Der Anaesthesist

, Volume 56, Issue 10, pp 983–991

Anästhesisten lernen – lernen Institutionen auch?

Bedeutung von institutionellem Lernen und Unternehmenskultur in der Klinik
Leitthema

Zusammenfassung

In der Medizin erfolgt Lernen typischerweise privat und individuell, weil das berufliche Umfeld Autonomie und persönliche Verschwiegenheit fordert. Institutionelles Lernen ist daher eine Herausforderung, denn Individuen lernen von Natur aus, Teams und Organisationen nicht. Organisationales Lernen entspricht jedoch nicht einfach der Lernsumme der ihr angehörigen Individuen. Institutionelles Lernen erfolgt im Gegensatz zum individuellen Lernen nicht durch eigenen Antrieb und ist nicht einfach eine vermeidbare Folge von Wiederholungen, sondern muss geführt werden. Organisationen lernen über veränderte oder neue Fähigkeiten der ihr angehörenden Individuen, über neue Systeme und Strukturen, aber auch durch eine neue strategische Ausrichtung und eine veränderte Unternehmenskultur. Anpassungsfähigkeit, Flexibilität und Innovation sind die herausragenden Herausforderungen für das moderne Krankenhaus. Diesem Anspruch kann ein Leistungserbringer nur genügen, wenn er zur lernenden Organisation wird. Um Kompetenz zu erreichen, ist zunächst Repetition erforderlich. Eine Steigerung des Leistungsvolumens garantiert jedoch noch lange nicht die verbesserte Performance einer Organisation. Entscheidend ist, wie Individuen und Teams Erfahrungen verarbeiten. So ist die Patientensicherheit nicht das Resultat einer individuellen Fähigkeit, sondern eine Systemeigenschaft. Wissen wird individuell schrittweise geschärft und gleichzeitig kollektiv reflektiert. Robuste Organisationen akkumulieren, bewahren und verwenden Wissen und Fähigkeiten trotz erheblicher Personalfluktuation. Es werden verschiedene Formen organisationalen Lernens unterschieden: „Single“- und „Double-loop“-Lernen, Entlernen (Verlernen) und Metalernen. Diese Lernformen sind für anästhesiologische Abteilungen als wichtige Querschnittdienstleister im Krankenhaus von großer Bedeutung. Für erfolgreiches organisationales Lernen sind eine umsichtige Führung und ein Wandel der Unternehmenskultur mit offener Kommunikation und gegenseitigem Respekt erforderlich. Organisationales Lernen erfordert eine Kombination von Werthaltungen, Fähigkeiten und Strukturen. Die Entwicklung von Wissen, Kompetenzen und Lernkapazitäten sowie von Informations- und Kommunikationssystemen sind zentraler Gegenstand lernbezogener Managementaktivitäten. Organisationales Lernen kann zu strategischen Vorteilen durch den Erhalt oder die Verbesserung von Wettbewerbsfähigkeit, Produktivität oder Innovativität führen. Die Bedeutung des organisationalen Lernens wird diskutiert und deren Umsetzung an Beispielen erläutert.

Schlüsselwörter

Institutionelles Lernen Unternehmenskultur Kommunikation Anästhesie 

Anaesthetists learn – do institutions also learn?

Importance of institutional learning and corporate culture in clinics

Abstract

In only a few contexts is the need for substantial learning more pronounced than in health care. For a health care provider, the ability to learn is essential in a changing environment. Although individual humans are programmed to learn naturally, organisations are not. Learning that is limited to individual professions and traditional approaches to continuing medical education is not sufficient to bring about substantial changes in the learning capacity of an institution. Also, organisational learning is an important issue for anaesthesia departments. Future success of an organisation often depends on new capabilities and competencies. Organisational learning is the capacity or processes within an organisation to maintain or improve performance based on experience. Learning is seen as a system-level phenomenon as it stays in the organisation regardless of the players involved. Experience from other industries shows that learning strategies tend to focus on single loop learning, with relatively little double loop learning and virtually no meta-learning or non-learning. The emphasis on team delivery of health care reinforces the need for team learning. Learning organisations make learning an intrinsic part of their organisations and are a place where people continually learn how to learn together. Organisational learning practice can help to improve existing skills and competencies and to change outdated assumptions, procedures and structures. So far, learning theory has been ignored in medicine, due to a wide variety of complex political, economic, social, organisational culture and medical factors that prevent innovation and resist change. The organisational culture is central to every stage of the learning process. Learning organisations move beyond simple employee training into organisational problem solving, innovation and learning. Therefore, teamwork and leadership are necessary. Successful organisations change the competencies of individuals, the systems, the organisation, the strategy and the culture.

Keywords

Institutional learning Communication Corporate culture Anaesthesia 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Institut für Anästhesie, chirurgische Intensivmedizin und SchmerztherapieKantonsspital LuzernLuzern 16Schweiz
  2. 2.Human Resource Management (HRM)Universität ZürichZürichSchweiz
  3. 3.Berufsverband Deutscher Anästhesisten, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin NürnbergDeutschland

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