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The use of Delphi technique in conjunction with activity analysis to obtain congruency of objectives… Loughlin, Keith Gilbert 1977

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THE USE OF "DELPHI" TECHNIQUE IN CONJUNCTION WITH ACTIVITY ANALYSIS TO OBTAIN CONGRUENCY OF OBJECTIVES AND ACTIVITIES WITHIN AN ACADEMIC MEDICAL DEPARTMENT by Keith Gilbert Loughlin B.A. Simon Fraser University, 1975 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE STUDIES DEPARTMENT OF HEALTH CARE AND EPIDEMIOLOGY We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1977 © Keith Gilbert Loughlin 1977 In presenting th is thes is in pa r t i a l fu l f i lment of the requirements f an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree tha the L ibrary sha l l make it f ree ly ava i lab le for reference and study. I fur ther agree that permission for extensive copying o f th is thes is for s c h o l a r l y purposes may be granted by the Head of my Department or by h is representa t ives . It is understood that copying or pub l ica t ion of th is thes is fo r f inanc ia l gain sha l l not be allowed without my wri t ten permission. Department o f Health Care and Epidemiology The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1WS Date August 26, 1977 i i ABSTRACT This study was undertaken to answer the following question. Can the Delphi technique be used i n conjunction with act i v i t y analysis to obtain consensus and c l a r i t y of objectives and a c t i v i t i e s of full-time faculty members with-i n an academic medical department? The results of this study indicate that the Delphi technique i s a useful method for not only obtaining consen-sus of objectives * but also for elucidating areas where there i s no apparent consensus. The results also indicated which a c t i v i t i e s contributed to the objectives of the department, and also the areas i n which there was a diver-gence of objectives from the actual a c t i v i t i e s being carried out. The conclusions of this study are that the Delphi technique used i n conjunction with a c t i v i t y analysis i s an excellent methodology for identifying the objectives and a c t i v i t i e s which are performed within an academic medical department. Furthermore, the results and findings can be used as baseline data i n setting departmental policies, as well as identifying areas i n which structural change within the department i s necessary i n order that a c t i v i t i e s i n the department may be more congruent with department objectives. Finally this methodology would be highly appropriate for undertaking studies of a similar nature i n other academic medical department settings. i i i TABLE OF CONTENTS PAGE ABSTRACT i i LIST OF TABLES v LIST OF FIGURES v i ACKNOWLEDGEMENT v i i CHAPTER I INTRODUCTION 1 D e f i n i t i o n of Terms . . . . . 4 Study Question 5 Outline of Study . . . . . 6-7 CHAPTER II LITERATURE REVIEW 8 Delphi Technique . 9-12 C r i t i q u e of Delphi 13-15 A c t i v i t y Analysis 16-1? C r i t i q u e of A c t i v i t y Analysis 18 Objectives • • 19 Questionnaire and Interview . . . . . . . . 21 CHAPTER I I I METHODOLOGY 23 Assumptions, Limitations and Drawbacks . . . 23-24 Project Methodology 25-27 A c t i v i t y Analysis Findings 28 Proposal f o r Delphi Study 29-30 Delphi Round 1 Findings 31-32 Delphi Round 2 Findings 33-34 Delphi Round 3 Findings 34-35 CHAPTER IV RESULTS , 36 Summary of Objectives 58-60 CHAPTER V RECOMMENDATION AND CONCLUSIONS 61 Generalizations about Delphi Recommendations °j~f5 Conclusion 66-67 Areas f o r Further Research 67 REFERENCES AND BIBLIOGRAPHY 68-71 i v PAGE APPENDICES . . 72 I. Faculty A c t i v i t y Report with Explanatory Le t t e r . . 72-84 I I . Proposal f o r a Delphi Study 85-87 I I I . Delphi Round 1 and Explanatory Let t e r 88-94 IV. Delphi Round 2 and Explanatory Letter 95-IO7 V. Delphi Round 3 and Explanatory Let t e r 108-133 V LIST OP TABLES TABLE PAGE 1 Returns by Category of Respondent 39 2 Comparison of Delphi Round 3 and A c t i v i t y Analysis . . 46 3 Degree of Importance of Objectives with Consensus . 48 4 Evaluation of Objective rated as being "very important" . . . . . . . . . 49-51 5 Evaluation of Objectives rates as being "important" 52 6 Objectives E x h i b i t i n g P o l o r i z a t i o n or Broad D i s t r i b u t i o n of Responses . . . 54-57 1 v i LIST OF FIGURES FIGURE PAGE 1 Chart of A c t i v i t i e s f o r the Delphi Study . . . . . 37 2 Comparison of Consensus between Delphi Round 1, 2, and 3 . 41 3 Comparison of Consensus of Primary A c t i v i t i e s between Delphi Round 2 and 3 • 42 4 Comparison of Degree of Consensus of Objective between Delphi Round 2 and 3 44 5 Comparison of Degree of Consensus of Primary A c t i v i t i e s between Delphi Round 2 and 3 4jJ ACKNOWLEDGEMENT I would l i k e to take t h i s opportunity to thank my thesis committee members Dr. Larry Moore, (Chairman) i n the Faculty of Commerce and Business Administration at U.B.C, Mr. P. M. Nerland, (advisor) Director of Business Administration f o r the Health Sciences Centre U.B.C, and Dr. Robert Boese, (advisor) Medical So c i o l o g i s t , Department of Paediatrics U.B.C, f o r t h e i r very h e l p f u l advice and assistance with t h i s project. I also want to thank Dr. Sydney I s r a e l s , Chairman of the U.B.C. Department of Paediatrics, f o r approving the study, and a l l the f u l l - t i m e f a c u l t y members i n h i s depart-ment f o r t h e i r cooperation, assistance and taking time from t h e i r busy schedules to provide the necessary data, without which, t h i s study could not have been done. DEDICATION To E i l a 1 CHAPTER I INTRODUCTION The complexities of health care today which now i n -volve