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This month’s edition of Healthcare Review – OnlineTM focuses on the concept of the learning organisation and its application in health care.
While the concept of the learning organisation can be traced to the to the 1950s and 1960s, it was widely popularised in the 1980s through the work of Peter Senge, author of The Fifth Discipline: the Art and Practice of the Learning Organisation [ 1 ].
Peter Senge argues that five disciplines are present in a learning organisation: systems thinking, personal mastery, mental models, shared vision and team learning. In his view, where these disciplines occur together they create an environment where the organisation becomes more dynamic and its component parts share common goals.
Interest in learning organisations can be seen to reflect managers’ efforts to manage given the increasing rates and complexity of change in their environments. This view is particularly applicable in the heath care sector.
Michael Kelleher, Director, Learning Futures Ltd [ 2 ], Visiting Professor in the Department of Human Resource Management, Nottingham Trent University, Nottingham, England, and a former General Secretary of the European Consortium for the Learning Organisation (1996-2001) explores the concept of the learning organisation in his paper "The Learning Organisation - From Metaphor to Model".
Kelleher highlights that that the concept of the learning organisation embodies many of the more contemporary notions of good practice in the development of all employees whilst simultaneously creating a climate of participation, contribution and support in which employees are valued and their talents employed for the benefit of the whole organisation. Clinical governance, for example, has apparent undertones of similar aspirations in that it offers opportunities for health care organisations to establish personal development programmes linked with organisational strategies.
Kelleher goes on to establish a three-dimensional model that can allow health care professionals to understand how the learning organisation concept may be developed in practice in their organisational contexts.
Dean Phelan and Gregory Birchall, Partners in TopWheel: People Intelligence present "Applying the Principles of Organisational Learning" in which a range of meanings and definitions of organisational learning are canvassed and four principles for establishing organisational learning in health care organisations are discussed.
Phelan and Birchall outline concrete steps for creating a learning organisation along with other initiatives found to be beneficial in the creation of organisational learning in the health sector, including the use of "action learning" teams to work through and around blockages to organisational learning and the creation of a "Teachable Point of View" to cascade a new vision and objectives down through the many management levels within organisations.
In his paper "Learning organisations in health care" Robin Youngson, Chair, Clinical Leaders’ Association of New Zealand and Clinical Leader, Waitakere Hospital, Waitemata District Health Board, New Zealand, considers how the application of the principles of learning organisations could assist in the improvement of health care systems.
This paper uses the example of health care provision in New Zealand to consider how the application of the principles of learning organisations could assist in the improvement of health care systems.
Youngson presents evidence highlighting the apparent failure of the New Zealand health care system to meet patient needs or even to maintain patient safety. He notes barriers to change such as the requirement for a fundamental change in mind-set, inappropriate organisational forms, the lack of financial investment in leadership development in health care, for both clinicians and managers.
He goes on to consider how it might be possible to create health care organisations with the capacity to solve such deep-rooted problems and how much of the failure to address these issues stems from inappropriate models of thinking and organisational design?
Youngson describes three foundations of a learning organisation: a culture based on transcendent human values of love, wonder, humility and compassion; a set of practices for generative conversation and co-ordinated action and; a capacity to see and work with the flow of life as a system. Learning organisations are built by communities of "servant-leaders", people who lead because they choose to serve, both to serve one another and to serve a higher purpose. In Youngson’s view, development of this style of leadership, among both clinicians and managers, is crucial for the improvements we desire in quality, safety and effectiveness of health care.
Youngson also highlights that in New Zealand, there might be the opportunity to evolve a unique form of learning organisation by working alongside our indigenous peoples and understanding and adopting indigenous concepts from Maori cultures such as shared learning, mutual respect and obligation.
1. Senge PM. The fifth discipline: the art and practice of the learning organisation. New York: Doubleday Currency; 1990.
2. Learning Futures is a small independent research and consultancy company based in Wales. It specialises in knowledge sharing and organisational innovation through learning.
