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Assessment of Learning Organization Practice and

Disciplines in Case of Sire District Public Health Office, Arsi
Zone, Oromia Region, Ethiopia, 2018:Qualitative Case Study
Biniam Worku Hailu
Human Resource Development and Management Directorate, Oromia Regional Health Bureau, Addis Ababa, Ethiopia

Email address:
biniamworku50@gmail.com Mob Number +251945780237

Abstract: Learning Organizations are organizations where people continually expand their capacity to create the
results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspirations are set
free and where people are continually learning how to learn together. The aim of this study was to assess Learning
organization practice and disciplines in case of Sire District Public health office. Learning organization if implemented in
the health institutions it enables ignition of newly created more another’s learning organization units moreover, learning
organization concept if implemented in the organization it can enables organization to achieve their goal systematically
besides this, it also enhance employees their job commitment whereas, the organization not implemented learning
organization concept might be opposite of this or vice versa. The study employed qualitative case-study design in sire
District public health office. Document review, in depth interview and Focus group discussion with flexible probing
techniques were employed to collect the data from 3 key informants and 2 FGD from January 1, 2018 to January 11,
2018. A semi structured interview guide was prepared to explore key informants’ idea about current situation and efforts
made to enable organization to be a learning organization and also thematic analyses were used to analyze the findings of
the study. The study result revealed that the organization assessed in both parameter of learning organization (five
disciplines Peter Senge and Pedler et al criteria of practice of learning organization) the organization was practiced
preponderance of learning organization concept was practiced within five disciplines of learning organizations there
were implemented in their office. The finding of the study revealed that sire district public health office was practiced
learning organization and disciplines in there organization that was exercised as good and the organization also
participate entire employees and stakeholders to carry out organizational plan that were align with national strategies of
the country moreover, the organization had created enabling learning opportunities to enhance a learning organization
among themselves and others.
Keywords: Learning Organization, Practice and Disciplines, Ethiopia

Learning in an organization means the continuous testing of

1. Introduction experience, and the transformation of that experience into
A health system consists of all organizations, people and knowledge- accessible to the whole organization, and
actions whose primary intent is to promote, restore or relevant to its core purpose [5].
maintain health according to the World Health Organization According to Federal Democratic Republic of Ethiopian
WHO [1]. Healthcare organizations are composed of health government, Minister of health in their Transformation plan,
care professionals from multiple disciplines forming several stated that best practice and experience should be disseminated
interconnected care teams that strive to provide safe and amongst health facilities. In this context the health sector
consistent care [2].The care teams have to coordinate and transformation plan incorporate four basic pillars; amongst those
communicate amongst their team members and with other pillars District transformation is one of its pillar. The District
teams to function in a cohesive manner to execute their task transformation in the context of health sector indicates the
the highly coordinated to satisfy patient care and then to concept relate with creation of learning organization and this
achieve organizational goals [3]. process pass through selecting District those who have best
Learning Organizations are organizations where people experience and integrated activities ( Learning organization )
continually expand their capacity to create the results they truly and disseminating best experience to other health facilities
desire, where new and expansive patterns of thinking are (Organizational learning ). This leads to transformation of
nurtured, where collective aspirations are set free and where organizational learning to learning organization [6, 7].
people are continually learning how to learn together [4]. The study aimed to assess learning organization practice and
The important component of the definitions above is the disciplines in case of sire District Public Health office.
requirement that change occur in the way work gets done. Furthermore, this study will also generate knowledge that can
NOTE: This preprint reports new research that has not been certified by peer review
contribute to and shouldResearch
ongoing not be used to guide
efforts clinical
and also practice.
will be used as
 medRxiv preprint doi: https://doi.org/10.1101/2020.10.02.20205807; this version posted October 5, 2020. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
perpetuity.
It is made available under a CC-BY 4.0 International license .
2 Biniam Worku Hailu: Assessment of Learning Organization Practice and Disciplines in Case of Sire District Public
Health Office, Arsi Zone, Oromia Region, Ethiopia, 2018:Qualitative Case Study

additional input for further study in the same area of inquiry. 2.5. Sampling Technique and Procedure
Operational Definition of Learning Organization
Learning Organizations: are organizations where people Purposive sampling technique was employed in selection
continually expand their capacity to create the results they of participants for both in-depth interview and focus group
truly desire, where new and expansive patterns of thinking are discussion.
nurtured, where collective aspirations are set free and where The numbers of in-depth interview were determined by
people are continually learning how to learn together [8]. saturation of information. However, a total of three In-depth
Personal mastery- Learning to expand personal capacity to interviews were carried out in sire District health office. In-
create results most desire and creating an organizational depth interview was conducted for 3 key informants
environment which encourages all its members to develop consisting of; one health extension worker, 1 Primary health
themselves toward goals and purposes they choose [8]. care unit director, 1 district health office Head who was
Mental Models- reflecting upon, continually clarifying, selected purposively based on their expertise and experience
and improving internal pictures of the world, and seeing how within the district health office.
they shape our actions and decisions [8]. Focus group discussion was conducted in two groups that
Shared Vision- Building a sense of commitment in a group [8]. were purposively selected from Health Extension Workers,
Team Learning- Transforming conversational and District health office Core process owners, And each group
collective thinking skill [8]. consisted of 12 and 10, experienced moderator facilitated the
Systems Thinking- a way of thinking about, and a discussion using semi-structured interview questionnaire
language for describing and understanding forces and focusing on Peter Senge Five Discipline of learning
interrelationships that shapes the behavior of systems [8]. organization and 8 Criteria of learning Pedler et al challenge to
be learning organization and their contribution in solving the
problems. The FGD took an average of 69 minute to discuss
2. Methods and Materials the issue under study.
2.1. Study Area and Period During this study District Health office plan and
achievement on Wash, health extension data concerning
The study was conducted in Sire District from January, 1-11, maternal and child health, nutrition and others program areas
2018. The district is one of the 26 districts found in Arsi zone. were reviewed.
The district has 18 kebeles, 1 urban kebeles and 17 rural kebeles.
The district is located 145KM and 75 KM from A.A and Asela
respectively. The population of the district was 73,970 in 2007 2.6. Data Collection Techniques
according to National census reported the rural population In-depth interview, Focus group discussion, and Review of
accounts for about 67,757 (91.6%) of the population [9]. The documents were used. A total of two FGDs were conducted
district has four health centers and 17 health posts. with Health Extension Workers, district health office Core
2.2. Study Design process owners and PHCU directors.
As well as FGD; in a way that appropriate time and
Case study (Qualitative) design was employed comfortable place of meeting was selected and organized.
Before conducting the discussion, explanation and
2.3. Population elaboration of the need to do the FGD was made and the
2.3.1. Source Population participants were asked for their willingness to participate in
All Health Workers Working in Sire District Public Health the FGD. Each FGD group was conducted by two team
office were source of population. members composed of recorder and facilitators who were
fluent speaker of local language.
2.3.2. Study Population In-depth interviews; were made with three key informants
District Health office Head, vice head, District Health Sire district public health office it was made by who were
Office process owners, Primary health care directors and fluent speaker of local language. Audio record and notes
kebele’s health extension workers. were used for taking qualitative data in FGD and in depth
interview.
2.4. Sample Size
2.7. Data Collection Tools
A total of two Focus group discussion (with minimum and
maximum duration of 57 and 82 minutes respectively, and Data were collected using FGD guiding questions,
with the number of participants ranged from ten to twelve), Document review checklist (data extraction tool) and In-
three in-depth interview and Document reviews (1) depth Interview guides.
operational and program plans;, changes to existing To assess sire district public health office whether the
programs, or to end programs; (2) Performance appraisal organization is learning organization or not the investigator
result (3) organization-level documents (e.g., organizational had adopted two study tools for interview and FGD to make
chart, strategic plan). In total, 8 documents were submitted assessment coherent and enhance accuracy before the
all available documents were reviewed). investigators had adapted a semi structured questionnaire
 medRxiv preprint doi: https://doi.org/10.1101/2020.10.02.20205807; this version posted October 5, 2020. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
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3

