Innov High Educ (2011) 36:161–176 DOI 10.1007/s10755-010-9164-6
Creating an Innovative Interdisciplinary Graduate Certificate Program Kathleen L. McFadden & Shi-Jie (Gary) Chen & Donna J. Munroe & Jay R. Naftzger & Evan M. Selinger
Published online: 22 October 2010 # Springer Science+Business Media, LLC 2010
Abstract In response to a growing movement within higher education to provide interdisciplinary educational programs, this study describes the creation of an interdisciplinary graduate certificate program in healthcare policy and management. Building on prior research, we surveyed healthcare executives to examine their perceptions about the need for such a program and the importance of core subject areas. Drawing on our findings as well as the literature on “interactional expertise” and “wicked problems,” we provide a detailed method for Kathleen McFadden is Professor of Operations Management in the College of Business at Northern Illinois University. She earned her B.A. and M.B.A. from Gonzaga University and her Ph.D. from the University of Texas at Arlington. Her research interests include healthcare quality and airline safety. Email contact:
[email protected] Shi-Jie (Gary) Chen is Associate Professor of Industrial and Systems Engineering at Northern Illinois University. He received his M.S. and Ph.D. from the State University of New York at Buffalo. His research interests include healthcare systems engineering, concurrent engineering, project team management, and lean manufacturing systems. Donna Munroe is Professor of Nursing in the School of Nursing and Health Studies at Northern Illinois University. She earned her B.S.N. and M.S.N from St. Louis University and her Ph.D. from the University of Southern California. Her research interests include organization and policy related to the older adult, evidence-based nursing practice, and culture change in nursing homes. Jay Naftzger is a Practitioner in Residence in the College of Law at Northern Illinois University. He received his B.B.A. and J.D. from The University of Iowa and his M.B.A. from Northwestern. He previously served as Vice President, Legal at WellPoint Health Networks and as Vice President, General Counsel, and Secretary at Rush Prudential Health Plans. Evan Selinger is Associate Professor of Philosophy at Rochester Institute of Technology. He received his B. A. from Binghamton University, M.A. from The University of Memphis, and Ph.D. from Stony Brook University. His research focuses on problems in philosophy concerned with innovation, namely, the philosophies of technology and expertise. K. L. McFadden (*) Department of Operations Management and Information Systems, College of Business, Northern Illinois University, DeKalb, IL 60115-2854, USA e-mail:
[email protected] S.-J. (. ChenChen S.-J. (Gary) Department of Industrial and Systems Engineering, Northern Illinois University, DeKalb, IL 60115-2854, USA
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launching an interdisciplinary program. Our process may be useful in guiding other institutions interested in setting up new interdisciplinary programs of their own. Key words Curriculum design . Interdisciplinary . Team teaching . Integration . Pedagogy The importance of interdisciplinary education has become evident in recent years. Not only educational administrators but also funding agencies have begun to realize that society faces complex challenges that do not necessarily fall within just one discipline (Stone et al. 2009). Therefore, to address the more dynamic societal problems effectively, educational programs need to extend across the traditional disciplinary boundaries. This need has led to the creation of multidisciplinary and interdisciplinary approaches in education. A key difference between the terms multi- and interdisciplinarity is that interdisciplinarity refers to an integrative process or relationship, whereas multidisciplinarity draws separately from several disciplines and is therefore simply an additive process. Interdisciplinary courses have been defined as “the work that scholars do together in two or more disciplines, sub-disciplines, or professions, by bringing together and to some extent synthesizing their perspectives” (Davis 1995, p. 5). In this article we focus on the interdisciplinary approach, which is characterized by flexibility, innovation, and the creation of new constructs for dealing with complex issues (Stone et al. 2009). Healthcare is a perfect example of an industry that faces an environment fraught with ever-increasing complexity. Anticipating and managing current regulatory and financing issues are daily challenges. Addressing complexity often requires interdisciplinary collaboration as well as an understanding of the various viewpoints of diverse professionals. Specifically, the healthcare setting typically relies on medical, business, engineering, and legal professionals to accomplish its goals. However, the education of these professionals is radically different, leading to a “silo” mentality that defies organizational cohesion. Tomorrow’s healthcare executives need to possess the ability to bring together these professionals in collaborative practice so as to support the goals of their organizations. To do so effectively, healthcare organizations need leaders trained through an interdisciplinary educational process that exposes them to the unique culture, language, and practices of several disciplines. Despite at least a decade of effort, there appear to be significant barriers to developing interdisciplinary collaboration in the day-to-day world of healthcare practice. Similarly, educational programs have struggled to achieve true integration in interdisciplinary education, which requires collaboration and integration of content from faculty members in diverse disciplines. Given this insight, leadership at our institution saw a clear need to develop an interdisciplinary healthcare program that would prepare healthcare administrators to address the diverse and complex issues facing healthcare today. The program they envisioned would be designed to expose healthcare leaders to a variety of perspectives as they explore healthcare issues through the lenses of different disciplines. D. J. Munroe School of Nursing and Health Studies, Northern Illinois University, DeKalb, IL 60115-2854, USA J. R. Naftzger College of Law, Northern Illinois University, DeKalb, IL 60115-2854, USA E. M. Selinger Department of Philosophy, Rochester Institute of Technology, Rochester, NY 14623, USA
