From the Editor


Robert Fromberg, Editor-in-Chief

In college, I had a teacher who did not speak.

It was a creative writing class, and in the first class meeting, the teacher distributed a piece of writing, read it aloud, and then sat in silence. After a painful 15 minutes, a student finally said, "I like it!" and an animated discussion followed.

I kept in touch with this teacher for many years, and after I began to teach writing in college myself, our conversations often focused on teaching methods. This teacher told me that he was speaking less and putting more responsibility on the students, to the point where after the first week of class, he stopped speaking altogether.

"Well," I said, "I suppose that might work in an upper-level writing class."

"No," he replied. "I do that in freshman composition courses. I do diagnostic writing, put them into groups, and give them a textbook. I tell them to design their own course. And I don't speak for the rest of the semester."

I asked him how he teaches the students punctuation. "They teach themselves punctuation."

I asked him how he teaches them grammar. "They teach themselves grammar."

My teacher friend insisted that research supported his approach. "I know you," he said, "and I know you talk too much in your classes. You should try silence. Here," he handed me a stack of papers, "read the research."

A few months later, I was teaching a three-hour writing class at a local university. After about 20 minutes, I was experiencing two sensations: One, I was laboring with little success to get a discussion started, and two, I had to use the restroom. It was too early for a break, so I said, "Carry on without me; I'll be right back." When I returned a few minutes later, I was greeted by a fascinating sight. An active discussion was under way…without any help from me.

OK, I know my friend's silent approach to teaching is extreme. But the approach makes the point that learning is not a matter of bringing an empty bucket for an expert to fill. Rather, every person has a valuable perspective that can be honed through expression and interaction, and synthesized into a deeper understanding.

This is also an important lesson for leaders. One example can be found in this month's cover story, "From Promise to Reality: Achieving the Value of an EHR" by Beverly Bell and Kelly Thornton. The authors show that listening to physicians is a critical part of getting value from EHRs. The authors state that the "deep understanding" of physicians and nurses needs to be infused "in every aspect of the design, functionality, and workflow of the new EHR/CPOE system." And the authors stress the importance of listening and responding to clinician suggestions and concerns once the system is implemented, and of developing trust by responding to those concerns.

Although the HFMA publications team may disagree, it would probably be a bad idea for me to stop speaking altogether. But I remind myself daily that the more we listen, the better the outcome.

Publication Date: Tuesday, February 01, 2011

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