diffusion of new knowledge. As noted in Chapter 6, some types of knowledge are easier or more difficult to disseminate broadly than others, and environmental factors, such as health care payment policies and regulations, can further promote or inhibit knowledge uptake (Berwick, 2003; Greenhalgh et al., 2004; Rogers, 2003). One common challenge to the diffusion of knowledge throughout an organization is a lack of awareness that the knowledge exists; for example, one unit of a hospital may have the potential to benefit from knowledge produced by another but may not be aware of that unit’s activities. As relationships among individuals in different units and departments are critical to meeting this challenge, the social dynamics of the organization come into play and influence the diffusion and uptake of new insights (Ford and Angermeier, 2008). Another potential barrier relates to whether the recipient is willing to receive new knowledge or recognizes how the knowledge might be applied in a new context. For example, a common challenge is resistance from leaders or workers who are accustomed to doing things in a particular way and would prefer to continue those practices.

Several methods—including reports, staff rotations, education and training programs, and adoption of new policies and standards that align with organizational goals—can be used to overcome these barriers and encourage knowledge transfer (Garvin, 1993; Lukas et al., 2007). These barriers also can be overcome by a strong organizational culture that values continuous improvement focused on patient-centered goals and by leadership that highlights the innovative work of front-line workers and unit leaders. One strategy for increased knowledge dissemination—the Framework for Spread—is described in Box 9-4.

Also essential to the development of a continuously learning health care system is learning from others. To this end, organizations need to seek out new perspectives from similarly situated institutions (Garvin, 1993). As is characteristic of dissemination in other industries, some health care organizations will be innovators and early adopters of new innovations, while others may be more hesitant to adopt the lessons of field leaders (Berwick, 2003; Rogers, 2003). Still other organizations may resist the adoption of interventions proven to improve quality, citing local conditions that make adoption unworkable. Finally, some organizations may adopt a new innovation enthusiastically only to find that their staff reject it because the organization lacks the business model, leadership, or cultural elements that make adoption sustainable. One means of supporting organizations that continually learn from others may be through the accreditation, certification, and licensure processes for health care organizations provided by the Joint Commission and state agencies.

While the importance of building a learning organization—one that has staff buy-in and adapts to local conditions—from within cannot be

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