In 2018, I had a sweet setup for my work commute. My friend, who also worked downtown, would pick me up at my house, use the carpool lane on the highway, and drop me off in front of my office building. When I offered to pay for gas, he refused me. “Matt, I am actually saving money and time because we carpool.” It was too good to last. Soon my friend accepted a job in another city, and I was left figuring out the fastest and cheapest route to work.
That is when I fell in love with public transportation. But this romance did not come without a rocky courtship. After finding an express bus route near my house that went downtown, I purchased an annual pass and planned my first trip. The pickup was a mile from my house, so the first day I rode my bike and loaded it on the bus. No problem. After work, I saw the returning bus was fully loaded with bikes from other passengers. No space for my bike. The next bus came an hour later, but I was already late for dinner. I no longer take my bike.
Early on, I missed the morning bus many times and took a crowded light rail to work instead. Another time I boarded the wrong returning bus because I was distracted by a phone call and soon found myself miles from my house. Recently, I found a new pickup spot that will shave five minutes off my commute. In all, my mistakes gave me the knowledge I needed to maximize my use of public transportation.
We all generate and transfer knowledge on better ways to live and work. Our ability to learn is instinctive. You see it while watching a child find a way to reach something high, away from her grasp. Things become a little more complicated working in large organizations and systems, like health care delivery. Yet, complex organizations, like hospitals and clinics, need to learn (i.e., generate and transfer new knowledge) more than ever as they confront mounting forces like provider burnout and new payment models. But do our sophisticated health care delivery systems actually have the capacity to learn?
Several years ago, Harvard Business Review asked the question: Is Yours a Learning Organization? The authors argued that few organizations become learning systems with employees who continually create, acquire, and transfer knowledge-helping the organization improve and prepare for the unpredictable. Managers don’t know the steps to become a learning organization, the authors continue, and lack the tools to pinpoint areas where they need to foster knowledge sharing, idea development, learning from mistakes, and holistic thinking. In health care, a learning environment is vital for quality improvement work.
The authors offer three building blocks. First, develop a supportive learning environment. Help employees feel safe disagreeing with one another, asking naïve questions, and owning up to mistakes. Recognize the value of opposing ideas and taking risks to explore the unknown. Leaders can institute policies of “blameless reporting” or give employees protected time to start innovative projects. Second, build concrete learning processes for generating, collecting, interpreting, and disseminating information. Many organizations are “data rich, but information poor”. This is especially true in healthcare. Your employees will need training and technology support to maintain these learning processes. Third, create leadership that reinforces learning and exemplifies willingness to entertain alternative viewpoints. Open-minded discussions are crucial to learning and leaders can, in short, lead by example.
First, develop a supportive learning environment. Second, build concrete learning processes for generating, collecting, interpreting, and disseminating information. Third, create leadership that reinforces learning and exemplifies willingness to entertain alternative viewpoints.”
These ideas are not new or revolutionary. Sometimes old ideas need new packages to catch our attention and spark fresh applications. Perhaps the fresh packaging here is that real and effective health care improvement needs a learning environment and leadership to go with it. Learning at the individual level is innate. Learning at the complex, large systems level? Not so much.
There are many reasons to become a learning hospital or clinic. First, we are increasingly challenged to effectively meet the needs of patients with health complexity, like multiple chronic conditions (MCC). Alarmingly, a recent AHRQ publication shows that the number of children and adolescents with MCCs has recently grown. We need to learn new ways of caring for these patients. Second, burnout among health care workers is at epidemic levels. Clinician and staff turnover are costly to employers and patients. Many organizations still have not learned how to decrease burnout and increase joy. There is a current effort to reduce the clerical burden on providers, a common driver of burnout. Third, new value-based payment models increase the responsibility of providers to generate good health outcomes and that requires learning a new way to do business.
There is one building block missing from the list above: hire people who like to learn and improve. It is difficult to endow a new employee with curiosity and drive. Much easier to attract and hire such people. Develop interview questions that find those people, give them the tools and time they need, and then get out of the way. Hopefully they will solve problems bigger than finding a good bus route.