The ASELPH Fellows (Albertina Sisulu Executive Leadership Programme in

Health) and rating of their learning style using Honey and Mumford's
Learning Style Questionnaire.

Prof Eunice Seekoe a, Prof Graham Wright ab, Prof Champak Jinabhai a, and Dr
Helen Betts b
a Faculty of Health Sciences, the University of Fort Hare, South Africa
b HELINA Education Working Group

Keywords: Leadership, Learning Styles, Honey and Mumford, Information

Abstract
Launched in 2013, the Albertina Sisulu Executive Leadership Programme in Health
(ASELPH), provides executive-level training and support to build the capacity of the
managers who drive health system transformation in South Africa. South Africa Partners
forged this programme in partnership with the University of Pretoria (UP), University of
Fort Hare (UFH) and Harvard School of Public Health (HSPH), and in collaboration with
the South African National Department of Health. ASELPH is envisioned as a local
‘flagship programme’ capable of setting the standard for executive level health leadership
and management training in South Africa.

The Honey and Munford learning inventory was used to determine the student learning
style of the first cohort of 49 ASELPH students studying at the University of Fort Hare
towards their Masters in Public Health. This 80 item inventory was developed from David
Kolb’s model and divided the learners into four preferred learning styles: reflector,
pragmatist, activist and theorist. (Fleming et al., 2011) Learning styles are said to have
an influence on how students learn and perform academically (Mohamed and Helal,
2012).

INTRODUCTION & BACKGROUND - THE ALBERTINA SISULU EXECUTIVE

LEADERSHIP PROGRAMME IN HEALTH FELLOWSHIP

The Albertina Sisulu Executive Leadership Programme in Health (ASELPH) is named

after Albertina Sisulu and was launched by the Minister of Health, Dr Aaron Motsoaledi,
on 16 May 2013 to provide executive-level training and support to build the capacity of
the managers who drive health system transformation in South Africa. A partnership
between the University of Pretoria (UP), University of Fort Hare (UFH) and Harvard T.H.
Chan School of Public Health, works in collaboration with the South African National
Department of Health.

The three key components of health transformation in South Africa are service delivery
improvements, meeting key policy operationalization goals and excellence in executive-
level training. Through the Fellowship period, one of the competencies students need to
develop is understanding the value of executive’s leadership to exploit global information
regarding supporting organisation strategic decision making (McKinney and Sen,
2012:111).

The programme, which focuses on the Harvard Case Study Method, develops Fellows’
reflective thinking skills. Reflection provides Fellows with unique active and structured
ways of thinking to facilitate strong executive leadership orientation for both executive
and other health managers (McKinney and Sen, 2012:111). It emphasises executive
leadership skills and competencies, health policy analysis and transformation, strategic
health human resources and the financing of management modalities. Throughout the
fellowship programme, there is significant focus on building competencies in information
searching, the ability to synthesise from a variety of sources to be able to create valuable
policies and organisational reports (Seekoe, 2015: 5). According to McKinney and Sen
(2012:111) guidance and supervision are key to developing critical thinking and reflective
skills. Executive Fellows are linked to a formal mentoring programme which provides an
opportunity to develop reflective thinking skills (Seekoe, 2015: 5). They have an
opportunity to engage with mentors and reflect actively through writing their research and
management reports and analysing and utilising information effectively.

Method
The Honey and Mumford learning inventory was used to determine the student learning
style of the first cohort of 49 ASELPH students studying at the University of Fort Hare
towards their Masters in Public Health. This inventory was developed from David’s Kolb’s
model and divides learners into four preferred learning styles, reflector, pragmatist,
activist and theorist. (Fleming et al., 2011). The questionnaire of 80 items, is then scored
and the answers identify the students preferred learning style. The Honey and Mumford’s
Learning Style Questionnaire was administered to ASELPH students to assist them to
select learning experiences that suit their style of reflector, activist, theorist or pragmatist
(Honey and Mumford, 2000).

Participants
The University of Fort Hare (UFH) offers a three-year Masters in Public Health (MPH)
programme, with the first cohort of 49 students graduating in April 2017.

