Action learning and healthcare

Action learning has long had a symbiotic relationship with healthcare. Revans, in his early study of staff communications at Manchester Royal Infirmary (1964), built on the work of Menzies-Lyth (1959) and described a hospital as an ‘institution cradled in anxiety’. He went on in the late 1960s and early 1970s to work with 10 London teaching hospitals in the Hospital Internal Communications (HIC) project (Revans 1982a) which may have been the first Organisation Development intervention in the UK’s National Health Service (Edmonstone 2022). The HIC project was the subject of extensive external and internal evaluation (Wieland and Leigh 1971; Wieland 1981; Revans 1972) and led, in turn, to another major project concerned with the multi-agency coordination of services for people with learning disabilities from 1969 to 1972 (Brook 2020; Revans 1982b; Revans and Baquer 1972).

However, it was not until the current century that the use of action learning in healthcare became more widespread. A cursory study of published journal articles on this subject from 1972 (the year that action learning was ‘clarified in both content and form’ (Boshyk 2019) to 1999 (a period of 26 years) identifies some 32 articles, while the period 2000–2021 (some 21 years) provides 173, many of which have featured in this journal. The applications of action learning are especially pronounced in relation to leadership development in different contexts (Scowcroft 2005; McCray, Warwick, and Palmer 2018) and include:

• A planned and timetabled activity interwoven with other more formal aspects of a leadership programme, with the action learning set either ceasing at the end of the programme or being encouraged to continue in a self-managed fashion for as long as set members derive benefits.

• An activity introduced towards the end of a formal programme, with the programme organisers’ anticipation that participants would form sets as a way of continuing their development, so bridging the potential divide between the programme and the work setting.

• A discrete development activity in its own right, neither relying on, nor continuing the momentum of, a formal programme, but often focused on support for people in newly-emergent roles.

Action learning has featured in the professional fields of medicine, nursing, midwifery, health promotion, public health, mental health and learning disability, with more generic applications in such fields as multi-agency working, practice development, primary care, clinical governance, information technology and knowledge management (Edmonstone 2018).

It has been suggested (Edmonstone 2008) that the attractiveness of action learning in healthcare is due to:

• Its ability to release or reawaken personal energy and enthusiasm within healthcare professionals and to foster the solidarity that peer support and critique generate.

• The sense of balance and perspective that it offers set members in making personal and organisational choices.

• The fostering of a democratic ethos which runs counter to the traditional inter-professional ‘pecking-order’, thus serving to promote multi-professional teamwork.

More generally, the attractiveness may relate to Claxton’s (2021) assertion that learning is a moral and ethical business and not just a technical one. This, in turn, seems rooted in Zuboff’s (2019) concept of modernities. The first of these being located in the late nineteenth and early twentieth centuries, as globalisation and migration became increasingly common and where life became gradually more individualised for greater numbers of people as they separated away from their historical and traditional social norms, meaning and rules. Each individual life became instead an open-ended reality to be discovered, rather than a pre-defined certainty to be enacted. People became convinced that they could begin to shape the kind of person that they wanted to be and the kind of life that they wanted to live.

The second modernity dates roughly from after the Second World War and was stimulated by democratic politics, distributional economic policies (especially progressive taxation) an increased investment in, and access to, education, health and social care and by the creation and enhancement of strong civil society institutions (Piketty 2014). It was part of an ethos which emphasised a need to rebuild, reorganise and manage a new post-war world and stressed the importance of the common good above individual gain. Increasing numbers of people gained access to those experiences which had once been solely the preserve of a tiny social elite – university education, increased life expectancy, disposable income, rising living standards, domestic and foreign travel, access to consumer goods and intellectually demanding work. Action learning is clearly an outgrowth of, and has its roots in, this second modernity.

In this section of the journal the use of action learning in healthcare reveals its relevance at both individual and organisational levels.

George Boak conducted a literature review of peer-reviewed journals on action learning between 2011 and 2022 and identified a variety of benefits derived from various action learning projects in a range of situations and for a range of purposes. The balance between immediate service improvement and longer-term learning and development, the importance of networking and the necessity of seeking and obtaining support for change efforts resulting from action learning projects are all highlighted.

Five members of the journal’s Editorial Board (and experienced action learning facilitators) shared their experience of both affinities (processes that support the use of action learning in healthcare) and challenges (difficulties and disablers), identifying a range of themes. Of the enabling activities reflective practice, professional supervision, multi-professional team working, critical action learning and an emphasis on improvement in services for patients all featured. The more negative elements which emerged included workload and staffing, inter-professional pecking orders, a preference for individual rather than system-wide issues and the perception of action learning as simply a technique, rather than also as an ethos.

Pauline Joyce’s account of practice demonstrates how action learning can be used as part of the supervisory process for quality improvement projects, with an emphasis on how the questioning approach central to action learning links with a communication model used to guide medical interviews.

Jackie Kilbane and colleagues’ account of practice describes how an action learning set features as part of a blended learning MSc in Healthcare Leadership programme run jointly by two UK higher education institutions, including such aspects as set formation and building trust – and includes reflections on the experience from set members and the set facilitator.

Toby Lindsay’s account of practice focuses on learning derived from a co-designed leadership development programme for allied health professionals across two integrated health and social care systems.

Ten years ago Kathryn Winterburn jointly wrote a paper in this journal (Winterburn and Hicks 2012) on the innovative use of action learning as part of a pilot education programme with doctors striving to improve end-of-life care. In this issue Kathryn revisits the programme and its successors 10 years on and reveals how changing organisational structures and priorities, together with default habits, an emphasis on immediate results and short-term remedies and a didactic preference in clinical education all combine to make action learning still seem something of an anomaly in some healthcare settings.