I’ve been doing a lot of thinking about “how we learn,” particularly in this uncertain health care landscape, where change is inevitable and honing our agility and learning chops is more important than ever.
In the Practice Transformation Initiative (PTI), our program in partnership with Pacific Business Group on Health and Integrated Healthcare Association, is working with provider organizations throughout California and their practice facilitation coaches to transform the way care is being delivered in primary care practices. Our emphasis is on changing culture by building learning organizations and creating sustainable change.
One of the top challenges we hear from practice facilitation coaches is how many practices are resistant to change and exploring new ways of delivering care. “The old ways work just fine, thank you!”
But I recently read an article in Harvard Business Review that has inspired a fresh response to these PTI coaches. In “Learning to Learn,” Erika Andersen outlined 4 key attributes that adept learners have — aspiration, self-awareness, curiosity, and vulnerability. Though we often consider people to either have these attributes or not, the author made a strong case that by changing our “self-talk” and practicing a “beginner’s mind” — a Zen Buddhism concept: “In the beginner’s mind there are many possibilities. In the expert’s mind there are few.” — all of us can learn how to better navigate these changing times and become better learners.
The lessons outlined in this article translate beautifully to our work in health care — particularly for those “in the practice” (i.e., practice facilitation coaches or other QI team members). So, while we cannot force anyone to change, here are some ideas that might help us nurture the development of these learning attributes, so we can more successfully navigate these uncharted waters.
We all know people who are naturally aspirational, but is this really something we can learn? I’ve heard many coaches say that their most difficult practices are fine with the status quo, and they are not motivated to change or improve. This is often a natural reaction to the unknown – we resort back to what we know. It takes an enormous amount of effort to start a transformation effort. But what if we created an environment of possibilities?
In the Practice: Andersen talks about the power of shifting one’s focus from the challenges to the benefits. And as a coach, asking a question such as, “I’m curious what it would it look like in a year if you were able to achieve this?” gets the juices flowing. Suddenly the presence of the possibilities has the potential to overpower fears of the challenges. This vision lights the way and provides an experience of potential!
It always feels better to think we are providing above average care, and that our patients love us. While that is often the case, how often do we take time to look in the mirror with an open mind to see the things we might improve? When a safe space is provided for this, there is a greater opportunity to explore our potential.
In the Practice: Many coaches tell me that their most resistant practices are defensive and sometimes feel attacked when areas of improvement are communicated. One response I have is, “How might you create an environment that feels safer for a practice to self-reflect?” Coming into a practice and whipping out the data and pointing out the less-than-stellar performance might not be the best approach. Coming in with a friendly curiosity, asking questions about what is going well and where they are interested in making some changes, lessens defensiveness and creates a space for self-awareness and reflection. And I always go back to “Relationships! Relationships! Relationships!” If a team trusts you and feels that you are a partner and not a judge, the willingness to do a little self-introspection increases dramatically.
We all were experts in this area as children, but not all of us have maintained our curiosity as adults. In fact, we are often quick to respond with a guarded negativity when we are asked to change. (“Is this just another ‘flavor of the month’? I’m sure it will pass if we lie low!”) But with the simple practice of changing our thoughts and using “curious language” (How…? What if…? I wonder…?), our interest kicks in and suddenly the seemingly unbearable change becomes an opportunity for new things. What felt before like powerlessness has transformed into a situation that we feel empowered to explore.
In the Practice: We can help practices or teams navigate change by introducing some of these “curious questions” into the conversation. It allows the creative juices to start flowing when we ask, “How might we make this a reality?” or “What could we learn from this new ‘requirement’ that might help us take better care of our patients?” or “I wonder if we could leverage this change to make our system better?”
The opportunity to feel vulnerable is not something we are all pursuing aggressively. It’s one of the less comfortable experiences — to be new or just learning — that often results in a feeling of shame. But, there is so much value in vulnerability. In fact, I believe that vulnerability is the breeding ground for curiosity, aspiration, and self-awareness. It is when we allow ourselves to be comfortable with not knowing, and embracing that we can ask, “What on Earth are you talking about?” Only then can we relax, play with new ideas, and learn new things.
In the Practice: There is a lot of pressure in health care to “get it right,” so with the right support from a coach, it can be quite refreshing to have a space to “not know.” Again, this is impossible without a strong relationship, but when you have that relationship established, you can facilitate that safe space by acknowledging the feelings of vulnerability (“I know it feels like this is impossible, or that your team is not getting this quite yet.”) and using language that values the space of vulnerability and opportunity to try new things (“Mistakes are common, and if we fail fast and often, we will learn a whole lot more about what doesn’t work!”)
We all have the ability to be better learners and grow in this changing landscape of ours. Creating environments for our practices to do the same is more important than ever. Practicing “beginner’s mind” and shifting the way we talk to ourselves – and our teams – is an important first step. I’d love to hear from you! How are you creating an environment that fosters learning and growth?