Collective learning, change and improvement in health care: piloting a facilitated learning initiative with general practice teams
Keywords:Action research, change, clinical team, collective learning, communication, facilitated learning, improvement, learning practice programme (LLP), primary care
AbstractRationale, aims and objectives: Now, more than ever, the National Health Service (NHS) in Scotland, UK requires healthcare professionals to work together in highly effective ways to meet patient needs. This study examines the pilot stage of the Learning Practice Programme (LPP): a practical experiment to support multi-disciplinary general practice teams in cultivating the attributes of learning organisations. This paper builds on an earlier trial by extending the size and scope of the LPP to explore its relevance and transferability across a wider range of healthcare teams, contexts and facilitators.Methods: The LPP pilot paper reports on a range of qualitative data sources gathered using an action research approach. Overall the study gathered evidence from participant teams, facilitators and researchers and this paper particularly focuses on the data generated by participants. This includes anonymous written learning notes, mid-point review responses and semi-structured post-pilot interviews. Results: The LPP introduces teams to concepts, processes and tools they can use in practical ways to enhance shared learning and create more effective collective change in their practice. Participating teams found their established communication patterns were changed, redirected or deepened as a result of the learning activities. All teams designed and introduced ways to enhance their effectiveness in working and learning together. Practices where all members of the team engaged with the LPP had much greater success in achieving their self-designed goals compared with those who had varying commitment across their team members.Conclusion: Where teams have a basic willingness to learn and change together the LPP provides a process for them to design new ways of working together. All teams took steps to apply the principles of learning organisations and make effective changes to their existing practice; their efforts are a good enactment of the underlying spirit of the Scottish Government Quality Strategy, which calls for greater multi-professional working, shared decision-making and innovation in working practices to enhance the patient experience. The hope of the LPP is to empower teams to be proactive in clarifying what matters most to them as a professional healthcare team and how they can express that in the day-to-day service of their patient community.
Gubb, J. (2009). Have targets done more harm than good in the English NHS? Yes. British Medical Journal 338, a3130.
Crump, B. & Adil, M. (2009). Can quality and productivity improve in a financially poorer NHS? British Medical Journal 339, b4638.
The NHS Confederation. (2008). Futures debate Paper 2. Compassion in healthcare: The missing dimension of healthcare reform?
Doherty, C. (2009). A qualitative study of health service reform on nurses’ working lives: Learning from the UK National Health Service (NHS). International Journal of Nursing Studies 46 (8) 1134-1142.
Benn, J., Burnett, S., Parand, A., Iskander, S. & Vincent, C. (2009). Perceptions of the impact of a large-scale collaborative improvement programme: experience in the UK Safer Patients Initiative. Journal of Evaluation in Clinical Practice 15 (3) 524–540.
Lewina, S. & Reeves, S. (2011). Enacting ‘team’ and ‘teamwork’: Using Goffman’s theory of impression management to illuminate interprofessional practice on hospital wards. Social Science & Medicine 72 (10) 1595-1602.
Bunniss, S., Gray, F. & Kelly, D.R. (2011). Collective learning, change and improvement in health care: trialling a facilitated learning initiative with general practice teams. Journal of Evaluation in Clinical Practice 18 (3) 630-636.
Senge, P.M. (1990). The Fifth Discipline. The art and practice of the learning organization. London: Random House.
Morton-Cooper, A. (2000). Action Research in Healthcare. Oxford: Blackwell Science.
Hart, E. & Bond, M. (1995). Action research for health and social care: A guide to practice. Maidenhead: Open University Press.
Wakeling, J. (2008). Evaluating the Learning Practice Workshops: Participation of the Glenrothes and North East Fife Community Health Partnership. NHS Education for Scotland (Internal Report)
Rushmer, R., Kelly, D.K., Lough, M., Wilkinson, J. E., Greig, G.J. & Davies, H.T. (2007). The Learning Practice Inventory: diagnosing and developing Learning Practices in the UK. Journal of Evaluation in Clinical Practice 13, 206–211.
Kelly, D.K., Lough, M., Rushmer, R., Wilkinson, J.E., Greig, G.J. & Davies, H.T. (2007). Delivering feedback on learning organization characteristics using a Learning Practice Inventory. Journal of Evaluation in Clinical Practice 13, 734–740.
Bunniss, S. & Kelly, D.R. (2010). Research Paradigms in Medical Education Research. Medical Education 44, 358–366.
Wood, L., Hassell, A., Whitehouse, A., Bullock, A. & Wall, D. (2006). A literature review of multi-source feedback systems within and without health services, leading to 10 tips for their successful design. Medical Teacher 28 (7) e185-191.
Bowie, P., McKay, J., Dalgetty, E. & Lough, M. (2005). A qualitative study of why general practitioners may participate in significant event analysis and educational peer review. Quality & Safety in Health Care 14, 185-189.
The Scottish Government. (2010). The Healthcare Quality Strategy for NHS Scotland.