Learning Organization Model: Accountable Care

On the continuum from status quo thinking to “thinking heaven”, my unit is 8 out of 10 (where 1 is status quo thinking and 10 is “thinking heaven”). I give my work environment these high marks based on Rubenfeld and Scheffer (2015) definition of “learning organizations” (p. 75). They explain that within this model “organizational cultures encourage critical thinking and acknowledge the inevitability of change” through characteristics of “trustworthiness, autonomy, responsibility and reflection” (Rubenfeld & Scheffer, 2015, p. 75). Through the implementation of the Accountable Care Unit (ACU), our nurses have been able to demonstrate the specific characteristics of a “learning organization” and we have learned the importance of using open

dialogue and “shared thinking” to further nurture critical thinking (Rubenfeld & Scheffer, 2015).
My organizational culture attempts to affect my work environment positively by expecting that I will think critically and, therefore, foster insightful ways to improve patient care. This support is exemplified yearly through the Test-of-Change Project that requires me to address areas of patient satisfaction that my unit is not scoring well in. For instance, this year I geared my project towards determining if improved intentional-rounding, where nurses purposefully enter a patient’s room every hour to assess the patient for positioning, personal needs, pain, and proximity of personal items, would reduce the instances patients need to use the call light. When I presented my findings to my Unit Director, one of the ways he supported my findings was proposing to staff we divide patient assignments by zones, so staff members are geographically located near their patients and consequently more readily available to check on them and address concerns before the patient needs to use the call light.
My position on the unit I work is the dual role of clinician and educator. Therefore, I must continually challenge myself to think critically about my patients and their care, while at the same time equipping a novice nurse with the tools to begin doing the same. I believe I can influence the organization culture through the daily implementation of what Rubenfeld and Scheffer (2015) call “knowledge work”, which is “based on assessment, judgment, problem-solving, and the generation of ideas” (p. 63). This framework influences the culture of my work environment because the ideas I generate and share are taken into account when decisions are made about my patient.