Leadership Lessons on the path
to creating a Learning
Organisation
Dr. Sonia Joseph
Consultant Paediatrician, ADMERHSC Edinburgh
www.med.scot.nhs.uk
@sjpaeds #MEDFMLM
NHS Lothian
Population 2018
• SES 2804,400 people
NHS Lothian
• 708,100 people
• 405,000 Emergency admissions
Infrastructure
• 5 teaching hospitals & 32 peripheral sites, 124 GP practices
Workforce
• 800 Medical students
• 1300 Junior doctors
https://www.isdscotland.org/Health-Topics/Hospital-Care/Publications/2018-09-25/2018-09-25-
Annual-QuarterlyAcuteActivity-Report.pdf?96015566588
Aug,Dec,
Feb, April> 400
https://corporate-rebels.com/iceberg-of-ignorance/
85%
https://www.ted.com/talksmargaret_heffernan_the_dangers_of_willful_blindness
Bronfenbrenner’s
Ecological Systems Theory
Professional Bodies
System Culture
Personal Beliefs
Doctor
Jones, D; Aitken, G; Fawns, T; Joseph, S (2019) Systems Thinking in Medical Education: Seeing the Individual in the Bigger Picture. Scottish Medical Education Conference Workshop, Session 3: 24
What they
think they
gain from
training
What they
actually
gain from
training!
Developed
Skills
Childhood &
health factors
Learning
Styles
The facts
• 10% Patient admissions experience harm as a result of medical error (WHO 2008)
• 6 %-13% Increase in mortality reported in hospitals on first Wednesday in August
• 49% of 139 reflective notes on e-portfolio of 30 FY1 doctors had documented patient safety incidents in them (Ahmed et al 2012)
• UKFPO 58% of medical students took a medical post in the same region as their medical school
• 38% of University of Edinburgh students stay on for Foundation Year 1 in Lothian
• FY > Specialty Training
• 2011 -71.3%
• 2017- 42.6%
• GMC July 2017 > 90% of previous FY2 were back in training 4 years after FY2
2012 Challenges
Known Unknowns
Organisational silos
No ability to learn
from patient stories
and SAE
Overcoming improvement
inertia and Culture
Nomadic Staffing group
No curriculum, aims
and objectives for
induction
Changing
national
perspectives
Significant variation
in knowledge, skills
and needs of
individuals
Where we were
Patient
ConsultantMedical
Student
Trainee Doctor
Dental trainee/
locums/honorary
Non-training grades
HR/OH/IT
Patient Safety
Latent Failure
• Management Decisions
• Organisational Processes
Conditions of Work
• Workload
• Culture
• Supervision
• Communication
• Equipment
• Knowledge
• Ability
Active Failures
• Unsafe acts
• Omissions
• Action slips/failures
• Cognitive failures
• Mistakes
• Violations
Barrier
Barrier
Accident/
Harm
Stages in the development of an organisational accident and an adapted model from Vincent et al114 supporting the London Protocol
Pixabay: black cave
2 types of changes in
systems:
1st order-change to return
the system to a normal
level of performance
2nd order- a change that
alters the system and
results in a new level of
system performance
We needed 2nd order
change.
Doctors Learnpro
http://doctors.learnprouk.com/doctorslanding/
Learning Organisations
• Information is shared and
accessible
• Learning is emphasised and
valued
• People are expected to
learn constantly
• Mistakes or failures are not
punished but are used to
learning
Source: Peter Senge
The Fifth Discipline
Patient
Dental trainee/
locums/honorary
Medical Student Trainee Doctor
ConsultantNon-training grades
MED
network
Corporate/
LD/HR/IT
systems
SCIP Saved 10 hours per trainee per rotation = 7,740 Hrs. for FY and 28,000 hours for GP and ST
3 full days at
induction
4 hours/year
for appraisal
3 full days at
induction
4 hours/year
for appraisal
GP
OOH
Where we are now
Take Home Messages
• Criteria for change in complex systems
• Myron’s Maxims @Myron Rogers
• People own what they help create
•
• Real change takes place in real work
• The people who do the work do the change
• Connect the system to more of itself
• Start anywhere, follow everywhere
• The process we use to get to the future is the future we get.
• The way we work together today creates the way we’ll work together tomorrow
• (attributed to Kurt Lewin and Margaret Mead et al.)
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j41 (Published 13 January 2017)
Cite this as: BMJ 2017;356:j41
https://www.foundationprogramme.nhs.uk/sites/default/files/2018-
07/2017%20F2%20Career%20Destinations%20Report_0.pdf
1 https://reports.gmc-uk.org/views/2017-Recruitment-PG-
publicrelease/PUBDash_Summary?%3Atabs=no&%3Atoolbar=no&%3Aembed=y
#3
https://blog.holacracy.org/whats-wrong-with-your-organizational-structure-
91dd71a76eb7
http://www.maestro-business.co.uk/cultural-operating-system/
Bronfenbrenner’s Ecological Systems Theory
https://www.youtube.com/watch?v=HV4E05BnoI8
https://en.wikipedia.org/wiki/NHS_Scotland
https://www.ted.com/talks/margaret_heffernan_the_dangers_of_willful_
blindness
Resources: www.med.scot.nhs.uk
Contact: [email protected]
Twitter: @sjpaeds #MEDFMLM
References: