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8/13/2019 Experiences From Employees With Team Learning in a Vocational
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Review
Experiences from employees with team learning in a vocational
learning or work setting: A systematic review of qualitative
evidence
K. Hannes a,, E. Raes b, K. Vangenechten a, M. Heyvaert a, F. Dochy b
a Methodology of Educational Sciences Research Group, KU Leuven, Belgiumb Professional Learning and Development, Corporate Training and Lifelong Learning Research Group, KU Leuven, Belgium
a r t i c l e i n f o
Article history:
Received 22 November 2012
Revised 2 August 2013
Accepted 5 October 2013
Available online 24 October 2013
Keywords:
Team learning
Vocational learning
Employees
Qualitative evidence synthesis
Systematic review
a b s t r a c t
This qualitative evidence synthesis aimed to integrate findings on the experiences of
employees with team learning in the context of their work or vocational learning setting.
The meta-aggregative approach to qualitative evidence synthesis was used to summarize
the findings from original research papers in which the experiential level of employees
was investigated. The findings suggest that employees learn for different reasons and in
different ways. Three major lines of actions for practice and policy were developed from
the synthesis. A first advice is to stimulate communication, boundary crossing and knowl-
edge sharing and establish an enabling learning environment that triggers positive factors
for team learning. Secondly, it is important to analyse the authority structures that influ-
ence the relationships within a team, minimise the power inequalities that flow from hier-
archical differences, and support and enable team leaders to influence the power
differences inside their team. Finally, it is recommended to try to recognise the authentic-
ity, the commitment and devotion of employees toward team learning, to stimulate but not
to intervene in the natural process of team learning, and to consider the place of reflection
and action in this process.
2013 Elsevier Ltd. All rights reserved.
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
1.1. Review questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
1.2. Defining the main concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
1.2.1. Teams or groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
1.2.2. Team learning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1182. Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
2.1. Search strategy for identification of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
2.2. Criteria for considering studies in this review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
2.2.1. Type of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
2.2.2. Type of participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
2.2.3. Type of outcome measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
2.3. Critical appraisal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
1747-938X/$ - see front matter 2013 Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.edurev.2013.10.002
Corresponding author. Address: Methods of Educational Sciences Research Group, KU Leuven, Andreas Vesaliusstraat 2, 3000 Leuven, Belgium. Tel.: +32
16 32 62 20.
E-mail address: [email protected](K. Hannes).
Educational Research Review 10 (2013) 116132
Contents lists available at ScienceDirect
Educational Research Review
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l oc a t e / E D U R E V
http://dx.doi.org/10.1016/j.edurev.2013.10.002mailto:[email protected]://dx.doi.org/10.1016/j.edurev.2013.10.002http://www.sciencedirect.com/science/journal/1747938Xhttp://www.elsevier.com/locate/EDUREVhttp://www.elsevier.com/locate/EDUREVhttp://www.sciencedirect.com/science/journal/1747938Xhttp://dx.doi.org/10.1016/j.edurev.2013.10.002mailto:[email protected]://dx.doi.org/10.1016/j.edurev.2013.10.002http://-/?-http://crossmark.crossref.org/dialog/?doi=10.1016/j.edurev.2013.10.002&domain=pdf8/13/2019 Experiences From Employees With Team Learning in a Vocational
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2.4. Data extraction and synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
3. Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
3.1. Synthesis 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
3.2. Synthesis 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
3.3. Synthesis 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
4. Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
4.1. Implications for practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
4.2. Research limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
4.3. Implications for future research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
1. Introduction
Effectiveness, efficiency and innovation have become key factors to the survival of modern organisations (Cameron, 1986;
Davenport & Prusak, 1998). Teams are increasingly expected to generate effective and efficient results (Sessa & London,
2008). As a consequence, the responsibility of teams for the workload within and the output of an organisation has grown
(Devine, Clayton, Philips, Dunford, & Melner, 1999). In order to be competitive in a changing environment, organisations as
well as their employees should engage in a process of continuous learning (Edmondson, 2002; Sessa & London, 2008). Apart
from stimulating individual learning (Slavin, 1996; Sweet & Michaelsen, 2007), it increases a teams effectiveness (Crossan,Lane, White & Djurfeldt, 1995; Van den Bossche, Gijselaers, Segers, & Kirschner, 2006; West, 1999) and contributes to organ-
isational learning and innovation (Crossan, Lane & White, 1999).
The concept of team learning needs to be considered with caution, as it means different things to different people in
different situations. It has frequently been investigated from a conceptual point of view (Decuyper, Dochy, & Van den
Bossche, 2010; Senge, 1990; Sessa & London, 2006). Several researchers have defined team learning as a group level phe-
nomenon that generates potential beneficial effects (Dillenbourg, Baker, Blaye, & OMalley, 1996). The strong focus on
effectiveness is mostly driven by the need to think in terms of performance outcomes of team members. It has been
criticised by Decuyper and colleagues (2010), who argue that going beyond inputs and outputs, in explicitly focusing
on team learning processes, is important in understanding why team learning outputs occur. Establishing a firm causal
link between those who have been subject to team learning processes and their actual performance is still challenging.
Allen and Hecht (2004), in their study on the romance of teams, showed that teams are not as effective as many per-
ceive them to be. According to the authors, the attraction of team work is not based on actual performance benefits, but
rather on psychological ones. First, there are socio-emotional benefits from being involved in a team: reduced uncer-tainty about the work, increased satisfaction and fulfilment of social needs. Second, managers, employees and lay per-
sons may also gain some competence-related benefits, such as an increased personal responsibility for the success of the
team, decreased personal responsibility for team failures and higher self-evaluations of individual and group perfor-
mance. There are several other aspects that may impact on employees actual performance: the meaningfulness they as-
sign to team learning, whether or not they believe the learning processes they are involved in are appropriate or feasible
etc. This seems to suggest that in order to better understand the why and how of team learning it is important to look
into how team learning is experienced by its group members.
Qualitative research evidence on the lived experiences of stakeholders with team learning has not yet systematically been
synthesized. It is nevertheless important to consider, mainly because the perceptions of employees can increase our under-
standing of why certain team learning processes fail or succeed, what employees value in team learning and what may need
to be adapted for a more successful implementation of team learning programs.
1.1. Review questions
The main research question we address in this qualitative evidence synthesis (QES) with team learning as our main topic
of interest is: How is team learning experienced by employees? We investigate the meaning of team learning, inventory the
overall opinions and beliefs about team learning, and identify potential positive and negative aspects of team learning. A sec-
ondary question we address is: Which implications for team learning practice and team learning policy can be drawn from
the synthesized findings? Our implication for practice and policy section in this review will be grounded in the suggestions
for improvement that have been offered by employees in the original studies as well as our own understanding and insights
derived from synthesizing the findings of these studies.
1.2. Defining the main concepts
One of the important features of a QES is that it attempts to synthesize findings from original, qualitative studies in order
to create a new understanding or develop lines of actions for practice and policy. It compares and contrasts the content of
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several original research articles in order to develop overarching descriptions that build on the meaning employees assign to
team learning. We considered it beneficial to work with an unambiguous and understandable definition of teams and team
learning to develop a transparent set of inclusion- and exclusion criteria for our review. In what follows, we will draw on
previous research in order to conceptualise teams and team learning for our review.
1.2.1. Teams or groups
The words team and group are frequently used as synonyms, however not always clearly defined. They are often said
to even suggest different meanings. For many, team connotes more than group, namely that groups become teams when
they develop a sense of shared commitment and strive for synergy among members (Katzenbach & Smith, 1993). Firth-
Cozens (1998) argues that spelling out the criteria that makes a team does not always help the recognition of where a team
begins and ends, who is a member and who is not, how much overlap between teams is useful and how much is divisive. A
variety of very similar definitions can be found in the literature (e.g., Guzzo & Dickson, 1996; Hackman, 1987). In line with
other authors (e.g., Boon, Raes, Kyndt, & Dochy, 2013; Decuyper et al., 2010; Devine, 2002) we choose to follow the definition
ofCohen and Bailey (1997)because to our opinion it entails all the important aspects of the definitions developed by other
authors. The focus in this definition is on five applicable and straightforward criteria that distinguish a team from a group of
people and are therefore convenient to integrate in a screening checklist evaluating the eligibility of studies for inclusion:
A team is a collection of individuals who are (1) interdependent in their tasks, (2) who share responsibility for outcomes,
(3) who see themselves and who are seen by others as an intact social entity embedded in one or more larger social sys-
tems (for example, business unit or the corporation), (5) and who manage their relationships across organizational
boundaries (Cohen & Bailey, 1997, p. 241).
1.2.2. Team learning
The current literature proposes over 30 different definitions and theoretical frameworks on team learning that are
currently used and applied to frame research studies (Decuyper et al., 2010).Senge (1990)originally defined team learn-
ing as the process of aligning and developing the capacity of a team to create the results its members truly desire(p. 236).
The definition of Decuyper et al. (2010) is the result of a systematic review of the team learning literature. It is integra-
tive and a clear and practical conceptualisation of team learning. We therefore adopted this working definition for the
review:
Team learning is a compilation of team-level processes that circularly generate change or improvement for teams, team
members, organizations, etc. Being a compilation, it consists of changing combinations of different types of processes
(sharing, co-construction, constructive conflict, team reflexivity, boundary crossing, team activity, storage and retrieval).
Working circularly, it dynamically translates a complex body of influences from multiple levels into different types of out-
puts at multiple levels, which in turn influence team learning ( Decuyper et al., 2010, p. 128).
2. Methodology
A lot of different methods for QES have recently been developed and reported on (Dixon-Woods, Agarwal, Jones, Young,
Sutton, 2005; Hannes & Lockwood, 2012). We opted for the Joanna Briggs meta-aggregative approach to synthesis, designed
to mirror the procedures used in the systematic review and meta-analysis of randomized controlled trials and other quan-
titative research (Pearson, Robertson-Malt & Rittenmeyer, 2011). Meta-aggregation takes an inclusive approach to searching
and selecting studies and stresses the importance of methodological quality of studies to be included in a synthesis, from the
point of view that methodological flaws in a particular study could have a negative impact on the findings of a synthesis and
its trustworthiness. Meta-aggregation is aligned with the philosophy of pragmatism in that it is particularly sensitive to the
practicality and usability of its findings. It takes the complex picture of the phenomenon of interest derived from the original
qualitative papers into account, and, also proposes particular lines of action (close to recommendations) on an individual
and an organisational level. It distinguishes itself from other QES approaches developed within an interpretive research par-
adigm in its presentation of a declamatory form of synthesized statement or description that indicates direct action. It does
not seek to re-interpret findings from other studies. Rather, it is developed to emphasize the probability of a particular claim
that may lead directly to an operational prediction (Hannes & Lockwood, 2011).
2.1. Search strategy for identification of studies
We conducted a comprehensive search of the literature produced since 1990 until December 2011. Because the biggest
amount of research on team learning started after the publication ofThe Fifth Discipline (Senge, 1990), we anticipated that the
benefit of including studies conducted before 1990 was small. An initial scoping of the literature resulted in the formulation
of a list of key words to be used to search the major databases. The following subject terms were used: team learning, group
learning, collective learning, and cooperative learning. These were combined with a set of context related terms including
employee, vocation training, vocational training, vocation learning, vocational learning, vocation, organization, and
organisation.
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In the first stage of the search strategy these search terms were used within seven relevant, major databases:
ERIC, PsycINFO, EconLit, POOLL, Web of Science, Francis, and the EBSCO database from Academic Search Premier.
