Changing and Sustaining Practices in the Healthcare and Construction Sectors? - Reflections on the Achievements of the Learning Layers Pilots
This document complements the more particular viewpoints of the other reporting documents of the Learning Layers. It explores the project work with a comparative view on developments in the sectoral pilots:
We present firstly the sectoral starting points for pilot activities in construction and healthcare sectors in the light of initial interviews and stakeholder talks from the beginning phase.
We give insights into the processes in both sectors with the help of comparative table.
We present specific findings on the sustainability of co-design work, on the role of tools that were developed and on the responsiveness of users.
In the final reflections we try to draw conclusions from the relative strengths and weaknesses experienced in the project work.
Challenges for research & development activities and for valuing the achievements
The Learning Layers project has worked in two pilot sectors - construction sector and healthcare sector. The aim has been to develop and introduce appropriate tools and technology solutions that support the application partners in workplace-based learning, knowledge sharing and networking - given the sectoral boundary conditions. However, during the project work the pilot teams have encountered also several hindrances as well as organisational and cultural barriers.
In the reporting of the project this has been taken into account by providing a picture on the progress in both pilot sectors. This may easily lead to particularisation of the view - the achievements of the project are to be judged on the basis of success in particular pilot organisations with the respective tools and measures introduced there. This would leave to margins the fact that the project worked towards integrative tool development and that the sectoral pilot teams tried to learn from each others’ experiences. Therefore, this document provides comparative insights into project work in the two pilot sectors and reflects on lessons learned when comparing the experiences and achievements.
Starting points for the sectoral pilots
Starting points for Construction pilot
In the beginning phase of the project following kinds challenges, problems and interests were identified in the initial interviews and stakeholder talks in the construction sector:
Recent innovation campaigns of construction industry and trades (see e.g. the joint document of construction sector stakeholders “Leitbild Bau” 2009) highlighted improvement of human productivity as a major innovation factor. At the same time construction sector was suffering from lack of skilled workers and apprentices.
Construction companies that had pioneered with digital tools, mobile offices and first-generation apps at construction sites had made negative experiences with non-mature technologies, less user-friendly software solutions and compatibility problems between different tools and apps. Construction sector trainers had mostly encountered such ‘domain-specific’ apps that were designed for laymen users but were not adequate for professional use (or as support for learning).
Apprentices were not familiar with domain-specific apps and had mainly become familiar with digital tools, web resources via private use of Internet.
Most construction companies were very restrictive regarding the use of mobile devices at construction sites - partly due to data privacy issues, partly due to hazard risks and partly because use of such devices was perceived as distraction.
Given this background, the training centre Bau-ABC was interested in starting pilot activities that would give mobile technologies a new role in construction work, training and learning. (See Impact Card C-11 and the User Survey in Bau-ABC)
Starting points for Healthcare pilot
In the healthcare sector the Learning Layers project was working with General Practices within the UK National Health Service. These General Practices are independent, SME organisations (usually owned by a partnership of doctors) employing doctors, nurses and other healthcare professionals to deliver first-line healthcare services to their registered patients. In the early stages of the project the following issues were identified from the empirical work (interviews, focus groups, observations) and stakeholder meetings with these healthcare professionals:
There was an increased emphasis on collaboration both within General Practices (working in interprofessional teams) and between General Practices (working in the newly set-up Clinical Commissioning Groups and Federations).
This collaboration was currently being facilitated mainly through email and face-to-face meetings but healthcare professionals felt that this was not effective, was contributing to their information overload and was inhibiting the work.
The General Practice work was mainly office-based, using PCs, and the General Practices did not have wifi installed nor any plans to add this.
The key driver for the General Practices was healthcare service delivery and improvement, particularly through collaboration.
