Giving Up Control to Build a Learning Culture in a Healthcare System

photo of a woman releasing a heat balloon in the nightA case of strategy development through participation in a large, complex organization. 

Few other industries have the potential to impact life and death as much as the healthcare sector.  Healthcare organizations that don’t provide sufficient attention to learning, improvement, and growth put their patients’ safety and well-being at risk.

A team I led facilitated an 18-month process to enhance learning within a 40-location healthcare system with over 12,000 employees that faced unprecedented changes due to internal and external pressures.  The CEO wanted to make learning “everyone’s business,” as opposed to trainer-centric.  The goal was to have “perfect alignment” between overall systemwide strategy and the learning occurring in the system.  To help achieve this goal, the Chief Learning Officer (CLO), who reported directly to the CEO, hired us to facilitate engagement across their system.  He tasked us with helping build a results-oriented mechanism to achieve alignment between strategy and learning.

The Process

Within large, complex organizations, cultural shifts generally only happen through deliberately planned interventions designed to shift behavior.  We spent some time understanding the culture, which had a good deal of strengths.  These strengths included being the dominant and most respected healthcare provider in its region.  Although the organization was undergoing significant shifts, there was no major crisis that provided the impetus for this initiative. 

Healthcare systems have attempted to shift from a reactive approach emphasizing illness to a more proactive health and well-being focus.  Given that shift, we proposed a different type of orientation for this initiative.  We undertook a strength-based process to build on the best internal practices of informal learning, formal learning (e.g., training), and organization development.  In other words, we focused on helping the organization do more of what was working rather than trying to fix things.  David Cooperrider pioneered the process we used, Appreciative Inquiry, in his work at Cleveland Clinic.  We used a modified version of a process outlined by James Ludema and his colleagues for facilitating large-group change that builds on organizational strengths. 

Widespread participation provided a genuinely distinctive approach for this initiative.  A planning team of nine strategically-recruited executives from various units guided the overall process.  Ten project champions were recruited and trained from throughout the organization to serve as “evangelists” for the initiative and to enlist over 100 members of the Visioning Team, who participated in three full-day off-site summits, interviewed stakeholders about their learning experiences, and participated in benchmarking processes. 

What We Did

We had four primary phases to the process, which included:

  1. Discovering the best of learning within the organization and in other related industries,
  2. Dreaming about what learning might look like,
  3. Designing a new approach to learning that builds on existing strengths, and
  4. Acting to implement the new initiatives.

The first phase focused on discovering the best of learning.  We did that by understanding how employees perceived the alignment between learning and their everyday work.  Next, we brought the visioning team of over 130 stakeholders together to develop core strengths for learning.  Finally, these employees from throughout the system visited and interviewed staff from a children’s hospital known for its leading-edge learning culture and with Marriott International, known for its superb hospitality experience. These experiences provided a baseline understanding of the ideal state of learning and the strength-based core of learning within their own healthcare system.

After the first summit, folks went out to interview at least three other employees to hear about one particular high-point learning experience in their time with the organization.  These stories were shared and documented during the second summit.

For the second phase, we developed a process for visioning team members to dream about the potential for learning within their organization and identify a “positive core” for learning within their healthcare system.  Especially unique, in this phase, folks brought in data from dozens of interviews about “peak experiences” with learning while employed within the organization.  Ultimately, a positive core of learning emerged, which provided a graphical representation of learning as a holistic experience affecting the day-to-day work of employees.  This positive core was both based in reality and aspirational, in building upon current strengths.

During the third phase, visioning team members designed a dream statement for the future of learning, along with six specific action teams designed to deliver results in the following areas:

  • Leadership Buy-in
  • Develop Video Content
  • Personal Learning Aligned with Strategy
  • Better You, Better Care (accountability and recognition for learning)
  • Just Lean Hours – 40 hours of designated paid time per year for learning
  • Nterest (Pinterest-based learning platform)

Lastly, we transitioned the project to internal management and stakeholder teams emerging from the last summit.  During that transition, the CLO took additional steps in gaining top leadership support for moving forward with the initiative.  He connected those actions to data from the survey and corporate strategic metrics. The action teams emerged as a critical development in moving a unified learning strategy forward in an environment with multiple siloes for learning.

Lessons for Other Organizations

The process wasn’t perfect.  For example, there were delays in completing the project due to a massive operational initiative that took precedence.  However, many things went right because of decisions made by the top leadership, consultants, and the planning team.

Provide Direction and then Give Up Control 

The CEO provided a compelling vision of learning being everyone’s business.  The CLO provided additional direction in insisting on involvement for planning the initiative beyond the corporate university (his direct reports).  Both got out of the way to rely on the wisdom of employees from throughout the organization.  Because of that clear vision, without specificity for the operational details, they created conditions for people to be heard in a way they had never been heard before. 

Insist on Widespread Participation

We repeatedly heard from participants that they had never experienced the level of voice and involvement in organizational decision making as they engaged in this process.  The design included different levels of ambassadors who sought insights, spread the word about the initiative, and ultimately provided the real momentum to make it a success.

Provide Assurance by Using a Structured Process

Participation without a structured process can lead to chaos and anarchy.  When fostering culture change, some framework or process provides the “North Star” that allows folks to make efficient use of their time.  In this case, the structured process, along with skilled facilitation, provided for a process that didn’t allow individual voices to dominate, while still moving the initiative forward in an efficient way.

Market, Market, Market

Awareness of various learning initiatives had ebbed and flowed over the years.  We committed to ensuring that the initiative touched as many folks as possible.   Over 2200 people directly engaged n this process in some manner, while many others had an awareness of the initiative.

Employees and leaders widely heralded the process as being one of the highest-profile learning initiatives in the history of the organization. The internal communication plan that led to that awareness continued in elevating the visibility of learning throughout the system.

Overall, the initiative provides a good model for leaders willing to take a risk and give up some control for operational specifics, trusting in those with the on-the-ground knowledge.  It also requires that leadership support the idea of building on its strengths rather than trying to tear down and start over.  Frankly, tearing something down rarely works because people resist.  This model took a different approach that provided inspiration that they could build a better future for learning within their organization.

Photo by Robert Metz on Unsplash