Cross-Sector Research on Continuous Learning and Improvement

Abstract

The body of literature on continuous learning and improvement is divided into applied research documenting or evaluating specific codified methods, and a more theoretical literature about how organizations can learn and improve. Both literatures emerged in the 1970s, and they remained distinct for some time. On the applied side, consultants to industry began to codify the approaches of high-performing companies, producing a set of methods that combined continuous improvement (CI) with a customer orientation, emphasis on teamwork, tools for structured decision making, and systems thinking. One of the earliest and most studied packages of these methods is called Total Quality Management (TQM). Studies documented consistent evidence of associations between TQM implementation and performance in the private sector, but a weaker relationship in the public sector. Theoretical research increasingly explained why this might be so, drawing productively on contingency theory to explain why methods from production may need to be adapted or reconsidered in service or public sectors. Yet the initial reluctance of scholars to follow the demands of managers in deciding what to study led to the underinvestment in direct research on individual CI methods like TQM, which may have contributed to its hype and rapid spread despite mixed results. This rapid spread was then largely explained by scholars via neoinstitutional theories, wherein organizations adopt CI methods as a way of securing legitimacy, rather than because of their technical value. Over time, scholars have taken up a more integrated role in theorizing, investigating, and evaluating CI initiatives, often grounding their empirical research in theories of organizational learning and using this theoretical foundation to deepen our understanding of the conditions under which and the mechanisms by which CI methods work. Yet, particularly in health care, they have struggled with the appropriate standards of evidence and research designs for evaluating CI methods. Again, theoretical perspectives have helped to delineate the challenges. For example, contingency and neoinstitutional theories raise questions about whether conformity with prescribed practices is the best indicator of effective take-up of CI, or whether adaptation is more desirable. This question arose particularly as methods spread to sectors with more fragmented and turbulent environments, difficult-to-monitor tasks, and uncertain technologies (e.g., many public sectors). Faced with growing understanding of the incompatibility of traditional CI methods with the complexity of many contexts, the latest generation of literature on CI in both the private and public sectors promotes more adaptive, less tightly codified methods.