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First, the program would bring together the following perspectives: business, law, engineering, and health sciences. Existing multi- and interdisciplinary healthcare policy and management programs typically do not place nearly as much emphasis upon the engineering and information technology perspective as they do on the others. Systems engineering methods and tools can be directly used to improve healthcare delivery systems (Institute of Medicine [IOM], 2005). Human factors engineering can help hospitals better integrate human elements into systems analysis, modeling, and design (Klein and Isaacson 2003; Klein and Meininger 2004). The program ultimately developed thus would be novel by virtue of bringing a needed disciplinary re-balancing into the core of the standard interdisciplinary matrix. Second, the target audience for the program would be mid-career healthcare professionals who are looking to acquire advanced training that would provide added organizational value. Third, to integrate perspectives from different disciplines and break through the silo mentality without losing sight of the aim of empowering graduates to navigate complex healthcare problems, the program would be guided by a unique vision. It would be rooted in an understanding of “interactional expertise,” which would support and add value to the interdisciplinary curriculum.
The Literature and Curriculum Development Interactional Expertise Interactional expertise is a distinctive form of expertise that is at the center of a new empirical and theoretical research program (Collins 2004b; Collins and Evans 2007). The simplest way to appreciate what interactional expertise entails is to focus on its difference from “contributory expertise.” Contributory experts are in the class of professionals designated by the typical use of the word “expert.” For example, contributory experts in healthcare include physicians and nurses, individuals who go through formal education and physically immersive training in hospitals and other healthcare settings. By contrast, interactional experts are not primary practitioners. They learn about a field by talking with the people who have acquired contributory expertise and come to obtain considerable discursive expertise in a specialized domain even though they lack the practical skills required to make the standard contributions that directly advance the profession. Recent research has isolated interactional expertise as the skill that permits someone to learn to speak a specialist language—to see the world from a specialist’s perspective, and even make jokes and raise devil’s advocate questions that revolve around ideas typically known only to specialists in a field—without actually becoming a contributory expert oneself. Interactional experts are so skilled at “talking the talk” of a field outside of their specialization that their ability is characterized as the capacity to “walk the talk!” (Collins and Evans 2007). Interactional expertise thus is the medium of interchange in interdisciplinary research as well as the medium of exchange that operates between specialized disciplinary knowledge and public understanding. Since interactional expertise involves mastery of a language, it makes use of tacit knowledge that cannot be fully explicated in terms of operational rules. Because of its tacit dimension, interactional expertise is a skill that differs in kind from formal knowledge. Like physical activities that make use of somatic tacit knowledge, such as learning to drive a car or ride a bicycle, interactional expertise cannot be acquired merely by reading texts, participating in lecture courses, or engaging with computer programs that present detailed facts but fail to convey tacit knowledge (Collins
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2010). While the concept of interactional expertise is a new idea, the premise that tacit knowledge is crucial to healthcare practice but hard to recognize and teach belongs to a distinguished body of healthcare literature, especially the writings of Patricia Benner (Benner 2001, 2009). Benner (2001) used Dreyfus’s (Dreyfus and Dreyfus 1986) five-stage model of expertise as the basis of her analysis of tacit knowledge in clinical care nursing practice. Dracup and Bryan-Brown (2004) discussed the following example to illustrate how Benner's model successfully applied Dreyfusian principles and clarified why this application matters in real practice. For example, to the novice focusing on mastering the technical aspects of care, an unstable, critically ill postoperative cardiac surgery patient is an urgent to-do list. The vital signs must be noted every 15 minutes, the cardiac rhythm assessed, intravenous drips titrated to keep the blood pressure within a certain range, the lungs auscultated, chest tubes checked routinely, and intake and output recorded. An expert nurse caring for the same patient would complete the same tasks but not be caught up in the technical details. The expert integrates knowledge of cardiovascular physiology and pathophysiology to assess symptoms and guide patient care. . . The expert has gone beyond the tasks to read and respond to the whole picture. A potential catastrophe (“failure to rescue” in the lingo of patient safety) is averted. (Dracup and BryanBrown 2004, p. 449) Lacking hands on training, how can