Degree Name

Doctor of Philosophy


Faculty of Education


Clinicians and managers often think differently about how health care should be organised, what constitutes best practice and how resources should be allocated (Degeling, Maxwell, Kennedy & Coyle 2003; Greater Metropolitan Clinical Taskforce 2004; Lawson & Rotem 2004). Despite management education using a variety of approaches to develop managerial thinking, there are concerns about management development and education in Australia (Karpin, 1995; Holian, 2004). In this study the development of managerial thinking using a “reflection-on-experience” approach was explored as a method that could address differences between how clinicians and managers think about the organisation of work and the use of resources.

The purpose of this study was to investigate whether clinicians in a postgraduate health services management subject developed managerial thinking through a reflection onexperience approach supported by an online discussion forum and reflective journal. This purpose was addressed by two research questions: 1. To what extent did clinicians develop managerial thinking and how did the online discussion forum influence this development? 2. What was the nature of reflection that helped clinicians to develop their ways of thinking using an online discussion forum and reflective journal?

The study was implemented within a subject entitled, HSM401 Perspectives on Health Care Systems. This subject was developed over several years to promote the reflectionon- experience approach. A single offering of this subject was the basis for this case study research. The data to address the first research question drew on changes in 12 participants’ definitions of management concepts at the commencement and conclusion of the academic session and their engagement with the online discussion forum. Three major conversations in the online discussion forum were examined for evidence of managerial thinking. The data to address the second research question were based on analysis of three in-depth case studies focussing on nominated examples of reflection selected by each learner. The analytical framework used to analyse reflection was developed by Kember et al. (1999) which focused on three levels of reflective writing - content, process and premise reflection. Content reflection described the problem; process reflection considered the strategies to resolve the problem; while premise reflection reviewed the problem and could lead to a change in perspective. Analysis of the data to address the first research question revealed that the majority of participants who consented to the study (12/19) demonstrated a more comprehensive understanding of a health services manager’s role. Learners identified issues with managerial implications and engaged in sustained conversation about these in the online discussion forum. The discussions increased the students’ depth of analysis of issues but their influence on the development of managerial thinking varied according to the level of participant interaction and relevance to their work context and experience. The relationship between use of the online discussion forum and reflective journal was examined in greater detail through the case studies.

In the second research question, analysis of three case studies found that the learners did not always progress stepwise through each level of reflection. A recursive process of reflection was observed with each learner revising at least one of the problems of their nominated examples of reflection. Revision resulted in vacillation between content and process reflection until problem clarity was achieved. This revision process varied from the linear reflective frameworks commonly identified in the literature (Boud & Walker 1993; Korthagen, 1985; Loughran, 1996; Moon, 1999, 2006). Progression through the levels of reflection depended largely upon the quality of the content reflection. The online discussion forum and reflective journal were often used in a complementary fashion to develop reflective thinking.

This study found that the online discussion forum and reflective journal supported the use of reflection-on-experience as an integral part of the development of managerial thinking. Implications arising from the findings include the benefit of designing learning resources and activities to increase learner recognition of different perspectives that arise from sharing experiences and contexts. The activity of writing key concept definitions and expectations to make explicit tacit understandings helped learners to experience thinking that was conducive to reflection and two of the three case studies make specific reference to that. That activity also raised the potential for learners to recognise the authority of that experience (Munby & Russell, 1994). Further research could investigate the use of richer descriptions to represent understandings such as vignettes and scenarios. It is recommended that online subjects should encourage learners to reflect on their workplace experiences scaffolded with appropriate resources.

Keywords: reflection, managerial thinking, asynchronous online discussion forum

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