=Paper=
{{Paper
|id=Vol-3239/paper14
|storemode=property
|title=Leading and organizing workplace learning in healthcare digital transformation: The proposal of a conceptual model
|pdfUrl=https://ceur-ws.org/Vol-3239/paper14.pdf
|volume=Vol-3239
|authors=Ann Svensson,Helena Vallo Hult
|dblpUrl=https://dblp.org/rec/conf/stpis/SvenssonH22
}}
==Leading and organizing workplace learning in healthcare digital transformation: The proposal of a conceptual model==
https://ceur-ws.org/Vol-3239/paper14.pdf
Leading and organizing workplace learning in healthcare digital
transformation: The proposal of a conceptual model
Ann Svensson 1 and Helena Vallo Hult 1, 2
1
School of Business, Economics and IT, University West, Trollhättan, Sweden
3 Region Västra Götaland, NU Hospital Group, Trollhättan, Sweden
Abstract
Developing the digital health environment for the future is an important and prioritized initiative to meet
increasing demands and requirements for high-quality healthcare. The digital transformation of healthcare
not only entails changes in the IT environment but also affects the healthcare professionals’ daily clinical
work, as it includes changes that require learning and the development of new working methods. The
challenges are thus both complex and sociotechnical, which calls for holistic approaches and a better
understanding of existing practices and new competencies required in response to current changes associated
with digitalization. In this context, workplace learning plays a vital role. This paper draws from initial
experiences of a digitalization initiative at two hospitals in Sweden, which partly focuses on the management
and organization of digital transformation. By studying the development, implementation, and use of digital
technologies from a learning perspective, the main focus is to contribute to better knowledge about how to
lead and organize workplace learning for healthcare professionals, which also benefits the patients. The aim
is to identify key activities associated with learning in healthcare digital transformation. Hence, we propose
a conceptual model that illustrates and exemplifies activities and roles related to learning through digital
change. In conclusion, we argue that a better understanding is needed of i) how management and
organization can facilitate change in working methods and related processes, and ii) how learning in
everyday work can be integrated with digital transformation in order to achieve the full potential of
digitalization.
Keywords
Digital transformation, healthcare, workplace learning, leading, organizing, sociotechnical perspective
1. Introduction
Developing the digital health environment for the future is an important and prioritized initiative to
meet increasing demands and requirements for high-quality healthcare. Introducing new digital
solutions is expected to contribute to utilizing the possibilities of digitalization and e-health. It is part
of the national strategy for developing healthcare in Sweden toward the government’s vision for e-
health in 2025 [1]. Designing, using, and managing healthcare technologies involves complex
sociotechnical challenges. Health IT research, however, has historically placed more focus on design
and implementation, rather than on how clinical end users react to already implemented IT [2]. The
understanding of existing practices is therefore limited, and there is a mismatch between predicted and
actual benefits of health information systems [3]. It is argued that established models of technology
adoption may be insufficient to explaining the adoption process of new and future technologies, as the
focus is placed on technology and individual users, whereas equally important aspects, such as
contextual factors and social consequences of introducing new technologies, are backgrounded or
ignored [4, 5].
The digital transformation of healthcare not only entails changes in the IT environment but also
affects the healthcare professionals’ daily clinical work, as it involves changes that require learning and
development of new working methods. A sociotechnical perspective considers multiple dimensions of
IT and learning, and is therefore considered especially important for the study of technology use in
complex, diverse, and dynamic work settings [4, 6]. In order to gain the best possible benefits of the
new healthcare information environment, activities need to be managed and organized to be able to
shape standard processes and working methods. Previous research has identified and outlined
challenges and knowledge critical to the digitalization of healthcare [6-8]. How the digital
transformation is lead and organized has proven to significantly influence to what extent the
digitalization leads to improvements and efficient provision of healthcare [9]. The sociotechnical,
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holistic approach to learning is also essential to better understand and support strategies undertaken by
healthcare professionals as they navigate and interact with both people and technologies in emerging
digital learning environments [10, 11]. In this context, workplace learning—defined as the integration
of theoretical and practical knowledge and experiences across educational as well as work-life and civil
society contexts [12]—plays a vital role.