interactional experts acquire tacit knowledge? The short answer is that they need to obtain experience-based pattern recognition skills through a distinctive form of immersion into the practices where specialist communities make use of their specialist languages. Harry Collins, sociologist and godfather of the concept of interactional expertise, referred to this apprenticeship as “linguistic socialization” (Collins and Evans 2007). Collins has tested the linguistic socialization hypothesis empirically in a number of experiments (Collins and Evans 2007). He even used his own experience as a case study to justify the radical interactional expertise thesis concerning what can be said in the absence of direct experience. Although trained as a sociologist, Collins successfully developed such an extensive understanding of the esoteric domain of gravitational wave physics that he was able to write the lengthy and technical book Gravity’s Shadow: The Search for Gravitational Wave Physics (Collins 2004a) and conduct a test in which he fooled practicing gravitational wave physicists into thinking that he was an actual gravitational wave physicist and that actual gravitational wave physicists were sociological imposters. Collins ultimately concluded that, just as colorblind people learn to converse about colors (in the absence of being immersed in the practice of color perception), so, too, did he, as an interactional expert, use linguistic socialization to converse about gravitational wave physics (in the absence of being immersed in the practice of gravitational wave physics research). Since interactional experts understand how members of other fields frame and discuss problems, they are extremely effective in communicating in collaborative settings made up of members from different areas of expertise. This skill is especially important in healthcare where problems are inherently interdisciplinary and complex in nature, and they are viewed differently by diverse types of professionals. It could also be useful in interdisciplinary educational settings where professors from varied disciplines are required to collaborate as they integrate course content. The infusion of interactional expertise into the curriculum could be viewed as a method or language for enhancing the delivery of interdisciplinary content knowledge.
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Wicked Problems Some healthcare problems are relatively simple to address. These “tame” situations include “administering an influenza vaccination, diagnosing a simple cold or the stomach flu in a 10-year-old, treating an infected cut in a healthy person, and following up on an uncomplicated gall bladder surgery” (Drinka and Clark 2000, p. 37). In such cases, “the outcome can be predicted and procedures for intervention can be quantified, measured, replicated” (Drinka and Clark 2000, p. 37). Other dilemmas facing the U.S. healthcare system are so complicated and frustrating that it has become commonplace to characterize them as “wicked problems.” Rittel and Webber (1973) and Camillus (2008) depict wicked problems as social policy and planning dilemmas that are so complex as to be subjects of contestation. They resist a single, definitive formulation; are prone to inciting multiple and often irreconcilable stakeholder views; go beyond the scope of a single solution algorithm or even single best solution; permit little tolerance for error; and cannot be resolved by a single, trustworthy source of expertise. Textbook examples include: . . . scheduling an influenza vaccine for a demented elder who has had a prior adverse reaction to an influenza vaccine; treating Cryptosporidium infection presenting as stomach flu and rheumatoid arthritis in a person recovering from cancer treatments; or treating an infected cut in a diabetic with poor vision who lives alone in a house with no running water. (Drinka and Clark 2000, p. 37) According to Rittel and Webber (1973), the systems approach alone is insufficient for dealing with wicked problems. They advocated the collective give-and-take dialogical process that considers multiple perspectives from various disciplines. The solution to the problem eventually emerges as the group of diverse participants evaluates and judges the problem through critical argument. In this way, decisions can be made and the relevant communities of decision-makers as well as the affected stakeholders can agree that progress has been made. The concept and knowledge of interactional expertise thus would appear to be extremely useful in this shared context of decision-making. Given the heightened levels of uncertainty and risk that wicked problems present, academics, politicians, professionals, and stakeholders of various stripes remain conflicted about the best way to negotiate them. Since Rittel and Webber (1973) introduced their idea, various proposals have been offered regarding how to make innovative use—in educational, policy, and institutional settings—of public participation (especially nonexpert knowledge and diverse stakeholder values) and multi- and interdisciplinary collaboration. Collaboration between disciplines has become a crucial area of focus in healthcare because wicked problems tend to involve situations where solutions require contributions from multiple disciplines. Interdisciplinary Curriculum Development Typically interdisciplinary curriculum development involves a team of faculty members from diverse backgrounds, training, and perspectives who collaborate in developing course content, delivery methods, and assessment tools. Kang (2001) explored collaborative course development and found that subject matter, design knowledge, resources, and technical skills are critical to the design process. Developing interdisciplinary course content, whether in an online or face-to-face format, requires the understanding of how various disciplines overlap as well as how they may view and frame problems differently.
