“You can’t fix what you don’t know about” is an old adage, but it remains true today. Especially in a busy clinical environment, it is likely there is always something that will need to be ‘fixed’ -- whether it is a communication problem among care team members or a piece of malfunctioning equipment.

A learning system is characterized by its ability to self-reflect and identify strengths and defects. Leaders, from the charge nurse to the hospital CEO, must highlight the importance of continuous reflection to assess performance and drive improvement. Learning and a healthy culture reinforce one another by identifying and resolving clinical, cultural, and operational defects.

Learning is most robust when all members of a work setting have access to the same information and when they have confidence that any concern they raise will be taken seriously. Many times, incident reports or observations about a problem seem to “disappear into a black hole” which leaves staff frustrated and unsure if they should even bother taking the time to bring up issues or concerns.

Posting issues on the LENS Board is important for improving culture and reinforcing the learning system in the following ways:

1) it increases transparency -- issues and problems are not being hidden from the frontline, which is often the perception. 

2) it reinforces that management is interested in learning about defects and builds trust that concerns are being addressed.

3) it opens issues up for discussion and problem solving among the group. 

Members of a work setting should be encouraged to post a wide variety of issues to the LENS Board, ranging from suggestions about a way to improve something, to "pebbles in the shoes" -- the little annoying things that get in the way of smooth functioning -- to observations of malfunctioning or missing equipment, poor communication or other lapses that involve patient care.  No identifiable patient information (PHI) should be posted on the board, however.