Harnessing Potential: Upstream Drivers of Learning in a Large Health System

Background: The ability to learn is central to performance and innovation across industries, yet the upstream drivers of organizational learning remain underexplored in healthcare. Understanding how learning arises within complex systems is critical for achieving the Quadruple Aim and building Learning Health Systems (LHS) capable of continuous improvement. This study examined how and why learning occurs—or fails to occur—within a large, integrated community hospital system, to identify the structural, contextual, and leadership factors that create the conditions for learning in practice.

 

Approach: We used a multi-method design to assess and explore organizational learning capability (OLC) across formal leaders in a large Canadian health system with more than 17,000 staff. Phase 1 included a cross-sectional survey of 231 leaders using the 14-item OLC scale, which measures experimentation, risk-taking, dialogue, participative decision-making, and interaction with the external environment.

 

Latent Profile Analysis (LPA) identified subgroups of learning profiles. Phase 2 included 12 realist-informed interviews with leaders from both high and moderate OLC groups to examine how contextual and leadership factors enabled or constrained learning. The study was co-designed with executives, researchers, and the organization’s LHS leadership. Interest holders validated findings through member checking and ongoing and internal knowledge translation sessions to ensure relevance and practical application.

 

Results:The mean OLC score was 4.74/7 (SD = 0.99), indicating moderate overall learning capability. Two learning profiles emerged: one characterized by high OLC (n = 71) and one by moderate OLC (n = 70). Dialogue had the highest mean score (5.72), while interaction with the external environment (3.82) and risk-taking (4.02) were lowest. Qualitative findings revealed that learning unfolds sequentially: dialogue creates psychological safety and shared sense-making, which in turn enable participative decision-making and external engagement, ultimately fostering experimentation and risk-taking.

 

Four key themes emerged:

(1) dialogue drives learning but must link to transparent decision-making;

(2) structural and funding constraints undermine learning despite motivation;

(3) leadership microclimates create localized learning cultures; 

(4) over-prioritization dilutes focus and sustainability.

 

Implications: Learning is both a cultural and structural property: it thrives when dialogue and trust are supported by leadership, time, and systems for reflection and action. For integrated care systems internationally, three priorities emerge. First, link communication to action by embedding dialogue within governance and decision-making processes. Second, create protected time and resources for learning, rewarding experimentation and adaptive capacity alongside efficiency. Third, cultivate inclusive, inquiry-driven leadership microclimates that empower teams to test and scale solutions. By identifying the upstream drivers of learning, this study offers a roadmap for embedding continuous learning in the everyday work of integrated care—transforming how systems think, adapt, and improve for patients, staff, and communities.