External Reviewer Report Spring 2007

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1 Bachelor of Science in Health Systems Management School of Public Affairs Yale Gordon College of Liberal Arts University of Baltimore External Reviewer Report Conan Dickson, Ph.D., M.P.H. Administrator, Operations Support The Johns Hopkins Health System

2 Introduction HSMG Report Dickson As a graduate of three health administration programs (undergrad, MPH, PhD) from three different schools, I enjoyed going through this process and learning about the program at the University of Baltimore and was very impressed with the program and the effort to provide an objective self-study. I currently get the opportunity to interview candidates from top graduate health administration programs across the country during our recruitment of Administrative Fellows and see a number of programs as a result. In my opinion, the Bachelor of Science in Health Systems Management at the University of Baltimore is well-designed and well-positioned to be an excellent program. The following sections provide my assessment of strengths and weaknesses across several domains: faculty, curriculum, students, program and congruence with established goals. Faculty The faculty members of the HSMG program are outstanding. They have excellent credentials and are all experienced in both the academic world as well as the practical field. The is a nice blend of full time to adjunct faculty (5 to 9) and this is especially important given the fact that most of the students are part-time students and have significant work experience. The student comments consistently reflect the high quality faculty with glowing feedback. The syllabi from the courses reflect the time that faculty put into organizing their courses and developing learning goals. I do not have any criticisms of the faculty. Curriculum The curriculum is well-designed and appropriately focuses on adult learners. There is a clear layout of recommended courses that are congruent with the nature of the degree. I found this to be a very easy to follow curriculum with a nice blend of structure and flexibility, which is very important given that the University of Baltimore has only recently converted to a four-year program and is still very open to transfer students from two-year programs. Based on my count there are fiftyone credits of electives available ( credits HSMG - 9 business and finance - 9 elective - 9 core). This is roughly forty percent of the program. This is important in terms of providing maximum flexibility to working students, but it may be too much flexibility (this is difficult for me to assess, but I will discuss in the opportunity section below). There was one student comment that indicated disappointment that the accelerated program is ending. I might have missed something, but I got the impression that this option is still available. If it is, the accelerated option is also a great incentive 1

3 to encourage academic pursuit beyond a bachelor level of study. It provides an incentive for students to at least try a couple of graduate level courses. I would have been interested in knowing how many students go on for a masters degree although it would be difficult to interpret given that most of the students are older than the traditional student and are fairly established in their jobs. The syllabi were well prepared in terms of content (it would be nice to see a more consistent format across the courses with learning objectives). Also, the balance of classic texts (i.e. Kongstvedt, Griffith and White) with less traditional texts such as the book about a hospital run by Disney was also a positive feature of this program. There are a few opportunities within the curriculum. First, there is not a strong enough emphasis on courses related to financial management. There is one accounting course, one economics course, and a choice between financial management or marketing management. I realize that this program offers a lot of elective opportunity; however, the number of credits taken in the business school is capped at thirty. This should be enough opportunity to take finance-oriented courses, but my experience is that students who are not comfortable with finance will not take advantage of flexibility to supplement it. I recognize that I may have a bias, but I think it is important for them to have a strong foundation in finance and accounting as it is the vocabulary and grammar of business. I realize that other accredited undergraduate programs also require minimum financial coursework, but I have found this to be a problem with recent graduates (from other programs that I have hired). The students are also uncomfortable with the financial training received in the program as the exit interview question related to things you wish you had learned resulted in the most hits related financial topics ( budgeting, accounting, health finance, how to manage a budget ). At a minimum, I would recommend making the financial management course required and not an option. Second, there is a noticeable absence of quality improvement concepts in the curriculum or the syllabi provided. I am primarily referring to simple tools that should be taught such as fishbone diagrams, plan-do-study-act, run charts, etc. This is especially important given that many of the students are working as well. This is something that they could take to their current work environments and make a difference. I think that these concepts are harder to teach to students without experience or context; thus, I believe the program is missing out on a key opportunity to leverage the experienced student profile. Third, I think the program need a little more rigor in data analysis. This includes developing a skill set of working with data as well as practical statistical analysis. There is some evidence of database work in one of the courses where Microsoft 2

4 Access is covered in three lectures, but the assignment is a more simple Microsoft Excel assignment (which is good, but still not enough application of working with some data). There is a choice between Survey Research & Data Analysis and Health Planning & Program Evaluation. If students chose the planning course, the are able to miss out on some key opportunities for understanding some important data analysis concepts, which are becoming more and more critical with CMS implementing consumer satisfaction surveys and core measures. Students are not required to take statistics. It is a recommended elective, but I think it is a core undergraduate course that at least an understanding is needed in most health care administration jobs and most graduate programs require it as a pre-requisite. Some of the concepts are taught in Epidemiology, but the emphasis is different. Fourth, I thought the readings in the provided syllabi were too much. For example, the Health Management I course has five required reading / information sources for ten class sessions. I do not believe that undergraduate students will be able to digest this amount of material sufficiently. Health Management II follows up with two textbooks; Policy also has two books. Also, there were not many sources of readings besides texts, but this may be a function of the syllabi provided. Also, many of the assignments required journal article research, so this is probably sufficient. At first I was not sure why undergraduates would need two managed care courses since most graduate programs only have one; however, I did realize that the second course is a recommended elective. As an elective, it does make sense as students can pursue it if they are interested. Despite the several opportunities for improvement in curriculum listed above, these are fairly specific recommendations and I believe the overall curriculum is very good. This curriculum is surprisingly comprehensive for an undergraduate program. Students The students in this program are very different from most undergraduate health administration programs. The diversity in terms of age, ethnicity and experience is phenomenal. The average age is in the mid-thirties, which has a profound impact on the nature of the program and the ability of students to learn from each other. Also, it impacts the need for seasoned faculty with practical experience; this need is met in this program. An interesting trend in the program is the profound shift from full time to part time since the program s inception in It would be interesting to see what this translated into in terms of credit hours and impact on growth or decline of the 3

5 program in this relative value. My sense is that the shift to weekend and on-line courses was an important step for this program to be positioned for some very good students that are looking to go back to school. I have done a couple of guest lectures at health administration classes at the University of Baltimore and I have been struck by the maturity level and insights that the students have as well as their desire to learn. In this market, there is a critical need to provide training and educational opportunities to adult students. This program is well-designed for this purpose and I am glad that metropolitan Baltimore health care organizations have this tremendous resource available to their employees who want to better themselves and their organizations. Program By program, I am referring to the facilities, academic support, and placement services associated with HSMG. The structure of HSMG is very good. There is a willingness of leadership of the program to openly evaluate and improve the program far beyond the requirements of accreditation. The facilities are top-notch complete with audio-visual support and on-line resources for faculty and students. The program lists advising as a key strength area. While it is difficult to find evidence of this in the material provided, I agree that this is probably a strength given the number of students that are working and the need to motivate them to get through the program. Another strength listed was the on-line options available. While there was not much further explanation, my sense is that the program is well-designed to accommodate the students who are working. When guest lecturing, I observed that a great deal of the content of the on-site course was housed in the course web site. It appeared to be a relatively user-friendly tool and the students were very comfortable with it. One opportunity area with the program may be the internship option. My understanding is that students unable to provide sufficient documentation pf previous health systems management employment must do an internship. One of the student comments indicated that the program should help its students find an internship because all the students don t work in the health care environment. I recognize that this is one comment, but it did spark the question in my mind about the internship. I thought the layout of the expectations of the internship was excellent; however, it seemed very rigorous for a ninety-hour experience. Ninety hours is probably the correct amount of time coinciding with three credits (my guess of how this number was obtained). I also realize that if a student is working full time somewhere in a non-health care organization, that it could be very difficult to get ninety hours. However, I do think it is worth providing more 4

