Exploring types of individual unlearning by local health-care managers: an original empirical approach

Exploring types of individual unlearning by local health-care managers: an original empirical approach CR Coombs,* D Hislop, J Holland, SLC Bosley and E Manful School of Business and Economics, Loughborough University, Loughborough, UK *Corresponding author Background: The ability of health-care managers or organisations to adapt and respond to change is vital if they are to succeed in the contemporary health-care environment. Change involves the learning of new behaviours and giving up, or abandoning, some established ones – more formally defined as unlearning. However, research on unlearning is lacking. This original exploratory study investigates UK NHS health-care managers’ engagement with behavioural unlearning and cognitive unlearning, and also considers the related concept of fading. The study also investigates the impact of individual unlearning on participating health-care managers’ decision-making. Research questions: (1) To what extent do health-care managers engage with the process of unlearning and what impact does the engagement with this process have on health-care managers’ decision-making? (2) What are the barriers and enablers that influence the engagement of health-care managers with the process of unlearning? (3) To what extent does the health-care setting affect the level of engagement with the process of unlearning by health-care managers? Methods: The study investigated these questions through an examination of the academic literature. Several management (Business Source Complete, Emerald), psychological (PsycINFO), health (MEDLINE) and education [Education Resources Information Center (ERIC)] electronic databases were searched for English-language articles that were published between January 2000 and March 2012. The literature provided the basis for original exploratory research that investigated local health-care managers’ experiences of unlearning. A case study approach was adopted for empirical data collection, using qualitative interviews to investigate experiences of unlearning in two secondary care NHS trusts (an acute trust and a mental health trust). A total of 85 episodes of unlearning were identified from a purposive sample of 29 health-care managers. The sample participants varied in terms of clinical/non-clinical background, type of department/unit and length of time as a manager. Results: The findings show that the health-care managers who participated in this study engaged with unlearning and fading. The engagement is triggered through either an individual experience or a change event. There was little evidence to indicate that health-care setting or professional background had a strong influence over health-care managers’ engagement with unlearning, although this finding is limited by the exploratory nature of the study, sample size and range of settings examined. Participants identified a variety of barriers to individual unlearning including personal behaviour and staff resistance to change. Enablers such as personal skills, attitudes and relationships were more commonly cited than organisational enablers such as policies, procedures and work circumstances. The findings also suggest that unlearning does influence the decision-making of health-care managers, encouraging a more discovery-orientated approach. Limitations: This study has a number of limitations. It is an exploratory study involving a small number of participants drawn from two NHS trusts, which limits the depth of insight that it can provide regarding specific aspects of unlearning processes. Further, because of the relatively low numbers of participants in our v © Queen’s Printer and Controller of HMSO 2013. This work was produced by Coombs et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.