Examples of double-loop learning in global health

Five examples of double-loop learning in global health

Writing

Read this first: What is double-loop learning in global health? Example 1: Addressing low uptake of a vaccine program Single–Loop Learning: Improve logistics and supply chain management to ensure consistent vaccine availability at clinics. Double–Loop Learning: Engage with community leaders to understand cultural beliefs and concerns around vaccination, and co-design a more localized and trustworthy immunization strategy. What is the difference? Double-loop learning questions the assumption that the primary goal should be to increase uptake at all costs. It considers whether the program design respects community autonomy and addresses their real concerns. It may surface competing values of public health impact vs. community self-determination. Example 2: Responding to an infectious disease outbreak Single–Loop Learning: Rapidly mobilize health workers and supplies to affected areas to contain the outbreak following established emergency protocols. Double–Loop Learning: Critically examine why the health system was vulnerable to this outbreak, and work with communities to redesign …

Why learning culture is the missing link between learning and performance in global health

Learning culture: the missing link in global health between learning and performance

Global health

Read this first: What is double-loop learning in global health? Learning culture is a critical concept missing from health systems research. It provides a practical and actionable framework to operationalize the notion of ‘learning health systems’ and drive transformative change. Watkins and Marsick describe learning culture as the capacity for change. They identify seven key action imperatives or “essential building blocks” that strengthen it: continuous learning opportunities, inquiry and dialogue, collaboration and team learning, systems to capture and share learning, people empowerment, connection to the environment, and strategic leadership for learning (Watkins & O’Neil, 2013). Crucially, the instrument developed by Watkins and Marsick assesses learning culture by examining perceptions of norms and practices, not just individual behaviors (Watkins & O’Neil, 2013). This aligns with Seye Abimbola’s assertion that learning in health systems should be “people-centred” and occurs at multiple interconnected levels. Furthermore, this research demonstrates that certain dimensions of learning …

What is double loop learning in global health

What is double-loop learning in global health?

Global health

Argyris (1976) defines double-loop learning as occurring “when errors are corrected by changing the governing values and then the actions.” He contrasts this with single-loop learning, where “errors are corrected without altering the underlying governing values.” This is challenging because it can threaten one’s sense of competence and self-image. ‘Are we doing things right?’ vs. ‘Are we doing the right things?’ In global health, double-loop learning means not just asking “Are we doing things right?” but also “Are we doing the right things?” It means being willing to challenge long-held assumptions about what works, for whom, and under what conditions. Epistemological assumptions (“we already know the best way”), methodological orthodoxies (“this is not how we do things”), and apolitical stance (“I do health, not politics”) of epidemiology can predispose practitioners to be dismissive of a concept like double-loop learning.  Learn more: Five examples of double-loop learning in global health Seye …

Why lack of continuous learning is the Achilles heel of immunization

Why lack of continuous learning is the Achilles heel of immunization 

Global health, Theory

Continuous learning is lacking in immunization. This lack may be an underestimated barrier to the “Big Catch-Up” and reaching zero-dose children This was a key finding presented at Gavi’s Zero-Dose Learning Hub (ZDLH) webinar “Equity in Action: Local Strategies for Reaching Zero-Dose Children and Communities” on 24 January 2024. The finding is based on analysis large-scale measurements conducted by the Geneva Learning Foundation in 2020 and 2022, with more than 10,000 immunization staff from all levels of the health system, job categories, and contexts, responding from over 90 countries. Year n Continuous learning Dialogue & Inquiry Team learning Embedded Systems Empowered People System Connection Strategic Leadership 2020 3830 3.61 4.68 – 4.81 4.68 5.10 4.83 2022 6185 3.76 4.71 4.86 4.93 4.72 5.23 4.93 TGLF global measurements (2020 and 2022) of learning culture in immunization, using the Dimensions of Learning Organization Questionnaire (DLOQ) What does this finding actually mean? In immunization, the …

Protect Invest Together

Protect, invest, together: strengthening health workforce through new learning models

Global health

In “Prioritising the health and care workforce shortage: protect, invest, together,” Agyeman-Manu et al. assert that the COVID-19 pandemic aggravated longstanding health workforce deficiencies globally, especially in under-resourced nations.  With projected shortages of 10 million health workers concentrated in Africa and the Middle East by 2030, the authors urgently call for policymakers to commit to retaining and expanding national health workforces.  They propose common-sense solutions: increased, coordinated financing and collaboration across government agencies managing health, finance, economic development, education and labor portfolios. But how can such interconnected, long-term investments be designed for maximum sustainable impact? And what is the role of education? Rethinking health worker learning In a 2021 WHO survey across 159 countries, most health workers reported lacking adequate training to respond effectively to pandemic demands. This exposed systemic weaknesses in how health workforces develop skills at scale. Long before the COVID-19 pandemic, limitations of traditional learning approaches were …

