Stories

Tag: Victoria Marsick

  • Learning culture: the missing link in global health between learning and performance

    Learning culture: the missing link in global health between learning and performance

    Learning culture is a critical concept missing from health systems research.

    It provides a practical and actionable framework to operationalize the notion of ‘learning health systems’ and drive transformative change.

    Read this first: What is double-loop learning in global health?

    Watkins and Marsick describe learning culture as the capacity for change. They identify seven key action imperatives or “essential building blocks” that strengthen it: continuous learning opportunities, inquiry and dialogue, collaboration and team learning, systems to capture and share learning, people empowerment, connection to the environment, and strategic leadership for learning (Watkins & O’Neil, 2013).

    Crucially, the instrument developed by Watkins and Marsick assesses learning culture by examining perceptions of norms and practices, not just individual behaviors (Watkins & O’Neil, 2013).

    This aligns with Seye Abimbola’s assertion that learning in health systems should be “people-centred” and occurs at multiple interconnected levels.

    Furthermore, this research demonstrates that certain dimensions of learning culture, like strategic leadership and systems to capture and share knowledge, are key mediators and drivers of performance outcomes (Yang et al., 2004).

    This provides compelling evidence that investments in learning can yield tangible improvements in health delivery and population health.

    Learn more: Jones, I., Watkins, K. E., Sadki, R., Brooks, A., Gasse, F., Yagnik, A., Mbuh, C., Zha, M., Steed, I., Sequeira, J., Churchill, S., & Kovanovic, V. (2022). IA2030 Case Study 7. Motivation, learning culture and programme performance (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7004304

    As Watkins and Marsick (1996) argue, to develop a strong learning culture, we need to “embed a learning infrastructure”, “cultivate a learning habit in people and the culture”, and “regularly audit the knowledge capital” in our organization or across a network of partners.

    While investments in learning can be a challenging sell in resource-constrained global health settings, this evidence establishes that learning culture is in fact an indispensable driver of health system effectiveness, not just a “nice to have” attribute.

    Subsequent studies have also linked learning culture to key performance indicators like care quality, patient satisfaction, and innovation.

    Why lack of continuous learning is the Achilles heel of immunization

    To advance learning health systems, it is important to translate this research in terms that resonate with the worldview of global health practitioners like epidemiologists and to produce further empirical studies that speak to their evidentiary standards.

    Ultimately, this will require expanding mental models about what constitutes legitimate and actionable knowledge for health improvement.

    The learning culture framework offers an evidence-based approach to guide this transformation.

    References

    Abimbola, S. The uses of knowledge in global health. BMJ Glob Health 6, e005802 (2021).

    Watkins, K. E. & O’Neil, J. The Dimensions of the Learning Organization Questionnaire (the DLOQ): A Nontechnical Manual. Advances in Developing Human Resources 15, 133–147 (2013).

    Watkins, K., & Marsick, V. (1996). (Eds.). In action: Creating the learning organization (Vol. 1). Alexandria, VA: ASTD Press.

    Yang, B., Watkins, K. E. & Marsick, V. J. The construct of the learning organization: Dimensions, measurement, and validation. Human Resource Development Quarterly 15, 31–55 (2004).

  • What is double-loop learning in global health?

    What is double-loop learning in global health?

    Argyris (1976) defines double-loop learning as occurring “when errors are corrected by changing the governing values and then the actions.” He contrasts this with single-loop learning, where “errors are corrected without altering the underlying governing values.”

    • Double-loop learning involves questioning “not only the objective facts but also the reasons and motives behind those facts”.
    • It requires becoming aware of one’s own “theories-in-use” – the often tacit beliefs and norms that shape behavior – and subjecting them to critical reflection and change. 

    This is challenging because it can threaten one’s sense of competence and self-image.

    Checking for double-loop learning: ‘Are we doing things right?’ vs. ‘Are we doing the right things?’

    In global health, double-loop learning means not just asking “Are we doing things right?” but also “Are we doing the right things?” It means being willing to challenge long-held assumptions about what works, for whom, and under what conditions.

    Epistemological assumptions (“we already know the best way”), methodological orthodoxies (“this is not how we do things”), and apolitical stance (“I do health, not politics”) of epidemiology can predispose practitioners to be dismissive of a concept like double-loop learning. 

    Learn more: Five examples of double-loop learning in global health

    Seye Abimbola is part of a growing community of researchers who argue that double-loop learning is critical for advancing equity and self-reliance in global health systems, because global health tends to overlook its own assumptions.