Second, thirteen topic specific journals were hand searched: Journal of Workplace Learning, Adult Education Quar-
terly, Vocations and Learning, Studies on Continuing Education, Human Resource Development Quarterly, Journal of
European industrial Training, The Learning Organization, Innovation in Education and Training International, Educa-
tion + Training, Journal of Vocational Education and Training, New Directions for Adult and Continuing Education,
Journal of Education, and Work and Small Group Research. Relevant studies were identified based on information
provided in the abstract, or title when the abstract was not available. In case of doubt based on the title only,
the full text was sought. Third, a screening instrument was developed based on the inclusion and exclusion criteria
specified below, which guided the reviewers in assessing the relevance of retrieved studies based on abstract and
titles (Box 1).
Box 1 Screening instrument
Title of the study:
Inclusion criteria:
Types of participants:
Employees > adults > members of a team
Topic studied:
Experiences with team learning
Vocational learning or work setting
Types of studies:Qualitative studies with a clear method and result section > primary research (exclude secondary data)
The five characteristics of a team:
1. A collective of individuals who are interdependent in their tasks
2. Share responsibility for outcomes
3. See themselves and are seen by others as an intact social entity embedded in one or more larger social systems
(two characteristics are combined)
4. Manage their relationships across social boundaries
0 Include
0 Exclude: Reason for rejection:
Studies were considered if they met at least two of the five criteria of a team as defined by Cohen and Bailey (1997). From
studies that passed this initial screening phase the full text was sought. A second reviewer duplicated the full text screening
phase. An inter rater agreement score was calculated. Disagreements were discussed with a third reviewer. For pragmatic
reasons only articles written in a language that could be read and understood by the members from the research team were
included (i.e., English, Dutch, French, and German).
2.2. Criteria for considering studies in this review
2.2.1. Type of studies
All types of qualitative research studies were considered. In line with the basic viewpoint of the developers of the meta-
aggregative approach that a critical appraisal of methodological quality should be considered an obligatory passing point for
inclusion, we restricted included qualitative research reports to empirical studies with a clear description of the sampling
strategy, the methodology chosen, data collection procedures used and the type of data-analysis considered. A transparent
description of these issues facilitates the systematic use of critical appraisal as well as a more paradigmatic appraisal process.
Editorials and opinion pieces were therefore excluded from the analysis.
2.2.2. Type of participants
Since the context of this QES was restricted to work or vocational learning settings, only studies on adult workers were
included. In addition, the participants had to be part of a team and had to engage in team learning. Studies on team leaders
were included, since we considered them being part of a team. Studies targeting top managers were excluded from the study,
because their main task consisted of supervising teams.
2.2.3. Type of outcome measures
We only considered studies that explored the experiences with team learning for employees in the context of their work
or vocational learning. All studies reporting on either the meaningfulness, appropriateness, feasibility, perceived effective-
ness, barriers or facilitators of team learning or a combination of these were considered for inclusion.
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2.3. Critical appraisal
The critical appraisal instrument developed by the Joanna Briggs Institute (JBI) was used to appraise the methodological
quality of all relevant studies. In a recent comparison of three critical appraisal instruments, the JBI tool appeared to be the
most coherent, because of its focus on congruity (Hannes, Lockwood, & Pearson, 2010). The critical appraisal instrument con-
sists of 10 quality criteria (Box 2). The minimum threshold for studies to be included was that they met criterion eight of the
instrument evaluating whether or not a study has adequately represented the adult workers voices. One of the character-
istics of qualitative research is that the investigator has a potential influence in the interpretation of the data. Over- or under
interpretation from a researcher may have an impact on the trustworthiness of the findings of a study. A reference to the
original quotes of the participants in an original research paper allows a reviewer to evaluate whether or not a particular
claim from an author is credible. It assists in judging the trustworthiness of the claims made by an author, based on the
raw data gathered within the research project. The importance of interpretative validity in qualitative research has been
stressed in the paper fromHannes, Lockwood and Pearson (2010), which is why we gave it a prominent role in the quality
appraisal. Each study had to comply with criterion eight evaluating the credibility of the studies. We decided on a cut-off
score of 710 to consider studies for inclusion.
Box 2 Quality criteria critical appraisal exercise
1. There is congruity between the stated philosophical perspective and the research methodology.
2. There is congruity between the research methodology and the research question or objectives.
3. There is congruity between the research methodology and the methods used to collect data.4. There is congruity between the research methodology and the representation and analysis of data.
5. There is congruity between the research methodology and the interpretation of results.
6. There is a statement locating the researcher culturally or theoretically.
7. The influence of the researcher on the research, and vice versa, is addressed.
8. Participants, and their voices, are adequately represented.
9. The research is ethical according to current criteria or, for recent studies, there is evidence of ethical approval
by an appropriate body.
10. Conclusions drawn in the research report do appear to flow from the analysis, or interpretation, of the data.
2.4. Data extraction and synthesis
We used a three step approach to extracting, analysing and synthesizing the findings of original qualitative research
reports. Conceptual and descriptive communality was sought in the themes and metaphors presented in each study. The
analytic process consisted of the aggregation or synthesis of findings to generate a set of overarching descriptions pre-
sented as declamatory statements that were grounded in the findings. In a first step we assembled the findings from ori-
ginal research papers. A finding is defined as a theme, category or metaphor reported by authors of the original paper.
We took the literal descriptions presented in the results sections of original articles into account. For each of the findings
a supporting citation was sought that demonstrated the origin of the findings. We adopted the levels of evidence outlined
byPearson (2004) and assigned them to each of the original themes identified (Box 3). Only findings that were consid-
ered unequivocal and credible were considered for further categorisation. The second step was to summarize these find-
ings on the basis of similarity in meaning across all papers. We searched for conceptual similarity to construct these
categories; a particular theme, metaphor or part thereof that could be identified across multiple papers. In addition,
we looked at potential descriptive similarity, whether the terminology associated with a theme or metaphor was consis-
tent across papers. In a third step these categories were subject to a meta-aggregation in order to produce three com-prehensive sets of aggregated findings. In this process, we concentrated on the summary of common and competing
findings to produce cross generalisations that led to the recommendations for action. What adds to the robustness of
the meta-aggregative approach is that the cues to action can be traced back to the original data. We have integrated
the level of evidence and the identification number of the included studies (Box 4) that generated particular findings
in our conceptual models (Figs. 13).
