This article was originally published by Healthcare Markets and has been republished here with permission.
While Covid-19 has undoubtedly caused considerable hardship to patients, families, and healthcare professionals, the emergence of new and improved methods of learning is one emerging ray of light at the end of the pandemic tunnel. Stephen Priestley examines how the lessons learned from the pandemic are offering new ways of learning in a healthcare environment
Covid-19 has been the definitive focus for medical science and clinical technology globally over the past two years. It will undoubtedly remain so for some time as we seek answers on managing a ‘post-Covid’ or ‘living-with-Covid’ world from a healthcare perspective.
In an encouraging show of collaboration and agility, developed nations worked together quickly and effectively to design healthcare responses that will help societies better prepare for the threat of future pandemics. Perhaps most importantly, there has been transformational change that improves future safety culture, prioritises clinical workforce safety and removes barriers to technology use with a consequent uplift in patient safety and outcomes.
Learning lessons from these transformations – including continuous evaluation of promising early changes and dedicated sustainment efforts – could positively accelerate the adoption and deployment of innovations and shorten the time period between the initial idea of an innovation or change to the point at which it produces tangible results.
Transformation — changing command structures and transparency
Over the past two years, healthcare leaders have realised that to successfully battle this disease, they need to focus on culture and transparency to drive organisational change. Many leaders are now communicating daily with urgency about safety using much more accessible and immediate channels — for example, online meetings or teleconferences, daily huddles and safety rounds — with a related increase in direct input from frontline personnel about concerns and challenges.
Changes to incident command structures have also facilitated rapid decision-making and the breaking down of silos in clinical settings. In addition, at the individual clinician level, during the early days of the pandemic there was far less resistance and greater acceptance of rapid deployment of new protocols and standardisation of care processes.
One of the most remarkable changes in healthcare in the current environment is that transparency from healthcare organisations hit an all-time high, with clinicians and hospital system leaders working together regionally and nationally to rapidly share internal data, concerns, challenges and best practices.
Transparency became the norm for many healthcare organisations, with daily communication internally and to the public about census, personal protective equipment availability, numbers of cases and fatalities.
Technology finally delivering on its promises
Despite billions being spent on the implementation of health information technology (IT) solutions over recent decades, the use of technology to improve patient safety had been suboptimal until the pandemic.
Technology applications, including electronic health records (EHRs) and the data they capture, have not historically been adequately applied to either predict or reduce preventable harm. To add insult to injury, EHRs have also emerged as a major source of clinician burnout which carries other potential negative effects on patient safety.
However, over the course of the pandemic, we have seen unprecedented cooperation among clinical stakeholders, regulators, IT developers and suppliers. This new spirit of collaboration has led to substantial progress in removing previously intractable barriers and allowing technology to help clinicians do their work and improve quality and safety. The recent and promising redefinition of relationships and the development of a truly collaborative approach between healthcare and technology providers is long overdue and must be maintained in the future.
We know that technology enabled organisations of all shapes and sizes to quickly adapt to the restrictions in early stages of the pandemic and continue to operate virtually online while navigating the early disruption. In healthcare, this was evident in the immediate adaptation to telemedicine consultations by providers, ringing in a change that has not only transformed some forms of primary care but is here to stay.
For decades the medical community has delivered high-quality education incorporating technology into teaching and patient care. Naturally the uptake of medical education through telemedicine increased significantly during the public health crisis, offering an ongoing opportunity to scale future education programmes for medical students.
Blending traditional research and bedside learning for better patient outcomes
The term ‘teaching hospital’ describes an academic or university hospital providing training and learning in various specialist areas and contributes to the quality-of-care healthcare workers can offer their patients — doctors train to be surgeons, nurses develop skills in oncology, or students complete work-based experience before becoming pharmacists or physiotherapists.
Traditionally this training and accreditation were primarily focused on individual learning and the model of evidence-based medicine, built on the presumption that new knowledge is created through research and implemented into practice by delivery organisations. Now a modern learning organisation collectively moves forward in its learning and ability to deliver great care and achieve the best patient outcomes while remaining focused on reduced costs and improved job satisfaction for healthcare professionals.
