The general improvement from baseline to completion for Intervention participation (that was calculated from 35 to 67%), reinforces the idea that individuals within communities of practice can facilitate and strengthen collective learning [19]. Importantly, qualitative data from participants demonstrates that data collection processes and methods, whether intervention or control arm, provided learners with conducive conditions and a safe place to face anxieties of real-world problem solving, enabling reflection and subsequent personal and professional development [20,21,22].
Each participant, whether in the Control or Intervention arm of the study, used his or her own lived experience [23] applying interpretative analysis [24] to improve individual professional competency [25].Through the process of action learning and participatory practice-based research [26], individual knowledge and know-how was able to be expressed, perceptions and assessments of “self” and “organisation” were legitimised, ensuring that action planning for improvement was fully contextualised [27, 28]. This facilitates and contributes to bridging the gap between knowing what and knowing how to convert theory into practice [29]. The combination of iterative process and action of transferring knowledge into practice is a prime example of the SECI [30] model in action which addresses the needs of both individual and organisation in terms of improving knowledge, skills, and confidence to deliver an important clinical service at perhaps one of the most challenging times of life.
Relevance to organisational learning
The results of the study also suggest organisational learning may be strengthened by the notion of transformational, intra-, and inter-organisational learning, which resonates with learners and those designing learning for meaningful and demonstrable change. Thus, action learning can be perceived to have utility as both a method and a process for healthcare professionals, their line managers, service-design professionals and ultimately service-users. Successful transformative learning from effective communication skills can only occur within organisations and across systems by bringing together the needs and expectations of these diverse stakeholders [26, 31].
Utility and impact of measures and approaches
Learning from exploration and innovation is most likely to take place within a culture that values knowledge and innovation [32] and necessarily involves the discomfort of experiencing uncertainties, risks and ambiguities associated with iterative processes of potential change [33]. The type of learning occurring within the research is indicative of the double-loop learning [34] that utilises reflection on the learning process itself. This is evidenced by participants consistently describing their satisfaction with the process and its feasibility in seeking to determine insight. This indicates a shift from explicit knowledge to tacit and implicit knowledge [35, 36]. This is the point at which learning becomes “transformational” [37, 38] as underlying patterns of thinking change shape and lead to an informed change in behaviour, as evidenced by perception from some participants. When transformational learning occurs from individuals to their environments, this can act as a catalyst for the direction of knowledge to change, and its outcomes become more securely integrated into existing and new knowledge sets within specialised communities of professional practice [39]. Using knowledge and experience of participants from their own professional clinical practice as a foundation, a collective competence in communication skills may have formed the basis of a professional identity with specific insights found from the data [40].
The importance of coaching within action learning and reflexivity
It has been said that coaching is informed by, and utilises a set of psycho-dynamic, goal-seeking and solution-focused principles [41,42,43] and that the coaching relationship is “one in which coach and coachee form a collaborative working alliance, articulate goals and develop specific action steps designed to facilitate goal attainment.” [42] Findings from this study arising from telephone-based coaching sessions are evidence of a strong behavioural solution-focused approach, with participants planning and executing actions, reflecting, and viewing success and continuing to evaluate next steps in the execution of professional duties. The ability to engage in constructive-style thinking of solutions is of particular importance when working in organisations that are in a state of flux and change [44]. Although the focus was not strictly connected with resilience, dealing with setbacks, and feeling an increased sense of personal mastery as challenges began to be overcome. This appeared to be an additional value-added benefit of coaching, which can also help to reduce general anxiety and stress, as seen in feedback from Intervention participants [45, 46]. Additionally, data from coaches’ perspectives triangulates well with participants’ perceptions, with coaches agreeing that, although variable, participants generally demonstrated a positive attitude to receiving coaching and held its value in high esteem. This is despite logistical challenges with diary availability and the relatively short time space for delivery (30 min). Even with differences in personal coaching styles and the experience in providing the intervention to participants, there is a positive appetite for the utility and feasibility of this type of action learning approach.
Limitations of the study
There is often a risk that participants do not report behaviour fully or accurately [47, 48] and that participants from this sample population could easily demonstrate natural tendencies to “problem solve” rather than “learn though the process.” [49] Equally, the purpose and perceived benefits to participants in using this research to strengthen individual performance, calibre, and visibility [50] may have been intentional for those who consented to the study. Although 100% response rate can be illustrated at baseline (T0) and at the beginning of T1, limited numbers completed the study; in the Control group, 1 completed all three time points (T1-T3) and 1 withdrew after submitting data at T2, so final response rate was 16.67%. In Intervention Group, 3 completed all time-points, T1, T2, T3 (50% response rate). Following intervention, at T4, 4 participants remained, and were interviewed, thus overall 33% response rate for participants was recorded. Although coaches were also interviewed for their perceptions, these are not included as “participants.”
Given the lack of time and conflict with professional duties, agreeing to participate in this study may have compromised reflexive effort for some participants, and this may have been part of the reason for the numbers withdrawing or “lost to study” but without further investigation, this assumption cannot be proven. Other factors may have also contributed to the success (or otherwise) of levels and nature of completion rates. For example, the research study may have appealed to the personality and preferred learning styles of participants [5]. Participants with a more reflexive preference may have been more motivated to join a study offering these opportunities, or those without may have been deterred from engaging in such activities. Although the research was conducted according to ethical standards, utilising a consistent approach to data collection methods and processes, it is difficult to establish if non-verbal communication encouraged a skewed response to demonstrate a favourable response to the research in question. Without independently assessing researcher and/or participant bias, reliability and validity [51] cannot therefore be fully established.
