From the moment we are born, we begin the lifelong process of learning. As children, we learn by observing, listening, and experiencing; we are open to all new things. As we grow, our experiences begin to take form through what we learn and what we do. The knowledge gained shapes us into who we are today.
Consider how you learn as an adult. Do you learn for yourself, for your chosen career path, or for growth in another area?
In 1990, Peter Senge’s bestselling book, The Fifth Discipline, defined the concept of a learning organization.(1) His five disciplines offer a framework to create and operate in a learning environment:
Shared vision — The organization has a purpose and vision that it strives to achieve. This vision should be shared with everyone in the organization.
Mental models — Our experiences shape how we think and what we do. Our mental models guide how we react and why we do things the way we do them. All employees are different. In a learning organization, it is important to understand everyone’s mental model and how best to help those individuals learn.
Team — Individuals learn, but so do teams. Teams within learning organizations need to work together to contribute to the vision of the organization. Individual departments exist, but they are not silos with purposes and functions entirely on their own. How the organization addresses team learning is crucial to its success.
Personal mastery — Personal mastery speaks to the growth of individuals in areas related to their teams and responsibilities but also to their own improvement. A lifelong learning process will help everyone achieve a level of mastery in their chosen profession or area of interest.
Systems thinking — This is a framework for putting the other four disciplines together to achieve the learning organization’s vision. Using systems thinking, organizations can improve care for every patient they serve.
In today’s complex medical world, the need to respond, to improve, to change, and to innovate is based on learning. A learning program, rather than a training program, is a cornerstone for success in the organization. Rather than training personnel, the idea is to encourage learning for all members of the organization. Training identifies the “how,” “what,” and “when” that are necessary for growth; learning offers the “why” behind the training. Through learning, the organization will be better able to respond to the constantly changing world.
Two key aspects of this learning organization are operational and clinical, and the desired outcomes should be improved patient care and solid financial performance for the organization.
LEARNING ORGANIZATION MODEL
Figure 1 illustrates the learning organization model. What data do you have, what data are available, and what can you do with that information? Data from external sources include what the competition is doing, what is happening in the local market, and what others are doing (benchmarking) to succeed. Internal sources include your organization’s practice management system, EHR, and financial management system.
Using these data, you can compare your organization’s performance to its goals and your key performance indicators (KPIs), which are related to your outcomes. Once you identify the data that are relevant to your vision, you can identify areas to improve or change. You also may be encouraged to innovate. After exploring the data, you may realize the way you’ve always done it no longer works to meet the goals of the organization.
This data-gathering focuses on what information needs to be shared — the “what” piece of the equation. The organization’s performance will then be measured against the goals and KPIs established through the data review. This is fed back to the base phase of the learning organization for a focus on continuous improvement and growth.
Figure 1. Model of a Learning Organization
LEARNING ORGANIZATION GOALS
Every program must have goals, a purpose for its existence, and a way to measure its success. Each organization will need its own set of goals. Examples include:
Change your culture to one that focuses on learning as an every day, every activity component of the organization.
Improve performance through:
Employee development and retention.
Enhanced skills and capabilities.
Engagement of team members and patients.
Meeting KPIs.
Achieve compliance through:
Regulatory requirements.
Internal policy and procedures.
Care/treatment plans.
Ethical approach: no fraud, no abuse.
Develop and manage a succession plan by identifying key positions that will need to be filled.
Increase innovation. Do not accept the standard way as the mantra. Instead, challenge each member to find ways to improve what they are doing.
Several reasons to establish a learning organization include:
For superior performance and competitive advantage.
For improved customer relations.
To improve quality.
To understand risks and diversity more deeply.
For innovation.
For personal and spiritual well-being.
To increase the ability to manage change.
For a more energized and committed workforce.
To expand boundaries.
To engage in community.
For awareness of the critical nature of interdependence.
Because the times demand it.
The main benefits of establishing a learning organization are:
Maintaining levels of innovation and remaining competitive.
Being better placed to respond to external pressures.
Having the knowledge to better link resources to customer needs.
Improving the quality of outputs at all levels.
Improving corporate image by becoming more people- oriented.
Increasing the pace of change within the organization.
Making knowledge of key personnel within the organization explicit, codified in manuals, and incorporated into new products and processes.
Increasing responsible decision-making through knowledge, facilitating educated choices.(2)
What would you include as priorities on your list?
ADULT LEARNING
One of the key points in the learning organization model is mental models. Malcolm Knowles identified key principles in adult learning that must be considered when developing any learning program.(3)
Self-Concept. As people mature, their self-concept moves from being dependent to being self-directed.
Adult Learner Experience. As people mature, they accumulate experience that becomes an increasing resource for learning.
Readiness to Learn. As people mature, their readiness to learn becomes increasingly oriented to the developmental tasks of their social roles.
Orientation to Learning. As people mature, their time perspective changes from the postponed application of knowledge to the immediate application of knowledge. As a result, their orientation toward learning shifts from subject-centeredness to problem-centeredness.