6 information on the internship in future assessments, such as the percentage of students who participate in an internship; the placement process; the partnerships developed with health care organizations that are able to provide these internships; and the success of the internship in terms of meeting the learning objectives outlined. Congruence with Goals At the college level (Liberal Arts), the goals were described as excellent education programs accessible to traditional and non-traditional students who seek professional advancement, life-long learning and personal development in and urban setting. The college also suggested that students should work toward mastering subject knowledge, thinking critically, and writing and speaking clearly and effectively. I believe this program clearly exceeds the goal related to excellent educational programs. I believe that the curriculum and program are emphatically designed to allow the students to master subject knowledge. The program exceeded the University actual average score twelve of the fourteen exit survey questions. Writing effectively was slightly lower than the University average; however, students rated their writing skills higher than the other students in the University self-ranked their skills in the personal assessment. In terms of the objectives set by the HSMG program itself, the program also does very well. The program states that is oriented toward adult learners currently employed in health professions and related fields who seek greater knowledge of the complexities and interrelationships n the management and development of health systems organizations. There is a substantial amount of evidence in the self-study that indicates that the program attracts the students that it sets out to attract: adult learners currently employed seeking greater knowledge. The program also does a careful job planning how to evaluate itself on these goals in several courses. The program clearly demonstrates through its curriculum and sample syllabi that it teaches subject matter knowledge (organization, financing, delivery). I believe that the program also demonstrates that students should be able to hit its goal of providing students with the ability to conduct assessments of health status populations, determinants of health and illness, factors influencing the use of health care services. I was very impressed from this perspective. The program effectively incorporates its foundation in liberal arts to enable students to understand terminology and context within a complex management environment. I also think the program effectively demonstrates that its structure is capable of providing the learning and application of critical management skills. 5

7 In terms of opportunities, the program does not offer as many courses with understanding values and ethical issues specifically in health care settings. Many programs incorporate ethics across many of the courses. I did not see indicators of ethics discussions embedded into the courses, but these concepts could be woven into the courses and just not visible on the surface. The student feedback indicated that they did not feel as comfortable with their communication skills. There is a writing course in the liberal arts core requirements, but I did not see a course on business communications (speeches and memo writing). Several courses had presentations and the class sizes are small enough that this may not be an issue. The self-evaluation noted that the program believes it needs to focus on the goal to enhance one s ability to conceptualize, apply and synthesize information from various sources. I thought this was noteworthy and perhaps related to the communications skills referenced above; however, the student evaluations scored high in integrating theory and practice, enhancing skill proficiency and working in team. This suggests that they are applying and synthesizing information to me. Overall The HSMG is a superb undergraduate health administration program. It has established a mission of training currently employed adult learners interested in bettering themselves. I believe that this is a fairly unique program due to this emphasis on educating experienced students. The program shows evidence of adhering to its mission with the shift toward part time students over the last few years. The program provides flexibility for students by primarily offering weekend and on-line coursework. The program is committed to self-evaluation and measurement. The program outlines an ambitious plan to roll out individual course and goal performance starting in the Spring of I am confident that this data will be used to improve the program. The mere design of explicit program goals with an evaluation plan driven by the faculty shows superior academic leadership. The program s greatest strengths are its faculty and students. The faculty is diverse in terms of interests, academic training and experience. The students are diverse in ethnicity, age and experience. This diversity establishes an environment where students can learn a lot not only from the faculty, but also from their peers. The program s greatest area for opportunity is to enhance the financial management and quality management dimensions to the curriculum. However, this is not a call for a radical transformation. Instead, it is a suggestion for incremental adjustments. 6

8 I appreciate the opportunity to review this program and look forward to the program s continued success. I believe that it is an excellent undergraduate program, which has identified a target adult learning audience and has developed a robust and accessible program to provide a high quality educational experience for these students. Please feel free to contact me with questions. Respectfully Submitted Conan Dickson 7

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