........................92 4.13 Descriptive Statistics for Cooperation Indicators..................................................94 4.14 Descriptive Statistics for Organizational Learning Scale......................................95 4.15 Correlation Analysis for Coopera tion and Organizational Learning.....................96 4.16 Multivariate Analysis for Coope ration under Different Technology Use Types ………………………………………………………………………...…98 4.17 Univariate Analysis for Individual Cooperation Factors under Different Technology Use Types......................................................................................100 4.18 Tukey’s Post Hoc Analysis for C ooperation under Different Technology Use Types..................................................................................................................101 4.19 Tukey’s HSD Tests for Social Skills by Levels of Appropriation of Reporting …………………………………………………………………………..103 4.20 Tukey’s HSD Tests for Social Skills by Levels of Event Complexity................104 4.21 Tukey’s HSD Tests for Positive Interdependence by Levels of Event Complexity…………………………………………………………………….105 4.22 Multivariate Analysis for the overal l Organizational Learning under Different Technology Use Types......................................................................................108 4.23 Univariate Analysis for Individual Organizational Learning Factors under Different Technology Use Types.......................................................................109 4.24 Tukey’s Post Hoc Analysis for Or ganizational Learning under Different Technology Use Types......................................................................................112 4.25 Tukey’s HSD Tests for Transfer of Knowledge (TOK) by Levels of Event Complexity.........................................................................................................112 4.26 Tukey’s HSD tests for Transfer of K nowledge (TOK) by Levels of Appropriation of Resolution......................................................................................................114

xii 4.27 Number of Code for Constructs...........................................................................115

xiii TECHNOLOGY USE, COOPERATION, AND ORGANIZATIONAL LEARNING IN PATIENT SAFETY REPORTING

Pei-Ju Liu

Dr. James Laffey, Dissertation Supervisor

ABSTRACT

Information technology has the potential to support cooperation and facilitate organizational learning. However, technology use, cooperation, and organi zational learning are complex constructs that were often oversimplified and resulted in inconsistent findings in past studies. This study employed an innovative approach to buildi ng new knowledge about the use of technology in support of coopera tive work and organizational lear ning in a health care setting. This study examined the use of the Patient Safe ty Network (PSN) within the University of Missouri Health Care (UMHC). The purpose of this study is to understand in what ways and to what extent health care practiti oners at UMHC used the PSN and how it influenced cooperative work and contributed to organi zational learning. Activity was used as the unit of analysis to examine members’ actions and interactions su rrounding a common patient sa fety activity that were recorded by the PSN. Follow-up surveys of perceived organizational learning were collected at the end of each patient safety activ ity. The findings of this study provide evidence that technology use and cooperation can be ope rationalized and examin ed in context and demonstrate how it can be done reliably. Three types of PSN technology use were found: Event Complexity, Appropriation of Reporting, and Appr opriation of Resolution. The results show the importance of understanding the participation of different roles within a CSCW context and of considering task characteristic s, such as event complexity. The degree of cooperation depended on how well the basic elements were met. The resu lts indicate that at th e time of the study, those using PSN show evidence of working cooperativ ely through the system, but in general are not scoring high on the indicators of cooperati on. Additionally, the overall relationship between cooperation and organizational lear ning was found weak. Finally, the re sults show that factors of

xiv technology use impact levels of cooperation an d perceived organizational learning. The overall cooperation was influenced by the levels of Appropriation of Reporting as well as by the interaction between the level of Event Comp lexity and Appropriation of Reporting. More specifically, the higher th e Appropriation of Reporting, the high er the overall cooperation was found. Event Complexity reduced the effect of Appropriation of Reporting on the overall cooperation. The overall perceive d organizational learning was infl uenced by the levels of Event Complexity and Appropriation of Resoluti on. More specifically, the higher the Event Complexity, the lower the overa ll perception of organizational learning. Extremely high and extremely low overall scores on Appropriation of Resolution had higher perceptions of organizational learning.