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Interdisciplinary methods move beyond multidisciplinary approaches where more than one discipline are involved but do not require faculty members to integrate their perspectives and create a different way of approaching complex issues (Stone et al. 2009). Given that professors involved in interdisciplinary curriculum development come from different knowledge domains, their discipline-specific language or jargon often serves as a barrier to clear communication (White 2000). Xu and Morris (2007) called for more rigorous research on the course development process as well as in the use of collaboration in course development. Interactional expertise is a medium of interchange that may prove useful in addressing the challenges involved in the collaborative process required for developing and delivering interdisciplinary programs. The literature on curriculum development clearly demonstrates the benefits of an interdisciplinary approach. Ducoffe et al. (2006) explored student and alumni perceptions of the value of interdisciplinary, team-taught business courses and concluded that the more integrated the course the greater the perceived benefit. Buchbinder et al. (2005) provided a conceptual framework for an interdisciplinary case study workshop, documenting their process of creating and developing the workshop from conception through implementation. The study concluded that an interdisciplinary method develops not only students but also the faculty members involved. Merton et al. (2009) studied curricular change within an engineering curriculum and found that successful change occurred when strategies were aligned with the organizational culture. Uchiyama and Radin (2009) pointed out that the norm of faculty autonomy and independence in higher education is shifting to one of collaboration and collegiality. They argue that curriculum mapping is one way to achieve this objective. Interdisciplinary teaching and research is yet another way (Goodman and Black 2006). Harris and Cullen (2009) argued for the need of curriculum redesign rather than simply design by adding to current models. They focused on the engineering curriculum as they developed a model for curricular revision that is based on learning types. The findings of Holley (2009) indicate that implementing interdisciplinary initiatives occurs concurrently with transformation change or a shift in the culture of the institution. Such change requires support from senior administrators, flexibility, collaboration, faculty and staff development, and visible action (Holley 2009). The importance of aligning interdisciplinary strategies with institutional priorities is also stressed. Walrath et al. (2006) developed and evaluated a four week interdisciplinary program that addressed (1) health care system structure, (2) healthcare financing and purchasing, (3) effect of organizational culture on quality improvement, and (4) a quality improvement project. Shewchuk et al. (2006) surveyed healthcare administrators and academics to determine the five most critical issues having the greatest impact on healthcare executives. The issues that emerged were (1) traditional management; (2) patient interests; (3) political, legal, and environmental concerns; (4) medical issues; and (5) financial and economic issues. Similarly, White et al. (2006) surveyed alumni and identified leadership, communication, business skills, and technology as important competencies. Crow et al. (2005) developed a conceptual model for a graduate program in healthcare administration that focused on eleven core subject areas. Specifically, the subject areas were Analytical Foundations, Accounting and Financial Management, Economics and Essentials of Quantitative Analysis, Marketing, Operations and Quality Management, Organizational Behavior and Human Resources Management, Health Management Technology, Policy Analysis and Response, Legal Environment and Ethical Issues, Epidemiology and the Language of Healthcare, and Strategic Management. The authors identified several barriers
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to better acceptance of healthcare education programs by executives, such as lengthy completion time, too many prerequisites, and expensive tuition. The literature discussed above substantiates our argument that effective healthcare leadership requires an understanding of diverse disciplines to include not only medicine but also business, law, and engineering. Yet, in many organizations, healthcare executives may have a limited exposure to the integration of knowledge from these disciplines. Similarly, interdisciplinary teaching requires faculty members to move beyond their own disciplinary boundaries in order for true integration of course content to occur and for new methodological perspectives to emerge. The literature also suggests that interdisciplinarity could be enhanced as faculty members move towards acquiring interactional expertise in other disciplines. Stone et al. (2009) explained that a shift in discussion has occurred, moving from the benefits of interdisciplinary approaches to the question of how to develop such programs.
Our Curriculum Development Process To that end, we describe and explain an interdisciplinary curriculum development initiative in healthcare policy and management. Table I provides a process map of the entire curricular development process that includes the basic timeline of events, the specific tasks involved in the process, and who was involved with each task and decision. The following sections provide details on the curriculum development effort. Stage 1: Preliminary Approach and Needs Assessment A university donor, who had a vision for interdisciplinary healthcare education, provided seed money for the development of this program. The Provost and Deans from the Colleges of Business, Law, Health and Human Sciences, and Engineering and Engineering Technology collaborated on a planning proposal to create this interdisciplinary program. Each dean identified a faculty member from their college to serve on the project team (Later on, they added an additional team member, a philosophy professor from another university with a research background in interactional expertise.) The team (authors of this article) met regularly, documenting in the minutes of the meetings the major decisions made and future assignments. We gathered information on healthcare policy and management educational programs available nationally. We mapped course offerings for selected programs against the Crow et al. (2005) conceptual model to determine how broadly these programs addressed the content areas in this model. While multi- and interdisciplinary healthcare programs abound, we did not identify an interdisciplinary program that not only integrated perspectives from four colleges but also incorporated the unique pedagogy of interactional expertise as a way of bridging the disciplines. Therefore, we saw a competitive opportunity for an interdisciplinary healthcare policy and management program. To develop a sense for the practicality of developing an interdisciplinary healthcare policy and management program at our institution, we mapped existing courses within the colleges involved against the Crow et al. (2005) conceptual model. While several courses existed that fell within the 11 subject areas, particularly in the College of Business and Health and Human Sciences, additional courses (and multi-college integration of topics within courses) would need to be developed to support an interdisciplinary healthcare policy and management program. The scope of the need for additional course development obviously would be driven by the curriculum determined to be most appropriate.