Insights into the sectoral pilot activities
In both sectors the general approach was to adopt co-design and capacity for implementing and rolling out the technology in the application partner organisations. In addition to work in the primary pilot contexts, the pilot teams engaged additional, ‘secondary’, contexts.. Three of the key contexts explored by the Learning Layers project are summarised in the table below.
|Construction main context (A)||Healthcare main context (B)||Healthcare secondary contexts (C)|
|Lead application partner organisation(s)||Bau-ABC, training centre funded by construction sector||3 ‘champion’ General Practices||Association for Medical Education in Europe; Primary Care Training Company|
|Application partner’s organisational focus||Vocational training, in construction sector||Healthcare delivery||Training/education in healthcare sector|
|Partner organisations’ status in the project||Full partner (with contract and budget)||Affiliated partner||Stakeholders engaged during the project|
|Tools developed or piloted||Learning Toolbox (in practice),||Bits & Pieces, Confer, Living Documents||Learning Toolbox|
|Tools users||Full-time trainers and apprentices||Healthcare professionals (not in training activities)||Healthcare professionals (in training activities)|
|Modes in which tools could be used||Individual or collaborative||collaborative||Individual or collaborative|
|Tools use||To support a formal learning process - adding informal learning support||To support a work process - adding informal learning support||To support regular conferences - adding informal learning support|
|Management and steering of co-design and tool deployment||Participative R&D dialogue, user-led tool deployment||Researcher-led co-design activities (incl. different parties)||N/A|
|Capacity building activities||First training scheme - voluntary participants: second as a campaign for whole organisation||With a subset of the healthcare professionals and embedded within the co-design activities||1-to-1 meetings with decision makers to demo and discuss tools - stakeholder engagement focus|
|Pilot context||Piloted in the lead application partner organisation||Piloted in networks of professionals involved in the co-design work||Used by both organisations at their annual conferences|
Findings of the research & development teams
In construction the process started as digitisation of existing training and learning resources and through a process of research and development dialogue. In this context the co-design shifted from digitisation of learning content to shaping a flexible digital toolset - the Learning Toolbox. The Bau-ABC trainers adopted the Learning Toolbox as part of their normal practice and starting to develop digital learning resources themselves. This activity enhanced their efforts to change the role of the trainers from a more didactic role to a facilitative one (see Action-Oriented Learning in Apprentice Training).
In the outreach activities to present the Learning Toolbox to other users in construction sector the ‘champion case’ has been the example in which a architect Thomas Isselhard (from the network for ecological construction work) demonstrates how to use the toolset in managing a construction site and the cooperation between different craftsmen. In the light of this example the construction companies have developed their own ideas, how to use the Learning Toolbox for their purposes.
In healthcare the initial empirical and co-design work had identified three potential opportunities for technology to support informal learning at the healthcare workplace. Co-design teams w followed a Design Based Research approach to the subsequent development and field-testing of the tools - Bits & Pieces, Confer and Living Documents. By the end of the third year the tools had been used by small groups within each General Practices within a short field-study to support their collaborative work. There was some evidence that the groups involved in the pilots started to work in a more collaborative way (Healthcare Teamwork in and between General Practices). Yet, there is little sign that the pilot tools themselves will continue to be used beyond the project. However, Learning Layers had involved a key commercial partner (PinBellCom) in the co-design work to help with longer-term sustainability. PinBellCom’s Intradoc247 software is a leading intranet solution designed specifically for General Practices. Therefore the changes in practice observed within the pilot activities may be continued through the use of collaborative working functionality now embedded within Intradoc247 and supported by PinBellCom (Layers Tools Enhancing Commercial Software).
The wider stakeholder engagement work in healthcare has involved work with a regional training company (Primary Care Training Company - PCTC) and an international medical education organisation (Association of Medical Education in Europe - AMEE). In year 4 with the maturing of Learning Toolbox, PCTC identified the possibility for it to support their annual conference for Healthcare Assistants and they are now also exploring whether it can support their training courses. Learning Toolbox was successfully used as part of the technology-enhanced informal learning package at AMEE’s 2016 conference and they are exploring with us how this use can be extended in 2017 to include using Learning Toolbox as an ePoster solution (A Technology-Enhanced Informal Learning Package for Conferences).