CHAPTER 1

INTRODUCTION

1 CHAPTER I INTRODUCTION Overview In order to remain competitive in today’ s rapidly changing business environments, organizations have to continuously adapt and improve (Dodgson, 1993; Scott, 2003). Over the last several decades, organizatio ns have increasingly used information technology, made efforts to support organi zational learning, and sought to foster cooperation among employees as a means to improve performance and effectiveness (Dodgson, 1993; Templeton, Lewis, & Snyder, 2002; Tippins & Sohi, 2003; Tjosvold, Dean & Tsao, 1989).Although organizational lear ning has been defined in number of different ways (Argyris & Schön, 1978; Crossan, Lane, & White, 1999; Fiol & Lyles, 1985; Huber, 1991), most agree that it is a complex, multi-level, multidisciplinary, and dynamic means of creating colle ctive knowledge and organizati onal memory. It is used for continuous development of knowledge and ab ility, both for individual members of the organization and the orga nization as a whole. Six key aspects of organizational lear ning emerge from the literature: 1.

Individuals are the learning agen ts within organizations. Although individual learning does not guara ntee organizational learning, organizational learning cannot occur w ithout individual learning (Argyris & Schön, 1978). 2.

Organizational learning is greater than the sum of its parts (Senge, 1990).

2 3.

Communication and information shari ng are critical to organizational learning. If individuals do not want to or have a proper channel to share and communicate with each other, or ganizational learning simply cannot occur (Huber, 1991). 4.

Organizational learning involves dynamic processes across individual, group, and organization levels. Organizat ions learn through the individuals, and individuals are also socialized by organizations through rules and routines (Crossan et al., 1999; Kim, 1993). 5.

A collective form of knowledge is accumulated and stored as organizational memory for future use (Huber, 1991; Levitt & March, 1988). 6.

The source of learning may vary over time according to the aims of the industry. For example, in the health care industry, adverse event reporting is one means of organizational learning that seeks to improve patient safety and health care qualit y (Carroll & Edmondson, 2002). One of the most critical factors for organizational learning is communication. Individuals in the organiza tion need resources and opport unities to communicate and share their knowledge with others in order to negotia te and build organizational knowledge. Putting people together to work in the same place and time does not guarantee that they will nego tiate meaning and build knowledge. They can choose to compete with others, complete the task alone, or simply take advantage of others’ efforts while contributing nothing to the organization. A key concept for achieving positive outcomes in social exchange is the notion of cooperation. Cooperation refers to the ways

3 that individuals work interdependently and contribute efforts to achieve mutual benefits through active participation and communication among one another. Cooperative work involves sharing individual expertise, experience and responsibilities in the pursuit of common goals. Johnson and Johnson (2002) outline five elements in cooperative work: positive interdependence, individual accountability, promotive interaction, social skills, and group processing. They argue that the value of cooperative work primarily depends on the manner in which it is implemented; it can only be maximized when all elements are in place. Thus, cooperation best contributes to organizational learning when individuals are positively interdependent, accountable and responsible for their actions, actively engaged and positively interacting with others, and coordinating and negotiating their work efficiently and effectively. Even if individuals are willing and eager to work with others, poor mechanisms or lack of support for coordination, communication, and information sharing can cause problems. In a face-to-face context those working together on a task can easily tell what others are doing, where they are, and what is going on because they can see, listen, and talk to each other. However, this intuitive process becomes more complex and difficult to achieve when work is distributed and people no longer work at the same time or location, such as in an organization that runs 24/7 or in a global organization that manufactures and markets goods and services across the world. Under these circumstances, it is challenging to keep members aware of each other’s actions and able to cooperate efficiently and effectively across physical and temporal boundaries.

