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

C. Scott Smith, Magdalena Morris, William Hill, Chris Francovich, Juliet McMullin, Jennifer Christiano, Leo Chavez, Craig Roth, Anthony Vo, Stephanie Wheeler, Caroline Milne

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)152-157
Number of pages6
JournalJournal of general internal medicine
Issue number2
StatePublished - Feb 2006

Bibliographical note

Funding Information:
This material is based upon work supported by the Office of Research and Development, Health Services R&D Service, Department of Veterans Affairs (grant #PCC 01-178).


  • Ambulatory care
  • Culture
  • Education
  • Graduate medical

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