Healthcare systems face growing pressure from aging populations, staff shortages, and limited resources, yet they often struggle to translate knowledge and improvement ideas into sustainable practice. Rachel Margrethe Lørum’s doctoral thesis investigates how organizational learning can be strengthened across professional, organizational, and sectoral boundaries in fragmented healthcare systems.
Through five studies conducted in a large Norwegian healthcare region, the thesis identifies strategies, learning actions, and leadership behaviors that enable improvements across silos.
What challenges do you focus on in your research?
“I focus on the challenge that many healthcare systems face today: they aspire to become learning healthcare organizations, but fragmentation, multiple external demands, siloed structures, and limited leadership autonomy make it difficult to turn this ambition into reality. My work examines why learning often breaks down across boundaries between primary care and specialist care, and what it takes to overcome these barriers.”
How do you address the problem?
“I study organizational learning directly in practice, using a participatory action research approach in a regional healthcare system involving thirteen municipalities and one hospital trust. Through interviews, surveys, observations, workshops, and mixed-methods analyses, I examine how leaders and clinicians collaborate, share knowledge, and adapt their work. By combining insights from research on expansive learning, learning-oriented leadership, and organizational network architecture, I develop a deeper understanding of how learning can be strengthened in fragmented systems.”
What are the main findings?
“My results show that organizational learning develops most effectively through participatory and iterative actions such as cross-site feedback, joint reviews of patient records, structured reflection sessions, and rapid co-creation cycles etc. These learning actions worked best when supported by collaborative, network-based strategies and leadership that fostered trust, learning climates, and knowledge sharing.”
“The research also shows that learning-oriented leadership seem to be highly context-dependent and shaped by structural conditions such as multiple external demands, siloed organizational structures, wide spans of control, and restricted autonomy. Despite these constraints, leaders who provided support, built climates for learning, and facilitated knowledge dissemination seemed to be more able to sustain learning across boundaries. Together, the findings form a four-part model showing that sustainable organizational learning depends on the alignment of context, organizational architecture, collaborative leadership, and collaborative learning.”
What do you hope your research will lead to?
“I hope my research will help healthcare organizations design more effective ways of learning and improving across traditional boundaries. By applying such strategies, learning actions, and leadership practices identified, health systems could work more collaboratively, adapt more quickly, and create safer and more coherent services for patients. Ultimately, I hope this work contributes to the development of truly learning healthcare systems able not only to cope with complexity, but to use it as a catalyst for improvement.”
Read the thesis: Organizational learning for improvement of fragmented healthcare systems
Public defence: 15 December 2025 at 10:00
