An Action Research Based On The 4I Framework Of Organizational Learning Towards Near Miss In Chinese Nursing Organization

Background:Near miss is an abnormal event or situation stopped by timely intervention or sheer luck,it can offer early warnings to the healthcare system before reaching the patient and improve the patient safety.Near miss organizational learning is essential for the transformation from the passive,retrospective risk management to the proactive,prospective risk management.But the transient characteristics of near miss determined that it is more difficult to grasp and learn from than that of the adverse event and hazard.Besides current researches indicated that the near miss organizational learning in most healthcare organizations were unsatisfactory,thus more theoretical and experiential researches are needed in the future.The 41 Framework of Organizational Learning is a highly-recommended organizational learning theory for error learning,thus providing sound theoretical foundation for near miss organizational learning,but we have not applied and evaluated this theory in near miss management in clinic yet.Objectives:To verify the theoretical hypotheses of 41 Framework of Organizational Learning therefore to determine whether this theory applied to Chinese nursing organizations among tertiary hospitals.To develop a near miss organizational learning scheme based on the 41 Framework of Organizational Learning in a Chinese nursing organization from a tertiary hospital.Methods:This research has two phases.In the first phase,we applied the crosssectional study as the research design.First of all,researchers recruited 2475 nurses from 13 tertiary hospitals across 7 administrative regions in mainland,China by convince sampling,then we conducted survey by the cross-culturally adapted version of Strategic Learning Assessment Map,afterwards we described the current status of organizational learning in surveyed nursing organizations by SPSS 25.0 and testified the theoretical hypotheses through Structured Equation Modeling by AMOS 24.0.In the second phase,we applied the action research design.Researchers selected three nursing units(the emergency department,the urology department and department of gynaecology)for the action research by purposive sampling among the high-,middleand low-scored group in organizational learning survey,then we conducted three cycles of action research following the steps of ’ Question-Plan-Implementationevaluation ’,assessed its effect in guiding near miss organizational learning and developed a near miss organizational learning scheme based on the 4I Framework of Organizational Learning in a Chinese nursing organization from a tertiary hospital.Results:(1)The mean score of each dimension in the Strategic Learning Assessment Map was slightly lower than six and there is room for improvement among the surveyed 13 tertiary hospitals,the feed-forward learning flows scored the lowest(5.83±0.93)among all the dimensions of 4I Framework of Organizational Learning and the most outstanding negative factor for organizational performance is the poor absorption in surveyed nursing organizations(βMisalignmeng=-0.29).The theoretical hypotheses have been validated,the independent variables together explain 75%of the total variance in organizational performance.The regression equation is organizational performance=-0.714*misalignment+0.394*organizational level learning stocks+0.291*group level learning stocks+0.245*individual level learning stocks+0.165.(2)Through three cycles of near miss organizational learning,the recognition,the intention of second-order problem solving behavior and its conduction towards near miss have been improved in the department of high scored department(department of gynecology)and the middlescored department(emergency department).The urology department dropped out at the end of the second-round action research.The number of reporting cases among action research departments was 0 at the baseline,the number of reporting cases among action research department at the end of 1st,2nd and 3rd was 22(18 invalid),20 and 26.The feed-forward and feed-back learning flows in the near miss organizational learning initially formed during the action research,the nursing department started the institutionalizing work and the absorption has been improved,finally developed a near miss organizational learning scheme.Conclusions:This research has verified the hypotheses of 41 Framework of Organizational Learning and approved that this theory can be applied in nursing organizations in Chinese tertiary hospitals,supporting that the individual-,group-,organizational level learning stocks has positive relationship with organizational performance and the misalignment has negative relationship with organizational performance.Meanwhile we have concluded a near miss organizational learning scheme based on our research results,thus providing solid theoretical basis and management referee for near miss organizational learning in Chinese nursing organizations among tertiary hospitals.