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Table I Process map of curricular development Stage 1: Assessing the Need Donor provides project vision for interdisciplinary healthcare education.
Summer 2007
Provost and Deans write a funding proposal for the possible creation of a new interdisciplinary healthcare program.
Summer 2007
Donor provides seed money for the project.
Summer 2007
Deans identify one faculty members from each of 4 colleges (Business, Engineering, Law and Health) for the project team.
Fall 2007
Project team researches competitive programs.
Fall 2007
Project team explores related literature and identifies a curricular model.
Fall 2007
Project team maps curriculum with competitor's courses as well as existing courses from the 4 colleges.
Fall 2007
Project team develops survey instrument for need/market assessment.
Fall 2007
Project team, with help from the Public Opinion Lab, administers email and paper surveys and analyzes results.
Spring 2008
Project team presents results and recommendations from the study to the Deans, Provost and donor. Spring 2008 Stage 2: Designing the Program Provost and deans deliberate on deliverables, resources, timelines, etc. for the project.
Fall 2008
Provost and deans decide to offer a graduate certificate program starting in Fall 2010.
Fall 2008
Deans develop and submit a strategic planning budget for the project to the provost.
Fall 2008
Project team meets periodically to develop curricular plan.
Spring 2009
Deans identify "interactional expertise" consultant from another university to join project team.
Spring 2009
Expert provides presentation to faculty team on "interactional expertise."
Spring 2009
Project team meets periodically with expert to refine curriculum plan.
Spring 2009
Project team prepares curricular materials/approval paperwork for submission to college curriculum Summer committees. 2009 Each team member submits curricular materials to their specific college curriculum committee for approval.
Fall 2009
All 4 college curriculum committees approve the certificate program and the proposed courses within Fall 2009 the program. Stage 3: Developing the Courses and Marketing the Program Deans identify instructors to teach in the program.
Spring 2010
Team of instructors meets to develop a plan for integrating and developing course content.
Spring 2010
Public relations and outreach market the program to prospective students.
Spring 2010
Team of instructors meets periodically to develop course content and create integrated games and class exercises.
Summer 2010
Faculty team attends an "Interactional expertise" boot camp to learn to apply and integrate concepts Summer into courses. 2010 Faculty team recommends, confirmed by Deans, that the format be a hybrid delivery: face-to-face with online components.
Summer 2010
Hire a project manager to prepare and implement recruitment plan.
Summer 2010
Project manager works with admissions to develop application criteria; review and acceptance procedures; review applications, monitor registration
Summer 2010
Deans, project manager, and outreach work to obtain necessary funding.
Summer 2010
Faculty team meets periodically to enhance course content and scenario activities.
Fall 2010
Begin accepting students into the program.
Fall 2010
Offer the first course in the program.
Spring 2011
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We decided that a needs assessment was the next step in this process. We sought to answer the following research questions: 1. 2. 3. 4.
Is there a need for an interdisciplinary healthcare policy and management program? What are the most important subject areas that should be included? What specific topics within each subject area are most important? What program structures and formats are of greatest interest?
