This document provides a literature review on action learning in the health care sector. It discusses several key points: 1) It reviews foundational literature on action learning and prominent models. It finds definitions and models vary but focus on learning through solving real-world problems. 2) It examines similarities and differences between action learning and other learning concepts, finding a focus on pragmatic problem-solving distinguishes action learning. 3) Inquiry and reflection are identified as important processes that connect learning to action in action learning. Questioning and reflection help participants learn from experiences. 4) The paper evaluates studies on balance between action and learning in action learning programs using criteria from Cho and Egan. Most studies on health

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. Running head: Action Learning in Health Care Sector 2
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

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 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 examineempirical action learning
studies in health care sector with Garrard’s matrix methodology and proxy document
technique with NVIVO software.

4. Running head: Action Learning in Health Care Sector 4
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 differsbetween 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
andHannum, 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

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Table 1
Action learning definition
Authors Definition of action learning
Zuber-Skerritt (1990) Subordinate of action research
Dilworth and Willis (2003) A process of reflecting on one's work and beliefs
Martineau and Hannum (2004) Collaborative inquiry process
A process and tool that enable individuals and groups to
Marquardt (2010)
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

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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

7. Running head: Action Learning in Health Care Sector 7
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) identified50 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

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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
processof the current state of scholarly literature in health care sector.
Search Process

9. Running head: Action Learning in Health Care Sector 9
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

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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 thenaction learning cycle where the balance issue took place was identified
by proxy document technique.
Result
Overview

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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 identifiedas 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

12. Running head: Action Learning in Health Care Sector 12
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 wasselected 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

13. Running head: Action Learning in Health Care Sector 13
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.
.

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16. Running head: Action Learning in Health Care Sector 16
Appendices 1
Literature Review Matrix
Lead Conceptual Analytic
NO 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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