various l e v e l s of government, funding agencies, health care d e l i v e r i e s and educational i n s t i t u t i o n s , have created s i g n i f i c a n t changes i n academic medicine over the l a s t decade. An academic medical department can no longer function i n semi i s o l a t i o n . I t has an important role to play i n the community and i n association with other health care i n s t i t u t i o n s . Academic medical departments are dependent on government funding agencies as well as some private founda-tions f o r the necessary money to carry out medieal education and research. Much of the funding provided by these agencies i s done on an objective orientated basis ( i . e . the money i s provided to achieve c e r t a i n objectives), (2). Furthermore with the increasing complexity of health care many backup and l i a i s o n people are needed to administer the system. These people also have c e r t a i n objectives to pursue. Therefore i t would seem that i f the funding and coordination of medical research, education, and the delivery of health care i s now being done on an objective orientated basis, i t would seem that academic medical departments should also attempt to set t h e i r objectives. Otherwise they w i l l eventually f i n d them-selves t r y i n g to function i n a s i t u a t i o n where the objectives have already been set f o r them. 2 At t h i s junction i n time the U.B.C. Department of Paediatrics does not have a written set of objectives, although the Annual Report f o r the Health Centre f o r Children does maintain that the objectives of the Department of Paediatrics i s "to provide a higher standard of health care f o r tomorrow's c i t i z e n s by making knowledge available i n the promotion, treatment, and i n v e s t i g a t i o n of childhood disease to those who practice c h i l d health care today and i n the future." This i s a most laudable objective yet i t i s rather vague, very broad and generally non s p e c i f i c . Sound manage-ment p r i n c i p l e s suggest that objectives must be s p e c i f i c , give d i r e c t i o n and o f f e r a challenge i n meeting them. The question now arises as to how one goes about set t i n g objectives f o r an academic medical department. Should the objectives be a r b r i t r a r i l y set by the head of the depart-ment or should they be arrived at through a committee process? It i s l i k e l y that neither of these processes would achieve a t r u l y representative viewpoint of a l l members of the department. The objectives set by a single i n d i v i d u a l may not be appropriate f o r c e r t a i n areas within the department, whereas the committee process has a number of negative psycho-l o g i c a l connotations associated with i t , such as bandwagon ef f e c t s and perceived status d i f f e r e n t i a l s , which detract from obtaining a wide d i v e r s i t y of viewpoints. F i n a l l y committees which are formed to determine objectives may waste many man-hours of valuable time, and eventually a r r i v e at a set of 3 objectives which may be thought of as the 'blue ribbon var i e t y ' suitably vague and intended not to offend anybody. Once i t was decided that the U.B.C. Department of Paediatrics should have a set of objectives, the problem arose as to the most appropriate method to" a r r i v e at thesm. The Delphi technique was then proposed as a viable a l t e r n a -t i v e to the two methods mentioned previously. I t would take a small amount of the respondent's time, approximately 45 minutes per month over a three month period. Furthermore, i t would eliminate a l l the l o g i s t i c problems i n t r y i n g to bring a large group together at a single time. F i n a l l y , con-sensus of objectives could be achieved through a systematic evaluation of responses, and not through group pressure which i s so prevalent i n the committee process. The Delphi method i s a technique f o r systematically s o l i c i t i n g opinions from a group of experts on an i n d i v i d u a l basis about a p a r t i c u l a r subject, i n which they are believed to possess expertise. These opinions are then tabulated by the coordinator of the study and returned to the respondents over several i t e r a t i o n rounds. The r e s u l t s of these i t e r a t i o n rounds usually show a consensus of opinion on c e r t a i n items. However the technique i s also useful f o r i d e n t i f y i n g areas of no consensus. The instrument f o r f a c i l i t a t i n g t h i s enquiry i s a questionnaire form, which can be supplemented by interviews. The study undertaken was an attempt to determine the objectives of the entire U.B.C. Department of Paediatrics as 4 perceived by the f u l l - t i m e f a c u l t y members within i t . A f u r -ther aim of the study was to ascertain whether °or not there was congruency of objectives with the various a c t i v i t i e s car-r i e d out by i n d i v i d u a l f u l l - t i m e f a c u l t y members. An a c t i v i t y analysis of f u l l - t i m e f a c u l t y members was completed i n the summer of 19?6 i n order to f a c i l i t a t e t h i s aim. At t h i s time i t i s appropriate to define the key terms used i n t h i s study. Defi n i t i o n s ; Delphi - i s a technique f o r systematically s o l i c i -t i n g opinions from a group of experts on an i n d i v i d u a l basis about a p a r t i c u l a r subject i n which they are believed to have expertise. The mechanism f o r accomplishing t h i s i s a ques-tionnaire form, which can be supplemented with interviews. The three caveats of the v a l i d i t y of Delphi are 1) c o n t r o l l e d feedback 2) anonymity and 3) s t a t i s t i c a l group response (34, 28, 10). A c t i v i t y Analysis - i s a