Continuously Learning Health Systems


Learning requires humility. It requires us to accept that we don’t know everything, that we get it wrong sometimes, make mistakes and need to own up to them so that we don’t do the same thing again. Learning is a vital part of all we do in health and social care, if we are to create truly safe, sustainable, compassionate and excellent services. But humility, although vital, is not enough on its own. There are things we need to put in place to ensure our organisations are continually learning, and not only so but that we actually implement our learning and incorporating it into new ways of working so that we change as a result.

The IHI and Allan Frankel have come up with a really helpful and pretty straight forward framework which enables us to do this. It requires 3 basic ingredients:

 

1) Leadership commitment

2) Individual responsibility

3) A shared learning culture for quality and safety

 

Leadership is absolutely vital in setting the right structures and support in place for learning to take place. It requires:

 

-transparency with the public, patients and staff

-vulnerability about weaknesses

-openness about what is being learned and what is changing as a result

-ensuring we are learning with and from our patients not just within our clinically teams. (Some of the most powerful learning we have done in Morecambe Bay has been from women using our maternity services. Our attitudes, communication skills and expertise have all improved dramatically as a result).

-commitment to the psychological safety of staff in developing a culture in which no question is too stupid and no concern is dismissed

-genuine care for each member of staff, creating a culture in which every person can be mentored, coached and encouraged

-time given and protected in which learning can be fostered

 

Personal Responsibility

Who are you?

In my role as a coach/mentor or trainer I have found that we have become far too obsessed with ensuring that people have the right skills but not necessarily paying too much attention to who people are, what their character is like, what their strengths and weaknesses are and how they are developing as a human being. Our medical/nursing and other clinical schools are filled with people eager to learn but who often have no idea about who they are and who, not what they would like to become. Knowing who you are as a person, hugely affects your clinical practice and we do not give it any way near enough attention. I am personally a huge fan of the Enneagram. For me it has been transformational to understand as a type 7, not only what my root need is (to avoid pain) what my root struggle is (gluttony) how I do under stress (become a falsely happy control freak) but also, what my invitation is (towards sober joy and deeper understanding), how to become a more healthy version of me and therefore a better gift to my family, my team and all the people I’m trying to serve. It has helped me to recognise when I’m doing well and when I’m not and to understand how to bring my core strengths to the fore whilst also recognising where I need discipline and boundaries to function from a more healed place. We each have a responsibility not just to be good at stuff, but to be good at being us. And  being us is more than just knowing how we function (e.g. ENFP in Myers-Briggs) but to get below the surface to the core of what makes us tick, that makes us human. Knowing who we truly are enables us to be better, kinder, more humble, genuine, compassionate people, who put aside the need to beat others down and learn to appreciate them so much more. When you really know the team you are working with, they become your friends, you understand the little idiosyncratic things about them with a whole lot more patience and you can also challenge them when they are not behaving in a way that is conducive to good care and you can also receive that challenge back when you are out of line. I wish that we were more interested in caring about who we are rather than only in what we can do. This has got to be a part of the culture of joy I have blogged about previously.

How are you?

Personal responsibility beckons us to be more honest with ourselves and others about how we’re doing emotionally/physically/mentally. It has been a transformational practice in our team to simply check-in with each other and talk about where we’re at. In this way, we can carry each other when needed and treat each other with kindness and compassion. But our individual agency, must also cause us to recognise when we are at a wall/ceiling/limit personally or professionally. We must simply own up when we don’t know something or are out of our depth or need help. We cannot pretend to be able to have a competency that we don’t have. We need to be self-aware and humble enough to accept when we don’t know something or have become unwell and ensure that we take it upon ourselves to find out or get the help we need. This is learning to have an internal, rather than an external locus of control. An external locus, always looks elsewhere for the answer. An internal locus takes responsibility to find out and keep learning. We need to develop a core value, that learning is really really important and we will prioritise ensuring that we keep making time to do so, through whatever form that takes, especially reflective practice. Yes there is some dependency on supportive structures and time being given, but there is also that sense of motivation that comes from within that we take ourselves and our roles seriously. It’s one of the reasons why I’m such a fan of a combination of problem-based learning and a solutions-focussed approach. If we do this ourselves and foster it in our teams, the care we provide will be beyond stellar!