4 Information technology is increasingly being used to bridge these boundaries for distributed work groups (Munkvold, 2002). Information systems can also reduce the costs of recording the knowledge and experiences of individuals and transforming them into organizational routines and memory. Information technology also provides members greater and quicker access to organizational memory (Dewett & Jones, 2001). Computer Supported Cooperative Work (CSCW) is a framework often used to understand and develop technological support for activities and relationships in work groups. CSCW is defined as "an endeavor to understand the nature and requirements of cooperative work with the objective of designing computer-based technologies for cooperative work settings" (Bannon & Schmidt, 1989). Hutchins (1995) further suggests two characteristics of CSCW: the support of cognitive artifacts of a group and the support of member behaviors. A CSCW system facilitates effective cooperative processes and supports meaningful communication among members. Research in CSCW provides guidelines for system development and a range of analytic frameworks for articulating important social characteristics of work, which may be used to guide analysis and understanding of cooperative work (Crabtree, 2003). Current technology for cooperation pales in comparison with the natural senses, instincts and habits people use in face-to-face settings. However, information technology has the potential of providing new affordances not easily available in face to face settings, such as automatic tracking of member’s behavior and recording of all communication. Information technology can provide new means for communication, coordination, and cooperation and open the door to new opportunities for engaging members, teams,

5 workgroups, and organizations as a whole. However this pot ential is often difficult to realize (Huber, 1991; Mazn evski & Chudoba, 2000). Understanding how information technology can address the needs for cooperative work in orga nizations is a substantial challenge (Driskell, Radtke, & Salas, 2003; Sarker & Sahay, 2002; Schmidt, K. & Simone, 1996; Thompson & Coovert, 2003). Statement of the Problem The use of cooperative work to build organizational learning for continuous improvement is a goal of all organizations . Rapidly developing information technology has the potential to suppor t cooperative work and improve organizational learning. Understanding how to develop and use these t ools effectively is a major challenge facing organizations today. Applications that can support cooperative work for distributed organizations are the “killer applications” of today; major technology organizations are competing to create and market their so lution. How does an organization determine which ones work best and work best for th eir organization? Past research has used surveys and interviews to demonstrate eff ects of various technol ogies in cooperative work settings. Further research is needed to examine the use of these tools in context so as to understand how and to what extent the us e of technology influences each element of cooperation in the work setting and how it aff ects an organization’s ability for learning.

Purpose of the Study This study employed an innovative appr oach to building new knowledge about the use of technology in support of cooperati ve work and organiza tional learning in a

6 health care setting. This study examined the use of the Patient Safety Network (PSN) within the University of Missouri Health Care (UMHC). Patient safety reports represented organizational members’ actions and interactions. These reports were the primary artifacts of the study. Follow-up surv eys of perceived organizational learning were collected at the end of each patient safety activity. The overall goal of the study was to unde rstand the relationships between and among technology use, cooperation, and organiza tional learning in this health care setting. The study had three objectives. 1.

To examine how practitioners used the PSN to cooperate to ensure patient safety at UMHC. 2.

To examine the effects of technology use on cooperation and organizational learning. 3.

To test and verify new methods and an alytics for examining computer supported cooperative work. The study is based in the analytical te chniques and theoretic al insights from information systems research and social science research to assess artifacts and perceptions at the activity level. This combin ation of approaches is powerful, especially when the problem under study is one that both disciplines have e xplored extensively. Significance of the Study

Recent advances in technology and globalizat ion have led to a distributed work force where individuals often in teract via networked technol ogy. It is likely this growth

7 will continue, with more and more people n eeding to interact and work in new and different ways mediated by technology. Ne w knowledge about the how and to what extent the use of technology affects cooperati on and organizational learning can inform the design and development of information technology to advance computer supported cooperative work and organiza tional development. Statement of the Research Questions 1.

How do members use the PSN to re port and resolve safety events? 2.

In what ways and to what extent do members use the PSN to cooperate for patient safety? 3.

In what ways and to what extent do staff members perceive that the organization learns through the use of the PSN? 4.

In what ways and to what extent does the level of coopera tion in the use of PSN influence members’ percepti on of organizational learning? 5.

In what ways and to what extent does the use of PSN help people work more cooperatively? 6.

