An investigation of near miss organizational learning in nursing organization: A mixed method study

Abstract Background: Near miss organizational learning is important for perspective and proactive risk management. Although nursing organization is the largest component of the healthcare system and always act as the final safety barrier, there is little research about the current status of near miss organizational learning. Thus, we conducted this research to explore near miss organizational learning in a Chinese nursing organization at first and lay a solid foundation for future improvement.Methods: This is mixed method research with an explanatory sequence. It was conducted in a Chinese nursing organization of a tertiary hospital under the guidance of the 4I Framework of Organizational Learning. The quantitative study explored near miss organizational learning with 600 nurses by random sampling. Then, we applied purposive sampling to recruit 16 nurses across managerial levels from low-, middle- and high-scored nursing units and conducted semi-structured interviews. Descriptive statistics, structured equation modelling and content analysis were applied in the data analysis. The GRAMMS checklist was used to report this study.Results: Only 33% of participants recognized near miss correctly, and 4% of participants always reported near miss. The 4I Framework of Organizational Learning was verified in the surveyed nursing organization (χ2=0.775, P=0.379, RMSEA<0.01), and the current organizational learning behaviour was not conducive to near miss organizational learning due to poor group-level learning (bGG=0.284) and poor learning absorption (bMisalignment= -0.339). In addition, researchers developed 13 codes, 9 categories and 5 themes to deduct the near miss organizational learning, which is characterized by nurses’ unfamiliarity with near miss, preference and the dominance of first-order problem solving behaviour, the suspension of near miss learning since group level and poor absorption of learning.Conclusions: This is pioneering research to investigate near miss organizational learning in nursing organizations under a solid theoretic foundation. The results showed that the performance of near miss organizational learning is unsatisfying even in nursing organization of tertiary hospital; therefore, the situation may be worse in primary hospitals. Thus, more studies should be done to investigate near miss organizational learning and propose useful strategies for improvement.