Clinical care has become more complex and specialized in the U.S. healthcare delivery system. No longer is one specific health professional responsible for the patient's health outcomes. A healthcare team comprises multidisciplinary professionals such as doctors, nurses, and other health professionals from various specialties who work together, communicate often, and share resources. Researchers have found that team-based care can reduce medical errors and increase health care safety, efficiency, and quality. Team training is a critical part of healthcare management education. Learning the fundamentals of teamwork, collaborative care, and effective communication within healthcare management curricula helps students be better prepared for real-world situations. Especially in the online classrooms, students do not feel isolated because they support each other in the learning process and rely on each other to acquire new knowledge, solve a problem, complete a task, or create a product in a collaborative project. If any team members are behind in their studies, they could perform better eventually because of collaborative learning.
Many higher education institutions have incorporated high-impact practices (HIPs) acknowledged by the Association of American Colleges and Universities (AACU) to improve student engagement and success. HIPs are a collection of teaching and learning strategies that positively impact student learning and promote deep learning by enhancing student engagement. Compared to those students who did not, students who participated in any impact practices demonstrated higher commitment and more desirable learning outcomes, leading to increased retention, completion, and satisfaction rates. HIPs are necessary for helping educational institutions ensure access, equity, and quality of courses. Collaborative projects and e-portfolios are among 11 high-impact educational practices endorsed by AACU. The use of multiple HIPs has been proven as beneficial educational modalities in understanding and applying concepts and theories of disciplines. This revised course includes a quality improvement collaborative project from week one to week six and an ePortfolio learning activity for students to start their baby steps building their ePortfolios.
Research Method Course evaluation is the key approach to improving the course quality we offer in the program. After this revised course was implemented, there were inevitably opportunities for improvement. Triangulation from various sources is always the best option to confirm the findings. The study population comprised adult learners who enrolled in this redesigned course after this course was implemented at the first year. The instructors who had taught this course during the same time period were also included in the study population. The information gathered from in-house student and instructor surveys provided valuable information that could be used to inform course redesign. Finally, artifacts collected from classes were the best sources for triangulation.
Key Findings The survey item, ‘this course increased my knowledge in healthcare’ received the highest score. About 87% of surveyed students agreed or strongly agreed with this statement. Although most of our students are mid-aged frontline healthcare professionals, they learned a lot from this course because the course material is full of practical knowledge. One student commented, “This course went more in-depth about QI and associated topics than I had.” Similarly, another student stated, “I knew a lot beforehand but it enhanced my knowledge.”
Earning four certificates from the Institute for Healthcare Improvement (IHI) received the second highest score at 82.5%. Students voiced positively about the value of getting the certificates. The IHI certificates not only helped students learn better in this course but also prepared them for dealing with real-world issues. Here are some examples of students’ feedback. “These certifications provided real-world examples for the material we were learning which will be extremely beneficial in the workforce and in the classroom.” “The IHI certificates were worth the time and knowledge needed for the course.” “I enjoyed the IHI certificates. I thought they were a good enhancement to the course.” “Yes, it was a great tool and very excited to list these certificates on my resume.”
Among all survey items, the collaborative project obtained the lowest score. Only 55% of surveyed students felt that the collaborative project helped them learn to work with peers having different backgrounds and experiences to solve problems in a healthcare organization. Some students had a positive attitude toward the collaborative project and felt it benefited them. On the contrary, other students had negative attitudes towards the collaborative project due to the lack of participation from their team members, different time zones/work schedules, and unequal distribution of group work. Positive comments include, “I really enjoyed this part of the course. It was nice to hear from others and get their feedback.” and “I enjoyed working with my team members. Especially my team leader is a great leader who reminded us of things to do in 6 weeks and made sure that we were on the same page.” Negative comments include, “The project was not collaborative. It was workload heavy for 1 person.” and “The collaborative project was a good experience and it did allow us to focus on teamwork, but it can be difficult when everyone is not on the same work schedule. Some team members did not participate as much as others.”
Prior research showed that students who participated in group work in online courses were likely to be less satisfied with the overall experience and possessed a more negative perception when compared to those who took part in the face-to-face format. Favor and Kupl found that 38% of online MBA students preferred to work in a team, and 39% believed teams increased their learning. In addition, two of the most frequently cited challenges of teamwork are free riding and unequal workload distribution. In Smith et al’s study, 65.9% of graduate students felt positive about the group assessment. Thus, the finding (55%) regarding students’ perception of a collaborative project from our study falls between these two empirical studies.
All surveyed instructors offered positive opinions regarding this revised course. Several instructors expressed the need for teamwork in the healthcare administration program. “Team concept helps them to collaborate.” “Because they are in teams, they were more apt to give feedback to their team members, as it may have a direct impact on their final project.” “The activities allowed students to critically think about all aspects of quality improvement. Having students in groups enhanced engagement in discussions throughout the learning week. Students expressed positive experiences with group activities.”
Implications
Working on a collaborative project in the online classroom can be exciting, challenging, and rewarding. Performing a team project without the physical presence of team members in online courses may present an additional challenge as students are in different time zones and work schedules, leading to increased difficulty in setting deadlines and developing team dynamics. Students resisted a team-based project in the online classroom because they did not have time to collaborate effectively or because there was an underachiever on their team for whom they would have to compensate. Although many challenges are inherent in collaborative learning in the online classroom, there are compelling reasons to overcome the difficulties and make collaborative learning a fruitful learning experience. For instance, incorporating the Group Work Contract and peer-review could be the solutions to reduce students’ anxiety and frustration, resulting in better collaboration and learning experiences.
Researchers Dr. Hwangji “Sherrie” Lu is a Core Faculty member in the Master of Arts in Health Care Administration Program in the College of Arts and Sciences at the University of Arizona Global Campus. Prior to this post, she had over 25 years of professional experience in various industries — inside and outside the health care arena. Dr. Lu holds two master’s degrees in nutrition from North Dakota State University and health services administration from Center Michigan University. She earned her Ph.D. in management with a specialization in leadership and organizational change from Walden University. Dr. Lu has served as a peer reviewer for several international conferences and peer-reviewed journals. Additionally, she is an advisory member for the Institute of Research Engineers and Scientists, the International Society for Engineering Research and Development, and the Universal Conferences Institute. Her research interests include high-impact educational practices, student engagement in online learning, educational technology, course evaluation, and leadership development.
Dr. Robert Smiles is the Program Lead in the Master of Arts in Health Care Administration Program in the College of Arts and Sciences at the University of Arizona Global Campus. He obtained a Ph.D. in health care administration with a specialization in organizational change resistance from Capella University, a master’s degree in health care administration from Bellevue University, and a Bachelor of Science in biology from the University of Maryland. He started his career as a regional marketing and admissions director for a long-term care organization in middle Tennessee, then began working as an adjunct professor with Ashford (now UAGC) in 2011. His research interests include student success, student engagement, and high impact practices.
Contact Information Dr. Hwangji Lu at
hwangji.lu@uagc.edu; Dr. Robert Smiles at
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