Need and Market Assessment Next we developed a survey instrument and administered the surveys for the need and market assessment study. We surveyed senior healthcare management executives. We believed feedback from professionals within the field could be a good indicator of educational program need and would provide insight into the type of courses and topics that should be included in a program. To improve the clarity and reduce any ambiguity of the questions, the initial survey instrument was pilot tested on a group of healthcare executives in the local area. The finalized survey instrument and correspondence to recipients were approved by our University’s Institutional Review Board. The first section of the survey explained that the goal of the program would be to provide healthcare professionals with a working knowledge of a variety of disciplines in addition to their specialization so they could deal more effectively with healthcare system problems. It asked respondents about their assessment of the overall need for an interdisciplinary healthcare policy and management program that would combine business, law, health and human sciences, and engineering disciplines. Questions included asking the respondent how appealing this type of program would be to them personally, how interested they would be in enrolling in such a program if offered, and how likely they would be to encourage others within their organization to enroll. The respondents were instructed to assess these questions using a 4-point scale. A second part of the survey focused on curricular design, specifically on the subject areas of courses and topics within each possible course offering. Respondents were asked to rate the importance of including each possible subject area in a healthcare executive education program. They were also requested to indicate the level of importance of various topics within each subject area, using a 5-point Likert scale. For clarification, a description of each specific topic was provided in a glossary to the survey. The subject areas used in our survey were drawn from Crow et al. (2005), and the topics within each subject area were based on feedback received from faculty members who currently teach similar courses within each subject area. The final section of the survey solicited demographic information. We utilized a database of healthcare clients obtained from a healthcare consulting firm. The finalized survey was sent to all 433 healthcare executives on this list. These persons resided in 35 states, but were mostly in the Midwest and eastern United States. The population of recipients consisted of senior healthcare management executives holding a position as Chief Executive Officer, Chief Financial Officer, or Chief Nursing Officer within a healthcare organization. A total of 254 recipients had email addresses, and the remaining 179 had only USPS addresses. A letter was sent via USPS to the email recipients alerting them that they would be receiving an email, including a link to a web-based survey, an ID, and a password. In an attempt to increase the response rate, two separate follow-up emails were also sent approximately two weeks apart. The 179 persons without an email address were sent a letter via USPS that included the paper survey along with a postage-paid return envelope. In the letter was a link, ID, and password information so recipients could respond electronically if they preferred to do so. From the email listing, 46 messages were returned as undeliverable, while
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only one of the USPS addresses was returned as undeliverable. Forty-one surveys were received from 14 states, yielding a response rate of 10.6%. In an attempt to improve our response rate, we distributed 98 paper surveys to attendees at the 2008 American College of Healthcare Executives Conference in Chicago. A total of 37 questionnaires were completed, yielding a response rate of 37.8% for this second sample. The overall response rate for the survey with both samples combined was 16.1%. A series of t-tests were conducted on all 127 continuous variables within the survey to examine the possibility of response differences between the two samples. Only 8 of these 127 tests emerged as statistically significant; consequently, we decided to combine the two samples for analysis. Survey Results The majority of respondents were male, between the ages of 31 to 65, with a mean age of 52 years. About 86% held some type of advanced degree and had an average of 22 years of experience in healthcare management. They were positioned in small, medium and large healthcare organizations in the United States. Approximately 70% of respondents felt an interdisciplinary program was appealing or very appealing to them personally, 68% said they would encourage others in their organization to enroll in such program, while 40.3% said they would enroll themselves. This latter finding is noteworthy, given that respondents were predominantly high-level executives who already possessed advanced degrees. Over 60% of the respondents also indicated there was a high or very high need for an interdisciplinary program targeting new healthcare administrators and/or healthcare executives. Table II provides the mean ratings for the perceived importance of each of the eleven subject areas from Crow et al. (2005). Average mean scores ranged from 3.04 to 3.67 on a 5-point scale. The areas of Strategic Management, Organizational Behavior/Human Resources and Operations/Quality Management averaged highest at a mean importance rating of 3.67, 3.62 and 3.50 respectively. The respondents also provided useful guidance regarding their interest in potential topics within the subject areas. Table III provides a ranking of the 20 most popular course topics, based on mean scores. As seen in Table III, the specific course topics with the strongest interest included strategic planning, improving customer satisfaction, strategic management, quality management, patient safety and tools for process improvement. Table II Subject areas by importance rankings Topic and subject areas
Mean importance
Standard deviation
1. Strategic Management 2. Organizational Behavior & Human Resource Management
3.67 3.62
0.939 0.894
3. Operations and Quality Management
3.50
0.931
4. Accounting and Financial Management
3.45
0.922
5. Legal Environment and Ethical Issues
3.25
0.854
6. Analytic Foundations
3.21
1.220
7. Marketing
3.21
0.977
8. Epidemiology/Healthcare Language
3.16
1.043
9. Health Management Technology 10. Policy Analysis and Response
3.12 3.06
0.942 0.892
11. Economics & Quantitative Analysis
3.04
1.065
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Table III Importance rankings of course topics Ranking
Course topic
Mean score
Standard deviation
1
Strategic Planning
4.05
1.079
2
Improving Customer Satisfaction
3.96
1.136
3
Strategic Management
3.95
1.079
4 4
Quality Management Patient Safety
3.84 3.84
1.067 1.414
6
Tools for Process Improvement
3.79
1.130
7
Change Management
3.78
1.096
8
Managerial Leadership
3.77
1.124
9
Negotiations /Conflict Management
3.74
1.143
9
Organizational Behavior
3.74
1.000
9
Recruitment and Retention
3.74
1.068
12 13
Problem Solving Cost Structure and Reimbursements
3.71 3.70
1.136 1.167
14
Capital and Operational Budgeting
3.69
1.134
15
Project Management
3.66
1.133
16
Health Law Overview
3.60
1.024
17
Motivation
3.59
1.091
18
Human Resource Management
3.56
1.054
19
Value Based Management
3.55
1.049
20
Decision Analysis
3.54
1.172
The results of our needs assessment provided empirical support for the development of an interdisciplinary healthcare policy and management program. The findings indicate there is value in institutions exploring the possibility of offering such a program in the future.
