The HCOL Compass: Preliminary Development and Evaluation of a Systems-Oriented Leadership Tool for Organizational Learning in Small-to-Medium Healthcare Organizations.

BACKGROUND: Small- to medium-sized healthcare organizations (SMHCOs) are often led by clinicians who simultaneously deliver care and manage organizational systems. Although organizational learning is recognized as an important driver of organizational adaptability, practical tools to support its application within SMHCOs remain limited. OBJECTIVE: To develop and evaluate the Healthcare Organizational Learning (HCOL) Compass, a prototype systems-oriented leadership tool oriented around the foundational concepts of leadership that reinforces learning (LRL), organizational context (OC), and knowledge management and mobilization (KM/KMb). METHODS: Guided by principles of complex intervention development and design-based research, this iterative multiple-methods study evaluated and refined the HCOL Compass across two sequential rounds (n=8). Content validity was assessed using the Content Validity Index (CVI), while implementation utility was evaluated using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Semi-structured interviews were analyzed using deductive, inductive, and axial thematic coding. Participants included organizational learning experts and clinician-leaders in Canadian community-based optometry. RESULTS: Content validity and implementation scores improved from Round 1 to Round 2 (S-CVI: 81% to 94%; AIM from 80% to 95%; IAM from 73% to 96%; and FIM from 67% to 91%). Qualitative analysis identified four themes: sense-making through visual design, balancing guidance with reflective practice, hidden sources of organizational complexity through structured scaffolding, and systems thinking as an integrative mechanism. CONCLUSION: The HCOL Compass showed preliminary evidence of feasibility and utility as a systems-oriented leadership tool for SMHCOs. The emergence of a Systems Thinking layer suggests that organizational learning may be strengthened by intentionally designing for redundancy, margin, and shared understanding across organizational domains.