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Box 3 Levels of evidenceUnequivocal: relates to evidence beyond reasonable doubt which may include findingsthat are matter of fact, directly reported/observed and not open to challenge.
Credible: relates to those findings that are, albeit interpretations, plausible in light of the data and theoreticalframework. They can be logically inferred from the data. Because the findings are interpretive they can be
challenged.
Unsupported: is when the findings are not supported by the data.
3. Findings
In this part we will present the findings related to the search strategy and critical appraisal exercise, provide an overview
of the main characteristics of the included studies and present the overarching descriptions based on the data-extraction of
the findings in the original research papers as lines of action for policy and practice.
The comprehensive search strategy identified 3783 potentially relevant studies. Based on abstract and title 273 studies
met the inclusion criteria. After filtering out the doubles, 218 studies were assessed, based on the full-text article. A total
of 191 studies were excluded from the review because they did not meet all inclusion criteria. The inter rater agreement
between reviewers for the screening phase was 92%. A complete list of the references of all 191 excluded studies can be ob-
tained from the first author. Most of the excluded studies (N= 90) did not primarily address team learning. Twenty-six stud-ies reported on the experiences of students instead of employees. Eleven studies were excluded because the articles did not
refer to a work or vocational learning setting and 37 texts did not meet the criteria for team work outlined by Cohen and
Bailey (1997). Another 25 studies were mainly quantitative and two articles were excluded based on language. In the
end, 27 studies met all inclusion criteria. All studies were appraised by one reviewer. A random sample of 7 out of 27 articles
was independently appraised by a second reviewer to check on potential differences in interpretation of the appraisal instru-
ment (Table 1). Inconsistencies between reviewers were solved through discussion and through involving a senior research-
er. The first reviewer double checked the remaining 20 studies, based on the line of argument from the discussion. Fourteen
out of 27 studies finally passed the critical appraisal exercise and were used for further data extraction and synthesis.
Table 2outlines the main characteristics of the 14 included studies (listed in Box 4). Several papers reported findings of
studies that were conducted in the health and social care sector (N= 4) or in private production, and manufacturing compa-
nies (N= 7). Other authors reported on team learning in universities or educational alliances (N= 2) or a theatre company
(N= 1). Some of the included papers did not mention the geographical region wherein the interventions were conducted,
however most of the studies were conducted in western countries such as the UK, the USA or Scandinavia. From the 14 re-search papers 115 findings were extracted. These were assigned to seven different thematic categories, based on similarity in
meaning, and further synthesised into three overarching descriptions.Figs. 13visually represent the key findings and cat-
egories related to these statements.
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15, 352360.
Y Y Y
23. Sense, J.A. (2004). An architecture for learning in projects. Journal of Workplace Learning, 16(3), 123145. N Y Y
24. Sense, J.A. (2005). Facilitating conversational learning in a project team practice. Journal of Workplace learning, 17(3), 178193. N Y Y
25. Soule, D.L., & Applegat, L.M. (2009, January). Virtual team learning: Reflecting and acting, alone or with others.Manuscript submitted for
publication.
N Y Y
26. Szejnwald Brown, H., & Vergagt, P.J. (2008). Bounded socio-technical experiments as agents of systematic change: The case of a zero-energyresidential building. Technological Forecasting and Social Change, 75, 107130.
U Y Y
27. Van Wijngaarden, J.D., de Bont, A.A., & Huijsman, R. (2006). Learning to cross boundaries: The integration of a health network to deliver
seamless care. Health Policy, 79, 203213.
N Y Y
Y = Yes; N = No; U = Unclear.* The numbers refer to the criteria listed in Box 2.** Reviewer 1.*** Reviewer 2.
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Table 2
Main characteristics of the 14 studies selected for data extraction and synthesis.
Nr. Methodology Method Phenomena of
interest
Setting Geographical Participants Data
analysis
1* Socio-cultural
perspective/
analysis
Observations and
interviews
Procedures and
competence
development
methodology
An oil refinery and
petrochemicals
manufacturing complex
UK Process operators,
maintenance
technicians, office
employees,
training staff,refinery analysts,
refinery
technologists and
various categories
of manager
Thematic
analysis
2 Interpretive
interactionist
approach
Qualitative multiple
case study
The link between
the distribution of
formal power to
individual team
members and the
collective team-
learning outcome
of producing
useful new
knowledge
The research and
development unit of a
large high-technology
manufacturing company
/ Four teams whose
task was to
improve the
production
process. 10 to 15
people in a team
(voluntarily).
Selected to
achieve a broad
variation of
hierarchical rank,gender, age, and
ethnic and racial
background
Thematic
analysis,
negative-
case
analysis
3 Case study Personal in depth
and semi-structured
interviews
The effect of
leadership style of
a team leader on
team-member
learning in
organisations,
ambidextrous
leadership in a
team context
Large and prominent
university
/ Three teams, from
three different
disciplinary units,
responsible for
teaching activities
and some research
tasks. With a clear
top management
team leader (3), a
team leader (3),
and team
members (6)
Content
analysis
4 Interpretive
epistemology
Observations and
interviews
To explore how
collective learning
and change
happen
Primary care teams UK 10 teams Thematic
analysis,
use of
mindmap
software
leading to a
meta-
framework
of results
5 Ethnographical
approach
Developing
sequence of social
interaction
The process of
inter-professional
work and learning
Surgical operating
theatre = interprofessional
groups
Finland Doctors (surgeons
and physicians)
and nurses
Basic
results
compared
with ideal
vignettes
6 Exploratory
study
Observations and
interviews
The role of team
learning in
organisational
learning
Five types of teams: top
management, middle
management, product
development, internal
services, and production.
