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Purpose The purpose of this paper is to examine how the design and implementation of learning models for performance management can foster continuous learning and quality improvement within a publicly funded, multi-site community hospital organization. Design/methodology/approach Niagara Health's patient flow performance management system, a learning model, was studied over a 20-month period. A descriptive case study design guided the analysis of qualitative observational data and its synthesis with organizational learning theory literature. Emerging from this analysis were four propositions to inform the implementation of learning models and future research. Findings This performance management system was observed to enable: ongoing performance-related knowledge exchange by creating opportunities for routine social interaction; collective recognition and understanding of practice and performance patterns; relationship building, learning for improvement, and "higher order" learning through dialogue facilitated using humble inquiry; and, alignment of quality improvement efforts to organizational strategic objectives through a multi-level feedback/feed-forward communication structure. Research limitations/implications The single organization and descriptive study design may limit the generalizability of the findings and introduce confirmation bias. Future research should more comprehensively evaluate the impact of learning models on organizational learning processes and performance outcomes. Practical implications This study offers novel insight which may inform the design and implementation of learning models for performance management within and beyond the study site. Originality/value Few studies have examined the mechanics of performance management systems in relation to organizational learning theory and research. Broader adoption of learning models may be key to the development of continuously learning and improving health systems.

Original publication




Journal article


Int J Health Care Qual Assur

Publication Date





587 - 599


Continuous quality improvement, Organizational learning, Performance management, Performance measurement, Quality improvement, Health Services Administration, Humans, Interpersonal Relations, Learning, Qualitative Research, Quality Improvement, Total Quality Management, Workflow