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A triangulation assessment: The value of an MBA Degree: An evidenced-based management (EBMgt) systematic review (SR)
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The primary question researched for this paper is: How successful are MBA programs in meeting the competency needs of employers who are hiring MBA graduates? In the ever-changing business landscape, it is essential that MBA graduates possess the expected competencies employers require in the 21st-century workplace. Employers are seeking talented MBA graduates that can apply soft skills, such as have practical work experience, critical thinking, and advanced problem-solving skills. In this study, a systematic review process was applied by performing a data triangulation assessment from the perspectives of the three stakeholders in the MBA education-employment continuum: employers, students, and degree-granting institutions. An aggregative and configurative approach was used to examine 53 empirical studies, 14 informal gray published articles, and 10 employer-related surveys. Kirkpatrick’s 4-levels of learning evaluation, Kolb’s experiential learning theory, and Bloom’s taxonomy of educational objectives were applied as the theoretical frameworks and used as a critical lens for examining the elements of learning and curriculum in the literature. Notably, the findings revealed a lack of empirical data demonstrating that competency skills employees gained in an MBA program have an impact in the business world. Thus, concluding that employers and university administrators should collaborate to collect evaluation data based on job performance and together design a universal set of business management competency standards to ensure that MBA degree programs strengthen alignment with workplace needs.Running head: A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 1
A Triangulation Assessment: The Value of an MBA Degree
An Evidenced-Based Management (EBMgt) Systematic Review (SR)
Randall Fisher
A Dissertation Submitted to the Graduate Faculty of the
University of Maryland University College
in Partial Fulfillment of
the Requirements for the Degree of Doctor of Management
Dissertation Advisors:
Dr. Deborah Wharff
Dr. Wanda Wagner
December 2018 A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 2
© Copyright by
Randall D. Fisher
2018 A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 3
Abstract
The primary question researched for this paper is: How successful are MBA programs in meeting the competency needs of employers who are hiring MBA graduates? In the ever-changing business landscape, it is essential that MBA graduates possess the expected competencies employers require in the 21st-century workplace. Employers are seeking talented MBA graduates that can apply soft skills, such as have practical work experience, critical thinking, and advanced problem-solving skills. In this study, a systematic review process was applied by performing a data triangulation assessment from the perspectives of the three stakeholders in the MBA education-employment continuum: employers, students, and degree-granting institutions. An aggregative and configurative approach was used to examine 53 empirical studies, 14 informal gray published articles, and 10 employer-related surveys. Kirkpatrick’s 4-levels of learning evaluation, Kolb’s experiential learning theory, and Bloom’s taxonomy of educational objectives were applied as the theoretical frameworks and used as a critical lens for examining the elements of learning and curriculum in the literature. Notably, the findings revealed a lack of empirical data demonstrating that competency skills employees gained in an MBA program have an impact in the business world. Thus, concluding that employers and university administrators should collaborate to collect evaluation data based on job performance and together design a universal set of business management competency standards to ensure that MBA degree programs strengthen alignment with workplace needs.
Keywords: competencies, curriculum, employer, evaluation, MBA program, soft skills A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 4
Acknowledgments
The accomplishment of my doctoral journey is only possible due to the support and encouragement of many great individuals. First, I want to thank my Uncle “Bishop” Clark Parks and my stepfather, Al Bennett, for sparking and debating the dissertation topic. The Bishop’s perspective from the point of view of a small private business owner; Al’s perspective from a large cooperate vice-president; and my perspective as a lifelong Federal government employee laid the foundation of the initial debate question: After recently obtaining my own MBA degree, did I possess the competencies to step-in and start managing their “real-world” companies? Instead of debating, impulsively on Christmas Eve, I suggested: “let the evidence from this dissertation process answer the question.”
Second, I would like to offer my sincerest thanks to my dissertation advisors, Dr. Deborah Wharff and Dr. Wanda Wagner, for their continuous support. They provided encouragement when needed and a shove when required. It was certainly my fortunate opportunity to have them guide my way.
I would like to thank my subject matter experts for their valuable input, especially Dr. Jon Waldrop. As my MBA capstone professor, Dr. Waldrop, also a retired United States Air Force Officer and Doctor of Management himself, is the individual who encouraged me to pursue this terminal degree. Throughout the nine semesters, he would check-in and write “just keep putting one foot in front. Enjoy the voyage!” Those inspirational words led me to finish.
Finally, I would like to thank my wife, Jodie, and my two daughters, Carleigh and Chelsea, for their understanding, patience, motivation, support, and words of encouragement. They endured many hours alone while I labored over this dissertation — thank-you all for believing in me. I love you. Doc Fish A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 5
Dedications
This dissertation is dedicated to my mother, Charlene Elizabeth Bennett, and to my uncle, Clark “Bishop” Kittredge Parks. First, thank you to my mother for always believing I could finish. Second, thank you to my uncle for being an exemplary and visionary mentor and guiding me on the right path.
A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 6
Table of Contents
Abstract .......................................................................................................................................... 3
Acknowledgments.......................................................................................................................... 4
Dedications .................................................................................................................................... 5
Table of Tables ............................................................................................................................. 10
Table of Figures ............................................................................................................................ 11
Chapter 1: Introduction ................................................................................................................. 12
Background .............................................................................................................................. 14
Stakeholders in the Assessment of MBA Degree Program Effectiveness ............................... 16
Employers’ desired core competencies ............................................................................... 16
Student as the customer ....................................................................................................... 18
Academic considerations ..................................................................................................... 20
Problem Statement ................................................................................................................... 21
Purpose and Scope of the Dissertation ..................................................................................... 22
Importance and Implications for Management ........................................................................ 23
Research Questions .................................................................................................................. 24
Definitions/Terminology .......................................................................................................... 24
Summary ................................................................................................................................. 26
Organization of Dissertation .................................................................................................... 26
Chapter 2: Literature Review and Theoretical Framework .......................................................... 27
Discussion of Theoretical Framework ..................................................................................... 27
Donald Kirkpatrick’s 4-levels of principles of effective evaluation. .................................. 28
David Kolb’s experiential learning theory. ......................................................................... 31
Bloom’s taxonomy of educational objectives. .................................................................... 33
Scoping Literature Review ....................................................................................................... 35
Employer perspective. ......................................................................................................... 35 A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 7
Students’ needs perspective................................................................................................. 47
Academic perspective. ........................................................................................................ 58 Examination of MBA Program Criticism and Practitioner Surveys ........................................ 63
MBA program criticism. ..................................................................................................... 63
Employer-related reports. .................................................................................................... 65
Context, Intervention, Mechanism, and Outcome (CIMO) Framework .................................. 68
Conceptual Framework and Narrative ..................................................................................... 70
Thesis Statement ...................................................................................................................... 72
Summary ................................................................................................................................. 72
Chapter 3: Research Methodology................................................................................................ 73
Evidence-based Management................................................................................................... 74
Systematic Reviews ................................................................................................................. 75
Selection of mixed methods research synthesis .................................................................. 77
Seven-step systematic review process ................................................................................. 79
Review initiation ................................................................................................................. 80
Review questions and methodology .................................................................................... 81
Search strategy .................................................................................................................... 82
Study characteristics ............................................................................................................ 84
Quality and relevance assessment ....................................................................................... 85
Coding methodologies ......................................................................................................... 97
Subject matter expert panel review ................................................................................... 104
Chapter Summary................................................................................................................... 107
Chapter 4: Findings ..................................................................................................................... 108
Organization of Analysis and Findings .................................................................................. 109
Analysis and Synthesis of Published Research Results ......................................................... 110
Finding 1 – Employers' assessments of MBA graduates’ competencies found 68% of needed competencies were rated as “not met.” ................................................................. 110
Finding 2 – Student competency priorities differ from employers’ most needed competencies ..................................................................................................................... 119 A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 8
Finding 3 – Students select MBA programs based on three factors: school rankings, projected time and effort expended, and costs .................................................................. 122
Finding 4 - Universities update MBA curricula to remain relevant, however, it is not evident how they make their content decisions ................................................................. 134
Finding 5 - Some universities are seeking business practitioners as adjunct professors to stay current with employers' needs .................................................................................... 139
Concluding Section ................................................................................................................ 141
Reinterpreted Conceptual Model and Narrative .................................................................... 142
Alternative Perspectives ......................................................................................................... 145
Chapter Summary................................................................................................................... 146
Chapter 5: Conclusions and Recommendations ......................................................................... 148
Research Summary................................................................................................................. 148
Best Practices and Recommendations for Employers and University Administrators .......... 153
Phillips’ return on investment (ROI) model ...................................................................... 154
Develop a curriculum (DACUM)...................................................................................... 155
Employer internship opportunities. ................................................................................... 157
Limitations ............................................................................................................................. 159
Implications for Future Research ........................................................................................... 161
Pre-employment competency entrance examinations. ...................................................... 161
Universal business management competencies. ................................................................ 162
Study Conclusions .................................................................................................................. 163
Appendix A ................................................................................................................................ 184
Appendix B ................................................................................................................................ 187
Appendix C ................................................................................................................................ 190
Appendix D ................................................................................................................................ 195
Appendix E ................................................................................................................................ 196
Appendix F................................................................................................................................. 198 A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 9
Appendix G ................................................................................................................................ 213 A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 10
Table of Tables
Table 1 Top 10 MBA Programs .................................................................................................... 49
Table 2 Search Terms/Relevance .................................................................................................. 83
Table 3 Field Search Criteria by Database .................................................................................. 84
Table 4 Search Results by Journal ................................................................................................ 89
Table 5 MMAT Top Articles Results ............................................................................................. 93
Table 6 Initial First Round Codes ................................................................................................ 99
Table 7 Summary ........................................................................................................................ 100
Table 8 Summary of Subject Matter Expert Credentials ............................................................ 105
Table 9 Subject Matter Expert (SME) Questions ........................................................................ 106
Table 10 Key Findings ................................................................................................................ 110
Table 11 Employers’ Evaluation Report Card of Top Competencies ........................................ 112
Table 12 Competencies Students Rate as Most Important versus Employers’ Ratings.............. 120
Table 13 2017 Sample Comparison of MBA School Rankings Used by Students to Select MBA Programs Based on Major Sources ............................................................................................ 124
Table 14 Phillips’ Return on Investment (ROI) .......................................................................... 155
Table 15 Top 10 Popular Employer Internships......................................................................... 158
Table A1 Complete Listing of Databases. .................................................................................. 184
Table B1 Summary of All Literature Search Results. ................................................................. 187
Table C1 Weight of Evidence – MMAT Results. ......................................................................... 190
Table D1 Summary of Employer Surveys. .................................................................................. 195
Table E1 Summary of Coding Results. ....................................................................................... 196
Table F1 Competency Frequency Analysis. ................................................................................ 213 A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 11
Table of Figures
Figure 1. CIMO model of the triangulation assessment. ............................................................. 69
Figure 2. A depiction of the triangulation of desires. .................................................................. 71
Figure 3. Systematic review process steps. .................................................................................. 80
Figure 4. PRISMA: Extraction process diagram. ......................................................................... 86
Figure 5. Mixed Methods Appraisal Tool (MMAT) method quality review screening tool. ...... 91
Figure 6. MMAT results for P1 and P2. ....................................................................................... 95
Figure 7. MMAT results for P3 and P4. ...................................................................................... 96
Figure 8. MMAT results for P5 and P6. ....................................................................................... 97
Figure 9. Correlation of key codes. ............................................................................................ 103
Figure 10. Coding results organized by cycle. ........................................................................... 104
Figure 11. Student versus employer: comparison of the variance in the importance of competencies as related to the MBA program. ........................................................................... 121
Figure 12. Part-time & full-time versus MBA programs. .......................................................... 130
Figure 13. Sample of top-10 MBA program annual tuition. ...................................................... 132
Figure 14. Interpersonal competencies academics believe employers look for in successful MBA applicants. ......................................................................................................................... 136
Figure 15. A reinterpreted depiction of the triangulation of desires. ........................................ 144
A TRIANGULATION ASSESSMENT: THE VALUE OF AN MBA DEGREE 12
Chapter 1: Introduction
The Master of Business Administration (MBA) degree ha
Socio-cultural outcomes of mergers and acquisitions: How organizational compassion matters as a mediating factor
No full textMerger and acquisition (M&A) implementation activities have a high rate of commercial failure yet, because definitions of success and failure for M&A have expanded from traditional accounting principles to embrace socio-cultural dimensions, framing compassion through an organizational behavior lens is a relatively recent area of study in management science. Tracking the reasons for mergers’ success and failure using standard accounting principles is particularly difficult in mission-driven organizations, especially in the health care industry. This dissertation seeks to explore how organizational compassion affects socio-cultural outcomes for employees of merged organizations by researching whether organizational compassion is an influential factor in the M&A process for non-commercial organizations and commercial organizations. A thematic synthesis of 33 empirical case studies of M&A transactions revealed three relevant themes: how organizational behaviors impact employee engagement, how organizational responding and noticing impacts employee engagement, and how reduced levels of organizational compassion cause burnout in M&A implementation. The finding support organizational compassion as an influential factor in the success of an M&A planning process and identifies an important difference between non-commercial and commercial organizations in their ability to integrate compassion behaviors in M&A implementation. Non-commercial organizations have reduced levels of organizational compassion behaviors resulting in high levels of disengaged employees and negative work environment. Managers are challenged with maintaining organizational performance and often crippled in moving the organization beyond status quo. When non-commercial organizations understand how organizational compassion is part of organizational culture, they can better integrate these factors into the merged culture to improve the potential of a successful M&A transaction. By extending the relevance of organizational compassion research into M&A literature, compassion as an influential factor in successful M&A can further identify the positive impact on employees and organizational performance when incorporating organizational compassion in planning for merged cultures. Keywords: organizational compassion, mergers and acquisitions, non-commercial organizations, compassion burnout, employee engagement, collective behaviorsRunning Head: ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
Socio-Cultural Outcomes of Mergers and Acquisitions: How Organizational Compassion
Matters as a Mediating Factor
by
Amanda Jean Llewellyn-Neikam
Dissertation submitted to the Faculty of the Graduate School of the
University of Maryland University College, in partial fulfillment
of the requirements for the degree of
Doctor of Management
Advisory Committee
Dr. Denise A. Breckon
Dr. Thomas J. Mierzwa
December 2017
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
2
© Copyright by
Amanda Jean Llewellyn-Neikam
ALL RIGHTS RESERVED
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
3
Abstract
Merger and acquisition (M&A) implementation activities have a high rate of commercial failure
yet, because definitions of success and failure for M&A have expanded from traditional
accounting principles to embrace socio-cultural dimensions, framing compassion through an
organizational behavior lens is a relatively recent area of study in management science.
Tracking the reasons for mergers’ success and failure using standard accounting principles is
particularly difficult in mission-driven organizations, especially in the health care industry. This
dissertation seeks to explore how organizational compassion affects socio-cultural outcomes for
employees of merged organizations by researching whether organizational compassion is an
influential factor in the M&A process for non-commercial organizations and commercial
organizations. A thematic synthesis of 33 empirical case studies of M&A transactions revealed
three relevant themes: how organizational behaviors impact employee engagement, how
organizational responding and noticing impacts employee engagement, and how reduced levels
of organizational compassion cause burnout in M&A implementation. The finding support
organizational compassion as an influential factor in the success of an M&A planning process
and identifies an important difference between non-commercial and commercial organizations in
their ability to integrate compassion behaviors in M&A implementation. Non-commercial
organizations have reduced levels of organizational compassion behaviors resulting in high
levels of disengaged employees and negative work environment. Managers are challenged with
maintaining organizational performance and often crippled in moving the organization beyond
status quo. When non-commercial organizations understand how organizational compassion is
part of organizational culture, they can better integrate these factors into the merged culture to
improve the potential of a successful M&A transaction. By extending the relevance of
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
4
organizational compassion research into M&A literature, compassion as an influential factor in
successful M&A can further identify the positive impact on employees and organizational
performance when incorporating organizational compassion in planning for merged cultures.
Keywords: collective behaviors, compassion burnout, employee engagement, mergers and
acquisitions, non-commercial organizations, organizational compassion
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
5
Dedication
I dedicate this dissertation to my daughter Amelia Llewellyn Neikam whose spirit was a
guiding force even before she arrived in our lives. While at the outset this degree was one more
item to check off a long list of things to do, it became a journey of years and life experiences
offering invaluable lessons. The friendships and relationships that have been made and altered
over these years are a testament to a true journey.
Over those years, this degree has become the culmination of my life experiences and life
changes: marriage, children, love, loss, illness, adventure, and all the day-to-day efforts in
between. Each day stacked on another, finding change and a new amazing challenge around the
corner with hours and days passing by more quickly than the student on the first day of
orientation could have imagined.
I am forever grateful to my husband, Charles, for knowing what needed to happen and
not giving up on me, for being there, pushing at times, and knowing when to leave things quiet.
And, for the days when he went to work with a cranky wife at home trying to get the tab setting
right one more time or ordering out for food while watching the Miraculous Ladybug (again). I
am also grateful to my mother, Jean Llewellyn, who will always be my academic and
professional hero—single mom, healthcare executive, and great friend.
I am humbled and grateful for those that, in their hearts, supported me even when
sometimes it was with a swift kick. My thanks to Michael Figgs for believing Amanda
Llewellyn can do anything. And finally, heartfelt and sincere gratitude to Dr. Mohamed Ezz for
harassing me endlessly about the Miata, to get the “darn thing done,” and being the living
example of real compassion which has changed not only this dissertation but my entire life.
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
6
Acknowledgements
It is my humble pleasure to acknowledge those that were able to guide and support the
journey to the completion of this dissertation.
UMUC offered exceptional opportunities to me as a student and faculty member over the
years. My thanks to the esteemed faculty I have been fortunate enough to learn from as I made
this journey. I especially acknowledge the amazing contribution and support given by Dr. Bryan
Booth, Dr. Thomas Mierzwa, Dr. Denise Breckon, Dr. Joseph Drasin, and Dr. Wanda Wagner. I
would not have been able to achieve the completion of this journey without them.
Many “villagers” contributed to my success. My student colleagues challenged and
supported me along the way, especially through the changes in cohorts, lapses in time, and an
evolving doctoral program. My professional colleagues, who thought I was out of my mind to
pursue one more set of letters behind my name, but then were so proud that I was just crazy
enough to see it through. My family, near and far, that always asked “how is that PhD thing
going?” and still made time to talk me off the ledge when things seemed too challenging.
Finally, and not least, I am awed and amazed by the patients, students, and employees I
interact with every day…you have shown me the true meaning of resilience, perseverance, and
commitment through your actions and your lives. I am honored to know you all.
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
7
Table of Contents
Abstract .......................................................................................................................................... 3
Dedication ...................................................................................................................................... 5
Acknowledgements ......................................................................................................................... 6
List of Tables ............................................................................................................................... 10
List of Figures ............................................................................................................................... 11
Chapter 1: Introduction ................................................................................................................. 12
Organizational Compassion as a Presence in Mergers and Acquisitions ................................. 13
Problem Statement .................................................................................................................... 15
Merger and Acquisition Success and Failure ............................................................................ 15
Key Terms ................................................................................................................................ 18
Employee Engagement ............................................................................................................. 20
Organizational Compassion ...................................................................................................... 22
Health Care Industry ................................................................................................................. 24
Research Purpose and Significance .......................................................................................... 25
Scope and Limitations ............................................................................................................... 27
Research Question .................................................................................................................... 27
Dissertation Chapters ................................................................................................................ 28
Chapter 2: Literature Review and Conceptual Model .................................................................. 30
Systematic Processes and Collective Behaviors ....................................................................... 31
Change management. ............................................................................................................ 31
Organizational structure. ....................................................................................................... 35
Mergers and acquisitions. ..................................................................................................... 36
Characteristics of non-commercial mergers. ........................................................................ 41
Merger and acquisition outcomes. ........................................................................................ 44
Theoretical Framework: Social Identification and Psychological Contract ............................. 45
Social identity theory. ........................................................................................................... 46
Psychological contract. ......................................................................................................... 48
Social identity theory and personal contract in employee engagement. ............................... 50
Organizational Compassion and Advancing Cultural Norms ................................................... 51
Measurement of employee engagement. ............................................................................... 52
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
8
Organizational compassion. .................................................................................................. 55
Key role played by communication. ..................................................................................... 57
Organizational compassion burnout. .................................................................................... 59
Conceptual Model ..................................................................................................................... 61
Thesis Statement ....................................................................................................................... 62
Summary .................................................................................................................................. 62
Chapter 3: Methodology ............................................................................................................... 64
Research Design ........................................................................................................................ 65
Evidence based research. ...................................................................................................... 66
Systematic review approach. ................................................................................................ 66
Search Strategy ......................................................................................................................... 67
Terms and search strings. ...................................................................................................... 68
Quality Assessment ................................................................................................................... 69
Inclusion & Exclusion ............................................................................................................... 70
Significance ............................................................................................................................... 73
Rigor Standards ......................................................................................................................... 74
Variables .................................................................................................................................. 76
Thematic Coding ....................................................................................................................... 76
Establishment of Themes .......................................................................................................... 78
Use of Subject Matter Expert Reviews ..................................................................................... 79
Subject matter experts’ profiles. ........................................................................................... 80
Limitations ............................................................................................................................... 82
Summary .................................................................................................................................. 83
Chapter 4: Analysis and Findings ................................................................................................. 84
Findings .................................................................................................................................... 86
Thesis 1. Framing the Effects of Organizational Compassion ................................................ 87
Collective noticing. ............................................................................................................... 89
Collective feeling. ................................................................................................................. 91
Collective responding. .......................................................................................................... 93
Thesis 2. Role of Organizational Compassion Burnout ........................................................... 96
Thesis 3. The Role of Organizational Type in Levels of Organizational Compassion ........... 99
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
9
Limitations .............................................................................................................................. 102
Alternative Perspectives .......................................................................................................... 103
Summary ................................................................................................................................ 104
Chapter 5: Conclusions and Recommendations ........................................................................ 105
Conclusions ............................................................................................................................. 105
Implications for Practice ......................................................................................................... 107
Understanding collective behaviors. ................................................................................... 107
Including collective behaviors in M&A planning, design, and implementation. ............... 108
Communication is critical. .................................................................................................. 109
Collective responding impacts the psychological contract. ................................................ 109
Adoption of socio-cultural success factors. ........................................................................ 110
Organizational compassion by type of organization. .......................................................... 111
Implications for Scholarship ................................................................................................... 113
Creating measurement tools. ............................................................................................... 113
Industry specific focus. ....................................................................................................... 115
Recommendations for Future Research .................................................................................. 116
Planning for employee engagement. ................................................................................... 116
Understanding the role of organizational compassion burnout. ......................................... 117
Increased research on non-commercial organizations. ....................................................... 118
Determining if organizational compassion behaviors are global. ....................................... 118
Summary ................................................................................................................................ 118
References .................................................................................................................................. 120
Appendix A. Personal Assessment Tool ..................................................................................... 140
Appendix B. Application of Inclusion Criteria ........................................................................... 144
Appendix C. Application of Exclusion Criteria .......................................................................... 146
Appendix D. SME Invitation Letter and Evaluation Form ......................................................... 151
Appendix E. SME Feedback ....................................................................................................... 154
Appendix F. Psychological Contract Factors .............................................................................. 157
Appendix G. Organizational Compassion Factors ...................................................................... 158
ORGANIZATIONAL COMPASSION IN MERGERS AND AQUISITIONS
10
List of Tables
Table 1. Health Care Specific Search Strings ............................................................................... 69
Table 2. Variables, Definitions, and Measurement ....................................................................... 77
Table 3. First Iteration of Data Coding ......................................................................................... 77
Table 4. Second Iteration of Data Coding .................................................................................... 78
Table 5. Coding for Organizational Compassion Behaviors and Subsequent Outcomes ............. 87
Table 6. Behaviors in Organizational Compassion, Weight of Evidence Summary .................... 88
Table 7. Sample Set of Studies with Responding Behaviors ........................................................ 94
Table 8. Organizational Compassion Level, by Organizational Type ........................................ 100
Table 9. Collective Behaviors and the Psychological Contract .........................
Service innovation through boundary-spanning and collaboration of front-line employees and middle managers
No full textThe research question for this paper is: What boundary-spanning and collaborative behaviors and characteristics enable front-line employees and middle managers to develop innovation in service organizations? Service organizations need the ability to effectively develop innovation in order to distinguish themselves from the competition and show profit for their shareholders, but the nature of these organizations is not conducive to traditional research and design methods. Thus, the concern lies in determining the most effective way service organizations can innovate given that the process tends to be informal and unstructured, resulting in ad-hoc innovation that occurs through interactions with customers. A realist synthesis approach was applied to the systematic review of 45 empirical studies on the research topic. The theoretical framework for this study was created using Rogers' diffusion of innovation theory, Weick's sensemaking perspective, Uhl-Bien's leader-member exchange theory, and Rapert and Wren's organizational structure theory. An analysis of the evidence revealed several behaviors and characteristics for both front-line employees and middle managers in their roles as boundary spanners and collaborators that enable them to develop service innovation. The findings also describe the conditions under which these behaviors and characteristics were found to be effective, which include a focus on the innovation climate of service organizations, the role of senior managers, and overcoming specific barriers to innovation.Running head: INNOVATION IN SERVICE ORGANIZATIONS i
Service Innovation through Boundary-Spanning and Collaboration of Front-Line
Employees and Middle Managers
A Systematic Review by
Karen K. Carmack
A Dissertation Submitted to the Graduate Faculty
of
University of Maryland University College
In Partial Fulfillment of
The Requirements for the Degree
of
Doctor of Management
Dissertation Advisors:
Dr. Deborah Wharff
Dr. Wanda Wagner
INNOVATION IN SERVICE ORGANIZATIONS ii
@ Copyright by
Karen K. Carmack
2018
INNOVATION IN SERVICE ORGANIZATIONS iii
PREFACE
1 All reprinted or adapted figures have been researched with regard to obtaining permission for
use.
2 Any such figure not explicitly stating that permission has been granted did not require
the permission.
INNOVATION IN SERVICE ORGANIZATIONS iv
Abstract
The research question for this paper is: What boundary-spanning and collaborative behaviors
and characteristics enable front-line employees and middle managers to develop innovation in
service organizations? Service organizations need the ability to effectively develop innovation
in order to distinguish themselves from the competition and show profit for their shareholders,
but the nature of these organizations is not conducive to traditional research and design methods.
Thus, the concern lies in determining the most effective way service organizations can
innovate given that the process tends to be informal and unstructured, resulting in ad-hoc
innovation that occurs through interactions with customers. A realist synthesis approach was
applied to the systematic review of 45 empirical studies on the research topic. The theoretical
framework for this study was created using Rogers’ diffusion of innovation theory, Weick’s
sensemaking perspective, Uhl-Bien’s leader-member exchange theory, and Rapert and Wren’s
organizational structure theory. An analysis of the evidence revealed several behaviors and
characteristics for both front-line employees and middle managers in their roles as boundary
spanners and collaborators that enable them to develop service innovation. The findings also
describe the conditions under which these behaviors and characteristics were found to be
effective, which include a focus on the innovation climate of service organizations, the role of
senior managers, and overcoming specific barriers to innovation.
Keywords: boundary-spanning, collaboration, front-line employees, middle managers, service
innovation
INNOVATION IN SERVICE ORGANIZATIONS v
Dedication
This dissertation is dedicated to my family, who made me who I am today. I have taken
lessons learned from each of you along with me on this dissertation journey. I am grateful for
your influence and inspiration.
My late paternal grandfather, Emil Carmack, taught me that working hard and doing well
in school could reap rewards, as evidenced by the dollar he gave me for my first good grade in
elementary school. His encouragement motivated me to do my best.
My paternal grandmother, Laverne Carmack, taught me the value of positivity. Her
positive outlook on life influenced me to look for the best in people and situations, even during
adversity.
My father, Donald Carmack, who I lost while completing this doctoral program,
demonstrated what it means to have a strong work ethic. His example showed me the
importance of working hard and being dedicated to seeing a goal through to completion.
My aunt and uncle, Mike and Marian Carmack, taught me to have a generous spirit. The
generosity they have shown to me over the years reminded me to be selfless and help others in
their time of need.
My maternal grandmother, Barbara Jean Oliver, who I also lost while completing this
doctoral program, taught me to embrace the lightheartedness of life. Her fun-loving nature
encouraged me to laugh and have fun along the way.
My brother and sister-in-law, Jeremy & Charvaughn Carmack, taught me the importance
of setting priorities. For them, nothing is as important as family. This perspective enabled me to
focus on what was truly important during this journey.
INNOVATION IN SERVICE ORGANIZATIONS vi
My step-father, Mark Dougherty, taught me to strive for excellence. His attention to
detail demonstrated to me that it was important for me to take my time and do things right.
And my mother, Linda Dougherty, taught me the power of resilience. She overcame
tremendous adversity in her life and always bounced back stronger and better than before. She
was an excellent role model for me. Her resilient nature influenced me to be strong and keep
going, even when I felt like the odds were stacked against me. She is, and will forever be, my
biggest cheerleader.
To each of you, thank you from the bottom of my heart. Each of your strengths
combined to give me the fortitude to make it through this process. I love you all beyond words.
INNOVATION IN SERVICE ORGANIZATIONS vii
Acknowledgements
Writing this dissertation was a period of intense learning for me. I would like to take a
moment to reflect and give thanks to those who have supported and helped me so much
throughout this process.
To begin, I’d like to thank my dissertation advisors, Drs. Deborah Wharff and Wanda
Wagner. Each of you gave of yourselves selflessly to ensure that I produced a quality product
that I would be proud of. To Deborah, you challenged me in ways that I have never been
challenged before in my academic career, which brought out the best in me. Thank you for the
times that you talked me “off the ledge” and helped me realize my tendency to see things as
much harder than they actually need to be. With your guidance and support, I was able to
produce a dissertation that has great meaning to me and will hopefully make a difference in
service organizations. I am so grateful for the time you invested in me and the interest you took
in my research topic. Thank you. To Wanda, I appreciated your encouragement and support
throughout this process. Your comments were uplifting to me at times when I may have been
feeling defeated. The time I spent with you in the content courses prior to starting the
dissertation process prepared me well for this journey. You were an excellent role model.
Thank you.
To my fellow cohort members, I feel so blessed to have met each of you, and it has been
a true honor to go through this process with you. I remain in awe of how talented and
accomplished you all are. You have inspired me to work hard so I could remain alongside of
you in this cohort. I would like to especially acknowledge my colleagues, friends, and soon-to-be
fellow doctors, Max Frost and Jeff Victor. We became fast friends and have shared many
laughs together. You made this process so enjoyable; it almost did not feel like work at times.
INNOVATION IN SERVICE ORGANIZATIONS viii
To Max, we were always in the same spot at the same time with our assignments and deadlines
throughout this process, and I could not imagine anyone else I would have liked to have hung
with. Thank you for being my partner in this process and for all of your generosity. To Jeff,
since you were always “a couple of pages ahead in the book,” you were such a great resource at
critical points in this process. Thank you for your willingness to share, as well as for all of the
laughs and random ridiculousness. I look forward to a lifelong friendship with you both.
To those who took the time to serve as part of the Subject Matter Expert Panel for this
dissertation, I appreciate your time and feedback. A special thank you to Claudia Williams and
Drs. Annette Cremo, Linda Eagle, and Marit Engen for providing valuable input that helped to
shape this research. My work was strengthened by your involvement, and for that I am truly
grateful.
To my work family at F&M Trust, I cannot express how much your interest and
encouragement has meant to me. So many of you asked about my progress and cheered me on,
which has meant the world to me. Now I look forward to sharing what I have learned with you.
Special thanks are in order to President & CEO, Tim Henry, who gave me the inspiration for this
research topic and was also a great source of encouragement. To my peers on the senior
management team, thank you for serving as a sounding board and support to me through this
process. I am lucky to work with such a talented and professional group of people. And lastly,
to my wonderful HR team, who kept encouraging me to press on and offering to help in any way
possible, I could not ask for a better group of people to work with. Thank you for the support
you show to me every single day.
INNOVATION IN SERVICE ORGANIZATIONS ix
To Chris Horne, I cannot thank you enough for all that you have done to help me along
the way. You have always been there for me, for the big things and the little things, and I cannot
thank you enough for your support throughout this process.
And lastly, to my pup Jack, you have been very patient with me as I sat for periods on
end in front of the computer, all I can say now is, “Go get your ball!”
INNOVATION IN SERVICE ORGANIZATIONS x
Table of Contents
PREFACE ..................................................................................................................................... iii
Abstract ......................................................................................................................................... iv
Dedication ...................................................................................................................................... v
Acknowledgements ....................................................................................................................... vii
Table of Contents ............................................................................................................................ x
List of Tables .............................................................................................................................. xvii
List of Figures ............................................................................................................................ xviii
CHAPTER 1: INTRODUCTION AND OVERVIEW ................................................................. 19
Background .................................................................................................................................. 22
Customer Participation .............................................................................................................. 27
The Role of Front-Line Employees in Developing Innovation................................................. 27
Problem Statement ........................................................................................................................ 29
Purpose of the Study ..................................................................................................................... 30
Significance of the Study .............................................................................................................. 32
Research Question ........................................................................................................................ 33
Discussion of Concepts and/or Themes ........................................................................................ 35
Definitions and Terminology ........................................................................................................ 37
Chapter Summary ......................................................................................................................... 40
INNOVATION IN SERVICE ORGANIZATIONS xi
Organization of Dissertation ......................................................................................................... 42
CHAPTER 2: LITERATURE REVIEW ...................................................................................... 43
Discussion of Theoretical Framework .......................................................................................... 44
Diffusion of Innovation Theory ................................................................................................ 44
Sensemaking............................................................................................................................. 50
Leader-Member Exchange Theory............................................................................................ 52
Organizational Structure Theory ............................................................................................... 53
Scoping Literature Review ........................................................................................................... 54
Innovation Process and Service Organizations ......................................................................... 54
Customer participation .......................................................................................................... 55
Service innovation process .................................................................................................... 56
Front-Line Employees as Boundary Spanners .......................................................................... 60
Front-Line Employees and Middle Managers as Collaborators................................................ 62
Innovation climate ................................................................................................................. 63
Middle Managers as Boundary Spanners .................................................................................. 65
Personal characteristics .......................................................................................................... 67
Upward influence .................................................................................................................. 68
Role conflict .......................................................................................................................... 68
Conceptual Framework ................................................................................................................. 70
Chapter Summary ......................................................................................................................... 71
INNOVATION IN SERVICE ORGANIZATIONS xii
CHAPTER 3: METHODOLOGY ................................................................................................ 72
Research Design........................................................................................................................... 73
Evidence-Based Management ................................................................................................... 73
Systematic Reviews................................................................................................................... 76
Realist Synthesis ....................................................................................................................... 77
Systematic Review Process........................................................................................................... 81
Review Initiation ....................................................................................................................... 82
Review Question and Methodology .......................................................................................... 82
Search Strategy .......................................................................................................................... 83
Inclusion and exclusion criteria ............................................................................................. 83
Search process ....................................................................................................................... 86
Screening preliminary search records – application of inclusion and exclusion criteria ...... 89
Selection of eligible papers .................................................................................................... 90
Study Characteristics ................................................................................................................. 90
Quality and Relevance Assessment........................................................................................... 91
Appraisal tool ........................................................................................................................ 91
Synthesis................................................................................................................................... 92
Coding process ...................................................................................................................... 93
Considerations of the Subject Matter Expert Panel .................................................................. 98
Using Reviews........................................................................................................................ 101
INNOVATION IN SERVICE ORGANIZATIONS xiii
Chapter Summary ....................................................................................................................... 102
CHAPTER 4: FINDINGS: ANALYSIS AND DISCUSSION .................................................. 103
Results of Line-by-line Coding ................................................................................................... 105
Results of Realist Synthesis ........................................................................................................ 109
Finding 1: Front-Line Employees as Boundary Spanners: Behaviors and Characteristics..... 109
Finding 1a: situational awareness as a boundary-spanning behavior exhibited by front-line
employees ............................................................................................................................ 109
Finding 1b: generating ideas as a boundary-spanning behavior exhibited by front-line
employees. ........................................................................................................................... 110
Finding 1c: interacting with customers as a boundary-spanning behavior exhibited by front-line
employees. .................................................................................................................... 110
Finding 1d: absorbing knowledge as a boundary-spanning behavior exhibited by front-line
employees. ........................................................................................................................... 111
Finding 1e: being intrinsically motivated as a boundary-spanning characteristic possessed by
front-line employees ............................................................................................................ 112
Finding 1f: innovation effort or engagement as both a behavior and characteristic of front-line
employees as boundary spanners .................................................................................. 113
Finding 1g: sharing knowledge as both a behavior and characteristic of front-line employees
as boundary spanners ........................................................................................................... 114
Finding 2: Middle Managers as Boundary Spanners: Behaviors and Characteristics ............ 115
Finding 2a: facilitation as a boundary-spanning behavior exhibited by middle managers . 115
INNOVATION IN SERVICE ORGANIZATIONS xiv
Finding 2b: serving as a conduit for knowledge sharing as a boundary-spanning behavior
exhibited by middle managers ............................................................................................. 116
Finding 2c: mobilizing creative talent as a boundary-spanning behavior exhibited by middle
managers .............................................................................................................................. 117
Finding 2d: creating a shared perspective as a boundary-spanning behavior exhibited by
middle managers .................................................................................................................. 117
Finding 2e: allocating resources as a boundary-spanning behavior exhibited by middle
managers .............................................................................................................................. 118
Finding 2f: possessing personal
Effectiveness of clinicians as first-time managers: A systematic review of the evidence
No full textThe purpose of this systematic review was to examine the factors associated with clinicians' effectiveness as first-time healthcare managers. The high demand for clinicians to become healthcare managers has been predicated on their strong clinical knowledge and their credibility among their peers. While existing medical expertise and credibility among peers are crucial when transitioning into management, there are other factors that could impact clinicians' effectiveness as first-time managers. Utilizing a conceptual framework that incorporates motivation theory, social identity theory, leader–follower theory, and leader–member exchange theory, this research sought to identify factors associated with the effectiveness of clinicians as first-time healthcare managers. Evidence from 67 studies was analyzed using a thematic synthesis approach. The following six major factors were identified as factors that are associated with clinicians' effectiveness as first-time healthcare managers: (1) clinicians' motivation to transition into management, (2) clinicians' ability to detach from their social identity as clinicians and adopt a new social identity associated with their new role, (3) quality and convenience of formal developmental programs, (4) utilization of succession planning, and (5) cultural alignment. Based on the findings of this study, implementation of evidence-based succession planning programs would allow organizations to identify current and future open management positions, to systematically screen high-potential clinicians who are motivated to solve healthcare issues and achieve excellence, and to provide convenient and high-quality in-house management training and mentorship programs prior to role transition.EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
Effectiveness of Clinicians as First-Time Managers: A Systematic Review of the Evidence
Roza Masoumi, MBA
A Doctoral Dissertation
Submitted to the Graduate Faculty
of
University of Maryland University College
In Partial Fulfillment of the Requirements for the Degree
of
Doctor of Management
Advisory Committee
John Sherlock, Ph.D.
Kuan Collins, DM
EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
2
Abstract
The purpose of this systematic review was to examine the factors associated with clinicians’ effectiveness as first-time healthcare managers. The high demand for clinicians to become healthcare managers has been predicated on their strong clinical knowledge and their credibility among their peers. While existing medical expertise and credibility among peers are crucial when transitioning into management, there are other factors that could impact clinicians’ effectiveness as first-time managers. Utilizing a conceptual framework that incorporates motivation theory, social identity theory, leader–follower theory, and leader–member exchange theory, this research sought to identify factors associated with the effectiveness of clinicians as first-time healthcare managers. Evidence from 67 studies was analyzed using a thematic synthesis approach. The following six major factors were identified as factors that are associated with clinicians’ effectiveness as first-time healthcare managers: (1) clinicians’ motivation to transition into management, (2) clinicians’ ability to detach from their social identity as clinicians and adopt a new social identity associated with their new role, (3) quality and convenience of formal developmental programs, (4) utilization of succession planning, and (5) cultural alignment. Based on the findings of this study, implementation of evidence-based succession planning programs would allow organizations to identify current and future open management positions, to systematically screen high-potential clinicians who are motivated to solve healthcare issues and achieve excellence, and to provide convenient and high-quality in-house management training and mentorship programs prior to role transition.
Keywords: clinician managers, nurse managers, physician managers, clinicians as leaders, effective role transition, transition to management, healthcare managers, first-time managers, systematic review EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
3
Table of Contents
Abstract ................................................................................................................................................ 2
Table of Contents ................................................................................................................................. 3
Acknowledgment ................................................................................................................................. 5
List of Figures ...................................................................................................................................... 6
List of Tables ....................................................................................................................................... 7
Chapter 1: Introduction ......................................................................................................................... 8
Background ...................................................................................................................................... 9
A complex environment. ............................................................................................................... 9
History of clinicians as leaders. .................................................................................................. 11
Problem Statement .......................................................................................................................... 13
Purpose and Scope of the Study...................................................................................................... 15
Research Question .......................................................................................................................... 18
Definitions...................................................................................................................................... 18
Chapter Summary ........................................................................................................................... 18
Chapter 2: Literature Review .............................................................................................................. 21
Motivation Theory .......................................................................................................................... 23
Motivation to become a manager. ............................................................................................... 24
Social Identity Theory..................................................................................................................... 26
The social identity approach to role identity............................................................................... 27
The social identity approach to role transition. ........................................................................... 28
Role identity conflict................................................................................................................... 34
Follower–Leader Theories .............................................................................................................. 36
From peers to superiors. .............................................................................................................. 39
Relationship with superiors......................................................................................................... 41
The political environment ............................................................................................................... 43
Chapter Summary ........................................................................................................................... 45
Chapter 3: Methodology ..................................................................................................................... 46
Systematic Review Process............................................................................................................. 47
Phase one: review initiation. ....................................................................................................... 48
Phase two: review question and methodology ............................................................................ 50
Phase three: search strategy. ....................................................................................................... 52
Phase four: description of characteristics of studies. .................................................................. 56
Phase five: quality and relevance assessment. ............................................................................ 57
Phase six: data synthesis. ............................................................................................................ 62
Chapter Summary ........................................................................................................................... 64
Chapter 4: Findings ............................................................................................................................. 66 EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
4
Factor one: Motivation .................................................................................................................... 71
Positively associated motivational factors. ................................................................................. 71
Negatively associated motivational factors. ............................................................................... 73
Factors Three, Four, and Five: Developmental Factors .................................................................. 81
Factor three: In-house leadership and management training programs. ..................................... 81
Factor four: mentorship programs. ............................................................................................. 85
Factor five: Formal succession planning. ................................................................................... 88
Chapter 5: Implications and Conclusion ............................................................................................. 92
Current Healthcare Talent Management Problems ......................................................................... 92
Lack of appropriate succession planning. ................................................................................... 93
Recommendations ........................................................................................................................... 94
Implementation of evidence-based succession planning. ........................................................... 96
Research Limitations .................................................................................................................... 102
Conclusion ................................................................................................................................... 104
Appendix A ...................................................................................................................................... 131
Appendix B ...................................................................................................................................... 139
Appendix C ...................................................................................................................................... 140
Appendix D ...................................................................................................................................... 141
Appendix E ...................................................................................................................................... 147
EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
5
Acknowledgment
First, I would like to acknowledge my dissertation chair, Dr. Sherlock. I could not have asked for a more knowledgeable and dedicated professor as my advisor and dissertation chair. He often challenged me and pushed me to my limits, which helped me to think deeper and work harder. His consistent and valuable feedback kept me focused, while his words of encouragement helped me to push through even when I thought I could not.
I would also like to thank my wonderful and supportive husband, Dr. Kourosh Ardekani. I would like to acknowledge his patience and positivity when I needed it most. Without his relentless support, I would not be able to dedicate the necessary time and energy to complete my research. Kourosh, I love you, and I am so grateful to have you.
Last but certainly not least, I would like to acknowledge my cohort members for always being supportive: you are among the most intelligent and exceptional people I have ever had the pleasure of working with. Every one of you has inspired me in a unique way and played an essential part in my success!
EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
6
List of Figures
Figure 1. Conceptual framework: factors associated with clinicians’ effectiveness as first-time healthcare managers based on a theoretical framework ..................................................................... 22
Figure 2. Attributes of Role Transition. The difficulty and valence of transition are affected by the attributes of role transitions. Adapted from B. E. Ashforth (2001). Role transitions in organizational life: an identity-based perspective. Mahwah, NJ: Lawrence Erlbaum Associates. ............................ 29
Figure 3. Systematic review process. Systematic review process. Reprinted from An Introduction to Systematic Reviews by Gough, Oliver, & Thomas, 2012, London, UK: Sage Publications Ltd. ...... 49
Figure 4. Example of the thematic synthesis process. Reprinted from An Introduction to Systematic Reviews by Gough, Oliver, & Thomas, 2012, London, UK: Sage Publications Ltd. ........................ 64
Figure 5. Factors associated with clinicians’ effectiveness as first-time healthcare managers based on findings of the systematic review. ...................................................................................................... 70
Figure 6. Code tree: individuals’ motivation ...................................................................................... 71
Figure 7. Code tree: Social identity .................................................................................................... 76
Figure 8. Code tree: developmental programs .................................................................................... 81
EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
7
List of Tables
Table 1. .............................................................................................................................................. 31
Table 2. .............................................................................................................................................. 55
Table 3. .............................................................................................................................................. 60
Table 4. .............................................................................................................................................. 61
Table 5. .............................................................................................................................................. 67
Table 6. .............................................................................................................................................. 68
EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
8
Effectiveness of Clinicians as First-Time Managers
Chapter 1: Introduction
The healthcare industry has undergone various transformations that challenge the status quo and impact its rate of change. Some of those changes include the speed at which healthcare is growing due to mergers and acquisitions (Athey, 2016; Ohlson & Anderson, 2017; Shalala, Bolton, Brennan, Devlin, & Vladeck, 2010), the shift from a volume-based to a value-based system (Angood, 2014), and payment models based on quality of care (Angood, 2014; Cox, 2016; Loh, 2015; Satiani, Sena, Ruberg, & Ellison, 2014). Since many of these changes are related to the practice of medicine, it is difficult for organizations to achieve their desired outcomes without the support and involvement of their clinicians (Buell, 2015). Consequently, the need for clinician engagement in the boardroom and in managerial leadership roles has grown steadily over the past decade and is predicted to continue growing (Angood, 2014; Athey, 2016; Blanchard, 2017; Cox, 2016; Loh, 2015; Satiani & Prakash, 2016).
Demand for clinician managers has been predicated on their strong clinical knowledge (Angood, 2014; Athey, 2016) and their credibility among their peers (Loh, 2015; Spehar, Frich, & Kjekshus, 2014). Healthcare organizations are interested in filling their managerial vacancies with managers with a clinical background (Loh, 2015; Spehar et al., 2014). It is believed that clinicians with outstanding clinical results and credibility among their peers can positively influence and motivate their clinical peers, reduce resistance to change, and work with other healthcare leaders to meet organizational objectives (Loh, 2015; Spehar et al., 2014).
Although there are several case studies of clinicians succeeding in improving quality of care, there are many accounts of clinicians who have struggled or failed as healthcare managers (Angood, 2014; Fernandez, 2016; Freerksen, 2012; Lawson, 1994; Loh, 2015; Olivo, 2014; Shalala et al., EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
9
2010; Weberg, 2012). Clinicians who transition to management will face challenges that may hinder their success or lead to their failure (Casida & Pinto-Zipp, 2008; Henson, 2017). While having medical knowledge and credibility are crucial, there are other factors that could affect clinicians’ effectiveness as they transition to become first-time healthcare managers (Angood, 2014; Fernandez, 2016; Freerksen, 2012; Lawson, 1994; Loh, 2015; Olivo, 2014; Shalala et al., 2010; Weberg, 2012).
First-time clinician managers encounter difficulties coping with their new administrative responsibilities, prioritizing organizational objectives over patient care, managing finances, and collaborating with non-clinical managers (Chandrasiri, 2015; Freerksen, 2012; Lawson, 1994; Leicher, 2016; Loh, 2015). If not addressed appropriately, these challenges will lead to weak performance and burnout (Blanchard, 2017; Olivo, 2014). Hiring clinicians as healthcare managers is an expensive and critical investment for both the healthcare organization and the clinician (Blanchard, 2017). Thus, it is essential to examine and evaluate the factors associated with the transition of a clinician to management. This dissertation seeks to conduct a systematic review to identify and investigate the influential factors associated with the effectiveness of clinicians as first-time healthcare managers.
Background
A complex environment. As the healthcare industry becomes increasingly complex, its leaders are struggling to perform (Olivo, 2014; Weberg, 2012). At the macro level, some of the known reasons behind poor and inconsistent performance include increasing federal and local regulations, the incredibly complex organizational environment, and the presence of professional bureaucracies (Loh, 2015; Olivo, 2014; Warren & Katen-Bahensky, 2016).
Firstly, the healthcare industry is one of the most highly regulated fields. Federal and state regulations shape the business and clinical areas of healthcare in both the private and non-profit EFFECTIVENESS OF CLINICIANS AS FIRST-TIME MANAGERS
10
sectors (Warren & Katen-Bahensky, 2016). Examples include regulations such as Medical Necessity, Concurrent Review, and Retrospective Review, which allow insurance companies to review all services rendered to a patient before, during, and after care is provided. If the insurance companies determine that the patient does not meet the requirements for minimum medical necessity, they have the right to deny payments or request refunds from healthcare providers (Centers for Medicare & Medicaid Services [CCMS] & Department of Health & Human Services [HHS], 2016). Such regulations often pressure clinicians and patients to allow insurance companies to dictate the course of action for patients’ health. These policies are not only detrimental to patients’ health but are also reprioritizing the healthcare system.
Secondly, the healthcare industry has a complex organizational environment with multiple internal and external stakeholders who are part of the decision-making process (Warren & Katen-Bahensky, 2016). The multiple decision-making parties, including politicians, academic personnel, clinicians, and administrative managers, each have different visions, giving healthcare managers conflicting and unclear objectives to follow (Warren & Katen-Bahensky, 2016). In fact, the healthcare industry is one of the few systems in which subcultures and power infrastructures continue to coexist in silos (Loh, 2015).
Lastly, a culture of professional bureaucracy has existed in the healthcare industry since the 1960s, when hospitals were monopolized by a few elite clinicians who had complete power and influence over the organization (Dickinson & Ham, 2008; Greenwood, Hinings, & Brown, 1990; Loh, 2015). Professional bureaucracy involves a group of professionals with technical skills that are influential informal managers and are responsible for implementing strategic regulations and policies in organizations (Business Dictionary, n.
An application of learning theories for STEM degree seeking students in community colleges
No full textSTEM attrition is an issue of concern that impacts the economy of the United States. According to the Trump administration (2018), investing in STEM education is essential for the workforce of the future. Community colleges play a key role in addressing STEM’s workforce needs. This research examines the application of the learning theories of elaboration theory, situated learning theory, and action learning theory to address the academic barriers that impact STEM’s retention and completion rates in community colleges. Academic barriers for STEM course learning include: lack of academic preparation in STEM courses, lack of motivation and student engagement in STEM courses, intensity of course taking in the first academic year, and lack of confidence in STEM skills. Through the critical interpretive synthesis methodology, the literature was analyzed and synthesized. The interpretation of the findings led to the creation of an intervention strategy that can be used by community college leadership to support STEM student success. In order to ameliorate STEM attrition rates, leadership should use a combination of methods to improve the classroom environment. Some of these methods include: revamping classroom instruction tools, utilizing technology to teach competencies of STEM courses, providing authentic hands-on learning experience, and creating changes that are feasible and are relevant to address the needs of the students. Community college leadership should create a comprehensive intervention plan that can target different areas of classroom instruction and environment.An Application of Learning Theories For STEM Degree Seeking Students in Community
Colleges
i
An Application of Learning Theories For STEM Degree Seeking Students in
Community Colleges
Jennifer Nunez
A Thesis
Submitted to the Graduate Faculty
of
University of Maryland University College
in Partial Fulfillment of
the Requirements of the Degree of
Doctor of Management
Dr. Charlene Nunley
Dr. Susan McMaster
August 30, 2018
An Application of Learning Theories For STEM Degree Seeking Students in Community
Colleges
i
Abstract
STEM attrition is an issue of concern that impacts the economy of the United States.
According to the Trump administration (2018), investing in STEM education is essential for the
workforce of the future. Community colleges play a key role in addressing STEM’s workforce
needs. This research examines the application of the learning theories of elaboration theory,
situated learning theory, and action learning theory to address the academic barriers that impact
STEM’s retention and completion rates in community colleges. Academic barriers for STEM
course learning include: lack of academic preparation in STEM courses, lack of motivation and
student engagement in STEM courses, intensity of course taking in the first academic year, and
lack of confidence in STEM skills. Through the critical interpretive synthesis methodology, the
literature was analyzed and synthesized. The interpretation of the findings led to the creation of
an intervention strategy that can be used by community college leadership to support STEM
student success. In order to ameliorate STEM attrition rates, leadership should use a combination
of methods to improve the classroom environment. Some of these methods include: revamping
classroom instruction tools, utilizing technology to teach competencies of STEM courses,
providing authentic hands-on learning experience, and creating changes that are feasible and are
relevant to address the needs of the students. Community college leadership should create a
comprehensive intervention plan that can target different areas of classroom instruction and
environment.
Key Words: STEM attrition, learning theories, elaboration theory, situated learning theory,
action learning theory, instructional methodologies, classroom environment, academic barriers
in STEM
ii
Dedication
To my husband, Cesar De La Rosa, who was my biggest cheerleader and motivated me
each day. I thank you for your patience and compassion. To my special daughter, Jeilanny, who
always gave me strength and provided me with unconditional love. You both mean the world to
me.
iii
Acknowledgement
I contribute my success in the DMCCPA program to the wonderful faculty. I appreciate
the support of my dissertation advisors, Drs. McMaster and Nunley. Both of you believed in me
and provided me with guidance every step of the way. I also want to acknowledge Dr. Gena
Glickman for being genuine and humble. You always motivated me and gave me wonderful
advice.
My wonderful cohort: Dr. Frost, Dr. Wilson, Dr. Ayers, Dr. LaVigna, and Dr. Beshara.
You all are very special to me, and we have a strong bond. This journey has provided me with
the best gift, which is our friendship.
iv
Table of Contents
CHAPTER ONE: INTRODUCTION ................................................................................................ 1
Background and Context .............................................................................................................................. 1
The Problem Statement ............................................................................................................................... 4
Significance of the Problem ......................................................................................................................... 5
Purpose .............................................................................................................................................................. 7
Research Questions ....................................................................................................................................... 7
Theoretical Framework Section ................................................................................................................. 8
The Elaboration Theory .............................................................................................................................................. 8
The Situated Learning Theory .................................................................................................................................. 9
Action Learning Theory ............................................................................................................................................... 9
Definition of Key Concepts and Terms .................................................................................................. 11
Summary ........................................................................................................................................................ 14
CHAPTER TWO: METHODOLOGY ........................................................................................... 16
Introduction .................................................................................................................................................. 16
Research Methodology ............................................................................................................................... 16
Initial Scope of the Literature ................................................................................................................................ 19
Literature Search ......................................................................................................................................................... 19
Formulating the Research Question .................................................................................................................... 20
Searching the Literature .......................................................................................................................................... 21
Keywords ........................................................................................................................................................................ 23
Sampling .......................................................................................................................................................................... 26
Determination of Quality ........................................................................................................................... 27
STEM academic success and elaboration theory ............................................................................................ 34
Expert Panel .................................................................................................................................................. 45
Expert A ........................................................................................................................................................................... 45
Expert B ........................................................................................................................................................................... 45
Expert C ........................................................................................................................................................................... 46
Summary ........................................................................................................................................................ 46
CHAPTER THREE: LITERATURE REVIEW ........................................................................... 47
Introduction .................................................................................................................................................. 47
Attrition and Academic Barriers in STEM Major Students ............................................................. 48
Attrition Rates .............................................................................................................................................................. 48
Attrition Factors and Barriers ................................................................................................................. 49
Ways to Overcome STEM Academic Barriers ..................................................................................... 51
Theoretical Framework ............................................................................................................................. 54
The Elaboration Theory ............................................................................................................................. 55
Elaboration Theory of Instruction and Pedagogical Approaches ................................................ 59
Active Learning Strategies ...................................................................................................................................... 59
Situated Learning Theory .......................................................................................................................... 63
Situated Learning Theory in the Classrooms ................................................................................................... 67
Action Learning Theory ............................................................................................................................. 72
Summary and Analysis of the Literature .............................................................................................. 74
Conceptual Model ........................................................................................................................................ 75
Elements of the Model ............................................................................................................................... 77
STEM Academic Barriers ......................................................................................................................................... 77
Elaboration Theory .................................................................................................................................................... 77
Action Learning Theory ............................................................................................................................................ 80
v
Summary ........................................................................................................................................................ 82
CHAPTER FOUR: ANALYSIS AND FINDINGS ....................................................................... 83
Introduction .................................................................................................................................................. 83
Expert Panel Feedback ............................................................................................................................... 84
General Comments by Each Expert ...................................................................................................................... 84
Analysis of the Responses and Comments of Each Expert ......................................................................... 85
Comments Not Incorporated into the Paper .................................................................................................... 90
Critical Analysis of Literature Related to the Problem Statement .............................................. 91
Impacts of STEM Attrition ....................................................................................................................................... 91
Barriers to Improve STEM Attrition .................................................................................................................... 92
Critical Analysis of Literature Related to the Research Questions .............................................. 93
Analysis of Findings .................................................................................................................................... 98
Synthesis of Findings ............................................................................................................................... 101
Interpretation of Findings ....................................................................................................................... 103
Limitations of the Research .................................................................................................................... 104
Conclusion ................................................................................................................................................... 104
CHAPTER FIVE: IMPLICATIONS, RECOMMENDATIONS, AND NEED FOR
FUTURE RESEARCH .................................................................................................................... 105
Introduction ................................................................................................................................................ 105
Implications of Findings for Management Practice ........................................................................ 106
Recommendations .................................................................................................................................... 107
Research Question 1 ................................................................................................................................................ 107
Research Question 2 ................................................................................................................................................ 109
Research Question 3 ................................................................................................................................................ 110
Research Question 4 ................................................................................................................................................ 111
Research Question 5 ................................................................................................................................................ 112
Implementation Model ............................................................................................................................. 114
Challenges and Opportunities ............................................................................................................... 117
Challenges ..................................................................................................................................................................... 117
Opportunities .............................................................................................................................................................. 117
Suggestions for Future Research .......................................................................................................... 118
Conclusion ................................................................................................................................................... 120
vi
List of Figures
Figure 1.1 STEM Jobs without a bachelor’s degree, projected growth 2014-2024 ....................... 6
Figure 1.2 The Action Learning Theory Cycle ............................................................................. 10
Figure 3.1 General to Detailed Sequence Graph .......................................................................... 56
Figure 3.2 Conceptual Model ....................................................................................................... 76
Figure 3.3 Levels of communities of practice .............................................................................. 79
Figure 3.4 Implementing Change ................................................................................................. 81
Figure 4.1. Critical Interpretive Synthesis Process ..................................................................... 102
Figure 4.2. Synthesis and Interpretation of Research Findings .................................................. 103
Figure 5.2 Implementation Model .............................................................................................. 115
vii
List of Tables
Table 2.1 Results of Data Searches by Research Question .......................................................... 23
Table 2.2 Inclusion/Exclusion Criteria Chart ............................................................................... 26
Table 2.3 Studies on STEM Attrition. .......................................................................................... 28
Table 2.4 Studies on STEM Academic Success and Elaboration Theory .................................... 34
Table 2.5 Applied Learning and Situated Learning Theory in STEM ......................................... 38
Table 2.6 Action Learning Theory ................................................................................................ 42
Table 5.1 Framework Applying Three Learning Theories for STEM Classrooms .................... 114
An Application of Learning Theories For STEM Degree Seeking Students in Community
Colleges
1
CHAPTER ONE: INTRODUCTION
Background and Context
In 1957, the “Soviet Union launched the Sputnik, a satellite into space, which orbited the
Earth for 98 minutes” (Jolly, 2009, p. 1). The Soviet Union felt accomplished and superior in
being the first country to launch a satellite (Woodruff, 2013). The aftermath of this event led to
the criticism of America’s poor educational system, and it inspired Americans to invest in
technology and engineering (Woodruff, 2013). President Eisenhower in his famous speech in
1957 stated the following: “The Soviet Union now has—in the combined category of scientists
and engineers—a greater number than the United States. And it is producing graduates in these
fields at a much faster rate” (Eisenhower, 1957, para. 70). Because the Soviet Union had
superseded the United States in the fields of science and technology, the United States had to
create a better educational system. In order to create opportunities for students and provide
funding for colleges and universities, the United States created the National Defense Education
Act of 1958 (Jolly, 2009). This act:
Became one of the most successful legislative initiatives in higher education. It
established the legitimacy of federal funding of higher education and made substantial
funds available for low-cost student loans, boosting public and private colleges and
universities. Although aimed primarily at education in science, mathematics, and foreign
languages, the act also helped expand college libraries and other services for all students.
The funding began in 1958 and was increased over the next several years. (U. S. Senate,
1957, para. 4)
As a result, in 1960 there were 3.6 million students in college, and in 1970, the number increased
to 7.5 million (U.S. Senate, 1957).
2
The emphasis on science and technology education has not abated, as demonstrated by
that fact that over the past 20 years the acronym STEM (science, technology, engineering and
mathematics) has emerged to designate American interest in these fields. “There were over 200
[federal] bills containing the term science education” (Gonzalez & Kuenzi, 2012, p. 2). It is
estimated that “the federal investment in STEM education programs is between 3.4 billion annually” (Gonzalez & Kuenzi, 2012, p. 2). According to the World Economic
Forum (WEF) (2012), the United States was losing its competitive edge relative to other
developed nations; in their report the United States ranked 7th out of 140 countries. In order to
remain globally competitive, the federal government invested in STEM fields, “which fuel
innovation and economic growth” (National Math and Science [NMS], n.d.). From 1950 to 2000,
occupations in science and engineering (S&E) grew from fewer than 200,000 to approximately
4.8 million workers in the United States (National Scien
Nonprofit talent management: Using compensation, benefits and incentives to effectively attract and retain top talent employees at nonprofit organizations
No full textHigh performing employees in the nonprofit sector can gain better compensation, benefits, and incentives by working in the for-profit sector. Employees departing for the for-profit sector decreases the overall talent pool in the nonprofit sector, and removes top talent from nonprofit organizations. Nonprofits require employees who are working at peak performance, as they can typically only afford a reduced headcount due to budgetary restraints. Employees are attracted to positions which afford adequate or above standard levels of compensation. The most talented employees are the most unattainable with the current method of employee attraction and retention.•Nonprofits pay their executives and employees less than comparable for-profits.
•Nonprofits employees and executives are better educated, skilled and have more experience on average than for-profit employees.
•Nonprofit work statements are more complex, and require a high degree of responsibility and autonomy on average compared to for-profits.
•Nonprofits provide significant racial equality, gender equality, flexible work schedules, medical benefits and intrinsic motivation. This helps to attract and retain employees.
•Employee turnover is high due to wage comparison to for-profit institutions’ baseline compensation and incentive packages, as well as high workloads and burnout.
•Nonprofits are free to pay compensation to employees that they can prove is reasonable to the IRS.
•The Agency Theory is not a valid concern when determining executive compensation and benefits.
•Specific performance measures should be implemented to determine employee compensation, benefits, promotion and growth opportunities.
•Roles of nonprofit boards, executives and employees should be clear and understood.
•
•
•
•
•
METHODOLOGY
THEMES
CONCEPTUAL MODEL
FINDINGS
IMPLICATIONS
PROBLEM STATEMENT
RESEARCH QUESTIONS
Nonprofit Talent Management: Using Compensation, Benefits and Incentives to Effectively Attract and Retain Top Talent Employees at Nonprofit Organizations
Nell Allen, Doctor of Management Candidate | Dissertation Committee: Dr. Walter Cason, Dr. CandisBest and Dr. Heather Welzant
High performing employees in the nonprofit sector can gain better compensation, benefits, and incentives by working in the for-profit sector. Employees departing for the for-profit sector decreases the overall talent pool in the nonprofit sector, and removes top talent from nonprofit organizations. Nonprofits require employees who are working at peak performance, as they can typically only afford a reduced headcount due to budgetary restraints. Employees are attracted to positions which afford adequate or above standard levels of compensation. The most talented employees are the most unattainable with the current method of employee attraction and retention.
•1.5M nonprofits operating in the U.S. with 14.5M employees
•Nonprofit CEOs earned almost 50% less than for-profit executives
•Nonprofit employees make between 4-32% less than for-profit workers in comparable positions
•20-40% turnover rates per year; costs for the attraction and training of new personnel range from 50-200% of the employee’s salary
•21% of nonprofit firms provided bonuses versus 67% of for-profits
•Nonprofit employees have more education than for-profit employees
•Nonprofit employees have a higher and more complex workload
•Key Words: “nonprofit”, “staffing”, “compensation”, “benefits”, “employee+incentive”
•Inclusion Criteria: Peer-reviewed journals, English language, research based on U.S. operating entities
•Exclusion Criteria:Duplicated sources, observations including non-U.S. entities, research focused on volunteers instead of employees
•Evaluation through the Mixed Methods Appraisal Tool created by researchers at McGill University for use with qualitative and quantitative research studies
1)How can leadership address the compensation, benefits, and incentives of high performing employees in the nonprofit sector to ensure attraction, retention and engagement?
2)How does compensation, benefits and incentives impact the resources available to a nonprofit via donations or public funds?
PRISMA Diagram
Thematic Synthesis was performed on the selected research articles and consisted of three stages; primary coding, descriptive themes, and analytical coding.
Primary codes called out a key concept or theme for the data points. Descriptive coding explained further details about the primary code, and relationships from one data point to another, to show connections amongst the literature and findings. Analytical coding tied the coding process back to the original dissertation purpose and answered the research questions.
PROPOSITIONS
P1: Nonprofit employees and management who are compensated at levels commensurate with for-profit compensation perform higher than nonprofit employees who are paid below standard wages for similar positions in the for-profit sector.
P2: Nonprofit managers and executives do not take advantage of a lack of governance to overcompensate themselves or their employees.
P3: Nonprofit employees who are compensated commensurate or higher than for-profit employees in similar positions are less likely to leave the nonprofit.
P4: Nonprofits which compensate positions equally or higher than similar positions in for-profit entities attract employees who are higher educated and greater skilled than nonprofits which compensate employees lower than for-profit entities.
P5: Nonprofit employees have higher job satisfaction and there is lower incidence of turnover in institutions for which there are clear and specific performance goals for employees that align to the entity’s mission and vision.
AREAS FOR FURTHER RESEARCH
The retention of nonprofit employees depends upon a blending of compensation and benefits, intrinsic motivation, work environment, and nonmonetary benefits.
The direct impact of increasing compensation and benefits on public donations is not well known. A thorough observation of the financial impact of shifting resources from public donation acquisition to employee compensation and benefits is recommended for the field.
The impact of volunteers on the nonprofit workforce was outside of the scope of this dissertation. Volunteers and their impact upon nonprofit resources, employee culture, and employee talent pools should be observed and analyzed.
The impact of compensation and benefits on small nonprofit organizations (>25K in revenues) would be valuable to the field
An examination of change management strategies contributing to a work climate supportive of ethical employee behavior and decisions in U.S. colleges
No full textThis presentation will identify change management strategies senior academic
administrators can implement to cultivate an ethical
work climate supportive of ethical employee behavior and
decisions.An examination of change management strategies contributing to a work climate
supportive of ethical employee behavior and decisions in U.S. colleges
Matt Hisrich – University of Maryland University College
Dissertation Advisors: Deborah Wharff, D.M., James Gelatt, Ph.D., Wanda Wagner, D.M.
The Problem for Practitioners
Research Question
Purpose of the Study
Methodology
PRISMA
Conceptual Framework
Findings
To identify change management strategies senior academic
administrators can implement to cultivate an ethical
work climate supportive of ethical employee behavior and
decisions.
What change management strategies can college leaders
implement to cultivate an ethical work climate that
supports ethical employee behavior and decisions?
This dissertation will also address two underlying questions:
• Have college leaders effected ethical work climate change?
• What mechanisms influence employee ethical decisions and
behavior within the college ethical work climate?
Scandals involving employees at U.S colleges continue to make
headlines, damaging reputations and undermining enrollment,
fundraising, and public trust in institutional leadership.
Finding 1. Leaders have been able to effect ethical work climate
change. Twelve studies demonstrate a direct link between ethical
leadership and either increases in ethical employee behavior or
decreases in unethical employee behavior.
Finding 2. Seven studies support the concept that leaders
model and adopt ethical leadership through the following
mechanisms:
• a deontological ethical approach,
• a transformational leadership approach,
• supportive supervision, and
• procedural fairness.
Finding 3. Thirteen studies indicate specific mechanisms that
improve the ethical work climate by bringing about positive
changes in employee ethical behavior and decisions. These
include:
• ethics codes,
• ethics training,
• accountability,
• mastery goals,
• corporate social responsibility,
• organizational support,
• social norms, and
• quality-related human resources practices.
The findings suggest that ethical leadership working in
tandem with the above mechanisms forms the change
management strategy of ethics institutionalization. Ethics
institutionalization implemented as a strategy by
practitioners can establish an ethical work culture. This is a
necessary antecedent to an ethical work climate and ethical
employee behavior and decisions.
This dissertation draws upon the theories of:
• ethical work climate as distinguished from ethical work
culture (Arnaud & Schminke, 2012);
• ethical leadership (Brown & Treviño, 2006);
• change management (Lewin, 1958);
• moral disengagement (Bandura, 1986); and
• a typology of ethical lapses in higher education (Kelley &
Chang, 2007).
An iterative process of screening and quality assessment using a
weight of evidence model based on relevance, rigor, and study
design reduced the data set from over 4,000 results to 37 articles
for synthesis.
This dissertation is a systematic review of the existing research
literature using a configurative approach. A realist synthesis
methodology is used because the goal is to recognize the
contextual realities of both primary research and practitioner
application of findings. Following Saldaña’s pattern coding
methodology, three cycles of coding were completed (2013).
Codes were checked against the research results of each study
and a network map of linkages was developed using Atlas.ti
software.
Theoretical Framework
Records identified through database searching
(n = 4,062)
Included Eligibility Screening Identification
Records after limiting to English-language scholarly and peer-reviewed
articles from academic journals, to the previous 10 years (2008-2018)
(n = 2,115)
An iterative process of reviewing initial finding titles to add NOT qualifiers eliminated studies
which were clearly not relevant and the addition of “change leader*” to the search string
(n = 613)
After duplicate removal
(n = 330)
Elimination of articles clearly identified as a non-U.S. context, non-English language, book
reviews, or not focused on ethics in the workplace
(n = 256)
Review of abstracts followed, looking for relevance to the RQ
(n = 71)
After Retraction Watch screening
(n = 70)
Full-text articles assessed
for eligibility
(n = 70)
Full-text articles excluded,
with reasons
(n = 33)
Studies included in
qualitative synthesis
(n = 37)
Ethical
employee
behavior and
decisions
Ethical work
climate
Ethical crisis of moral
disengagement among college
employees
Change management Ethical leadership
Change Management Strategy:
Ethics Institutionalization
- a deontological ethical approach
- a transformational leadership approach
- supportive supervision
- procedural fairness
- ethics codes - ethics training
- accountability - mastery goals
- social norms - CSR
- organizational support
- quality-related HR practices
An ethical work culture supportive o
Breast Cancer Prediction with K-Nearest Neighbor Algorithm using Different Distance Measurements
No full textThis study evaluates the accuracy of using the K-nearest neighbor (KNN)
classifier algorithm as a predictor of breast cancer in women. The objective of the
proposed algorithm was to develop a better method of predicting breast cancer without
the need of a surgical biopsy. Although mammograms currently detect abnormal growths,
they are not always 100% accurate in determining all breast cancers. It is currently not
possible to provide confirmation of the presence of breast cancer without a biopsy.
An algorithm was created using KNN which will analyze a mammographic
dataset to predict breast tissue malignancy using predefined attributes. A portion of the
data is reserved to train the algorithm, leaving the remaining values to test the accuracy,
precision, recall, specificity, and F1 scores of the model. The output of the algorithm is
then used to determine the highest values of K combined with the distance function,
which will predict whether it’s beneficial for a biopsy to be performed.
The KNN algorithm utilized is leveraged using distinct parameters, including six
different distance metrics. The strongest overall results were found using the Manhattan
distance measurement and a K value of 7, yielding accuracy, precision, recall, specificity,
and F1 scores of 81.67%, 80.05%, 83.72%, 79.61%, and 81.80%, respectively. Further
research is warranted to identify more accurate distance measurements and to analyze
varied datasets.Breast Cancer Prediction with K-Nearest Neighbor Algorithm using Different Distance
Measurements
by
Victoria Rodriguez
Karan Sharma
Dana Walker
A research paper submitted in partial fulfillment of the requirements for Software
Engineering Project (SWEN 670)
Master’s of Science in Information Systems with Specialization in Software Engineering
University of Maryland University College
2018
Breast Cancer Prediction with KNN using Different Distance Measurements
2
I hereby certify that this research paper, submitted by Victoria Rodriguez, Karan Sharma
and Dana Walker, conforms to acceptable standards and is fully adequate in scope and
quality to fulfill the Software Engineering Project (SWEN 670) requirements for this
class.
Michael Scott Brown 12/12/2018
Program Chair
Breast Cancer Prediction with KNN using Different Distance Measurements
3
An Abstract of K Breast Cancer Prediction with K-Nearest Neighbor Algorithm using
Different Distance Measurements
by
Victoria Rodriguez
Karan Sharma
Dana Walker
December 2018
This study evaluates the accuracy of using the K-nearest neighbor (KNN)
classifier algorithm as a predictor of breast cancer in women. The objective of the
proposed algorithm was to develop a better method of predicting breast cancer without
the need of a surgical biopsy. Although mammograms currently detect abnormal growths,
they are not always 100% accurate in determining all breast cancers. It is currently not
possible to provide confirmation of the presence of breast cancer without a biopsy.
An algorithm was created using KNN which will analyze a mammographic
dataset to predict breast tissue malignancy using predefined attributes. A portion of the
data is reserved to train the algorithm, leaving the remaining values to test the accuracy,
precision, recall, specificity, and F1 scores of the model. The output of the algorithm is
then used to determine the highest values of K combined with the distance function,
which will predict whether it’s beneficial for a biopsy to be performed.
The KNN algorithm utilized is leveraged using distinct parameters, including six
different distance metrics. The strongest overall results were found using the Manhattan
distance measurement and a K value of 7, yielding accuracy, precision, recall, specificity,
and F1 scores of 81.67%, 80.05%, 83.72%, 79.61%, and 81.80%, respectively. Further
research is warranted to identify more accurate distance measurements and to analyze
varied datasets.
Keywords: KNN, k nearest neighbor, breast cancer, machine learning, classification,
Euclidean, Manhattan, Minkowski, Chebyshev, Cosine similarity, Cosine distance.
Breast Cancer Prediction with KNN using Different Distance Measurements
4
Table of Contents
Chapter 1 Introduction .............................................................................................................7
Overview ............................................................................................................................... 7
Background ........................................................................................................................... 7
Problem Statement ............................................................................................................... 8
Chapter 2 Literature Review ................................................................................................. 11
Bayesian Networks Classifiers .......................................................................................... 11
Nearest Neighbor Method.................................................................................................. 12
Support Vector Machine .................................................................................................... 13
Chapter 3 Methodology ........................................................................................................ 14
Overview ............................................................................................................................. 14
K-Nearest Neighbor Algorithm ......................................................................................... 14
Research Parameters .......................................................................................................... 15
Format of Results ............................................................................................................... 17
Chapter 4 Results .................................................................................................................. 19
Parameter Values Settings ................................................................................................. 19
Results for K-Nearest Neighbor Algorithm...................................................................... 19
Results from Other Research ............................................................................................. 22
Analysis of Results ............................................................................................................. 23
Chapter 5 Conclusion ........................................................................................................... 33
Comparing Results ............................................................................................................. 33
Future Research .................................................................................................................. 33
Summary ............................................................................................................................. 34
References .............................................................................................................................. 35
Breast Cancer Prediction with KNN using Different Distance Measurements
5
List of Tables
1 KNN Test Results for K is 3 20
2 KNN Test Results for K is 5 20
3 KNN Test Results for K is 7 20
4 KNN Test Results for K is 9 21
5 KNN Test Results for K is 11 21
6 The averaged results for each distance metric for all values of K 21
7 The averaged results for all distance metrics per value of K 22
8 The best results for other algorithms 22
9 Accuracy results for each value of K 23
10 Precision results for each value of K 25
11 Recall/Sensitivity results for each value of K 26
12 Specificity results for each value of K 28
13 F1 Score results for each value of K 30
Breast Cancer Prediction with KNN using Different Distance Measurements
6
List of Figures
1 The averaged accuracy for each distance measurement throughout all K values 24
2 The averaged accuracy results for all distance measurements per K value 24
3 The averaged precision for each distance measurement throughout all K values 25
4 The averaged precision results for all distance measurements per K value 26
5 The averaged recall/sensitivity for each distance measurement throughout all K values
27
6 The averaged recall/sensitivity results for all distance measurements per K value 27
7 The averaged specificity for each distance measurement throughout all K values 29
8 The averaged specificity results for all distance measurements per K value 29
9 The averaged F1 score for each distance measurement throughout all K values 30
10 The averaged F1 score results for all distance measurements per K value 31
Breast Cancer Prediction with KNN using Different Distance Measurements
7
Chapter 1 Introduction
Overview
Breast cancer is one of the leading causes of death for women in the United
States. At least one in eight women will be diagnosed with breast cancer in their lifetime.
There are several risk factors that contribute to developing this disease including age,
genetics, family history, lifestyle, and most simply being a woman. Approximately 2.6%
of breast cancer cases will result in mortality (Donepudi, Kondapalli, Amos &
Venkanteshan, 2014), fortunately leaving much hope for women that are diagnosed with
this disease.
Background
Currently, when a mammogram test reveals abnormal findings, the only definitive
way of confirming the existence breast cancer is through a biopsy. A breast biopsy is a
test that removes tissue or sometimes fluid from a suspicious area (Chhatwal, Alagoz &
Burnside, 2010). It provides a sample of the tissue that allows doctors to identify and
diagnose abnormalities in the cells that make up breast lumps, other unusual breast
changes, or suspicious findings in a mammogram or ultrasound After the cells are
removed, they are examined under a microscope and checked for the presence of breast
cancer. There are three type of biopsies normally performed which are fine-needle
aspiration, core needle and surgical biopsy (Chhatwal, Alagoz & Burnside, 2010). One
method of biopsy will likely be recommended over another due to the shape, size, patient
medical history, or location of the abnormality.
Breast Cancer Prediction with KNN using Different Distance Measurements
8
There are many disadvantages to testing for breast cancer through a biopsy. One
reason is due to possible side effects. Some of these effects include:
• Bruising of the breast
• Swelling of the breast
• Infection at the biopsy site
• Soreness at the injection site
• Altered appearance of the breast depending on the size & tissue removed
Although these types of complications are usually rare, the side effects can temporarily
cause discomfort and pain for a patient.
Biopsies not only cause physical stress on the body, but emotional stress as well.
Many patients that receive abnormal mammogram or ultrasound are often advised to
undergo a biopsy. Although only roughly 20% of breast lumps are cancerous, that does
not make the experience of getting a breast biopsy any less overwhelming. The anxiety of
waiting for results means many women go through unnecessary discomfort, stress,
emotional turmoil, as well as financial expense.
Problem Statement
Although a mammogram can reveal the existence of abnormalities in breast
tissue, it is currently not possible to provide confirmation of the presence of breast cancer
without a biopsy. This is because an analysis of the cells has to be conducted in order to
determine the type of cells involved with the breast cancer as well as the aggressiveness,
or grade, of the specific type (Myers, Moorman & Gierisch, 2015). It is also considered
better practice to know if you are definitively dealing with cancer or not before a
treatment plan is executed.
Breast Cancer Prediction with KNN using Different Distance Measurements
9
Having an alternative method of predicting breast cancer will essentially reduce
the number of biopsies performed each year. With a reduction in biopsies, we could save
patients from the unnecessary anxiety and stress of waiting weeks for results. Patients
with benign growths would be able to go home assured that their health is not
compromised. If it is breast cancer, the patient would be able to detect it early and
progress with a plan of action immediately.
A reduction in biopsies is not only emotionally taxing but a potential financial
burden. Biopsies are expensive and patients without health insurance typically pays out
of pocket costs between 5,000 in out-of-pocket expenses. This does not
take into account additional procedures that may need to be performed such as
ultrasounds; CT scans, etc. (Myers, Moorman & Gierisch, 2015). If a patient is shown to
not have a cancerous growth, they will have spent a significant amount of money on
something that could have been avoided all along. An alternative method of determining
breast cancer would save the patient money that could be used towards something
important to them such as creating family memories or a vacation.
Lastly, an alternative to biopsies will not only benefit patients but healthcare
providers as well. If a physician suspects that a patient has breast cancer, they may need
to refer the patient to a specialist for the specific biopsy needed. Afterwards, the breast
cancer tissue is evaluated by a board- certified pathologist for diagnosis. When a patient’s
growth comes back as benign, the healthcare providers will have expended a significant
amount of time and energy only to return a negative diagnosis. An alternative method
Breast Cancer Prediction with KNN using Different Distance Measurements
10
would save healthcare providers time that they could use to treat patients that actually
have significant health risks.
Research Goal
The goal of this research is to develop a better method to predict breast cancer
without the need for a biopsy. The algorithm will allow healthcare providers to calculate
an accurate prediction of the patient’s likelihood of having a cancerous growth.
Breast Cancer Prediction with KNN using Different Distance Measurements
11
Chapter 2 Literature Review
Several studies have been conducted on breast cancer in relation to accurately
predicting its rate of occurrence. Within many studies the Mammographic Dataset was
used but with various data distributions, distance measurements, and similarity measures.
Due to the surplus of research papers as well as time constraints, we have selected a
subset of papers that also utilized the Mammographic Dataset. The research we selected
to review contain comparable algorithms to KNN , and include a variety of algorithms in
order to best compare our results.
Bayesian Networks Classifiers
Elsayad (2010) approaches the mammographic mass dataset using two Bayesian
network classifiers: Markov blanket estimation (MBE) and tree augmented naive Bayes
(TAN). A Bayesian network (BN) is a directed acyclic graph linking attributes of a
dataset with conditional probability distributions. The purpose of a BN is to identify the
probabilistic inference and numeric effect of each individual attribute on a specific target
attribute (in this dataset, the severity, or malignancy of the mass). Generally, a BN is
developed using the naive Bayes classifier, in which attributes have strong independence
from one another. As a result, Naive Bayes is better suited for more simple distributions
and does not lend itself to the mammographic mass dataset.
Elsayad instead develops four BNs for analysis: MBE with Chi-square, MBE with
Likelihood ratio, TAN, and an ensemble. MBE improves the predictive accuracy of a BN
model by analyzing each attribute within the dataset to identify which attributes are
Breast Cancer Prediction with KNN using Different Distance Measurements
12
conditionally independent. The attributes found to be conditionally independent from the
target attribute are automatically removed from the classification test. The test for
conditional independence is completed using Chi-square and Likelihood ratios. TAN
improves the predictive accuracy of a BN model by linking each attribute to another
attribute of the dataset in additional to the target attribute. The ensemble model combines
the predictions of the MBE and TAN Bayesian networks.
Nearest Neighbor Method
In 2017, Jan Bohacik and Michael Zabovsky conducted an experiment on the
Mammographic Mass Data set using a Nearest Neighbor Method that used non-nested
generalized exemplars (Bohacik & Zabovsky, 2017). Their goal was to retrieve the
specificity, sensitivity, and sum of both to compare with the traditional nearest neighbor
algorithm. Prior to the experiment, rather than removing the missing values, they
replaced the missing attributes with the mean of the non-missing values of the same
attribute. The experiment was conducted with the results being validated using 10-fold
cross-validation. Their research found that using the Non-nested Generalized Exemplars
with the Nearest Neighbor Method outperformed the traditional nearest neighbor method.
The traditional nearest neighbor method resulted in a sensitivity of 0.71, 0.80, and
resulted in a sum of 1.51. The Non-nested Generalized Exemplars Nearest Neighbor
method resulted in a sensitivity of 0.78, specificity of 0.78, and a sum of 1.56.
Sahar A. Mokhtar and Alaa. M. Elsayad conducted a study on the Mammographic
Mass Data set using 3 different classification methods (Mokhtar & Elsayad, 2013). This
included modified versions of the Decision Tree, Artificial Neural Networks, and Support
Breast Cancer Prediction with KNN using Different Distance Measurements
13
Vector Machine classification methods. The Decision Tree was used with the Chi-squared
automatic interaction detection method (CHAID), pruning parameters were used
along with the Artificial Neural Networks model, and Support Vector Machine was used
with a polynomial kernel. Their goal was to retrieve and compare the accuracy of the
three algorithms. Prior to running each algorithm, they split the dataset into a 70/30 ratio.
The results showed that the Support Vector Machine algorithm performed the best of the
three with 81.25% accuracy. The Decision Tree and Artificial Neural Networks
algorithms results in 78.12% and 80.56% accuracy.
Support Vector Machine
In the paper “Breast Cancer Biopsy Prediction Based on Mammographic
Diagnosis Using Support Vector Machine Learning” by Julia, Kathleen, and George
Miao (2015), support vector machine learning classification was used. It is a non-linear
classification based on the Gaussian radial basis function (RBF) kernel, which allows
more flexibility in dealing with any non-separable mammographic mass data (Miao
REVISE). The classification provided not only a higher but more reliable accuracy in
diagnosing malignant breast cancer & benign biopsy.
The testing results showed that the SVM learning model classification had a
sensitivity of 94.54% in diagnosing malignant breast cancer, 93.44% in diagnosing
benign disease, and precision of 93.15%, a F score of 0.94, and an overall accuracy of
93.98% in diagnosing malignant breast cancer and benign growths.
Breast Cancer Prediction with KNN using Different Distance Measurements
14
Chapter 3 Methodology
Overview
The algorithm will analyze a mammographic dataset to predict breast tissue
malignancy using predefined attributes. A portion of the dataset will be reserved to train
the algorithm, while the remainder will be used to ascertain the accuracy, precision,
recall, specificity, and F1 scores of the model. The output of the algorithm will be used to
determine the strongest combination of distance function and K value, to be used as an
indicator for whether biopsies should be performed.
K-Nearest Neighbor Algorithm
K-Nearest Neighbor, originally formulated by Fix and Hodges (1951), is a lazy
learning, non-parametric, machine learning algorithm that works by classifying instances
based on their similarity. Lazy learning refers to the method of generalization for the
training data. With lazy learning, the system does not attempt to create a model of the
training data, and instead compares each data point within the array against the entire
training set. A non-parametric model devises a modeling structure solely from the data
itself, without any underlying preconditions or assumptions. KNN falls under the
supervised learning variant of machine learning, where the system is trained by example.
The system examines a set of data consisting of observed values and classifications, and
uses that data to predict classifications for a new set of observed values. The KNN
algorithm can be used for both classification and regression. Classification analyzes data
to produce a classification as the output, whereas regression outputs a value for an object.
Breast Cancer Prediction with KNN using Different Distance Measurements
15
This research harnesses the KNN classification algorithm to classify each object in the
mammographic dataset as either malignant or benign.
The KNN algorithm works by first using a programmed distance function to
identify the nearest neighbors of a specific object. The closeness of the objects is
determined and calculated using overlapping attributes, such as patient age, mass shape,
margin, or density. The KNN algorithm has two user-determined parameters: the K value,
and the distance function used. The K value is the number of neighbors used for the
classification, and the distance function is the calculation used to analyze closeness
between the unknown object and all other objects within the dataset. The algorithm
assesses the most frequently occurring classification of the K value nearest neighbors and
subsequently classifies the unknown obje
