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A course desing and delivery template 179

Teaching Tips & Tools Think Like an Administrator: An Instructional Design and Delivery Template for Healthcare Administration Asa B. Wilson, PhD, DHA

Abstract More than ever, current leadership challenges in U.S. health services require compelling cognitive strengths. Considerable attention has been devoted to identifying establishing course and program competencies for health administration education. These outcomes are fully incorporated in credentialing and accreditation guidelines for academic programs. The purpose of this paper is to present a template that: (a) guides course design; (b) drives content delivery; and thereby (c) fosters an administrative mindset. This framework aligns course material with executive thinking by creating a link for students between academic rigor and administrative cognition. Using this template provides an opportunity for students to practice thinking like an administrator before being required to fulfill such accountabilities. Also, the template can be used at all degree levels by adjusting content rigor accordingly.

Please address correspondence to: Asa Wilson, PhD, DHA, College of Health Professions, Rowe Hall, Central Michigan University, Mount Pleasant, MI 48859 Email: [email protected]

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Introduction Today, when critical thinking is in high demand and is a career success factor, the academy is struggling to build this quality into its graduates (Korn, 2014; Belkin, 2015). It is accepted also that thought (cognition) is the prelude to behavior (Ferry, 2001; Leach, 2002). In the Enlightenment transition to the scientific age, Emanuel Kant (1781) established the quintessential role of thought in his treatise, The Critique of Pure Reason. More recently, John Dewey (1910), in his essay How We Think, identified training one’s thought as an essential role of education. The power of cognition as a driver of conduct has been highlighted by cognitive behavior therapy approaches developed at the University of Pennsylvania. The relationship between one’s thinking and psychological difficulties is established as is the therapeutic result of reversing and replacing negative cognition (Beck, 1979; Burns, 1999). More than ever, current leadership challenges in U.S. health services require compelling cognitive strengths. Also, considerable attention has been devoted to identifying establishing course and program competencies for health administration education. These outcomes are fully incorporated in credentialing and accreditation guidelines for academic programs. As such, it is argued, as did Dewey (2010), that “Our schools are troubled with a multiplication of studies, each in turn having its own multiplication of materials and principles … (a situation requiring that) some clew of unity, some principle that makes for simplification must be found”. How We Think unfolds the view that “the needed steadying and centralizing factor is found in adopting as the end of endeavor that attitude of mind, that habit of thought, which we call “scientific.” Further, the concept of a healthcare management scholar/practitioner posits a similar challenge of balancing a degree program of relevant, engaging courses with the academy’s applied obligation of training thought. Both features, in turn, comprise a solid foundation for continuous workplace readiness and life-long professional development. A similar concern has emerged within medical schools and the practice-ofmedicine research domain over the relationship between the rate of diagnostic errors and physician thinking (Graber, 2005; Groopman, 2008; Leach, 2002; Redelmeier, 2005). The prevalence of diagnostic errors has prompted an academic and research emphasis on how doctors think and what can be done to strengthen their meta-cognition about their practice behaviors. An emphasis on physician cognition has occurred in the face of entrenched diagnostic algorithms and evidence-based treatment protocols; so much so that Groopman contends that rate of diagnostic errors “can be reduced by understanding how a doctor thinks and how he or she can think better.”

A course desing and delivery template 181 The purpose of this paper is to present a template that: (a) guides course design; (b) drives content delivery; and thereby (c) fosters an administrative mindset. This framework aligns course material with executive thinking by creating a link for students between academic rigor and administrative cognition. Using this template provides an opportunity for students to practice thinking like an administrator before being required to fulfill such accountabilities. Also, the template can be used at all degree levels by adjusting content rigor accordingly. This approach does not contradict the literature and practices about healthcare program competencies, common competencies, and interprofessional competencies (Calhoun et.al., 2008; Casciani, 2012; Stefl, 2008).