In a medium-sized
manufacturing company
/ Senior executives,
middle managers,
engineers,
production
workers, and
providers of
various staff
services
An iterative
approach
7 Qualitative
field study
Interviews The operating-
room-team work
routine
Hospitals USA Members of the
OR teams using
MICS
Cross-case
analysis
8 Multiple case-
study design
Direct
observations + semi-
structured
interviews
Conditions for
informal learning
in care work
Home help service Sweden Care workers, and
the head and
deputy of each
unit
Cross-case
analysis
124 K. Hannes et al./ Educational Research Review 10 (2013) 116132
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Table 2(continued)
Nr. Methodology Method Phenomena of
interest
Setting Geographical Participants Data
analysis
9 Case-based
approach
Interviews Team-based
knowledge work
A large insurance company
and a small engineering
company, a large
consumer health product
company
Sweden, USA Members of
project teams
Thematic
analysis
10 Clinicalapproach
Participantobservation,
structured and
unstructured
interviewing
Learning in theworkplace from a
practice based
perspective
A regional theatrecompany = Center Theatre
Company
Mid-west ofthe USA
35 companymembers
Groundedtheory
11 Soft knowledge
systems theory
Qualitative cross-
case study:
interviews, archival
document review,
and direct
observation
Knowledge
production and
successful change
in teams. The
existing
knowledge
networks
Part of the Antimicrobial
Resistance Educational
Alliance (AREA)
USA Health care teams
which matched
the criteria
NVivo
software:
primary
level using
a coding
dictionary,
secondary
level using
emergent
themes
12 Grounded
theory
Team members
written reflections
How to learn to
become an
entrepreneurial
teacher?
An entrepreneurial team-
teaching intervention
Finland The author and
two teacher
colleagues
Open
coding,
axial
coding, and
selective
coding
13 Interpretative Interviews Virtual teams and
the learning of
work practices
A large company USA Workers and
managers of three
cross-functional
teams
Categorical
coding
14 An exploratory
study
Interviews,
observations, access
to electronic project
records
Virtual team
learning
New product development
situations in a
multinational company
/ 7 new product
development
teams: team
members and
managers
Within-
team
analysis
and cross-
team
analysis
*
Number referring to studies included in the synthesis listed in Box 4.
K. Hannes et al. / Educational Research Review 10 (2013) 116132 125
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Box 4 Final set of included studies
1. Boreham, N., & Morgan, C. (2004). A sociocultural analysis of organizational learning.Oxford Review of
Education, 30(3), 307325.
2. Brooks, A. K. (1994). Power and the production of knowledge: Collective team learning in work
organizations.Human Resource Development Quarterly, 5(3), 213235.3. Bucic, T., Robinson, L., & Ramburuth, P. (2010). Effects of leadership styles on team learning. Journal of
Workplace Learning, 22(4), 228248.
4. Bunniss, S., & Kelly, D. R. (2008). The unknown becomes the known: Collective learning and change in
primary care teams.Medical Education, 42(12), 11851194.
5. Collin, K., Paloniemi, S., & Mecklin, J. P. (2010). Promoting interprofessional teamwork and learning - The
case of surgical operating theatre. Journal of Education and Work, 23(1), 4363.
6. Edmondson, A. C. (2002). The local an variegated nature of learning in organizations: A group-level
perspective.Organization Science, 13(2), 128146.
7. Edmondson, A. C., Bohmer, R. M., & Pisano, G. P. (2001). Disrupted routines: Team learning and new
technology implementation in hospitals.Administrative Science Quarterly, 46(4), 685716.
8. Ellstro m, E., Ekholm, B., & Ellstro m, P. E. (2008). Two types of learning environment: Enabling and
constraining a study of care work. Journal of Workplace Learning, 20(2), 8497.
9. Erhardt, N. (2011). Is it all about teamwork? Understanding processes in team-based knowledge work.Management Learning, 42(1), 87112.
10. Ford, R. (2008). From situated practice to informed theory: Learning cycles and enabling structures.
The Learning Organization, 15(2), 126148.
11. Olson, C. A., Tooman, T. R., & Alvarado, C. J. (2010). Knowledge systems, health care teams, and clinical
practice: A study of successful change.Advances in Health Sciences Education, 15(4), 491516.
12. Peltonen, K. (2008). Can learning in teams help teachers to become more enterpreneurial? The interplay
between efficacy perceptions and team support. LTA, 3, 297324.
13. Robey, D., Khoo, H. M., & Powers, C. (2000). Situated learning in cross-functional virtual teams.
IEEE Transactions on Professional Communication, 43(1), 51-66.
14. Soule, D. L., & Applegat, L. M. (2009).Virtual team learning: Reflecting and acting, alone or with others .
Cambridge, USA: Harvard business school. Retrieved fromhttp://www.hbs.edu/research/pdf/09-084.pdf.
Whatever type of team learning is occurringon the work floor, there are three conditional
team learning processes that one shouldalways take into account: communication,
boundary crossing, and knowledge sharing.Besides these essential conditions an enablinglearning environment may further stimulate
the learning of a team.
Category 1: Different types of learning
Active-reflectiveBoth types of learning occur separately,simultanously or not at all (U: 6, 10, 14)
Reflective learning may happen in a formalor an informal way (U: 10)
Feed back-feed forwardFeedback learning is described as theexploitation type of learning and feed
forward learning as the exploration type (U:3).
Single-double loopBoth types of learning are mentioned in thecontext of coping with mistakes (U: 4, 9)
Knowledge creationFor well structured problems limited
knowledge sharing occurs. For ill-structuredproblems knowledge sharing occurs more
frequently (U: 9).
