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This paper considers the role of team learning in organizational learning. I propose that a group-level perspective provides new insight into how organizational learning is impeded, hindering effective change in response to external pressures. In contrast to previous theoretical perspectives, I suggest that organizational learning is local, interpersonal, and variegated. I present data from an exploratory study of learning processes in 12 organizational teams engaged in activities ranging from strategic planning to hands-on manufacturing of products. These qualitative data are used to investigate two components of the collective learning process—reflection to gain insight and action to produce change—and to explore how teams allow an organization to engage in both radical and incremental learning, as needed in a changing and competitive environment. I find that team members' perceptions of power and interpersonal risk affect the quality of team reflection, which has implications for their team's and their organization's ability to change.

\"Award-winning Harvard Business School professor Amy Edmondson has influenced legion MBA grads as well as Big Think authors from Brené Brown to Adam Grant with her pioneering work on psychological safety. Now, Amy is bringing her work to the wider world, upending our entire cultural notion of failure with this guide to the science of failing well, which actualizes the potential of psychological safety for both individuals and organizations alike\"-- Provided by publisher.

This paper contributes to research on organizational learning by investigating specific learning activities undertaken by improvement project teams in hospital intensive care units and proposing an integrative model to explain implementation success. Organizational learning is important in this context because medical knowledge changes constantly and hospital care units must learn new practices if they are to provide high-quality care. To develop a model of factors affecting improvement project teams driving essential organizational learning in health care, we draw from three streams of related research—best-practice transfer (BPT), team learning (TL), and process change (PC). To test the model’s hypotheses, we collected data from 23 neonatal intensive care units seeking to implement new or improved practices. We first analyzed the frequency of specific learning activities reported by improvement project participants and discovered two distinct factors: learn-what (activities that identify current best practices) and learn-how (activities that operationalize practices in a given setting). Next, ordinary least squares (OLS) regression analyses supported three of our four hypotheses. Specifically, a high level of supporting evidence for a unit’s portfolio of improvement projects was associated with implementation success. Learn-how was positively associated with implementation success, but learn-what was not. Psychological safety was associated with learn-how, which was found to mediate between psychological safety and implementation success.

This paper reports on a qualitative field study of 16 hospitals implementing an innovative technology for cardiac surgery. We examine how new routines are developed in organizations in which existing routines are reinforced by the technological and organizational context. All hospitals studied had top-tier cardiac surgery departments with excellent reputations and patient outcomes yet exhibited striking differences in the extent to which they were able to implement a new technology that required substantial changes in the operating-room-team work routine. Successful implementers underwent a qualitatively different team learning process than those who were unsuccessful. Analysis of qualitative data suggests that implementation involved four process steps: enrollment, preparation, trials, and reflection. Successful implementers used enrollment to motivate the team, designed preparatory practice sessions and early trials to create psychological safety and encourage new behaviors, and promoted shared meaning and process improvement through reflective practices. By illuminating the collective learning process among those directly responsible for technology implementation, we contribute to organizational research on routines and technology adoption.

Background Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students’ educational experiences in longitudinal integrated clerkships. Methods We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs—at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates. Results Analysis of 20 graduates’ interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates’ descriptions with both high psychological safety and high accountability characterized optimized learning and performance. Conclusions This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates’ experiences as students. Graduates described high and low psychological safety and accountability. Graduates’ descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.