method by which i n d i v i d u a l s are asked to estimate the amount of time they spend carrying out the various a c t i v i t i e s which are a part of t h e i r occupation, over to some predetermined time period. The analysis can be eit h e r prospective or retrospective. The instrument used f o r acquiring t h i s information i s a questionnaire or survey form which can be supplemented with interviews (42, 18, 4, 25). Objectives - the concept of objectives implies they are measurable, have s p e c i f i c i t y , d i r e c t i o n , and that they 5 are aims foregone as well as those which are sought; otherwise a l l that i s l e f t i s a set of Boy Scout maxims (33, 41). Expert - a highly educated and/or experienced s p e c i a l i s t , or any person who can contribute relevant inputs to the question being asked (34). Consensus - a r b i t r a r i l y set, when 51$ or more of respondents agree on a c e r t a i n p o s i t i o n . For the purposes of t h i s study 51$ agreement would indicate a low degree of con-sensus, whereas 95$ would indicate a high degree of consensus. These terms as defined above represent the key con-cepts i n attempting to answer the study questions Can the Delphi method be used i n conjunction with a c t i v i t y analysis to determine, evaluate and obtain consensus of objec-t i v e s within the U.B.C. Department of Paediatrics, as they are perceived by i t s f u l l - t i m e f a c u l t y members, as w e l l as deter-mining whether or not these objectives are congruent with the a c t i v i t i e s being c a r r i e d out by these same f a c u l t y members? The remaining chapters of t h i s thesis provide a l i t e r a t u r e review, methodology, and r e s u l t s . The f i n a l chap-t e r contains the recommendations and conclusions derived from t h i s Delphi study. The advantages and disadvantages of Delphi and a c t i v i t y analysis are discussed i n the l i t e r a t u r e review. Also discussed i n t h i s section are the concepts of objectives, and the appropriateness of questionnaire and interview survey forms. 6 The chapter on methodology reviews the process of going through an ac t u a l Delphi sequence, gaining acceptance by top management, the designing and pretesting of questionnaires, and the response rate i n each round. The study was unusual i n that, the second round achieved a higher response rate than the f i r s t round. According to the l i t e r a t u r e t h i s i s only the second time that t h i s has occurred i n a Delphi study. Chapter Four describes the findings and provides an analysis of them. One modification to the concept of consensus was attempted by the author. Generally speaking, consensus i s reported as agreement when 51$ or more of the respondents agree on an issue. This paper attempts to take the concept of consensus one step further by defining consensus as being eithe r low, moderate, or high. This was done on the premise that those objectives which exhibited a high consensus, would meet with less resistance when being implimented than those with a low consensus. The l a s t chapter suggests some tentative recommenda-tions based on the findings of the study. In conclusion, i t i s noted that the Delphi technique i s an extremely usef u l method f o r achieving consensus. The drawbacks of the techni-que are considerable, i n that i t takes a great deal of time and e f f o r t to keep the process going from s t a r t to conclusion. The amount of administration work involved i s d i r e c t l y asso-ciated with the size of the respondent group. Enthusiasm must be maintained and the i n t e r e s t of the respondents must be kept 7 up as w e l l . To carry out a Delphi enquiry requires a well l a i d out plan i n advance, otherwise the study w i l l be unsuccessful. 8 CHAPTER II LITERATURE REVIEW Several hundred a r t i c l e s , papers, and studies con-cerning Delphi have now been completed. No attempt w i l l be made here to l i s t them a l l , however Linstone and Turoff (24) do provide an excellent bibliography of these a r t i c l e s i n the f i n a l chapter of t h e i r book. The purpose of t h i s l i t e r -ature review i s to provide a short history of the Delphi technique and A c t i v i t y Analysis. There w i l l also be a d i s -cussion of each method's strengths as well as a c r i t i q u e of each technique. F i n a l l y the concept of objectives w i l l be discussed. H i s t o r i c a l Development of Delphi The Delphi technique was o r i g i n a l l y developed by Norman C. Dalkey and Olaf Helmer of the Rand Corporation i n 195^- as a technological forecasting t o o l (9). The technique was developed as a means of systematically asking several experts i n m i l i t a r y warfare to estimate the number of missiles needed by the Soviet Union to destroy major targets of s t r a -tegic importance within the United States. A f t e r three rounds of feedback and i t e r a t i o n , the experts came to a con-sensus on the answer to t h i s question. Since t h i s topic was of a highly c l a s s i f i e d and secret nature, the technique was described i n the l i t e r a t u r e u n t i l 1962. Since then several hundred studies using Delphi have been completed, both on a public and proprietary b a s i s . 9 Delphi studies have been used mainly f o r technolo-g i c a l forecasting purposes (23, 14, 1?, 8). Recently Delphi has moved away from the technological forecasting purposes and has been used i n such diverse f i e l d s as corporate planning, medicine, education, urban planning, p o l i c y making, and man-power planning (4, 1, ?, 35» 24, 29). These studies have made modifications to the o r i g i n a l "pure" Delphi methodology to take into account s o c i a l issues, such as value judgements. An example of a value judgement i s the concept of objectives used i n the studies of Skutsch (41), Cyphert (?), Judd (21), and J i l l s o n ' ( 2 0 ) . DELPHI TECHNIQUE Delphi; Delphi i s a technique f o r systematically s o l i c i t i n g opinions from a group of experts on an i n d i v i d u a l basis about a p a r t i c u l a r subject i n which they are believed to possess expertise. The instrument f o r acquiring the data i s a ques-tionnaire form which can be supplemented with interviews of the respondents. As mentioned e a r l i e r , the three caveats of the v a l i d i t y of Delphi are anonymity, feedback through mul-t i p l e i t e r a t i o n s , and s t a t i s t i c a l group response (27, 28, 10). 1) Anonymity - Ensures that no member of the group knows what any other member has said about a p a r t i c u l a r subject. I t does not require that the i d e n t i t i e s of the group members be unknown to each other, and t h i s may i n f a c t be a motiva-t i n g f a c t o r i f they are known (28). In t h i s study a l l of the respondents knew each other. 10 2) Feedback through multiple i t e r a t i o n - This includes feed-back of a d d i t i o n a l data through several i t e r a t i o n s such as comments and other information r e l a t i n g to the topic by the various respondents. 3) S t a t i s t i c a l group response - This provides each respondent with information regarding the group response to the l a s t round. This information may be provided i n a va r i e t y of dif f e r e n t forms, such as histograms, standard deviations, modes, medians, means, and interquantile ranges. Committee process; Many of the advocates of Delphi view i t as a method of replacing the committee approach. They argue that Delphi avoids many of the inherent psychological factors which come about during committee or group meetings. These factors include: a) perceived status d i f f e r e n t i a l s between group members b) bandwagon e f f e c t s c) the domineering personality who takes over the commi-ttee process d) the reluctance of an i n d i v i d u a l to change p o s i t i o n a f t e r a public stance has been taken e) the unwillingness of i n d i v i d u a l s to take a p o s i t i o n u n t i l a l l of the information i s i n , or u n t i l i t i s cle a r , which way the majority opinion i s directed f ) the reluctance of an i n d i v i d u a l to contradict a per-son i n a higher p o s i t i o n 11 . g) the reluctance to make suggestions, i n the face of, that they may appear f o o l i s h i n the l i g h t of ad d i t i o n a l i n f o r -mation. Some further disadvantages or weaknesses i n the committee approach are alluded to by Lanford and Martino (23, 27) who suggest that: a) i t i s a truism that there i s at lea s t as much misin-formation a v a i l a b l e to the group as to any one of i t s members b) the group can exert strong s o c i a l pressures on i t s members to agree even i f the i n d i v i d u a l f e e l s the majority view i s wrong c) experiments i n small groups indicate that i t i s not the v a l i d i t y of arguments or comments made but rather the number of comments and arguments f o r or against an issue that decides f o r or against i t d) the group often takes on a l i f e of i t s own, and the idea of reaching agreement often becomes more important than an idea that i s well thought out and us e f u l , f o r the issue being discussed e) the members of the group may have vested i n t e r e s t s i n s p e c i f i c areas of concern to the group, and the objective may then become winning other group members over to t h e i r point of view f ) the whole group may have a common bias, f o r example when members share a common subculture i n an area of techno-logy i n which members are regarded as experts. 12 Despite the large number of negative psychological factors found i n groups, they do have advantages as well: a) It i s a truism that the group possesses at least as much information as any one individual within the group. Furthermore i f one member of the group does possess a l l of the information i t does not necessarily reduce the total information of the group, since other members may also be able to make useful contributions. b) The group i s able to consider at least as many factors outside the specific area of discussion as any one member, and this may be of more significance than any of the inter-nal factors. c) Groups are often more willing to take risks than are individuals. For instance an expert may be unwilling to make a statement which i s i n disagreement with colleagues i n his f i e l d and i f he does, he may be taking a considerable risk from a professional standpoint. CRITIQUE OF DELPHI Since Delphi i s a relatively new technique, there have been few criticisms of the method. What criticisms were made, were usually done by the authors of the various papers. Although they undoubtedly attempted to be objective i n their criticisms, i t i s quite d i f f i c u l t to c r i t i c i s e one's own work; i t i s much easier and more preferable to defend i t . 