Teams and Learning Organizations
Are you still practicing medicine the way you did when you finished your residency? Have you ever considered that while you were “learning” in residency, your instructors were “training” you? Of course your practice has changed as you have gained experience and learned of new approaches. Is it possible for organizations to learn from experience and reflection in the same way you have?
Twenty years ago, Peter Senge published a widely read book[i] arguing that it was possible to create learning organizations, which he defined as organizations that consciously and intentionally learned from their collective experience. A substantial body of literature has been generated exploring this notion, and recently Crites, et. al., summarized this literature as it applies to medical organizations.[ii] They identified four actions that represent the processes required for organizations to learn and share new knowledge more effectively: inquiring, deciding, relating, and advocating.
They also identified behaviors at the level of the provider that represent roadblocks to building an effective learning organization. Providers who are not inquiring are not able to use information systems effectively and have a “punch the clock” mentality. Providers who are not deciding have little time to deliberate and evaluate decisions and the nurses defer decisions to the physician. Providers who are not relating are resistant to change and lack proper motivation. Providers who are not interpreting are not forming judgments about what is needed to improve practices.
We can all think of examples of roadblocks, but I am not so sure we have a clear idea about what an effective learning organization might look like and how it might operate. We are starting a process to create learning teams on every nursing unit in the hospital. We need physicians to serve as “sponsors” for each of these nursing units. The only rewards I can promise are an opportunity to improve patient care and perhaps some chicken fingers, but I expect the time commitment will be proportionate. I hope you will inquire further, reflect upon the decision, come to the conclusion that it is possible for positive change to occur, and help our staff form good judgments about what is needed to improve care for our patients.
[i] Senge, Peter M. The Fifth Discipline: The Art & Practice of the Learning Organization. (New York: Currency/Doubleday, 1990.)
[ii] Crites, Gerald E., et al. Evidence in the learning organization. Health Research Policy and Systems 2009;7:4. doi 10.1.186/1478-4505-7-4. Located online at http://www.health-policy-systems.com/content/7/1/4. Accessed 12 June 2010.
Written 18 June 2010. Revised 1 May 2014.
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