Organizational learning in hospitals: A realist review


high-reliability organizations, inpatient, leadership, nurse administrators, organizational learning, psychological safety, quality improvement, realist review, safety, systematic review


Aim: To establish a middle‐range theory of organizational learning in hospitals.

Design: A realist review of the literature, conducted according to established standards for realist and meta‐narrative evidence syntheses. Middle‐range theory development was performed according to Smith and Liehr's recommendations.

Data sources: Two comprehensive scientific databases and six discipline‐focused databases spanning health care, life sciences, business, sociology, and psychology were searched from inception to 12 May 2016.

Review methods: Citations meeting the inclusion criteria were appraised using the Mixed Methods Appraisal Tool. Data extraction was guided by a focus on the contextual factors, mechanisms, and outcomes associated with organizational learning.

Results: The initial search yielded 2,332 citations, 147 of which were ultimately included in the review. The included citations were generally of high quality. Reviewed evidence indicates certain aspects of organizational context can be conducive to mechanisms of organizational learning, leading to a range of positive organizational outcomes.

Conclusion: This review updates and expands on a previous review of the literature on organizational learning in hospitals, refines the concept of organizational learning in hospitals, and provides a middle‐range theory of organizational learning in hospitals.

Impact: This updated review provides a strong evidence base for future work on the topic of organizational learning in hospitals. The refined concept of organizational learning makes it possible to develop reliable, valid research instruments that better reflect of the full scope of organizational learning. Finally, the middle‐range theory guides researchers and clinical leaders as they advance the science and practice of organizational learning.

Original Publication Citation

Lyman, B., *Jacobs, J. D., *Hammond, E. L., & *Gunn, M. M. (2019). Organizational learning in hospitals: A realist review. Journal of Advanced Nursing, 75(11), 2352-2377.

Document Type

Peer-Reviewed Article

Publication Date


Permanent URL


Journal of Advanced Nursing





University Standing at Time of Publication

Assistant Professor