Motivation to Learn. As people mature, the motivation to learn is internal rather than external.
Each employee is different, shaped not only by their cultures and experiences, but also by how and what is important to them.
GENERATIONS
Let’s focus on the Gen X and Y generations in terms of developing learning approaches. The Florida Institute of Technology put together an excellent review of traits and strategies for these groups.(4)
Gen X learners:
Are skeptical and cynical.
Are independent and self-reliant.
Are entrepreneurial thinkers.
Are resourceful/problem solvers.
Defy authority.
Are loyal to individuals, not organizations.
Are reality-driven.
Are turned off by “touchy-feely” teaching methods.
Are competent with technology.
Are intolerant of bureaucracy.
View freedom as the best reward.
Are multitaskers, balancing work and life.
Instructional strategies for Gen X learners include:
Offer direct/immediate communication through emails and phones.
Get to the point and provide clear instructions.
Avoid micromanaging them.
Make assignments “real-world” related.
Provide opportunities for individual work.
Incorporate technology when possible.
Use games and case studies.
Gen Y learners:
Tend to be optimists.
Expect immediate feedback.
Are not accustomed to negative feedback.
Have a short attention span.
Are “connected” 24/7.
Are more accepting of authority than Gen X.
Are sheltered by their helicopter parents.
Are team-oriented.
Have a strong sense of entitlement.
Are highly visual learners.
Expect accommodations.
As digital natives, expect to use technology.
Are often concerned with style over substance.
Are opinionated.
Instructional strategies of Gen Y learners include:
Communicate through texting and social media.
Provide clear objectives and standards.
Develop self-assessment items.
Provide opportunities for group work.
Incorporate technology.
Create a multimedia environment.
Give them group projects to complete.
Connect to learners through social media.
These strategies are worth considering when developing a learning program for younger team members. Be mindful, however, that not everyone in Gen X or Gen Y will fit neatly into these categories.
EMOTIONAL INTELLIGENCE
In his book on emotional intelligence, published in 1995, Daniel Goleman suggests that the IQ, intelligence quotient, of an individual is only part of the whole person. He highlights five domains of emotional intelligence (EQ):(5)
Self-awareness: Knowing your emotions.
Self-regulation: Managing your own emotions.
Motivation: Motivating yourself.
Empathy: Recognizing and understanding other people’s emotions.
Social skill: Managing relationships.
Develop your training programs with the idea that the emotions of the team members are critical to a successful relationship and a compassionate approach to caring for patients.
DESIGNING THE LEARNING PROGRAM
What do you need to do to develop and design a training program for your practice? Figure 2 offers a framework(6) that should apply whether you are training everyone in the practice, such as annual OSHA training, or onboarding a new employee.
Figure 2. Training Program Design
As you look at each box noted in the figure, consider the following:
Needs assessment — What do you need to train? How critical is the need?
Organization-wide program to meet strategic or regulatory requirements.
Operational in nature with skills and task requirements considered.
Individual needs from onboarding to targeted skills or tasks in their key work area.
Objectives — What do you wish to accomplish with the training effort? What will the participants be able to do, explain, or demonstrate that they learned?
Learning style — Each program or individual may require a specific training style or approach.
Delivery mode — Classroom, eLearning, mentoring, or something different?
Budget — The cost-benefit of any program effort must be considered.
Delivery style — Formal? Informal? Typically, more interactive styles are better than a lecture format.
PowerPoint (be cautious of “death by PowerPoint”)
Role play
Case studies
Audience — To whom will the program be directed?
Content — What will be taught based on the needs assessment? Who will teach the content? Do you have resources in-house, or must you look outside for help?
Timelines — When will the training occur? How frequently and for how long?
Communication — How will team members be made aware of the program?
Measure effectiveness — How will you know that it worked? What are the key metrics, or methods to ensure the program was successful?
When considering the objectives of any training program, the Bloom’s taxonomy model works well (see Figure 3).(7)
Figure 3. Bloom’s Taxonomy
Donald Kirkpatrick offers a model for assessing the effectiveness of training programs: (8)
Reaction — How did the participants react?
Learning — Did the participants improve or change in their level of knowledge or skills?
Behavior — Did the participants’ behavior improve or change in a positive direction?
Results — Did the organization benefit from the training effort?
Don’t overlook the benefits of cross-training, including cost savings, employee retention, and improved performance. Understanding the requirements of related positions (e.g., front desk and billing office, front desk and scheduling), will provide positive results.
Another key need that is often overlooked is the aspect of a succession plan. Too often, little is done to develop a replacement or a team of replacements for key employees such as lead physicians, other physicians, managers, skilled technologists, and mid-level providers. You can even look to the receptionist — do you have someone who can step in to do the tasks? What will it take to fill that unmet need, should it arise?
