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The authors provided a welcome introductory overview to
organisational development in the NHS. They rightly summarised that most
NHS learning takes place at 'single loop level' by individuals (for health
professionals at least) through a continuing professional development
capacity; they also called for empirical evidence to help inform future
practice. The authors however shed no new light as to NHS organisations
could take forward plans to develop as a learning organisation. Calling
on theoretical perspectives (Senge, Mintzberg, Argyris and Shon,et al) is
important and makes interesting reading, yet fails to address the learning
paradox evident in the NHS: how do we transfer learning at an individual level so that groups
within the organisation can benefit?
Transfer learning from one NHS organisation to others?
Learning in the NHS is a human endeavour and yet the authors state
that learning is achieved by the organisation. This begs the question
which part(s) of the organisation and by whom? How do you measure this
learning? What are the ‘structure, routines and norms’, by which the
organisation embodies learning? It will be important to clarify the
extent and nature of these internal processes that are so vital to the
health of an organisation.
The authors stated ‘learning organisations do not focus exclusively
on correcting problems.. They aim for more fundamental shifts..’ Just who
are ‘they’ of an organisation? Does it matter who ‘they’ are? What is the
modus operandi of ‘they’ in an NHS organisation?
We recently carried out a needs assessment review of nursing and PAM
staff within our Trust. We were interested in what the educational needs
were and how best to manage expectation within resources. The report
identified that there was considerable divide in opinion as how best to
manage practice development (1). In short, there would have to be a
multifaceted approach to clinical practice development throughout the
Trust. Furthermore, we have used this review to inform our management
practice.
If we are to invest (even possible divest) NHS resources to
management albeit for all encompassing educational goals, we must ensure
that research tackles the important issue of translation: to what extent
can we apply lessons leaned in one Trust to other Trusts in the country.
We must therefore apply ‘double loop learning’ and even meta loop learning
on the very process we are extolling
One further technical point: one of the six conclusions (commitment
to team learning) is already being addressed in England through a recent
consultation exercise (2) and the merging of medical, nursing and PAM
training budgets.
References
Ref (2) Loughlan C, Ford J Improving your practice - a needs assessment
review of nursing and PAMs University of Cambridge, Addenbrooke’s NHS
Trust 1999
Ref (1) ‘A Health Service for All: Developing the NHS Workforce’
Consultation Document on the Review of Workforce Planning Department of
Health 2000
In the last five years, pioneering work on using Learning
Organisations principles and model in Child and Adolescent Mental Health
Services have been carried out by Prof. Peter Birleson in Melbourne,
Australia. The experience of using the model and the changes in mental
health organisational structure and culture in improving quality is
described in his publications which the readers are referred to.
Learning Organisations: a suitable model for improving mental health
services? Australia and New Zealand Journal of Psychiatry 1998;32:214-222
Turning Child and Adolescent Mental Health Services into Learning
Organisations. Clinical Child Psychology and Psychiatry 1999;4:265-274
Competing interests:
No competing interests
09 April 2000
Hemamali Perera
Locum Consultant Child and Adolescent Psychiatrist
Iddesleigh House Child and Adolescent Mental Health Services, Exeter, Devon
Organisational develpment in the new NHS - the learning paradox
The authors provided a welcome introductory overview to
organisational development in the NHS. They rightly summarised that most
NHS learning takes place at 'single loop level' by individuals (for health
professionals at least) through a continuing professional development
capacity; they also called for empirical evidence to help inform future
practice. The authors however shed no new light as to NHS organisations
could take forward plans to develop as a learning organisation. Calling
on theoretical perspectives (Senge, Mintzberg, Argyris and Shon,et al) is
important and makes interesting reading, yet fails to address the learning
paradox evident in the NHS: how do we transfer learning at an individual level so that groups
within the organisation can benefit?
Transfer learning from one NHS organisation to others?
Learning in the NHS is a human endeavour and yet the authors state
that learning is achieved by the organisation. This begs the question
which part(s) of the organisation and by whom? How do you measure this
learning? What are the ‘structure, routines and norms’, by which the
organisation embodies learning? It will be important to clarify the
extent and nature of these internal processes that are so vital to the
health of an organisation.
The authors stated ‘learning organisations do not focus exclusively
on correcting problems.. They aim for more fundamental shifts..’ Just who
are ‘they’ of an organisation? Does it matter who ‘they’ are? What is the
modus operandi of ‘they’ in an NHS organisation?
We recently carried out a needs assessment review of nursing and PAM
staff within our Trust. We were interested in what the educational needs
were and how best to manage expectation within resources. The report
identified that there was considerable divide in opinion as how best to
manage practice development (1). In short, there would have to be a
multifaceted approach to clinical practice development throughout the
Trust. Furthermore, we have used this review to inform our management
practice.
If we are to invest (even possible divest) NHS resources to
management albeit for all encompassing educational goals, we must ensure
that research tackles the important issue of translation: to what extent
can we apply lessons leaned in one Trust to other Trusts in the country.
We must therefore apply ‘double loop learning’ and even meta loop learning
on the very process we are extolling
One further technical point: one of the six conclusions (commitment
to team learning) is already being addressed in England through a recent
consultation exercise (2) and the merging of medical, nursing and PAM
training budgets.
References
Ref (2) Loughlan C, Ford J Improving your practice - a needs assessment
review of nursing and PAMs University of Cambridge, Addenbrooke’s NHS
Trust 1999
Ref (1) ‘A Health Service for All: Developing the NHS Workforce’
Consultation Document on the Review of Workforce Planning Department of
Health 2000
Conflict of interest
none
Competing interests: No competing interests