Table 1.
Summary of Potential Facilitators of Double-Loop Learning
| Facilitator | Characteristics | Studies |
|---|---|---|
| Psychological safety | Nonpunitive; less punitive reporting; anonymous, confidential; absence of “blame culture” and fear of reprisals. | Anderson et al. 201340; Conlon, Havlisch, and Porter 201369; Cooke, Dunscombe, and Lee 200789; Elhence et al. 201078; Frey et al. 200299; Jayaram et al. 201191; Kalapurakal et al. 2013103; Kivlahan et al. 2002104; NHS Quality Improvement Scotland 200688; Nicolini, Waring, and Mengis 201176; Pierson et al. 200770; Ross, Wallace, and Paton 200071; Savage, Schneider, and Pedersen 200574; Spigelman and Swan 200572; Stainsby et al. 200693; Stainsby et al. 200494; Takeda et al. 200381; Weissman et al. 200568; Wong, Kelly, and Sullivan 201367 |
| Focus on learning | Learning as the function/output (vs “audit culture,” etc.); actual, genuine focus on learning (vs rhetorical/espoused); discrepancies, emotion, etc., allowed. | NHS Quality Improvement Scotland 200688; Nicolini, Waring, and Mengis 201176; Pierson et al. 200770; Wong, Kelly, and Sullivan 201367 |
| Reflects complexity | ||
| Cross-departmental/organizational/professional | Multiagency; interorganizational; multi- or cross-disciplinary; cross-functional; no silos and barriers between departments. | Conlon, Havlisch, and Porter 201369; Cooke, Dunscombe, and Lee 200789; Herzer et al. 2012100; Jayaram et al. 201191; Kivlahan et al. 2002104; Pierson et al. 200770; Rebibo et al. 200496; Stainsby et al. 200693 |
| Multiple interventions | Holistic/systemic approach; complementary, systemwide interventions vs single interventions in isolation (eg, training). | Callum et al. 200177; Cooke, Dunscombe, and Lee 200789; Ross, Wallace, and Paton 200071; Roughead, Gilbert, and Primrose 1999106; Sullivan and Ghroum 201390 |
| Local and participative | Built within the context (vs imposed); locally designed vs centrally or externally designed; participants involved in problem-solving instead of being hierarchical, in the hands of specialists. | Conlon, Havlisch, and Porter 201369; Cooke, Dunscombe, and Lee 200789; Herzer et al. 2012100; NHS Quality Improvement Scotland 200688; Nicolini, Waring, and Mengis 201176 |