A critical task in collaborative improvement is integrating what has been learned across all improvement teams about how to meet the aim of the improvement effort. Such synthesis of learning involves collecting information about the changes each team tested, making judgments about which changes appear to be most closely associated with improvement (taking into account the experience of all teams), and developing guidance that can help others apply that knowledge to improve care elsewhere.
To summarize what has been learned and package it in ways that facilitate scale-up to new places, leaders and organizers of an improvement initiative involving multiple teams need to:
- Maintain an inventory of changes tested by each team or site
- Regularly consolidate and share learning about tested changes across the improvement initiative
- Analyze the consolidated changes in light of results (data) to understand what’s working, what’s not working, and the key implementation challenges faced by sites, to determine which changes seem to lead to better results
- Package and share learning about effective changes with others
Aggregation and analysis of the tested changes is best done on an ongoing basis as learning emerges. This can be accomplished through regular analysis of learning following coaching visits and during times when representatives from many teams come together, such as at learning sessions. These channels also provide a conduit for disseminating “consolidated learning” so that all teams are learning from the collective experience of the improvement activity.
When an intervention has demonstrated good results and is ready for scale-up, a dedicated workshop with representatives from the participating sites, coaches, and government officials can be helpful to review the results and consolidated learning to determine the most effective changes to be promoted during scale-up. Such workshops are often called “harvest meetings” because their purpose is to “harvest” the key learning from an improvement activity.
Techniques for Integrating and Synthesizing Knowledge
The field of knowledge management provides many techniques for integrating and synthesizing information which have proven invaluable for use in improvement initiatives. General principles that facilitate synthesis include:
- Use small groups to generate new knowledge and insights. We learn and create new ideas through our conversation with others in small groups. A small group is 3-5 members. This is the size that produces the richest and most in-depth thinking. It is large enough to contain diverse views yet small enough for members to engage each other. Engaging each other means asking questions to clarify the meaning another has expressed and challenging as well as building on others’ ideas. It is in this give and take of small group conversation that new knowledge is generated.
- Use large groups to integrate knowledge. After small groups have been in conversation, their ideas need to be brought together in a large group setting to integrate their insights into the thinking of the whole. In a lengthy meeting, small and large group discussions can be alternated to stimulate knowledge creation and synthesis.
- Use time for reflection. Before beginning a discussion or conversation, ask each participant to think silently for a minute about the question or topic under discussion. Giving just a small time for individual reflection increases the quality of each person’s contribution. Routinely making time for group reflection—bringing together the collective thinking of a group to make a judgment about key lessons—facilitates ongoing synthesis of learning.
- Integration of knowledge benefits from diversity. Having different perspectives in meetings designed to develop collective knowledge provides a more robust environment for the generation of new knowledge. The greater the diversity of prior knowledge in the room, the more likely that new knowledge and insights will be generated.
Many techniques have proven useful for stimulating the synthesis of knowledge among improvement teams. These include: