The use of action learning in a higher education setting to improve the quality of healthcare Practice Paper Professor Naomi Chambers Manchester Business School EHMA Conference in Lahti, Finland 1 July 2010

Summary Action learning principles & approach Action learning and healthcare management programmes Methods of evaluating impact Findings from evaluations Focus for further action & learning

Background & principles Reg Revans - ‘father’ of action learning Learning > Change Action learning = f(p,q) (p = programmed knowledge q = questioning insight) No learning without action, and no (sober and deliberate) action without learning Support and challenge for intractable problems

Approach Main vehicle is the ‘set’ of 6-8 people Members present issues which they have interest & authority to take action on Membership of the set remains constant for 4 + meetings over 9 + months Set meetings last from 2 hours – 1 day With / without a facilitator ‘Open’ questioning, learning from programmed knowledge, taking action from new insights, & reflection are at the heart of the work of the set

Examples Scientific discoveries in academic setting (University of Cambridge in 1920s) Reconstruction of a post war economy (Belgium) Discovery and development of new drugs in multinational pharmaceutical company Leadership programme for a global security solutions organisation

Action learning & examples in health care UK NHS chief executive learning sets Fast track UK NHS graduate management training scheme Developing and embedding innovation and service improvement tools and approaches Masters degree in healthcare management

Role of the higher education institution/university/ business school Programme design Provision of facilitation for action learning sets Hub for action learning research and practice (cf Revans Academy for Action Learning at Manchester Business School)

Methods of evaluating impact CASIL framework: completion, adoption, spread, impact & learning ( from NHS Institute for Innovation & Improvement) Kirkpatrick model: reaction, learning, behaviour & results Ethnographic approach: experiencing a programme and capturing process using participative enquiry

Findings from evaluations (1) Graduate management scheme ( n= 60) Improvements in working relationships with peers, managers and managed staff Support in managing conflict Built personal confidence & resilience Knowledge sharing to address problems Importance of skilled facilitation Many sets still meeting after programme end

Findings from evaluations (2) Action Learning for Improvement in the NHS (n=45) Support for specific problem-solving Space and ‘permission’ to think & act differently / reframe ( exploration as well as exploitation of knowledge) Built personal confidence and resilience Importance of skilled facilitation

Findings from evaluations (3) Masters degree in Healthcare Management (n=7) The process of AL mimics group problem solving in the workplace more so than the traditional learning methods found in universities Helps to ice break within the set and also across the MSc group of 40 students The facilitator moves the discussion within the set forward but does not interfere with the content of the discussion The very wide mix of the set is perceived as a strength – 7 people, 5 countries, 6 full time students, 1 part time student

Focus for further action & learning Role of the facilitator Part played by AL in building personal resilience Potential for the approach to develop empathetic working relationships Connections with & learning from allied approaches eg problem-based learning, appreciative inquiry, peer coaching, action research etc

Acknowledgements & Reference Elaine Clark, Lawrence Benson, Liz Smith, Mandy Shephard have all made significant contributions to this area of work for more information about the Revans Academy for Action Learning at Manchester Business School Revans R (1982) The Origins and Growth of Action Learning. Bromley:Chartwell Bratt