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The importance of culture is often emphasized for continuous learning and quality improvement within health care organizations. Limited empirical evidence for cultivating a culture that supports continuous learning and quality improvement in health care settings is currently available.

The purpose of this report is to characterize the evolution of a large division of physical therapists and occupational therapists in a pediatric hospital setting from 2005 to 2018 to identify key facilitators and barriers for cultivating a culture empowered to engage in continuous learning and improvement.

An ethnographic methodology was used including participant observation, document review, and stakeholder interviews to acquire a deep understanding and develop a theoretical model to depict insights gained from the investigation.

A variety of individual, social, and structural enablers and motivators emerged as key influences toward a culture empowered to support continuous learning and improvement. Features of the system that helped create sustainable, positive momentum (e.g., systems thinking, leaders with grit, and mindful design) and factors that hindered momentum (e.g., system uncertainty, staff turnover, slow barrier resolution, and competing priorities) were also identified.

Individual-level, social-level, and structural-level elements all influenced the culture that emerged over a 12-year period. Several cultural catalysts and deterrents emerged as factors that supported and hindered progress and sustainability of the emergent culture.

Cultivating a culture of continuous learning and improvement is possible. Purposeful consideration of the proposed model and identified factors from this report may yield important insights to advance understanding of how to cultivate a culture that facilitates continuous learning and improvement within a health care setting.

This study uses structural equation modeling to investigate the impact of ABC implementation factors (management support, clarity and consensus of ABC objectives, non-accounting ownership, and training) on quality, cost, and cycle time improvements, the relations among quality, cost, and cycle time improvements and, the influence of quality, cost, and cycle time improvement on financial performance at the business unit level. Overall, the results of the structural analyses support the theoretical model indicating that ABC implementation factors influence quality, cost, and cycle time, and partial support for the relations among quality, cost, and cycle time improvement and their effect on financial performance. When these relationships are further analyzed within the context of ABC implementation stage, adoption of advanced manufacturing practices, industry characteristics and plant size to determine if these contextual factors impact the model constructs and the relationships between the variables in the theoretical model, the results show that these contextual factors do not affect the model constructs, however, they affect the model relations.

This chapter describes how the New Zealand Ministry of Education’s Iterative Best Evidence Synthesis Programme seeks to improve education and serve the public good. New Zealand’s best evidence programme is used (1) to determine what works, why and how; (2) what makes a bigger difference and what does not work to improve learning for all students across policy, research and practice communities; (3) to spotlight expertise, tools and actions needed to mobilise knowledge and (4) to pinpoint challenges in the change process in order to strengthen knowledge mobilisation at the system level.

We analyze the role of top managers in the process of improving existing products in large established firms. The results of an inductive study reveal two key arguments. First, we find that the process is an “involved” top-down approach, rather than middle-up-down or bottom-up, discussed in previous studies on new product creation. Top managers actively participate throughout the process, taking on four roles: evaluation of product market performance, selection of products for improvement, initiation of the innovation process through delegation to middle managers of the responsibility to organize bottom-level employees to take actions toward product improvement, and monitoring of progress to ensure improvement (ESIM). Top managers become involved as necessary to reduce the resistance of people at the middle and lower levels to change in current routines. Second, we find that in companies that achieve superior product improvement, managers have well-developed professional absorptive capacity and have routinized frequent interactions to evaluate, select, initiate, and monitor. Other characteristics of managers, such as personal absorptive capacity, incentive system, or mandate from above, are common across both high and low performers.

This study collected perceptual data from 162 manufacturing managers to assess whether their perception of organizational learning is related to firm profitability or whether the relationship is indirect through firms’ competitive advantage (quality improvement, cost improvement, cycle-time improvement). The results indicate that managers perceive that organizational learning is significantly related to competitive advantage that, in turn, is positively related to profitability. The results also indicate that the relation between organizational learning and profitability is fully mediated by firm competitive advantage.