The learning practice

A vision of where the practice is going: common goals.
Notes on the learning organisation

The ideal learning practice

Focus on patient care
Creative dissatisfaction (can we do better from the patients point of view?)
Learning by trying
Challenging norms
Investing in leadership and support

The blameless society

Blame is a waste of time.
Focus on the issue, not the person.
Treat as a challenge, not a problem.
Set up improvement measures.
Celebration of success.

Use this as a basis for appraisal

Developing the learning practice

Make the ideal learning practice explicit.
Brainstorm vision (no restrictions) in, say, two years time. How do you measure the components of the vision?
Forcefield analysis: how do we get there?
- Helping
- Hindering
Develop an action list (Gantt charts/time plan). Objectives should be SMART
- Specific
- Measurable
- Achievable
- Relevant
- Trackable

The "A" vision

Corporate view > shared vision
Team involvement and valued
Learning ethos
Blameless society
Continual development/improvement/appraisal/audit
Positive strokes/rewards
Patient centred

The "B" vision

Area		Measures
A learning environment	Resources People Skills Numbers Buildings//equipment/info systems	Skills Defined needs addressed
Common goals (shared ownership)	Commitment Quality service Access Delivery EBM guidelines	Access Appt waiting times Access to PHCT Repeat prescriptions Access to deliverers by consumers Delivery Quality measures Targets/chronic disease Screening Protocol review Clinical audit Managerial audit Prescribing Appropriate referral Teamwork
A culture of managed change	Critical appraisal Feedback > evaluation > redirect	Critical appraisal Management/information/systems review
Mutual support	Sharing knowledge Mentor/teacher	Meeting attendance Dealing with problems Investors in people
Individuals are valued and their opinions	Listening Communication Pay Satisfaction

Additions to the learning environment for the GP registrar

Learning environment
- protected time/place/equipment.
- A responsible mentor/teacher.
- Educational needs assessment > progressive education > timetable.
- Library/information systems.
- Feedback and reward.
Common goals
- Recognition of individual goals.
- All people aware of educational goals for trainee.
A culture of managed change
- Induction and personalisation of learning/teaching. Encourage feedback.
- Recognise pace of change.
- Concentrate on managing change.
Mutual support
- Access to mutual support.
- Use of day release course/peer support.
Individuals are valued and their opinions
- Emphasise that trainee is valued
  - Encourage to participate eg practice meetings.
  - Emphasise strengths.
  - Equality/fairness of work.

A further example (collated) for a 2 year vision of the learning environment

Improved library facilities
- Online database
- Librarian/cataloguing
- More up-to-date books (system for purchase)
Improved practice teamworking
- Common aims in management/clinical/educational
- Mutual respect
- Defined roles
- Involving team expertise in teaching
- Effective team meetings
  - Achieves aims
  - No antagonism
  - Respect and building of team members
  - Promotes enthusiasm
  - Produces appropriate action
  - Effective use of time
Research in practice: pursuing questions and exhibiting enthusiasm
- Established patterns of research/published articles
- Support and encouragement and time allowed for research
- Research network and presenting at conferences
- Multidisciplinary research involving trainee
Quality measurement and assurance
- Agreed standards
- Measuring outcomes
- Continuous and on-going
- Audit as a dynamic tool with all practice members
Involving the partners in teaching
- Time for teaching
- Responsibility for the trainee
- Ongoing education for the whole practice
- Development of the training practice ethos with the support and development of the non-trainer partners
- Development of the "educational manager"
- Identifying training needs within the practice as part of the ongoing plan
Management systems
- Appraisal systems for all
- Improve patient feedback
- Focus groups of patients
- Patient satisfaction surveys
Celebration of good practice
- A congratulation book
- Social events within the practice
Effective leadership within the practice
- Partners investing in leadership/management training
- Look after the emotional needs of the training team members
- Teaching skills training for all practice members

Forcefield analysis

Negative	Positive
Lack of appraisal skills Resistance to change Skills in influencing External goals Fear and anxiety Personal agenda Losses Defence Instability Sabotage Work to start Learning new skills Complexity Multiple change Uncharted territory Poor leadership	Appraisal skills Desire for change Desire for quality service External goals Control of own destiny Control of change that is already happening Improved job satisfaction Money Uncharted territory Strong leadership

Possible roles for a trainers group

Mutual support
Develop own teaching and other skills
Peer referencing
Recruitment
- Trainers
- Trainees
Develop leadership
Undergraduate teaching
Junior hospital doctors
Day release course - new scheme?
CME
Research
Development of tools
Working with health authority
Recertification/reaccreditation/rehabilitation

Source: group work with Peter Havelock 1997

Brad Cheek: last updated Dec 2006
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