The secret ingredients for a rich learning culture: trust and transparency?

Many organizations and individuals, including those working in primary care, want to find and adapt relevant promising practices from others; but few programs are replicable in their entirety. Through CHMI’s Learning Initiatives, we’ve seen that programs are searching for opportunities to transfer and adapt innovations more broadly, including within one country, across borders and within and across sectors. The Center for Health Market Innovations launched the Primary Care Adaptation Partnership (PCAP) in the fall of 2015 to bring together three pairs of organizations to practically test how to adapt “what works” in primary care.  

In this blog, we take a look at the partnership between Ross Clinics, a chain of multi-facility outpatient health clinics with a focus on delivering primary care in New Delhi, India and Quinta Bonita, a Mexican mental health program that hopes to offer primary health care services to low-and middle-income communities in Mexico.

The CHMI team spoke with Devashish Saini, Founder of Ross Clinics, and Sergio Guerrero, Co-Founder and Chief Financial Officer of Quinta Bonita, to learn more about their adaptation experience. As a part of PCAP, Sergio traveled to Gurgaon, India to learn from Ross Clinic’s model. For both Quinta Bonita and Ross Clinics, the role of knowledge sharing and learning within an organization’s culture emerged as a core component to providing high quality primary care.

CHMI: Why is knowledge sharing so important to primary health care organizations like yours?

DS: Continuous learning and knowledge are very important for any health care organization, but is particularly important for primary care because primary encompasses many things. There has to be a culture of continuous learning and there has openness between employees. Primary care means that we have to take care of conditions that belong to all the different specialties in medicine. We cannot say to a particular patient, “This is not my specialty” because in primary care, everything is our specialty. In each of the fields, there are cases that we can treat at the primary care level and we need to develop more expertise and knowledge and skills around those things. Another reason why it is so vast is because we realize that it is too much for some people and obviously everyone cannot have all the skills on Day 1. That’s why the learning has to be continuous because the material to learn is so vast.

CHMI: How would you best describe your organizations’ learning cultures?

DS: It’s trust. That’s the key word. We do everything we can to build that trust. There is transparency within the organization and with the patients. There’s information sharing. There is an exchange of learnings and knowledge. If we use organizational terms, our culture is more like a flat structure rather than a hierarchical structure. In many cases, our employees have come from organizations with a closed culture where you can’t talk [openly] to people outside of your immediate superior or team members. We have openness and information sharing and trust.

SG: We [at Quinta Bonita like to] think that we don’t have the perfect answers to everything, but we work hard to improve our services. We try to improve our services by doing even simple things like being polite and transparent with the information we provide. The short answer to your question is that we are very humble, very committed to improve, and we try to learn from others.

CHMI: How do you practically build this type of a learning and knowledge sharing culture?

DS: We have started to build structures to encourage people and motivate them to do a lot of different things around learning. One measure is holding peer-to-peer knowledge sharing sessions. Everyone in these sessions has to prepare a 5- to 10-minute presentation and then present that topic [to the team]. We have four of these sessions every month. One for doctors, one for dentists, one for clinic managers, and one for the management. We have seen that people are becoming more proficient and confident [in their skills].

SG: What we realized a few years ago is that different members of our team have really good ideas for solving different problems, however, since we have offices across multiple cities in Mexico, it is difficult for these individuals to come together to shares these ideas. Therefore, we started having video calls. That helped, but later we realized that people have ideas or need ideas all the time and it’s not realistic for them to wait for the next video call to share these ideas. We started using Slack, an online messaging, archiving and search application. Slack has helped us a lot because now we have different forums within Slack in which we can talk about specific topics, but everyone can provide input or suggestions. By having Slack, people feel more empowered.

Looking Forward

Over the next few months, we will regularly document key activities and learnings from PCAP. Please be sure to follow our blog in order to stay up-to-date with the latest news and updates from our participating programs. Contact Ankita Panda at with any questions or comments regarding PCAP.