In supporting collaborative improvement in over 15 countries during the past 25 years, we have come to define sharing learning as a key principle for effective health care improvement.
During a collaborative improvement activity, sharing learning across participating teams allows for rapid spread of ideas that have been shown to improve care, informs teams about unsuccessful changes to avoid, and allows for consolidation of effective changes to develop an evidence base for how to improve a specific area of care in a particular setting.
After the learning from a collaborative improvement activity has been synthesized to create key insights and guidance that can help others improve the same area of care, this learning needs to be deliberately shared with others.
Those who have made improvements need to convey the overall results from the tests of changes they implemented, what changes yielded improvement, what changes did not, what factors may have influenced these results, what evidence supports these conclusions, how to implement the changes, and what advice they have for others so as to best apply what they have learned.
Skills and Techniques for Sharing Learning
Sharing learning during and after an improvement activity requires both communication skills and the thoughtful design of opportunities to allow those who have implemented improvements in care to talk with and answer the questions of those who can learn from them.
Such communication may involve verbal, visual, and/or written means. In thinking of how to best convey learning from improvement, it is useful to keep in mind the advice of knowledge management expert Dave Snowden, who notes that “We always know more than we can say, and we will always say more than we can write down.”
Learning can be shared most effectively through small group conversation during meetings or workshops or during coaching or supervision visits. Video clips, photographs, diagrams, and other visual aids can often convey key information more effectively that written documents. While written products may be the least effective method of sharing on their own, they can help to summarize key messages and points of learning.
In thinking of written products that convey the key advice to others, it is helpful to keep in mind the various intended audiences for the learning from improvement and decide on the most appropriate format and content for each audience. As a general principle for development of written materials, it is helpful to “field test” draft versions with representatives of the intended audiences to ensure that the materials clearly convey what they are intended to.
For sharing a consolidated set of lessons from a large improvement activity, it can be useful to think of this sharing process as a handover of knowledge from those who have made improvements to those who want to learn from them.
The field of knowledge management provides many insights and techniques for sharing information which have proven invaluable for use in improvement initiatives. General principles that encourage sharing include:
- Utilize small groups of 4-8 people to allow people to exchange knowledge; use larger groups to integrate knowledge that has been created in small groups.
- Give every person a chance to say something early on (for example, within the first 30 minutes) in a meeting. This puts participants in an active mode of participating, rather than a passive mode of just listening.
- Give people a chance to get connected to each other before they try to construct new ideas together. Use introductions, social activities, information provided before the meeting, or ice-breakers that allow participants to talk informally to get a sense of each other.
- Before asking participants to discuss their thoughts on an idea or question, ask them to reflect silently for a minute to think about their answer first. Even a short time for individual reflection improves the quality of individual responses.
Finally, an important principle in transferring knowledge is that we learn when we talk. Listening provides us new ideas but as long as those ideas are just swimming around in our heads, they are neither fully formed nor implementable. It is only when a person puts an idea together in a way that allows him or her to explain the idea to others, that the idea takes shape for the person, as well as for those the person is talking with. (For more ideas on how to draw on all the knowledge in the room, see Dr. Nancy Dixon’s essay.)
Many techniques have proven useful for stimulating the sharing of learning among improvement teams. These include:
Some of these techniques are also useful for integrating insights across teams. The resource guide, Engaging Everyone with Liberating Structures, developed by Group Jazz, contains a large number of simple group process techniques that can facilitate sharing of insights among meeting participants.
The Maternal and Newborn Health in Ethiopia Partnership learning sessions report explains how the project took many of these knowledge management techniques and adapted them for large groups using break-out groups.