Bringing Value: In a 'Learning Organization,' Knowledge Is Power

Acquiring information and processing it into useful business insight is essential in every industry, including health care. Physician leaders have an important role to play.

The concept of organizational learning includes both acquisition and dissemination of knowledge that an organization can use to shape its future. To efficiently manage the information, learning organizations use knowledge management systems to facilitate sharing and integration.1,2 Using these systems, learning organizations have the ability to think for themselves, communicate effectively internally, and use the knowledge they acquire to create and innovate.

It is important to know the difference between “organizational learning” and a “learning organization.”3

Any institution may participate in ongoing organizational learning, yet only a few can be called learning organizations, especially in health care. That’s because there are environmental, organizational and ecosystem constraints on every health care organization that limit their planning, financing and operational functions.4 Accordingly, the scope and practice of a health care organization as a learning organization should be viewed in that framework.

Successful organizations are those that continually evolve, using specific tools and strategies to adapt to the changing marketplace. The best ones take a learning organization approach. While organizations can offer learning activities, they aren’t learning organizations until they undergo key process changes. That includes a transformation in which all primary stakeholders are involved — senior management, the board of directors, the medical staff and, of course, the workforce.4

Specific conditions within an organization are essential to facilitate learning, including the capabilities for continuous improvement, a willingness to practice the newly acquired skills, taking the necessary risks to learn, providing feedback to the participants, and fostering a climate of rewarding all learning participants.4 Often, that means major cultural change must occur within every aspect of the organization and its related processes.

BRINGING VALUE: More Columns in the Series on Leadership Development

In addition to the conditions noted above, six additional critical elements5 help define a learning organization:

• A process of continuous knowledge acquisition by the workforce and the integration of this knowledge into routine institutional processes.

• Effective knowledge generation and sharing among participants.

• Critical systems thinking.

• A culture of learning.

• A group spirit of flexibility and experimentation.

• An organizational culture that values its workforce.

These additional critical elements characterize and define the organization’s knowledge management system. An effective system creates the ideal framework for an organization’s workforce to learn and compete.

Five Enabling Drivers

In today’s competitive business environment, an organization’s only sustainable advantage is its ability to acquire knowledge at a faster rate than its competitors.2 Understanding this is critical in a modern, ever-changing health care environment.

In addition to the concept of rapid knowledge development, there are five enabling drivers that, if mastered, will propel any health care organization to higher levels of knowledge acquisition. These drivers began appearing approximately 20 years ago but only now are starting to converge into an organizational learning model. These drivers include:

Systems thinking: Seeing the big picture and how work processes are linked.

Personal mastery: Making individual commitment to lifelong learning.

Mental models: Managing preconceived ideas that could hinder new insights and ideas.

Shared visions: Building visions that will survive good times and bad times.

Team learning: Realizing organizations cannot learn and improve if team members cannot learn and improve.

One could argue that these drivers can be organizationally grouped under one common strategic initiative: the ability to innovate faster than your competitors.

Employees must become skilled at acquiring, mastering, and transferring and/or teaching new knowledge. Senior leaders must be able to allow their organization to remain flexible, take risks and use newly acquired information within the framework of the organization’s strategic plan.

Despite a significant amount of information advising leaders how to put a learning organization into operation, there has been significant difficulty in doing so.6 Senior leaders have had problems measuring organizational progress, using important tools of a learning organization successfully, and managing knowledge for innovation.6

To help direct physician leaders, three primary operational pillars are key starting points for organizational learning and adaptability.6 They are:

• Developing a supportive learning environment.

• Building strong learning processes into the culture and work systems of the organization.

• Developing leadership behaviors that reinforce organizational learning and knowledge acquisition.

The Role of Physician Leaders

To help develop a supportive learning environment, physician leaders should consider directing attention to creating psychological safety for their employees.6 The idea of removing psychological risk from the workplace first was proposed in the 1950s by Edward Deming in his famous 14 Points for Total Quality Management. Workers must feel safe, rather than fearful of their superiors, so that they can work effectively with their leadership team, rather than withdrawing out of fear of retribution.7

Physician leaders also should be open to differences of opinion and opposing ideas. This attitude energizes individuals and tends to spark creativity and innovation. Third, employees should be encouraged to explore new ideas, even if these new ideas entail some risk. Finally, physician leaders should factor in some time during the day for problem-solving and thoughtful reflection among their employees.

Another major task for physician leaders in helping to develop a learning organization is to create the subsystems of the learning processes and practices.6 These include the processes of generation, collection, interpretation and dissemination of information.

Information in any organization resides not only in the formal written arena of protocols and white papers, but also in the minds of the workforce. For physician leaders, the ability to tap into this workforce knowledge for organizational innovation is important. Many successful companies are using their employees to advance innovation and learning through team interaction, knowledge sharing across silos, and shared information data banks. Finally, senior leaders must reinforce the learning environment, which entails human behavior. When the environment is safe and leaders are supportive, employees will be willing to entertain alternative ideas without fear of losing their jobs.

