Health and social care are labour-intensive service industries which are currently facing enormous change. Achieving staff engagement, excellent leadership and clinically focused organisations, particularly when 1.3 million NHS staff members are involved, calls for some radical rethinking of about how individuals learn and may achieve change in their working practices.

As long ago as Confucius and Socrates the wise have known that real learning comes through action, reflection and experimentation. Yes - there is a place for reading, amphitheatre lectures etc, to gain the theories and constructs. We need to solve problems and make decisions.

However when we face complex, new and downright difficult issues, whether as managers or clinicians, we need to go beyond the theory and develop our own strategies and approaches - we need to develop our learning power by ‘getting better at knowing when, how and what to do - when you don’t know what to do.’

Fly on the Wall (FOW) is a deceptively simple process that can help us do this. The tool combines two well known approaches for learning: action learning and reflective practice.

Reg Revans developed the concept of action learning in the 1940s as a learning process by which individuals study their own actions and experience in order to improve performance. Individuals reflect on and review the action they have taken and identify what they have learnt from that experience. These learning points can then be used to a guide future action and improve performance.

The use of reflective practice is particularly valued in the health and teaching professions as a way of thoughtfully considering our own experiences in applying knowledge to practice while being coached by professionals/experts.

The model of experiential learning produced by Kolb and his colleagues (Kolb and Fry, 1975, Kolb ,1984) will be familiar to those interested in action learning; learning styles; and the structure of knowledge and lifelong learning. Schön’s (1967) premise that ‘change’ is a fundamental feature of life and that social systems that learn and adapt has led to many theories of professional and organisational learning, and individual reflective practice. ‘Reflection-in-action’ has become part of the language of education. His pragmatic approach was to focus on what people actually do at work, which is of great interest to trainers, educators and managers in healthcare and business. It encouraged an approach to understanding the change process and developing mechanisms that allow reflection and learning in organisations.

Schön’s (1983) approach allows for errors to be corrected in ways that enhance understanding. This extends Kolb’s learning cycle beyond simply reflecting-on-practice to theory-in-action. It closes a loop by involving individuals in considering their experiences and feelings to gain timely understanding of the immediate work situation. Individuals, within the safety of the group, may admit surprise, confusion and concern about a situation or behaviour and begin to build knowledge and appropriate responses.

Building on these well accepted theories The Greenbank Partnership has developed some highly effective learning tools. They are an innovative training and development consultancy which works closely with clients to build and sustain high performance through the development of leadership and business development skills and approaches.

Over the last 15 years Greenbank have worked with individuals and groups in both the UK and around the world to encourage and promote learning and have always incorporated the idea of action learning and reflective practice in their approach.. Although Greenbank design and deliver workshops, they understand that real performance is only truly achieved when the learning is applied back at work.  Greenbank are therefore passionate about incorporating tools and techniques which can help people continue their learning in a direct work situation

We have all heard managers say they have no time or budget for “development and learning” - as though learning can only happen in discrete settings.  Yet, to be truly effective, learning needs to be an integral part of the way we all do our normal work, - every day. It also needs to be independent of specialist facilitation. Greenbank started to look for some simple methodologies to give to people so that they could do just that. The Fly on the Wall tool is the result of that search. Over the years they have refined the approach and evaluated its effectiveness working with a wide range of clients with whom they have established long standing relationships and have been able to track the impact of FOW for individuals, teams and their organisations.

Why does FOW work so well?

To start with it is simple and fast - taking only 20 minutes to leverage the learning and experience of others, gather new ideas and alternatives to real work issues. It is extremely flexible and once the core process has become familiar to everyone it can be used in many different contexts. For instance Greenbank have carried out interviews after the use of FOW and received many examples of how it has helped. It is reported to:

  • Provide new insights and practical approaches to complex problems, such as tackling performance problems, getting new work procedures accepted and acquiring funding for new business initiatives.
  • Help leaders get a better understanding of the part they may be playing in the implementation of change.
  • Assist leaders to identify ways in which they can flex their own management style to gain greater acceptance and reduce resistance.
  • Enable teams to gain a better appreciation of the challenges facing others and how they can leverage their shared experience and skills to move forward - and reduce conflict as team members are able to understand far better the difficulties their colleagues may be facing.
  • Develop a greater sense of trust and openness - teams that learn together tend to take a more problem-solving and collaborative approach with one another.

Where FOW has been introduced to groups, during a course or team workshop, post -training evaluation reports identify it as one of the most highly valued aspects of the learning experience. Many participants have introduced it back in their own organisations as a regular part of the their meeting process.

How does “Fly on the Wall” work in practice?

The tool is best suited to a small group of people so that everyone gets the opportunity to get involved.  Each person prepares by thinking about a real, current problem or situation that they want to improve. It could concern their own performance, that of another individual or an organisational issue. However it should not be a technical problem which has only one answer. The greatest benefit is achieved where the group makes a commitment to confidentiality or “Chatham House rules” so that each person can feel free to discuss real issues and concerns in a safe environment.

