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Running head: Action Learning in Health Care Sector 1

Selective Literature Review: Action Learning in Health Care

Sector

Chungil Chae

Pennsylvania State University


Abstract

In spite of prevailing popularity of action learning research and practice, there are

relatively limited studies and interests in the health care sector. This asymmetry limited

our understanding in the characteristics of action of health care sector. Thus, the purpose

of this selective literature review aim to explore action learning literature and to examine

action learning characteristics in the health care sector by implementing Cho and Egan’s

(2009) balance issue criteria and Chenhall and Chermack’s integrated action learning

model by Garrard’s matrix method and proxy document method with NVIVO software.

Keywords: action learning, health care, matrix method, proxy

document


Selective Literature Review: Action Learning in Health Care

Sector

HRD practitioners in the United States are successfully utilizing Action Learning to

help learners acquire knowledge through actual actions and practices rather than through

traditional instruction (Marquardt, 2011). This form of knowledge acquisition is highly

successful and often preferred by learners where elevated precision of a complicated

procedure and near perfect outcomes is expected. For example, hospital environments

often conduct resuscitation on patients experiencing severe cardiac arrest.

Action learning has attracted attention over multidiscipline as a research subject

and intervention for learning and organization development (Cho & Egan, 2010; Marquardt

& Banks, 2010; Waddill, Banks, & Marsh, 2010). Action learning’s strength and

effectiveness is drawn from its fundamental philosophy, “there can be no learning without

action and no action without learning” (Revans, 1998, p.83). In spite of lack of unified

definitions of action learning between action learning scholars, it is differentiates it from

other learning interventions by its effectiveness based on participants’ real-world problem

and focus on questions rather than solutions (Cho & Egan, 2010; Marquardt, Seng, &

Goodson, 2010). In the health care sector, however, comparing with other sector such as

business, education, nonprofit, and government, relatively limited researches and practice

of action learning program has been. As the result, this asymmetry limits our

understanding about how action learning is conducted and what different characteristics

exist in the health care sector. Thus, in this literature review, the purpose of this selective

literature review is to explore precedent action learning scholarship and to examine


empirical action learning studies in health care sector with Garrard’s matrix methodology

and proxy document technique with NVIVO software.

Literature Review

Ravans has regarded as the father or the most important contributor of action

learning by majority of scholars (Chenhall & Chermack, 2010; Cho & Egan, 2009;

Marquardt & Banks, 2010; Yeo & Nation, 2010; Zuber-Skerritt, 2002). In 1930s, Revans

observed a series of procedures that researchers in Cavendish share their problem and

facilitate each other by corresponding questions (Marquardt, 1999). In the 1940s, action

learning was initiated when Revans introduced action learning in the coal-mines industry

of Wales (Marquardt & Banks, 2010). Since then, action learning has diffused to other

sectors and nations. As the result, 63% of all executive leadership programs in the United

States was action learning (Marquardt, 1999).

Definition and Conceptual Models

Action learning definition differs between action learning scholars (Cho & Egan,

2009). Zuber-serritt (1999) defined action learning as subordinate form or procedure of

action research. Other researchers defined action learning as process of inquiry (Martineau

and Hannum, 2004) or a process of reflection (Dilworth and Willis, 2003). Sofo (2010)

conceptualized action learning as sustainable and interpretive form of learning

methodology. Marquardt (2010) suggested a definition of action learning in manner of

incorporating action learning principles as the following; “Incorporating these principles

and the experiences of these action learning gurus, we define action learning as a process

and tool that enable individuals and groups to learn while solving problems and


implementing actions” (p.160). These definitions of action learning were presented in

Table 1

Table 1

Action learning definition

Authors Definition of action learning

Zuber-Skerritt (1990) Subordinate of action researchDilworth and Willis (2003) A process of reflecting on one's work and beliefsMartineau and Hannum (2004) Collaborative inquiry process

Marquardt (2010)A process and tool that enable individuals and groups to learn while solving problems and implementing actions

Sofo (2010) Learning methodology

Action learning model is largely distinguished as U.S. model and England model.

