Without question, every healthcare organization, regardless of size, is experiencing tremendous pressure to improve across numerous dimensions, including cost control, quality of care, patient safety, and patient experience. Complicating matters, the healthcare sector is undergoing sweeping change. A McKinsey article, “How US Healthcare Companies Can Thrive Amid Disruption” states: “This industry and business-model shift is on a scale that few companies and few sectors in the economy have been through… cost and productivity pressures have continued to mount and have created enormous impetus for innovations that drive better outcomes at lower costs.”
If you’ve been working in healthcare for any length of time, this probably isn’t new news. In fact, I venture to guess that, right now, your organization is involved in more than one initiative to get lean, such as reduce waste in the system, and to build capacity for transformation and innovation. But how well are these initiatives working in your organization? I suspect that most organizations still aren’t fully leveraging social learning opportunities to build capacity for change and innovation, which may explain why so many initiatives fall short of intended outcomes and improvements fail to stick over the long term.
What Implementation Science Can Teach Talent Development
Multiple bodies of literature support the importance of social learning in the health professions, recognizing that social networks are a preferred method of learning by health professionals. Gabbay and le May (2004) emphasize the importance of social networks as preferred sources of knowledge updates, and note that clinicians rely on “mindlines” or collectively reinforced, internalized tacit guidelines that are primarily informed by professional interactions rather than direct evidence.
This might seem surprising, at first, considering the value placed on data and evidence in the health professions. However, an evaluation of the literature supports that evidence based care is the exception rather than the norm. In fact, research outlined in a 2014 Implement Sci article estimates that only 30 to 45 percent of patients in the United States are receiving care guided by scientific evidence. This phenomenon is officially known as the “knowledge to practice gap.” Implementation science is the study of methods aimed at closing the gap. The implementation science literature just may inform better learning and development design and implementation in healthcare settings.
Given all the mechanisms for disseminating knowledge, one has to wonder what gives. The answer may lie in a failure to recognize and leverage the importance of the intrinsic social nature of knowledge translation, which describes the activities involved in moving knowledge or evidence into practice. It is conceived as a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of new knowledge.
McWilliam and colleagues (2008) suggest that knowledge translation is, by definition, a socially interactive process where knowledge is co-created through the blending of evidence with experiential knowledge, where knowledge is amplified, validated, and adapted to the specific context. Given this understanding, it stands to reason that social learning opportunities may hold a key to closing the knowledge to practice gap and in changing attitudes and behaviors of the healthcare workforce. Everett Rogers, an acclaimed scholar of how new ideas are spread and author of Diffusion of Innovations, also highlights the importance of social context, noting that “…people follow the lead of other people they know and trust when they decide whether to take it (a new idea) up. Every change requires effort, and the decision to make that effort is a social process.”
Accelerating Knowledge Translation with Social Learning
In their book, The New Social Learning, Connect. Collaborate. Work., authors Tony Bingham and Marcia Conner highlight OPENPediatrics, a global social learning platform developed to share medical knowledge at scale. In this context, they note that, “Every year close to 7 million children die each year after being stricken with diseases that are mostly treatable. The challenge is not that more research is needed for new treatments, or even access to drugs and hardware. Instead, it’s getting the information needed to treat those diseases in the right hands before it’s too late.”
In fact, this is only part of the problem. Getting information in the right hands is known as knowledge dissemination in implementation science and represents only part of the knowledge translation process. Equally, if not more important in the process of spreading new knowledge and innovation, is facilitating the translation of new knowledge, or facilitating its synthesis and application. Knowledge translation might not be in your purview as a talent development professional, but its study provides additional evidence of the efficacy of social learning methods in learning and development in the health professions.
Atul Gawande brilliantly highlights the importance of social ties in spreading innovation, or new knowledge and practices. He explores why some innovations spread swiftly and others so slowly in the New Yorker article, “Slow Ideas.” Gawande stresses the importance of social ties and interaction in helping create new norms, and in helping to understand people’s existing norms and barriers to change.
So how do organizations better leverage social ties and interaction to affect change and build capacity for innovation? Gawande and Rogers both emphasize the power of high-touch learning to support socially mediated knowledge translation. High-touch learning has its foundation in a social constructivist pedagogy where emphasis is given to relationships and social networks. The importance of context and culture are recognized and practice is adapted accordingly.
To help reduce infant mortality resulting from hypothermia, Gawande describes how his team used childbirth-improvement workers to visit birth attendants, to show them why and how to follow a checklist of essential practices, to understand their difficulties and objections, and to help them practice doing things differently. Gawande’s successful model for spreading best practice and ensuring long-term behavior change embraces the power of social learning.
Social learning leverages relationships, provides opportunities for collaborative interaction, opportunities to observe desired behavior modeled by others, and honors context and culture as integral components in the learning process. Social learning and a social constructivist pedagogy are strongly supported in the implementation science literature as facilitating more effective knowledge translation. In healthcare especially, talent development initiatives should seek to incorporate high impact social learning methods and tools to help extend and deepen learning. Doing so just may help exponentially expand capacity for transformation and innovation in healthcare.
I’d love to hear how your organization is embracing social learning. What’s working and what’s not? What social tools have your leveraged? In a true social learning exercise, share your thoughts in the Comments below to get the conversation going.
B. Buescher, P Vigueri, How US healthcare companies can thrive amid disruption. McKinsey & Co. June 2014.
B Moritz, “America’s new healthcare economy: 3 trends to watch.” Fortune website. January 21, 2015.
Gabbay J, le May A. Evidence based guidelines or collectively constructed "mindlines?" Ethnographic study of knowledge management in primary care. BMJ. 2004 Oct 30; 329(7473):1013.
Thomas A, Menon A, Boruff J, Rodriguez AM, Ahmed S. Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review. Implement Sci. 2014 May 6; 9:54.
Bingham, T., Pink, D. H., & Conner, M. L. (2015). The New Social Learning: Connect. Collaborate. Work. Alexandria, VA: ATD Press.
McWilliam CL, Kothari A, Leipert B, Ward-Griffin C, Forbes D, King ML, Kloseck M, Ferguson K, Oudshoorn A. Accelerating client-driven care: pilot study for a social interaction approach to knowledge translation. Can J Nurs Res. 2008 Jun; 40(2):58-74.
Rogers, E. M. (2003). Diffusion of innovations. New York: Free Press.
- Gawande, A. (July 29, 2013). “Slow Ideas: Why innovations don't always catch on.” New Yorker Magazine.