Why (we think) facilitation works: insights from organizational learning theory.

Carole A. Estabrooks,James W. Dearing,Whitney Berta,Janet E. Squires,Lisa Cranley,Elizabeth J. Dogherty

doi:10.1186/s13012-015-0323-0

Abstract

BackgroundFacilitation is a guided interactional process that has been popularized in health care. Its popularity arises from its potential to support uptake and application of scientific knowledge that stands to improve clinical and managerial decision-making, practice, and ultimately patient outcomes and organizational performance. While this popular concept has garnered attention in health services research, we know that both the content of facilitation and its impact on knowledge implementation vary. The basis of this variation is poorly understood, and understanding is hampered by a lack of conceptual clarity.DiscussionIn this paper, we argue that our understanding of facilitation and its effects is limited in part by a lack of clear theoretical grounding. We propose a theoretical home for facilitation in organizational learning theory. Referring to extant literature on facilitation and drawing on theoretical literature, we discuss the features of facilitation that suggest its role in contributing to learning capacity. We describe how facilitation may contribute to generating knowledge about the application of new scientific knowledge in health-care organizations.SummaryFacilitation’s promise, we suggest, lies in its potential to stimulate higher-order learning in organizations through experimenting with, generating learning about, and sustaining small-scale adaptations to organizational processes and work routines. The varied effectiveness of facilitation observed in the literature is associated with the presence or absence of factors known to influence organizational learning, since facilitation itself appears to act as a learning mechanism. We offer propositions regarding the relationships between facilitation processes and key organizational learning concepts that have the potential to guide future work to further our understanding of the role that facilitation plays in learning and knowledge generation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0323-0) contains supplementary material, which is available to authorized users.

Highlights

DiscussionWe argue that our understanding of facilitation and its effects is limited in part by a lack of clear theoretical grounding
Facilitation is a guided interactional process that has been popularized in health care
We offer propositions regarding the relationships between facilitation processes and key organizational learning concepts that have the potential to guide future work to further our understanding of the role that facilitation plays in learning and knowledge generation

Summary

Discussion

Facilitation defined and redefined as meta-routines Here, we extend our description of facilitation and describe work in health care that highlights its intended function in organizational practice and performance improvement initiatives. Proposition 6: Facilitation micro-processes and activities (establishing effective communication channels, empowering staff, promoting positive changes in culture or climate, and creating a vision that embraces evidence-based practice) comprise internal absorptive capacity meta-routines for sharing knowledge and superior practices across the organization. Proposition 8: Facilitation micro-processes and activities (creating a vision that embraces evidence-based practice, promoting a culture for positive change, creating a supportive local climate) comprise internal absorptive capacity meta-routines for managing adaptive tension. Future work to explore these propositions will contribute a deeper, more nuanced understanding of facilitation’s role in research implementation and in generating learning and knowledge associated with introducing new scientific evidence Work of this nature would go some way toward realizing the promise of scientific evidence for improving clinical and managerial practices and patient outcomes and organizational performance.

Background