from Pedler et al and five disciplines Peter Senge [10,11]. generalized in to eight themes.
The determination whether the organization learning 1) Adopt a learning approach to strategy
organization or not the assessment tools trace the following 2) Participative policy-making
main points: 3) Access and transparency of information,
1) Assess the organization in terms of criteria (dimension ) 4) Formative accounting
of learning organization 5) Internal exchange and dialogue
2) Assess the organization in terms of Discipline of 6) Reward flexibility,
learning organization? 7) Inter-company learning,
3) Learning organization cycle 8) Self-development opportunities for all
4) Challenge the organization faced to be learning A learning organization is continually getting ‘smarter’
organization because learning is planned, systematic and in alignment with
The jotted down above points address the key the concept the organization's strategic goals. In order to get smarter, the
of learning organization. the result of assessments tools are organization needs to capture its organizational knowledge.
analyzed and presented similar idea amalgamated together Pedler et al have described the process of how organizations
have been described to make description clearly also learn, and identify the outcomes of the process as the
comparison also made between assessment tools results vs. development of core competencies, which are ‘… the
scholars view to make the study rational. collective learning in the organization’. This occurs at all
levels and functions within the organization [10]. On the
2.8. Data Analysis surface, developing core competencies has an intuitive appeal,
Data were transcribed in to text by principal investigator examined in this literature when the investigators assessed sire
after listening audio recoded and reading the written District health office by criteria of learning organization to
interview notes. Different ideas in the text are color coded determine the organization is whether learning organization or
and merged in their thematic areas and thematic analyses not the investigators examined the sire District health office
were employed manually. And then the analyzed data were according to. Pedler et al scholar learning organization
presented in text, table and diagram. assessed. Data were transcribed in to text by principal
investigator after listening audio recoded and reading the
2.9. Ethical Considerations written FGD notes. Different ideas in the text are color coded
and merged in their thematic areas and thematic analyses were
Formal letter of permission was obtained Sire Woreda employed manually. And then the analyzed data were
public health office to communicate with Health Extension presented in text. Thematic areas are as follows;
workers, Primary health care directors and district health Theme 1. Organizational adopts a learning approach to
office core process owners. strategy.
In this study most of participants said that organization
3. Result Adopt a learning approach to strategy and the organization
also participate entire employees and stakeholders to carry
In FGD open ended questions attached on the Annex out organizational plan that was also align with national
guided the data to capture information towards 8 Criteria of strategy of the country. One of the discussant from FGD 2
learning organization Pedler et al and In depth semi- structure stated that “……when Sire District health office carried out
interview question guided Peter Senge Five Discipline of its plan it involves the entire employees and important
learning organization and challenge to be learning stakeholders. the District health office plan started from
organization and their contribution in solving the problems situational analysis after the plan is performed its
[10, 11]. The data were organized and managed manually. achievement is monitored consistently through Performance
Open coding assists us to identify specific categories of monitoring team carry out its tasks according to plan they
learning organization mentioned by discussants while axial routinely identify root causes problems and develop action
coding used to connect Criteria learning organization using problem investigation and action plan form this make
assessment sited prior identified by discussants. the office to follow up and implementation proposed
3.1. Focus Group Discussion (FGD) intervention were to identify early and make instance
decisions for the gap manifested”
Two FGDs (One FGD with Hews and one FGD with job Theme 2. Participation of employees and stakeholders
process coordinators and expert were conducted. Each FGD In this study most of participants said that the organization
comprised of ten to twelve participants. Participants of FGDs observe a problem from different aspects and encourage
were purposely selected. A total of 21 participants (10 male employees to engage across the organization and with outside
and 12 females) were included. The age of the participants environment to bring solutions together.
ranged from 20 to 54 years. All participants engaged well with One of the discussant from FGD 1 stated that “……The
the topic and responded enthusiastically to the questions. organization participate employees and stake holder starting
During the qualitative data collection of FGD were from organizational plan up to achievement of the plan. The
learning organization assessments. Finally, the findings were district health office oriented the employees regarding their
 medRxiv preprint doi: https://doi.org/10.1101/2020.10.02.20205807; this version posted October 5, 2020. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
perpetuity.
It is made available under a CC-BY 4.0 International license .
4 Biniam Worku Hailu: Assessment of Learning Organization Practice and Disciplines in Case of Sire District Public
Health Office, Arsi Zone, Oromia Region, Ethiopia, 2018:Qualitative Case Study

job duties and also empowered to perform their job duties communication flow of the organization relevant and crucial
under full of accountability’’ for the organization”.
Theme 3. Access, transparency information Theme 6. Reward flexibility
One of the discussant from FGD 1 stated that “……The In this study most of participant said that the organization had
access of information in the organization is possible to be facilitate reward and career benefit scheme for their employees
seen in two perspectives. The health office initially depend on performance status employees. Possible explanation
accessibility of information toward training concerning for this could be promoting a culture of engagement.
capacity building of the organization in this case the As an example one discussant from FGD 1 stated that
organization enable Entire employees has to took integrated “……The organization rewarding systems depend on
and program training so as to make enhance accessibility performance status employees. The District has organized team
training the organization to adopt various strategies, the first those who perform reward and career prospect the so called
is implementation of on job training in the organization reward and career team. The team does their own work plan and
example with trainee staff after taking training either at also work aligned with performance appraisal committee.”
zonal or regional level and when he/she return back to work One of the discussant from FGD 1 stated that “……Sire
place he/she expect to rendered on job training to concerned District health office since 2014 its performance evaluation
staff members and also human resource managers of at Zonal and District level its Rank is first owing to this, the
organization audited training. Secondly, the organization District Role models employees has got seven Master and
staff including supportive staff and health workers access Three Degree the employees got Tertiary education even
information regarding their job in the organization via one to though this education solely given to a few role module
five network on daily bases’’. employees, it provide opportunities for other individual
Also another discussant from FGD 2 stated that “……to employees to have bright Career prospects. And also for the
make information within the organization transparent; every rest of workers the organization facilitate might be either
department unit posted their performance in the office in the extrinsic reward (promotion, increase in pay according to
visible place. This enables possible everyone to saw their public service laws) or intrinsic reward (greater fulfillment
performance without support of the departmental personnel through a more demanding or higher-status job)”.
with shorter span of time and on the other hand transparency Theme 7. Inter-health facility learning,
of information in the organization adhered by transparent In this study most of participant said that the organization
financial system control such as the ledger balanced book put collected the best experience and share those best
on visible place and also the liquidation and expenditure of experiences for different health institution. In healthcare
the budget was posted monthly and quarterly in the office”. settings, the learning acquired from the new knowledge
Theme 4. Formative accounting system of organization should be deep rooted and become part of daily operations of
One of the discussant from FGD 1 stated that “…… The health institution this enables.to be Acquired knowledge and
formative accounting system of the our organization incorporated from outsiders embedded in the working
Emphasis on the formative processes through which control systems, practices, and structures can be used and shared to
procedures occurred and the tasks performed are then argued improve performance
between the monitoring actor and the controlled one, with the One of the discussant from FGD 1 stated that “……the
purpose is to generate progress and learning. Constructive organization initially start collecting best experience via
approaches should be shared on an organizational level and photograph, video and report. The organization organize the
become part of the overall procedural system. The collected data of best experience of primary health care unit
accounting, budgeting and reporting systems have to be set share those best experience for the rest primary health care
up so they promote learning.’’ unit during review meeting conducted afterword the District
Theme 5. Internal exchange and dialogue facilitate the primary health care unit to make action plan to
In this study most of participants said internal exchange and implement and improve those best practice through the
dialogue system of the organization was decentralized system process of above indicated jotted down stage the District
that mangers or team process owners didn’t make decision reached learning organization level owing to this the
solely rather managers consider Dialogues open space for regional as well as the zonal health office selected sire
critical thinking and bring logical, appropriate and new ideas District health as pilot learning organization center and the
to contribute to the culture of learning for their organization. District also share experience for different District health
One of the discussant from discussant from FGD 1 stated office, health facility and zonal health department”
that “……Internal exchange and dialogue system the Theme 8. Self-development opportunities for all
organization is decentralized the manager does not solely One of the discussant from FGD 1 stated that “……There
make decision rather participate employees in the decision were a lot of opportunities, materials, and resources
making. Employees also share information themselves daily available for learning. Thus resource has been allocated by
through one to five network they also solve the problems and the government and Non-Governmental organization such as
make decision in their network regarding to the function and transform health care project which facilitate break through
responsibility which are articulated within the organization grant and work on transformation agenda for enhancement
this communication and dialogue schemes make the of capacity of employees focuses on the possibility to access
 medRxiv preprint doi: https://doi.org/10.1101/2020.10.02.20205807; this version posted October 5, 2020. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
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5