13 However, within the l a s t f i v e years several c r i t i q u e s of Delphi have been produced by Sackman, P i l l , Martino, Lanford, and Morgenstein et a l (36, 34, 30, 27, 23). Sackman's major c r i t i c i s m of Delphi i s that i t f a i l s to provide s c i e n t i f i c truths, and i s not amenable to psycho-metric t e s t i n g . P i l l argues that the technique perhaps should be more c l o s e l y a l l i e d with metaphysics than hard s c i e n t i f i c f a c t s . He goes on to mention that i t would be probably more useful as a communications devise than a theory. Lanford (23) c r i t i c i z e s the Delphi technique on four points» a) not being s u f f i c i e n t l y r e l i a b l e b) tends to produce s e l f f u l f i l l i n g prophecies c) the form of the questions may exert too great an i n -fluence on the panel members d) and i t i s d i f f i c u l t to u t i l i z e the expertise of the panel. Many of the aforementioned c r i t i c i s m s are related to using Delphi as a forecasting t o o l . Since many of these r e s u l t s would require several years of waiting to be able to determine t h e i r accuracy, i t becomes very d i f f i c u l t to t e s t the technique against s p e c i f i c c r i t e r i a . However the Delphi technique was not designed f o r obtaining s c i e n t i f i c facts but instead as a h e u r i s t i c device, and therefore i s not intended to provide s c i e n t i f i c f a cts or truths. The strengths of the technique are i t s a b i l i t y to gather information that i s important, but also which i s vague, v e i l e d i n uncertainty, and often where no information previously existed i n written form. 14 Although i t i s d i f f i c u l t to replicate a Delphi study-by asking the same questions over again to the same panel i t was done i n one experiment, (21). when the respondents were requested to answer the survey again, i t was found that 79 percent of a l l respondent's answers were only one answer point away i n either direction from the previous consensus. Further-more i t has been shown that i n studies comparing face to face groups with Delphi groups, the decisions~arrived at by the Delphi group were of a higher quality (17» 45, 3) than of the face to face ones. Another criticism of Delphi has been the use of experts. Much of this discussion has centred upon the concept of what an expert i s . If one wants to be cynical, an expert can be thought of as a person who knows an awful lot about very l i t t l e , and very l i t t l e about an awful l o t . For the purposes of this study, the definition of expert i s a combina-tion of those used by the Hand Corporation and P i l l Ok), An expert i s defined as a highly educated and experienced specialist, or any person who has relevant inputs to the question at hand. The respondents i n this survey f u l f i l l e d both of these c r i t e r i a . Delphi has been used i n isolation as an independent method of s o l i c i t i n g opinions from experts, and then attemp-ting to arrive at a consensus. Some of the literature has recommended that Delphi be used i n conjunction with some other method. Although i t i s often mentioned that Delphi can 15 be used as a technique to replace committee discussions, i t i s the position of this paper that i t can be more useful as an aid to decision making. The benefit of this approach i s that i t can s o l i c i t opinions from a wide number of people, which would be very d i f f i c u l t to accomplish i n a committee room setting. These opinions can also be evaluated by the respon-dents and the f i n a l evaluation can be presented to top o f f i c i a l s of an organization for their consideration and implementation. Although research can be fraught with a l l types of hazards when combining different methodologies (i.e. the pro-blem of validi t y when comparing results; i t was decided to attempt this. When one i s working with incomplete data, i n -complete theory, and uncertainty, you can either wait u n t i l a theory i s developed, or you can go ahead and attempt to obtain the data i n the light of these shortcomings. It v/as f e l t that the study undertaken here could be most useful by combining the Delphi technique with activity analysis to analyze and identify the objectives as perceived by full-time faculty members within the U.B.C. Department of Paediatrics and the a c t i v i t i e s carried out by these members. The aim of this study then i s to obtain consensus of objectives, as well as dilineating areas of divergence and convergence of a c t i -v i t i e s with objectives. The next two sections w i l l discuss the concepts of activity analysis and objectives. 16 EFFORT REPORTING Historical development; Effort reporting i s a method for determining how people spend their time i n carrying out the various a c t i v i -ties which are necessary to f u l f i l l the requirements of their job. The method was developed as a means for cost analysis by Hilles, Campbell and Stoddard U8, 4, 42J. This should not be confused with cost accounting<which i s a process of moni-toring costs on a day to day basis. Cost analysis on the other hand i s a method of cost finding over a certain period of time. Effort reporting i s a technique for doing this, (i.e. finding out what act i v i t i e s an individual does, and then using his salary as basis for allocating costs to these a c t i v i t i e s ) . In analyzing the ac t i v i t i e s of full-time members of an academic medical department, i t soon becomes apparent that there i s a problem of joint cost allocation. For instance how can i t be determined i n the case of medical care of patients the amount of time spent on actual medical care, and the amount of time spent on teaching i f students are present? Another example i s the area of research, how much of this time can be allocated to research, and how much to teaching? There are three methods by which this information can be obtained, the v i s i t content method, random sample time motion studies and activity analysis (,42). 