What’s the Cure for Conventional Learning?

Every professional yearns for the sweet spot — the intersection where interest and passion collide with expertise. Justin J. Lombardo has found his.

“I either build it or I fix it — that’s what I do and that’s what I enjoy doing,” said Lombardo, vice president of the Learning Institute and chief learning officer at Children’s Medical Center of Dallas. “I enjoy building something from scratch. I like seeing it optimized and really contributing back to the institution, and then I’m ready to move and build something else.”

Built It. Fixed it. Now What?
One might say learning always has been in Lombardo’s blood. While embarking on a career in higher education as a faculty member at St. John’s University in Minnesota, Lombardo had the opportunity to look at curriculum and really study how adults learn.

It was a natural progression for him to join Motorola University during its formative years; corporate universities were just beginning to take shape and gain traction as learning vehicles. Fifteen years later, after going through almost every rotation — from managing sales training to leadership development to global instructional systems design — he moved on to Northwestern Memorial Hospital in Chicago.

The hospital was looking for someone to step in and create a corporate university. Curious about the health care field, Lombardo rolled up his scrubs and went to work building Northwestern Memorial Academy — removing unwarranted silos and consolidating every aspect of learning and development under one roof.

Ten years later, with the academy up and running, Lombardo set his sights on a new challenge — the builder in him was thirsty for more — and an employment prospect in Dallas at Children’s Medical Center appeared.

So Long, Silos
Since joining Children’s in January 2010, Lombardo has led all the clinical and non-clinical education and training for the medical center, which has a population of approximately 6,500, including employees and physicians who are not technically employees.

“The Learning Institute model — complete consolidation of clinical and non-clinical education and training — has shown to be more efficient and effective in delivering services to the entire enterprise, especially the core operations of our organization,” said Jim Herring, executive vice president, corporate services at Children’s Medical Center of Dallas.

Minus training and medical education for physicians, Lombardo’s team has oversight for anything related to hospital operations or patient care. That includes quality improvement, process improvement, management and leadership development, staff development, nursing education, systems training and development for medical records and finance training.

That job description is relatively standard for a CLO in the health care industry. What’s atypical about Lombardo’s job is he also assumed responsibility for organizational development initiatives, succession planning and employee communications — areas where CLOs typically don’t have oversight.

“What we’re dealing with now is not just training and education, but consolidating all the various disciplines that contribute to human performance improvement,” he said. “Communication, especially with digital generations, is a key element in driving that performance change.”

To its detriment, Lombardo said learning in the health care space typically has been characterized by silos. For instance, there are separate groups in charge of nursing development, systems training and finance training.

This was par for the course at Children’s as well, until the medical center’s leadership began to use its resources more effectively, creating a consolidated infrastructure unique in the industry, and leading the way for other pediatrics facilities to duplicate the training and development human performance system.

“I was recruited to create a consolidated education infrastructure that would help people leverage all the assets they were using in employee development and training into a consolidated system that gave them better efficiencies and effectiveness to drive performance change,” Lombardo said.

For example, instead of having separate methods to identify and roll out what types of learning physicians or nurses need, Children’s has a holistic performance improvement system for everyone. Lombardo said the system considers adult learning principles, instructional design and organizational development.

“When we do a major intervention, we will create an implementation plan that doesn’t just look at training and development, but looks at systems, coaching opportunities, organizational structure as well as the education pieces that are needed to consolidate the whole thing — that drives it across disciplines and divisions, which is very different,” he said.

Lombardo has been fielding inquiries from other pediatrics hospitals that aim to follow suit and consolidate resources. One of the benefits of this approach is the speed at which errors can be fixed. For instance, if the medical center needs to make an improvement in a clinical process, this now can be conveyed to the center’s 2,000 nurses within a matter of days.

Another key advantage of adopting this approach is that learning and performance interventions tend to more closely align with the organization’s strategic needs. Lombardo said a reduction in nonessential training is the result.

Further, if something goes wrong, the knee-jerk reaction is no longer to retrain everyone. Instead, the medical center uses analysis to determine whether the problem was in fact a result of employees not knowing something versus other external factors.

“We’re doing fewer interventions, but the interventions we’re doing have greater strategic impact to drive the concomitant results we want in care outcomes — reduction of error and improvements in productivity — and we track those,” he said.