Thinking like an administrator: a template The template consists of six attributes of administrative cognition that together define how a healthcare administrator considers his/her responsibility for organizational effectiveness. These attributes are derived inductively from 25 years of senior executive experience in healthcare facilities. They were augmented by self-reflection or metacognition about the mindset needed to position a facility for success. Following a transition to academia, topics from health service administration courses appeared to cluster naturally around these attributes, i.e., a type of conceptual “factor analysis.” When thinking like an administrator, an individual will: (a) sustain a knowledge of the industry; (b) pursue information literacy throughout one’s career; (c) take responsibility in one’s sphere of accountability; (d) prepare and distribute decisive, unavoidable communications; (e) maintain a balance of cost, quality, and access in one’s area; and (f) build and maintain a strategic perspective. Even though these attributes are often characterized behaviorally, collectively they represent a mind map about routine administrative responsibility. Table 1 summarizes each attribute in cognitive terms. That is, the template is first a collection of mental qualities, beliefs, outlooks, or viewpoints that in turn motivate professional behaviors, define needed skills, and clarify essential competencies. The unifying theme among the six qualities is the extent to which healthcare leaders are obligated to be accountable for the welfare of the organization assigned to them or the organizational domain which they direct.

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Instructional design example The instructional design template begins with a definition of each attribute. As such, it is important to avoid describing the attribute rather than defining it. A definition is the foundation on which the academic content is anchored for each cognitive perspective. Also, these definitions do not require modification for different content area. Instead, each attribute exists as a stand-alone factor around which course topics “load.” Table 1 shows how topics from a senior-level financial management course can align with, encourage, and reinforce the think-like attributes. It is possible to visualize how the template guides course design and ultimately drives course delivery. Content elements cluster around and exemplify think-like cognitions. Thus, assignments, problems, and exams are prepared to encourage both content mastery and enhance leadership thinking. Such a balanced approach helps build critical thinking skills and leadership behaviors which are valuable drivers in the future workplace. Emphasizing the applied relevance of course materials also prepares undergraduates for the impending practicum experience.

A course desing and delivery template 183 Table 1 Think-like attributes aligned with course content Attribute Defined

Content Alignment

A. Sustain a knowledge of the industry Supporting course content The effective administrator is motivated by an outlook that professional development and environmental scanning are career-long accountabilities. Such a mindset drives a sensitivity to external sources that will have a positive impact one’s sphere of responsibility.

• Participate in HFMA chapter sessions • Use HFMA webinars in class sessions • Understand role of regulatory agencies • Secure Familiarity with provisions of the ACA • Monitoring Current Health Industry Trends • Reimbursement policies and payments • Merger and Acquisition impacts • Managed care vs. Fee-for-service payments • Physician employment and compensation

B.

Pursue information literacy throughout your career

Supporting course content

The pursuit of life-long information literacy is prompted by a belief that an informed administrator is best able to navigate the challenges and maximize the opportunities of the health service industry. This mental map encourages one to continuously strengthen and expand his/ her skill inventory; all done in the organization’s best interest.

• Develop annotated bibliographies • Use publication formats for class writing • Analyze articles as exams items • Review Federal Register final rules • Build a healthcare finance vocabulary • Use course technical writing tasks • Be familiar with regulatory agency publications

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Table 1, cont. C. Take responsability within your sphere of influence


Independent initiative derives from • Analyze an organization’s financial position an a priori mental commitment to accepting responsibility for the wellbe• Conduct ratio analysis on results ing of the domain to which one is • Conduct operating indicator assigned. Doing so is anchored in a analysis belief that understanding the status of one sphere of accountability is • Understand fiduciary responsibility foundational to leadership action. • Exposure to financial decision supThis attribute is an outlook that, “I port tools knew or should have known the condition of my area so I can guide it as needed”. D. Prepare and distribute decisive, unavoidable communications “Thinking like an Administrator” involves a view that communication is a priority obligation of one’s position. This outlook contains high respect for all parties to the organization and a willingness to use all manner of communication methods to inform, influence, encourage, and direct. An effort is made to create an environment in which information flow is a natural feature of the culture.