Analog gates or digital bridges.png

Digital bridges cannot cross analog gates

Global health, Thinking aloud

I’ve been doing a lot of thinking recently about an interesting question, as I’ve observed myself and colleagues starting to travel again: “Why are we again funding high-cost, low-volume face-to-face conferences that yield, at best, uncertain outcomes?” I am surprised to have to ask this question. I was hoping for a different outcome, in which the experience of the COVID-19 pandemic led to a lasting change in how we bridge physical and digital spaces for a better future. We were brutally forced to work differently due to the COVID-19 pandemic’s restrictions on freedom of movement. Nevertheless, we discovered that it is possible to connect, meet, collaborate, and learn without sinking budgets into air travel and accommodation. At least some of work-related travel was due to habit and convention, not necessity. Yes, there were limitations, especially due to the emergency nature of the pivot to online. But the debate is open …

Credible knowers

Credible knowers

Global health, The Geneva Learning Foundation, Thinking aloud

“Some individuals are acknowledged as credible knowers within global health, while the knowledge held by others may be given less credibility.” – (Himani Bhakuni and Seye Abimbola in The Lancet, 2021) “Immunization Agenda 2030” or “IA2030” is a strategy that was unanimously adopted at the World Health Assembly in 2020. The global community that funds and supports vaccination globally is now exploring what it needs to do differently to transform the Agenda’s goal of saving 50 million lives by the end of the decade into reality. Last year, over 10,000 national and sub-national health staff from 99 countries pledged to achieve this goal when they joined the Geneva Learning Foundation’s first IA2030 learning and action research programme. Discover what we learned in Year 1… Learn more about the Foundation’s platform and network… What is the Movement for Immunization Agenda 2030 (IA2030)? In global health, personal experience is assumed to be anecdotal, the …

Partially-melted chocolate

Hot fudge sundae

Writing

Through their research on informal and incidental learning in the workplace, Karen Watkins and Victoria Marsick have produced one of the strongest evidence-based framework on how to strengthen learning culture to drive performance. Here, Karen Watkins shares an anecdote from a study of learning culture in which two teams from the same company both engaged in efforts to reward creative and innovative ideas and projects. However, one team generated far more ideas than the other. You won’t believe what turned out to be the cause of the drastically disparate outcomes.   I recorded Karen via Skype while she was helping me to perform my first learning practice audit, a mixed methods diagnostic that can provide an organization with new, practical ways to recognize, foster, and augment the learning that matters the most. Recognizing that the majority of learning, problem-solving, idea generation, and innovation do not happen in the training room …

Submarine control panel. Bowfin Submarine Museum, Pearl Harbor. Personal collection.

How do we measure the impact of informal and incidental learning on organizational performance?

Learning strategy

Evidence from learning science clearly identifies how to strengthen learning culture in ways that will drive performance. However, in a recent study conducted by Learning Strategies International (LSi), we quickly found limitations and gaps in the data available from the organization examined, despite the best effort by the organization’s staff to answer our questions and requests. We found two gaps that needed to be addressed before the most effective approaches to develop capabilities could  be applied usefully – and their impact measured: The gap between a commitment in principle to learning and skepticism about its actual value. (This gap surprised us.) Gaps in data and reporting needed to measure internal learning (and how to improve it). We believe that the first gap (skepticism about the value of learning) is the direct result of the second (lack of measurement). Without a measure of its impact on performance, internal (staff) learning is likely …

Painting at Trigonos (25 January 2017). Personal collection.

The future of learning that could have been

Learning strategy

In June 2017, the Institute’s president, together with its Chief Learning Officer (CLO), convened an all-hands-on-deck meeting to announce the Institute’s commitment to strengthening its learning culture of innovation and change through an innovative, evidence-based internal learning strategy. Staff were invited to nominate and then elect representatives to the Learning & Development Committee (LDC), mandated with the challenge of ingraining learning “karma in the walls and halls” as key to delivering on its promise to prepare a new generation for the coming humanitarian challenges. In July, the Institute performed its first benchmark of learning culture and performance. This demonstrated that staff learning is key to mission, financial, and knowledge performance (ie, to delivering results). This benchmark was followed by a learning practice audit in August that woke both managers and staff to their existing strengths and the amazing ways in which they were already continually learning at the point of …