17 1) v i s i t content method -This technique makes demands that require very thorough and extensive recordings of each "patient contact". An example of the types of data recorded i s the type of treatment given, the length of time of each patient contact, and whether or not students were present. The major drawback to this technique i s that the staff may have negative connota-tions of i t , i f they perceive the increased paperwork as unnecessary. The technique i s also time consuming as well as being expensive. Z) random sample time motion study -This method involves contacting the respondents at various times and asking them what they are presently doing. Variations of this method include the use of daily, weekly or monthly time logs i n which the respondents record their a c t i v i t i e s . These f i r s t two methods make the assumption that the study i s going to be a prospective one. However many studies of this nature are not preplanned and often the decision to go ahead with one i s done on an "ad hoc" basis. Furthermore neither of the above methods attempts to separate out the joint cost problem, and they may also have a stigma of time clock punching associated with them. The third method dis-cussed below addresses the joint cost problem directly. 3) faculty a c t i v i t y reports -These reports are usually completed by faculty and staff at the end of the time period i n question. Activities 18 are l i s t e d on a questionnaire and respondents are asked to estimate the percent of time they spent on each activity over the time period i n question. See Appendix (1). Although a l l three methods are open to distortion the acti v i t y analysis has received a great deal of criticism. CRITIQUE OF ACTIVITY ANALYSIS The most common criticisms of activity analysis are that i t i s an impressionistic technique, lacks objectivity and i s open to distortion. For instance the respondent may reply with percentage estimates of time that are based on salary sources (i.e. the salary sources are research, there-fore most of time allocated i s to research). However i t must be remembered that act i v i t y reports are tools for cost ana-l y s i s , and their fundamental use i s to find or present costs over a period of time rather than monitoring on a day to day basis as i n cost accounting. Therefore there i s a greater scope for the use of subjective methods i n cost analysis than there i s i n cost accounting. Furthermore the accuracy of the reports can be improved i f the following suggestions are adhered to: a.) interviewing the respondents at the time of completion of the survey aids i n a consistent interpretation of the terminology b) proper orientation of the respondents as to the purpose of the study, aids i n gaining increased acceptance of the questionnaire 19 c) respondents should be reassured of the confidentiality of their reports d) acceptance of the study i s also made easier i f they know that top management i s giving support to the study e) request respondents not to consider salary sources i n their estimates of time spent on various a c t i v i t i e s . In light of the criticisms of activity analysis, i f tne above suggestions are followed the accuracy of the reports can be improved. Furthermore this instrument has been used i n many studies investigating, the costs involved i n medical education, and remains i n the opinion of many researchers as being the best mecnanism available for cost analysis (18, 42, 31;. The f i n a l area of discussion i n this section of the paper i s the concept of objectives. OBJECTIVES most people w i l l admit that objectives are important, but i s i t necessary to analyze them, or can they be taken for granted {16), The answer of course i s that they should be analyzed and not be taken for granted. There have probably been countless decisions made which could have been made better i f the decision maker had been more aware of the desired objectives. Furthermore when the members of an organization are asked to l i s t the objectives of the organi-zation, there may be many different ones lis t e d , which are 20 often i n c o n f l i c t with one another, This can e a s i l y r e s u l t i n wasted e f f o r t and money i n pursuing objectives which are incompatable to each other. F i n a l l y committees often waste countless hours attempting to make a decision on some item that has no r e l a t i o n to the actual objectives of the organi-zation. This project looks at the objectives of the Depart-ment of Paediatrics i n an attempt to i d e n t i f y them, as well as c l a r i f y i n g them and t r y i n g to put them into an order whicn i s b e n e f i c i a l to the department. Many of the a r t i c l e s which discuss objectives, often use the term interchangeably with other terms such as goals, aims, i d e a l s , purposes, p o l i c i e s , and alt e r n a t i v e s 148). Attempts have also been made to separate the concepts of goals and objectives (41). One a r t i c l e by Perrow claims that organizations do not pursue goals only people do (33). The view of t h i s paper i s that t h i s attempt to separate goals from objectives i s a f u t i l e and often time wasting academic exercise. Tnis paper contends tnat goals and objectives can be thought of as being the same thing. This eliminates the necessity of attempting to separate them. In f a c t i n Schiebes (38) study which t r i e d to separate goals from objectives, i t was found that goals and objectives were i d e n t i c a l i n four out of nine cases, and found to be quite s i m i l a r i n the other f i v e cases. As an al t e r n a t i v e to the concept of goals being defined on some vaguely higher l e v e l than objectives, objectives 21 for the purpose of this paper can be thought of as "aims that are foregone as well as those which are sought". The wider and more general objectives may be thought of as global objectives, whereas those which relate to achieving the global ones can be perceived as specific objectives. Kor instance in the U.B.C. Department of Paediatrics, quality of care i s a global objective whereas the objectives of improving the quality of care through chart