Learning in Healthcare Presents Principles for Creating a High Learning Organization in Healthcare (And Delivering Measurable Outcomes From Learning)

Healthcare has often looked at education as "non-productive time that should be limited or eliminated if at all possible". By adopting a different set of core principles, education can be turned into learning that delivers measurable changes in patient outcomes: 1. Everything is about our patient(s) 2. Education ≠ learning 3. Learning = changed outcomes 4. Learning is an expertise (that should be consulted by content experts) 5. Everyone is in Learning

Healthcare is a constant state of change. Healthcare organizations need to become “high learning organizations” to respond to the current pace of change. Currently, education is seen by healthcare finance as ‘non-productive time that should be limited or eliminated if at all possible;’ therefore, organizations need a new way to look at learning. High learning organizations in healthcare need to embrace five core principles:

1.      Everything is about our patient(s)

Learning in Healthcare needs to shift to a focus on the patient and improved outcomes.

Jay Zigmont, PhD, CHSE-A, Learning Innovator/Founder

2.    Education ≠ learning

3.    Learning = changed outcomes

4.    Learning is an expertise (that should be consulted by content experts)

5.    Everyone is in learning

To compete with the rapid pace of change, healthcare systems have adopted change management systems, including lean and continuous improvement systems with varying results. Unfortunately, it still generally takes over a decade to make good changes, even with good research. The reason for providers slowly changing may well be due to the educational system within healthcare being ineffective. 

Practicing providers will tell you that they learned how to do their ‘job’ by doing it; reflecting experiential learning (Kolb, 1984). When organizations have a ‘problem,' they set up another class, CME, or worse yet, an online module (often the opposite of experiential learning). Providers all have different responses to this 'education'  (ranging from all out fighting, to sleeping through the class) and what providers have learned is how to click fast through online modules just to ‘check them off.'  The result is that education in healthcare is becoming a fallacy, and it is hard to find documented changes from education at the bedside. 

1.  Everything is about our patient(s)

Learning in healthcare needs to keep the patient at the forefront. If the patient is at the center of our learning, then the focus is removed from the learner and educator. The result then, is that all initiatives can be seen through a lens of: “Will this change outcomes at the patient bedside and/or would the patient ‘pay’ for this change?” When healthcare systems spend money on education, they are spending our patients’ money, and our patients are only interested in paying for things that improve care for them. 

Our patients see us as a team, therefore the need to train as a team. Training as a team does not mean a one time a year simulation; it means redesigning our learning systems to be integrated throughout. Specialty training for nurses, physicians, and other health providers ought to be more of a rarity than a regular occurrence and only used for truly specialized areas.  Then again, the best learning is via experience, so if experiential learning is at the core of what we do, it will force us to learn together, at the bedside for the patient.

2.  Education learning

Just because a student sat their butt in a seat does not mean they learned anything. Too much of our current education (such as mandatory education) is just checking a regulatory box without getting to the intent of the education or changing an outcome. If anything, healthcare systems have over-educated their workforce. Most healthcare systems have learning management systems (LMS) full of ‘online learning’ that sucks hundreds of productive hours from each provider, each year, and yet organizations still struggle to prove that online learning has effected a change at the bedside.

A great example of education not causing change is hand washing. Most healthcare systems have hours (if not days) of training on hand washing, yet still have mixed results. Adding more education has rarely (if ever) worked. Healthcare systems add education because it makes them feel better. Healthcare systems have ‘checked the box’ and now can hold someone accountable when they make mistakes, even if they have not learned a thing.

If organizations shift away from a focus on education (i.e. hours, accountability, etc.), the litmus test then becomes: Is this being done to ‘check a box’ or to change outcomes? 

3.  Learning = changed outcomes

Adult learners learn what they want to learn when they want to learn it (Knowles, 1985). In healthcare, the result is that providers want to learn when they think the result will be a positive change in outcomes (either for us as an individual, or for our patients). Providers have been inoculated by inadequate education, and therefore all too often tune out anything that is ‘presented'. To shift away from this education mindset, healthcare needs to look at learning differently and realize that if there is not a change in the outcome, the initiative wasted participants’ time.

Changing outcomes requires a change in the learner, their experience, and their environment (Zigmont et al, 2011). Putting out a memo or policy to change practice may change the environment, but it will not change the way healthcare providers practice (unless they are watched regularly and held accountable). At the same time, a great experience that changes the way an individual thinks will not work if the environment does not support it (i.e. students learned how to wash their hands, but the sinks are broken). 

“Six Sigma/Lean” does great work in the environment, but often changes fail because systems do not appropriately work to change the learner, or their experience.  Learning practitioners complain because they ‘did a great class' but then their learners were ‘untrained' in ‘real' practice. Getting a measurable change in practice and making it ‘stick' takes changes in all three areas: the learner, experience, and environment. (Zigmont et al, 2015)

4.  Learning is an expertise (that should be consulted by content experts)

Most everyone feels they know how best to do education, however, creating learning that changes outcomes is an expertise on its own. Content experts should have learning experts whom they can use to help create meaningful learning initiatives. Content experts need to be at the bedside and focus on being the best provider possible. Learning experts, therefore, need not be content experts themselves, as it is tough to maintain competency in both (content and learning) over the long term. As noted, leadership author John Maxwell (2015) says, "If you are teaching it, and not doing it, you are teaching history".

5.  Everyone is involved in learning

To keep up with the pace of change and continuously grow, providers need to realize that everyone is involved in learning. At all times, providers are both a learner themselves and a facilitator of learning for others (both providers and patients). Therefore, both organizations and individuals need to continuously build skills in learning. Learning, in this case, is more than passing a test. Providers need to learn how to continually learn from their experiences, build reflection skills and help others learn at the same time.  

The result of everyone being involved in learning every day is that experiential learning becomes the core of everything. Providers then can go back to practicing medicine and realize that things can always be better. 


If healthcare systems are going to keep up with the pace of change, they need to become "high learning organizations" before they can ever become high-reliability organizations. Learning needs to be built and valued as a skill that changes outcomes at the bedside. When everyone is involved in learning to improve patients'

Application Experience

Participants: 8-12

Time to complete 30 minutes

Directions:  Have learners break into three groups and discuss the 5 principles.  Focus on the following questions (and then share their findings with the group):

·       Which principle is the most obvious?

·       Which one is the hardest to embrace (and why)?

·       What would happen if all learning in the organization embraced these principles?

·       Is everything really about the patient?

This part of a series called "Learning That Works" (http://www.learninginhealthcare.com) by Jay Zigmont, Ph.D., CHSE-A (jay.zigmont@gmail.com ). For a video on this topic and more information, visit http://L10.LearningInHealthcare.com . The principles above are part of the core content (Learning Card 10) of the Foundations of Experiential Learning Faculty Development Manual (http://FEL.learninginhealthcare.com ).


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Kolb, D. A. (1984) Experiential Learning. Upper Saddle River, NJ, Prentice Hall

Knowles, M. (1985) Andragogy in Action London, Jossey-Bass

Maxwell, J. (2015) "Hoglin Leadership Forum". Presentation.

Zigmont, J.J., Kappus L, and  Sudikoff S.N. (2011) Theoretical Foundations of Learning Through Simulation. Seminars in Perinatology, 2011, 35(2), pp 47-51

Zigmont J.J., Wade A., Edwards T., Hayes, K.,  Mitchell J., and Oocumma, N., (2015) Utilization of Learning Outcomes Model Reduces RN Orientation by >35%, Clinical Simulation in Nursing, 11(2): pp 79-94

Source: Learning in Healthcare