The deferred model of reality for designing and evaluating organisational learning processes: A critical ethnographic case study of Komfo Anokye teaching hospital, Ghana

Abstract

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The study proposed an evidence-based framework for designing and evaluating organisational learning and knowledge management processes to support continuously improving intentions of organisations such as hospitals. It demarcates the extant approaches to organisational learning including supporting technology into ‘rationalist’ and ‘emergent’ schools which utilise the dichotomy between the traditional healthcare managers’ roles and clinicians’ roles, and maintains that they are exclusively inadequate to accomplish transformative growth intentions, such as continuously improving patient care. The possibility of balancing the two schools for effective organisational learning design is not straightforward, and fails; because the balanced-view school is theoretically orientated and lack practical design to resolve power tensions entrenched in organisational structures. Prior attempts to address the organisational learning and knowledge management design and evaluation problematics in actuality have situated in the interpretivist traditions, only focusing on explanations of meanings. Critically, this is uncritical of power relations and orthodox practices. The theory of deferred action is applied in the context of critical research methods and methodology to expose the motivations behind the established organisational learning and knowledge management practices of Komfo Anokye Teaching Hospital (KATH) which assumed rationality design conceptions. Ethnographic data was obtained and interpreted with combined critical hermeneutics and narrative analyses to question the extent of healthcare learning and knowledge management systems failures and unveil the unheard voices as force for change. The study makes many contributions to knowledge but the key ones are: (i) Practically, the participants accepted the study as a catalyst for (re)-designing healthcare learning and knowledge management systems to typify the acceptance of the theory of deferred action in practice; (ii) theoretically, the cohered emergent transformation (CET) model was developed from the theory of deferred action and validated with empirical data to explain how to plan strategically to achieve transformative growth objectives; and (iii) methodologically, the sense-making of the ethnographic data was explored with the combined critical hermeneutics and critical narrative analyses, the data interpretation lens from the critical theory and qualitative pluralism positions, to elucidate how the unheard emergent voices could bring change to the existing KATH learning and knowledge management processes for improved patient care