learning opportunities and to start personalized development first degree holders. Two of them were males and one was
processes but, the allocated resource for us not adequate but, female. By the position they held, one were deputy or vice
we use it as intensively ” This criterion could be related to heads, one PHCU Director and one job process coordinator.
Senge’s discipline of personal mastery and with Stewart’s The age of the participants ranged From 23 to 48 years. In-
requirement of individuals committed to self-development. depth interview results were merged and presented together
The problem here consists in who owns the learning, the by quoting the words of the interviewees.
employees or the employers, and the uses to which the new During in depth interview data collection were learning
learning will be put. organization assessment finally, the findings were
generalized in to five themes.
3.2. In Depth Interview Theme 1 ...Personal mastery
A total of three key informants were planned to in depth Theme 2. Mental Models
interview from three planned key informants three of them Theme 3 Team Learning
were accessed with minimum and maximum duration of 50 Theme 4. Shared Vision
and 95 minutes of interview respectively. Out of the three Theme 5. Systems thinking
interviewed key-informants, one was second and two were
Table 1. The five Disciplines of learning organization assessment of sire District health office, 2018.

Does the organization Implement

S.N Theme learning discipline element? The Participants expressed their view during in depth interview as follows
Yes No
A 23 years old man who was from Sire District Health office said that,” Sire District
health office its personal mastery characterized by in their base the right employees are
Theme 1.
1 P allocated to in the right place according to their profession and structure of the
Personal mastery
organization the employees besides this they are committed to the achievement of the
organization goal.”
A 25 years old man who was from Sire District Health office said that, “A mental model of
the organization when we evaluate the employees have grasped the information and
Theme 2. Mental technical new things through different mechanism such as on job training, off job training,
2 P
Models Google search and in their one to five network those mention mechanism described
facilitate by the organization owing to this the employees update their knowledge and
critically questioning old assumption.”
A 48 years old man who was from Sire District Health office said that, “The organization
Theme 3. Team creates a sense of common sprite within the organization. employees of the organization
3 P
Learning also enhance team learning via in their one to five network they discussed, communicate,
share new idea and solve the problem with cooperatively by assisting each other.”
A 48 years old man who was from Sire District Health office said that, “The organization
involved entire employees in the process of planning and employees also empowered in
Theme 4. Shared
4 P their job so that a shared vision of the organization begin with the individual employees
Vision
also build a sense of commitment toward the achievement of the organization vision or
common goal.”
A 25 years old man who was from Sire District Health office said that, “The organization has
not focus on limited activities of the organization rather the organization integrate entire the
Theme 5. systems activities of the organization achieved its target and on the other hand on behalf of employees
5 P
thinking they are assign each employees of District health office supervisors to supervise one Primary
health care unit when they conducted supervision expert giving supportive supervision with
using planned integrated checklists.”