Chenhall and Chermack’s (2010) study provides details and specific definition of various

action learning models. This literature briefly introduced the models. Gregory’s (1994)

action learning group process model has a incorporated action learning and action

research models feature. Hicks and Peterson (1999) suggest a development pipeline action

learning model which has a strength in developing complex skills. Watkins and Marsick’s

(1993) continuous learning model is based on a practical approach to problem solving in

real life. Paton (1996) suggests the systemic action learning cycle model that is based on

critical systems theory.

Similarity and Difference with Other Concept

Major similarity between the action learning and other learning concepts based on

its common assumption as like Zuber-Skerrit (1994) stated, “knowledge can be gained

from concrete experience or action through observation of, and reflection”(p.441).


Similarity and shared assumption between action learning and other learning concepts

often leads people conclusion in vague perception of action learning boundary. The

difference between action learning and other learning and organization development

intervention is that action learning is due to action learning characteristics that action

learning is focused on pragmatic basis (Cho & Egan, 2009), and is “framed by the urgency of

the problems being worked on and the diversity of the group membership to produce

multiple levels of situated practice” (Yeo & Nation, 2010, p.182). Gregory (1994a)

distinguished action learning and action research by its usages such as action learning is

regarded as a methodology but action research is described in terms of strategic method.

Cho and Egan (2010) emphasized individual learning process as difference from action

research. Sofo and Villafane (2010) distinguished action learning difference from problem-

based learning by the following, “In this respect, problem-based learning and action

learning can handle similar levels of problem messiness, yet the action generated may be

more adaptive for problem-based learning given the way learning is systematized”(p.207).

Inquiry and Reflection Process

Reflection and inquiry process is common characteristics over other different action

learning conceptual models and important factors that connect learning and action.

Marquardt and Seng (2010) emphases inquiry process’s collective wisdom, “members are

expected to continuously tap into the collective wisdom of the group” (p.250). Also inquiry

in action learning regarded as effective tool that present complex real-world problem and

become beginning point for developing innovative strategies. (Sofo, 2010). Strength of

inquiry is based on social activity and its synergy (Sofo, Yeo, & Villafañe, 2010; Yeo &

Nation, 2010). Sofo, Yeo and Villafane (2010) stated their perspective in terms of social


context by the following: “Questioning is both an individual and social activity, but its

benefits are greater when it is embedded within the social context”(p.211). And its benefit

of collective inquiry in the social context is synergized by diversity among group members

(, 2010).

If inquiry process is helpful to understanding complex participants real world,

reflection is vital factor of learning. Sofo, Yeo and Villafane (2010) viewed that participants

reflection is drawn from powerful question. Reflection is cognitive process as well as

learning, creates a deeper awareness because it interpreted as “a type of disciplined

thinking about an experience that is relevant to problem solving and action taking”(Sofo,

Yeo, & Villafane, 2010, p.210). By the reflection process, learning is grounded (Chenhell &

Shermack, 2010) and motivated for future action (Cho & Egan, 2009). Cho and Egan (2010)

provided examples of reflective practice such as dialogue, problem exploration, system

thinking, individual and group process feedback, public reflection, break space, end-of-

course interview, and action learning conversation.

Action and Learning Balance Issue

Cho and Egan (2009) addressed asymmetry between action-oriented and balanced-

oriented action learning researches programs. Cho and Egan (2009) major argument is that

unbalanced action learning is not productive, and action learning is effective when related

to work applications. They assumed action learning programs have tendency toward

whether action- or learning-orientation. By a systematic literature review, Cho and Egan

(2009) identified 50 empirical studies whether it is action-oriented, learning-oriented, or

balanced. In order to examine the action learning tendency, they used a evaluation criteria


for comparison which consist of 8 items such as objective, problem, problem selection,

sponsor, implementation, learning coach, reflection.

Chenhall and Chermack’s Integrated Action Learning Model

Chenhall and Chermack (2010) suggested a integrated action learning model based

on the action learning group process systemic action learning cycle, and systemic action

learning spiral. This model has six major elements: (1) the structure of the integrated

model, (2) observation and reflection about each of the four models reviewed, (3) analysis

and research methodologies commonly used, (4) the inclusion of testing and evaluating, (5)

action, and (6) methods for research application. In this model, action learning cycle works

based on four phases of learning elements: (1) identity problem, (2) observe & reflect, (3)

analyze, and (4) plan & evaluate possible strategies.

Method

The purpose of this selective literature review is to explore precedent action

learning scholarship and to examine empirical action learning studies in health care sector.

