Skip to content

Q logo

  • Matthew Mezey posted an update in the group Culture of Continuous Improvement 3 months, 1 week ago

    I’ve had the opportunity lately to hear from James Mountford (Director of National Improvement Strategy) and Dominique Allwood about the ‘Learning System’ they helped set up at the Nightingale Hospital in London.

    The real surprise was that “We didn’t need people with specialist QI training”, Dom said.
    It seems that if you build an operating system that fosters learning you create conditions whereby – even without improvement training – people can become effective ‘improvers’ because the set-up is such that their ideas get tested almost by default.
    In other words: the operating system is looking for material to test; and all staff willingly supply this.

    Giving people voice seems to be the key foundation. They will be ‘improving agents’ if a learning system captures their voice, and considers it systematically.

    Bohmer, Mountford, Allwood and others wrote up their Nightingale experience in a July NEJM article: ‘Learning Systems: Managing Uncertainty in the New Normal of Covid-19’ (nb not open access so can’t share).

    But I’ll attach the abstract.

    • Delighted to say James will be joining us for #FabChange20 talking on this very topic titled – Making “learning” core to “doing” in the NHS. You can listen live and for free on the 21st October as part of Fab Change Day 2020 https://fabnhsstuff.net/campaigns/fabchange2020

      • That’s great to hear – nice one!

        I was also telling James how much I liked the ‘Deliberately Developmental Organisation’/growth cultures approach in Robert Kegan et al’s book ‘An Everyone Culture’ (which showcases 3 case studies).

        That book has a strong focus on the people/mindsets side of building ‘Learning Systems’.

        I’ve been trying and failing to find out about the US hospital system that is, I believe, using this ‘Deliberately Developmental’ approach….

      • I don’t know if they use this approach in New York or not, but we have 2 NY speakers at #FabChange20 too.

      • I’d like to see what their ‘standard processes’ looked like.

    • This is fascinating. I’ve been exploring how the design of organisations supports continuous improvement so it does make sense to me. Well designed governance systems facilitate learning.

    • I’ve been leading on development of something called kata – on the surface is its the daily incorporation of improvement into daily activity though coaching. In reality its creating the conditions for staff to solve problems through testing ideas – failure being seen as a source of successful learning, so creating a culture of learning. Managers coach (not matter how junior), through humble enquiry – you coach to a routine of problem solving. It moves right through the organisation – the chief executive will have a coach. Its really interesting – staff only need to use the tools required to solve the problems in front of them, so need v few. there are 7 sites testing in the UK, with much more advanced in the US (who have been really generous in sharing their learning)

      • Sounds fabulous – is this related to the ‘Toyota Kata’ – any good link where we can read more about the 7 UK Kata sites?

      • That’s really interesting, I’d love to find out more about what’s involved. I’m now firmly of the belief that coaching needs to be a key part of continuous improvement.

    • Interesting concepts. I would like to know how you are tackling the adaptive or behavioural aspects of change? Thanks