Category 2: Essential conditions of teamlearning
Knowledge sharingTeam members exchange what they know,
think, hear from eachother (U: 1, 2, 9, 10)Boundary crossingContacts occur within teams and outside teams(consumers and management) (U: 6, 14). These
contacts are mainly used to exchange whathappened, spread knowledge and information,facilitate learning and change (U: 2, 3, 5, 6, 11,
14). Employees use pre-existing and newlinkages (U: 11, 14).
CommunicationCommunication can be task or socio-emotional
related and occurs face-to-face (mostappreciated form), via media or virtually.
Respect for linguistic conventions andovercoming stereotypical expectationsassociated with cultural differences is
considered important(U: 13).
Category 3: Enabling learning factors
Team/social supportDifferent types of support that enable learning arementioned, including instrumental, informational,
emotional, appraisal, collegial,intra/interprofessional support (U: 5, 12) . An
inclusive atmosphere is appreciated (U: 5).
Structural support
An emphasis on the planning and organisation ofwork, multidisciplinary teams, formal as well as
informal meetings, active engagement in learningactivities, accessible managers, an optimal use of
architecture and space seem to enable learning(U: 2, 8, 10, 11, 14 / O: 4)
Fig. 1. Findings contributing to synthesis 1 (numbers refer to studies fromTable 2, U = unequivocal and O = unsupported evidence).
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3.1. Synthesis 1
Whatever type of team learning is occurring on the work floor, there are three conditional team learning processes that
one should always take into account: communication, boundary crossing, and knowledge sharing. Besides these essential
conditions an enabling learning environment may further stimulate the learning of a team.
This synthesis results from the combination of three categories (Fig. 1): different types of learning (Category 1), essential
conditions for learning (Category 2), and enabling learning factors (Category 3).
Category 1. This category shows that teammembers experience different kinds of learning and theirstories demonstratethat
these different learning types occur either simultaneously or iteratively. Types of learning thathave often beenmentioned are:
reflection and action, feedback/exploitative learning and feed-forward/exploration learning, single- and double loop learning,
individual- and team learning, and knowledge creation (3, 6, 9, 10, 12, 141). The team members also describe conditions that are
important for the teams to engage in a learning process.
Category 2. Communication, knowledge sharing and boundary crossing are all described as conditional team learning pro-
cesses. Communication can help to improve team members understanding of each other and should be task-related as well
as socio-emotional (13). Communication seems essential in different kinds of groups, but its importance is particularly
stressed by virtual teams wherein different communication media are chosen based on urgency, individual preference, need
for documentation and ease of use (13). Members of the virtual teams still perceive face-to-face communication as the most
valuable option and appreciate this kind of interaction (13). Boundary crossing refers to team members communicating withcolleagues outside their own team; experts or informants, consumers or managers (2, 3, 5, 6, 14). It is primarily done to
spread or obtain knowledge and information and sometimes to seek feedback and direction (2, 11, 14). Knowledge sharing
is mentioned in four different studies and seems to flow from communication and boundary crossing that are both featuring
the issue of exchange (1, 2, 9, 10). These findings seem to suggest that team learning can be stimulated by ensuring that
these three components are at place. This would then facilitate the creation of an enabling learning environment.
Category 3. The third category shows that both peer and structural support seem to be important facilitators for team learn-
ing. Study participants have mentioned factors such as collegial support, inter- and intra-professional interaction and guid-
ance, inclusive atmosphere, architecture/lay out of the work space, instrumental-, informational-, emotional- and appraisal
support of team members. On a structural level multidisciplinary teams, accessibility of the leader, and individual and organ-
isational learning readiness are all mentioned as important facilitators for team learning to occur (4, 5, 8, 10).
For team learning and conditional team learningprocesses to occur, power differences should be
minimised or eliminated and authority structuresthat reproduce power differences should be
analysed. The team leaders should takeresponsibility to influence the power relationships
inside their teams and as a result influence the kind
of learning that takes place.
Category 4: Organisational authority structureand distribution of formal power
Negative consequences of lack of formal powerNo control over time movement and work, not invited
for team meetings limiting the chance to integrateknowledge resulting in a perception of being lessvaluable (U: 2, 7). Disencouraging factors include
meetings outside working hours, fear of'identification' with a problem (U: 2, 6, 7), stifling and
intimidating nature of meetings (C: 2).
Sources of power differencesPower differences are institutionalised by ahierarchical authority structure and supporting
policies: communication patterns are steered byhierarchical positions, authority results from formal
position rather than technical knowledge, topmanagement keeps the differences in place (U: 2, 6,
7). Knowledge becomes a source of power in thecontext of persuading stakeholders and gaining
respect and trust (U: 11, 14).
Power differences and team learningReflection and action mostly occurs in teams whereleaders minimize power (U: 1, 2, 9, 11) and create a
psychologically safe, collaborative and inclusiveatmosphere (U: 2, 3, 5, 6, 7).
Category 5: Leadership styles and theirinfluence on team learning
A leader's taskLeaders engage in selecting and motivating staff,
enrol staff intellectually and emotionally in aproject, coaches and reflects on the team, with
sensitivity to potential hierarchical structures inthe organisation. The importance and fit for
purpose of a person for a project should becommunicated (U: 7).
Leadership influencesLeadership is guided by existing personality traits
as well as external influences such as timepressure, hierarchical structure. Leaders may takeover the leadership style of top management (U:
3).
Leadership stylesDifferent styles are identified including
transactional, transformational, ambidextrous andmulti champion or expert leadership, stimulating
different types of learning (C: 3, . A focus oncontact and relationship building and shared
leadership is appreciated (U: 2, C: 7, 11).
Fig. 2. Findings contributing to synthesis 2 (numbers refer to studies fromTable 2, U = unequivocal, C = credible evidence).