Thus, the objectives are examination of (1) balance issue in action learning research papers

in health care sectors by Cho and Egan’s (2009) action learning balance criteria, and (2)

using Chanhall and Chermack’s (2010) action learning cycle in the integrative action

learning model’s. By systemic literature review, Cho and Egan (2009) provide rational

criteria for evaluating action learning research and program. However, in the broad range

of context, which element has tendency is vague. Also identifying in what stage of action

learning cycle, the balance issue happened provides valuable information that is direct to

evaluation of action learning research and program to researcher and practitioner. To

achieve these research objectives the matrix method and proxy document technique was


selectively used. The systematic literature review is used to conduct determination process

of the current state of scholarly literature in health care sector.

Search Process

The search strategy included primarily through searching electronic database such

as Business Source Premier database, ABI/INFORM, Applied social sciences index and

abstracts, ERIC, ProQuest, international bibliography of the social sciences, ProQuest

Nursing & Allied Health Source. The keywords and term, “medicine”, “action learning” was

used with the ‘Boolean Operation’, “NOT” and exclusive term such as “active leanring” in

order to acquire more subject related search result. In doing so, a total 227 research article

were identified.

Selection criteria

In order to leave subject related and research quality article that satisfy the examine

purpose, a criteria was used as an exclusion strategy. The articles had to satisfy the

following criteria: (1) empirical studies, (2) research article from peer-reviewed journal,

(3) articles that published between 1995 to 2012. Among the identified 227 articles,

editorial, non-research-based articles, and conceptual articles were excluded. As the result,

six research articles were included to examine in a perspective of action learning balance

issue and cycles.

The Matrix Method

Garrard’s (2011) the matrix method was implemented to examine the balance issue

of the action learning in health care sector. Garrard’s (2011) matrix method provide overall

systematic literature review guideline and protocol. The matrix method is hinged by its

matrix that is including author, year of publication, purpose of the study, conceptual


framework, participants, study design, analytic methods and finding. Overall systematic

literature review process observed Garrard’s (2011) matrix method’s protocol and

guideline. Synthesis process and criteria for analysis of the balance issue in action learning

was following Cho and Egan’s (2009) procedure. In Cho and Egan’s (2009) systemic

literature review, finding that describe whether action- and learning- oriented or balanced

context with [A], [L], [A/L] in a matrix was basis of the synthesis. In this paper, same

criteria were used to determine articles action learning balance issue.

Proxy Document Technique

Articles in the literature review have proxy document characteristics. Proxy

document is NVIVO’s tool that makes researcher to be enable to coding a segment of the

context and combine it as a theme over separated articles(Di Gregorio, 2000). Proxy

document technique enables to conduct systematic literature review and provide useful

tools.

Action Learning Balance Issue Evaluation Technique

In this paper, Action Learning Balance Issue Evaluation Technique is suggested. The

Action Learning Balance Issue Evaluation Technique is based on Cho and Egan’s action

learning criteria and proxy document technique. Garrard’s matrix method is the guideline

over the whole literature review process and produces research matrix. In the other hands,

proxy document technique plays as the practical tool for conducting systematic literature

review. Co-related contents segments were classified as the upper level theme or

categorized. In this paper, health care sector’s action learning balance issue was identified,

and then action learning cycle where the balance issue took place was identified by proxy

document technique.


Result

Overview

Total six research articles in the field of health care were identified from 227

searching result. Research articles attributes were various. First, the countries that the

research take place were Australia(2), U.K.(3) and U.S.(1). Qualitative and case studies

were each three and two article, there were one quantitative research. As the conceptual

framework, action learning, open space methodology, reflective process, action learning

set, cultureal fit, virtual action learning, effective leadership were identified. Various study

designs were identified such as open space methodology, participant observation, focus

group , questionnaire, summative reflective essay and interview

Balanced Action and Learning Issue and Action Learning Cycle

Four research articles were identified as balanced action learning [AL], and one

learning oriented [L] articles were identified as view of holistic perspective. Action learning

cycle phases were identified such as identity problem [I], observe & reflect [O], analyze [A],

and plan & evaluate [P]. This result is presented in appendix 1.

