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ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 175-181

Application of dimensions of learning organization questionnaire in a dental institution in national capital region of India: A cross-sectional study


Department of Public Health Dentistry, D. J. College of Dental Science and Research, Modinagar, Ghaziabad, Uttar Pradesh, India

Date of Web Publication10-Jun-2016

Correspondence Address:
Jishnu Krishna Kumar
Department of Public Health Dentistry, D. J. College of Dental Science and Research, Ajit Mahal, Niwari Road, Modinagar, Ghaziabad - 201 204, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.181898

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  Abstract 


Introduction: The research knowledge translation along with evidence-based learning in health systems has increased during the last decade, particularly because of the recognition of its importance for achieving many of the Millennium Development Goals. Till now, no studies have highlighted the learning atmosphere in dental learning institutions. Aim: To assess learning culture in a dental institution in National Capital Region of India applying the dimensions of the learning organization questionnaire (DLOQ). Materials and Methods: DLOQ pro forma was distributed among 236 employees at all levels of the dental institution. Data were analyzed using SPSS software version 19.0; Chicago; IL, USA and was subjected to quantitative analysis and nonparametric tests. Results: The dimension “embedded system” scored the lowest mean of 2.36, while the dimension “systems connection” scored the highest mean of 4.02 in general. A significant difference (P ≤ 0.05) between the means of the different professions was noted, whereas on comparison of the relation between each of the professions were performed and a significant difference (P ≤ 0.05) with respect to all the seven dimensions was also noted. Conclusion: The results provided sufficient inputs about the multidimensional learning organization capacity of a dental school in a rapidly developing country like India. This tool can be used as a reliable assessment technique in a dental learning setting to inculcate a wave of individual and organizational learning.

Keywords: Dental, hospital, learning, multidimensional, teaching


How to cite this article:
Kumar JK, Patthi B, Singla A, Gupta R, Prasad M, Pandita V. Application of dimensions of learning organization questionnaire in a dental institution in national capital region of India: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:175-81

How to cite this URL:
Kumar JK, Patthi B, Singla A, Gupta R, Prasad M, Pandita V. Application of dimensions of learning organization questionnaire in a dental institution in national capital region of India: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 May 26];14:175-81. Available from: http://www.jiaphd.org/text.asp?2016/14/2/175/181898




  Introduction Top


Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity, commonly in the dentition but also in the oral mucosa, and of adjacent and related structures and tissues, particularly in the maxillofacial (jaw and facial) area. Dentist's areas of care include not only their patient's oral cavity but also the musculature of head, neck, and jaw including the diagnosis and treatment of salivary glands, the nervous system of the faciomaxillary region and the adjacent areas.[1],[2] Thus, dental schools need utmost quality and technological know how at par with international standards.

According to “global goals for oral health 2020,” sustainable overall development of health necessitates the reduction of disease of oral and craniofacial origin. Learning organizations have improved themselves in capturing and transforming knowledge intentionally for strategic leadership. Many low- and middle-income countries have a great disparity in the oral health care provided, and there is a need to expand the delivery of oral health services to those in need.[3],[4] Pan nation knowledge transfer along with proper uptake of information is definitive in all learning institution.[5],[6]

Practice-based knowledge transfer with qualitative applicable knowledge is a necessity in the ever chaotic healthcare environment. India though being a developing country has the highest number of dental colleges in the world.[7],[8],[9]

However, it does not have a systematic and reliable approach to quantify specific different dimensions of a learning organization. The research knowledge translation along with evidence-based learning in healthcare learning institution has increased during the last decade.[10]

Marsick and Watkins defined a learning organization as one that learns continuously and proactively uses learning in a way that is infused with its work. In their view, seven interdependent action imperatives characterize organizations that are aiming to become learning organizations: The organization should (1) create an environment that continuously supports learning, (2) promote inquiry and dialog, (3) encourage collaboration and team learning, (4) establish systems to capture and share learning, (5) empower people to have a collective vision, (6) connect the organization to its environment, and finally (7) leaders should provide strategic support for learning.[11],[12]

The dimensions of learning organization questionnaire (DLOQ) is a 21-item-based questionnaire spanning seven dimensions of various capacities in a learning institution. The scores obtained from DLOQ may be used to create and evaluate the profile of a learning organization as a basis for improving its capacities qualitatively.

