I am excited to share that I recently transitioned into a new role at University of Chicago Medicine: the Associate Chief Medical Officer for the Clinical Learning Environment. You may wonder what does that even mean? Well, five years ago, I started in a role in Graduate Medical Education to improve the clinical learning environment for residents and fellows. Essentially, a big part of the job was to look for ways to integrate residents and fellows into activities related to our institutional quality, safety and value missions. Essentially, I aligned the work of the medical trainees with that of the institutional priorities. While everyone was doing a QI project, a trainee may not be able to explain how it is aligned to the organizational priorities. As I led efforts to improve alignment and learning for our trainees, I quickly realized that this work is necessary for everyone, including faculty and staff.
In the interim, what started out as a job that a handful of us had has now become a career path that we call “Bridging Leaders”. This past June, I helped organize the first Bridging Leaders Track at the AAMC Integrating Quality Meeting. We thought maybe 30 would come, but more than 60 attended; this year, we are holding a pre-Summit.
Not surprisingly, many of the original bridging leaders are card-carrying hospitalists with educational leadership experience who also had trained in quality improvement and could easily understand the alphabet soup of these worlds such as “EPA” and “PDSA.” While most bridging leaders present are on the education side bridging to health system leadership, certain challenges remained, such as timely data acquisition and how to engage health system leaders in these efforts. For true alignment, it is equally important that the C-suite invest in bridging leaders to improve, implement, and support opportunities in clinical operations to enhance learning for all clinicians.
Why should the C-suite invest in improving the learning environment? Well, here are a few reasons that come to mind:
- Job satisfaction and professional growth: There is nothing worse than a high turnover of staff due to low job satisfaction or professional growth. Turnover is not only costly; it prevents new initiatives from “sticking,” and you are on a hamster wheel. It is costly to recruit new talent, so one of the best ways to ensure that you get top talent is to homegrow it! That means investing in professional growth opportunities for frontline staff to acquire new skills and advance in their position.
- Improving efficiency of learning for all healthcare professionals: Current on-the-job training in healthcare is done in siloes. Nurses, pharmacists and physicians all need to know how to use the event reporting system or request quality improvement data. But all of that is likely uncoordinated, and the wheel is being re-invented for each of these groups. In fact, there is a major effort to standardize training in patient safety for all clinicians new to an organization. There are also basic things literally not covered in health professions education that are critical to team-based care such as effective and professional use of communication tools like pagers, texting, EHR inboxes and patient portals to manage patient care issues. Standardizing such training could be a very powerful and efficient way of onboarding and retraining all staff.
- Avoiding death by web modules: In the learning field, there used to be death by PowerPoint, but that has now been replaced by a more evil nemesis: the web module. The web module is even worse than a live lecture because you have to often fit it in to your already crunched schedule, and often times, the material is not web-friendly. Having a leader who is thinking about the best way to deliver information to advance learning in this day and age is critical to healthcare. One of the most common questions I get is, “How can we let others know to do X.” Everyone, of course, gravitates immediately to the web module that is too easy to disengage with and still get through. Web modules have a place, but we need to combine them with newer forms of active and immersive learning like simulation. One example of this is our simple “Room of Horrors” that can emphasizes both unsafe practices and low-value care.
- Purging regulatory myths and medical urban legends: This is one of my favorites. I recently moderated a panel on value-based care and physician experience for Humana when this emerged as a major issue facing physicians trying to practice in value-based care models. Interestingly, the conditions for rumors to spread include topic of interest and importance, underlying ambiguity and anxiety. This pretty much means any health are policy or regulation is subject to rumor! Many years ago, we noticed residents were telling patients they were liable for the financial cost of hospitalization if they left against medical advice. This wasn’t only true, it was mentioned on the AMA form. It was not just us either. The good news is that we were able to not only develop education, but also work on a fix to the form to educate others. We need to purge other myths and legends as well.
- Staying ahead of new and emerging trends in health: The healthcare system is in transition. Change is never fun, but it’s worse if our workforce feels unprepared for the change. Given the myriad of changes in the way we deliver care not just at the system level but at the individual level from working with artificial intelligence or even robots to integrating personalized medicine and genomics, we need new ways of learning and training on the job. This is especially important as technology becomes a greater part of what we do.
It turns out we are not the only ones that are thinking along these lines. I was fortunate to visit Christiana Care and met a physician who was just hired as their Associate Chief Learning Officer. The role of a C-suite executive focused on learning is growing in healthcare and hospitals. Given the change that our healthcare system is undergoing, it is not surprising that learning is on the radar for healthcare executives. After all, in the words of famed management consultant and author Peter Drucker, “We now accept the fact that learning is a lifelong process of keeping abreast of change. And the most pressing task is to teach people how to learn.”