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Grand Rounds: Journey to Becoming a Learning Organization


By Sandip Godambe, MD, PhD, , Professor of Pediatrics, University of California at Irvine; Chief Medical Officer, Children's Health of Orange County (CHOC), Orange, California

Objectives (Educational Content) :

1. Identify the traits of a learning organization. 2. Describe how improvement science approaches can help facilitate change. 3. Explain how the creation of the capability and capacity for improvement science can help foster better collaboration and engagement, joy in work, and timely problem-solving.

Target Audience:

General pediatricians, family physicians, nurse practitioners, physician assistants, social workers, psychologists, and nurses.

Identified Gap:

Improvement science will enhance collaboration and engagement and provide timely problem-solving.

Estimated Time to Complete the Educational Activity:

1 hour(s)

Expiration Date for CE/CME Credit:


Method of Participation in the Learning Process:

The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.

Evaluation Methods:

All learners must successfully complete a post-test, as well as an activity evaluation, to claim CE/CME credit.


The speaker, Sandip Godambe, MD, PhD, has returned the disclosure form indicating that there are no relevant financial or other relationships with any commercial interests.

Accreditation Statement:

Children’s Hospital Medical Center of Akron is accredited by the Ohio State Medical Association to provide continuing medical education for physicians.

CHMCA designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit TM.  Physicians should only claim the credit commensurate with the extent of their participation in the activity.


1.           Ohno T. Taiichi Ohno’s Workplace Management: Special 100th Birthday Edition. New York: McGraw Hill; 2013. 195 p.

2.           Lloyd RC. Quality Health Care: A Guide to Developing and Using Indicators. Burlington, MA: Jones and Bartlett Learning; 2019. 368 p.

3.           Lloyd RC. Navigating in the Turbulent Sea of Data: The Quality Measurement Journey. Clinics in Perinatology. 2010;37(1):101-22.

4.           Lloyd RC. Better Quality Through Better Measurement. August 22, 2020 ed. Orlando, FL: IHI National Forum; 2018.

5.           Lloyd RC. Building Improvement Capacity and Capability. Healthcare Executive. 2018(May/June):68-70.

6.           Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2 ed. San Francisco: Jossey-Bass; 2009.

7.           Provost LP, Murray SK. The Health Care Data Guide: Learning from Data for Improvement. San Francisco, CA: Jossey Bass; 2011. 445 p.

8.           Deming WE. The New Economics. 3 ed. Cambridge: The MIT Press; 2018 2018.

9.           Senge PM. The Fifth Discipline: The Art and Practice of the Learning Organization. New York: Crown Business Publishing; 2006. 466 p.

10.         J. Bonini SAG, C.D. Mangum, J. Heer, S. Black, D. Ranada, A. Berbano, K. Stringer. Building an Engaging Toyota Production System Culture to Drive Winning Performance for our Patients, Caregivers, Hospitals and Communities. In: R. Shah S.A. Godambe, editors. Quality Improvement and Safety Science: A Case-Based Approach. 1st edition. Philadelphia: Springer Nature Publishing; 2021.

11.         Mangum CD, Stanley AJ, Peterson CC, Biava L, Dice J, Khan J, et al. Use of the Lean Manufacturing Principles to Improve Total Parenteral Nutrition Logistics and Clinical Outcomes in the Neonatal Patient Population. Pediatric Quality and Safety Journal. 2019.

12.         Sepanski RJ, Godambe SA, Mangum CD, Bovat CS, Zaritsky AL, Shah SH. Designing a pediatric severe sepsis screening tool. Front Pediatr. 2014;2:56.

13.         Sepanski RJ, Godambe SA, Zaritsky AL. Pediatric Vital Sign Distribution Derived From a Multi-Centered Emergency Department Database. Front Pediatr. 2018;6:66.

14.         Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017.

15.         Sampath B, Rakover J, Baldoza K, Mate K, Lenoci-Edwards J, Barker P. Whole System Quality: A Unified Approach to Building Responsive, Resilient Health Care Systems. IHI White Paper. Boston: Institute for Healthcare Improvement; 2021.

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There are 10 nurses in the picture.

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The five differences are:
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– Clipboard paper color

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The two matching doctors are 9 and 14.

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The correct path:
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