    Is it reasonable to posit that some global health interventions have been driven by unchecked assumptions – assumptions about what communities need, what they value, and what will work in their context? How often have we relied on a one-size-fits-all approach, implementing ‘best practices’ from afar without fully understanding local realities? How do we know to what extent programs have thereby failed to meet their goals, wasted precious resources, and may have even caused unintended harm?

    As Abimbola (2021) notes, “double-loop learning goes further to question and influence frameworks, models and assumptions around problems and their solutions, and can drive deeper shifts in objectives and policies.”

    For example, affected communities hold vital expertise to mitigate health risks.

    However, fully leveraging this potential requires global health professionals to fundamentally rethink their roles and assumptions.

    • For research to serve the needs of affected communities, it is likely to be useful to reframe these roles and assumptions to see themselves as “subsidiary” partners in service of “primary” community actors (Abimbola, 2021).
    • Institutionalizing double-loop learning requires enabling critical reflection and co-production between health workers, managers and citizens (Sheikh & Abimbola, 2021).
    • It also depends on developing the learning capacities of communities and health workers in areas like participatory governance, team-based learning and innovation management.

    The next logical question is ‘how’ to implement double-loop learning.

    Learning culture is a critical concept missing from health systems research.

    It provides a practical and actionable framework to operationalize the double-loop learning notion of ‘learning health systems’ and drive transformative change.

    Learn more: Learning culture: the missing link in global health between learning and performance

    Further reading

    Learning-based complex work: how to reframe learning and development

    What learning science underpins peer learning for Global Health?

    How do we reframe health performance management within complex adaptive systems?

    References

    Abimbola, S. The uses of knowledge in global health. BMJ Glob Health 6, e005802 (2021). https://doi.org/10.1136/bmjgh-2021-005802

    Argyris, C. Single-loop and double-loop models in research on decision making. Administrative science quarterly 363–375 (1976). https://doi.org/10.2307/2391848

    Argyris, C. Double-loop learning, teaching, and research. Academy of Management Learning & Education 1, 206–218 (2002). https://www.jstor.org/stable/40214154

    Kabir Sheikh & Seye Abimbola. Learning Health Systems: Pathways to Progress. (Alliance for Health Policy and Systems Research, 2021).

    Image: The Geneva Learning Foundation Collection © 2024

  • Should we trust our intuition and instinct when we learn?

    Should we trust our intuition and instinct when we learn?

    How much of what we learn is through informal and incidental learning? When asked to reflect on where we learned (and continue to learn) what we need to do our work, we collectively come to an even split between our formal qualifications, our peers, and experience. As interaction with peers is gained in the workplace, roughly two-thirds of our capabilities can be attributed to learning in work.

    We share the conviction that experience is the best teacher. However, we seldom have the opportunity to reflect on this experience of how we solve problems or develop new knowledge and ideas. How do we acquire and apply skills and knowledge? How do we move along the continuum from inexperience to confidence? How can we transfer experience? Does it “just happen”, or are there ways for the organization to support, foster, and accelerate learning outside of formal contexts (or happening incidentally inside them)?

    Most of what we learn happens during work, in the daily actions of making contextual judgements. Such learning is more iterative than linear. Informal learning is a process that is assumed (without requiring proof), tacit (understood or implied without being stated), and implicit (not plainly expressed).

    The experience we develop through informal learning shapes our sense of intuition, guiding our problem-solving in daily work. Our narratives reveal that most of the learning that matters is an informal process embedded into work. The most significant skills we possess are acquired through trial, error, and experimentation. Informal learning has the capacity to allow us to learn much more than we intended or expected at the outset. This makes such learning very difficult to evaluate, but far more valuable to those who engage in it – and potentially to the organization that can leverage it to drive knowledge performance.

    The lack of mindfulness about informal and incidental forms of learning is a byproduct of the fact that such learning does not require overtly thinking about it. Undoubtedly, though, there are tangible benefits to reflecting upon individual or group learning practices. As George Siemens argued in Knowing Knowledge, informal learning is too important to leave to chance (2006:131). This is why we need the organization to scaffold the processes and approaches that foster learning in the informal domain.

    Reflection aids in informal learning, but carries the risk of embedding errors in the learning process when such reflection is private or too subjective. We must be connected to others to make sense of what we learn. When the institutional environment is highly political, this diminishes the incentive to learn more than the minimum needed in order to satisfy the demands of our senior management. Informal learning requires us to be mindful (to care) about what we do.

    Photo: Smoke (Paul Bence/flickr.com)