Supporting course content • Adopt-a-Hospital semester project • Study annual audit reports • Study key financial statements • Work with audit report notes • Display facility with operating indicators • Interpret Notes to Financial Statements • Know reporting tools to stakeholders • Develop model Community Benefit Report • Study Form 990/Schedule H content • Understand the Annual Medicare Cost Report

A course desing and delivery template 185 Table 1, cont. E.

F.

Maintain a balance of cost, quality, and access in your facility


Continuous healthcare information literacy growth provides needed knowledge, especially about the interplay among the variables of Cost, Quality, and Access. The resultant cognitive strengths enables the effective administrator to anticipate, identify, analyze, and pursue informed solutions; outcomes well aligned with industry trends and local objectives.

• Cost-Volume-Profit analysis problems • Applied cost allocation methods • Determining, justifying price strategies • Activity-based costing methods • Gain Budget Variance analysis skills • Know capital budgeting techniques

Build and sustain and strategic posture for your sphere of accountability


This attribute derives from a view that one must position his/ her sphere of responsibility in a way that maximizes the domain’s competitiveness and sustainability. Such an outlook is a composite of and dependent upon the interaction of the prior five mental views. This attribute is rooted in the belief that one is motivated to ensure the strategic success of his/her area of accountability.

• Application of key budgeting approaches • Deconstructing Vision and Mission statements • Reviewing strategic and operational planning • Measuring Community Benefit impact areas • Analyze CHNA methods and reports • Applied principles of equity financing • Applied principles of debt management

Instructional delivery features The template further supports two course delivery approaches. One format uses the six attributes as the course outline. Here, specific financial management issues are covered as they relate to and support behaviors that follow from the respective attribute. This approach ensures that a think-like perspective is reinforced throughout the course and within each class session. In addi-

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tion, supporting course materials can be modified in order to intensify and/or align rigor standards with the course level, from undergraduate to graduate course offerings. A second delivery option is to honor the content sequence in the selected text. As each topic is presented, it is also linked to its respective think-like attribute. The approach enables one to devote time to a review of course content as derived from the text’s topic outline. Once each topic has been addressed, the follow-up step involves an exposition of the linkage between content and the specific think-like attribute. In addition to these alternative delivery approaches, the template has further free-standing value. It can be used to: (a) build quizzes/exams; (b) create ongoing assignments; (c) design doctoral comprehensive exam questions; (d) align rigor within each of the six attributes for all academic levels; (e) foster applied research planning for master’s and doctoral students; and (f) balance cognitive and methodological aspects of course content.

Discussion Using topics from a healthcare financial management course, it has been argued that the think-like template has value as a course design and delivery format for offerings in a healthcare management curriculum. It fosters the building of an administrative mental map or cognitive outlook, one supported and reinforced by course content. In addition, the delivery format provides an experiential point of reference for students with no healthcare work experience. Since course content is linked directly to day-to-day managerial accountabilities, students are progressively prepared for internship experiences and workplace realities. This view is confirmed by email feedback and postgraduation survey findings, especially from undergraduate students. An additional template value is its ability to strengthen a scholar/practitioner balance among master’s and doctoral health service administration students. Frequently, individuals with healthcare work experience pursue advanced degrees, believing their practitioner background will insulate or exempt them from graduate-level scholarship rigor. The template, as a designdelivery tool, is able to challenge this assumption via instructional approaches that simultaneously present micro-issues linked to think-like attributes. For example, it is one thing to discuss valuation techniques for analyzing merger and acquisition (M&A) scenarios. Yet, it is a more difficult scholar/practitioner task to understand how M&A trends are linked to the think-like attribute (i.e., build and sustain a strategic posture for your sphere of accountability). A useful graduate exam question could be, “How do M&A valuation techniques

