Is it possible to create a learning organization while restrained by the rules of health care? To take risks and be innovative while watching for patient safety, worried about OIG and adhering to all the rules and requirements of compliance and quality? To be non-hierarchical while being a part of a rigid structure? To create a culture and environment that challenges conformity and value creativity while enforcing HIPAA and OSHA and Stark rules? Managing this yin and yang, it seems to me, this hardness and rigidity with suppleness and flow will create the Tao of Healing.
It is obvious that for a company to become a Learning Organization, first of all, learning must be at a premium, at all times, individually and as a team. For individual learning, the basics of training programs, learning incentives including its use in regular reviews, a strong culture that fosters personal growth and processes to manage and measure these are a basic requirement. For group learning, a team spirit and regular and intense interactions that spark new ideas and plant new perspectives are the key along with what Malcom Gladwell describes as the ‘ten thousand hours’ needed with each other in order to begin to gel together. There are no silos when learning together and from each other. There is no ego or arrogance. Instead, there must be humility, respect for each other, appropriate etiquette with spunk, clarity and transparency. Above all, team learning has to be fun and exciting for all.
A coach may be needed, a facilitator to keep people together who might otherwise be knocking heads off, a liaison who gives instant feedback when needed, allows for chance and chaos while maintaining order. A coach will ensure that basics are not forgotten, shoes are tied properly before the game, proper food and health and rest is maintained, and discipline creates the right platform for release of energy. With such a facilitator, what Peter Senge calls ‘a shared vision’ might be explored, goals and timelines for the future created and a focused implementation program followed.
Such a shared vision engenders responsibility, shift in attitudes and commitment and makes stakeholders out of the leadership. While managing the processes, systems and interactions, measurement of growth indices is key, not only via personal reviews but collective reviews. An ancient Japanese proverb states that the fish begins to rot in the head. It may also be said conversely that enlightenment begins in the head, or rather, starts at the top. An enlightened leadership is critical to any attempt to create a Learning Organization.
A Learning Organization might just become an Innovative Organization, changing not only process and systems as needed, but re-inventing the industry and transforming the line of business, in this case, health care. Learning involves individual growth and development but also is a product of environment and the ‘other’.
To create a Learning Organization, one must hire only the best, what Steve Jobs called the A’s. However, hiring is only the beginning. Constant training, skill development, education, appraisal, reviews and feedback are a must allowing for rapid promotion of those who show the greatest ‘evolutionary appetite’, to borrow a phrase from GB Shaw. Learning need not be academic but be useful and practical. However, publications, writings, forums and lectures among the team members must be encouraged. A Learning Management System with a curriculum and a school as a center for excellence is a fine idea. It is said that Steve Jobs considered Apple his greatest creation, above the iPod, iPhone and iPad. If so, he was absolutely correct. Creating an organization that will carry on with his energy, intensity and creativity would be his greatest legacy for the future.
Learning holistically, what Senge calls ‘Systems thinking’ would break mental models and cross-pollinate ideas among diverse disciplines. It is such dynamic inter-activity, say between technology and humanities, or arts and mathematics, that has often created some of humanity’s best products. Fear of mistakes must be eschewed replaced by successful failures which teach the entire organization. It must be said, despite the fear of excessive reiteration, that none of this transformative shift should come at the cost of patient safety or compliance. Garvin in his essay on ‘Building a Learning Organization’ has also pointed out that it is not sufficient to create and acquire knowledge but also to transfer it across the company and must also reflect in modification of behavior. He prescribes the three M’s: meaning, management and measurement to assess the rate and level of learning in the organization. It is important to apply easy-to-apply definitions, have clear operational guidelines and develop tools to assist in the same.
Nonaka writes about the ‘knowledge worker’ for whom inventing new knowledge is not a specialized activity but a way of behaving, rather, a way of being. He points out that tacit ideas need to be made explicit and organizational redundancy be utilized to focus thinking and encourage dialog.
To my mind, there is no better stimulus to organizational learning than challenging it constantly to expand its horizons. Such a galvanization lasers individual activity into a collaborative effort, and separates the wheat from the chaff with a gentle shock. The challenge must be critical to the growth of the organization, be in sync with its overall vision and inculcate a sense of adventure and the unknown. Such challenges, of course, should not be deliberate or sadistic but come with zeal and adhere to common purpose.
Systematic problem solving, insisting on data and reporting, accuracy and precision with details and explicit strategies to share knowledge are part of the Learning Organization, as Garvin notes. This metamorphosis takes time and happens as new neural connections are laid down and inter-personal bonds established. When learning and doing become inseparable in a carefully controlled setting, I believe, even Health Care Organizations can mutate into Healing Organizations. Then systems thinking become truly holistic and the organization heals itself first along with its healers before it can heal others.
I believe the time to create organizations that are both learning and healing is overdue. True growth always heals and true learning always builds happiness. Such is the organization we must all create.