COMPLETED RESEARCH PAPER

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Course Learning Outcomes for Unit VII

Upon completion of this unit, students should be able to:

7. Discuss the concept of learning organizations in health services organizations. 8. Compare the approaches of quality assurance and quality improvement.

Reading Assignment

Chapter 7: Statistical Thinking for Health Care Leaders: Knowledge About Variation, pp. 107-132

Chapter 9: A Health Care Leader’s Role in Building Knowledge, pp. 169-189

Unit Lesson

This lesson will explore the concept of learning organizations in health service organizations, and will compare the approaches of quality assurance and quality improvement.

Learning Organizations

The Business Dictionary (n.d.) defines a learning organization as an organization that acquires knowledge and innovates fast enough to survive and thrive in a rapidly changing environment.

Learning organizations (1) create a culture that encourages and supports continuous employee learning, critical thinking, and risk taking with new ideas, (2) allow mistakes, and value employee contributions, (3) learn from experience and experiment, and (4) disseminate new knowledge throughout the organization for incorporation into daily activities. (Business Dictionary, n.d.)

The healthcare environment is rapidly changing with new reimbursement systems and creating a learning organization is paramount to success. Let’s explore these elements and look at practical strategies to create a learning organization.

Continuous Employee Learning

Learning is an ongoing process, and it is scary if someone does not approach learning with that humility. Imagine needing brain surgery and your neurosurgeon tells you that the last time he or she was at a Continuing Medical Education (CME) course or discussed the latest imaging and surgical techniques with his or her colleagues was more than 14 years ago. How would you feel? The same need for continual medical education also applies to managers, which could be in the form of reading emails from list serves with current articles and management-help and leadership books or attending conferences and professional association meetings. It is important for managers to be life-long learners and value continuous education.

Employees have a natural thirst for training and knowledge, particularly in health care where clinicians conduct medical procedures and the science and knowledge is always expanding.

The Gallup Organization has been a pioneer for decades with employee surveys and they have found a high correlation to the question “Have you had enough training to do your job?” and employee engagement. Gallup

UNIT VII STUDY GUIDE

Learning Organizations and Quality Improvement

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Title draws the distinction between employee satisfaction and employee engagement. Their saying is “Employee satisfaction is not enough” (Adkins, 2015).

Healthcare leaders must enrich their team (and themselves) with continuous learning opportunities. This leads to employees feeling engaged and wanting to contribute in valuable ways.

Valuing Employee Contribution

As employees evaluate their worth to a department or organization and their relationship with their manager, how would they define their worth and value? To begin to answer these questions they would need to critically think about what it is they want from their work relationship, and this can vary widely by person. As a manager helps people identify the factors that motivate and engage them, perhaps he or she can have the team create their own list, to rank in order what motivates them. Then, compare their lists to this list below, which is typical for the order of highest correlation factors to employee engagement.

 Having a sense that the work I do is meaningful and makes a difference

 Having a feeling of stability in my job

 Having opportunities for my growth and career development

 Being recognized for the work I do

 Having my opinion valued and being involved with strategic decisions

 Being fairly compensated for my time

 Having a friend at work or feeling socially accepted

Knowing that these are driving factors for someone’s motivation and knowing the person’s capabilities and the job he or she does, a manager can tailor the approach to each employee to maximize his or her feelings of engagement, contribution and value.

Critical Thinking

Once someone is engaged and feels they are valued for their contributions, the environment becomes ripe to cultivate higher-order, critical thinking. One definition of critical thinking is to examine assumptions, discern hidden values, evaluate evidence, and assess conclusions (Warnick, Inch, 1994). This is exactly the behavior we want from our employees, for them to think critically and to advance patient care. They should feel they can independently explore problems, form a hypothesis, and justify their position. It is hoped that they can keep an open mind to see when their conclusions were incorrect, make adjustments, and continue the cycle. Most importantly, managers want employees to work collaboratively in this cycle of critical thinking and to experiment, as an inter-disciplinary team (IDT), to work together for the maximum good of the patient. This concept of critical thinking is best captured in scientific method, which has the following steps:

 make an observation,

 ask a question,

 form a hypothesis,

 conduct an experiment, and

 accept or reject your hypothesis (if rejected, repeat the steps).

Scientists look for the science behind someone’s hypothesis, and they look to replicate the results. While the scientific method tends to bring to mind the picture of a lab bench with scientists in white coats, this method has applicability in the daily operations of health care. This method encourages curiosity and exploration, documentation, and open-mindedness. Managers should encourage employees to be curious and to find better ways to do things, and to feel they have liberty (within the limits of not harming patients) to take risks.

