Why healthcare leaders need to develop learning organizations to succeed

As our world changes, healthcare organizations are pressured from all sides to improve quality, survive financially and meet increasing demands for services. To ensure success, some organizations are considering a merger or sale while others are creating learning environments that effectively use resources and knowledge to improve patient care.

What is a learning organization?

The Business Dictionary defines a learning organization as one that acquires knowledge and innovates fast enough to survive and thrive in a rapidly changing environment. Leaders in a learning organization:

• Create a culture that encourages and supports continuous employee learning, critical thinking and risk taking with new ideas
• Learn from experience and experimentation
• Disseminate new knowledge throughout the organization so that it can be incorporated into day-to-day activities

Learning organizations have a formalized approach to gaining and sharing knowledge that ranges from a budget for outside seminars and conferences to webinars and formal training. They also consider more formal internal training sessions and encourage team members to present on selected topics. One of my clients, a large practice with several offices, reserves the last Wednesday afternoon of each quarter for a practicewide meeting. No patients are seen and all staff is assembled to formally review practice metrics.

I have seen numerous advantages to creating a learning culture, including:

• Increased operational efficiency that leads to improved productivity and profitability
• Decreased employee turnover
• Increased employee satisfaction
• Increased customer satisfaction
• Employee engagement to create a sense of ownership and improve accountability
• Knowledge exchange
• Continuous cycle of improvement
• Recognition of the need for and acceptance of change

Creating a learning organization

A learning culture starts with leadership and the vision of who the practice is as a group, which helps the practice define its purpose. The true culture of a practice is represented by its traditions, behavioral standards, unwritten rules and the actions (or inactions) of leaders. A serious analysis and discussion about your organization’s culture and the ways in which knowledge is acquired and shared will be critical to long-term success.

Systems thinking, personal mastery, mental models, shared vision and team learning are all components of the learning organization as outlined by Peter Senge, author of The Fifth Discipline. He writes that a practice’s culture will dictate success, and I have seen that proven time and time again.

The term “systematic thinking” refers to the concept that we need to learn from the past so we do not repeat it. The reality is that we cannot continue to work the way we have in the past. Let’s not forget Albert Einstein’s definition of insanity: doing things the same way and expecting different results. To prevent this behavior, you must learn from others outside the organization, measure improvements and share knowledge throughout your organization.

To get started, define a problem. Then gather data, consider alternative solutions, decide which solution is best for the practice and proceed. This is a logical, basic format used by providers with patients.

The key is to exercise judgment in light of the data. Consider the following example: The receptionist or front-desk staff is required to collect $20 copays prior to visits. When a patient presents without payment, the staff member has the following options:

• Send the patient home
• Search for the administrator or doctor
• Exercise judgment based on guidelines provided

The first question is does your practice have set guidelines for staff members? The second question is how helpful are the guidelines if you have them? The third question is what have you done to create a learning environment?

Ideally your staff members are empowered to make some decisions independently so that they can check a patient’s record to learn whether it is a repeat patient who has paid for the last six visits and simply forgot his credit card and checks, or if this is the second time the same patient has presented without payment. If it is the former, the staff member might decide this is an exception and the patient should be seen. But if the patient is the latter, the patient is rescheduled.

Employee empowerment is a key component to a learning culture.

Measurable outcomes

To develop a learning organization, identify what key performance indicators (KPIs) are already in place and which need to be improved. As you implement a plan, calculate a base line that you will re-evaluate and update regularly.

It is not necessary to reinvent benchmarks. Ask how others do things and benchmark measurements internally. I tell my clients that if they don’t value a benchmark, they won’t measure it, and if they don’t measure it, they won’t change it.

• Here are examples of KPIs to consider:
• You have 22 employees and a 55% turnover rate, which means that 11 new employees are hired every year. Your goal is to reduce turnover by two people. If your pay rate is $10 per hour per employee and the cost of turnover is 70%, the net savings would be $28,000 ($10 per hour multiplied by 2,000 hours worked multiplied by two employees). This is not a check written but a more effective way of using resources to improve patient care. To make this type of change, review current hiring practices and train managers on interviewing techniques. An investment of $10,000 in an improved onboarding program will easily pay for itself.
• In the Lean Six Sigma world, we commonly acknowledge that employees waste 25% of their workdays due to rework, unnecessary movements, etc. If you improve this formula by 5%, you might see the following results:
  • If you gain two minutes per patient visit, given the average patient visit of 40 minutes from check-in to checkout, and multiply that by 20 visits, you gain 40 minutes per day. This can translate to at least one more patient visit (99213 code) per day at Medicare rates of about $70, which at 240 days per year equals $16,800.
  • Many practices have insurance claims denial rates of 20%. If you have five providers who have 20 insurance visits per day, that means that 500 claims (40 per week) are denied at $25 each. If you fix this issue, you stand to reclaim $1,000 per week. The 5% improvement reduces rework by two claims, or $50 in resources that can be used more effectively.
  • Collection rates at the front desk for copay and deductible are 90% of the 100 patients seen daily. Improvement of 5% means one more patient collection. At a collection rate of $20, that equals $100 a week or $5,200 per year. The other savings is the $8.75 cost to send out a statement.

Consider your team

One person cannot transition an organization into a new and improved model. Everyone must work together. In addition to hiring well and implementing a coaching plan, practices need to create an environment that encourages risk taking. One of the biggest inhibitors to individual learning is fear of failure, fear of embarrassment, fear of losing the job, etc. While competitive environments are common in healthcare, where staff and providers look at issues from a win-or-lose perspective, I have found that learning environments thrive when there is no fear or risk of losing.

While some individuals seek comfortable and repetitive environments, that type of approach can also be limiting. Generative learning occurs within the comfort of doing the same thing but attempting to improve the skill or approach. Adaptive learning occurs when an individual chooses to improve, innovate or leave his or her comfort zone.

One of the biggest inhibitors to individual learning is fear of failure, fear of embarrassment, fear of losing the job.

For best results, organizations should consider the perspective of each individual in developing his or her learning approach and create opportunities for team members to learn and apply that new knowledge to their work environments.