3.3. Document Review changes to existing programs, or to end programs; (2)

Performance appraisal criteria result; (3) organization-level
The purpose of the document review was to examine documents (e.g., organizational chart, strategic plan). In total,
if/how the concept and approaches of learning organization 8 documents were submitted all available documents were
were incorporated in the organization’s written items and to reviewed the documents result regarding to learning
discern changes in the presence of evidence and over time. organization the organization phase of being learning
representatives were asked to provide a sample of recent organization as shown below summarized figure 1.
documents, including: (1) operational and program plans,
 medRxiv preprint doi: https://doi.org/10.1101/2020.10.02.20205807; this version posted October 5, 2020. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
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It is made available under a CC-BY 4.0 International license .

Figure 1. The sire District learning organizations cycle its implementation status, 2018.

This figure shows clearly learning organization cycle of implemented in the District health office level up to the
sire District public health office Learning Organization cycle health facilities linked in primary health care unit. when this
of the district health office which indicate is total system or result compared with study conducted in Suffolk University,
integration of knowledge into the organization. The Boston, Massachusetts, USA on assessing change: can
Organization learning cycles are not merely collections of organizational learning “work” for schools which revealed
individuals, yet there are no organizations without such that if schools were not be a learning organizations it’s
collections. Yet the organizations learn only through the difficult to improved organizational performance as well as
experience and learning of individuals. It is clear that a major minimizing turnover [12].On the other hand the study
challenge is that of transforming or transferring individual conducted in Kenya revealed that specific knowledge scheme
learning into organizational learning. Learning takes account exerts competitive advantage for the organization [13]. This
of the creation and diffusion of knowledge at various levels: finding was in lined when compared with learning
the team, departments, and organization. organization criteria implementation sire District as it was an
The document review analyzed from sire District Public exemplary public organization that have nice performer as
health office specially the District plan vs. performance, knowledge and experience sharing organization. When
number of model employees having high Performance Senge’s five principles of learning organization assessed
appraisals grade had got recognition letters from different qualitatively the five principles in sire District were well
higher officials and also on behalf of the organization got developed when compared to study done in Technological
different reward from different organization based on good Educational Institution of Western Greece that are developed
performance in District as well as at zonal and regional level. well shared vision, team learning and system thinking only
out of the five learning organization principles[12]. The
4. Discussion result analyzed with clear thematazed from the FGD and in-
depth interview discussants told as to became as learning
The output of frame learning organization this study was organization as an organization many challenges was passed
analyzed and conceptually connected The results revealed through. The five senge’s learning principles was fitted as an
that majority of discussants raised sire District public health organization and the document review analyzed from sire
office as found as learning organization in both parameters District specially the District plan performance, number of
five "learning disciplines and eight Criteria of learning model workers with individually having high grade work
organization Pedler et al [10, 11]. evaluation and recognition letters took from different higher
The sire District public health office status in both the officials suggested that those principals are well and
FGD and in-depth interview the study result revealed that it integrally implemented.
was a benchmark District for horizontally or vertically inter Finally, findings from the document review, in depth
related organizations or institution. According to FGD result interview and FGD were well analyzed and give sense that
with the eight learning organization criteria/parameter like the studied organization was learning and other might be
adopt a learning approach to strategy, In Generative Learning used it as a bench mark.
Organizations, Participative policy-making access and This study has limitations of raising the same idea and
transparency of information, formative accounting, internal influenced by others idea during FGD discussion as well as
exchange and dialogue reward flexibility, Inter-company there might be self-reporting bias during in-depth interview.
learning, Self-development [10]. were accordingly Another limitation of this study was limited literatures to
discuss in Africa and Ethiopia context.
 medRxiv preprint doi: https://doi.org/10.1101/2020.10.02.20205807; this version posted October 5, 2020. The copyright holder for this
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
perpetuity.
It is made available under a CC-BY 4.0 International license .
7

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