DDHA 8006 Week 2 Scholarly Voice Exercise Example

One Passage Written Twice: Rebuilding an Opinion About Unclosed Referrals Into Scholarly Voice

Student Name

Walden University

DDHA 8006: Doctor of Healthcare Administration Foundational Concepts

Instructor Name

Month Day, Year

One Passage Written Twice: Rebuilding an Opinion About Unclosed Referrals Into Scholarly Voice

Purpose of the Exercise

Doctoral writing differs from professional writing less in vocabulary than in how claims are handled. In scholarly voice, each claim is attributed to a source or to the writer's own evidence, and each carries a limit that says how far it reaches. This exercise takes one paragraph I might write in a staff memo about unclosed specialty referrals at Tallgrass Medical Group, the composite primary care group I am studying, and rebuilds it so that every claim is attributed and bounded. A commentary then explains each change.

Version One: Opinion

"Referrals are falling through the cracks everywhere, and it is getting worse. Patients are being harmed because nobody follows up. Specialists never send reports back, and our clinicians are too busy to chase them. The answer is obviously an electronic referral system, which would fix the problem. Every good health system already uses one."

Version Two: Scholarly Voice

"Breakdowns in the specialty referral process have been described at several stages, including unclear referral questions, scheduling failures and missing communication back to the referring clinician (Mehrotra et al., 2011). The scale of the issue may be growing: in national ambulatory care data, the probability that a visit ended in a referral roughly doubled between 1999 and 2009 (Barnett et al., 2012), although those data do not show whether completion rates changed. Whether patients are harmed by unclosed referrals depends on the clinical question; for some referrals a missed visit carries little risk, while for others, such as suspected cancer, delay may be serious. At Tallgrass, a review of one quarter of referrals suggested that many lacked a documented completed visit within ninety days, but the review relied on scanned reports that may be filed inconsistently, so the true completion rate is uncertain. Electronic referral systems have been associated with improved access and communication in some settings, such as one large public hospital system (Chen et al., 2013), but evidence on whether they increase completion rates in independent primary care groups is limited."

Commentary on the Changes

Claim 1, "falling through the cracks everywhere." The opinion version asserts a universal problem without support. The rebuilt version names the specific stages at which breakdowns have been described and attributes the description to a review. "Everywhere" disappears because no source supports it.

Claim 2, "it is getting worse." The opinion version asserts a trend. The rebuilt version cites national data showing that referrals became more frequent, then states the limit: the data do not show whether completion worsened. More referrals and worse completion are different claims, and only the first is supported.

Claim 3, "patients are being harmed." The opinion version asserts harm generally. The rebuilt version makes the claim conditional on the clinical question, which is more accurate and more useful. It neither denies harm nor overstates it.

Claim 4, "nobody follows up" and "specialists never send reports back." These are absolutes, almost certainly false as stated, and they assign blame. The rebuilt version replaces them with the writer's own evidence from Tallgrass, stated with its limit: the data come from scanned reports that may be misfiled. Scholarly voice treats one's own data as evidence that also needs qualification.

Claim 5, "the answer is obviously an electronic referral system." The opinion version moves from problem to solution without evidence. The rebuilt version reports that electronic referral has been associated with improvements in a particular setting, names that setting and states the gap in evidence for settings like Tallgrass. "Obviously" is removed; scholarly voice reserves certainty for what has been shown.

Claim 6, "every good health system already uses one." This is an appeal to common practice, which is not evidence of effectiveness. It is removed entirely.

What Scholarly Voice Costs and Gains

The rebuilt passage is longer and less forceful. A reader looking for a call to action may find it frustrating. What it gains is trust. A board member or reviewer who checks any sentence will find it supported, and the limits tell them where more evidence is needed. For a doctoral practitioner, the limits are not weaknesses to hide; they are the questions the project exists to answer.

There is also a practical gain. The opinion version, if taken at face value, would lead Tallgrass to buy an electronic referral system. The scholarly version suggests a different first step: find out how many referrals actually go unclosed, at which stage they fail and whether the failures are the kind an electronic system addresses. Kim-Hwang et al. (2010) found that clinicians at a public hospital reported improved access and communication after electronic referrals were introduced, but their evaluation relied on clinician surveys rather than measured completion, which is exactly the kind of limit scholarly voice brings into view.

A Second, Shorter Example

The same method applies to single sentences in emails and reports. "Our no-show rate for cardiology is terrible" becomes "In the last quarter, about one in four scheduled cardiology referral appointments for Tallgrass patients was recorded as a no-show by the receiving practice, a figure based on the two practices that share schedules with us." The rebuilt sentence is longer but tells the reader what was measured, where the number came from and which practices it excludes. A reader can now act on it or question it, which the first sentence did not allow.

Principles Carried Forward

Four principles from this exercise will guide my writing for the rest of the program. Attribute every claim that is not common knowledge. State the limit of each source, including my own data. Replace absolutes with the strongest statement the evidence supports. And separate the problem from the solution, so that a proposed fix is judged on its own evidence rather than borrowed urgency from the problem.

Conclusion

The same paragraph, written twice, shows what scholarly voice changes. Claims gain sources and limits; absolutes become measured statements; the jump from problem to solution is slowed until the evidence catches up. The rebuilt version is less dramatic and more useful, because it tells Tallgrass what it knows, what it does not and what to find out first.

References

Barnett, M. L., Song, Z., & Landon, B. E. (2012). Trends in physician referrals in the United States, 1999-2009. Archives of Internal Medicine, 172(2), 163-170. https://doi.org/10.1001/archinternmed.2011.722

Chen, A. H., Murphy, E. J., & Yee, H. F. (2013). eReferral: A new model for integrated care. New England Journal of Medicine, 368(26), 2450-2453. https://doi.org/10.1056/NEJMp1215594

Kim-Hwang, J. E., Chen, A. H., Bell, D. S., Guzman, D., Yee, H. F., & Kushel, M. B. (2010). Evaluating electronic referrals for specialty care at a public hospital. Journal of General Internal Medicine, 25(10), 1123-1128. https://doi.org/10.1007/s11606-010-1402-1

Mehrotra, A., Forrest, C. B., & Lin, C. Y. (2011). Dropping the baton: Specialty referrals in the United States. The Milbank Quarterly, 89(1), 39-68. https://doi.org/10.1111/j.1468-0009.2011.00619.x