Learning Group Call May 4, 2006

1. Learning Group CallMay 4, 2006 Dialogue Prompts 1

2. Questioning #1:What do we mean by learning? “Early in life, we are urged to study hard, so that we’ll get good grades. We are told to get good grade so that we’ll graduate from high school and get into college...so that we’ll get a good job…so that we can buy a house and a car…. We spend our lives stretched on an iron rack of contingencies. “… The achievement of goals is important. But the real juice of life…is to be found not nearly so much in the products of our efforts as in the process of living itself, in how it feels to be alive.” - George Leonard, Mastery: The Keys to Success and Long-term Fulfillment “Human beings are the learning organism par excellence. The drive to learn is as strong as the sexual drive – it begins earlier and lasts longer.” - Anthropologist Edward Hall 2

3. Questioning #2:Based on the understanding of learning that emerged in questioning #1, what can we say about the essential nature of human being? Under what conditions are we most human? “Real learning gets to the heart of what it means to be human. Through learning we re-create ourselves. Through learning we become able to do something we never were able to do. Through learning we re-perceive the world and our relationship to it. Through learning we extend our capacity to create, to be part of the generative process of life. There is within each of us a deep hunger for this type of learning.” - Peter Senge, The Fifth Discipline: The Art and Practice of the Learning Organization “In truth…precisely nowhere does man today any longer encounter himself, i.e., his essence.” - Martin Heidegger, “The Question Concerning Technology” 3

4. Questioning #3:Let’s think about the institutional challenges to learning within ourorganizations. • Management by measurement • Focusing on short-term metrics • Devaluing intangible • (“You can only measure 3% of what matters” – W.E. Deming) • Compliance-based culture • Getting ahead by pleasing the boss • Management by fear • Managing outcomes • Management sets targets • People are help accountable for meeting management targets (regardless of whether they are possible within existing system and processes • “Right answers” vs. “wrong answers” • Technical problem solving is emphasized • Diverging (systemic) problems are discounted • Uniformity • Diversity is a problem to be solved • Conflict is suppressed in favor of superficial agreement • Predictability and controllability • To manage is to control • The “holy trinity of management” is planning, organizing, controlling • Excessive competitiveness and distrust • Competition between people is essential to achieve desired performance • Without competition among people there is no innovation (“We’ve been sold down the river by competition” – W.E. Deming) • Loss of the whole • Fragmentation • Local innovation do not spread • - Peter Senge, The Fifth Discipline: The Art and Practice of the Learning Organization 4

5. Questioning #4:What are some of the broader systems that can inform an understanding of health and health care? “Not only is the disaffected worker more likely to recall regional back (or arm) pain, he or she is more likely to find the morbidity so insurmountable that recourse is sought in workers’ compensation insurance schemes. “…We in medicine need to understand the toll that marginal employment and disaffection can take on any of our patients… “I believe that the crown jewel of capitalism is not the accumulation of wealth; it is the creation of sustaining jobs.” - Nortin Hadler, MD, “Laboring for Longevity”: Journal of Occupational and Environmental Medicine 5

6. Questioning #4:What are some of the broader systems that can inform an understanding of health and health care? “Technological medicine takes human beings out of the natural order, and does so increasingly as new technologies develop. To save lives which would in the course of nature have ended by means of drugs is one thing; it is a much greater thing still to save lives by assisting the function of failing organs by mechanical means, as in renal dialysis or the use of heart pace-makers; it is going yet further to save lives by replacing the organs altogether by other organs, taken from other human beings or even from animals of other species. Each of these marks a step further from the natural order, from the governance of processes by impersonal laws of nature, with which human beings can only cooperate, to an order constructed by human beings.” – Eric Matthews, “Medical Technology and the Concept of Health,” The University of Aberdeen 6