Within the group each Problem Holder is allocated about 20 minutes to focus on their issue following four clear steps:

  • The Problem Holder starts by describing their situation in two-three sentences and finishes with the question ‘How do I …?’
  • The other group members listen and ask questions for clarification. This activity lasts no longer than three minutes.
  • At this point the Problem Holder ‘leaves’ the group although they remain in the room and listen to the conversation. The rest of the group then discuss the problem as if the Problem Holder was not present. The aim of the discussion is to provide, in a relatively short time, as many thoughts, ideas and perspectives as possible. This should last no longer than 10-12 minutes.
  • The Problem Holder then rejoins the group and says what they found useful/thought provoking. This activity should last no longer than two minutes.

From our experience there are three key things to remember to make the process effective:

  • Stick to time - less can be more in this process.
  • Do not spend all the time seeking clarification of the problem - this can limit the ideas generated focusing more on problems that options.
  • Do not forget to discuss both the problem holder and problem-the problem owner’s style, experience and personality are always an important part of the equation.

FOW is deceptively simple; however the learning experience that results is complex, rich and often produces new breakthroughs in thinking. Within teams and for individuals there is a need to experience it to understand just how powerful a learning experience it can be. For example, in a recent action learning group of five people each member had the chance to bring an issue to the table. The very last person to offer up their issue said that although fully involved in the process it was not until he had the chance to be the ‘fly on the wall’ that he truly understood why everyone had been talking about the power of the experience. This was a good reminder  that being an observer is not enough, sometimes you need to be willing to ‘just do it’ to realise the full benefits of a learning experience.

Some examples:

Greenbank regularly use FOW as a way to ensure that their management training is totally relevant for each person and that they will be able to use their new skills and learning immediately on their return to work. Change is tough for us all but one way that it will happen is by having the opportunity to test out our learning back at work. One such training course which they have been delivering around the world for nearly nine years is  a programme for a large US Home Hygiene company. Interestingly they have found that although some concepts do not always ‘ travel well’ because of cultural differences  FOW works just as well whether used in Europe, Africa, Latin America, Asia or North America. Over the years participants have repeatedly found the process results in several new ideas and perspectives to put into action when they return to work. Greenbank work in close partnership with the organisations’ own Learning Consultants who follow up the results of the training with participants and their managers during the three months after the residential programme so that they can discover how the skills and tools learned during the residential programme are applied at work.

Following a Senior Leadership programme, one group of Senior Civil Service, Public Sector and Not for Profit Leaders have been using the tool as part of their regular action learning sessions. They have developed a high level of trust and openness which means that they feel able to work on both highly sensitive work issues and personal dilemmas such as major career decisions. For them FOW provides a structure that means they can work at real depth whilst making the most of the limited time they have working together.

The NHS Workforce Review Team experience: 

WRT is a national body working with the Department of Health and the Strategic Health Authorities in England. It is a small team of 40-50 busy, expert and experienced people. The Senior Management Team (six-seven people) adopted FOW last year and allocated 30 minutes, as a final agenda item, to a regular strategic meeting. Feedback has been positive from WRT colleagues, who have either shared a problem or been part of discussion group. There have been no issues of breaches confidentiality. There is a lot of rhetoric around notions of learning organisations but WRT have found this to be a useful and practical learning tool.

When to use it?

The situations in which FOW can be used are many and varied. Greenbank have used it successfully in workshops and conferences, team away days, action learning groups etc, but in today’s work environment it is not often possible to take people out of their workplace and invest heavily in external training events. Although they do find that it is a big advantage to introducing FOW with an experienced facilitator as they are able to role model the approach, encourage the group to work, stretch themselves and make sure that the first experience is a positive one. But once this has been done the tool has the great advantage of being able to be used again and again by team members and managers. It is after all a real tool for real situations and for this reason its return on investment is both substantial and long lasting.

For example, individual leaders have taken the tool and used it as a regular part of their meeting agenda focusing on just one issue each meeting. They have found that not only does it offer new insights and ideas for the individual; it also builds greater trust and a better understanding of the issues and challenges which each of them face. Most teams of professionals have years of experience and often untapped expertise between them. FOW is one way to make sure that the exchange of know-how and skills are shared and actively leveraged throughout a work group.

Potential applications in healthcare

There are many possible applications of FOW in healthcare ranging from an occasional addition to the agenda in regional strategy reviews and senior executive board meetings to a regular informal, small community-based team meeting. An important principle in Rock’s approach to “Quiet Leadership” is to think about people’s thinking and to become passionate about the way they think (Rock, 2007). Modern leaders in health care need to let the other person think through the issues and encourage conversation and support teams to focus on solutions and learn experientially. The FOW technique supports this approach and, very importantly in the current economic climate, it is simple, cost-effective and takes very little time.

Great ideas and powerful tools do not need to be complex to be valuable. Neither does learning necessarily need to take place on expensive residential programmes or at business schools led by leadership gurus. FOW is a simple tool that can be used quickly, every day to solve problems, build teamwork and empower our hard pressed professionals to learn, maintain confidence and share the load of learning with their colleagues.

But don’t take our word for it-try it out for yourself and let us know how it works for you!

Judith Hirst is a Senior lecturer at Tees, Esk and Wear trust. Christine Barrett is an academic adviser at the NHS Workforce Review Team.