Adopting a sociotechnical perspective on IT and learning, this conceptual paper draws from initial
experiences of the Health Information Environment of the Future (HIEF) initiative; a digitalization
initiative at two hospitals in Sweden that partly focuses on the management and organization of the
digital transformation. For the purpose of this paper, we have chosen to focus on real-time
documentation as a use case to illustrate and exemplify activities and roles related to learning through
digital change. Real-time documentation is a new feature that is being introduced as part of the larger
project. The availability of relevant documentation requires that the healthcare professionals know the
systems. Consequently, the technologies used need to support work processes in a standardized way. In
line with previous research on digitalization and workplace learning, we are interested in identifying
opportunities and barriers that arise within management and organization in relation to the digitalization
of working methods [9, 13]. A specific focus is placed on changes to professionals’ roles and
responsibilities, and the new demands these changes pose for competence and learning [14, 15]. The
project as a whole follows agile methodology, which means that the project is divided into phases, and
that new digital technologies and systems are introduced iteratively, and in phases, in the digital health
information environment of the future. This approach makes it possible to take advantage of experiences
from the transition at one hospital to shape new processes and working methods and support learning
across organizational boundaries over time. Against this background, the main focus of this paper is on
leading and organizing that stimulates workplace learning in everyday work for healthcare professionals
and contributes to increased patient benefit. The aim is to identify key activities associated with learning
through digital change, and the research question is: How can learning activities in digital change
processes be conceptualized and understood?
2. Theoretical background
Working life has become increasingly complex and ever-changing, placing higher demands on
continuous learning and continuing education. In healthcare, like other knowledge-intensive sectors,
employee competence and development are among the most important cornerstones. Having previously
primarily focused on the individual, and on formal education and training outside of the workplace,
competence development and learning today is just as much about raising or broadening the competence
of working groups at individual, group, and organizational levels [16]. Research and theories on
learning at work have developed correspondingly over the years to include formal and informal learning
in both working life and higher education.
Thus, the healthcare sector is an area where digital transformation requires that professionals acquire
and develop new competences [17]. Digitalization and e-health involve using digital healthcare tools
and require that the users are able to share information and communicate digitally, with the aim to
promote and maintain health in the population. Digital transformation places high demands on
healthcare professionals to learn and adjust the working methods. Previous research on professionals’
perceptions about digital technology has mostly focused on benefits for the organization rather than
improvements in professional practice and learning in practice [18]. At the same time, contextual
factors—such as peer support, leadership, time and resources for training, along with technological and
organizational aspects—have been identified as significant to how healthcare professionals understand
and use digital technologies [6, 19]. Prior research has highlighted the importance of sociotechnical
approaches in understanding the interdependencies among technologies, people, and work practices
[20], especially in healthcare, given the complex and dynamic nature of healthcare information systems
[21]. Sociotechnical thinking includes stakeholder participation, co-creation, and co-development, and
is important in meeting current challenges in the context of work [22, 23]. The perspective plays a
special role in healthcare, since active involvement of healthcare professionals as well as patients are
highlighted as key elements in the co-design process [24, 25].
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Workplace learning is considered essential to meet the growing demands for new competencies
required in response to rapid work-life changes [26]. Researchers have variously theorized workplace
learning with focus on interactive elements (learning from others, e.g., collaboration) and task-based
learning (learning through experiences and reflections) across different occupations and contexts [27].
As highlighted in recent research, theories and frameworks based on traditional learning models are
less suitable for reflecting on professional practices and learning associated with digitalization of the
work, which instead requires new forms of learning [13, 28].
This study takes its point of departure from the practice-based workplace learning literature, which
finds no separation between work and learning. In other words, people learn as they engage and interact
with each other, and with digital technologies, in the workplace [29]. This perspective considers
workplaces as essential learning environments for professional practices that generate potentially
important learning in its own right [30, 31]. Consequently, it is central to understand workplaces as
learning environments and how workplaces afford learning opportunities, as this impacts how
individuals elect to engage in learning activities [32]. The workplace needs to afford opportunities for
individuals to participate in everyday learning activities at work, as work and learning is integrated [33].
To engage in daily work activities hence means to be engaged in ongoing learning at the workplace.
Therefore, the managers’ readiness to lead and organize workplace learning activities is vital. Guidance
and leadership from the managers is a basis for how individuals and groups enact workplace learning,
together with the work-related knowledge of the professionals [8], their values, and how they elect to
engage in workplace activities [32]. Transformation involving the implementation of digital systems
requires a mutual adaption between the digital systems, the particular workplace, and its practices [30].
Innovation at work is premised on, and contributes to, the professionals’ learning. As such, ”there is a
co-occurrence and interdependence between innovation and learning at and through work” [34, p.
222].