1 The numbers refer to the numbers assigned to the studies included in this review listed in (Box 4).
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3.2. Synthesis 2
For team learning and conditional team learning processes to occur, power differences should be minimised or elim-
inated and authority structures that reproduce power differences should be analysed. The team leaders should take
responsibility to influence the power relationships inside their teams and as a result influence the kind of learning that
takes place.
The synthesis pulls together the findings from two categories (Fig 2): organisational authority structures and distribution
of formal power (Category 4) and leadership styles and their influence on team learning (Category 5).
Category 4. The statements in Category 4 represent the negative consequences of the lack of formal power for
particular groups of employees. Ones function or place in an organisation and in addition his/her specific knowledge
base determines ones power and therefore ones interaction with others. A position of power generally results from
experience and longstanding relations that leads to trust and respect (2, 7, 11, 14). Several findings indicate that the
particular authority structure within an organisation produces an unequal distribution of formal power that is kept in
place by top management and influences the learning of individual team members (2, 6, 7). Lower-power team
members (LPTM) describe their inability to influence important decision making processes, because they are not
invited to participate in important meetings (2). They also state that they would feel uncomfortable about raising
their voices in a meeting, because of a concern to lose credit with their employer (2, 6, 7). This implies that LPTM are
less likely to share and integrate their knowledge (2). Some studies highlight the importance of psychological safety
that, according to the adult workers, implies the confidence of each member to speak up (5, 6, 7). Many LPTM state
that their opinions are perceived to be less valuable (2, 7). The qualitative evidence further indicates that in order for
team learning to occur power differences can and should be reconstituted (1, 2, 11). An atmosphere of collaboration
and inclusion is perceived as stimulating for personal development (2, 3). Studies targeting adult workers from teams
that had succeeded in reducing the hierarchy between their members, report better overall results and learning
opportunities (7, 11).
Category 5. Category 5provides a summary of the stories of team members on their team leaders. On the task level they
stress the importance of a team leaders capability to motivate adult workers by engaging them on an intellectual and an
emotional level and by clarifying their particular role and why they have been selected for the job (7). Many team leaders
tend to take over the top management leadership style, however the findings suggest that a shared leadership has a positive
impact on both the team leaders and LPTM (2, 11). In one study team members of successful teams describe and appreciate
certain leadership tasks which help minimising power differences (7). Leaders themselves describe leadership as being all
about contact and relationships (2, 7). Different kinds of leadership stimulate different kinds of team learning: transactional
leadership stimulates feedback learning, transformational leadership stimulates feed-forward learning and ambidextrous
leadership implies exploration and exploitation, incremental and radical learning, flexibility and control, and feed-forward
and feedback learning (3).
Team learning is clearlyexpressed to be an experiential,
evolutionary and implicit process. Duringthis process positive as well as negative
feelings occur. Different patterns of teamlearning are described but no matter
which pattern of team learning isfollowed, reflective learning and active
learning (in a variety of different forms)should always be part of the
process.
Category 6: Descriptions of teamlearning
AssociationsUnpredictable (C: 4, 13), helpful in
coping with demands (U: 4), stimulatesreflection on the self and others, happens
unconsciously and experiental (U: 4), isdynamic and implicit and induces
knowledge about people and their roles(U: 4, 5, 13, 14)
Positive and negative feelingsThere is a shared responsability for
failure or succes in workinginterdependent, which reduces anxiety(U: 4, 7/C: 9). Seeing the benefits for
clients and the broader picture ismotivating (U: 2, 7, 8, 14). Negative
feeling associated with team learning areuncertainty, fear and stress (U: 4, 7).
Category 7: Patterns of team learning
Action and reflectionLearning occurs from the iteration between
reflection and action (U: 6)
Four step patternPutting learning in practice implies enrolment,
preparation, trials and reflection (U: 7, 14)
Four interconnected learning cycles
Components of learning cycles include actionlearning, direct structured learning, extended
participatory reflection, synthesis acrossdisciplines and dissemination of knowledge
(U/C: 10).
Efficiency perception patternLearning occurs in a pattern of three phases: aplanning, action and evaluation phase, with a
growing amount of self-efficacy belief resultingin a decreasing need for instrumental support infavour of emotional and appraisal support (U:
12).
Experiental learning patternThis pattern consist of two main actions beingthinking and doing, either alone or with others.
Fig. 3. Findings contributing to synthesis 3 (numbers refer to studies fromTable 2, U = unequivocal, C = credible evidence).
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3.3. Synthesis 3
Team learning is clearly expressed to be an experiential, evolutionary and implicit process. During this process positive as
well as negative feelings occur. Different patterns of team learning are described but no matter which pattern of team learn-
ing is followed, reflective learning and active learning (in a variety of different forms) are always part of the process.
Fig. 3outlines the process of team learning, building on two major categories of findings: descriptions of team learning
(Category 6) and patterns of team learning (Category 7).
Category 6. When analysing descriptions of team learning given by the participants and summarizing words as
unpredictable and unconsciously, mistakes and shared responsibly frequently occur (4, 9, 13). Team learning then seems
to be an experiential process that includes actions such as watching, listening, trying etc. (4, 14). Team learning is also
perceived as evolutionary or non-static (4, 5). Some studies describe it as an implicit process; the learning has a non-formal
nature and occurs during daily work (4, 13). Knowing the other team members, who they are, what they think, what they
will do next, and how to anticipate on this is considered very important, particularly in the context of individual members
specific roles and tasks (4, 5). Team learning helps the members to understand what happens in the company and how their
work is related to the overall goal of their employer (2, 14). The studies further suggest that employees experienced negative
emotions such as uncertainty, fear and stress. These were perceived as logic reactions to the demands placed upon the teams
(4, 7). Overall, the positive feelings concur the negatives ones and team learning is experienced as a valuable process (2, 4).