In what ways and to what extent does the use of PSN influence members’ perception of organi zational learning? Definition of Constructs •

Activity : In this study, an activity is defined as a set of work that incorporates tools, people, and resources needed to report and resolve a patient safety event

8 through the Patient Safety Network (PSN) at the University of Missouri Health Care (UMHC). •

Computer-supported cooperative work (CSCW): Computer applications or technology designed to support cooperative group work. •

Cooperation : Individuals work interdependently and contribute efforts to achieve mutual benefits through activ e participation and communi cation with one another. •

Learning Organization : An organization that focu ses on constructing structure and strategies to enable and maximize learning in ways that facilitate organizational transformation. •

Organizational Learning : A dynamic process of continuous development in knowledge and capacity, both individua lly and collectively (Senge, 1990). •

Technology Use : The extent to which an information system is incorporated into the user’s business processes (Cuellar, McLean, & Johnson, 2006). Chapter Summary This chapter introduced the foundation a nd rationale for this study. Researchers have viewed organizational le arning and cooperation as comple x constructs and indicated that the use of information technology ha s the potential to s upport cooperation and facilitate organizational learning. The purpose of this study is to understand in what ways and to what extent health care practitioners at UMHC used the Patient Safety Network and how it influenced cooperative work a nd contributed to organizational learning.

CHAPTER 2

LITERATURE REVIEW

9 CHAPTER II Literature Review Introduction This chapter begins with an overvie w of the theoretical foundations of organizational learning, includi ng definitions, key concepts, strategies, and previous research. Given the importance and dynami c nature of organizational learning, cooperation is discussed because of its pot ential to encourage information sharing, negotiation of meanings, and bu ilding common understa ndings, all of which are essential for organizational learning. Cooperative work in organizations requires not only high interdependence but also efficient and effective coordination among individuals. Information technology is often seen as a key in supporting cooperative work and the organizational learning process. This study was an attempt to develop new knowledge to about the use of information technology to support cooperative work and organizational learning. It was carried out in the context of the healthcare industry.

Organizational Learning Definitions of Organizational Learning No matter how successful an organiza tion has been in the past, it must continuously learn and adapt to survive and grow in today’s challenging and changing environment. The process of moving forward a nd adapting to change is often referred to as “organizational learning.” Organizationa l learning is a multidisciplinary and cross-

10 level phenomenon that has become the focus of organizational development in recent years. However, the meaning of this term varies widely by contexts and has been operationalized in a number of ways in past research (Table 2.1). Table 2.1 Definitions of Organizational Learning in Past Research

Researcher Definition of Organizational Learning Argyris and Schon (1978) The process of detection and correction of errors (p.2). Fiol and Lyles (1985) The process of improving actions through better knowledge and understanding (p.803). Levitt and March (1988) Organizations are seen as learning by encoding inferences from history into routines that guide behaviors (p.320). Dodgson (1993) The ways firms build, supplement, and organize knowledge and routines around their activities and within their cultures, and adapt and develop organizational efficiency by improving the use of the broad skills of their workforces (p.377). Kim (1993) Increasing an organization’s ca pacity to take effective action (p.43). Robey, Boudreau, and Rose (2000): An organizational process, both intentional and unintentional, enables the acquisition of, access to, and revision of organizational memory, thereby providing direction to organizational action (p.130). Templeton, Lewis, and Snyder (2002) The set of actions (knowledge acquisition, information distribution, information interpretation, and organizational memory) within the organization that intentionally and unintentionally influence positive organizational change (p.189) Lines (2005) The development or dissemination of work-based knowledge that is perceived to be useful for improving organizational performance (p.160). Real, Leal, and Roldan (2006) A dynamic process of knowledge creation generated at the heart of the organization via its individuals and groups, directed at the generation and development of distinctive competenci es that enable the organization to improve its performance and results (p.506).

