Running head: Action Learning in Health Care Sector                           1                Selective Literature Review...
Running head: Action Learning in Health Care Sector                                            2                          ...
Running head: Action Learning in Health Care Sector                                             3      Selective Literatur...
Running head: Action Learning in Health Care Sector                                          4                            ...
Running head: Action Learning in Health Care Sector                                          5Table 1Action learning defin...
Running head: Action Learning in Health Care Sector                                          6intervention is that action ...
Running head: Action Learning in Health Care Sector                                          7of collective inquiry in the...
Running head: Action Learning in Health Care Sector                                           8       Chenhall and Chermac...
Running head: Action Learning in Health Care Sector                                           9       The search strategy ...
Running head: Action Learning in Health Care Sector                                        10was following Cho and Egan’s ...
Running head: Action Learning in Health Care Sector                                           11       Total six research ...
Running head: Action Learning in Health Care Sector                                          12teaching reflection, partic...
Running head: Action Learning in Health Care Sector                                       13and result showed its balanced...
Running head: Action Learning in Health Care Sector                                            14                         ...
Running head: Action Learning in Health Care Sector                                            15    Developing Human Reso...
Running head: Action Learning in Health Care Sector                                                            16         ...
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  1. 1. Running head: Action Learning in Health Care Sector 1 Selective Literature Review: Action Learning in Health Care Sector Chungil Chae Pennsylvania State University
  2. 2. Running head: Action Learning in Health Care Sector 2 AbstractIn spite of prevailing popularity of action learning research and practice, there arerelatively limited studies and interests in the health care sector. This asymmetry limitedour understanding in the characteristics of action of health care sector. Thus, the purposeof this selective literature review aim to explore action learning literature and to examineaction learning characteristics in the health care sector by implementing Cho and Egan’s(2009) balance issue criteria and Chenhall and Chermack’s integrated action learningmodel by Garrard’s matrix method and proxy document method with NVIVO software. Keywords: action learning, health care, matrix method, proxydocument
  3. 3. Running head: Action Learning in Health Care Sector 3 Selective Literature Review: Action Learning in Health Care Sector HRD practitioners in the United States are successfully utilizing Action Learning tohelp learners acquire knowledge through actual actions and practices rather than throughtraditional instruction (Marquardt, 2011). This form of knowledge acquisition is highlysuccessful and often preferred by learners where elevated precision of a complicatedprocedure and near perfect outcomes is expected. For example, hospital environmentsoften conduct resuscitation on patients experiencing severe cardiac arrest. Action learning has attracted attention over multidiscipline as a research subjectand intervention for learning and organization development(Cho & Egan, 2010; Marquardt& Banks, 2010; Waddill, Banks, & Marsh, 2010).Action learning’s strength and effectivenessis drawn from its fundamental philosophy, “there can be no learning without action and noaction without learning” (Revans, 1998, p.83). In spite of lack of unified definitions of actionlearning between action learning scholars, it is differentiates it from other learninginterventions by its effectiveness based on participants’ real-world problem and focus onquestions rather than solutions (Cho & Egan, 2010; Marquardt, Seng, & Goodson, 2010).Inthe health care sector, however, comparing with other sector such as business, education,nonprofit, and government, relatively limited researches and practice of action learningprogram has been.As the result, this asymmetry limits our understanding about how actionlearning is conducted and what different characteristics exist in the health caresector.Thus, in this literature review, the purpose of this selective literature review is toexplore precedent action learning scholarship and to examineempirical action learningstudies in health care sector with Garrard’s matrix methodology and proxy documenttechnique with NVIVO software.
