The Enactment of Learning and Knowledge Creation: A Study of Hospital Leadership Group Interaction.

摘要

The ability of hospital leadership groups to collectively learn and build knowledge is critical to the competent and safe delivery of healthcare in the United States today. This study sought to contribute to the development of process theory on hospital leadership group learning by examining the dynamic interactive processes that enact learning and knowledge creation. A qualitative multicase study approach was used, relying on semistructured interviews and observations to collect the data and utilizing content analysis and conversation analysis to study the data.;The study of hospital leadership groups was based on an application of structuration theory (Giddens, 1984), which suggested that learning and knowledge creation could be studied by identifying the recursive patterning being enacted through the medium of language in the mutual shaping of group interactions and structures. The organizational learning systems model (OLSM) (Schwandt, 1997) provided another way to understand the complexity generated in dynamic interactive process related to learning and knowledge creation.;The study found that the dynamic interactive processes enacting learning and knowledge creation were generated in turns of talk and could be identified in the mutual shaping of structure and action reflected through the structurating properties of signification, legitimation, and domination. In addition, the study found that the juxtaposition of the OLSM with structuration, the ongoing recursive shaping between the subsystems and the interchange media, provided a way to capture the learning system enacted within the dynamic interactive processes of the leadership groups. The findings suggested that the talk in interaction within each leadership group shaped an approach to learning that tended toward exploitation or exploration (March, 1991).;The conclusions are oriented around the three properties of structuration: (1) communicative properties are reflected in concluding that talk in a group matters, that each turn of talk shapes what is to come; (2) normative properties are reflected in finding that group norms shape and are shaped by member interactions; (3) power-relating properties are reflected in finding that the distribution of power in a leadership group shapes the level of collective efficacy experienced by group members which, in turn, shapes member engagement and participation.