Reflecting on the Learning Organisation Attributes of Ambulance Trusts and moving them forward'

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Reflecting on the Learning OrganisationAttribu
tes of Ambulance Trusts and moving them forward.

• Julia R A Taylor

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Context

• Improvement Partnership for Ambulance
  Services(IPAS)
• 2002/3 Performance Ratings
• (50 of Trusts 0 or 1 starred)
• Category A target - non compliance in 2003 was
  Sept. 50 Oct 50 Nov
  56.25 Dec 65.63
• CHI Inspections 2002/3 nearly 40 had 5 or more
  ones in their CHI report. i.e. very poor systems
  in place for clinical governance.

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Context cont.

• Strong Competition between Trusts
• Disparaging attitude
• Unprepared to learn from each other
• Poor networks
• Insular
• Untypical of NHS e.g. not recruiting
  professionals
• Paramilitary Very hierarchical

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What were the findings cont

• Lack of project management and planning
• Poor understanding, accountabilities and
  responsibilities
• Little evidence-based decision-making
• Poor patient and public involvement (customer)
• Poor if any performance assessment frameworks
• Poor financial management

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What were the findings more!

• Lack of devolving financial management
• Needed advice regarding organisational and CG
  structures and committees
• Poor information flows, failing to learn from
  incidents, good practice etc
• Job roles, Objective development
• Review linkages risk, PPI, complaints,
  workforce and business planning, appraisal

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What were the findings more!!

• Lack of Clinical audit and clinical effectiveness
• Poor risk management
• Needed to identify and developing clinical
  leaders
• Needed to develop a learning culture
• Promoting improved communications through variety
  of methods
• Lack of performance management
• Transactional managment

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What were the findingslastly

• Sickness absence.22
• Diversity Gender and Race
• Lack of links with wider health community
• Failure to look at best practice

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Reflecting on

• Peddler, Burgoyne and Boydell (1997), suggested a
  model of the eleven characteristics of the
  learning organisation.

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• A learning approach to strategy
• Participative policy making
• Informating
• Formative accounting and control
• Internal exchange

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• Reward flexibility
• Enabling structures Boundary workers as
  environmental scanners
• Boundary workers as environmental scanners
• Inter-company learning
• A learning climate
• Self-development opportunities for all

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What did I do?

• IPAS Affiliates
• IPAS Performance Improvement Network (PIN)
• IPAS Leadership Development Portfolio
• Development of Good Practice Guidelines and
  Support the Sharing of Innovative and Good
  Practice

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IPAS Affiliates

• The IPAS Affiliates programme was designed to
  support the challenged one star trusts (as the
  zero star already receive similar support from
  the Performance Development Team).
• support on commissioning models
• The Affiliates have also provided IPAS with
  valuable expertise, access to their networks and
  assistance in the delivery of some of the IPAS
  work streams for example the development of the
  Good Practice Guidelines.

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For example

• One Trust needed a wide range of support from
  achieving key targets to handling human resource
  issues. We also brokered local relationships.
• Another requested support on Major Incident
  Planning, demand and capacity, clinical
  governance and clinical effectiveness.
• We are often requested to provide with support
  regarding refining their control room
• Sometimes the Trusts requested support sometimes
  the SHA (performance management) requested it.

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Addressing these Characteristics

• Boundary workers as environmental scanners
• Inter-company learning
• A learning climate
• Self-development opportunities for all

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IPAS Performance Improvement Network (PIN)

• Directors of Operations
• Our approach to CAT Cat C has been developed in
  conjunction with neighbouring Ambulance Trusts
  Lancashire, Mersey and West Yorkshire as part of
  the Improvement Partnership for Ambulance
  Services (IPAS) northern group.

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Horizon Scanning

• LOs need to look at the bigger picture,
  identifying factors in the external environment
  that will affect the Organisation, is essential,
  there is a need to avoid focusing on short-term
  events.
• Senge (1990) states generative learning cannot
  be sustained in an organisation where event
  thinking predominates.
• Pedler and Aspinwall (1998) comment a focus on
  short-term events means that we dont notice the
  slow gradual process where subtle changes in the
  environment are not detected until it is too
  late
• Senge, Pedler and Aspinwall identify that seeing
  challenges as individual events leads to a
  reactive response and describe this as a learning
  disability.