  4. 4. Running head: Action Learning in Health Care Sector 4 Literature Review Ravans has regarded as the father or the most important contributor of actionlearning by majority of scholars (Chenhall & Chermack, 2010; Cho & Egan, 2009;Marquardt & Banks, 2010; Yeo & Nation, 2010; Zuber-Skerritt, 2002). In 1930s, Revansobserved a series of procedures that researchers in Cavendish share their problem andfacilitate each other by corresponding questions (Marquardt, 1999). In the 1940s, actionlearning was initiated when Revans introduced action learning in the coal-mines industryof Wales (Marquardt & Banks, 2010). Since then, action learning has diffused to othersectors and nations. As the result, 63% of all executive leadership programs in the UnitedStates was action learning (Marquardt, 1999).Definition and Conceptual Models Action learning definition differsbetween action learning scholars(Cho & Egan,2009). Zuber-serritt (1999) defined action learning as subordinate form or procedure ofaction research. Other researchers defined action learning as process of inquiry (MartineauandHannum, 2004) or a process of reflection (Dilworth and Willis, 2003).Sofo (2010)conceptualized action learning as sustainable and interpretive form of learningmethodology. Marquardt (2010) suggested a definition of action learning in manner ofincorporating action learning principles as the following; “Incorporating these principlesand the experiences of these action learning gurus, we define action learning as a processand tool that enable individuals and groups to learn while solving problems andimplementing actions” (p.160). These definitions of action learning were presented inTable 1
  5. 5. Running head: Action Learning in Health Care Sector 5Table 1Action learning definitionAuthors Definition of action learningZuber-Skerritt (1990) Subordinate of action researchDilworth and Willis (2003) A process of reflecting on ones work and beliefsMartineau and Hannum (2004) Collaborative inquiry process A process and tool that enable individuals and groups toMarquardt (2010) learn while solving problems and implementing actionsSofo (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 variousaction learning models. This literature briefly introduced the models. Gregory’s (1994)action learning group process model has a incorporated action learning and actionresearch models feature. Hicks and Peterson (1999) suggest a development pipeline actionlearning 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 inreal life. Paton (1996) suggests the systemic action learning cycle model that is based oncritical systems theory.Similarity and Difference with Other Concept Major similarity between the action learning and other learning concepts based onits common assumption as like Zuber-Skerrit (1994) stated, “knowledge can be gainedfrom concrete experience or action through observation of, and reflection”(p.441).Similarity and shared assumption between action learning and other learning conceptsoften leads people conclusion in vague perception of action learning boundary. Thedifference between action learning and other learning and organization development
  6. 6. Running head: Action Learning in Health Care Sector 6intervention is that action learning is due to action learning characteristics that actionlearning is focused on pragmatic basis (Cho & Egan, 2009), and is “framed by the urgency ofthe problems being worked on and the diversity of the group membership to producemultiple levels of situated practice” (Yeo & Nation, 2010, p.182). Gregory (1994a)distinguished action learning and action research by its usages such as action learning isregarded as a methodology but action research is described in terms of strategic method.Cho and Egan (2010) emphasized individual learning process as difference from actionresearch. Sofo and Villafane (2010) distinguished action learning difference from problem-based learning by the following, “In this respect, problem-based learning and actionlearning can handle similar levels of problem messiness, yet the action generated may bemore 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 actionlearning conceptual models and important factors that connect learning and action.Marquardt and Seng (2010) emphases inquiry process’s collective wisdom, “members areexpected to continuously tap into the collective wisdom of the group” (p.250). Also inquiryin action learning regarded as effective tool that present complex real-world problem andbecome beginning point for developing innovative strategies. (Sofo, 2010). Strength ofinquiry 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 socialcontext by the following: “Questioning is both an individual and social activity, but itsbenefits are greater when it is embedded within the social context”(p.211). And its benefit
