Becoming a learning, healing, and impactful organization

The LHI model for transforming self, relationships, teams, and more

A trivium for humble leadership

In 2011, I became the health officer of the City and County of San Francisco, and director of the Population Health Division at the San Francisco Department of Public Health (SFDPH). In my new role I decided to focus on organizational leadership; that is, be more like a “head coach” instead of a player on the field. My hypothesis was that if I could improve the performance of individuals, teams, and programs across an organization, they would accomplish much more collectively that I could ever accomplish in my career. As a fellow in the California Health Care Foundation (CHCF) Leadership Program I focused on organizational transformation. Over the years I kept notes, some of which I self-published online.¹ ² ³ ⁴

After years of experimenting and learning as an organization leader, I have settled on promoting the trivium of “becoming a learning, healing, and impactful person, team, or organization” or the LHI model (Figure 1).

Figure 1: The LHI model is the trivium of “becoming a learning, healing, and impactful person, team, or organization.” The LHI model can also be framed as a holistic “way of knowing,” “way of being,” and “way of doing.”

In Latin, trivium means “the place where three roads meet.” The transformation magic happens when you harness the wisdom, knowledge, experience, expertise, ingenuity, innovation, and synergy from the three roads (in this case, learning, healing, and being impactful). Learning, healing, and being impactful applies first and foremost to individuals and interpersonal relationships, and then to teams and the organization.

In Latin, trivium means “the place where three roads meet.”

Years ago, influenced by the seminal work of Peter Senge⁵ I promoted building a “learning organization.” A learning organization was “a company that facilitates the learning of its members and continuously transforms itself.”⁶ A learning organization has the following characteristics:

1. systems thinking,

2. personal mastery,

3. mental models,

4. shared vision, and

5. team learning.

“The idea of the learning organization developed from a body of work called systems thinking.” Personal mastery is the “commitment by an individual to the process of learning.” Mental models are “assumptions and generalizations held by individuals and organizations.” Mental models should be challenged and improved. A “a shared vision is important in motivating the staff to learn.” And “the accumulation of individual learning constitutes team learning.”

Over the years we recognized that this framework was necessary but not sufficient. We also needed to address

• Continuous improvement

• Trauma, healing, and resilience

• Inequities, racism, and health inequities

• Achieving impacts that improve population health

The challenge was, and is, how can we make progress in these mission critical areas without overwhelming our staff with numerous, new initiatives that may be difficult to sustain? After years of deploying initiatives, I’ve come to appreciate that for any new initiative to take hold, succeed, and be sustainable, it must

• be human-centered (led by staff and community),

• fit into and improve existing workflows,

• add value immediately (eg, address pain points, align with mission),

• be scalable at all levels (person, team, organization), and

• have universal concepts that are applicable everywhere (at home, personal life, in the community, etc.)

At the California Department Department of Public Health (CDPH), the one phrase that captured our collective aspirations was “The CDPH Way—Becoming a learning, healing, and impactful organization.” The phrase was longer but my wise staff advised me to shorten it even further to the three main concepts. “We will become

• a learning organization (“Becoming the best at getting better”)

• a healing organization (“Connection mitigates trauma.”)

• an impactful organization (“Measure what matters.”)

These domains are connected, interdependent, and synergistic. More specifically, our CDPH top strategies are focused on

• Learning

  • Lean tranformation

  • People development

• Healing

  • Trauma responsive and preventive

  • Equity, antiracism, and health equity

• Impactful

  • Tackling key public health challenges with community partnerships (youth behavioral health, emergency preparedness and response, health inequities, etc.)

  • Embracing audacious goals with focus and discipline using OKRs

In practice, we should be in the intersection of the 3 circles where we are integrating these 3 dimensions (learning, healing, impactful). In other words, we always aspire to make a difference (impactful), do no harm (healing), and to get better (learning). The LHI model will strengthen your existing organizational core values that drive behavior and build culture.

The LHI model applies equally to individuals, teams, and organizations. Like Senge’s learning organization model, the LHI model (Figure 1) of organization transformation that depends on a theory of change (ToC) that starts with transforming self and interpersonal relationships (Figure 2).

The ToC is designed to make our strategic initiatives cross-cutting and to engage every person in the organization. We are still early in our journey and have made progress in our lean transformation, people development, trauma-responsive leadership training across California, and deploying OKRs.

Figure 2: Theory of Change for organizational transformation.

The LHI model (“becoming a learning, healing, and impactful person, team, or organization.”) can also be framed as a holistic

• way of knowing (learning),

• way of being (healing), and

• way of doing (impactful).

The LHI model also aligns with the cognitive (learning), emotional (healing), and behavioral (impactful) pillars of CBT (cognitive behavioral therapy). This model is holistic, integrative, and flexible.

