Creating a High Learning Organization in Healthcare (and delivering measurable outcomes from learning)

Healthcare is a constant state of change. Healthcare organizations need to become high learning organizations to respond to the current pace of change. Currently, education is seen by healthcare finance as ‘non-productive time that should be limited or eliminated if at all possible,’ so organizations need a new way to look at learning. High learning organizations in healthcare need to embrace five core principles:

  1. Everything is about our patient(s)
  2. Education ≠ learning
  3. Learning = changed outcomes
  4. Learning is an expertise (that should be consulted by content experts)
  5. Everyone is in learning

To compete with the rapid pace of change healthcare systems have adopted change management systems including lean and continuous improvement systems with varying results. Unfortunately, it still takes us over a decade to make good changes, even with good research. It may be that the reason providers slowly change is that the education system within healthcare is ineffective.

Practicing providers will tell you that they learned how to do their ‘job’ by doing it; reflecting experiential learning (Kolb, 1984). When organizations have a ‘problem’, they set up another class, CME or worse yet, an online module (often the opposite of experiential learning). Providers all have different responses to this ‘education’ (ranging from all out fighting to sleeping through the class) and what providers have learned is how to click fast through online modules just to ‘check them off’. The result is that education in healthcare is a fallacy, and it is hard to find documented changes at the bedside from education.

Everything is about our patient(s)

Learning in healthcare needs to keep the patient at the center. If the patient is at the center of all learning, then the learner and educator are not. The result is that all initiatives need to be seen through a lens of: Will this change outcomes at the patient bedside and/or would the patient ‘pay’ for this change? When healthcare systems spend money on education, they are spending our patients’ money, and our patients are only interested in paying for things that improve care for them.

Our patients see us as a team, so we need to train as a team. Training as a team does not mean one time a year simulation; it means redesigning our learning systems to be integrated throughout. There is such a thing as specialty training for nurses, physicians, and other health providers, but it should be a rarity rather than a regular occurrence for us to learn separately. Then again, the best learning is via experience, so if experiential learning is at the core of what we do, it will force us to learn together, at the bedside for the patient.

Education ≠ learning

Just because a student sat their butt in a seat does not mean they learned anything. Too much of our current education (such as mandatory education) is just checking a regulatory box without getting to the intent of the education or changing an outcome. If anything, healthcare systems have over-educated their workforce. Most healthcare systems have learning management systems (LMS) full of ‘online learning’ that sucks hundreds of productive hours out of each provider, each year, and yet organizations still struggle to prove that online learning has changed care at the bedside.

The best example of education not causing change is hand washing. Most healthcare systems have hours (if not days) of training on hand washing, but still have mixed results. Adding more education has rarely (if ever) worked. Healthcare systems add education because it makes them feel better. Healthcare systems have ‘checked the box’ and now can hold someone accountable when they mess up, even if they have not learned a thing.

If organizations shift away from a focus on education (i.e. hours, accountability, etc.), the litmus test then becomes: Is this being done to ‘check a box’ or to change outcomes?

Learning = changed outcomes

Adult learners learn what they want to learn when they want to learn it (Knowles, 1985). In healthcare, the result is that providers want to learn when they think the result will be a positive change in outcomes (either for us as an individual, or for our patients). Providers have been inoculated by inadequate education, and therefore all too often tune out anything that is ‘presented’. To shift away from this education mindset, healthcare needs to look at learning differently and realize that if there is not a change in the outcome the initiative wasted everyone’s time.

Changing outcomes requires a change in the learner, their experience, and their environment (Zigmont et al, 2011) Putting out a memo or policy to change practice may change the environment, but it will not change the way healthcare providers practice (unless you regularly watch them and hold them accountable). At the same time, a great experience that changes the way an individual thinks will not work if the environment does not support it (i.e. students learned how to wash their hands, but the sinks are broken).

Six Sigma/Lean does great work in the environment, but often changes fail because systems do not appropriately work to change the learner or their experience. Learning practitioners complain because they ‘did a great class’ but then their learners were ‘untrained’ in ‘real’ practice. Getting a measurable change in practice and making it ‘stick’ takes changes in all three areas of the learner, experience, and environment. (Zigmont et al, 2015)

Learning is an expertise (that should be consulted by content experts)

Everyone feels they know how best to do education, but creating learning that changes outcomes is an expertise on its own. Content experts should have learning experts whom they can use to help create meaningful learning initiatives. Content experts should be at the bedside and should focus on being the best provider possible. Learning experts, therefore, should not be content experts themselves as it is tough to maintain competency in both over the long term. As noted leadership author John Maxwell (2015) says, “If you are teaching it, and not doing it, you are teaching history”.

Everyone is in Learning

To keep up with the pace of change and continuously grow, providers need to realize that everyone is in learning. At all times, providers are both a learner ourselves and a facilitator of learning for others (both providers and patients). Therefore, both organizations and individuals need to continuously build our skills in learning. Learning, in this case, is more than passing a test. Providers need to learn how to continually learn from our experiences, build our reflection skills and help others.

The result of everyone being in learning every day is that experiential learning becomes the core of everything. Providers go back to practicing medicine and realizing that things can always be better.

Conclusion

If healthcare systems are going to keep up with the pace of change, they need to become “high learning organizations” before they can ever become high-reliability organizations. Learning needs to be built and valued as a skill that changes outcomes at the bedside. When everyone is in learning to improve our patients’ outcomes, change becomes part of what we do, for the right reasons rather than something we fight daily.

This post is part of a series called “Learning That Works” by Jason Zigmont, PhD and posted on Learning in Healthcare. The principles are part of the core content (card number L10) of the Foundations of Experiential Learning Course (http://learninginhealthcare.com/faculty-development-courses/ ). For more information about how to improve outcomes from learning (including faculty development courses and consulting) please visit http://www.learninginhealthcare.com. Please pass this on to any of your colleagues that may be interested.

References

Kolb DA. (1984) Experiential Learning. Upper Saddle River, NJ, Prentice Hall,

Knowles M. (1985) Andragogy in Action London, Jossey-Bass

Maxwell, J. (2015) “Hoglin Leadership Forum”.. Presentation.

Zigmont J.J, Kappus L, Sudikoff S.N. (2011) Theoretical Foundations of Learning Through Simulation. Seminars in Perinatology. 2011;35(2):47-51

Zigmont J.J., Wade A., Edwards T., Hayes K., Mitchell J., Oocumma N., (2015) Utilization of Learning Outcomes Model Reduces RN Orientation by >35%, Clinical Simulation in Nursing. 11(2):79-94

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