title: Why (we think) facilitation works: insights from organizational learning theory.
abstract: BACKGROUND
  Facilitation 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.
  
  
  CONCLUSIONS
  In 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. Facilitation'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.
authors.affiliation: Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada. whit.berta@utoronto.ca.
authors.forename: Whitney
authors.initials: W
authors.lastname: Berta
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. lisa.cranley@utoronto.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cranley
authors.affiliation: College for Communication Arts & Sciences, Michigan State University, East Lansing, Michigan, USA. dearjim@msu.edu.
authors.forename: James W
authors.initials: JW
authors.lastname: Dearing
authors.affiliation: St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada. Elizabeth.dogherty@queensu.ca.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Dogherty
authors.affiliation: School of Nursing, University of Ottawa, Ottawa, Canada. jasquires@ohri.ca.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Squires
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. cestabro@ualberta.ca.
authors.forename: Carole A
authors.initials: CA
authors.lastname: Estabrooks
mesh_terms: D004059:Diffusion of Innovation; D006302:Health Services Research; D006801:Humans; D007858:Learning; D009936:Organizational Innovation; D011340:Problem Solving