Stage 2: Program Design Based on the results of the needs analysis, our university decided to offer a Graduate Certificate in Healthcare Policy and Management. It became clear to us that creating a pedagogy that is guided by insights in the interactional expertise literature would not allow for the use of traditional courses. Rather than simply repackaging existing courses in various colleges, this certificate program involved developing a set of new interdisciplinary, team-taught courses delivered by faculty members from the four colleges. A major goal of the program is to train healthcare professionals how to communicate intelligently in a variety of disciplines without having to be contributory experts in all of them. To achieve this objective, we designed a 15-credit hour certificate program consisting of a set of five (3 credit hour) courses that include components from the disciplines of business, law, health sciences and engineering. The certificate program and each individual course within the program were approved by the curriculum committees of all four colleges in the fall semester of 2009. Students in the program begin by taking an introductory course that provides an integrated overview of the four disciplines and introduces the unique pedagogical vision that structures the
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program. With respect to the latter goal, emphasis is given to the concepts of strategic management and planning (importance ranking #1 and #3 from Table III) as they relate to interactional expertise and wicked problems. The specific objectives of the first course are as follows: (1) to describe why interdisciplinary training provides added value, (2) to understand the complex nature of healthcare, (3) to demonstrate how insights from interactional expertise can help healthcare managers improve operations, and (4) to discuss issues in terms of systems-based analysis. Students are required to identify a wicked healthcare problem that exists in their organization and articulate their best proposal for solving it. This requirement ensures that students know how to apply the new concepts they just learned while simultaneously acquiring problem identification skills that are relevant for making progress in real world issues. By providing students with a solid foundation on the philosophy and goals of the overall certificate program during their first course, we equip them with the knowledge and understanding they need to apply more difficult concepts later in the program. Although we expect the majority of students to be experienced health professionals, the program is designed so that this is not essential for a student’s success. The second phase of the program includes three courses organized around three critical healthcare performance measures identified in Table III—patient safety (ranked #4), operations efficiency (ranked #6) , and quality and customer satisfaction (ranked #2 and #4). Moreover, the success or failure of strategic management and planning (ranked #1 and #3) is typically measured by a combination of these key performance measures and how well they are integrated into the system. In addition, these target areas are central components of wicked problems, a concept that has recently been addressed in the strategic management literature (Camillus 2008). When bounded by business, legal, engineering, and the health sciences perspectives, different proposals can arise regarding how to best define and achieve patient safety, operations efficiency, quality, and customer satisfaction. Different orientations can engender practical conflicts, as in cases where one disciplinebased action plan conflicts with another. The third phase of the certificate program consists of an experiential learning capstone course that requires students to identify a problem, opportunity, or issue in an actual healthcare organization. Working with faculty mentors and a healthcare organization, they explore solutions and strategies utilizing the integrated concepts and tools from business, engineering, law, and health sciences. This “real world” project is intended to access students’ ability to integrate and synthesize disciplinary knowledge and to apply this mode of thinking in a healthcare delivery setting. Successful completion of the capstone course requires a paper and presentation by students to actual business leaders. In most cases, students revisit the wicked problem they identified during the introductory class and demonstrate their professional growth by providing solutions that are better than the ones initially provided. The curriculum combines face-to-face interactions among faculty members and students with online components. The team soon realized that a face-to-face format would be the most effective way to immerse students in the specialized languages and practices of each of the four disciplines. However, online learning activities are employed where applicable. For example, students demonstrate assimilation of knowledge and critical thinking by responses to faculty-driven queries in asynchronous discussion forums with specific learning goals. Students also engage in critical thinking exercises that describe wicked problems in a variety of healthcare setting and require interdisciplinary analysis. These exercises are conducted using online discussion forums that augment the face-to-face interactions.