There have been learning organization studies in healthcare settings, but no reported empirical studies anywhere around the world that assesses dimensions of learning organization in a dental institution. Considering this fact, it is therefore important to explore the applicability of the learning organization concept in a dental learning organization in India. The main objective of the study was to obtain an image of the learning culture in a hospital setting, and thus, the study was designed and executed to track the positive and negative performance of such an organization in a country like India.


  Materials and Methods Top


A Dental Care Center cum Teaching and Research Institute located in the National Capital Region of India was considered for the study since it is a teaching hospital for dental undergraduate and postgraduate students and dental hygienists and a major private dental institution covering Eastern part of National Capital Region and Western part of Uttar Pradesh, India. In the beginning of the month of May 2015, permission was granted by the head of the institution and ethical review board at Modinagar, India, to conduct the study. All the doctors, postgraduates, hygienists, technicians, and administrative staffs were notified using circulars. The pro formas were distributed among the participants in 2 days who had agreed to participate in response to the circular. The pro forma was then collected back within a span of 1 week after careful explanation of the questionnaires. The institution has a staff capacity of around 76 doctors (BDS and MDS), 135 postgraduate students of the 3 years stipulated MDS curriculum by the Dental Council of India, 8 hygienists and technicians, and 17 administrative staffs.

Around 100 undergraduate and 40 postgraduates are admitted each year according to the dental council mandates in India. The institution is equipped with around 250 dental chairs divided among undergraduate and postgraduate sections, along with maxillofacial trauma care unit attached to the maxillofacial surgery department. The dental teaching organization has an attached 150 bedded multispecialty hospital that caters to its necessary academic and medical needs.

A pilot study was undertaken on 10% of the total population (n = 32). It served as a preliminary study to check the feasibility and relevance of the study. The questionnaire was checked for its validity and reliability. Criterion and construct validity of questionnaire were assured using Spearman's correlation coefficient (P< 0.001). The construct validity was calculated for each dimension that is continuous learning, inquiry and dialog, team learning, embedded systems, empowerment, system connection, and strategic leadership by calculating Spearman correlation between individual items for the particular construct and overall score of that construct. The internal reliability for the responses to questions was assured using Cronbach's alpha coefficient (0.85). A pilot testing was conducted considering the requisites of modified DLOQ study. It was found that proper explanation of the items was necessary to maintain transparency of the DLOQ concept and prevent misinterpretation, which was done by the principal investigator. According to the pilot testing, the present sample size was estimated, and the pro formas were distributed on a day as suggested by the dean of the organization and it was made sure the distributed pro formas were collected after careful explanation of the questionnaires. As part of the study, the number of participants were tabulated from the institutions directory, and a total of 236 pro formas were distributed, 218 were collected, corresponding to a response rate of 92%.

The prime assessment technique used in this study is derived from the original version developed by Marsick and Watkins and as modified by Leufvén et al. for a healthcare setting. [Table 1] describes the seven dimensions and their statements in detail. The seven dimensions were measured on a 5-point Likert scale ranging from 1 - almost never to 5 - almost always [Table 2]. Ethical approval was obtained from the institutional review board at Modinagar, India. Informed consent was individually obtained from every participant after explaining the study. The questionnaires along with demographic forms were distributed personally among all the staffs, postgraduate junior residents, hygienists and dental technicians, and the administrative staffs, serving the institution.
Table 1: Marsick and Watkins model of the dimensions of the learning organization[12]

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Table 2: Demographic characteristics of the study subjects

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Data analysis

The collected data were analyzed using SPSS software (version 19.0); Chicago; IL, USA. The data were subjected to quantitative analysis and nonparametric tests were used. Kruskal–Wallis test was used to test the significant difference between the four groups of professionals, and Mann–Whitney test was used to compare the intergroup significance assessed with Kruskal–Wallis.


  Results Top


The respondents were 32% teaching staffs, 57% postgraduate junior residents, 4% hygienists and dental technicians, and 7% administrative staffs.

