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Learning From Organizations and "What can you do by next Tuesday?"

By John Gauthier | Tuesday, April 1, 2014

Anne Kilgallen MB BCh, MPH is a Health Foundation Quality Improvement Fellow (2013-2014). She is the medical director at Western Health and Social Care Trust in Londonderry, Northern Ireland.

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Myles at Contra Cost teaches in front of a learning board.

"What can you do by next Tuesday?” I foolishly said I would write my first blog. On sharing learning. A colleague asked me what I had learned during my fellowship that would help us accelerate and spread learning in our organisation.

First of all, I have learned that organisational culture matters. Our actions are based on our beliefs, and what we believe comes from our experience. If my experience tells me that I can make a change, that the organisation wants me and my service to be the best we can be, then I am more likely to make things happen. Organisations within which learning happens have created an environment in which people believe themselves capable of making change happen. I saw this at Contra Costa Hospital, in California, and at Cincinnati Children's.

I have learned that feeling the urgency of the need to change matters. At Intermountain Healthcare, in Utah, staff use their own service data to detect variations in practice and determine where they need to improve. You can't beat local data for making people focus. It is harder to be excited by a threat which feels remote, even if it is logical and credible. Flu vaccination, or rather the lack of uptake by health care staff, is a case in point. If staff on my unit haven’t had their flu shots, they put our patients – and us – at risk. Better information systems – systems staff can use to help us interpret the myriad, local data – can be transformational.

Learning organisations have a system for improvement; they have a shared language and associated tools so that everyone can improve together. It seems like hard work to train hundreds of staff – until someone calls this not just training but “a movement for a learning democracy.” Everyone can learn! Who could deny this freedom?

Most fundamentally, learning organisations are listeners – to the voices of their patients and of their staff. If a patients asks, “What can you do by next Tuesday?” will you deny her?
So, sharing information is important, but on its own not enough. It takes a village – a community of practice that recognises its shared purpose, uses information to understand how it is progressing, and has a platform for improvement based on a shared language and mutual respect. These are the characteristics that lead to success. Oh yes, and the humility to ask, “How can we be better?”

No challenge then! We can do it by next Tuesday!

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