Table 1: Profile of ASELPH Fellows at the University of Fort Hare: Provincial

Distribution & Management level

Province Designation Number

Eastern Cape Deputy Director 5
District Manager 2
Sub-District Manager 3
Medical Doctor 1
Chief Executive Officer 2
District Clinical Specialist 1
Senior Manager 2
Managers 11
Kwazulu Natal Province Chief Executive Officer 4
Manager 5
Northern Cape Province Clinical Specialist 1
Chief Executive Officer 1
Private Fellows Director 2
Chief Executive Officer 1
Manager 4
Senior Researcher 1
Statistical Consultant 1
Lecturer 1
Total 49

The ASELPH Academic Programme

 The ASELPH Fellows follow a course work Masters Degree at the notional qualification
level 9. Modules are offered throughout the year in semester one and two. Credits are
allocated to modules according to notional hours. The lowest credits are 8 equivalent to
80 notional hours. Research carries the highest notional hours of 30 for the research
methodology course and 60 for the dissertation.

Table 2: ASELPH Masters in Public Health Modules & Curriculum- Year 1

Year 1 ASELPH Modules NQF Semester Credits

/HEQF
Level
Fundamental Module
Introduction to Public Administration, Learning and issues in Public 9 1 8
health in the African context
Core Modules
Public Health Policy Transformation, Governance, Legislation and 9 1,2 16
Political Analysis Strategy, National Health Insurance, District Health
System Centralisation/Decentralisation and Re-engineering
Operations Management, Strategic Marketing and Communication 9 2 8
Executive Leadership in Health, Complex Problem Solving and 9 2 8
Negotiating Coherence and Coordination

Research Methodology 9 2 30
Strategic Human Resources, Labour Relations & Management 9 1 8
Performance
Strategic Economics and Finance Management in Health 9 2 8
Implementation of Quality Improvement Modalities (Strategies) in 9 1,2 16
Health Systems, Health Informatics, Monitoring & Evaluation
TOTAL CREDITS 110
Year 2 ASELPH Modules NQF / Semester Credits
HEQF/
Level
Mini-Dissertation 9 1.2 60
Elective Modules
(Students to Choose 1 of the 3 tracks)
Hospital Management Track
Hospital operations management 9 1.2 16
Critical units in hospital 9 2 8
Hospital specific competencies 9 1 8
OR
Health Research Track
Epidemiology 9 2 8
Advanced epidemiology 9 1.2 16
Biostatistics 9 2 8
OR
Occupational/Environmental Health Track
Health Education and Health Promotion 9 1 8
Advanced Epidemiology 9 2 8
Environmental health 9 1.2 16
OR
Occupational Health
92
TOTAL CREDITS (110+92) 202
NOTES: 1 NQF refers to the academic standards laid down by the National
Qualifications Authority (NQF); and the Higher Educational Quality Framework
(HEQF).

The overall pedagogic and programmatic approach is to locate Health Information

Systems and thinking – both at the conceptual and technical levels- as central pivotal
aspects of strategic and operational planning of Health systems; rather than separate
specialised areas isolated from the key decision and policy makers and implementers.
The ASELPH programme adopts the whole systems thinking framework, examining the
entire system of health promotion, prevention, treatment and care and rehabilitation. The
graduate outcomes of this programme ensure that in a resource constrained
environment, the professionals can function effectively with the full range of health
problems and challenges.

Learning Styles

The Honey and Mumford Learning style inventory was originally developed from David’s
Kolb’s model of experiential learning which he explained in his oringinally published 1984
book 'Experiential Learning: Experience As The Source Of Learning And Development'
(Kolb, 2014). It is widely recognised as a seminal work, however, Kolb did acknowledge
the early work by others in the 1900's, including Lewin, Dewey, Rogers, Bruner, Jung,
Piaget and James. (Kolb, 2014).

Diagram from Kolb 1984

Honey and Mumford divided the learners into four preferred learning styles, reflector,
pragmatist, activist and theorist (Fleming et al., 2011)
Honey and Mumford (2000) thought people prefered different methods of learning,
depending on the situation and their experience level. Where as Kolb thought that
learning was dominantly locked into one mode. Honey and Mumford state people move
between the four modes of learning depending on their experience and situation.

o Reflector - Prefers to learn from activities that allow them to watch, think, and
review what has happened. Likes to use journals and brainstorming. Lectures are
helpful if they provide expert explanations and analysis.
o Theorist - Prefer to think problems through in a step-by-step manner. Likes
lectures, analogies, systems, case studies, models, and readings. Talking with
experts is normally not helpful.
o Pragmatist - Prefers to apply new learning to actual practice to see if it works.
Likes laboratories, field work, and observations. Likes feedback, coaching, and
obvious links between the task-on-hand and a problem.
o Activist - Prefers the challenges of new experiences, involvement with others,
assimilation and role-playing. Likes anything new, problem-solving, and small
group discussions.