Category 7. A seventh and last category shows five different team learning patterns or pathways to implement team learn-
ing that have been identified in the original studies: action and reflection, the four step pattern, the four interconnectedlearning cycles, the efficiency perception pattern and the experiential learning pattern. The patterns starts from a different
point of view, however it was noticed that reflection learning and action learning occur in every pattern and can be consid-
ered the core characteristics of the learning processes within teams (6, 10, 12, 14).
4. Discussion
4.1. Implications for practice
This QES aimed to investigate how team learning is experienced by employees and subsequently extracted implications
for the team learning practice. The benefit of having used the meta-aggregative approach was that it permitted the reviewers
to formulate comprehensive descriptions implying several lines of actions, based on credible, high quality, qualitative re-
search evidence. The rich information resulting from the primary research papers enabled the reviewers to better under-stand the meaning of team learning for employees. Our review united the findings of various studies through assimilating
the amount of information from studies that we considered of high methodological quality. The method we opted for has
played an important role in producing accurate conclusions. It allowed us to conduct a proper and formal comparison of find-
ings from different studies involved and provides a qualitative knowledge base for researchers who will study team learning
processes in organisations. In what follows we will discuss the three synthesized lines of argument derived from our review
and their implications for practice.
The first synthesis addresses the importance of conditional aspects for team learning to occur. The finding that commu-
nication, boundary crossing and knowledge sharing are important conditions for team learning is adding to the current find-
ings in the field that were up till now mostly grounded in quantitative studies. The latter studies do stress more the
importance of psychological safety (Edmondson, 1999), interdependence and task cohesion, group potency (e.g., Boon
et al., 2013; Van den Bossche et al., 2006) and the presence of a transactive memory system the mechanism through which
groups collectively encode, store, and retrieve knowledge (Wegner, 1986) as basic conditions for team learning. Moreover,
Decuyper et al. (2010)identified sharing, boundary crossing and team reflection as important aspects of team learning pro-cesses. This model of team learning now receives additional support from the current study. Our findings do not particularly
suggest that there is one right way for teams to learn. Employers would do well to vary in the strategies they use to facilitate
communication, for example establishing meeting environments based on respect and open communication that allow all
employees to discuss important topics and issues within the workplace that may lead to certain activities, or disseminating
staff bulletins or email messages to communicate changes, expectations and relevant announcements to keep everyone in
the loop of what is going on in the organisation, which may induce reflection. This is expected to increase the chance that
team members engage in creative and innovative activities (Akkerman & Bakker, 2011; Cabrera & Cabrera, 2005; Kratzer,
Leenders & van Engelen, 2004; Tsui & Law, 2007; Walker & Nocon, 2007). We further recommend to create an enabling learn-
ing environment (Clarke, 2005; Govaerts & Baert, 2011; Sveinung, 2004). Based on the original articles studied, we advise
that such an environment should be sensitive to the conditions that are essential for team learning, such as communication
and engaging in a dialogue. Another example of an enabling environment is the promotion of an atmosphere in which errors
are recognised and acknowledged, analysed and reflected upon in order to promote creativity.
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We also opted for the JBI critical appraisal tool to assess the quality of the studies eligible for inclusion. One of the
strengths of this instrument is that it takes into account the theoretical, the descriptive and the interpretative validity of ori-
ginal qualitative research papers (Hannes et al., 2010). We emphasized the importance of interpretive validity by excluding
papers that did not meet the credibility of the study findings, criterion eight. In addition, we excluded findings that were
labelled as unsupported, meaning that the authors statements were not fully grounded in the data. These choices may have
resulted in some potentially illuminating findings not being included in the synthesis. Almost half of the articles which were
previously identified as relevant to the subject were excluded based on the quality appraisal. However, studies conducting
sensitivity analyses to evaluate whether low quality findings added substantial new information to a synthesis have found
that the effect of low quality evidence was modest. Hence, the choice to only include high quality papers is supported by
others (Carroll, Booth & Lloyd-Jones, 2012; Noyes & Popay, 2007; Thomas et al., 2004 ).
During the extraction phase it was noticed that all studies were conducted in western contexts and societies, which may
be due to the choice of databases and search terms. The limitation to four languages understood by the researchers may also
effect these mono-cultural results because articles in other languages, representing other cultures could simply not be in-
cluded. This may limit the transferability of the findings. It should be mentioned though that the findings from the western
papers were very coherent.
4.3. Implications for future research
There is still a lot of theoretical and conceptual confusion about team learning, which links into the different labels that
are used in different countries, learning contexts and situations. A systematic, transparent conceptual review may contribute
to the theoretical clarity in the field and can facilitate future research. The synthesis further highlights the conflicting posi-
tions around aspects such as the hierarchical inequality on team learning. Not being invited to or being able to participate in
important meetings have been a major concern for many employees. On the other hand, employees seem to dislike the sti-
fling and intimidating nature of these meetings and do not want to be identified with particular problems. Another factor
that negatively impacts on team learning processes is inappropriate leadership styles. It would be interesting to think about
how the impact of the discouraging factors on employees could be reduced in order to create a safer environment.
The field of QES might also benefit from methodological research focusing on how to appraise the types of qualitative
research that have not been included. For example, we only included empirical studies with a clear methods and results sec-
tion. Opinion, descriptive papers and editorials were excluded. This exclusion criterion has been used in previous research,
indicating the importance of study quality and credibility in the selection of qualitative research evidence. Hannes,
Goedhuys, and Aertgeerts (2012) state that editorials and opinion pieces are often political rather than empirical and
therefore lend themselves more for a discourse type of analysis than a meta-aggregation. Little guidance exists on how these
reports should be critically appraised and how data should be extracted. This is an area for future methodological research.
Alternatively, authors of original research could be stimulated to back up their statements with evidence from transcripts of
interviews, focus groups or observational descriptions in order to be considered for future evidence syntheses. This will
prevent the exclusion of potentially interesting, unsupported findings.
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