Why are you Here?

We talk about the law of two feet in our team. You are responsible to know why you are here, or if you need to be somewhere else. That might even mean a job change, but more often than not it means having some good boundaries, knowing whether or not you really need to be at a certain meeting or somewhere else, if you should be doing what you are or if you need to ensure other things get the right focus. And what about yourself? Have you taken time to eat well, stay well hydrated, exercise, sleep well, maintain health in your relationships? In teams that care for each other we need to help each other to know why we are there and why we are important.

 

A Shared Learning Culture

 

It’s amazing to me that so many of our learning environments are still so teacher-based. Adult education is so much more empowering than this and it’s high time our clinical learning environments (both preclinical and in every day life) reflect this. They should also be more inclusive and we should be learning with and from our patients far more than we do. Although the above graphic applies to classroom settings, it contains many lessons for us.

 

With leadership and personal agency holding true, a culture then develops in which continuous learning is the norm. Learning environments, fuelled by kenotic power create a space in which an organisation can begin to truly flourish. It creates a net of accountability, teamwork, improvement and measurement, making the entire system more reliable. It is vital that we create this as one of the core principles upon which we build our future health and social care systems.

 

 

 

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Healing our Corporate Soul

In my video blog about ‘Reimagining Health’, I talked about the fact that our well being is not and cannot be an isolated, individualistic experience. The truth is that we are part of a Corporate Body (that is a community of people with a physical environment in which we live) with a Corporate Soul (a set of beliefs/mindsets/worldview) and a connection to the Corporate Spirit (which in my view is either the spirit of love aka God or the spirit of fear). These corporate experiences have a massive impact on our individual sense of health and wellbeing, and actually, as we are part of the corporate, our individual wellbeing has an impact on others around us also.

Our Corporate Soul is the issue I want to concentrate on in this post. It is complex and something to which I believe we pay little attention. However, it’s effect on our individual and corporate wellbeing is vast. Take a moment to think about the subliminal messages that come through our various forms of news and multimedia everyday.

“Your life isn’t as good as your ‘friends’ on Facebook”

“You need to be on Facebook or you are missing out on so much”

“Unemployment is being caused by Immigrants – be wary of them”

“Be afraid – people hate our country and are trying to kill us for the ‘values’ we uphold”

“The way our country does things is right and just and those who die for ‘our country’ are never to be forgotten”

“Pollution is rising – we are heading for natural disasters”

“Buy the new car – you need it, don’t worry about the pollution – live for the now”

“The chocolate industry is built on the slave trade”

“You can’t change anything, so keep on eating all the chocolate you want”

“Banks are to blame for the financial crisis”

“We have bailed out the banks with taxpayers’ money, because we need them so much.”

“Really the reason for our national debt is the poor, who claim too many benefits – we should blame them because they are lazy – we won’t bail them out”

“We all need to live longer”

“We can live however we want – our healthcare is free”

“Our children aren’t doing as well as some other children around the world when we measure them against a set of very narrow targets – therefore we need more targets and more testing”

“The only way to keep our nation really safe is to keep the nuclear deterrent – in the end, this is what makes us safe”

“Our armed forces protect us by using violent force to topple regimes which do not suit our national interest. Power vacuums are now left in those nations with untold turmoil and the rise of significant extremism of which we should be even more afraid and need to silence. We will do this with more force. The use of violence make us feel safe”

 

No wonder we are so messed up. We have some very damaging and also conflicting messages coming at us, especially through the (social) media 24/7. When do we stop to ask ourselves how healthy our worldview/beliefs/mindsets are? How much of our life is driven by fear? A fear of want? A fear of lack? A fear of the ‘other’? A fear of loss? A fear of debt? A fear of attack? And how much of this feeds our individual(istic) souls of self-protectionism?

How badly we need some conversations together that enable us to challenge some of our current core beliefs. We will not find a place of health and well-being, happiness or wholeness until we do. We have aligned our lives with the Spirit of Fear and our Corporate Soul is entirely broken as a result. We must realign ourselves with the story of Love. There is so much goodness out there. Can you see it? Only love can drive out fear. Only love can heal and awaken our souls to another holistic way of being.

 

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