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Short abstract:

This study explores the institutionalization of reflexivity practices in healthcare organizations to address the need for continuous transformation. Based on thirteen Dutch healthcare projects, cyclical routes to healthcare impacts are described and applied to a tool for healthcare professionals.

Long abstract:

Healthcare organizations require continuous transformation to address an evolving landscape. Here, healthcare professionals are simultaneously navigating a changing context and shaping the direction of transformation through advocacy or resistance. To address this everchanging context, institutionalization of a continuous reflective learning process is needed. It is simultaneously individual and collective, and the level of reflection (a focus beyond behavior on underlying goals, values, strategies, and assumptions) influences the depth of change that can be established. This study describes routes to healthcare impacts through continuous learning and improvement practices at the (intra)organizational level. To achieve this, representatives of 13 learning and improvement projects in various Dutch healthcare contexts were interviewed. Using a theory of change approach for analysis, routes to impact were defined, including: inputs, activities, learnings and changes, and impacts. Importantly, these routes are cyclical in nature, meaning that each subsequent cycle can further establish a sustainable culture of reflexivity. Next, our routes to impact were converted into a tool for healthcare professionals, using design principles formulated during feedback and brainstorm sessions with both researchers and stakeholders. At the core of the tool is the idea that learning is situated; abstract concepts require active recontextualization (i.e. giving new meaning through reflecting on application in a new context) to be effective and enduring. Therefore, the tool contains broadly applicable indicators and definitions, exemplary quotes, and reflective questions for recontextualization. We argue that it can be applied in practice for meaningful reflexivity, contributing both to the quality and efficiency of health care.