reviews, and constant monitoring  of patient care can be thought of as the more specific objec-tives which contribute to the global one. Furthermore many of the respondents i n the study were of the opinion that this was a straight forward method for determining the objectives of the department. The next area of concern i s the use of questionnaires and interviews as instruments for data collec-tion. QUESTIONNAIRE AND INTERVIEWS This project relied heavily on the use of interviews and questionnaires to obtain the necessary information. Since i t i s beyond the scope of this project to discuss i n detail the advantages and disadvantages of questionnaire and inter-view formats, however i t was f e l t by the author that i t was necessary to be aware of them. An excellent presentation of their strengths and weaknesses i s presented by Cicourel (6). Finally the wide-spread use of survey forms and interviewing to obtain data which cannot be obtained i n the 22 sense of the laboratory experiments done i n the hard sciences indicates that these two methods of obtaining information are the best and i n many cases the only ones i n the present "state of the art" for obtaining this type of data. 23 CHAPTER III METHODOLOGY The use of the Delphi method to identify objectives, i s a relatively new technique. As stated earlier, Delphi has been primarily used in technological forecasting. However several attempts have been made recently to use Delphi as a method of identifying objectives, by Skutsch, Judd, Cyphert, and J i l l s o n (41, 21, 7, 20). This project takes this method one step further by attempting not only to identify objectives within an academic medical department, but also to identify the a c t i v i t i e s , which are perceived as being necessary to attain the objectives, as well as the amount of time spent on each activity both actual and perceived. The previous section of this paper has already dis-cussed the strengths and weaknesses of both methods, there-fore i t i s not necessary to repeat them i n this section. However i t i s appropriate at this time to discuss the assump-tions, limitations and drawbacks of this study. Assumptionst 1) Full-time faculty members could provide reasonably accurate estimates of their time spent i n carrying out their a c t i v i t i e s . 2) Full-time faculty members were considered experts, on the grounds that they were highly educated and experienced specialists, as well as being people who had relevant inputs. 3) Pull-time faculty knew and understood the concept of objectives, this was attested to by the fact that none of the respondents had any significant trouble i n their percep-tions of the objectives of the department. 4) Full-time members were able to evaluate the importance of objectives by using the seale provided. 5) Full-time faculty members were able to indicate which act i v i t i e s were most important for achieving certain objectives. 6) The respondents understood the questions and were able to answer them i n a uniform manner. Limitationsi 1) The study took into account only those objectives which were provided by full-time faculty members, the view of part-time faculty members, support staff, and patients were not taken into consideration due to time and f i s c a l constraints. 2) The views of other department members within the Faculty of Medicine and the members of various administrations i n which the Department of Paediatrics i s associated were not taken into consideration due to time and f i s c a l constraints. Drawbacks; 1) No researcher can ever guarantee accuracy when dealing with subjective data. However when certain precautions are taken i n the gathering of the data, i t i s f e l t that -he estimates obtained from the activity analysis are more accu-rate than otherwise could be obtained. 2) Although i t i s d i f f i c u l t to replicate a Delphi study, to determine whether or not the respondents would answer the question i n the same way, one such study was done by Judd (21). The results appear to be encouraging, i n that the consensus was only one number point away i n either direction from the previous consensus. 3) Delphi„,does not provide scientific truths, i n the sense of the hard sciences. However Delphi was not meant to do this. It i s a heuristic method. 4) A l l techniques which rely on human judgement and opinion (rather than on more r i g i d c r i t e r i a depend heavily on the r e l i a b i l i t y , imagination, committment and technical ade-quacy of the respondents). Finally the use of Delphi i n conjunction with activity analysis i s a useful exercise despite the drawbacks of relying on human judgement and opinion however well informed. Project methodology: This project was initiated i n the summer of 1976 at the request of Dr. S. Israels and Mr. P. M. Nerland. The original concept of the study was to complete an activity analysis of the U.B.C. Department of Paediatrics and compare these a c t i v i t i e s to the various funding sources of the f u l l -time faculty members of the department. It was only at a later date on the suggestion of Dr. Larry Moore, that using activity analysis i n conjunction with the Delphi method, was considered as a possibly useful technique for analyzing the department i n the context of the relationships between i t s objectives and a c t i v i t i e s . 