Reflections on co-design and changing practices in the pilot sectors
In the light of the above presented process characteristics and findings it is appropriate to reflect the lessons from the two pilot sectors with their respectively different processes of project work. Below we summarise the lessons of the two sectoral pilots concerning
factors that facilitated successful project work and take-up of innovation,
factors that caused hindrances and required efforts to overcome them,
factors that enabled transfer from initial pilot contexts and supported wider engagement of users.
A. Lessons from the construction pilot
In the primary pilot context - training centre Bau-ABC - it was possible create a multi-channelled research & development dialogue, in which different activities supported each other. Work process analyses, analyses of critical bottlenecks in training, pedagogic reflections on the use of tools - all this contributed to the shaping of the Learning Toolbox. Furthermore, in the trades that have been involved in the pilots, the apprentices have taken the Learning Toolbox as an adequate support for their own learning processes. (For further evidence, see Use of Learning Toolbox by Bau-ABC Trainers and Apprentices, Multimedia Training for and with Bau-ABC Trainers, Action-Oriented Learning in Apprentice Training, Accompanying Research and Participative Design, Training Interventions as Capacity-Building for Digital Transformation.)
During the pilot activities the following hindrances and restrictive factors were experienced and partly overcome: a) The initial design idea (comprehensive digitisation of training materials) was too specific to the primary pilot organisation and too complex in technical terms. This was overcome with the concept of Learning Toolbox and with its open and flexible framework. b) At a later phase the gaps of multimedia competences in the pilot organisation were seen as a risk for successful tool deployment across the organisation. This was partly resolved by introducing the Theme Room training scheme as a ‘whole organisation’ engagement. (For further information, see Use of Learning Toolbox by Bau-ABC Trainers and Apprentices, Multimedia Training for and with Bau-ABC Trainers, Action-Oriented Learning in Apprentice Training, Accompanying Research and Participative Design, Training Interventions as Capacity-Building for Digital Transformation.)
The transfer of innovation from the initial pilot context (training centre) to further pilot contexts - to construction companies and to other organisations in construction sector has been enhanced by the following factors: a) A specific impact case was presented by a construction site manager who demonstrated the usability of Learning Toolbox as means to share information in real time (and for reporting from the construction site). b) In promotion events both the training-related examples and the case of construction site management have enabled the company representatives to express their own interests on using Learning Toolbox. (For further information, see Organisational Learning and Cooperation at a Construction Site, LTB-Chronicle, Vol. 3, LTB-videos from Verden 1-2)
B. Lessons from the healthcare pilot
Factors that appear to have supported adoption of the tools and transformation of practice include working with organisations whose key remit/focus is training/education. This occurred with our work with both PCTC and AMEE (A Technology-Enhanced Informal Learning Package for Conferences). Both organisations had the interest and knowledge to see how they could use the tools within their practice and to use their own resources to support this. Another approach that has led to change in healthcare has been the involvement of a commercial/development company (PinBellCom) who already have a related product (Intradoc247) in the market (Layers Tools Enhancing Commercial Software).
Factors that appear to have hindered adoption of the tools and transformation of practice include the workload pressures within the healthcare SMEs. Learning Layers was working within the UK healthcare sector at a time of constant change and national reorganisation. Staff feeling under pressure have little time to devote to R&D projects which do not have a clear service delivery output. The co-design activity did lead to some healthcare professionals feeling ownership of the tools. However, this engagement and adoption did not appear to transfer fully when the tools were taken beyond the co-design teams and into their networks for the pilots.
Factors that have facilitated transfer beyond the initial contexts in healthcare include the use of the tools by healthcare professionals in real work settings and their own presentation and championing of the tools to others. Based on their understanding of the tools (developed through their engagement in the co-design work), healthcare professionals were able to present the tools to their healthcare networks and engage those networks in the pilots. However, this approach only succeeded in getting the wider networks involved in the pilots, it did not yet lead to the wider networks adopting the tools or making long-term changes in practice.
