4.4 Enabling conditions for learning

A final area of consideration for building learning health systems is how we set up an enabling environment in which learning can take place. Even with all of the strategies to institutionalize learning and abundant capacity for learning, organizations and systems can still struggle to enable learning without having a few key conditions in place. These are: 1) leadership and culture, 2) system design, and 3) resources (Figure 4.5). Let’s look at each of these in a bit more detail and how each one can be fostered and intentionally developed.

Figure 4.5 Enabling conditions for learning

Leadership and culture

Leaders play a key role in developing a vision for learning, spurring collective action, and modelling a process for exploration and problem-solving that encourages learning. Leadership can influence culture and vice versa.

Teamwork and cooperation, readiness for new ideas and change, and an appreciation of difference and inclusivity are key elements of culture. Culture determines how learning is valued and used. Very hierarchical cultures can inhibit openness and sharing. A persuasive culture and less hierarchical culture may include leaders that value experiential and deliberative forms of learning and, therefore, promote these.

How would you characterize your own organizational leadership and culture? Recognize that different structures and norms can work, but there is also always room for reflection and ongoing adaptation and improvement!

System design

How processes for teams, organizations and systems are designed can support or hinder learning. Therefore, an active learning agenda and vision are needed. Learning from deliberation, experience and action also need to be integrated. Often, feedback mechanisms are needed to internally capture and utilize this learning rather than relying on external standards or incentives to impose these expectations.

Organizational structures also influence how much and how well learning can take place within and organization. If teams are working in silos or when managers are not able to provide the time or skills to work through root causes and generate innovative approaches, learning can be stalled or stunted.

For example, the District Innovation and Action Learning for Health System Development (DIAHLS) programme in South Arica was aimed at creating the space and support for learning to take place within and across districts, which had formerly not been feasible. Many LMIC settings continue to face challenges to have the capacity and resources to do this, and good supervision requires ongoing efforts. Appropriately incentivizing learning can also help an organization or system determine what kind of processes, collaborations and resources are needed in order to achieve desired results – whether these are organizational partnerships, publications, relationships with policy-makers or opportunities for recognition and promotions.

Resources

Learning requires resources. First, establishing and sustaining mechanisms to institutionalize learning (see earlier section of this module) require support. Infrastructure for applied research requires long-term support. Further, costs to develop and deploy varied human capacity for learning also require resources. This includes trainees — including pre-service and in-service — from diverse backgrounds and supporting and sustaining interdisciplinary teams. These fees vary widely around the world but can be prohibitively expensive. Protected time is also needed to pursue innovations and produce the tools and methods to address learning questions, and this must be paid for.

While technology offers ever growing opportunities to scale and access learning globally, the platforms to run particularly online offerings also require resources to set up and manage, and need to be carefully considered.

External funding can play catalytic roles to jumpstart learning and learning cultures. However, external resources can also result in fragmentation of funding, externally imposed standards and conditions, and may not be sustainable in the long-term. Domestic resources engender long-term benefits and efficiencies, including improved systems functions, adaptivity and reduced dependence on external support. Often, both domestic and external resources are needed over the course of developing and sustaining a learning initiative.

In the Learning Health Systems report, you can read more about the examples and details are presented on pages 51-54.