Reducing perceived barriers to nursing homes data entry in the advancing excellence campaign: the role of LANEs (Local Area Networks for Excellence).

PURPOSE: Advancing Excellence (AE) is a coalition-based campaign concerned with how society cares for its elderly and disabled citizens. The purpose of this project was to work with a small group of volunteer nursing homes and with local quality improvement networks called LANEs (Local Area Networks for Excellence) in 6 states in a learning collaborative. The purpose of the collaborative was to determine effective ways for LANEs to address and mitigate perceived barriers to nursing home data entry in the national Advancing Excellence campaign and to test methods by which local quality improvement networks could support nursing homes as they enter data on the AE Web site. DESIGN AND METHODS: A semistructured telephone survey of nursing homes was conducted in 6 states. Participants included LANEs from California, Georgia, Massachusetts, Michigan, Oklahoma, and Washington. Facility characteristics were obtained from a series of questions during the telephone interview. Three states (GA, MA, OK) piloted a new spreadsheet and process for entering data on staff turnover, and 3 states (CA, MI, WA) piloted a new spreadsheet and process for entering data on consistent assignment. RESULTS: Many of the nursing homes we contacted had not entered data for organizational goals on the national Web site, but all were able to do so with telephone assistance from the LANE. Eighty-five percent of nursing homes said they would be able to collect information on advance directives if tools (eg, spreadsheets) were provided. Over 40% of nursing homes, including for-profit homes, were willing to have staff and residents/families enter satisfaction data directly on an independent Web site. Nursing homes were able to convey concerns and questions about the process of goal entry, and offer suggestions to the LANEs during semistructured telephone interviews. The 6 LANEs discussed nursing home responses on their regularly scheduled calls, and useful strategies were shared across states. Nursing homes reported that they are using Advancing Excellence target setting and goal entry to improve care, and that they would use new tools such as those for measuring satisfaction, consistent assignment, and advance directives. IMPLICATIONS: Having LANE members contact nursing homes directly by telephone engaged the nursing homes in providing valuable feedback on new Advancing Excellence goals and data entry. It also provided an opportunity to clarify issues related to the campaign and ongoing quality improvement efforts, including culture change.

'Flying below the radar': a qualitative study of minority experience and management of discrimination in academic medicine.

OBJECTIVES: This paper aims to give voice to the lived experience of faculty members who have encountered racial or ethnic discrimination in the course of their academic careers. It looks at how they describe the environment for minorities, how they manage discrimination and what institutions and majority-member faculty can do to improve medical academe for minority members. METHODS: Qualitative techniques were used for semi-structured, in-depth individual telephone interviews, which were audiotaped, transcribed and analysed by reviewers. Themes expressed by multiple faculty members were studied for patterns of connection and grouped into broader categories. A description of the faculty sample is provided, in which respondents ranked the importance of discrimination in hindering academic advancement and used Likert scales to evaluate effects of discrimination. The sample was drawn from 12 of 24 academic medical centres in the National Faculty Survey and included 18 minority-member faculty staff stratified by gender, rank and degree who had experienced, or possibly experienced, work-related discrimination. RESULTS: Minority faculty described the need to be strongly self-reliant, repeatedly prove themselves, develop strong supports and acquire a wide range of academic skills to succeed. Suggested responses to discrimination were to be cautious, level-headed and informed. Confronting discriminatory actions by sitting down with colleagues and raising the level of awareness were important methods of dealing with such situations. CONCLUSIONS: Academic medical centres may need to make greater efforts to support minority faculty and improve understanding of the challenges confronting such faculty in order to prevent the loss and/or under-utilisation of important talent.

Negotiation in academic medicine: a necessary career skill.