Results

The results are presented according to the four learning styles viz., activists, reflector,
theorist and pragmatist based on questions that were less and most favoured as
indicated in Table 3.

Table 3: Showing showing overall group results of ASELPH Fellows

LEARNING
STYLE Activist Reflector Theorist Pragmatist Group
TOTAL 226 403 384 369 Total
AV. SCORE 8,37 14,93 14,22 13,67 Average
The questions, which were less favoured are shown below:-
 I often act without considering the possible consequences
 I enjoy being the one that talks a lot
 I find the formality of having specific objectives and plans stifling
 People often find me insensitive to their feelings

The most favoured answers included:-

 I take pride in doing a thorough job
 I accept and stick to laid down procedures and policies so long as I regard them
as an efficient way of getting the job done
 In meetings, I put forward practical, realistic ideas
 I believe that rational, logical thinking should win the day
 I like meetings to be run on methodical lines, sticking to laid down agenda, etc.
 I take care over the interpretation of data available to me and avoid jumping to
conclusions
 It's best to think carefully before taking action

The latter reflecting some good leadership attitudes.

The next stage in this work is to retest the students and interview them to explore their
perceptions of their preferred learning style.

Discussion

The results show that reflector and theorist learning styles are the most preferred by the
students over pragmatist and activist. There are several unique features of these study
results that are pertinent for developing and developed countries.

Firstly, we have located the central focus of health information systems within the
broader health management paradigm - hence overcoming the fragmented approach
common to other management development programmes.

Secondly, the learning style inventory has been correctly applied to senior managers who
are required to develop their personal "learning styles" from both the MPH programme,
and most importantly from their workplace based learning – blending experiential
learning with pedagogic didactic teaching.

Thirdly, the learning style inventory allows each manager to identify their strengths and
weaknesses as they move from the classroom context to their hospital management
context – as they go through the four typologies of activist, theorist, pragmatist and
reflector.

The results reveal that the reflector and theorist are the dominant modalities followed by
the pragmatist and lastly the activist. Thus the results suggest that the students are
demonstrating "managerial" behaviours and attitudes and confirm the validity and
reliability of the instrument.

The critical aspect of this MPH Programme is to train Managers who are to build and
create learning organisations as outlined in the work of Peter Senge, who describes five
disciplines that must be mastered when introducing learning into an organisation:

1. Systems thinking
2. Personal mastery
3. Mental Models
4. Building Shared
5. Team Learning (Senge 1990,10).

It is argued that the dominant learning styles reflected in the data would contribute to the
capacity of the students to establish such learning organisations.

The National Department of Health (NDOH) in their Human Resources for Health 2030
vision Indicates "a workforce fit for purpose to meet the needs of the re-engineered
health system and measurably improve access to quality health care for all by 2030. Its
mission is to ensure adequate numbers of appropriately competent staff in all locations
(primary, secondary and tertiary) as a result of increased employment, production,
recruitment and reduced attrition and ensuring that health care workers have an optimal
working environment and rewarding careers and to increase retention.”
According to the National Health Insurance (NHI) in South Africa Policy Paper (NDOH.
12 August 2011, Pretoria) Section 6, states that: "To successfully implement a healthcare
financing mechanism that covers the whole population such as NHI, four key
interventions need to happen simultaneously: i) a complete transformation of healthcare
service provision and delivery; ii) the total overhaul of the entire healthcare system iii) the
radical change of administration and management iv) the provision of a comprehensive
package of care underpinned by a re-engineered Primary Health Care”.

It is argued that the results from the learning style inventory illustrate that the tested
students could contribute to these interventions.

Limitations to the study

As this was a baseline study, the learning style inventory would need to be administered
to subsequent cohorts of students to develop a larger database. A longitudinal study of
this group of students in their workplace settings is required to evaluate the full impact of
this MPH programme, specifically exploring the blend of didactic teaching and the work-
placed based experiential learning among the students.

Conclusions

The ASELPH MPH programme is a global flagship programme, and these early results
from the learning style inventory data suggest that the students have a preference for
reflective thinking, which underpins postgraduate learning behaviour.

Recommendations

Both the MPH programme curriculum as well the students learning styles, as identified in
this study, need to be further examined and reviewed to increase alignment. Follow-up
studies located at the working environment of the students are required to explore further
the applications of these learning styles.

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