title: Testing the exportability of a tool for detecting operational problems in VA teaching clinics.
abstract: 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.
authors.affiliation: NW Regional Faculty Development Center, VAMC, Boise, ID 83702, USA. scott.smith2@med.va.gov
authors.forename: C Scott
authors.initials: CS
authors.lastname: Smith
authors.forename: Magdalena
authors.initials: M
authors.lastname: Morris
authors.forename: William
authors.initials: W
authors.lastname: Hill
authors.forename: Chris
authors.initials: C
authors.lastname: Francovich
authors.forename: Juliet
authors.initials: J
authors.lastname: McMullin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Christiano
authors.forename: Leo
authors.initials: L
authors.lastname: Chavez
authors.forename: Craig
authors.initials: C
authors.lastname: Roth
authors.forename: Anthony
authors.initials: A
authors.lastname: Vo
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wheeler
authors.forename: Caroline
authors.initials: C
authors.lastname: Milne
mesh_terms: 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