Workforce and Training

From floristry to botany

Learning and development is about providing good quality and appropriate learning in a timely fashion to managers and staff as and when they need it. This means moving away from simply providing training to facilitating learning, in its widest possible form, says Mark Cole

Learning without thought is labour lost; thought without learning is perilous

Confucius (551 BC - 479 BC)

My late mother had countless, extremely ribald sayings that she would attribute without any basis in reality to Confucius. In consequence, mention of the Chinese philosopher invariably leads me with a broad smile on my face to think of flying planes upside down and cooking beans and peas in the same pot. (As in the “Jeopardy” quiz show, the reader is invited to imagine the gags from which these two references are drawn.)

But this quotation sums up so clearly how I think about workforce development that I could not help but use it to introduce this piece on the successes that learning & development has had at Queen Elizabeth Hospital and the challenges that we still face in a health care setting.

The first half of the quotation suggests to me the problem that exists with the whole idea of “training”. Traditionally, we have herded people into rooms. We have got them to sit in serried ranks or in small groups. We have talked at them a bit and maybe encouraged them to engage a little with one another around defined exercises. Ultimately, you are forced to ask: can enough thinking take place in such a context to justify the time and money dedicated to this type of activity?

Moreover, the “labour lost” is pretty substantial here, particularly for a busy service setting. Staff taken out of work to attend training put added pressure on the managers and other staff with whom they work – and have the potential to impact on the service experience of our patients.

Despite all the above, training remains the default option when personnel in health think about development. In particular, it is still called upon as a reward (“well done this year, what training would you like to go on?”) or as a punishment (“your customer care skills are terrible. I’m going to have to send you on a course!”) by managers throughout the service.

On a more positive note, the second half of the quotation reminds me of the importance of equipping people – in this case, all the staff from across the whole of my trust, from board to ward – with the knowledge and skills they require to do their jobs thoughtfully and well. If my department can support them in this way, then we are helping the trust to provide the best possible care to patients and other service users.

So, the challenge has been – and remains – to provide good quality and appropriate learning in a timely fashion to managers and staff as and when they need it. This entails a shift from trying to “pull” people into the learning & development department to join courses to “pushing” our services down as close to service as possible.

This, in turn, has required us to redefine what we do. My department is moving away in a slow yet constant turn from simply providing training -although, in regards to the mandatory requirements that we all face, this often remains the best possible way of ensuring compliance - to facilitating learning, in its widest possible form.

Hence, in a practical sense, it is no longer simply a matter for us of “delivering content”. It is now our intention wherever and whenever possible to work with staff groups and teams on live problems – and to support them to learn through that process, to define the situations that they face and come up with actions that are designed to address those issues.

Where we are providing formal training courses and programmes, such as in the area of leadership and management development, we have concerned ourselves with the three key issues of content, delivery and impact. First, is the knowledge and skills encapsulated in the course truly fit for purpose? Second, are we exploring a variety of ways of delivering that material that encompasses all the possible learning styles of the participants and which links it as closely as possible with their day-to-day experience? And, third, what impact does that learning have on the learner’s practice and hence the service that they provide?

In respect of our intermediate programme, entitled “Realising Management Potential”, the topics that are covered have been carefully reviewed and the pitch of the course has been raised. Second, in terms of delivery, we have developed a wide and expert faculty who we encourage and support to use innovative and learner-centred teaching methods such as action learning.

Lastly, the two cohorts who have passed through the revised programme thus far have undertaken careful evaluation of the benefits of the course six months after completion - the initial group through semi-structured interviews and the second through a detailed questionnaire. The emphasis in both exercises has been on the learning that came out of the experience and the ways in which participants have applied that back in practice.

We have also tried to adjust the way in which we provide access to learning to a way that more closely approximates the way in which a health care service might function. Staff often need quick access to good quality education in support of the work that they are doing in the here and now. This is particularly the case in a clinical setting for newly appointed managers. The traditional approach would be to book them onto a relevant course – no matter how far off in terms of time it might be – or to add them to a waiting list.

This is far from satisfactory. No one should need to wait to get access to learning that they need to do their job more effectively, particularly as this is likely to impact on the quality of the service that the trust offers. As a result, we have introduced “Learning ESSENTIALS” for such occasions - one-to-one sessions of not longer than two hours that give a basis introduction to a topic, such as appraisal or recruitment & selection, run at a time and place that is convenient to the learner.

All of these initiatives are designed to move the learning and development emphasis away from input and onto impact. Moreover, they are designed to provide timely learning opportunities to staff as close to where they work as possible. And they seek to broaden out the understanding of learning to encompass a wider range of activities – including a good deal of internal consultancy – rather than simply focusing on classroom activity.

It was Emerson, I think, who remarked that, while many may walk through the meadow, only a few would notice the flowers. This remark helps me to develop an analogy for the way in which I see learning & development at the Queen Elizabeth Hospital NHS Trust developing over the coming years. We will need to move away from being florists - presenting people with bunches of flowers that quickly wither away - to becoming botanists, showing people the paths through the meadow, pointing out where the living flowers are and encouraging them to engage with their environment.

Mark Cole is head of learning & development at Queen Elizabeth Hospital NHS Trust

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