Ideally, organisational learning now includes both ‘micro-learnings’ and ‘organisational-level’ learning. Micro-learnings can be anything from generic learning from patient feedback, greater depth of understanding of teams and how they function, the employment of professional behaviour standards, through to effective communication ideas arising from clinical incidents’ analysis or sources like employee safety culture surveys and external research. Organisational-level learning encompassing sensing and responding to progress new ways of doing things, is based on qualitative and quantitative inputs and requires a systems approach.
A study at the NHS Nightingale Hospital in London presents an excellent example, highlighting rapid-cycle learnings from the bedside and patient experiences as the key to organisations moving towards achieving their goals in safety and the delivery of care.
The findings of this study demonstrated that clinical processes can be simplified to enable decisions and changes to be made at the bedside by healthcare professionals, then tested using rapid-cycle measurement such as the Plan-Do-Study-Act (PDSA) improvement methodology.
Ultimately, when a swift response to changing circumstances is required, rapid learning cycles — such as through the PDSA structure — can enable teams to immediately adapt with minimal risk and interruption to clinical work. Having a mechanism to try, refine and test ideas before implementation can support teams to respond to challenges which have no currently known solution.
Throughout the pandemic, healthcare professionals have been provoked to learn how improvement and measurement can streamline and accelerate testing and learning while reducing demands on clinicians. This presents an opportunity to simplify language, avoid duplication of improvement methods and limit unnecessary requirements that stifle care and activity. Ideally in the future, continuous improvement in care and safety outcomes will be created through a blend of traditional medical research methods and beside-learning inputs.
What does the ideal learning system look like now?
In the ‘new normal’ of living with COVID-19 and the post-pandemic future, an ideal learning system must be applied at both system level – the analysis of aggregate patient data looking for opportunities for improvement – and organisational level – organisational structures, processes, and culture that promote internal learning. It will need to address both the what and how of learning.
Ultimately an organisational learning system can only be effective if it is supported by a culture of learning and has several notable design features including:
- A focus on learning from internal experience and study as much as from external published research, and interested in both problems relating to the design of a product or service and in the effectiveness of design implementation.
- Integrated qualitative and quantitative data from multiple sources used to solve problems in design and execution, and rapidly test and modify new approaches to put insight into action.
- Embedding the ability to learn in the organisation’s structure and internal processes at every level, with reinforcement through the culture and behavioural expectations of employees and leaders’ words and actions.
- A clear intention and focus within an organisation’s mission and culture on ‘getting better at getting better’
Improving safety through effective communication and open disclosure
What does all of this tell us about the optimal learning systems to deliver improved safety and care for patients?
At Cognitive Institute, our experience supports the practice of effectively led, regular safety huddles or briefings held with teams. As part of our offering to clients, we have designed programmes to assist healthcare providers, leaders and their staff in Speaking Up for Safety™, Open Disclosure and Effective Communication, and Promoting Professional Accountability.
To complement these programmes, Cognitive Institute has also developed a model for team briefings, RapidCheck™, which focuses on delivery of safe, reliable, high-quality care and is designed for implementation in all clinical circumstances and requires no training or orientation.
Diffusion of Innovation
This Diffusion of Innovation theory identifies five different types of adopters of innovations ranging from Innovators and Early Adopters – whom are the first to try out a new idea or process – through to Laggards whom are typically sceptical of change and represent the hardest group to bring on board when there is change.
During the pandemic we have witnessed remarkably rapid change and innovation with breakdown and shifts in this longstanding social sciences theory which has allowed rapid and successful spread of safety strategies and innovations in clinical environments – so called disruptive innovation.
- Singh H, Sittig D, Gandhi T. Fighting a common enemy: a catalyst to close intractable safety gaps. BMJ Quality & Safety. 2020;30(2):141-145. doi:10.1136/bmjqs-2020-011390
- Park H, Shim S, Lee Y-M. A Scoping Review on adaptations of clinical education for medical students during COVID-19. Primary Care Diabetes. 2021;15(6). doi: 10.1016/j.pcd.2021.09.004
- Bohmer R, Shand J, Allwood D, Wragg AW, Mountford J. Learning Systems: Managing Uncertainty in the New Normal of Covid-19. NEJM Catalyst Innovations in Care Delivery. Published online July 16, 2020.
- Rogers Everett, M. (2003). Diffusion of Innovations. New York, 5th Edition