Table 1 Overview of the 14 included studies on learning organizations and organizational learning in nursing homes, broken down per study aim, definition and/or description, key terms, theories, and operationalizations

Antonsson et al. [52], Sweden

To describe first-line managers’ experiences with alternatives modes of funding elderly care

No definition of LO or OL is provided. LOs are described as requiring employees to constantly develop and learn from mistakes. For learning organization development, the importance of leaders and transformational leadership (requiring a proactive and innovative mindset) is emphasized

• Learning from mistakes

• Transformational leadership

• Proactive and innovative mindset

• Senge [53, 54] on learning organizations

• Rosengren and Bondas [55] on a shared leadership model

• Type of study: qualitative

• Measure: interviews about organizational questions, leadership, and alternative modes of care for older people (private and public funding)

Grealish et al. [56], Australia

To explore the impact of a six-month educational programme focused on staff learning behaviours and organizational learning culture

LO is defined as: an organization committed to continuous service improvement, including individual and collective learning efforts to support high-quality service delivery and high staff satisfaction. LO strives to continuously transform and improve, and displays an underlying value of trust within its teams; members display goodwill, a willingness to collaborate, and an openness to (discussing) opposing views. For LO development, staff must be able to learn from practice, and possess both social and interpersonal skills (e.g., the ability to provide feedback, an awareness and ability to communicate emotions associated with learning)

• Workplace learning

• Facilitators to develop and empower individuals and teams

• Continuous quality improvement

• DeSilets and Pinkerton [57] and Sheaff and Pilgrim [58] on learning organizations

• Eraut [59] on workplace learning (individual and collective learning)

• Billet [60] on sociocultural theory of work-based learning for staff development through collective learning at work

• Type of study: mixed methods

• Measure: the Clinical Learning Organizational Culture Survey [61], conducted before and after an educational programme and consisting of five subscales: accomplishment, affiliation, recognition, influence, and dissatisfaction; logs documenting the experiences of clinical educators; observations of organizational learning, analysed and grouped into themes

Somerville and McConnell-Imbriotis [62], Australia

To gain insight into organizational learning by measuring the dimensions of a learning organization

LO is defined as: an organization that utilizes proactive interventions to generate, capture, store, share, and use learning at the systems level to create innovative products and services. LOs are further described as 1) aiming to embed learning at all levels of the organization by shifting the focus from education/training to workplace learning; and 2) characterized by a systems approach to learning, flexibility and adaptability, commitment to lifelong learning, and participation and cooperation, plus the presence of a shared vision, flat management structure, a wide view of learning, and managers who accept that learning and work are intertwined

• Innovation

• Workplace learning

• System approach

• Flexibility and adaptability

• Commitment to lifelong learning

• Participation and cooperation

• Shared vision

• Wide view of learning

• Leadership

• Marsick and Watkins [63, 64], and Burns [65] on learning organizations

• Type of study: mixed methods

• Measure: 55-item survey, the Dimensions of the Learning Organization Questionnaire [66]

Vinther et al. [67], Denmark

To improve an adverse event reporting system (AER system) and its organizational learning process by gaining insight into its feedback mechanisms and identifying potential obstacles in its learning cycles and feedback loops

No definition of LO is provided, however its five disciplines and a learning-loop theory were described. The five disciplines are seen as a skill set required to foster an organization’s learning capabilities. The learning-loop mechanism through an AER system enables learning at both individual and organizational levels, ultimately resulting in continuous improvement

Five disciplines of a learning organization:

• Personal mastery

• Team learning

• Mental models

• Shared vision

• Systems thinking

• Senge [30] on the five disciplines of learning organizations

• Argyris and Schön’s [68] theory of learning loops

• Type of study: qualitative

• Measure: interviews and observations of an adverse event reporting system (AER system), and a workshop

Amble [69], Norway

To gain insight into employee reflection as a condition for organizational learning

No definition of LO or OL is provided. Self-reflection and reflection, both immediate and retrospective, are described as prerequisites for sustainable OL. Collective reflection is identified as key to capitalizing on the knowledge of individual employees

• Reflection

• Joint learning

• Knowledge creation

• Senge [30] on organizational learning

• Bandura [70] on the concept of ‘mastery’ and theory of ‘self-efficacy’

• Argyris and Schön’s [71] model of ‘detecting and correcting of error’

• Type of study: qualitative (action research)

• Measure: situation logs, focus groups, and evaluation surveys on reflection

Augustsson et al. [72], Sweden

To identify factors that influence organizational learning

No definition of LO is provided. OL is defined as a work culture that supports questioning, feedback, experimentation, and collaboration. Workplace learning is emphasized, encompassing social and collective processes involving sharing of both information and experiences to develop work practices. A shared vision, collective problem solving with a strong link to practical work, and the role of leadership are identified as crucial to fostering a learning climate. To achieve organizational learning, individual knowledge must be transferred to the entire organization