11 Argyris and Schon (1978) defined organizational learning as a process of detection and correction of errors. They identified two types of learning processes: single-loop learning and double-loop learning. In single-loop learning, individuals improve their behaviors and make adjustments according to the outcomes of their actions. During single-loop learning, individuals continuously detect and correct their actions based on the deviations they perceive after comparing the results with the standard rules. Single loop learning corrects deviations in order to meet the standard rules without examining or challenging underlying assumptions. Double-loop learning requires individuals to reflect on themselves and their actions in ways that cause them to question the rules and assumptions they have brought to the problem at hand. Individuals must be active and reflective thinkers to achieve double-loop learning. Argyris and Schon argued that double-loop learning has the potential to lead to major changes and re-engineering in organizations. In double-loop learning, individuals are seen as the agents or instruments of learning for organizations. Indeed, organizations cannot learn without having individuals who are willing and able to learn and grow. Argyris and Schon pointed out that, although individuals may be learning every day, special conditions are necessary to bring forth the kind of learning (double loop) needed for substantial organizational learning. These are the conditions needed to make members active and reflective learners. However, organizational learning is not simply the cumulative sum of the parts of individuals’ learning (Fiol & Lyles, 1985). When individual members come and go, the knowledge and expertise they bring to the organization does not diminish because of turnover. Organizations can preserve and transmit their knowledge through developing an organizational memory of histories,

12 routines, and norms (Levitt & March, 1988). At the same time, individuals within an organization are socialized to thos e routines and norms (March, 1991). Development of Organizational Memory Levitt and March (1988) view organizati onal learning as routine-based, history- dependent, and target-oriented actions. Sp ecifically, to reach a desired outcome, organizations learn and devel op routines to guide behavior s, based on the interpretation of past history and experience. By doing s o, knowledge and experience are recorded and accumulated within those routines, regardle ss of the turnover of personnel over time. These accumulated experiences and routines are conserved in a collective memory often referred to as ”organizational memory” that is available for future decision making and action taking. Huber (1991) argues “An entity learns if , through its processing of information, the range of its potential be haviors is changed.” From Huber’s view, organizational memory is a repository of knowledge stored for future use. He also describes how organizational memory is formed through different forms of information processing within organizations. First, knowledge must be created by individuals through information acquisition, including several pro cesses to acquire info rmation or knowledge, such as congenital learning, experiential learning, vicar ious learning, grafting, and searching and noticing. After knowledge is created, it can be shared among units and individuals to produce new knowledge and unde rstanding. This information distribution process is a necessary precu rsor to organizational lear ning. Organizational learning cannot occur if individual members keep information and experience to themselves.

Full document contains 210 pages
Abstract: Information technology has the potential to support cooperation and facilitate organizational learning. However, technology use, cooperation, and organizational learning are complex constructs that were often oversimplified and resulted in inconsistent findings in past studies. This study employed an innovative approach to building new knowledge about the use of technology in support of cooperative work and organizational learning in a health care setting. This study examined the use of the Patient Safety Network (PSN) within the University of Missouri Health Care (UMHC). The purpose of this study is to understand in what ways and to what extent health care practitioners at UMHC used the PSN and how it influenced cooperative work and contributed to organizational learning. Activity was used as the unit of analysis to examine members' actions and interactions surrounding a common patient safety activity that were recorded by the PSN. Follow-up surveys of perceived organizational learning were collected at the end of each patient safety activity. The findings of this study provide evidence that technology use and cooperation can be operationalized and examined in context and demonstrate how it can be done reliably. Three types of PSN technology use were found: Event Complexity, Appropriation of Reporting, and Appropriation of Resolution. The results show the importance of understanding the participation of different roles within a CSCW context and of considering task characteristics, such as event complexity. The degree of cooperation depended on how well the basic elements were met. The results indicate that at the time of the study, those using PSN show evidence of working cooperatively through the system, but in general are not scoring high on the indicators of cooperation. Additionally, the overall relationship between cooperation and organizational learning was found weak. Finally, the results show that factors of technology use impact levels of cooperation and perceived organizational learning. The overall cooperation was influenced by the levels of Appropriation of Reporting as well as by the interaction between the level of Event Complexity and Appropriation of Reporting. More specifically, the higher the Appropriation of Reporting, the higher the overall cooperation was found. Event Complexity reduced the effect of Appropriation of Reporting on the overall cooperation. The overall perceived organizational learning was influenced by the levels of Event Complexity and Appropriation of Resolution. More specifically, the higher the Event Complexity, the lower the overall perception of organizational learning. Extremely high and extremely low overall scores on Appropriation of Resolution had higher perceptions of organizational learning.