  7. 7. Running head: Action Learning in Health Care Sector 7of 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 participantsreflection is drawn from powerful question. Reflection is cognitive process as well aslearning, creates a deeper awareness because it interpreted as “a type of disciplinedthinking 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 andEgan (2010) provided examples of reflective practice such as dialogue, problemexploration, 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 thatunbalanced action learning is not productive, and action learning is effective when relatedto work applications. They assumed action learning programs have tendency towardwhether action- or learning-orientation.By a systematic literature review, Cho and Egan(2009) identified50 empirical studies whether it is action-oriented, learning-oriented, orbalanced. In order to examine the action learning tendency, they used a evaluation criteriafor 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
  8. 8. Running head: Action Learning in Health Care Sector 8 Chenhall and Chermack (2010) suggested a integrated action learning model basedon the action learning group process systemic action learning cycle, and systemic actionlearning spiral. This model has six major elements: (1) the structure of the integratedmodel, (2) observation and reflection about each of the four models reviewed, (3) analysisand 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 worksbased 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 actionlearning 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 papersin 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 actionlearning model’s. By systemic literature review, Cho and Egan (2009) provide rationalcriteria for evaluating action learning research and program. However, in the broad rangeof context, which element has tendency is vague.Also identifying in what stage of actionlearning cycle, the balance issue happened provides valuable information that is direct toevaluation of action learning research and program to researcher and practitioner. Toachieve these research objectives the matrix method and proxy document technique wasselectively used. The systematic literature review is used to conduct determinationprocessof the current state of scholarly literature in health care sector.Search Process
  9. 9. Running head: Action Learning in Health Care Sector 9 The search strategy included primarily through searching electronic database suchas Business Source Premier database, ABI/INFORM, Applied social sciences index andabstracts, ERIC, ProQuest, international bibliography of the social sciences, ProQuestNursing & Allied Health Source. The keywords and term, “medicine”, “action learning” wasused with the ‘Boolean Operation’, “NOT” and exclusive term such as “active leanring” inorder to acquire more subject related search result. In doing so, a total 227 research articlewere identified.Selection criteria In order to leave subject related and research quality article that satisfy the examinepurpose, a criteria was used as an exclusion strategy. The articles had to satisfy thefollowing 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 balanceissue and cycles.The Matrix Method Garrard’s (2011) the matrix method was implemented to examine the balance issueof the action learning in health care sector. Garrard’s(2011) matrix method provide overallsystematic literature review guideline and protocol.The matrix method is hinged by itsmatrix that is including author, year of publication, purpose of the study, conceptualframework, participants, study design, analytic methods and finding. Overall systematicliterature review process observed Garrard’s (2011) matrix method’s protocol andguideline. Synthesis process and criteria for analysis of the balance issue in action learning
  10. 10. Running head: Action Learning in Health Care Sector 10was following Cho and Egan’s (2009) procedure. In Cho and Egan’s (2009) systemicliterature review, finding that describe whether action- and learning- oriented or balancedcontext with [A], [L], [A/L] in a matrix was basis of the synthesis. In this paper, samecriteria were used to determine articles action learning balance issue.Proxy Document Technique Articles in the literature review have proxy document characteristics. Proxydocument is NVIVO’s tool that makes researcher to be enable to coding a segment of thecontext and combine it as a theme over separated articles(Di Gregorio, 2000). Proxydocument technique enables to conduct systematic literature review and provide usefultools.Action Learning Balance Issue Evaluation Technique In this paper, Action Learning Balance Issue Evaluation Technique is suggested. TheAction Learning Balance Issue Evaluation Technique is based on Cho and Egan’s actionlearning criteria and proxy document technique. Garrard’s matrix method is the guidelineover the whole literature review process and produces research matrix. In the other hands,proxy document technique plays as the practical tool for conducting systematic literaturereview. Co-related contents segments were classified as the upper level theme orcategorized.In this paper, health care sector’s action learning balance issue wasidentified,and thenaction learning cycle where the balance issue took place was identifiedby proxy document technique. ResultOverview
