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What Health Care Can Learn from 18th Century Miners

By Derek Feeley | Monday, September 30, 2019


I was recently reminded of a story about a village called Leadhills in Scotland. In 1741, a group of Leadhills miners established the first privately funded library in the UK. Locals call it the world’s first library for working people.

The miners formed a learning community they called the Leadhills Miners Reading Society. They wanted to learn but couldn’t afford to buy books of their own on a miner’s pay. They pooled their money to “purchase a collection of books for [their] mutual improvement.”

They mostly read texts about religion, history, and science. Members would read the books and meet once a month to discuss what they learned. The success of the Leadhills Miners Reading Society inspired other nearby mining villages to start their own reading societies and, consequently, raised the levels of literacy in the area.

What does a group of 18th century Scottish miners have to do with health care today? The Leadhills Miners Reading Society is an example of what I think of as democratizing knowledge.

Spread Knowledge to Spread Improvement

Democratizing knowledge is a term I first heard at the IHI National Forum a few years ago. Sanjeev Arora used it to describe the initiative he founded, Project ECHO. It’s probably best known for using videoconferencing technology to connect often rural community health care providers with specialists located miles away.

The phrase “democratizing knowledge” struck a chord with me. IHI can’t achieve our mission to improve health and health care worldwide without partnering with people around the globe. We need to open access to improvement knowledge and spread it far and wide.

The IHI Open School is an example of democratizing knowledge. Open School online courses are free for individual students, residents, and professors, as well as learners from the UN-designated Least Developed Countries. More than 700,000 students and residents have completed an Open School course. More than 180,000 have earned the Basic Certificate in Quality & Safety. The Open School Chapter Network has grown to over 950 Chapters on university campuses in more than 90 countries around the world. Many health professionals and organizations also use the Open School course catalog to build their improvement capability and patient safety expertise.


LEARN MORE: IHI Open School Courses offer 35+ continuing education credits


But the Open School is more than online courses. The IHI Open School Recover Hope Campaign is teaching community organizing skills to increase awareness, prevention, and treatment of substance use disorders (SUDs) around the world. More than 7,300 people have signed the Change the Narrative pledge and committed to using person-centered, recovery-focused language in an effort to reduce the stigma that prevents many people struggling with SUDs from receiving care.

Like all IHI’s best campaigns and collaboratives, the Recover Hope Campaign is a bit like the Leadhills Miners Reading Society on a global scale. Participants have access to shared resources, and — perhaps most importantly — they get connected to the collective knowledge and support of the learning community.

What Gets in the Way?

Unfortunately, many things get in the way of democratizing knowledge. For example, in health care, many of us think knowledge is power. We behave as if it’s a precious and limited commodity we must keep from others to maintain our authority, control, or competitive advantage. But when there are barriers to knowledge access — what you might call a colonization of information — and it flows only to a select and privileged few, progress is too slow for too many.

Without access to knowledge, innovation is stifled. We limit our opportunities to learn from our neighbors and colleagues.

As Jason Leitch and I argued in last year’s IHI Forum keynote, knowledge isn’t power; sharing knowledge is powerful.

If you need confirmation of this, ask the communities having meaningful end-of-life discussions with their loved ones as part of The Conversation Project. Talk to the pioneering participants in IHI’s Africa Hospital Patient Safety Initiative. Learn how creating an Age-Friendly Health System can be part of a community-wide effort to provide better support for older adults.

I believe people who are part of these efforts and others would tell you they’ve benefited from both giving and receiving knowledge. They could tell you how sharing the power of the many has been much better than going it alone.

What Leaders Can Do

Health care leaders can make a virtue of sharing knowledge. Enable it. Celebrate it. Here are some ways to do this:

Embrace the “all teach, all learn” philosophy — Be humble enough to accept that you have something to learn and generous enough to share what you know. Democratizing knowledge is not just about giving it to others; it’s also about acknowledging the many places we can find it. Achieving the Triple Aim and pursuing equity, for example, require health care organizations to seek knowledge beyond their four walls.

Use knowledge to achieve equity — We know that it’s easier for those with wealth and other resources to get access to health care and health information. This means we need to improve the spread of information and increase access, but that won’t be enough to achieve health equity. We also need to share QI knowledge with communities and use improvement knowledge to better understand and address the social determinants of health.

Bridge the gap between “what we know” and “what we do” — Our traditional approaches take too long to bring knowledge to practice at scale. This frustrates every leader I’ve ever met. I am frequently asked, “How do I scale up and spread improvement more quickly?” One of the answers is to democratize knowledge. Every time a health care leader shares what they know with others, they’ll get something back from another leader. It happens to me all the time. This kind of exchange can help leaders solve some of their most pressing problems. But in order to get knowledge, you have to give it.

Like the Leadhills Miners Reading Society, we can multiply the benefits of scarce resources by banding together for our mutual improvement. If we could see ourselves not as keepers of knowledge, but as part of a global learning community, the possibilities would be endless.

Editor’s note: Look for more from IHI President and CEO Derek Feeley (@DerekFeeleyIHI) on leadership, innovation, and improvement in health and health care in the “Line of Sight” series on IHI.org. 

Leadership and Building Improvement Capability sessions are part of IHI’s National Forum this December.

(Having difficulty watching this video? Watch on YouTube.)

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