The workplace learning perspective aligns with the sociotechnical approach, as it addresses the
dynamics of people’s interactions with each other and technology in a situated context, where learning
is intertwined when working methods are changing at the same time as they are digitalized. This
perspective contrasts with more reductionist perspectives that view learning as the transfer of
knowledge or technology as the cause of change. In all, adopting a sociotechnical and workplace
learning standpoint provides a holistic perspective on the analysis of digital healthcare, as well as on
the demands for new competencies and changing conditions for learning that emerge in this new
context.
3. Research context
The empirical setting is the digital changes and challenges related to working and learning in the
context of the Swedish healthcare sector. The project is based on an engaged research approach that
aims for collaboration between research and practice for the benefit of all involved stakeholders [35].
For the participating hospitals, the engagement in the project means that the research will be
implemented to develop and improve healthcare, at the same time as participation in activities such as
workshops is expected to contribute to development and learning for participating stakeholders at both
individual and organizational level. The goal is also to generate knowledge exchange and new
perspectives across organizational boundaries through collaboration in data collection activities for
research and business development.
The project is connected to the HIEF project; an ongoing digitalization initiative and transformation
approach to healthcare in the second largest of the 21 regions in Sweden. This region, Region Västra
Götaland, has about 1.75 million inhabitants. The HIEF project envisions the implementation of a
modern healthcare information environment that provides the inhabitants with accessible and inclusive
healthcare of high quality.. Such an implementation includes managing and organizing the digital
transformation at hospitals, primary care centers, and municipalities in the region. As all professions at
the hospitals are affected, it is vital to understand how digitalization affects and changes the work. The
HIEF project has a clear structure and intends to standardize working methods within healthcare.
One particular area within the larger HIEF project is real-time documentation, i.e., documentation
made in a patient record during or in close connection with a consultation or other interaction with
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healthcare. The self-monitoring that patients do is also included in the real-time documentation. Real-
time documentation is already used in healthcare today and will be scaled up along with the increasing
digitalization of healthcare at large. Real-time documentation affects the healthcare professionals’
established ways of working before, during and after all clinical encounters with patients. From a patient
perspective, real-time documentation can be beneficial as it provides new possibilities, but risks and
challenges are also involved.
Dialogue meetings, conducted at one of the hospitals as part of the HIEF project, revealed common
benefits and challenges associated with real-time documentation from a patient perspective. Important
advantages highlighted by patients are 1) more comprehensible patient record entries, 2) less need for
repeating information as medical records from previous meetings can be revisited, and 3) access to
patient record information during the consultation, which provides opportunities for reflecting, giving
feedback and asking questions in connection with the patient meeting. Perceived challenges and risks
include, for instance, that 1) the patients cannot decide whether they want to have access to all
documentation and, if so, how, and 2) the meeting is characterized by the staff following a pre-
structured template in the medical record at the expense of more free-flowing social talk, increasing the
risk that certain parts that the patients consider important are missed. The patients also expressed the
opinion that consolidated medical records should not be mandatory, as it is not always desirable to make
all information available to everyone.
4. Leading and organizing digital transformation
Digitalization requires that the healthcare professionals work task-based, i.e., by placing digital
orders that describe what needs to be done, and by whom. The professionals hence both need to learn
and unlearn, as the work is redesigned. In this way, the care process is carried forward. Thus, each
professional is both a producer and a consumer of documentation. Leading and organizing the digital
transformation presupposes workplace learning in hospital organizations, where people with different
professions collaborate to exchange knowledge and experiences. How the management and
organization can anchor this perspective is an important goal in the introduction and implementation,
which calls for the sociotechnical perspective.
This research is based on an identified need to develop theories and models for workplace learning
that focus on the management and organization of changing working methods and processes and
support new evolving work processes and learning in the everyday clinical practice. We argue that it is
necessary to investigate how to provide the best conditions to bring about learning in this
transformation. Therefore, it is important to include learning aspects already in the change process in
the preparation and implementation phase, and build resilient structures and processes between and
within professions that last beyond the introduction. Knowledge exchange between professions is a
prerequisite, and workplace learning models will be developed and tested.
In the exploratory phase of this project, it is important to identify the different roles and tasks in each
of the planned activities. As seen in Figure 1 below, the roles are important in each of the six phases.
All professions in the healthcare organization are affected by the implementation of the new health
information environment with its the various platforms, systems, and applications. Therefore, it is
important to study how digitalization affects and changes work practices for all roles. We also need to
investigate how to create the best conditions for learning in this transformation for all the different roles.