  11. 11. Running head: Action Learning in Health Care Sector 11 Total six research articles in the field of health care were identified from 227searching result. Research articles attributes were various. First, the countries that theresearch take place were Australia(2), U.K.(3) and U.S.(1). Qualitative and case studieswere each three and two article, there were one quantitative research. As the conceptualframework, action learning, open space methodology, reflective process, action learningset, cultureal fit, virtual action learning, effective leadership were identified. Various studydesigns were identified such as open space methodology, participant observation, focusgroup , questionnaire, summative reflective essay and interviewBalanced Action and Learning Issue and Action Learning Cycle Four research articles were identified as balanced action learning [AL], and onelearning oriented [L] articles were identifiedas view of holistic perspective. Action learningcycle 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 learningwas delivered in Ashworth hospital. In this case study, action learning and cultural fit wasconceptual framework and participants were mangers on MDP program in Ashworthhospital. As a methodology participant observation was implemented. In this case study,described program was identified as learning oriented and its tendency was revealed inobserve & reflect phases. Heidari and Galvin’s (1995) study is a quantitative research thatusing focus group and thematic analysis as analytic method. This study purpose aims toidentify four different styles of teaching reflection and acknowledged the need for moretraining and cleaner guidelines for teachers and student. This study is identified as learningoriented study. In this study, because the purpose of the study was identifying different
  12. 12. Running head: Action Learning in Health Care Sector 12teaching reflection, participant were brought emergent individual issues andimplementation 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 theclinical setting. Conceptual framework of this study were virtual action leanring andreflection. In this study, problem wasselected in real-world issue and showed fullyrecognized reflection process (Plack, Dunfee, Rindflesch, & Driscoll, 2008). This study usesummative reflective essay to examine action learning effectiveness and the data wereanalyized by Chi-square test and contents analysis. Its balanced criteria item revealed inidentity 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 thatis use open space methodology and observation. In this study, learning coach’s role wasfully recognized. This balanced features presented in identify problem and observe &reflect phases of action learning cycle. Lamont Brunero and Russell (2010) provided aqualitative research. In this study, action learning set was used as a conceptual framework.Objective were organizational problem solving and individual learning related andreflection was led by learning coach. These action learning balanced characteristics isrevealed in identity problem, observe & reflect, and plan & evaluate possible strategiesstages in action learning cycle. Wilson (1999) conducted a case study to tell a story of howmembers of different communities engaged in a development project. In this case study, asmall team of university researchers in laboratory medicine was investigated. To conductstudy interview and participants observation were used. In this study, its reflection process
  13. 13. Running head: Action Learning in Health Care Sector 13and result showed its balanced feature in observe and reflect and plan &evaluate possiblestrategies cycles. Conclusion Throughout literature of action learning, action learning definition andcharacteristics were identified. Action learning is regarded as a team based tool andprocess that implement balanced action and learning with collective critical inquiry tosolving participants’ practical problem in individual, team, and organizationlevels{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 interms of balance issue and action learning cycle by Garrard’s (2011) matrix method andproxy document technique. .
