they experienced throughout this ordeal was receipt of Mr. Q.’s bill (Cleary, 2003).

As with many other aspects of the health care enterprise, there is great diversity in the organizations that deliver care, from small group practices, to independent practice associations, to individual hospitals, to large integrated delivery systems. Each brings different strengths and weaknesses, and each plays a significant and important role in delivering high-quality, high-value care. Because of their size and care capacities, however, health care organizations can set an example for improvement in the health care system by using new practice methods, setting standards, and sharing resources and information with smaller practices.

The role of health care organizations is especially important in a learning health care system, because organizational factors have been shown to have an impact on care quality and patient outcomes. One study found that high-performing organizations in heart attack care, as measured by improved mortality rates, generally had features such as good communication and coordination, shared values and culture, and experience with problem solving and learning (Curry et al., 2011). Similarly, another study found that staff engagement and hospital leadership influenced the success of a program designed to prevent hospital-acquired infections (Sinkowitz-Cochran et al., 2011). And numerous studies have shown that engagement of hospital boards and other leaders in quality improvement has a significant effect on quality and outcomes (IHI, 2007; Jiang et al., 2008, 2009; Vaughn et al., 2006).

Given the importance of health care organizations to the broader learning enterprise and the impact of organizational factors on care, it is critical that health care organizations increase their learning capacity. A learning health care organization harnesses its internal wisdom—staff expertise, patient feedback, financial data, and other knowledge—to improve its operations. It engages in a continuous feedback loop of monitoring internal practices, assessing what can be improved, testing and adjusting in response to data, and implementing its findings both locally and across the organization. Although the particular policy elements that will encourage well-led, continuously learning organizations while discouraging those that are poorly run are unknown, it is evident that organizations engaged in continuous improvement efforts are more nimble and better suited to weathering changes in the market and in the practice of medicine.

Simply put, an organization that promotes continuous learning and improvement is one that “make[s] the right thing easy to do” (Halvorson, 2009). Its environment reduces stress on front-line staff, improves job satisfaction, and prevents staff burnout (Boan and Funderburk, 2003). Its



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