Consequently, it is essential to achieve this in the change process already in the preparation and
implementation phase of the HIEF project and build structures and processes both between and within
professions that last after the implementation from program to operation, in the short and long term.
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Figure 1: Conceptual model/study protocol
The first activity (1) is identifying the effect goals and disseminating this knowledge in the organization.
Here, structured meetings with focus group interviews will be conducted, where the professionals will
have the opportunity to establish a common ground and get an overview of the basic principles
underpinning the HIEF implementation. The second activity (2) is to identify the needs for collaborative
learning, such as where the learning takes place, who is learning in different situations, and how the
learning could take place. This activity will be supported by identifying rich learning activities and
situations for learning. Dialogue meetings and focus group interviews will be conducted, where
healthcare professionals and researchers will reflect and collaborate democratically as peers to develop
shared conceptions on rich learning activities [36]. The third activity (3) is to identify possibilities and
risks. Here, methods for learning will be discussed in focus group interviews, in relation to learning
situations and learning within and between different roles and professionals. The fourth activity (4) is
choice and design of learning activities and methods. In this activity, learning scenarios will be created
and reflectively discussed in focus groups that include healthcare professionals and researchers. Here,
the basic principles for a collaborative learning framework will be outlined. The fifth activity (5)
consists of tests of collaborative learning activities and methods. This activity will focus on scenarios
in everyday work. Dialogue meetings and reflective discussions in focus groups will take place to
further refine the learning activities and methods. The sixth and final activity (6) is to create the
workplace learning framework and learning model associated with the implementation of the HIEF
project. The framework will constitute a basis for providing the best conditions to bring about learning
in this healthcare transformation.
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5. Project contributions and next step
Digital transformation of healthcare is a broad issue related to the societal challenges of sustainable
community building and precision health. The project aims to identify different types of learning
associated with fundamental change, creation of new knowledge structures, incremental changes in the
existing knowledge structures, as well as validation and reinforcement of existing knowledge structures
[33]. The developed workplace learning framework and learning model will be used in the healthcare
practice to implement new working methods in parallel with the implementation of the HIEF. The focus
will initially be on the use case described here, i.e., real-time documentation, and subsequently on other
digital transformation processes in healthcare. The learning types need to be considered in order to
identify in which activities different learning types are of vital importance. This is also important to
recognize in order to create a sustainable and continuous learning environment in healthcare that
contributes to increased patient benefit.
First, the project contributes to an equal society by managing and organizing new community
initiatives. Healthcare services must be available to all people regardless of age, gender, place of
residence or origin, or ethnicity. This research contributes to a better understanding of how healthcare
can develop improved services and support people in need of hospital care. The future health
information environment can facilitate communication and contact between patients and hospitals (and
other healthcare providers) and includes innovations based on society’s needs.
Second, the project contributes to the societal challenge of sustainable precision health. Society’s
health challenges are complex and driven by demographic changes, economic realities, increased
individual focus, and technological development. At the same time, all people need to be treated as
equals and given equal opportunities without discrimination. New technical opportunities and
digitalization create opportunities for staff to support their work-related health and well-being in a
sustainable way. Therefore, the sociotechnical perspective is important. Digitalization also increases
and streamlines access to healthcare for the general population, as well as for patients in care. This
project hence contributes to creating conditions for healthcare professionals to be more involved in their
work situation and, with the support of digital technologies, develop their working methods and skills.
6. Conclusion
In this paper, we have addressed a need to develop theories about workplace learning for
management and organization to support new and changing work processes and learning in healthcare
professionals’ everyday work. By studying the development, implementation, and use of digital
technologies from a learning perspective, we need to focus on the management and organization of
changing working methods and processes. The paper contributes to better knowledge about how to lead
and organize workplace learning for healthcare professionals in order to create better conditions for
achieving the impact goals of the digital transformation. By researching the digital transformation
process while considering the interplay between technical and social aspects in the work context, we
want to gain knowledge and increased understanding of management and organization, to be able to
integrate changing work processes and learning in the everyday work. This means that we need to gain
more knowledge about i) how management and organization can facilitate change in working methods
and related processes, and ii) how learning in everyday work can be integrated with digital
transformation in order to achieve the full potential of digitalization.
7. Acknowledgements
The authors disclosed receipt of the following financial support for the research, authorship, and
publication of this article: the Interreg Sweden-Norway, European Regional Development Fund
(ERDF) (Grant number: 20202391, 2019) and by the Health Academy West.
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