Learning to change and/or changing to learn

Two parallel developments concerning learning and change can be discerned in Health and Social Care. Managers and policy makers have recognized the need for almost continuous change for some considerable time, but, with a few notable exceptions, have tended to regard change as a political and administrative process involving decision-making and persuasion, rather than as a learning process. Insofar as learning has been emphasized, the focus has been on practitioners learning new practices by attending briefing events and courses rather than managers learning how to facilitate change through many different clusters of activities, of which continuing professional development (CPD) is but one. The management literature, and even political speeches, increasingly argue that both organizational change and practice development have become a central, permanent aspect of professional work, but the experience of most practitioners is that of disengaging and re-engaging with an endless series of separate new initiatives. Even when such initiatives are similar to their predecessors, they are presented and organized as if they were entirely different, especially in their discourse and terminology, by managers or politicians determined to make their own distinctive contribution. Ironically, the problems of change and approaches to the management of change are one of the most researched areas of the social sciences, but also one of the areas most ignored by governments or chief executives in a hurry. Instead, ill-defined concepts, such as that of the ‘learning organization’, are taken up by a stream of management gurus and capture the minds of would-be ‘miracle managers’ with only scant attention to their research base. They sometimes provide useful ideal types, but tend to give rise to unrealistic expectations from naïve disciples. Thus, while the problems of managing change are constantly on the agenda, the problem of learning how best to promote and facilitate change is given far less attention. The other development has been the increasing recognition that learning in education settings has limited impact without at least an equal emphasis on learning in workplace settings, and that the interaction between them is of vital importance. This applies to both initial training and CPD, and raises many critical questions, for example: How can busy service organizations and busy educational organizations best interact to improve the quality of healthcare through the organization and facilitation of practitioners’ learning? How can work be best organized to provide potential learning opportunities for practitioners? What kinds of educational support for particular learning challenges offer the best value? The answers to these questions will almost certainly point to the need for organizational changes focused on the enhancement of practitioners’ learning and managers’ learning. Many of those working at the interface between service and education have already recognized that there are organizational barriers to learning, as well as individual barriers, but the problem has rarely been articulated with sufficient clarity for appropriate problem-solving and decision-making processes to be set in motion. The purpose of this article is to revisit the research on both change and workplace learning in order to establish a clear relationship between the goals of learning to change and the goals of changing to learn. The research literature on change has been subjected to so many digests that it is often perceived like a smorgisborg of models, factors and perspectives from which users can pick whatever takes their fancy, without understanding either the contexts for which they were developed or their theoretical underpinning. This practice is ill-advised, because many of the theories are complementary rather than oppositional, and a pick-and-choose mentality will probably oversimplify the complexity of change processes and lead to the neglect of some important aspects. This point is well made by House (1979), who suggests that all change processes have at least three dimensions: technological; political; and cultural. These operate at several levels, from the State down to the local working group. The technological dimension is primarily concerned with what works, or, more frequently, with what works best. However, the question of what counts as ‘best’ will probably be decided by a combination of cultural norms and political negotiation and/or decision-making. These questions align themselves closely with the three change paradigms first articulated by Bennis, Benne & Chin (1961) – the empirical-rational approach (technical), the power-coercive approach (political) and the normative-re-educative approach (cultural). But the change from regarding these three approaches as separate alternatives to treating them as different dimensions of the change process is extremely significant. In practice it is easier to think of hybrid approaches, which give different relative emphases to these dimensions. They may also vary with the level of the actions being observed and the stage that the change process has reached. Historically, there have also been changes in the relative attention given to the three dimensions. For example, there was a strong emphasis on the empirical-rational approach in the late 1960s and early 1970s, then it peaked again at the turn of the current century. In each case there was a strong emphasis on research evidence, but the political context was very different. In the 1960s, there was considerable funding for large projects following a Research, Development and Diffusion Model (RD & D), and funders naively assumed that, if the evidence was good, political and cultural concerns would fade away. Potential users of practice would be persuaded to change their practice by evidence alone, and the evaluation of new programmes would provide that type of evidence. In spite of many failures on the ground, the wishful thinking of government and some researchers has kept these assumptions afloat. The one type of research evidence that is not accepted by proponents of this approach appears to be that relating to the change process itself. A counterpart to the RD & D model, also developed in the 1960s, assumes that change arises from recognizing, diagnosing and responding to problems, rather than being enticed by new opportunities that claim to offer improved benefits. This problem-solving model places the initiative with knowledge users rather than knowledge creators, and lends itself to locally initiated change as well as large-scale change. It has a strong empirical-rational core, based on the processes of problem diagnosis, searching for relevant options and evidence, and option assessment, but it grew out of the work of the social psychologist Kurt Lewin, who also gave considerable attention to the cultural aspects of change. However, the recent emphasis on knowledge management, using information technology and evidence-based practice, has prioritized the empirical-rational dimension of the model. Nevertheless, its success still depends on the extent to which the problem-solvers incorporate the political and cultural dimensions into both their definition of the problem and their assessment of the possible solutions. Hence, it is both rational and evidence-based practice to give proper attention to the political and cultural dimensions at every level of change. Dalin (1973), who led several cross-national reviews of innovation and change in the educational sector under the auspices of the Organisation of Economic Co-operation and Development (OECD), preferred the term ‘political-administrative’ to ‘power-coercive’, arguing that this was more appropriate for democratic nations. This directed attention to the wide range of political and/or administrative strategies for directing or promoting change. Standard setting is one of the more complex examples, because it can involve almost any combination of government agencies, accreditation bodies, professional bodies and healthcare organizations. Such standards do not apply only to outcomes, but also to staffing, quality assurance, user consultation, ethics and governance. Another critical area is finance, where levels of direction accompanying the funding of healthcare organizations can vary from broad brush with significant local determination of priorities, to very detailed financial controls that leave little room for manoeuvre. This is complicated by multiple sources of funding operating with limited cooperation and coordination. An increasing number of these are temporary rather than ongoing, as projectization accounts for increasing proportions of the total budget. One result is uneven access to resources across the organization and continual financial crises, as funding taps are turned on and off and under-funded projects suck resources out of dwindling core budgets. This increases internal competitiveness in ways that can have a negative impact on mutual learning. Projects often try to introduce changes without any additional budget for supporting the associated learning, as well as putting financial pressure on the core CPD budget. Almost inevitably, some of these political-administrative factors will be driving or promoting certain changes, while others will present barriers to those changes, almost inadvertently. Often it is the administrative structures and processes that are most difficult to change. Either the organization is too inflexible to handle some changes in its component groups, or powerful individuals or groups will use their micropolitical influence to oppose changes that might diminish their power or their budget, or increase their workload. In spite of Dalin's (1973) optimism, the direct exercise of power still plays an important role in resisting change, especially in relation to job retention and career progress. People are very concerned about their career prospects and even about possible dismissal or loss of status and influence. These issues tend to come to the fore whenever any significant change is proposed, and even when there is very little real threat, people become very anxious. Morale can quickly plummet and cooperation may dwindle. However, confining our attention to the more blatant exercise of power can cause us to neglect the many ways by which power is exercised through cultural norms or differential access to relevant knowledge. Cultural norms can constrain people's thinking about change through preserving large areas of organizational or group practices by simply taking them for granted and treating them as unproblematic. This affects not just what people feel they cannot do or must do, but also the many things that they never even think of doing. Seen from House's (1979) technological knowledge perspective, lack of knowledge about the proposed change itself makes it difficult to argue against it, suggest improvements or even implement it; and lack of knowledge about alternative ways of achieving the same purpose can be equally constraining. The cultural dimension is equally complex. Healthcare organizations have subcultures, often identified with professions, work groups or internal factions, which also have a micropolitical role within the organization and press for their members’ interests. They are very likely to develop internal norms associated with this micropolitical purpose, but less likely to develop norms that encompass more than a small proportion of the values and norms of their individual members. Both organizational and work group cultures are strongly influenced by their work patterns and relationships and also by the views of their leading members, yet individual attitudes and values are only partially shaped by workplace socialization. Nevertheless, one