  14. 14. Running head: Action Learning in Health Care Sector 14 ReferencesChenhall, E. C., &Chermack, T. J. (2010). Models, definitions, and outcome variables of action learning: A synthesis with implications for HRD. Journal of European Industrial Training, 34(7), 588-608. Retrieved from Google Scholar.Cho, Y., & Egan, T. M. (2010). The state of the art of action learning research.Advances in Developing Human Resources, 12(2), 163-180. Retrieved from Google Scholar.Di Gregorio, S. (2000). Using nvivo for your literature review. In STRATEGIES IN QUALITATIVE RESEARCH: ISUUES AND RESULTS FROM ANALYSIS USING QSR NVIVO AND NUD* IST, conference at the institute of education, london (pp. 29-30). Retrieved from Google Scholar.Garrard, J. (2011). Health sciences literature review made easy (3rd ed.). Jones & Bartlett. Retrieved from Google Scholar.Harpur, S. M. A. (2012). Leadership collaboration during health reform: An action learning approach with an interagency group of executives in tasmania. Australian Health Review, 36(2), 136-9.doi:10.1186/1743-8462-5-22 10.1111/j.1467-8500.2004.00356.x 10.1108/17511870810845860 10.1186/1472-6963-9-162 10.1136/bmj.326.7390.649 10.1080/0194436690 8977225Heidari, F., & Galvin, K. (2003). Action learning groups: Can they help students develop their knowledge and skills? Nurse Education in Practice, 3(1), 49-55. doi:, S., Brunero, S., & Russell, R. (2010). An exploratory evaluation of an action learning set within a mental health service. Nurse Education in Practice, 10(5), 298-302.Marquardt, M., & Banks, S. (2010). Theory to practice: Action learning. Advances in
  15. 15. Running head: Action Learning in Health Care Sector 15 Developing Human Resources, 12(2), 159-162. Retrieved from Google Scholar.Marquardt, M., Seng, N. C., & Goodson, H. (2010).Team development via action learning.Advances in Developing Human Resources, 12(2), 241-259. Retrieved from Google Scholar.Newton, R., & Wilkinson, M. J. (1995). When the talking is over: Using action learning. Health Manpower Management, 21(1), 34-34.Plack, M. M. P. T. E., Dunfee, H., Rindflesch, A., & Driscoll, M. (2008). Virtual action learning sets: A model for facilitating reflection in the clinical setting. Journal of Physical Therapy Education, 22(3), 33-42.Revans, R. (2011). ABC of action learning.Gower Publishing Company. Retrieved from Google Scholar.Sofo, F., Yeo, R. K., &Villafañe, J. (2010). Optimizing the learning in action learning: Reflective questions, levels of learning, and coaching. Advances in Developing Human Resources, 12(2), 205-224. Retrieved from Google Scholar.Waddill, D., Banks, S., & Marsh, C. (2010). The future of action learning.Advances in Developing Human Resources, 12(2), 260-279. Retrieved from Google Scholar.Wilson, V. (1999). Action learning: A "highbrow smash and grab" activity? Career Development International, 4(1), 5-10.Yeo, R. K., & Nation, U. E. (2010). Optimizing the action in action learning: Urgent problems, diversified group membership, and commitment to action. Advances in Developing Human Resources, 12(2), 181-204. Retrieved from Google Scholar.
  16. 16. Running head: Action Learning in Health Care Sector 16 Appendices 1Literature Review Matrix Lead Conceptual AnalyticNO Year Study type Purpose Participants Study design Finding author Framework methods To use an action learning approach Action Open space to encourage a group of executive 16 selected leanring methodology 1 Harpur 2012 Case study leaders, responsible for the participant of N/A AL/IO Open space Participant implementation of a state health significant leaders methodology observation reform agenda To identify four differnt styles of Action teaching reflection and Focus groups with Qualitative learning Thematic 2 Heidari 2003 acknowledged the need for more among two cohorts Focus group L/IOP study Reflective analysis training and clearer guidelines for of 288 students process teachers and student To discuss the development of an Qualitative action learning set within an acute Action 3 Lamont 2010 evaluation mental health setting and evaluates 6 participants questionnaire N/A AL/IOP leanring set study the experience of participants within the set To describe how action learning was Action Managers on MDP deliverd in their program and Participant 4 Newton 1995 Case study Learning in Ashworth N/A L/OP encouraging more practitionar use observation Cultural fit Hospital action learning methodology Chi- To present a model for facilitating Virtual action Two groups of Mixed model square Quantitative the reflective process in resolving 5 Plack 2008 learning seven physical summative test AL/IO study real-world issues in the clinical Reflection therapis students reflective essay Contents setting analysis To tell the story of how members of A small team of different communities engaged in a Interview Action university 6 Wilson 1999 Case study development project and to revisit Participants N/A AL/OP learning researchers in the concepts of action learning and observation laboratory medicine action research
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