The 4I Framework & the University of Utah’s Department of Surgery

The 4I Framework & the University of Utah's Department of Surgery

According to Crossan et al. (1999), organizational learning entails four processes (intuiting, interpreting, integrating, and institutionalizing) utilized across three levels (individual, group, and organization), known as the “4I framework.”

Interestingly, while intuiting is an inherently “human” trait (i.e., performed at the individual level), and institutionalizing must be done at the organization level, the processes of interpreting and integrating blur the lines of individual/group and group/organization, respectively. In my opinion, this is apparent in virtually every facet of learning at the University of Utah.

For example, though our residents have all completed medical school, and presumably have a good fund of medical knowledge, they are continuously intuiting, or preconsciously recognizing similarities and differences in their patients as they go through their training. For instance, they may have learned about certain symptoms, diseases, or procedures in their classes, but it is in practice that they notice what a set of similarities and/or differences may indicate, including quandaries they may not have learned about in their schooling.

Interpreting can then occur in the form of “explaining, through words and/or actions, of an insight or idea to one’s self and to others” (Crossan et al., 1999, p. 525). In doing this, patterns begin to make sense, and by including fellow colleagues, the conversation becomes more robust and affords the chance for others to learn.

At a group level, once a situation is understood, shared understanding may be developed; in the different divisions and programs, this occurs in various forms – via creation of a treatment plan, quality improvement projects, Journal Club, education meetings, or research. If satisfactory, processes are then adapted, or institutionalized, at the department (organization) level to be used by all members.

The process(es) that the 4I framework describe(s) is one that positively influences the learning culture at the University of Utah. Understanding is organically gained at the individual level and works its way “up” to encompass not only other “typical” learners (medical students, residents, fellows), but also attending physicians, staff, patients, and others.

In turn, we are in the unique position to then be able to impact those outside of our organization by conducting and publishing research on what we have learned, or are learning, enabling better medical care and education worldwide.


Crossan, M.M., Lane, H.W., & White, R.E. (1999). An organizational learning framework: From intuition to institution. Academy of Management Review, 24(3), 522-37.

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