• Individual learning

• Workplace learning

• Continuous learning

• Learning from mistakes

• Leadership

• Shared vision

• Collective, practice-oriented problem solving

• Argyris and Schön [71] on workplace learning

• Senge [53], Senge et al. [73], and Marsick and Watkins [74, 75] on organizational learning

• Wenger [76] on collective and social learning processes

• Type of study: mixed methods

• Measure: evaluation of a workplace learning intervention (for collective learning and problem solving) through interviews and the Dimensions of the Learning Organization Questionnaire [74] divided into topics on 1) continuous learning, 2) inquiry and dialogue, and 3) team learning

Chalfont and Hafford-Letchfield [77], United Kingdom

To explore leadership styles that contribute to an organizational culture conducive to quality care delivery in nursing homes

No definition of LO is provided. OL is described as: dependent on individual learning and interpersonal experiences, with an emphasis on the role of transformational leadership for building a learning culture that promotes awareness, trust, and accountability—all three of which benefit employee efficiency, job satisfaction, decreased absenteeism, and the recruitment of motivated employees. Effective learning requires collective reflection and consideration of organizational development, informed by knowledge about effective care

• Individual learning

• Collective learning

• Learning climate

• Reflection

• Transformational leadership

• Wenger [76] and Hafford-Letchfield et al. [78] on collective learning

• Senge [30] on organizational learning

• Type of study: qualitative

• Measure: literature study and in-depth interviews

Desai [79], United States

To study organizational learning and improvement as achieved through the handling of complaints about products and services from known and anonymous stakeholders

No definition of LO is provided. OL is defined as occurring in organizations that use knowledge gained from employee experiences—such as procedural knowledge (routines, procedures, rules) and tacit knowledge (organizational culture, shared mental models)—to guide employee actions. OL thus leads to collective organizational knowledge and changes in organizational performances

• Organizational learning experiences

• Procedural, tacit, and collective knowledge

• E.g., Argote et al. [80], Darr et al. [81], and Levitt and March [82] on organizational learning

• Mitchell et al.’s [83] theoretical framework of power, legitimacy, and urgency, used to specify an organization’s effort to learn from their experiences with stakeholders

• Type of study: quantitative

• Measure: surveys based on a dataset derived from California national health data

Desai [84], United States

To gain insight into organizational learning and performance improvement by examining the influence of power, legitimacy, and urgency in stakeholder feedback interactions

No definition of LO is provided. OL is defined as occurring in organizations that use knowledge gained from employee experiences—such as procedural knowledge (routines, procedures, rules) and tacit knowledge (organizational culture, shared mental models)—to guide employee actions. OL thus leads to collective organizational knowledge and changes in organizational performances

• Organizational learning experiences

• Procedural, tacit, and collective knowledge

• Organizational memory system

• E.g., Argote et al. [80], Cyert and March [85], and Levitt and March [82] on organizational learning

• Type of study: quantitative

• Measure: surveys based on a dataset derived from California national health data

Hauer et al. [86], Sweden

To utilize the Breakthrough Collaboratives model [96] for evaluating both the ‘Steps for Skills’ intervention and the usefulness of new knowledge as predictors for a learning climate

No definition of LO or OL is provided. A learning climate is described as the space for learning within an organization, which leads to both individual learning and OL in order to gain and use new knowledge in practice. The role of leaders in supporting a learning climate is emphasized

Five components of a learning climate:

• Collaborative potential (facilitation of opportunities for teams to reflect, plan, and develop their work together)

• Decision autonomy (empowerment of individuals to decide what to do and how to do it)

• Manager support (support for employee learning)

• Developmental potential (development of skills through on-the-job tasks)

• Social support (engagement in social practices)

• Örtenblad [87] and Mikkelsen et al. [88] on organizational learning

• Westerberg and Hauer [89] and Marsick and Watkins [74] on learning climates

• Marsick and Watkins [90], Marsick [91], Ellström [92], and Clarke [93] on informal and workplace learning

• Salas and Cannon-Bowers [94] on the transfer and application of new acquired knowledge

• The Breakthrough Collaboratives model [96] on collaborative and informal learning

• Type of study: mixed methods

• Measure: case study and survey using the Learning Climate Scale [89] consisting of five components: collaborative potential, decision autonomy, manager support, developmental potential, and social support