BACKGROUND:Teamwork in health care settings is widely recognized as an important factor in providing high-quality patient care. However, the behaviors that comprise effective teamwork, the organizational factors that support teamwork, and the relationship between teamwork and patient outcomes remain empirical questions in need of rigorous study. OBJECTIVE:To identify and review survey instruments used to assess dimensions of teamwork so as to facilitate high-quality research on this topic. RESEARCH DESIGN:We conducted a systematic review of articles published before September 2012 to identify survey instruments used to measure teamwork and to assess their conceptual content, psychometric validity, and relationships to outcomes of interest. We searched the ISI Web of Knowledge database, and identified relevant articles using the search terms team, teamwork, or collaboration in combination with survey, scale, measure, or questionnaire. RESULTS:We found 39 surveys that measured teamwork. Surveys assessed different dimensions of teamwork. The most commonly assessed dimensions were communication, coordination, and respect. Of the 39 surveys, 10 met all of the criteria for psychometric validity, and 14 showed significant relationships to nonself-report outcomes. CONCLUSIONS:Evidence of psychometric validity is lacking for many teamwork survey instruments. However, several psychometrically valid instruments are available. Researchers aiming to advance research on teamwork in health care should consider using or adapting one of these instruments before creating a new one. Because instruments vary considerably in the behavioral processes and emergent states of teamwork that they capture, researchers must carefully evaluate the conceptual consistency between instrument, research question, and context.

This paper shows how mesolevel structures support effective coordination in temporary groups. Prior research on coordination in temporary groups describes how roles encode individual responsibilities so that coordination between relative strangers is possible. We extend this research by introducing key tenets from team effectiveness research to theorize when role-based coordination might be more or less effective. We develop these ideas in a multimethod study of a hospital emergency department (ED) redesign. Before the redesign, people coordinated in ad hoc groupings, which provided flexibility because any nurse could work with any doctor, but these groupings were limited in effectiveness because people were not accountable to each other for progress, did not have shared understanding of their work, and faced interpersonal risks when reaching out to other roles. The redesign introduced new mesolevel structures that bounded a set of roles (rather than a set of specific individuals, as in a team) and gave them collective responsibility for a whole task. We conceptualized the mesolevel structures as team scaffolds and found that they embodied the logic of both role and team structures. The team scaffolds enabled small-group interactions to take the form of an actual team process with team-level prioritizing, updating, and helping, based on newfound accountability, overlapping representations of work, and belonging—despite the lack of stable team composition. Quantitative data revealed changes to the coordination patterns in the ED (captured through a two-mode network) after the team scaffolds were implemented and showed a 40% improvement in patient throughput time.

This paper introduces the construct of leader inclusiveness-words and deeds exhibited by leaders that invite and appreciate others' contributions. We propose that leader inclusiveness helps cross-disciplinary teams overcome the inhibiting effects of status differences, allowing members to collaborate in process improvement. The existence of a professional hierarchy in medicine and the differential status accorded to those in different disciplines is well established in the health care literature, as is the need for quality improvement. We build on this foundation to suggest that profession-derived status is positively associated with psychological safety (H1)-a key antecedent of speaking up and learning behavior-in health care teams. We hypothesize that this effect varies across teams (H2), and furthermore, that leader inclusiveness predicts psychological safety (H3) and moderates the relationship between status and psychological safety (H4). Finally, we suggest psychological safety predicts engagement in quality improvement work (H5) and mediates the relationship between leader inclusiveness and engagement (H6). Survey data collected in 23 neonatal intensive care units involved in quality improvement projects support our hypotheses. These results provide insight into antecedents of and strategies for fostering improvement efforts in health care and other sectors in which cross-disciplinary teams engage in collaborative learning to improve products or services.

This paper contributes to a growing body of research on shared cognition by examining shared beliefs about failure in organizational work groups. We argue that the popular ideal of organizational learning from failure is likely to be impeded by powerful psychological and organizational barriers to engaging in behaviors through which this can occur. We hypothesize that people hold tacit beliefs about appropriate responses to mistakes, problems and conflict, and that these are shared within and vary between organizational work groups (H1). These shared beliefs vary in the extent to which they take a learning approach to failure - specifically in the extent to which they endorse identifying, discussing, and analysing mistakes, problems, and conflicts. We also hypothesize that effective coaching, clear direction and a supportive work context influence beliefs related to failure (H2), and that beliefs about failure influence group performance (H3). These hypotheses combine to suggest a theoretical model of antecedents and consequences of shared beliefs about failure in work groups. The paper presents empirical evidence from a recent field study to test the model and finds support for Hypotheses 1, 2, and 3. Hypothesis 4 - that shared beliefs about failure mediate between the antecedents and the outcome of group performance - was not supported.