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Stage 3: Developing the Courses and Marketing the Program Once the four college curriculum committees approved the certificate program, the deans identified instructors to teach in the program. The team met routinely to develop a plan for integrating and developing course content, simulation games, and class exercises. In the meantime, public relations and outreach began marketing the program to prospective students. A project manager was hired to prepare and implement a recruitment plan and work with university personnel on admission criteria. In addition, faculty members have been learning interactional expertise while developing this program through faculty development workshops conducted by experts in interactional expertise. The team decided that for each Phase 2 course students will participate in several integrated assignments and simulation games that address wicked problems and make use of interactional expertise; and all faculty members evaluate these activities. The games are designed to be emotionally compelling and cognitively challenging. By emphasizing the gaps between idealizations and real-world instantiations of disciplinary cultures, the games, which simulate interdisciplinary dilemmas, enable students to acquire tacit knowledge, identify obstacles that arise from competing disciplinary framings of a problem, and develop problem solving skills for making progress in wicked healthcare problems. Students thus experience first-hand why difficulties in healthcare arise due to conflicts in how cultures, not people, operate. This is a difficult lesson to grasp. While students cannot be expected to become full-fledged interactional experts, they gain a sense of how tacit knowledge fails to be conveyed in many reports, summaries, and analytic studies.
Discussion As explained above, this certificate program is not only interdisciplinary in nature, but also integrates the concept of interactional expertise to create a unique pedagogy which serves as a bridge between all of the disciplines involved. Moreover, the curricular design is based on integrating the various disciplinary perceptions of critical performance measures in healthcare delivery, as opposed to simply offering a set of traditional discipline-specific courses. Unlike other programs that reside in one college and package existing offerings from other disciplines, our program is designed to achieve true integration by breaking down the “silo” mentality of departments or colleges. It recognizes the large range of courses that people would ideally like to see in such a program, but tries to address the expansive issue by developing cross-cutting courses in patient safety, operations efficiency, and quality and customer satisfaction, each of which builds in elements of that larger laundry list. In addition, in order to tackle complex healthcare problems more effectively, our program encourages healthcare professionals and leaders to engage in “systems thinking.” According to the Institute of Medicine (2005), one of the major contributors to the absence of “systems thinking” in healthcare education has been the under-appreciation of the magnitude, complexity, and importance of the operational challenges faced by the industry. As a result, not enough healthcare professionals view their healthcare delivery process as a system and know how to work together with others to manage it effectively. Breaking down disciplinary and linguistic barriers and improving the overall healthcare system will require considerable changes in education and professional training. Ultimately, we believe that this certificate program offers a variety of benefits. First, it helps to address the communication and coordination challenges the industry faces because
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of the many different healthcare professionals who must work together to solve very complex problems. Second, given the complexity of healthcare delivery, our program provides administrators with an understanding of the tacit and explicit values, beliefs, language, and practices of other professionals with whom they work. Third, since our curriculum targets the most critical healthcare performance measures (patient safety, operations efficiency, quality and customer satisfaction), students will gain specific skills and knowledge that will enable them to achieve positive outcomes more effectively and address stakeholder’s expectations in these key performance areas within their own healthcare organizations. Crucially, the curriculum has the further advantage of encouraging instructors to avoid a deficit model of education. The program aims to impart new insights regarding (1) how to use methods related to “moral imagination” (i.e. a tool for generating common purpose and intellectual humility in collaborative settings) to cope with disciplinebased impediments in healthcare management not amenable to resolution through typical conflict resolution techniques and (2) how best to conceptualize crucial aspects of healthcare practice as complex systems while (3) encouraging students to use their newly acquired conceptual tools related to interactional expertise to re-examine familiar workplace interactions (Gorman 2008). Through guided re-examination, students will experience professional growth as they come to understand the tacit knowledge that they make use of during effective interactions and the main reasons why previous workplace interactions, which had initially seemed promising, turned out to be ineffective.
Conclusions Recent reports from government, business, and industry have called for greater emphasis on the cross-fertilization of disciplinary skill and have provided funding to promote such interdisciplinary education and training. This priority, which calls for multiple perspectives and more coherence in the curriculum, has led many institutions to consider exploring the idea of offering interdisciplinary, team-taught courses as an alternative to disciplinary specific ones. As departments and colleges begin to identify their own needs for creating new and innovative approaches to higher education, they will be looking for models to help assist them in the process. Health care organizations are not the only systems that could benefit from the concept of interactional expertise. Our curriculum model is really focused upon problem identification and problem-solving when diverse professional constituencies are involved. For example, this curriculum model could focus on secondary or higher education, drawing from the expertise of educators, business people, engineers, and lawyers. Courses based upon performance indicators such as operational efficiency, student retention and progression, and quality and constituent satisfaction might produce environments for learners to think beyond their own respective disciplines and develop behaviors for optimal functioning of interdisciplinary teams. Thus, while our application focuses specifically on healthcare, clearly an area of great need for reform, the methods and approaches used in this study could be duplicated at other institutions that are striving to achieve an interdisciplinary perspective in any context. Acknowledgements This study was funded by Cherilyn and Michael Murer of Murer Consulting, Inc., as part of their broader initiative in Healthcare Policy and Management. The authors would also like to thank the Northern Illinois University Public Opinion Lab for assistance with survey distribution and data analysis.
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