[Table 2] explains the demographic characteristics of the participants where the largest proportion of subjects stood in the age band of 20–30 years (68.35%) while 58.72% of the participants were females and the largest participating professional group were the postgraduate students (57.34%). The descriptive statistics for the proposed statements related to the dimensions are presented in [Table 3]. The overall means of Q1 and Q21 ranges between 2.35 and 4.09. On applying statistical tests, a significant difference between the means of the different professions was noticed among all the dimensions. [Table 4] shows profession-wise significant dimensional differences with system connection scoring the highest of 4.0 and embedded system having the lowest average of 2.36, where all the professional groups showed a significant interdimensional significant difference of the mean scores and interprofessional significant difference. Teaching staffs scored the highest mean of 4.53 in team learning, and the administrative staffs scored the lowest mean of 1.54 in the dimension continuous learning. Subsequently, a significant difference (P< 0.05) between all the study groups was noticed regarding the seven dimensions was noted.
Table 3: Distribution of responses and mean scores for questionnaire of the dimensions of learning organizations

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Table 4: Profession wise descriptive statistics as per dimension

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  Discussion Top


Multidimensional organizational learning in a postgraduate dental training school has been evaluated utilizing the art of DLOQ. Hence, our present study has been compared with the only past published study by Leufvén et al. in Nepal in a healthcare setting since there has been no published past research work to measure the learning organizational capacity of a dental school.[13]

The mean age of the employees was 33.5 ± 7.10 years, of which 41.74% were males and 58.26% were females. Throughout the systematic assessment, a supportive environment was noticed, inferring an optimistic approach of a health setting toward this tool. Taking the result into consideration, the dimension embedded system scored the lowest mean of 2.36, which shows a definitive overall potential zone for improvement. The earlier published study conducted in Nepal by Leufvén et al. scored 3.17 for the same dimension which shows a slight indifference to the said context which might be due to fear among study population of reprimand by their counterparts or superiors for trying out new activities. For an organization that strives toward becoming a learning organization, this is a concern due to the importance placed on teamwork and empowerment in learning organization models.[14] The working of a dental college like all other learning organization has always stayed hierarchical and bureaucratic that is the lower level employees, especially the lab technicians, hygienists, and to some extend the postgraduate junior residents do not have much role in the day-to-day decision-making, management, or working of the institution.[15],[16]

The dimension that scored the overall highest score was the one concerning system connection with an average 4.02. The study conducted in Nepal by Leufvén et al. scored a lower score of 3.21 for the said dimension. Denoting the link of the dental institution to communicate and barter the necessities even outside the institutional boundaries.[17] There is a persistent need to work from a global perspective since every healthcare setting is related to saving lives and improving health. This is made possible through interlinked collaborative efforts within the organization and the community.[18]

The innovative approach taken by the Dental Council of India to make adoption of at least four villages under a Dental College to provide comprehensive oromaxillofacial care was a splendid step toward community-based learning and innovation.[19] Team learning and collaboration scored an average of 3.26, this dimension is the primary necessity of every unit working in healthcare institution because medical science is a viable and necessarily a vital entity for human sustenance. While in the study by Leufvén et al., a score of 3.29 was noted which shows a net dimensional agreement. Inhomogeneous pattern of distribution of decision-making powers may cause disparity in team learning and cooperative thinking which might be a reason for comparatively lower scores.[19]

The dimension “continuous learning” scored 3.76, while the same dimension in the study conducted by Leufvén et al. scored a similar average of 3.24. In this dimension, the doctors have better opportunities to update knowledge and stay informed about latest cutting edge technologies since they regularly attend conferences and continuing dental education programs.[20]

The dimension inquiry and dialog obtained a mean of 3.65 which is in agreement to a slightly lower dimensional score of 3.14 as obtained in the study by Leufvén et al. This can be attributed to the fact that trust is an essential component of medical profession and sharing of open feedback has stayed in the limelight of modern medicine throughout the times. “Empowerment” scored an average score of 3.69, whereas in the study by Leufvén et al. scored a mean of 3.09. The motivational optimistic attitude that is “learning by working” in a health care clinical environment is widely influenced by professional attitude and administrative variation in different healthcare organizations in the country. However, there might be a lack in the core idea where every working individual is equipped and encouraged to take decisions and to handle the locus of routine control.[21]

Dimension “strategic leadership” scored a mean of 3.8, whereas in the Nepal study for the same dimension, the average score was 3.75.[13] There may also be an unwillingness to critique managers and leaders due to the hierarchical structure and the lack of amalgamation of equal representation from all sectors of institutional workforce in decision making.[22],[23]