Diagnosing Business Needs
To achieve its vision of becoming one of the best medical centers in the United States, Children’s views learning as a fundamental contributor to the organization’s strategic direction. By learning the business of health care, Lombardo has been able to earn a seat at the table.

“Even though I’m non-clinical, I’ve learned how clinical decisions are made. I understand more about how a hospital operates,” he said. “One of the big flaws you get with a lot of education officers is they don’t necessarily dig as deeply as they should into the processes and systems that drive the core business.”

Instead of being looped into strategic discussions later in the game, as many learning functions are, Lombardo and his team are brought in on the front end. He sits on the operations team and attends the operations leadership team meetings regularly so he can contribute to planning activities.

“As we encounter issues or problems or opportunities, from the very beginning the human performance factor — and what are the interventions we’re going to need to make that work — is integrated into the plan,” he said.

At the end of the day, it’s a matter of maintaining a healthy balance between tending to the day-to-day operations and fulfilling the strategic growth needs of the medical center, Lombardo said.

“We track the amount of time and resources that the overall institution puts into training and development of day-to-day run rate or operations development as opposed to the amount of time and energy and resources we put into strategic initiatives,” he said.

The board also takes a keen interest in the Learning Institute’s work. Herring schedules two meetings a year where the Learning Institute provides a status report to the board’s human resources committee. During these meetings leaders also discuss leadership development and succession planning.

Informal Learning: Moving the Needle
Children’s increasingly relies on forms of informal learning such as blogs and chatrooms to enhance one-to-one as well as group communications. Lombardo said the learning function monitors these activities as needed because posting incorrect information may not just cost the company — it could cost a life.

The medical center also has found learning via mobile device handy in certain situations. For instance, if a group of nurses needs to be trained on a particular procedure they don’t implement on a regular basis, they might use iPods to review a video of the procedure before conducting it to ensure accuracy.

Mobile devices are also useful when the medical center staff is deployed across different areas. For instance, an intensive care unit nurse may float to a post-op or general medicine floor. Even though the nurse is equipped with the basic competencies to perform the job, the individual might leverage mobile devices or other forms of informal learning to prep before performing a specialized task.

Children’s also uses simulations for learning, but Lombardo said the organization is looking for ways to use them to serve employees better. Simulation use isn’t groundbreaking in the health care realm, but Children’s is exploring how integrating simulations with gaming theory could appeal to the new generation of learners.

Healthy Outlook on Change
In an industry such as health care — where the landscape is constantly changing and growing — it’s a challenge and an opportunity to continually increase effectiveness and efficiency, Lombardo said. Dealing with all the legislative change the health care industry is subject to can be difficult as well.

“Any time you have something that impacts the amount of resources that an organization has in total, it’s going to have an impact on how you configure the learning and development,” he said. “We’ve already begun to look at: ‘How do we improve the effectiveness and efficiency of our learning and development so that we’re still getting the job done, but doing it at a better rate?’ If you do that carefully, the changes won’t impact you in learning and development any more greatly than it will in the rest of the operation.”

Children’s is far from alone in needing to cope with a shifting environment. The U.S. Supreme Court’s decision in June to largely uphold the Patient Protection and Affordable Care Act is also impacting insurers like Cigna Corp. But Cigna Chief Learning Officer Karen Kocher said the key to staying ahead of all the changes is to ensure employees are educated on specific aspects of the legislation, and are equipped with the right mindset to deal with change.

“It’s really getting people to think differently about what all of this may mean and ways in which we can be very innovative and creative in the context of these big, broad changes,” she said. “There’s so much opportunity to be had in these types of monumental changes, and employees don’t necessarily think that way. We can help them through all sorts of awareness-building activities and education initiatives.”

Back at Children’s, the mission is to make life better for children — something it has taken strides to accomplish since its inception nearly a century ago. As Lombardo and his colleagues prepare to celebrate the organization’s centennial next year, he said he paused to reflect on how his own professional journey led him to serve in an array of industries from education to engineering and manufacturing and now health care. What always has been constant is his passion for learning as a fundamental activity.

“It’s the one discipline where you have to get involved in all aspects of a business … you can’t segment it off; it touches so many different pieces,” he said. “I like the fact that there’s really a systematic approach to the best learning. The best learning looks at not what the educator wants to convey, but what the individual needs, and I like figuring that out.”

Deanna Hartley is a senior editor at Chief Learning Officer magazine. She can be reached at dhartley@clomedia.com.