Hauer et al. [95], Sweden

To utilize the Breakthrough Collaboratives model [96] to investigate the influence of quality improvement efforts on the perceived learning climate following the ‘Steps for Skills’ intervention, including its effect on resource adequacy and employee workload. Quality improvement efforts were classified into three areas of focus: 1) individual solutions, 2) general milieu, and 3) scheduled activities

No definition of LO or OL is provided. A learning climate is described as the space for learning within an organization, which leads to both individual learning and OL in order to gain and use new knowledge in practice. The role of leaders in supporting a learning climate is emphasized

Five components of a learning climate (see [86]):

• Collaborative potential

• Decision autonomy

• Manager support

• Developmental potential

• Social support

• Örtenblad [87] and Mikkelsen et al. [88] on organizational learning

• Westerberg and Hauer [89] and Hauer et al. [86] on learning climates

• Marsick and Watkins [74] on workplace learning

• The Breakthrough Collaboratives model [96] on collaborative and informal learning

• Type of study: mixed methods

• Measure: case study and survey using the Learning Climate Scale [89] consisting of five components: collaborative potential, decision autonomy, manager support, developmental potential, and social support

Nakrem et al. [97], Norway

To identify the enablers and barriers of an intervention—designed to target geriatric assessments and care planning with a focus on quality improvement and organizational change—by exploring staff learning experiences

No definition of LO is provided. OL is defined as: 1) dissemination of new insights among organizational employees, which become shared insights and shared mental images; 2) improvements in care practices based on individuals’ learning and adjustment of their attitudes and behaviour; and 3) implementation and sustainment of new procedures through their direct implantation in regular nursing home care practices

• Shared insights

• Quality improvement

• Attitudes and behaviour

• Argyris and Schön [71] on organizational learning

• Type of study: qualitative

• Measure: intervention study with focus groups

Ejdys and Gedvilaite [98], Poland

To measure learning orientation as a predictor of organizational innovation

LO is defined as: an organization with a learning climate in which information is created, shared, and transferred, shaping employee behaviour and leading to improved individual development and organizational performance. OL is defined as: the ability of individuals and/or organizations to 1) adapt and respond (in thought and action) to internal and external changes; 2) process information and knowledge aimed at changing organizational behaviours, capabilities, and performance; and 3) facilitate structures and systems that promote organizational adaptiveness and responsiveness. Learning orientation is linked to LO and OL and refers to a collection of organizational values that shape a company's approach to generating and applying knowledge, and influencing proactively learning in the organization

• Learning orientation with four constructs: commitment to learning, shared vision, open-mindedness, and intra-organizational knowledge sharing

• Learning at work

• Employees as learning agents

• Individual development

• Adaptive and responsive attitude to change

• Senge [30, 53], Örtenblad , [87, 99, 100], Somunoğlu et al. [101], and Öneren [102] on learning organizations

• Sinkula et al. [103], Kaya and Patton [104], Garvin [41], and Nasution et al. [105] on learning orientation

• Cohen and Levinthal [106], Nevis et al. [107], Argyris and Schön [68], on organizational learning

• Type of study: quantitative

• Measure: survey on learning orientations, based on four constructs: 1) commitment to learning, 2) shared vision, 3) open-mindedness, and 4) intraorganizational knowledge sharing and organizational innovativeness as an outcome variable

Rondeau and Wagar [108], Canada

To gain insight into whether a commitment to organizational learning facilitates the implementation of a TQM/CQI programme while securing enhanced organizational performance

LO is defined as: an organization that is skilled at creating, acquiring, and transferring knowledge, and at modifying its behaviour to reflect new knowledge and insights. In healthcare LOs, employees are empowered to participate and all individuals engage in recognizing and resolving issues, ongoing experimentation, risk taking, innovation, problem solving, and promoting continuous quality enhancement. LOs are further characterized by systems thinking and by open communication, collaboration, adaptability, and flexibility in work structures and processes. OL is described as: the learning that occurs within an organization that has successfully implemented a TQM/CQI programme, designed to support performance enhancements

• Creating, acquiring, and transferring knowledge

• Behaviour

• Empowerment

• Communication

• Collaboration

• Adaptability and flexibility

• Experimentation

• Innovation

• Risk taking

• Problem solving

• Systems thinking

• Continuous improvement

• Garvin [109] on learning organizations

• The framework of DiBella et al. [110] on organizational learning, which describes seven learning orientations: knowledge source, product-process focus, documentation mode, dissemination mode, learning focus, value-chain focus, and skill development focus

• Type of study: quantitative

• Measure: three crafted surveys, namely 1) a nine-item survey on organizational learning [110]; 2) a survey on organizational performance (using a modified balanced scorecard with 12 variables); and 3) a four-item survey on quality improvement, grounded in Total Quality Management/Continuous Quality Improvement (TQM/CQI) principles