For those who are interested in deploying or road-testing the LHI model, start with yourself, or you and your team. Your interpersonal relationships and teams are learning laboratories, and your conversations and meetings are opportunities for action learning⁷ or experiential learning.⁸ Consider organizing a learning community. For example, when I worked in San Francisco, we deployed a book club and a journal club.

I recommend the following

1. Read key books. See my recommended foundational books here.

2. Read this blog and start with the topic of healing (focused on humility and building trust).

3. Keep an eye out for training opportunities from CDPH or other organizations.

4. Experiment and share your learnings with us.

For example, a very influential book for me was Edward Hess’ Humility is the New Smart: Rethinking human excellence in the smart machine age. The NewSmart and Humility mindsets drive behaviors that are supported and improved with evidence-based skills. Hess clusters them into four behavioral categories:

1. Quieting Ego (mindfulness),

2. Managing Self (one’s thinking and emotions; critical self-reflection),

3. Reflective Listening (listen mindfully to truly understand), and

4. Otherness (emotionally connecting and relating with others).

At SFDPH, we read Hess’ book in our book club with all our senior and middle managers. We affectionately referred to the “green book.” For me, this was a game-changer in my personal and professional development. I began to appreciate the power of cultivating humility.

Good luck on your journey!

PLEASE send me your book recommendations and feedback on your journey!

Appendix

A — A blast from the past, circa 2018

In 2018, I wrote:⁹

“Humans have three core cognitive-behavioral processes: deciding, acting, and learning. Adaptation comes from adjusting our decisions and actions based on what we learn. Improvements are adaptations that make things better. These processes — mediated by emotions — are fundamental to all human activities, and form the basis for innovation and continuous improvement.

To become a learning organization, we must ensure:
1. decision quality (decisions, supported by data science)
2. strategic execution (actions; includes project and porfolio management)
3. performance improvement (learning; improving processes and results, achieving goals)
4. positive and safe environments (emotions)”

All these components are still valid today, but I believe it is much easier to anchor them to learning, healing, and being impactful. Figure 3 (below) summarized the lean thinking components of an organizational lean transformation with the theory of change along the edges.

Figure 3: Lean thinking components of a lean transformation.

Today, I categorize lean transformation under the “learning” of the LHI model. In future posts, I will dive into these components in more detail.

B — A triquetra for unity/oneness, and for inside-outside

In Figure 4 (below), the intersecting three arcs in the middle is called a “triquetra” and the path is contiguous, representing unity or oneness (eg, mind, body, spirit). This specific triquetra has a polarity: an internal path (representing looking inward at self) and an external path (representing outward to non-self).

Figure 4: A triquetra (source: https://en.wikipedia.org/wiki/Triquetra)

Footnotes

1. Tomás J. Aragón and Grant Colfax. “We Will Be the Best at Getting Better! An Introduction to Population Health Improvement.” eScholarship.org, December 30, 2019. https://escholarship.org/uc/item/9xg5t30s.

2. Tomás J. Aragón, Heather M. Mier, Tony Payauys, and Christine Siador. “Project Management for Health Professionals.” eScholarship.org, December 26, 2012. https://escholarship.org/uc/item/7bb8b9pw.

3. Tomás J. Aragón. “PDSA Problem Solving: With a Gentle Introduction to Double-Loop Learning, Program Theory, and Causal Graphs.” eScholarship.org, April 17, 2018. https://escholarship.org/uc/item/8wp451vd.

4. Tomás J. Aragón. “Population Health Thinking with Bayesian Networks.” eScholarship.org, November 23, 2018. https://escholarship.org/uc/item/8000r5m5.

5. Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Rev. and Updated ed. London: Random House Business Books, 2006.

6. Learning organization (Wikipdeia): https://en.wikipedia.org/wiki/Learning_organization.

7. Action learning (Google Gemini): “This method was pioneered in the 1940s by Professor Reg Revans, who used it in coal mines, laboratories, and later in management development. It's based on the idea that people can work together to solve problems in unfamiliar environments. Today, action learning is used in many professional fields, including organizational development, determining the impact of operational plans, and bringing about organizational change.”

8. Experiential learning (Google Gemini): “This method is rooted in experiential learning theory, which emphasizes learning through meaningful participation in and structured reflection on real or simulated experiences. Experiential learning activities can include residencies, internships, hands-on laboratory experiments, field exercises, study abroad, and undergraduate research.”

9. Tomás J. Aragón. “PDSA Problem Solving: With a Gentle Introduction to Double-Loop Learning, Program Theory, and Causal Graphs.” eScholarship.org, April 17, 2018. https://escholarship.org/uc/item/8wp451vd.