Perhaps, with so many different customs, values and beliefs, it is not so surprising that misinformation exists. Samina Munir and Ruth Boaden wrote in their “Culture Change at Hadfield Medical Centre” report
“Many writers point out that managers and employees do not perform their duties in a value free vacuum. Their work and the way it is done are governed, directed and tempered by an organisations culture: the particular set of values, beliefs and customs and systems that are unique to that organisation.” (Burnes, 2000). It is these values, customs and beliefs that are difficult to understand but are in need of deep understanding for any scale of change to be articulated. The quote illustrates that culture is an embedded facet of an organisation - in order to understand it each layer needs to be removed, until the deepest level is ascertained. Many different and varied models describing organisational culture are available. Of these, a model was chosen that best reflects the purpose of this report and best describes the organisational culture at the HMC. This model is that of Cummings and Huse (1989), who describe culture as 4 elements existing at different levels of awareness within any organisation. These levels are:
1. Basic assumptions
Robin Dunbar’s "Thinking Big; How the Evolution of Social Life Shaped the Human Mind" suggests that the average human can manage 150 relationships so many or a majority of groups may have no level 5 literacy peers in their group and there are many ranges of health literacy within even a 100% educated population:
National American Literacy Survey 1993 (http://www.hhvna.com/files/Courses/HealthLiteracy/Health_Literacy_Manual...) showed that
Level 1 22% - Sign name
• Find a country in short article
• Find expiration date on license
• Locate one piece of information in a sports article
Level 2 27.5%
• Enter background information on a Social Security application
• Find intersection on street map
• Locate two pieces of information in a sports article
• 31.5% Write a brief letter explaining an error on a credit card bill
• Enter information into an automobile maintenance record
• Identify information from a bar graph
• 16% State in writing an argument made in a lengthy newspaper article
• Explain difference between two types of employee benefits
• Compare two metaphors used in a poem
• 3% Summarize the way lawyers may challenge prospective jurors
• Compare approaches stated in a narrative on growing up
• Use table comparing credit cards to write about differences between them
Donald Mcintyre University of Oxford Department of educational studies wrote that “Adult learning” is best understood not as a set of principles about what should happen, but as a set of descriptive generalisations about what does happen, whether we like it or not, together with some tentative suggestions about how such learning can be facilitated.
Self-Concept: When a person begins to see himself not as primarily as a learner, but as an actor or doer in the world,(s)he acquires a new status in others’ eyes but especially in his or her own eyes, and belief in self as a self-directing personality. The adult has a need to be treated as autonomous and worthy of respect. At the same time, most adults are not accustomed to directing their own learning in any systematic or disciplined way. They need to take responsibility for their learning; and having done so, frequently achieve great satisfaction from self-directed learning.
Reservoir of experience: The adult learner has had a great deal of experience with which any new experience can be compared and in relation to which any new experience will be understood. The adult tends to view and value himself or herself as a product of past experience, and therefore values that experience and is likely to feel unfairly humiliated by tasks which reject the relevance of that experience. Correspondingly, the adult tends to have established habits and patterns of thought which are not easily changed.
Possible implications: Effective teaching methods are likely to be those that encourage the use of, and reflection upon, the experiences that an adult perceives to be relevant; new ideas should be exemplified in terms of adult learners’ past experiences; adult learners need to recognise the way in which their thinking is bound by their new situations. Just as each individual is likely to have a different pattern of relevant experience, so their concerns and what they can bring to them are likely to be unique to each individual.
Role of orientation in learning: Whereas children are motivated to learn by the opportunities for growth into general new understandings and for mastery of general new skills, adults tend to be most motivated by the need to meet the demands of new roles.
Immediacy of application: Adults generally learn not in preparation for some distant future but in order to meet present needs. They tend therefore to learn not according to the discipline of subjects but rather according to their problem-solving needs.
Possible implications: The educator’s chance to influence the adult learner is by offering information of the kind that the learner needs to solve his or her problems. The information needed may be of many diverse kinds, will vary according to the distinctive learner. And will at best be assimilated to established ways of thinking, or modifying these, rather than replacing them.
HIFA Profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data
Email address: richardpeterfitton7 AT gmail.com