AIMS: Negotiation and its use in academic medicine have not been studied. Little is known about faculty experience with negotiation or its potential benefits for academe. Barriers to negotiation and how they can be addressed, especially for faculty without perceived skill in negotiation, are unknown. METHODS: To better understand the problems that such faculty experience, we completed in-depth, individual telephone interviews of 20 academic medical faculty at 11 of the 24 medical schools in the National Faculty Survey, all of whom perceived difficulty in negotiation. Faculty were stratified by rank, gender, and degree. Semistructured interviews were audiotaped, transcribed, and analyzed by five reviewers. We explored the role of negotiation in academe, barriers to negotiation, what faculty and institutions can do to improve the use of negotiation, and possible differences in negotiation by gender. RESULTS: Faculty were relatively unaware of the possible uses of negotiation to advance their work in academe. Women tended to see negotiation as less important to an academic career than did their male colleagues. The perceived hierarchy and secrecy of many academic medical centers was believed to create a difficult environment for negotiation. For effective negotiation to occur, faculty stated the need to prepare, gather information, especially on compensation and resources, and to know their priorities. Preparation was particularly important for women, correlating with greater comfort with the degree of aggressiveness in the negotiation and greater self-confidence after the negotiation. These informants suggested that institutions need to provide more transparent information on salary and promotion guidelines. Further, institutions need to empower faculty with a solid understanding of institutional policy, goals, and resource needs of academic life. CONCLUSIONS: Many medical faculty are insufficiently aware of, or skilled in, the negotiation process and find significant barriers to negotiate in academe. Medical centers need to improve the climate for negotiation in academic medicine to maximize the potential contributions of negotiation to the institution.

"Having the right chemistry": a qualitative study of mentoring in academic medicine.

PURPOSE: To develop a deeper understanding of mentoring by exploring lived experiences of academic medicine faculty members. Mentoring relationships are key to developing productive careers in academic medicine, but such alliances hold a certain "mystery." METHOD: Using qualitative techniques, between November 1999 and March 2000, the authors conducted individual telephone interviews of 16 faculty members about their experiences with mentoring. Interviews were taped and transcribed and authors identified major themes through multiple readings. A consensus taxonomy for classifying content evolved from comparisons of coding by four reviewers. Themes expressed by participants were studied for patterns of connection and grouped into broader categories. RESULTS: Almost 98% of participants identified lack of mentoring as the first (42%) or second (56%) most important factor hindering career progress in academic medicine. Finding a suitable mentor requires effort and persistence. Effective mentoring necessitates a certain chemistry for an appropriate interpersonal match. Prized mentors have "clout," knowledge, and interest in the mentees, and provide both professional and personal support. In cross-gender mentoring, maintaining clear boundaries is essential for an effective relationship. Same-gender or same-race matches between mentor and mentee were not felt to be essential. CONCLUSIONS: Having a mentor is critical to having a successful career in academic medicine. Mentees need to be diligent in seeking out these relationships and institutions need to encourage and value the work of mentors. Participants without formalized mentoring relationships should look to peers and colleagues for assistance in navigating the academic system.

A "ton of feathers": gender discrimination in academic medical careers and how to manage it.

PURPOSE: To evaluate the experience of gender discrimination among a limited sample of women in academic medicine, specifically, the role of discrimination in hindering careers, coping mechanisms, and perceptions of what institutions and leaders of academic medicine can do to improve the professional workplace climate for women. METHODS: In-depth, semistructured telephonic individual interviews of 18 women faculty who experienced or may have experienced discrimination in the course of their professional academic medical careers from 13 of the 24 institutions of the National Faculty Survey. A consensus taxonomy for classifying content evolved from comparisons of coding. Themes expressed by multiple faculty were studied for patterns of connection and grouped into broader categories. RESULTS: Forty percent of respondents ranked gender discrimination first out of 11 possible choices for hindering their career in academic medicine. Thirty-five percent ranked gender discrimination second to either "limited time for professional work" or "lack of mentoring." Respondents rated themselves as poorly prepared to deal with gender discrimination and noted effects on professional self-confidence, self-esteem, collegiality, isolation, and career satisfaction. The hierarchical structure in academe is perceived to work against women, as there are few women at the top. Women faculty who have experienced gender discrimination perceive that little can be done to directly address this issue. Institutions need to be proactive and recurrently evaluate the gender climate, as well as provide transparent information and fair scrutiny of promotion and salary decisions. CONCLUSIONS: According to this subset of women who perceive that they have been discriminated against based on gender, sexual bias and discrimination are subtly pervasive and powerful. Such environments may have consequences for both women faculty and academic medicine, affecting morale and dissuading younger trainees from entering academic careers. Medical schools need to evaluate and may need to improve the environment for women in academe.