The authors have no conflicts of interest to declare.
Testing the Exportability of a Tool for Detecting Operational Problems in VA Teaching Clinics
Article first published online: 22 DEC 2005
Journal of General Internal Medicine
Volume 21, Issue 2, pages 152–157, February 2006
How to Cite
Smith, C. S., Morris, M., Hill, W., Francovich, C., McMullin, J., Christiano, J., Chavez, L., Roth, C., Vo, A., Wheeler, S. and Milne, C. (2006), Testing the Exportability of a Tool for Detecting Operational Problems in VA Teaching Clinics. Journal of General Internal Medicine, 21: 152–157. doi: 10.1111/j.1525-1497.2006.00313.x
Presented in part at the Association of Medical Education in Europe Annual meeting (Edinburgh, Scotland, September 2004), the VA HSR&D National meeting (Baltimore, MD, February 2005), and the SGIM Annual Meeting (New Orleans, LA, May 2005).
- Issue published online: 8 MAR 2006
- Article first published online: 22 DEC 2005
- Manuscript received March 23, 2005 Initial editorial decision September 12, 2005 Final acceptance September 21, 2005
- graduate medical;
- ambulatory care;
BACKGROUND: Recurrent operational problems in teaching clinics may be caused by the different medical preferences of patients, residents, faculty, and administrators. These preference differences can be identified by cultural consensus analysis (CCA), a standard anthropologic tool.
OBJECTIVE: This study tests the exportability of a unique CCA tool to identify site-specific operational problems at 5 different VA teaching clinics.
DESIGN: We used the CCA tool at 5 teaching clinics to identify group preference differences between the above groups. We averaged the CCA results for all 5 sites. We compared each site with the averages in order to isolate each site's most anomalous responses. Major operational problems were independently identified by workgroups at each site. Cultural consensus analysis performance was then evaluated by comparison with workgroup results.
PARTICIPANTS: Twenty patients, 10 residents, 10 faculty, members, and 10 administrators at each site completed the CCA. Workgroups included at minimum: a patient, resident, faculty member, nurse, and receptionist or clinic administrator.
APPROACH: Cultural consensus analysis was performed at each site. Problems were identified by multidisciplinary workgroups, prioritized by anonymous multivoting, and confirmed by limited field observations and interviews. Cultural consensus analysis results were compared with workgroup results.
RESULTS: The CCA detected systematic, group-specific preference differences at each site. These were moderately to strongly associated with the problems independently identified by the workgroups. The CCA proved to be a useful tool for exploring the problems in depth and for detecting previously unrecognized problems.
CONCLUSIONS: This CCA worked in multiple VA sites. It may be adapted to work in other settings or to better detect other clinic problems.