Concluding reflections - across the sectoral pilots
Altogether, it is difficult to formulate conclusions that could link together either success factors of the two different sectoral pilots. The circumstances were very different and the processes as well. However, some of the challenging experiences can be formulated as ‘paradoxes of co-design work’:
Co-design processes that start with a focus on very specific needs of particular user groups are not always able to pursue their work consequently to an end. Iterations and eventual revisions are natural elements of such processes. Radical shifts of emphasis during the process may lead to more flexible or better solutions but equally they can also cause a loss of momentum.
Processes that have created a ‘milieu’ of participative events and exchanges between the developers and users may be influential as facilitators of multimedia learning and upgrading of user-skills. Yet, positive experiences in the preparatory work do not necessarily guarantee successful deployment of tools in actual practice. Here it is necessary to look at the context in which the introduction of the tools takes place. There are limits to what a project can achieve when working in a complex and changing environment.
Concerning the changing of practices, takeup of the tools and transferring ownership of innovation, the experiences of both sectoral pilots emphasise the importance of critical transitions, such as:
Radical changes in the initial design idea should be supported in responsive co-design work. Yet such changes need to be made with care, since they can introduce problems (loss of motivation, dropping good ideas too early, losing the link to the original well-understood context) as well as leading to improvements.
Moving from the work with the initial group (involved in the co-design) to work with a similar group that had not been engaged in the co-design work. In such situations the new users may be less motivated to work with tools that are under preparation; they have not developed the same personal investment and feelings of ownership as the co-design group
Transferring the innovation from the initial pilot context to new ones with different user groups. If the tools can be easily customised for new contexts, engagement of users may be easier with new groups of users who first encounter the tools when mature.
In this respect, sustainable deployment of tools like the ones of the Learning Layers project require the readiness of both individuals, organisations and networks to complete the transition to use them. The introduction of the tools that were piloted has not been merely a replacement of older tools with newer ones. The pilots with collaborative tools have required changes in routines, knowledge processes and patterns of sharing information. If only some of the users are ready to complete the transition to new tools, then there is a risk that the tools are not used at all. If the tools can be used individually, for limited user groups and for collaborative processes (as the Learning Toolbox), then the transition can proceed from smaller pilot groups to wider use more easily.
Links to other sections
Organisational Learning and Cooperation at a Construction Site
Action-Oriented Learning in Apprentice Training
Progressive Inquiry and Knowledge Building
Sensemaking and Meaning Making in Informal Workplace Learning
Participatory Patterns Workshop
Accompanying Research and Participative Design
Training Interventions as Capacity-Building for Digital Transformation
Pilot Testing the AchSo Tool with Bau-ABC Apprentices
Supporting Distributed Teams in Healthcare
Healthcare Teamwork in and between General Practices
A Technology-Enhanced Informal Learning Package for Conferences
Use of Learning Toolbox by Bau-ABC Trainers and Apprentices,
Multimedia Training for and with Bau-ABC Trainers
Pekka Kämäräinen, Tamsin Treasure-Jones. Graham Attwell, Rose Dewey
- R. Dewey, M. Geiger, M. Kerr, R. Maier, M. Manhart, P. Santos Rodriguez, C. Sarigianni, and T. Treasure-Jones, “Report of Summative Evaluation in the Healthcare Pilots,” pp. under review, 2016 [Online]. Available at: Link
- V. Banken, M. Geiger, R. Maier, M. Manhart, C. Sarigianni, S. Thalmann, and J. Thiele, “Report of Summative Evaluation in the Construction Pilots,” pp. under review, 2016 [Online]. Available at: Link
- A. G. et al., 2015 [Online]. Available at: https://www.researchgate.net/publication/311045609_Changing_Learning_Practices_in_Healthcare_and_Construction_Deployment_Sustainability_Exploitation_of_the_Layers_Solutions?ev=prf_pub