The Learning Organisation

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
  • Meeting attendance
  • Dealing with problems
  • Investors in people
Individuals are valued and their opinions Listening

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


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