to creating a Learning Organisation Dr. Sonia Joseph Consultant - - PowerPoint PPT Presentation

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to creating a Learning Organisation Dr. Sonia Joseph Consultant - - PowerPoint PPT Presentation

Jan 13, 2024 275 likes •427 views

Leadership Lessons on the path to creating a Learning Organisation Dr. Sonia Joseph Consultant Paediatrician, ADME RHSC Edinburgh www.med.scot.nhs.uk @sjpaeds #MEDFMLM NHS Lothian Population 2018 SES 2804,400 people NHS Lothian

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Leadership Lessons on the path to creating a Learning Organisation

  • Dr. Sonia Joseph

Consultant Paediatrician, ADME

RHSC Edinburgh www.med.scot.nhs.uk @sjpaeds #MEDFMLM

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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

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https://corporate-rebels.com/iceberg-of-ignorance/

85%

https://www.ted.com/talksmargaret_heffernan_the_dangers_of_willful_blindness

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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

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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
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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

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Where we were

Patient

Consultant Medical Student Trainee Doctor Dental trainee/ locums/honorary Non-training grades HR/O H/IT

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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/failure s

  • 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

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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.

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Systems and Problems

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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

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Patient

Dental trainee/ locums/honorary

Medical Student Trainee Doctor Consultant

Non-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

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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.)
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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: sonia.joseph@nhs.net Twitter: @sjpaeds #MEDFMLM

References: