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Ambulatory Surgery Center Administrator Certificate Program Course Redesign Management Report Lydia Ellen Reeder For INTE 6930 Fall 2012 Internship


I. The Problem Professional Setting & History I can hear Julie’s exasperated voice on the phone in the cubicle next to mine. “I’ll have to look at your log-in, call IT if it’s not set up.” She hangs up, and then lets out a big sigh. Julie is the online project coordinator for the Ambulatory Surgery Center Administrator Certificate Course (ASC Certificate Course) that is comprised of eleven modules and worth 52 continuing nursing education contact hours. Module topics include Leadership, Human Resources, Quality Management, and Intra-Operative Diagnostic Services. In other words, it’s a big course that is introduced with a 2-day face-to-face meeting. The online portion of the course must be completed in 120 days. At the end, students receive a Certificate of Completion. The ASC Certificate Course was the first online program at AORN, developed in 2003. The content has been consistently updated, but not the design or presentation. I’m an instructional designer, and Julie and I are part of the education team in the Nursing Education Department at the Association of periOperative Registered Nurses (AORN) in Denver. AORN is a national specialty nursing association headquartered in Denver with about 100 employees and 43,000 members. Our team develops continuing education for nurses that meet the following vision and mission statements: Mission -- to promote safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses. To collaborate with professional and regulatory organizations, industry leaders, and other health care partners who support the mission. Vision -- SNA will be the indispensable resource for evidence-based practice and education that establishes the standards of excellence in the delivery of perioperative nursing care.

Current Issues and Concerns “You OK?” I say, walking over to her cubicle. She shakes her head, “No,” and then begins listing the problems with the ASC Certificate Course program that, in addition to the 11 modules, also includes about 90 discussion questions posted online in a different forum from the modules on the learning management system (LMS). The current issues and concerns with the course that Julie and I discussed included: 1. Too many discussion questions: leads to student not completing the course. 2. Discussion questions are located away from the LMS in ORNurseLink, AORN’s social medial website that is slow and maze-like. 3. Because the discussion questions are not in the LMS, Julie must spend hours each week manually searching through the discussion area and recording whether or not a student


has completed each question. Up to 30+ students can take the course, offered two to three times per year. 4. Most students print out the module contents PDF and don’t use the online module at all. In summary, we have a course structurally outdated, ill-used, that creates additional busy-work for the course coordinator, and is too often abandoned by students and left incomplete.

II. Constraints and Requirements The ASC Administrator Certificate course was not officially slated for re-design, but the idea arose and I took the opportunity. That circumstance has led to the biggest constraint – lack of time. Due to these time constraints, I could complete the first four modules in the ASC Certificate course for my internship. Initially, I had been assigned to redesign the Advanced ASC course, which had been pulled offline because the content was outdated. However, the Nurse Manager of Ambulatory Products chose not to revise the advanced course or hire a subject matter expert (SME) to update the course. We have no money budgeted, but fortunately we have a production department with capable graphics and illustrative capabilities. External constraints include managing the redesign so that the launch corresponds with one of the scheduled ASC Certificate Program face-to-face meetings in 2013, the first scheduled for this May. Internal constraints also exist. Our current LMS does not have a social learning capability, so the discussion questions can’t be uploaded and the student progress tracked by our LMS. Since the course redesign was my idea, mandated by the obvious need expressed by the online project coordinator and the students and not by my director, the development schedule must be clustered with other projects scheduled for the last part of this year, and they are numerous: participating in our LMS upgrade; CE Approval Unit web-based application re-development (I’m also managing the education portion of this project with our IT department); and finally, the re-accreditation process with our accrediting body, the American Nurses Credentialing Center (ANCC). I’m ultimately accountable for the redesign to the Nurse Manager of Ambulatory Products for the final implementation of this course. Final approval rests with her ability to inspect the course contents of all 11 modules. After their approval, then the modules will go through Beta Testing. The Nurse Manager of Ambulatory Products is often out of town attending meetings and must also find the time to view and approve each module. Due to these requirements, the scheduling of course redesign, approval, Beta testing, and final implementation must be flexible, adding additional constraints to the ultimate management process. In the process of completing this assignment, the Nurse Manager of Ambulatory Products, after initially approving the new course design, found issue with the design while reviewing Module 2: Human Resources. The entire internship project had to be re-thought. To gather data that will help guide future decisions about the re-design, I surveyed past participants of the ASC


Certificate Course about current issues with the course and their opinion about the re-design. I will discuss this in more detail in the Outcomes and Reflection sections of this report.

III. My Role/Participation At AORN, my title is Instructional Designer, but I also manage and coordinate the CE Approval Process, the ANCC accredited process for approving submitted applications for continuing nursing education. I work in the Education Department, which is part of the larger Nursing Department. I’m considered “staff,” and report directly to the Manager of Education Products. As stated under Constraints and Requirements above, I was initially assigned the updating and redesigning of the Advanced Ambulatory online course, with fewer modules and without a faceto-face meeting requirement. When that redevelopment project didn’t come to fruition, I came to see how I could redesign this ASC Certificate course. I describe further how I came to this decision in the Work Processes section below. Thus, I wasn’t sure of my mandate for action until I had demonstrated a draft of my module one redesign to the Director of Nursing Education, the Nurse Manager of Ambulatory Products, and Julie, the online project coordinator. After receiving positive feedback and excellent ideas to incorporate in my project, I felt assured that this project had received full backing. I am completely responsible for the instructional design for this project and for managing the review, testing, and implementation. I worked with the production department graphic designer for template illustrations and other graphic enhancements. The primary authoring tool I’m using is Lectora Inspire. I’m also incorporating Flash items I’ve created using Flypaper and screencapture videos using Camtasia. In addition to building the course in Lectora, other tasks and activities of the redesign include searching through the module references and bibliography to find pertinent learning links and ideas for videos to include.

IV. Timeframe Task Design development phase Meeting with stakeholders for design approval First module design complete First module uploaded for content review Second module design complete Second module uploaded for content review Meeting with stakeholders to discuss concerns about redesign

Date April – June 2012 June 2012 July 2012 July 2012 August 2012 August 2012 September 2012


Stopped redesign process to evaluate redesign elements Created and implemented survey to past ASC course participants about redesign elements Analyze results Meet with stakeholders to discuss results and future direction of redesign

September 2012 September 2012

October 2012 November 2012

V. Goals My primary goal was to take into consideration current issues students have and create a better organized, more learner-accessible course that is easier to manage and delivers better outcomes for students. Strategically, ambulatory surgery center care has been and is still growing at a rapid rate nationally. Developing education content for ambulatory nurses is part of AORN’s long-term strategic goals, and updating this course helps meet those goals. Another long-term goal is to provide students with a course that not only provides excellent content that enhances their work outcomes, but also inspires them to keep learning even after the course is complete. For the short term, my goals included:  Analyze the current course keeping in mind student needs and applicable learning theory for online course content  Apply organizational concepts to current course  Create the course using resources at hand.  Refine the ASC Certificate Course according to evaluations.

VI. Work Processes Developing the Concept The idea for the course redesign arose during the Spring 2012 semester in INTE 5380, Assessment for the 21st Century. After completing several projects for that course, I realized that students keep learning even during the assessment process, especially if the assessment includes Higher-Order Thinking (HOT) questions. Since students weren’t paging through the current ASC modules, but printing out the PDF and then taking the module post tests, why not make the online modules all about assessment as learning? All of my future redesign followed this idea.


Course objectives were already established, and course evaluations were already complete. Following my primary goal, I was determined to create a design that interested adult learners. The design process best suited for this project seemed to be a rapid, cyclical design process such as the one described in E-Learning by Design (Horton, 2012) and Tripp and Bichelmeyer’s Rapid Prototyping Model (in Chen, 2008) shown below:

Perform a Needs Analysis

Perform Research Using the Prototype

Construct a Prototype

Install the final System

Following Knowles’ assumptions about adult learning (Fogarty & Pete, 2004, p. 26), I worked from the idea proposed by transformative learning, that significant growth in the learner’s identity as a competent problem solver or practitioner occurs when the learner is a constructive participant as opposed to a consumer or recipient of content (Wilson, Switzer, & Parrish, & the IDEAL Research Lab, 2006).

Project Management Since this redesign was not officially scheduled for my department, my work processes had to be flexible, but still proceeding forward. The major task of developing the course re-design was on my shoulders, and in this case, I worked mostly alone. Under my guidance, the production department developed four graphic designs for each section of the course module: Read, Review, Apply, and Assess. We use ReviewLink, Lectora’s online review and collaboration tool, to review and make comments on drafts of courses. After completing the first module, I uploaded it into ReviewLink and asked the other instructional designers in my department for feedback, which I then incorporated into the module. When I had established a new course design, I held a stakeholder meeting for approval so that I could move forward. Attendees included the online project coordinator who also is the student liaison; the Director of Nursing Education, and the Nurse Manager of Ambulatory Products. After the meeting, I incorporated attendee feedback and proceeded to complete the first four modules. After completing the first module, Leadership, I uploaded the course into ReviewLink and asked the stakeholders who included my manager, the nurse educator for ambulatory courses, and the education director, to review the module. I asked for a two-week turnaround time, and scheduled my revisions after their reviews. I used the same process for the second module, Human Resources. However, this time the Nurse Manager of Ambulatory Products expressed concerns about the design, and I held a second stakeholder meeting to discuss these concerns. The take-away from this meeting was that the new design did seem to solve current issues with the course, but that these issues needed clarification. Thus, to help clarify student needs four course design, I decided to implement a survey to past students to gather data about the course re-design.


Using SurveyMonkey, I did my best to write questions free of bias, and submitted my questions to my peers at work for recommendations. I developed a two-minute screen-capture video about the changes that I embedded in the survey for participants to watch. Finally, I obtained approval of my survey questions from the Nurse Manager of Ambulatory Products, I sent out the survey in October 2012. See the next session for further discussion about the survey.

VII. Outcomes and Accomplishments Accomplishments Taking into consideration current issues and problems with the course, my primary goal was to create a better organized, more learner-accessible course. To achieve this goal, I applied a conceptual framework that divided the modules into the following sections: Read, Review, Apply, Assess (see screen-capture video available at ). This design solved certain problems with the course including the content management problem: content was available in a printable PDF and also in a click-through module. Now, content is in one location and is printed out by the student in a PDF format. In addition, the discussion questions are now revised and located inside the course as open-ended essay questions with learning links adapted from the content.

Problems This was an extensive redesign, and at first, it received positive feedback from stakeholders. However, when the Nurse Manager of Ambulatory Products pushed back with distinct criticism after reviewing the second re-designed module, I had to change course immediately and provide data that would either support aspects of the redesign or point toward another solution. The experience of this meeting was eye opening for me. Parts of the redesign that had received kudos during the initial stakeholder meeting now were being disparaged. My confusion was furthered by the fact that their new criticisms occurred after reviewing the second module, but not the first. The design for the second module is exactly the same as the first.

Solution Action research implemented to identify factors affecting the redesign seemed the best solution. Action research is a systematic approach to investigation that enables people to find effective solutions to problems they confront in their everyday lives …. and provides the means by which [organizations] may increase the effectiveness of the work in which they are engaged” (Stringer, 2007, p. 1). Using the online resource SurveyMonkey, I surveyed 195 past participants of the ASC Certificate Course, and received 30 responses. The questions contained both Likert and open-ended questions that would answer the following research questions:  What are the current issues students have with the Certificate Course?  How can the Certificate Course be redesigned to better meet the needs of the student?  To what extent does the current redesign address the needs of participants? Survey Findings The survey findings supported the current effort toward redesign. See Appendix A for complete survey results.


Students who responded to the survey felt that the current issues with the course, including the number of discussion questions, navigation away from the LMS, and whether or not students click through and read the module online or print the module out to read, would be met by the redesign. As one participant stated, “Given the changes, I would probably finish the course …. This looks very promising.” For example, the averages of the Likert questions (see Graph 1 below) provide a graphic picture to support this assertion.

Graph 1 – Likert scale averages: 1=strongly disagree; 2=disagree; 3-neigher agree or disagree; 4=agree; 5-strongly agree Questions 1-3 show that the ability to print the module is highly regarded, and also that a majority of participants printed the module instead of reading through the course materials online. Question 5 shows that participants felt it was difficult to navigate away from the LMS for the discussion questions. Question 10 sums it up: the overall changes do look favorable. In addition, of the 25 participants who responded to the open-ended question that asked what they liked the most about the course changes, 15 indicated that they liked how the discussion questions had been incorporated into the course. “Awesome getting rid of the discussion 8

questions!” one person responded. “Wish that would have been in place when I took the course.” Another stated that s/he likes “the fact that the discussion questions are incorporated into the material.” These represent the gist of most of the responses.

Present Status of Project After analyzing the survey results, I scheduled a meeting with the Nurse Manager of Ambulatory Products and the Project Coordinator. We reviewed the findings, and the Nurse Manager agreed that the re-design is probably on the right course. However, before continuing with the remaining modules, I will Beta test the completed modules to gather further information.

VIII. Recommendations for Future Action Based on the problems encountered and also the survey results, these are my recommendations for future action:  Beta test at least one of the completed re-designed modules with several participants  Implement results of Beta test including changes, if needed.  Continue course re-design according to survey and Beta-test results  Implement a tighter project management process (at least in the beginning) that involves a face-to-face meeting with the Nurse Manager of Ambulatory Products before uploading into ReviewLink o Pinpoint deadlines, provide scheduling, and remain flexible, all with the goal in mind: create a project within the timeframe that will give the best outcomes possible.  Revise online community for this course implementing the limitations as indicated by survey results such as fewer questions (just 2 per module) and ability for more student interaction.  Keep reviewing, evaluating, and assessing needs to make changes as required.  Use action research when necessary to solve or clarify student needs and/or course questions.

IX. Reflection Two INTE courses heavily influenced my ability to complete my internship. This internship came to fruition because of the theory, knowledge, and tools I gained from INTE 5380, Assessment for the 21st Century. And, the outcome has been improved because I was able to apply the action research strategy learned in INTE 6720 Research that clarified goals for me and helped me to better communicate these goals to the stakeholders. Thus, I believe one of the biggest successes of this internship was the chance to apply what I’ve learned during the course of this master’s program. In addition, working through this internship has helped me to better understand and incorporate project management goals into my work in general. I feel more confident about how to achieve 9

better outcomes. Instructional design requires the ability to work long hours alone focusing on content/course design, but also requires the ability to collaborate and communicate that design to others. I tend to get caught up in the design process. Thus, if I could go back and do something differently, I would incorporate action research about the course redesign earlier in the process. Also, I would schedule face-to-face review sessions with the Nurse Manager of Ambulatory Products so that we could establish how the review process works. I think those two things would have nipped in the bud the questions that arose about the appropriateness of the course redesign. In the end, I enjoyed the design process, how the idea for the course redesign emerged over time, and having the chance to improve my project management skills. I will continue evaluating how this redesign meets student needs, and I’m grateful for the support and cooperation of the education team at work and my instructor and classmates in INTE 6720 Research who critiqued my research, survey, and analysis. I appreciate it very much.


References Chen, I. (2008). Instructional Design Methodologies. In T. Kidd, & H. Song (Eds.), Handbook of Research on Instructional Systems and Technology (pp. 1-14). Hershey, PA: Information Science Reference. doi:10.4018/978-1-59904-865-9.ch001 Fogarty, R. & Pete, B. (2004). The Adult Learner: Some Things We Know. Thousand Oaks, CA: Corwin Press. Horton, W. (2012). E-Learning by Design (2nd ed.). San Francisco, CA: Pfeiffer. Stringer, E. (2007). Action research (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc. Wilson, B. G., Switzer, S. H., & Parrish, P. (2008). the IDEAL Research Lab. (2006). Transformative learning experiences: How do we get students deeply engaged for lasting change. Proceedings of selected research and development presentations. Washington DC: Association for Educational Communications and Technology. Online: http://thunder1. cudenver. edu/ideal/docs/AECT06ProceedingsRevised. doc.


Appendix A – ASC Administrator Course Redesign Survey to Past Participants











Management Report