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.

Systems and Problems

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: sonia.joseph@nhs.net

Twitter: @sjpaeds #MEDFMLM

References: