Learning to change and/or changing to learn

© 2004 Blackwell Publishing Ltd. Learning in Health and Social Care, 3, 3, 111–117

Blackwell Publishing, Ltd.

Editorial

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 con-

siderable 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 con-

tinuing 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 dis-

engaging 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 some-

times 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 inter-

action between them is of vital importance. This

applies to both initial training and CPD, and raises

many critical questions, for example:

1 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?

2 How can work be best organized to provide poten-

tial learning opportunities for practitioners?

3 What kinds of educational support for particular

learning challenges offer the best value?

The answers to these questions will almost cer-

tainly point to the need for organizational changes

focused on the enhancement of practitioners’ learn-

ing 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 suffi-

cient 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

112 Editorial: Learning to change and/or changing to learn


subjected to so many digests that it is often perceived

like a smorgisborg of models, factors and perspec-

tives 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 oppor-

tunities 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 con-

siderable attention to the cultural aspects of change.

However, the recent emphasis on knowledge manage-

ment, 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 solu-

tions. 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.

Editorial: Learning to change and/or changing to learn 113


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 com-

ponent 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 reten-

tion 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 perspec-

tive, 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’ inter-

ests. 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 acquisi-

tion 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 com-

promises, 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 con-

trasting, 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 para-

digms 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 unproblem-

atic 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 vul-

nerability. 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 con-

text 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 out-

comes. 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 differ-

ent 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 enhance-

ment of informal learning through changing the

learning climate and the learning culture; and the

establishment of formal arrangements for ascertain-

ing learning needs and evaluating progress towards

meeting them as part of a wider programme of

‘second order’ change, which is concerned with

making change an integral part of individual, group

and organizational practice.

My argument for giving greater attention to

informal learning is that it accounts for the majority

of learning in the workplace (Eraut et al 2000), and

the factors that facilitate or hinder informal learning

are capable of being strengthened or weakened by

changes both in how work is structured and allo-

cated and in the management and culture of work

groups. To explain this, I will start with the two

terms introduced above: comfortable, and confi-

dent. If the word comfortable suggests a complacent

attitude towards learning new practices, the word

uncomfortable suggests barriers to learning that

might have to be weakened or removed before

practitioners felt able to commit themselves to any

planned change. Hertzberg’s (1966) classic studies

of motivation found that demotivating factors,

such as incompetent management or bad working

conditions, tended to be context factors that caused

discomfort. But removing these negative factors

did not in itself increase motivation. The strongest

motivating factors, of which the most important was

challenge, arose from the work itself; so he called

them content factors. Hertzberg did not specifically

study motivation to learn, but my own research on

mid-career learning in engineering, finance and

healthcare organizations confirmed the importance

of challenge, while also noting that:

• successful completion of challenging work was

a major contributor to confidence in one’s own

capability; and

• such challenges were less likely to be accepted, or

even noticed, when there was little support in the

form of encouragement and constructive feedback.

Our research also found that most learning was

from other people in and around the job, and that

this was highly dependent on good relationships

(Eraut et al. 2004). In addition to the challenge of

the work itself, learning was strongly affected,

positively or negatively, by the climate and culture

of the workplace. This suggests that the confidence

needed to regard changing one’s practice as an

achievable challenge comprises both confidence in

being capable of meeting a challenge of a particular

kind (like Bandura’s 1997 concept of self-efficacy,

such confidence is situation specific) and confidence

in the continuing support of significant others in

overcoming any problems encountered.

Our discovery, that most learning occurred as a

by-product of the work itself, suggests that learning

can be enhanced both by creating more learning



opportunities and by taking greater advantage of

those opportunities that naturally occur. Recent

research on learning through participation is highly

relevant. We found that people learn from working

alongside other people and seeing how they do

things and handle tricky situations, and such learn-

ing is rarely in only one direction. Participation in

case discussions and problem-solving episodes is

another mode of workplace learning; and learning

from patients/clients and members of other profes-

sions can play an important part in developing a

wider perspective on one’s practice. All of these

learning opportunities can be created with a little

forethought and spread around a working group

in an inclusive manner, as long as the workplace

climate and working relationships are based on mutual

learning and mutual respect. The development of

skills in coaching and talking aloud about what one

is doing, either live or on video, will enhance a work

group’s capacity to learn from each other in a mode

that is especially useful for sharing practices with

other groups and learning new practices.

Given the changing membership of most working

groups, it is unrealistic to expect them to evolve

positive learning climates on their own. Hence, the

creation and maintenance of a positive learning

climate has to be a management responsibility,

for which they should receive appropriate training

(Eraut et al. 2001). Yet, such matters are given very

little attention in most management development

programmes.

Within the learning processes described above, the

extent to which practitioners are able to take advan-

tage of opportunities for mutual engagement will

depend not only on friendly relationsips, but also

on both parties feeling able to ask questions of each

other which might be interpreted as reflecting badly

on either party. For students and newly qualified

or appointed practitioners, this has to include

questions that might seem silly or trivial to someone

used to working on that site, because far more know-

ledge is taken for granted than most practitioners

realize. Thus, an ‘ask anything’ culture is important

for practitioner learning and also for patient/client

learning. Nevertheless, newcomers will still prefer to

ask questions of those with a similar level of experi-

ence when they first arrive (Eraut et al. 2004). Access

to peers or to practitioners only a little more senior

needs to be made easy for them. Cross-professional

understanding can also be improved by creating

opportunities for mutual shadowing and question

sessions.

The purpose of this section has been to demon-

strate how many small changes can have a consider-

able impact on informal learning, which accounts

for the majority of learning in workplace settings. We

accept that the introduction of new practices and

the CPD of practitioners often require some formal

learning in settings away from the workplace, but the

impact of such formal learning will usually depend

on the informal learning in the workplace that

follows it. Lack of proper preparation and follow-

up often neutralizes the effect of CPD programmes

whose quality is good in every other aspect.

Finally, we need to consider the possibility of intro-

ducing second-order change, a difficult concept that

carries at least two meanings. The first is described

by Watzlawick, Weakland & Fisch (1974), whose

focus was on therapy. The problem they identified

was that most people so restrict their frame of refer-

ence for thinking about their problems that little

learning can occur until they reframe their problem

in a wider context. The same phenomenon was

identified by Argyris & Schon (1974), who used

the term ‘double loop learning’ to describe a similar

phenomenon. In particular, they provided many

examples to show how the collection of evidence

about the effectiveness of professional practice was

largely determined by the expectations of the

practitioners concerned. They only collected data in

the areas where they expected to find it, and this

blinkered approach prevented them from noticing

other evidence that could have helped them to

reframe their mental model of the situation. In

effect, people tend to learn only from those aspects

of their environment that they have preselected

for attention. This problem can occur at all levels of

an organization, from top management to front-

line practitioners; and second-order change is the

preferred escape route.

The other meaning of second-order change,

closely linked to the literature on learning organiza-

tions, is to normalize change by building it into the

regular working practices of the organization. This



approach has brought more rhetoric than action,

for several reasons. First, its hyper-rational nature

neglects the political and cultural dimensions of

change. Senior managers, in particular, are liable to

feel that their power and status are threatened. The

second is that it takes time to establish and yield

positive results, and powerful stakeholders cannot

afford to wait that long. Then, third, there is a

danger in trying to tackle too many issues at once.

As I suggested in my last editorial on reflection,

evidence should be used to provide some guidance

as to which assumptions need to be prioritized for

re-examination.

In the public sector, this situation is even more

complicated because government also plays a

significant policy role, and there is little sign that

evidence-based policy wins votes, especially when

the influential media focus almost exclusively on

single cases that may be far from representative.

Hence, evidence gathering from the field needs to

be supplemented with intelligence gathering about

possible government actions. Strategic issues

probably suffer from both local and government

preoccupations, including the balance between

treatment and prevention, and the invisibility of

groups who lose out in the struggle for getting sup-

port for their needs because current users hold the

pole position.

Perhaps the most realistic approach is to combine

the monitoring of outcomes within the current

framework of assumptions, i.e. single-loop audit,

with a programme of evaluations designed to

examine specific areas for which there is at least

some evidence that the reframing of current policies

and practices may be needed. If a small number of

evaluations were conducted each year with the

appropriate involvement of the relevant stake-

holders, attention could be given to their selection

rather than debating whether they should take

place at all. This could become a normal part of

the management process, and learning from such

evaluations could be a normal part of CPD and

management-development programmes.

Michael Eraut

Editor

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Documents

Learning to change and/or changing to learn