Testing the exportability of a tool for detecting operational problems in VA teaching clinics.
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.


METHODS
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.


METHODS
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.


METHODS
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.
Smith
C Scott
CS
NW Regional Faculty Development Center, VAMC, Boise, ID 83702, USA. scott.smith2@med.va.gov
Morris
Magdalena
M
Hill
William
W
Francovich
Chris
C
McMullin
Juliet
J
Christiano
Jennifer
J
Chavez
Leo
L
Roth
Craig
C
Vo
Anthony
A
Wheeler
Stephanie
S
Milne
Caroline
C
D000554:Ambulatory Care Facilities; D000884:Anthropology, Cultural; D002755:Choice Behavior; D032921:Consensus; D004501:Education, Medical; D005180:Faculty, Medical; D006126:Group Processes; D006270:Health Facility Administrators; D006801:Humans; D007396:Internship and Residency; D010361:Patients; D014481:United States; D014493:United States Department of Veterans Affairs