It is important to consider the approach used in the setting. Interactive learning options are better for adult learners. Rather than presenting a PowerPoint lecture standing off to the side, get interactive. Stand in front of, walk around, and reach out to the audience. Use role plays. Present case studies to small groups who attempt to solve the problem and then share their findings with the entire audience. The Socratic method of asking questions about the material, drilling down to get the entire message across, also works well.
E-learning options are a viable alternative. Some companies have prepared programs that can be purchased for individual training. Topics include software, regulatory, and other technical programs.
One of the most effective approaches is to design and develop individualized programs through mentoring or coaching. A mentor does not provide all the answers but rather works with the employee to help them find or determine the answers. The mentors facilitate instead of train. This allows the employees to find their way, to try and sometimes fail, but learn through the process.
The mentor program for each member should become a formal part of the practice. Each department can identify a senior person who is willing to assume additional responsibility for helping the new team member learn how things are done. A formal program should have goals for the relationship, customer focus, timeframe and milestones (checkpoints), skills to be addressed, outputs from the effort, and the like.
Coaching is when an individual is available to offer advice. This advice may be highly technical or even managerial, but is more of a “how to” rather than providing examples. The coach is typically the supervisor or manager of the team member and functions much the same as the athletic coach. For example, the coach is not in the game but trains the player on how to do the job. When there is a time out, the coach is there to make suggestions, give further instructions, or congratulate for a job well done.
Here again, there is a need for a plan to be developed for everyone since all team members have different skills.
MEASURING SUCCESS
A learning program is expensive, and therefore its return on investment, ROI, must be considered. It’s important to explore the most cost-effective method to accomplish the objective.
As noted above, several goals should be identified and the expected outcomes considered. Do you want to change a behavior, change the way things are done, improve patient satisfaction scores by a certain percentage, improve the bottom line by a dollar/percent, or something else?
Ways to measure effectiveness include observation and skill assessments. It is not enough to assess change with one observation: instead, set up a schedule to follow up at specific yet random intervals. Long-lasting change in performance results need to be measured.
Once a learning project is complete, the individuals who put together the program as well as the participants should get together to review the process and outcomes and then offer input on what can be done better or recognize what went well.
COMMITMENT TO LEARNING
Most medical practices undertake the minimum education effort, typically limited to the required programs such as annual OSHA and HIPAA training. They invest little in the staff, which proves to be the most expensive asset.
Yet, consider this:
One practice that includes 15 doctors, 10 locations, and 250+ employees offers quarterly training. Each office is closed one afternoon per quarter for the first three quarters of training and for a full day in the fourth quarter. Their quarterly training breakdown is as follows:
First quarter: Required training and optional training programs for all staff are done online. Staff remains at their workstation, and tracking is done electronically.
Second and third quarter: Staff assembles at a location for motivational and focused training on such things as customer service. Those in each position, such as receptionists from each office, get together to review procedures and discuss improvements in their operation.
Fourth quarter: A full-day staff retreat at a resort includes education and networking opportunities. The staff has the opportunity to invite their families to enjoy the evening or weekend at a reduced rate. Bus transportation is arranged from the offices.
One practice hired a teacher to teach the issues of medical practice. Her teaching and mentoring skills resulted in incredible feedback, reduced turnover, and improved patient outcomes.
Other practices have made a conscious effort by requiring monthly departmental meetings, with one component focused on an educational effort that is general rather than practice-specific. This conveys the attitude that learning is part of the culture of the practice.
Excerpted from The High-Performing Medical Practice: Workflow, Practice Finances, and Patient-Centric Care by Owen J. Dahl, MBA, LFACHE, CHBC.
REFERENCES
Senge PM. The Fifth Discipline. New York, NY: Penguin Random House; 2006.
Yadav S, Argarwal V. Benefits and Barriers and Learning Organizations and Its Five Disciplines. IOSR-Journal of Business and Management. 2016;18:18-24. http://www.iosrjournals.org/iosr-jbm/papers/Vol18-issue12/Version-1/D1812011824.pdf .
Pappas C. The Adult Learning Theory — Andragogy of Malcom Knowles. eLearning Industry. May 9, 2013. Accessed December 1, 2018. https://elearningindustry.com/the-adult-learning-theory-andragogy-of-malcolm-knowles .
Griggs J. Generational Learning Styles (Generation X and Y) The Florida Institute of Technology. Accessed December 1, 2018. http://web2.fit.edu/ctle/documents/Course_Design/Generational%20Learning%20Styles%20Handout.pdf .
Emotional Intelligence. Learning Theories. https://www.learning-theories.com/emotional-intelligence-goleman.html . Accessed December 1, 2018.
University of Minnesota. Libraries Publishing. http://open.lib.umn.edu/humanresourcemanagement/chapter/8-4-designing-a-training-program/ . Accessed December 1. 2018.
Vanderbilt University Center for Teaching. https://cft.vanderbilt.edu/guides-sub-pages/blooms-taxonomy/ . December 1, 2018.
Kirkpatrick D. Evaluating Training Programs, 3rd ed. San Francisco, CA: Berrett-Koehler; 2006.