A comparison of the Levels of Organizational Learning in Hospitals , Based on Ownership Types : A Case Study in Iran

Medicine, Babol University of Medical Sciences, Babol, Iran E-mail: Drmajahani@yahoo.com ©Telif Hakkı 2018 Gazi Üniversitesi Tıp Fakültesi Makale metnine http://medicaljournal.gazi.edu.tr/ web adresinden ulaşılabilir. ©Copyright 2018 by Gazi University Medical Faculty Available on-line at web site http://medicaljournal.gazi.edu.tr/ doi:http://dx.doi.org/10.12996/gmj.2018.83 A comparison of the Levels of Organizational Learning in Hospitals, Based on Ownership Types: A Case Study in Iran


MATERIALS and METHODS
This cross-sectional study was conducted using an analytical-descriptive approach in selected hospitals, located in Lorestan province, Iran.Our main hypothesis is that organizational learning levels in hospitals vary according to hospital ownership, It included two teaching, one private, and one social affair (social security) hospitals in 2016.This study was approved by the Ethical Committee of Islamic Azad Sari Branch (IR.IAU.SARI.REC.1395.21).The statistical population of the study consisted of all the administrative, financial, and therapeutic staff members 2,162 (N=2162).A total of 339(S=339) participants were determined as the Sample size (124, 78, and 50 employees from the teaching, social security, and private hospitals respectively).The sample size was specified in accordance with Cochran formula, with 95% confidence interval.The sample size calculated by Cochran's formula is as follows: The clustering technique was utilized in randomized classification clusters in order to select the samples.Accounting, staffing, physician, nurse, operating radiology, and laboratory groups were selected as classes, and the samples were chosen within the classes using simple randomized sampling.The main tools used in this study comprised a Persian edition of questionnaire that included two parts of demographic information (gender, level of education, age, occupational background, and occupation level), and a specific Watkins and Marsick's questionnaire (2003) for organizational learning levels (26).
The Watkins and Marsick's questionnaire included 17 questions, The questionnaire was designed at three levels-individual, group, and organizational-marked from very low (1) up to very high (5) on the Likert scale.The learning areas comprised of individual, group, and organizational spheres.
In this study, 30 questionnaires were distributed, filled in, and collected to evaluate the reliability of the questionnaire (as a pre-test step).After entering the data into the system, the coefficient of reliability (Cronbach's alpha) was calculated using the SPSS-20 software, and it was found to be 0.82.
The data collected was analyzed by the SPSS-20 software at a significance level of P < 0.05.The multi-statistics tests were run for various purposes: Kolmogorov-Smirnov test was conducted to investigate the normality of data of quantitative variables; ANOVA test was run to scrutinize the differences between the research variables; the one sample t-test verified the status of the research variables; Levene's test assessed the equality of variances; and Welch's test was conducted to identify differences between variables.
Based on the K-S test, research data distribution was normal (Z = 0.74, p-= 0.64).The study of the status of variables of research, with one sample t-test and a constant value of 3 (mean and median), showed that the mean of variables was 2.77 ± 0.64 (p < 0.001), 3.21 ± 0.94 (p = 0.16), and 2.57± 0.77 (p <0.001) in the teaching, private, and social security hospitals of Lorestan province respectively (Chart 1 and Table 1).

INTRODUCTION
Organizational learning is a collection of dynamic, complicated, and holistic processes (1), based on existing knowledge and experience within the organization.It helps create fundamental qualifications and common experience alignments, and reduces issues, and also increases potential solutions among employees in reaching organization goals (2).It is well known that Competent employees may effect the efficiency and profit of the organization (3).
Organizational learning is a crucial factor undergoing fast environment changes (4).Failing to do so is a major cause of organization loss (1).Therefore, organizations attempt to provide workspaces that promote and enrich learning (5).Organizational learning is a resource that helps distinguish between organizations strategically, form a basis to create competitive advantages (6,7), and take better functional and financial decisions (8).The formation of new organizations, based on learning, is one of their essential characteristics (9).Successful managers use the learning capacity of the organization to turn threats into opportunities (9).Studies show that the understanding of the organizational learning culture is low among high-level, middle, and executive managers, with no significant difference among them (10).
Organizational ownership affects organizational learning culture, and influences the performance of the top management team (11).Satisfaction and performance desirability will be low in the organization if its structure does not encourage learning (10,12).Therefore, accomplishing scientific work and improving performance are disrupted in an organization such as hospitals (13).A change in behavior and improvement in organizational performance can determine the existence of all the three levels of learning in the organization (14).
A two-year study by Wilson and Hartang investigated leaders of noncompeting international companies and demonstrated that organizational learning occupied only 35% of the entire scenario.However, 13% of the learning took place through the group and 11% at the individual level.Operational and empirical kinds of learning were 29% effective, while it was merely 12% for knowledge-based learning (15).On the other hand, learning takes place in two cycles.First is the individual learning, which is the foundation of learning in organizations (16).The institutionalization of individual learning is important to boost learning in the organization (17,18).The second refers to the social phases of individual learning that are coupled with group learning in order to manifest into organizational learning.This process includes direct understanding (in individual learning), interpretation and convergence (in group learning), and formalization (in organizational learning) (16).
Several researches inside and outside Iran have studied individual, organizational, and group learning.Some Iranian studies were carried out by: Farzianpour et al. (13) on the level of organizational learning in Bandar Abbas; Bahadori and colleagues on the learning capacities of Iranian nurses (19); Mirkamali et al. (20) on the role of transformational leadership on learning in SAIPA.Furthermore, some foreign studies have also been conducted, which are as follows: Kaçmaz and Serinkan conducted a on levels of organizational learning in Turkish private and public educational institutions ( 21 (25).According to the referred articles, In order for hospitals to face rapid changes in environmental conditions, they should be based on organizational learning so that they can compete with other hospitals, No research was carried out on staff learning in hospitals, based on the types of ownership of the hospital (educational, social affairs, and private).This research was conducted with the aim of comparing the levels of learning in a hospital, based on the types of ownership, So that we can compare the levels of learning in hospitals.

