22 February 2019

QI Essentials: Learning systems for improvement

Achieving change in behaviour and culture in complex organisations requires intentional design. In this blog, Dr Amar Shah shares some learning on key components of the design of learning systems for improvement.



The pursuit of continuous improvement helps us create a learning organisation, described by Peter Senge as “where people continually expand their capacity to create the result they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning how to learn together”.

Achieving this change in behaviour and culture in complex organisations requires intentional design. Those of us leading continuous improvement will likely have toyed with a number of different ways of supporting large numbers of teams, working in different contexts, to apply quality improvement and align this towards a common goal. In this blog, I share my learning about the seven components that I’ve found are key to the design of learning systems for improvement, shown in the image below.

Bear in mind that as we look to create a learning organisation, we will be trying to build systems of learning at multiple levels – at the level of the macrosystem (whole organisation), at the level of mesosystems (divisions or directorates), at the level of microsystems (individual teams) and even at the level of the individual. Yes, even we as individuals ought to shift towards a learning mindset, and the seven components above are just as applicable at the individual or team level, as they are at the whole-system level.

  1. Shared purpose

Probably the most important of all. Having a clear purpose or goal, aligned to what really matters. Creating a deep visceral connection to emotion, rather than a set of words on the wall, is what we mean here. As a team, would everyone be able to talk passionately, and consistently, about what the purpose of the team is? As an organisation, is it clear what the mission is, and can people describe this in their own words and feel a connection to it?

  1. Shared language

For us to learn and play together, we need a common way to communicate. The language of improvement can be a wonderful bridge across different professions and power hierarchies. The use of improvement tools can allow all to have an equal voice and power in determining how we improve. Improvement can bring teams together from different contexts but facing similar challenges, learning together through the common language of improvement, and building networks across the organisation that otherwise might not exist.

  1. Autonomy

The application of quality improvement, in itself, shifts power outside of formal hierarchy to enable people to develop their own theories about what may make a difference, and the ability to try new ideas without fear of failure. In large-scale improvement, there’s a delicate balance between bringing teams together that are all working towards a common purpose with a shared theory of change (such as flow, or joy in work), whilst still devolving power and autonomy to each team to understand what matters most in their context, and make the changes that they believe will make a difference.

  1. Collective leadership

Collective leadership is described by Professor Michael West as “the purposeful, visible distribution of leadership responsibility onto the shoulders of every person in the organisation”. The design of large-scale improvement can support this by involving a diverse range of people in the work, including patients, service users and family members. We can also intentionally redistribute power within improvement work by allocating leadership roles to those who hold no formal hierarchical role. One of the beautiful aspects of supporting quality improvement work is that it witnesses the emergence of new leaders from unexpected places, given the opportunity and permission to improve the system for those we serve.

  1. Connections and relationships

Bringing people together and creating safe spaces to share with each other helps build relationships within teams and across teams. This is critical to allow the surfacing of difficult issues, the ability to explore and make sense through emotional connection, and to ensure people feel free to fail and learn in the pursuit of a common goal. Any learning system needs to develop ways for people to truly connect with each other as humans, not just as professionals. Story-telling can be a wonderful way in to this deeper connection.

  1. Data and measures to understand variation

Learning systems need to support teams to understand the variation that exists within their own microsystem, and also learn from the variation across teams. Key to this is the use of data over time, shared transparently, in order to support learning and adaptation. As with all quality improvement work, no single measure can help understand how a complex system behaves, so we need a range of measures (outcome, process and balancing). For large collaborative learning systems with multiple teams working towards a common purpose, there needs to be a way to learn across teams and from the variation, so standardising the outcome measure is really important.

  1. Infrastructure to support the learning system

Learning systems for quality improvement are usually built to tackle complex challenges that haven’t been solved before. Inevitably, this is going to be difficult work. Teams need close support through this journey, which will include access to improvement expertise and knowledge, leadership support to make changes that challenge the status quo and access to content knowledge about ideas and evidence that has been shown to be effective in solving the challenge. Any learning system design needs to give consideration to how teams will access this support as easily as possible, in order to accelerate the improvement work.

You can read all past QI Essentials posts here.

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