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The PIN addressed these characteristics

• A learning approach to strategy
• Participative policy making
• Inter-company learning
• A learning climate
• Self-development opportunities

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IPAS Leadership Development Portfolio

• Key Principles influencing the development of the
  Portfolio are
• Integration with the wider NHS
• Maximising the use of tried and tested products
• Identifying significant gaps and resolving them
• Focussing support on zero starred and CHI
  challenged organisations.

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IPAS Leadership Development Portfolio

• Ranges from
• Coaching for CEs to
• Health economy, multi-organisational development
  programme.
• Plus our commissioned
• IPAS SaM 14 organisations, 200 Staff

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Leadership

• Leadership is a key factor in enabling a Learning
  Organisation. Mahoney (2000) identifies that
  successful organisations actively encourage
  healthy exchanges of views and ideas, at and
  between all levels and Mahoney believes leaders
  should not be afraid to be questioned

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Addressing these Characteristics

• A learning approach to strategy
• Internal exchange
• Participative policy making
• Inter-company learning
• A learning climate
• Self-development opportunities

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IPAS SaM Feedback

• CE The IPAS Programme could not have come at a
  better time. As soon as I heard about the
  programme we decided to send all senior and
  middle managers despite the practical
  difficulties that this would present.
• Furthermore we identified a number of junior
  managers whose career development would benefit
  from this investment. I was not only pleased
  that IPAS were able to help support the Trust
  through the programme but that they took the time
  to engage the Trust and participants in the
  identification of those areas to be covered.

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IPAS SaM Feedback

• I found the course to be an invaluable driver to
  question both my deepest beliefs and to provide a
  staging platform for further development.
• I have now learnt my true role as a manager
• how to manage others, far more about myself
  than I ever knew before and the most important
  thing for me was the way I manage others, I have
  completely change my approach to managing my
  staff.
• I now realise I did very little listening, made
  light humour of situations to try and defuse
  situations instead of tackling them and
  preventing them happening again. thanks to IPAS I
  feel that I am better manager, understand others
  and their needs and I will share the experience
  and knowledge I have gained from this course with
  all staff within the trust.

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IPAS SaM Feedback

• I now have the direction and drive that was
  lacking in my ability, to take on my role and
  work within the management team as a more
  confident and productive member. I feel that all
  levels of management would benefit from the
  course and hope that it can be maintained for
  future staff development".
• I just wanted to let you know that I found the
  course absolutely brilliant. I have learnt lots
  of new skills, which I am putting into action
  daily.
• We have a good service but after attending this
  course and putting the skills into practise we
  will be a great service

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Development of Best Practice Guidelines and
Support the Sharing of Innovative and Best
Practice

• Best Practice Guidelines on Ambulance Operations
  Management
• Human Resource Guidelines for Ambulance
  Services. To assist in the delivery and
  measurement of your HR Services from IWL to CNST.
• Driving Change Good Practice Guidelines for
  PCTs on Commissioning Arrangements for Emergency
  Ambulance Services and Non-Emergency Patient
  Transport Services

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What Other Support did IPAS offer?

• Broker Relationships
• Information / good practice sharing
• Events e.g. National Learning Exchanges
• Share of knowledge of individual Ambulance Trusts
• Share our knowledge of generic Ambulance Issues
• Discuss how best to engage Ambulance Trusts

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Did IPAS get there?

• Depends on your measure?
• Star ratings..YES
• Learning Organisations..yes/getting there/not yet

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Definitions of Learning Organisations

• Pedler et al (1996) as an organisation that
  facilitates the learning of all its members and
  consciously transforms itself and its context
• I think Essex Ambulance Trust got there

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• The Learning Organisation is not just about
  learning but the ability to harness the learning
  and fully utilise it, at the whole organisation
  level Senge (1990) where people are continually
  discovering how they create reality and how they
  can change it. Essex

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• The leaders (at all levels) must demonstrate
  openness, a willingness to share and learn, to
  make mistakes and take risk without blame or
  punishment. Yes some got there
• In other words, demonstrate the culture that must
  be present in a Learning Organisation i.e. some
  of Pedler et al (1996) characteristics e.g.
  internal exchange, enabling structures, a
  learning climate and inter-company learning.

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Organisational Structure

• Organisational Structure away from the
  multi-layered hierarchical structure common in
  the NHS to a much flatter hierarchy and
  supported by empowered staff, enabling them to be
  more involved in the Organisation as a whole.
• Yes
• This would be reinforced with team/service
  objectives YES with learning enhanced by allowing
  staff and managers to work across service
  boundaries and to dip into other similar
  organisations to share and acquire learning. Just