Panel Highlights FOH Summit 2024: Creating Learning Systems at Scale

Moderator: Jan Van Acker – Strategic Advisor, ARC Innovations

Panelists:

Dr Alan Forster, VP Innovation, Transformation & Clinical Performance, McGill University Medical Centre

Prof. Dr. Heyo Kroemer, CEO, Charité Universitätsmedizin, Berlin

Dr. Bjorn Zoega, Deputy CEO, King Faisal Specialist, Hospital & Research Center

Professor Roseanne Harris, Health Policy Actuary and Head of Policy and Regulatory Affairs, Discovery Health

Jan Van Acker opened the session by putting everybody in sync around the definition of a learning organization: “A place where people continually expand their capacity themselves to create the results they desire, where new and expensive patterns of thinking are nurtured and where people are continually learning to see the whole together.” He then clarifies that the discussion would center around learning within organizations, not just technologically through AI like AlphaGo, but more about how people continuously expand their capacities within their organizations. He asked all the panelists to look at their roles in the past 5-10 years in driving learning into an organization and provide a positive example of things that have been working well.

Dr. Alan Forster discussed his experiences at an academic medical center in Quebec, highlighting the success in setting organization-wide goals that include frontline staff and leaders. He emphasized the importance of allowing frontline personnel to see their roles in these goals and providing them with the necessary tools and training. Forster noted, “It requires the leadership at the top level to understand what is possible, but also to have a continual conversation with people at the front line.”

Prof. Dr. Heyo Kroemer shared insights from his leadership at Charité Hospital during COVID-19. He pointed out that learning in organizations is usually incremental, moving in small steps towards one direction and emphasized the impact of disruptive events on organizational learning, particularly citing the COVID-19 pandemic as a critical example. “When the government suddenly designated our facility to handle all severe COVID cases in the large Berlin area, we had to overhaul our entire operation overnight.”

He explained that this rapid shift not only demonstrated the capacity for swift organizational adaptation but also brought to light the challenges of returning to normal operations. “The major problem was not adapting to the new system, but transitioning back to the old one, which we’ve struggled with for a very long time.” He concluded by saying that learning within organizations is a dynamic process that requires navigating both forward and backward changes, which can often be complex and demanding.

Dr. Bjorn Zoega discussed his experiences at Karolinska Institute, where he faced similar challenges with conservative learning systems that are slow to integrate innovative practices unless pressured by crises like COVID-19. Zoega remarked on the difficulty of maintaining new practices without reverting to old habits. “During COVID we did some things that were thought to be undoable, like ramping up our intensive care unit times five and never running out of beds. We learned a lot of things, and we did them very quickly, but it didn’t take many weeks until everybody was back to the old habits.”

Professor Roseanne Harris from Discovery highlighted the role of clear organizational values and purpose in fostering a learning environment. She stressed the importance of these values in attracting the right talent and using data deliberately to drive the organization’s core purposes.

The panel also touched on the democratization of data, Jan Van Acker noted that significant learning typically occurs in small teams where metrics and data are closely monitored and used to drive progress. He referred to the concept of data democratization, highlighting its prevalence and exploring its potential to enhance organizational learning and posed a question on how the widespread availability of data could further aid in advancing organizational practices and learning.

Alan Forster emphasized the crucial role of data transparency and accessibility in fostering innovation, transformation, and learning within healthcare institutions. He noted that while these institutions generate significant amounts of data, there are often substantial barriers to accessing this data, whether for providers, technology companies, or patients. He highlighted how this absence of transparency limits learning opportunities and impedes addressing systemic issues such as the lack of a just culture or accountability for poor performance. He also pointed out the technical challenges in data integration and storytelling, along with privacy concerns, as major obstacles and argued that improving access to data is essential for developing the necessary technical competencies to handle it effectively.

Bjorn Zoega expressed a strong belief in the benefits of decentralization in decision-making within organizations, whether in learning systems, hospitals, or businesses like Amazon. He argued that decisions made closer to the customer tend to be more effective, emphasizing the importance of empowering those at lower levels of the hierarchy rather than relying solely on top-down directives. To illustrate this point, he shared a personal experience from his recent role at King Faisal Hospital & Research Center where he was approached by the head of cardiac surgery who felt stuck after years of progress in robotic heart surgery. After sitting together for 30 minutes they devised a plan to advance their efforts, which led five months later, to a groundbreaking achievement, the first fully robotic heart transplant in the world.

Prof. Dr. Heyo Kroemer acknowledged the value of data in addressing organizational challenges but pointed out that it often falls short when confronting increasingly complex problems. He suggested that these complexities require novel forms of interaction beyond traditional organizational boundaries and highlighted the importance of learning systems recognizing their own limits and the necessity to seek external collaboration. Kroemer cited an example from Germany where the federal government funded a network linking all academic medical centers to combat COVID-19. This initiative, initially driven by the urgency of the pandemic and facilitated by financial incentives, led to successful collaboration among centers that had previously been in fierce competition, illustrating the need for learning systems to be able to identify when it is necessary to extend beyond their usual confines to address challenges effectively.

The final questions in the panel addressed the cultural aspect concerning learning and whether it is different from country to country.

Bjorn Zoega acknowledged that these aspects were not as influential as he had anticipated and explained that he often discouraged emotional or anecdotal evidence in professional discussions, insisting on data to support any proposals or requests. This approach quickly shaped the interactions within his team, setting clear expectations that staff should come prepared with data to substantiate their points.

Alan Forster emphasized the crucial role of leadership and soft skills in fostering organizational learning, placing them on par with the importance of data. He highlighted that while leadership at the executive level sets the overall tone, it is the leadership at the local level that significantly impacts the organization’s ability to solve problems collaboratively. Forster pointed out that leadership skills are essential for managing interdisciplinary teams, particularly in environments where professional silos and power imbalances can hinder progress. He stressed that addressing these challenges and facilitating effective group collaboration requires strong leadership capable of navigating these complexities. Forster believes that leadership is key not only in directing efforts but also in enhancing the ability of groups to work together effectively.

In conclusion, the panelists highlighted the challenges and successes in creating learning systems that can scale effectively within large and complex healthcare settings. They agreed on the critical role of data in learning and the importance of leadership at all levels to foster an environment where continuous improvement and learning are part of the organizational culture.

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