cannot easily separate organizational culture from organizational practices. The ‘normative re-educative’ paradigm of Bennis et al. also requires some analysis. The term ‘re-education’ can be confusing, because it tends to be associated with changing people's attitudes and values through group learning, whereas the term ‘education’ is strongly associated with the acquisition of knowledge through individual learning but in group contexts. This raises the question of whether activities directly addressing attitudes and values should precede or run parallel with activities for learning new practices. However, it could be argued that even to pose this question is to take too rational a view of the change process. Peoples’ values have to be viewed in a context where they also espouse potentially competing values and they resolve conflicts between them by a series of compromises, some of which become embedded in their practice, while others change according to their interpretation of the situation. Social factors can be of special significance in these circumstances, as people are more inclined to align themselves with those whom they trust. Another complication is that the values which practitioners espouse when questioned, or in public debate, may differ from those embedded in their practice (Argyris & Schon 1974). Contrary to common management discourse about the need to change values, people usually only need to re-address how potential conflicts between values are resolved in practice. Moreover, some new practices may enable different value priorities to be enacted, which had previously been seen as desirable, but not feasible, thus strengthening the alignment of the cultural and technical aspects of practice. Attitudes may be strongly influenced by norms and values, but other factors are also involved. Some people seek greater participation in decision-making; others prefer to limit their involvement. People's preferred balance of work, community and family activities may vary, as will their ambition and willingness to take on new responsibility. Two contrasting, but related, adjectives that come to mind are ‘comfortable’ and ‘confident’. ‘Comfortable’ has overtones of maintaining one's current spread of activities and relationships, whereas ‘confident’ suggests a willingness to take on new challenges. Both relate to the emotional dimension of change, which appears to be missing from the three paradigms of Bennis et al. Those aspects of change that carry a strong emotional content are more likely to be practical than theoretical once the change process has begun, because the learning challenges entailed in changing one's practice are often underestimated by an order of magnitude. The greatest challenge is usually the transition period, when practitioners are not only expected to learn new practices but also to unlearn old practices and abandon some of the routines to which one has become accustomed. This difficulty arises from the very nature of practice itself (Eraut 2000). Coping with the demands of a busy, crowded workplace depends on routinizing the unproblematic aspects of daily practice, so that one's attention can be focused on learning more about one's clients and therapeutically interacting with them. Thus, both efficiency and effectiveness depend on partly tacit routines that can be performed without too much stopping to think. However, the tacit nature of this expertise makes it difficult to unlearn such routines, or even appreciate their significant role in one's practice. During the transition period, practitioners have to avoid reverting to established responses and routines, either unthinkingly or as a last resort, but will find their performance level and work rate reduced because: situational understanding has become more problematic; many of the cues (or navigation lights) which they use, often unconsciously, to assess situations and keep on track are no longer available or appropriate; decision-making becomes more laboured and less confident; and their work is less fluent and demands more attention. The result is disorientation, exhaustion and vulnerability. The practitioners have become novices again without having the excuse of being a novice to justify a level of performance that fails to meet even their own expectations. Learning new practices can be equally challenging, because it involves much more than just learning new techniques. Sometimes, new practices are based on one or two key ideas, whose application still has to be worked out at local level. Even when a practice has been codified by a series of protocols, it still needs to be adapted to local contexts and clients. Further examination may be needed of a client's context and condition, and the practitioner's response has to be fine-tuned to take this new information into account. New practices cannot just be learned, they also have to be recreated for new contexts and clients. The implications for learning are that practitioners need to be: made aware of the implications and challenges involved in changing their practice; given a great deal of support, especially during the early stages of change when they are disoriented and often disillusioned; and encouraged to pool their experiences and adapt the new practice to their own contexts and clients. The extent to which this learning is an individual or group activity will depend on the nature of the job. Many individual tasks are performed by more than one person working in parallel, in which case there is a need for both individual learning, possibly involving some coaching or working alongside an expert for a period of time, and sharing practice through some combination of case discussion and mutual observation. Some jobs are performed in groups, although practitioners may have distinct roles within those groups, in which case both team and individual learning will be essential. Many jobs are performed individually, but also depend on periodic interactions with other practitioners that are vital for fluent, efficient working and positive outcomes. Learning these requires constructive group-learning episodes, especially at the stage where confidence is low and tetchiness is high. The importance of the concept of ‘learning to change’ lies in both its universality – it applies to all those involved in a change at every level – and its partial generalisability – some aspects of the learning involved in any particular change are generalisable to other change initiatives. The foregoing discussion confirms the need for managers to learn from both the research literature on change and their own reflections on their experiences of change at different points in their career. This is generally accepted, but not well implemented. However, the need for practitioners to learn about change processes and experiences is only rarely recognized, even though it helps them to be better prepared for change and to participate in planning for change within their own workplace. All change involves learning and the more prepared they feel for undertaking such learning, the more likely they are to find learning to change an achievable challenge rather than an emotional precipice. This brings us back to the second part of our title, ‘changing to learn’. This has two aspects: the enhancement of informal learning through changing the learning climate and the learning culture; and the establishment of formal arrangements for ascertaining learning needs and evaluating them as part of a of change, which is concerned with change an part of group and organizational practice. for greater attention to informal learning is that it accounts for the of learning in the workplace (Eraut et and the factors that facilitate or informal learning are of being or by changes both in how work is and and in the management and culture of work will with the two and the suggests a learning new the suggests barriers to learning that might have to be or practitioners to themselves to any change. of that such as management or working tended to be context factors that But these negative factors not in itself increase The of which the most important was from the work so them content not to but own research on learning in and healthcare organizations the importance of while also of work was a to confidence in one's own and such challenges were less likely to be accepted, or even when there was little support in the of and constructive research also that most learning was from other people in and the and that this was on relationships (Eraut et al. In to the challenge of the work learning was strongly or by the climate and culture of the workplace. This suggests that the confidence needed to regard changing one's practice as an achievable challenge both confidence in being of a challenge of a particular concept of such confidence is and confidence in the continuing support of significant others in any problems that most learning as a of the work suggests that learning can be both by more learning opportunities and by taking greater of those opportunities that research on learning through participation is that people learn from working alongside other people and how they do things and handle and such learning is rarely in only one in case and problem-solving is of workplace and learning from and of other can an important part in a on one's practice. All of these learning opportunities can be with a little and spread a working group in an as as the workplace climate and working relationships are based on mutual learning and mutual The development of in coaching and about what one is either or on will a work to learn from each other in a that is especially useful for sharing practices with other groups and learning new practices. the changing of most working groups, it is unrealistic to them to positive learning on their Hence, the and of a positive learning climate has to be a management for which they should appropriate training (Eraut et al. such are given very little attention in most management development the learning processes the extent to which practitioners are to take of opportunities for mutual will depend not only on but also on both to questions of each other which might be as on either For and or this has to questions that might or to to working on that because far more knowledge is taken for granted than most practitioners Thus, an culture is important for learning and also for learning. Nevertheless, will still prefer to questions of those with a similar level of experience when they first (Eraut et al. to or to practitioners only a little more needs to be made for them. understanding can also be improved by opportunities for mutual and question The purpose of this has been to how many small changes can have a considerable impact on informal learning, which accounts for the of learning in workplace that the of new practices and the CPD of practitioners often some formal learning in settings from the but the impact of such formal learning will usually depend on the informal learning in the workplace that of proper and often the of CPD programmes whose quality is in every other need to the of change, a difficult concept that at least two The first is by & whose focus was on The problem they identified was that most people so their of for thinking about their problems that little learning can they their problem in a The same was identified by & Schon who the term to a similar In they many to how the of evidence about the effectiveness of professional practice was determined by the expectations of the practitioners They only in the areas where they expected to find it, and this approach them from other evidence that could have them to their model of the situation. In people tend to learn only from those aspects of their that they have for attention. 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