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  1. Lyman, Bret
  2. Shaw, Lindsey
  3. Moore, Carly


The purpose of this study was to explore organizational learning in an orthopaedic hospital unit. Skill in organizational learning is necessary to achieve high reliability in a dynamic healthcare environment, yet organizational learning in hospital units is not well understood. A learning history was conducted with a high-performing orthopaedic unit. Findings were interpreted in the context of a previous learning history conducted with a critical care unit. Despite contextual differences, each unit progressed through the same four developmental stages to achieve its current state of high reliability. On both units, psychological safety and a healthy work environment proved essential for developmental progression. Hospital units may progress through distinct developmental stages to achieve their desired outcomes. Psychological safety and a healthy work environment appear foundational to organizational learning in hospital units. Nursing leaders should work with team members to evaluate their unit's development and use suggested strategies to facilitate organizational learning.