.77±0.64 Learning
There was a significant difference between organizational learning variables, based on the ownership of hospitals (p < 0.001).Moreover, a considerable distinction was found among the individual (p < 0.001), group (p = 0.007), and organizational learning based on the ownership of hospitals (p = 0.002) (Table 3).
Levene's test was conducted to out the equality of variances.However, it concluded that the variance of learning variables was not equal among the three types of hospital ownership-teaching, social security, and private hospitals (p < 0.001).Therefore, the results of Welch's test were used to check the mean difference between the groups.The results of this study showed the highest organizational and the lowest individual learning in private hospitals, as compared to teaching and social security hospitals.The top executives of an establishment, characterized by a low level of organizational learning, do not utilize learning as a strategy for convergence and achievement of organizational goals.Yan et al. (35) believed that organizational learning was very important at both high and low levels in order to respectively determine organizational strategy and execute activities.Further, Tamayo et al. (23) found that in dynamic organizations, organizational learning positively affected decision-makers to adapt to change.Hospital executives should create a proper place to motivate their staff to learn in their areas of responsibilities.Hasson et al. (22) stated that educational intervention in leadership training had positive effects on the perceptions of the personnel as regards the aspects of organizational learning levels and on the understanding of managers about the level of individual learning.In an organization with a low level of individual learning, the personnel do not have the capacity to listen to and ask for other people's point of views.In such an environment, organizational culture should be supported by the spirit of inquiry, feedback, and experimentation.

CONCLUSION
The results of the study demonstrated that the level of organizational learning among private hospital staff was significantly higher than that of social security and teaching hospitals.Therefore, it is recommended that managers of teaching and social security hospitals should improve the learning level.This can be attained by increasing employees' participation, establishing working teams, and empowering personnel toward common goals.Furthermore, it is suggested that equal opportunities be provided to all personnel on continuous learning, and the organization should maintain proper relationships with the surrounding environment.

DISCUSSION
The findings showed that organizational learning in private hospital was higher than the average.However, in the teaching and social security hospitals, it was less than average.The results of this research were aligned with the study performed by Farzianpour et al. (13).His study showed that the organizational learning capacity of private hospitals was much higher than social security and teaching hospitals.Moreover, this study is in tune with that of Mirkamali (20).According to him, the mean organizational learning in SAIPA was higher than the average.The results of this research are consistent with those of Kaçmaz et al. (21) and Aparicio et al. (27).They found a higher-thanaverage level of organizational learning for private educational institutions, as compared to public education institutions.The same was expressed moderately by Raj and colleagues (28).They suggested that organizational learning had a direct effect on innovation variables.
The findings of the current study are in contradiction with the results of Bahadori et al. (19).Their study indicated a moderate mean of organizational learning for nurses of a teaching hospital affiliated to Tehran University of Medical Sciences.It seemed like the hospital was undergoing a series of training courses for employees at that time.Hampton et al. (29) showed that online training courses had a positive impact on the effective learning outcomes of nursing students in the United States.Moreover, the study of Montgomerie et al. (30) positively evaluated the impact of online education on personnel professional development in New Zealand.The study of Heidari et al. in Iran (31) investigated the role of organizational learning on patient care quality in Kerman's public hospitals.The study showed that organizational learning plays a crucial role in respecting the rights and satisfaction of the patient.Lim's study in Korea (24) appraised a positive but average correlation between variables of learning culture in private companies.However, his results were inconsistent with the current research findings.
results of the study showed that there was a significant difference between the levels of organizational learning, evaluated on the basis of types of hospital ownership.The level of individual, group, and organizational learning in private hospitals is higher among all types of assessed ownership styles.The results of this study were consistent with Xin's research (32).He stated that there was a significant difference in terms of quality and cost between public and private hospitals in the United States.Beyene et al. (33) concluded that the ownership type of manufacturing organizations affected innovation performance.In their opinion, private manufacturing organizations had better performance indicators as they were investing more on R & D, as compared to government and public firms.
Furthermore, the investigation of Zhou et al. (34) in Chinese private firms showed a positive correlation between organizational learning levels and financial performance and creativity in the organization.Private firms provided more training for their workforce.This was because profitability and optimal financial turnover were important for the organization's continuity and survival.On other hand, managers were hiring their own human resources in private hospitals.Therefore, only those individuals who were closer to the organization's goals were selected.However, they were recruited in teaching and social security hospitals by conducting public tests through recruitment.
); Hasson et al. studied improvements in organizational learning through leadership training (22); Tomayo et al. researched on organizational learning and innovation as sources of strategic fit for high-tech manufacturing factories in Spain (23); Lim studied the relationships among organizational commitment, job satisfaction, and organization culture in one Korean private organization (24); and Cheung et al. studied the organizational learning at the shop-floor level In a company

Chart 1 :
The mean of learning and its levels in the hospitals, based on ownership type, 20

Table 1 :
Comparative study of learning status in hospitals, based on ownership type

Table 2 :
One-way Variance Analysis (ANOVA), learning variable, and its dimensions in the studied hospitals, 2016