The role and importance of context in collective learning: multiple case studies in Scottish primary care

Abstract

Organisational learning is conceptualised within healthcare policy as an acontextual entity to be implemented across services through a prescribed governance framework. \n \nStudies of organisational learning often exclude context in this way. The central questions of this thesis concern how and why context is relevant and important in relation to organisational learning. In order to address these issues, context and organisational learning were conceptualised as mutually constitutive activity and knowing-in-practice respectively. Taking a cultural-historical activity theoretical approach, learning is understood to be an intrinsic part of activity. These issues were explored empirically through qualitative case study in three purposively sampled Scottish primary care teams. \n \nInitial findings suggested collective learning occurred through participation in everyday activity. Team accounts of apparently the same routine object of work revealed distinctive patterns of activity. Each team seemed to be doing the same thing differently. Exploration of mediating means present in each teamâ s activity accounted for these differences: although similar on the surface, the attribution of meaning to each was contested and shaped through the cultural, historical and inherently contextual activity which they mediated within each activity system. Further analysis demonstrated members of each primary care team co-configured these objects with members of other interlinked activity systems. Different things were actually being done in similarly different ways. This showed how inherently contextual activities shaped the content of collective learning and offered an explanation of why context is relevant and important in collective learning. \n \nThese findings suggest efforts to transfer knowledge as a discrete, manageable entity between situations are unlikely to succeed due to the filtering and translating effect of inherently contextual activity. From this perspective, organisational learning and related concepts such as â implementationâ and â best practiceâ become problematic. Healthcare policy concerning collective learning, within which such approaches are central, may benefit from reconsideration.

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