Creating the Structure

Learning organizations neither can be developed nor sustained without understanding the underlying structures that allow organizations to constantly acquire and maintain new knowledge.8 Think of these as the foundation, pillars and roof that compose a physical building.

Foundation: management science, computer science, organizational development and cognitive psychology.

Pillars: the organization, its people, knowledge and acquired technology.

Roof: the environment, the economy, society, politics and evolving technology.6

For physician leaders, each of these components has important ramifications for guiding and directing not only the organization, but also in helping facilitate the ongoing development of the medical staff.

The list of substructures might sound fairly abstract, and it might be unclear how to ensure an organization has a realistic, easy-to-understand and actionable definition of a learning organization that is also acceptable to all levels of the work-force. Many suitable definitions have been proposed over the years, but here’s one of the best: “A learning organization is an organization skilled at creating, acquiring and transferring knowledge, and modifying its behavior to reflect new knowledge and insights.”6

What should be recognized is that learning begins with newly acquired ideas. New ideas sometimes are created internally, but they may also be acquired from the outside. It is not simply the act of generating new ideas but rather the act of generating and incorporating these new ideas into the fabric of the organization.

How many team events generate lots of ideas that are never actually implemented? Learning organizations find ways to translate ideas into action. They know how to positively change the behavior of the workforce. Physician leaders who wish to ensure their organizations are learning organizations should develop an understanding of organizational dynamics and personal interplay among key constituencies.

Five Action Plans

Physician leaders should focus on five specific action plans when thinking about how to develop their organization into a learning organization.6

• The first is related to problem-solving. Continuous-improvement organizations use specific tools, such as Deming’s Plan-Do-Check-Act Cycle, to ensure conclusions being reached by work teams are scientifically valid. In addition, using statistical methods ensures bias-free decision-making. This analytical approach creates workforce discipline and helps remove non-fact-based decisions. Systematically embedding these tools throughout an organization is critical to get every functional aspect of an organization aligned.

• The second is experimentation. For health care organizations, this often is difficult when they’re focused on protocols, pathways and policies. Ongoing experimentation requires risk-taking, employee time, educational programs, resource allocation and a defined process that allows ongoing experimentation.

• The third is to learn from the past. Human nature tends to extoll success while ignoring failure. But learning from failure is powerful — and perhaps the ultimate teacher. Most physicians hate failure and rarely admit to it. Yet they have used trial and error to improve their practices for centuries. Using information from others is an important concept, sometimes known as “benchmarking.”9 We can learn from colleagues, other organizations, our own actions and from customers. Organizations that do learn and can incorporate it into cohesive processes to retain learning and knowledge will be more competitive.

• The fourth is to learn how to transfer knowledge. Learning shouldn’t be one person learning a new technique. It must be a widespread effort so it can be effective organizationally. For example, many medical staffs employ “grand rounds” in which all members participate and learn from a presented case study. Many organizations also use site visits, training programs and cross-training to further the acquisition and sharing of knowledge.

• The fifth is to develop yourself as a teacher, a designer and coach. There is no easy process available for that. Learning organizations are not built overnight, but rather are cultivated over time. Same for individuals. Senior leaders should ensure appropriate commitments, management and processes are established to allow learning to flourish — not only for physician leaders, but also for medical staffs.

Consider starting with fostering an environment that’s conducive to learning.6 Physician leaders should build in time for reflection, analysis and strategic planning. This should involve all members of the workforce, who should be trained in brainstorming techniques and problem-solving. Problem-solving should be done in the context of team activity across the organization. Physician leaders should ensure that there are adequate resources, both in time and money, to support team activities of their organizations, and also should work to eliminate any boundaries or silos in their organizations. Reducing boundaries allows an organization to develop powerful and stimulating learning activities. Creating an environment of openness also allows for effective communication, sharing of ideas and risk-taking.

Eugene Fibuch, MD, CPE, CHCQM, FACPE, FABQAURP, is professor emeritus at the School of Medicine and co-director of the physician leadership program at the Henry W. Bloch School of Management at the University of Missouri in Kansas City.

Jennifer J. Robertson, MD, MSEd, FAAEM, is an assistant professor in the emergency medicine department at Emory University in Atlanta, Georgia.

REFERENCES

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Finger M, Brand SB., The Concept of the Learning Organization Applied to the Transformation of the Public Sector. In: Organizational Learning and the Learning Organization, (eds) Easterby-Smith M, Araujo L, Burgoyne J (1999). Sage, London.

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Garvin DV, Edmondson AC, Gino F. Is Yours a Learning Organization? 2008. Harvard Businsess Review.

Deming WE. 1986. Out of the Crisis. Massachusetts Institute of Technology. Center for Advanced Engineering study, Cambridge, MA, 510.

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Cox JW, Mann L, Samson D. Benchmarking as a mixed metaphor: Disentangling assumptions of competition and collaboration. 1997. Journal of Management Studies. Vol. 34 (2), pp. 285-314.