A course desing and delivery template 187 align with the theories of M&A behavior to support strategic organizational positioning?” Here, academic success is defined in scholar/practitioner terms by articulating the relationship between administrative thinking and technical decision support data. The template has further design and delivery utility when viewed as a fixed conceptual scaffolding. As such, it enables a designer to adjust content rigor within the framework according to degree levels and course outcomes. Doing so also allows for a consideration of the skill and experience level (i.e., experienced to non-experienced) of class participants. This flexibility is accomplished by viewing the think-like attributes and content rigor as factors existing along a high-low intensity continuum. As such, the designer can increase the thinklike attributes along a range from routine managerial accountability to policy responsibility, depending upon the organization or system scope. Likewise, course content can be intensified achieve the needed think-like and content balance. Thus, the template can create and deliver courses with relevance to leadership accountability at any level within a health facility as well as across different areas. Encouraging thinking like an administrator prepares one for strategic and operating challenges confronting area co-coordinators, function supervisors, department directors, service-line managers, vice presidents, Csuite executives, and system leaders. Finally, an additional template feature is its design and delivery support for courses other than healthcare finance. It is possible to use Table 1 as a starting point for building a healthcare performance-improvement quality course. One consistency in the quality-patient safety literature is the view that achieving desired satisfaction, safety, and care outcomes depends upon leadership commitment and support (Birk, 2015). Thus, thinking like an administrator is foundational to both organizational design for quality and deployment of quality methodologies at the operations level. As such, content in a healthcare quality course can be “loaded on” or aligned with the six think-like attributes, creating a course outline that, when delivered, fosters content mastery and reinforces the importance of administrative thinking, leading to consistent customer satisfaction, patient safety, and clinical outcomes.

Template limitations considered A frequent student objection is that learning six think-like attributes and course material is an unnecessary additional burden. However, this criticism abates as the applied linkage between course content and administrative applications becomes stronger. The think-like template becomes a more natural way to master course content and to perform well using course material to analyze administrative decision-making challenges. That is, within the think-

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like framework, academic issues and sources become administrative decision support tools – resources intimately linked with all manner of administrative accountability. Again, this applied reality is relevant for courses in addition to healthcare finance. A further limitation is derived from a visual inspection of the think-like attributes. One may be tempted to conclude that human capital appears not to be considered an essential feature of administrative thinking or reflective thought. However, an apparent weakness diminishes by the fact that a health service mission is accomplished through the organization’s personnel. The vital importance of personnel is an a priori because of the mission-delivery role played by the clinical, support, and administrative staff of a healthcare facility. That is, administrative responsibility for employee satisfaction, professional development, compensation, and team effectiveness are all points aligned with the think-like attributes. Depending on the specific course, all aspects of human capital management become course content opportunities. In the financial management example, the strategic positioning of the facility’s fiscal function is accomplished by ensuring that the accounting and financial management personnel congeal as a team that monitors the fiscal health of the facility. Thus, any lapse in attention to personnel is a form of supervisory neglect. A limitation for undergraduates is the absence of a point of reference regarding the importance of administrative thinking, especially for those with no healthcare work experience or who have not completed an administrative internship. The antidote for this limitation is enduring instructional engagement that works to establish the scholar/practitioner relevance and real-world readiness value of thinking like an administrator. As a final weakness, it is argued that the template and resultant delivery is too real-world focused. As such, it detracts from or dilutes academic content, rigor, and relevance. It is true that the think-like attributes derive from inductive reasoning anchored in hands-on executive healthcare experience. In spite of such an origin, there is no discernible disconnect between the template as an instructional design tool and a catalyst for academic rigor as reflected in the delivery of course materials.

Summary The think-like template, when applied to course design and delivery, adds an element of metacognition – thinking like an administrator – that arises as epiphenomenon from the way in which course materials are organized and conveyed. The alignment of content with administrative cognition enhances

A course desing and delivery template 189 thought readiness for internships, graduate degree pursuits, and world-ofwork challenges. If the think-like template premise is accepted, applicability to a health service management courses is a ready extension. In the end, the think-like-an-administrator format, as a driver of course design and delivery, seeks to establish an administrative mental map that is continuously reinforced by applications derived from course materials as well as health reform trends. The template has immediate applications for a number of health administration courses, including courses at all degree levels and those with considerable content rigor flexibility.

References

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