When the interprofessional dimensional variations were considered teaching staffs scored the highest mean of 4.53 in the dimension team learning, and the administrative staffs scored the lowest mean of 1.54 in the dimension continuous learning. The teaching staffs might have scored the highest mean because have better scope and access to cutting edge technology with the help of colleagues who have ample knowledge in varied aspects of dental research compared to other professional groups. Since teaching staffs play a lead role in academic capacity of a learning organization they have an upper hand in seeking goals and suggesting recommendations for the institutional development. While the administrative staffs scored the least of all the professional groups that might be due to their periphery being limited to their official routine activities and paperwork related to the organization and have seldom access to continuous learning opportunities though they play a major role in functioning of a dental institution. On comparison with the study by Leufvén et al., the study groups comprised doctors, nurses, nursing students, and a missing professional group (who did not mention their professional attachment). Of all the groups considered under hospital setting for study in Nepal, missing profession showed highest mean score of 4.10 in the dimension strategic leadership, and the second highest mean score of 4.06 was obtained by nurses in the same dimension, whereas the lowest mean of 2.66 was scored again by the nurses in the dimension empowerment in the study by Leufvén et al. but cannot be compared with our present study due professional variation of groups considered for the study.

Globally, published studies that look into learning organization concept in a health setting other than the study by Leufvén et al. are conducted by Al-Abri and Al-Hashmi and Ratnapalan and Uleryk in Oman.[24],[25] Al-Abri and Al-Hashmi in Oman conducted a study taking into account learning organization in a healthcare setting but the said study cannot be compared to our study due to lack of objective and dimension-wise descriptive analysis of the setting. In the study, the author has pointed on the individual or personal development of skills that can aid the person to cope rapidly to ever chaotic health care setup and move freely between the situations. Like in the previous study, effective leadership has also been given key importance without stressing on traditional hierarchical monopoly but a transformational involvement of people from different sectors for technology-infused learning environment.[24],[25]

Ratnapalan and Uleryk also conducted a study in which they suggest the relevance of a learning organization in a healthcare setting. In their study, effective leadership was noted as the foremost requirement for creation learning organization, along with developing a healthcare learning system that respects and advocates patient safety and quality care. The author also noted those organizations that were able to utilize, transform, and implement the right kind of space for learning and adapt existing knowledge were successful in providing organizational learning and primary healthcare around the world.[25] However, these studies lack objective analysis of the concept in the study and thus cannot be compared.

Since there are no published relevant studies pertaining to DLOQ in a dental institution; it has limited comparative analysis of this study. The possible variation that might be noticed in the future dental-related settings might be due to modifications in learning mentalities, new modes of technological advancements and financial utilization in between intra- and inter-national countries. This study though can be used as a template to further promote research in the realm of learning organization concept in a dental learning setting. The results support the applicability of DLOQ in a dental learning organization in India though being the first ever study done anywhere globally pertaining to a dental context. This measuring tool will definitely aid in inculcating a wave of individual and organizational learning along with positive organizational developmental attitude as coined in Global Goals 2020.

Implication for policymakers

  • Maintenance of dental multidimensional learning organizational database across the globe
  • Inclusion of DLOQ technique in every dental teaching institutional inspection
  • 5-year intra- and inter-organizational comparison to assess individual and organizational research-knowledge learning qualitative enhancement
  • Improvisation of dimension-wise task force to monitor development of dental institution in all the seven dimensions.


Implication for public

Head and neck region along with teeth are of prime importance to us. Efficient evidence-based dentistry plays a vital role in this. Hence, the organizations where they are trained should be of utmost quality and laden with cutting edge technology that supports learning in every dimension. Finally, this instrument can be used in conjunction with other validated measurement tools to expand further research to the realm of social factors, professional constraints, cultural limitations, and national variations that may be added to provide a better outlook about the learning organization. This study would benefit the same by looking into the systematic maintenance of knowledge translation and quality healthcare distribution. The dimension included in the study inculcates community participation and allows the dental institution to understand and act according to innate necessities of the population.


  Conclusion Top


The results from this study definitely provide a mirror image about the multidimensional learning organizational capacity of a dental institution in a rapidly developing economy like India. It has shown the dimensional bottlenecks and the sites of overall excellence in a learning organization. It suggests that the stepwise bureaucratic hierarchical structure of an organization may be a frank hindrance to the organizational learning capacity along with concurrent utilization of internal and external resources to learn and flexibly cater to the treatment needs of the society. Although there are large numbers of dental colleges in the country, this technique is suitable for intra- or extra-organizational developmental assessment. From this study, it can be concluded that though DLOQ was completely devised and developed in the United States of America for its main utilization in company setting and nonhealth-related institution, the result demonstrates its applicability in a dental institution also since a noticeable variation between each of the study groups was noted and it was in agreement with previous studies. This reliable probe can be utilized by University Grant Commissions, National Assessment and Accreditation Councils, and Dental Councils to efficiently assess a dental learning organization in a real-time systematic manner in the near future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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