Learning-oriented study. Newton and Wilkinson (1995) describe how action

learning was delivered in Ashworth hospital. In this case study, action learning and cultural

fit was conceptual framework and participants were mangers on MDP program in

Ashworth hospital. As a methodology participant observation was implemented. In this

case study, described program was identified as learning oriented and its tendency was

revealed in observe & reflect phases. Heidari and Galvin’s (1995) study is a quantitative

research that using focus group and thematic analysis as analytic method. This study

purpose aims to identify four different styles of teaching reflection and acknowledged the


need for more training and cleaner guidelines for teachers and student. This study is

identified as learning oriented study. In this study, because the purpose of the study was

identifying different teaching reflection, participant were brought emergent individual

issues and implementation were more reference for decisions and future participants

Action and learning balanced study. Plack, Dunfee, Rindflesch and Driscoll (2008)

present a model for facilitating the reflective process in resolving real-world Issues in the

clinical setting. Conceptual framework of this study were virtual action leanring and

reflection. In this study, problem was selected in real-world issue and showed fully

recognized reflection process (Plack, Dunfee, Rindflesch, & Driscoll, 2008). This study use

summative reflective essay to examine action learning effectiveness and the data were

analyized by Chi-square test and contents analysis. Its balanced criteria item revealed in

identity problem, observe & reflected phase of action learning cycle. Harpur (2012)

described a case to use an action learning approach to use an action learning approach that

is use open space methodology and observation. In this study, learning coach’s role was

fully recognized. This balanced features presented in identify problem and observe &

reflect phases of action learning cycle. Lamont Brunero and Russell (2010) provided a

qualitative research. In this study, action learning set was used as a conceptual framework.

Objective were organizational problem solving and individual learning related and

reflection was led by learning coach. These action learning balanced characteristics is

revealed in identity problem, observe & reflect, and plan & evaluate possible strategies

stages in action learning cycle. Wilson (1999) conducted a case study to tell a story of how

members of different communities engaged in a development project. In this case study, a

small team of university researchers in laboratory medicine was investigated. To conduct


study interview and participants observation were used. In this study, its reflection process

and result showed its balanced feature in observe and reflect and plan &evaluate possible

strategies cycles.

Conclusion

Throughout literature of action learning, action learning definition and

characteristics were identified. Action learning is regarded as a team based tool and

process that implement balanced action and learning with collective critical inquiry to

solving participants’ practical problem in individual, team, and organization levels

{Marquardt 2010; Cho 2010; Yeo 2010; Sofo 2010; Marquardt 2010a; Chenhall 2010;

Revans 2011}. In this paper, action learning studies in health care sector were examined in

terms of balance issue and action learning cycle by Garrard’s (2011) matrix method and

proxy document technique.

.


References

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Appendices 1

Literature Review Matrix

NO

Lead author

Year Study type PurposeConceptual Framework

Participants Study designAnalytic methods

Finding

1 Harpur 2012 Case study

To use an action learning approach to encourage a group of executive leaders, responsible for the imple-mentation of a state health reform agenda

Action lean-ringOpen space methodology

16 selected partici-pant of significant leaders

Open space methodologyParticipant ob-servation

N/A AL/IO

2 Heidari 2003Qualitative study

To identify four differnt styles of teaching reflection and acknowl-edged the need for more training and clearer guidelines for teachers and student

Action learn-ingReflective process

Focus groups with among two cohorts of 288 students

Focus groupThematic analysis

L/IOP

3 Lamont 2010Qualitative evaluation study

To discuss the development of an action learning set within an acute mental health setting and evaluates the experience of participants within the set

Action lean-ring set

6 participants questionnaire N/A AL/IOP

4 Newton 1995 Case study

To describe how action learning was deliverd in their program and en-couraging more practitionar use ac-tion learning methodology

Action Learn-ingCultural fit

Managers on MDP in Ashworth Hospi-tal

Participant ob-servation

N/A L/OP

5 Plack 2008Quantitative study

To present a model for facilitating the reflective process in resolving real-world issues in the clinical set-ting

Virtual action learningReflection

Two groups of seven physical ther-apis students

Mixed modelsummative re-flective essay

Chi-square testContents analysis

AL/IO

6 Wilson 1999 Case study

To tell the story of how members of different communities engaged in a development project and to revisit the concepts of action learning and action research

Action learn-ing

A small team of uni-versity researchers in laboratory medicine

InterviewParticipants observation

N/A AL/OP

[First Authors Last Name]

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