Innovation and Risk Taking

When an employee feels their contributions are valued, they will likely feel motivated and engaged; and when they are feeling motivated and engaged, they will likely think critically; and whey they are thinking critically, they are bound to be innovative and experiment to take risks and make improvements. The manager sets the tone; he or she can make the environment one where motivation, critical thinking, and experimentation are celebrated and encouraged. Below please find strategies healthcare leaders can use to encourage creative thought, innovation and risk taking:

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1. Encourage ideas. One company gave employees four hours a month to innovate. There were no strings attached and no rules. They could work with anyone, the only rule was that they had to share their results with the company. The company made those four hours as much fun as possible, bringing in food and drinks and having a buildup to the event. Up to that point, the company had simply tried rewarding good ideas with money, but they learned that money does not actually spur creativity, and people would get possessive of their ideas. What did work was having the dedicated time and space for innovation, and making it fun and engaging. This approach created the best ideas they had seen in years. It turned out that higher level thinking was not correlated to money, it was correlated to the desire for independence and autonomy.

2. Joke about mistakes: When you joke with your team about a mistake you made, you are giving them the space to do the same. Innovations do not come without experimentation, and failure is part of success.

3. Read books: Introduce a book every quarter or six months that you read as a group, this will spur the environment of learning and make critical thinking welcomed.

4. Attend seminars: Show that you value education and innovation by sending people to seminars. A secondary benefit of this is that employees bond with each other

A fascinating book on innovation techniques for managers is, "Tribes, We Need You to Lead Us," by Seth Godin (2008). Below are some of his thoughts:

 Sheepwalking: Godin uses the term sheepwalking to describe people who have been raised to be obedient; we give them brain-dead jobs and enough fear to keep them in line. Godin uses the example of the TSA worker who forced a mom to drink from a bottle of her own breast milk because any other option was not in the manual.

 Non-sheep behavior: Godin talks about embracing non-sheep behavior and claiming the career you deserve by refusing to walk down the same sheep path. Make change and start passionate movements toward your beliefs, getting people with like ideas connected.

 Enabling heretics: Godin suggests enabling heretics in your organization and giving them flexibility to build something new.

 Money versus doing what you believe: Godin talks about money, that we must realize it is not the point of innovation. The point is to build your followers up, being okay with being wrong and doing what you believe.

Speaking of doing what you believe, typically the list of motivators you will see includes having a sense that the work we do is meaningful and makes a difference. Health care gives us that gift of serving others and making a difference in that person’s life. Health care is among the most noble of employment opportunities.

Disseminating Knowledge

Sharing information is empowering to people and it only helps motivation and productivity to increase. We live in the era of immediate information and technology. Today’s workers are empowered and they want to know the why’s and how’s behind decisions. The more we can involve our team in the decision-making process, and the more we can involve them with information regarding operations, the more engagement, productivity, and innovation we will achieve.

Quality Assurance versus Quality Improvement

We need to define the difference between Quality Assurance (QA) and Continuous Quality Improvement (CQI). Quality Assurance is defined as an effort to overcome problems with quality (Lohr, 1991), while Continuous Quality Improvement is defined as combining a scientific methodology with a management philosophy of improving processes continually (Goldstone, 1997).

Regarding QA, have you ever met a business owner or person who seems to live in the past without innovation, who seems to rest on their laurels, as though they feel their past achievements have put them in a sufficient space of comfort and distinction? That can be the result of QA, the assumption that if serious failures are inspected and eliminated, the rest must somehow be excellent or good enough (Goldstone, 1997). When we stop innovating, we leave things to the chance or luck of QA, a passive approach to simply maintain the status quo, to not rock the boat too much. QA programs are what we used to call our healthcare quality committees 10 years ago.

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Regarding CQI, there is a great saying by the legendary author of Good to Great, Jim Collins (2001), “What got you here won’t get you there.” With CQI we embrace the concept of Total Quality Management (TQM), that no system is finite, but each system affects another. One hospital historically had systems and silos of care, for example a great cardiology department that operated separately of the radiology department, both operating separately of the emergency department. That silo thinking and merely assuring the quality of one area does not work. The new wave in quality is CQI. Aside from CQI being a philosophy, It is a methodology of industrial and statistical process control; it is looking at regression analysis to see what factors are causal to which outcomes, and continuously changing processes and controls to create more desirable outcomes.

There is always the possibility to improve quality. Today’s healthcare environment demands that we focus continuously, relentlessly, and fanatically on improvement. After all, human life is in our hands.

References

Adkins, A. (2015). Majority of U.S. employees not engaged despite gains in 2014. Gallup. Retrieved from http://www.gallup.com/poll/181289/majority-employees-not-engaged-despite-gains-2014.aspx

Collins, J. (2001). Good to great. New York, NY: HarperCollins.

Goldstone, J. (1997). The role of quality assurance versus continuous quality improvement. Journal of Vascular Surgery, 28(2), 378-380.

Learning Organization. (n.d.). In The Business dictionary [Web page]. Retrieved from http://www.businessdictionary.com/definition/learning-organization.html

Lohr, K. N. (1991). Quality of health care: An introduction to critical definitions, concepts, principles, and practicalities. Ann Arbor, MI: Health Administration Press.

Warnick, B., & Inch, E. (1994) Critical Thinking and Communication (2nd ed.). New York, NY: Macmillan.