26 The i n i t i a l activity analysis study began i n May, 1976. A review of the literature concerning activity analysis was undertaken, then formulation of the questionnaire began. The questionnaire was developed over a period of one and one half months. The two major concerns of the questionnaire were to identify and define ac t i v i t i e s of full-time faculty members, and address the joint cost allocation problem directly. The f i r s t problem was resolved by using definitions and examples from the Institute of Medicine's study, on the costs of Education of Health Professionals (31). However certain modi-fications were necessary to meet the requirements of the U.B.C. Department of Paediatrics. The second problem was more complex. The joint allocation issue involves the separation of simultaneous a c t i v i t i e s being carried out at the same time. For instance i n the activity Medical Care of Patients, how much time i s spent on teaching i f students are present? The two step method was used (18, 42) by asking respondents to a l l o -cate their time spent on Medical Care of Patients to Medical Care with students present, and without students present. It was assumed that when no students were present only pure medical care was being provided. When students were present 45$ of Medical Care of Patients was allocated to teaching a c t i v i t i e s . This was i n accordance with the finding of Institute of Medicine Study (3D for Medical Care of Patients i n a paedia-t r i c setting. In the activity of Research i t was not necessary to allocate time to research and teaching since the respondents 27 agreed that when students were present, they were graduate students, and no teaching was being carried out, instead the research had the purpose of increasing present knowledge i n the area under investigation. Therefore the entire research acti v i t y was allocated to research. After the questionnaire had been formulated i t was pretested on three members of the Department of Paediatrics who agreed to complete the form. After completion of the form by the respondents, an analysis was done to determine whether or not the questionnaire was able to derive the information that was sought. After a slight modification which took into consideration the suggestions of the respondents, a f i n a l draft was completed. This questionnaire (see Appendix 1) was then mailed to each full-time faculty with a covering letter signed by Mr. P. M. Nerland explaining the purpose of the study and i n -dicating i t s support by Dr. Israels, chairman of the Department of Paediatrics. At this point i t i s important to realize that increased acceptance can be achieved from the respondents i f they perceive that senior management within the organization i s supporting the project. Activity Analysis Sample Size; The sample was not random but selective, including only full-time faculty members i n the U.B.C. Department of Paediatrics. In total there were 30 members composed of physicians specializing i n various areas of paediatrics, 28 audiology and speech scientists, a biochemist and a medical sociologist. Responses were obtained from 25 members within the department. The five members who did not respond were either on vacation or sabbatical at the time of the study. The majority of the respondents found the form f a i r l y easy to answer. This may have been fa c i l i t a t e d by the fact that interviews were conducted with each of respondents to avoid any misinterpretations. Each interview lasted approxi-mately one hour although some were shorter wherein the respondent had completed the form earlier, but wanted to dis-cuss the implications of the study. Each respondent was reassured that his or her replies would remain confidential and that their reports would not be released i n any identifiable form to their colleagues, super-visors, or department chairman. Several respondents expressed concern over the question of private office practice i n the Medical Care of Patients category. This problem was brought about by the assumption of the researcher that private office practice, on a fee for service basis would be done without students being present. Although this was the case i n most instances, two respondents mentioned that they have had stu-dents present during private office practice. Therefore to eliminate this problem i n the future i t i s suggested that the category of private practice be divided into private practice with students present, and private practice without students present. 29 The findings of this study (25) are available from the chairman of the U.B.C. Department of Paediatrics. The findings most applicable to this study are listed on page 4 6 . The Activity Analysis Report was then presented to Dr. S. Israels, and preliminary discussions were begun to con-tinue the study with the use of Delphi to identify the objectives of the Department of Paediatrics. In January 1977» a meeting was held with Dr. Israels, the members of my thesis committee and myself. The discussion centered around the applicability of the Delphi technique to identifying departmental objectives and i t s use i n conjunction with activity analysis. The meeting was adjourned, by Dr. Israels with a request for a written proposal concerning the project. This proposal was then drawn up (see Appendix II) and delivered to Dr. Israels. A faculty meeting was then scheduled by Dr. Israels for March 12, 1977• There were approximately 20 members of the Department of Paediatrics at this meeting. The proposal was presented, and then questions were invited from the audience. These questions were either answered by myself or Dr. Larry Moore (thesis chairman) and Mr. Paul Nerland (thesis advisor). The questions asked concerned the technique of Delphi what was going to be done with the data and whether or not the question-naire had been formulated or pre-tested. 30 The audience was informed that the questionnaire had been designed and pre-tested on two members of the Department of Paediatrics. Although the identities of these two people were not revealed to the audience, one of them volunteered that he had been one of the respondents. This person i s not only a senior professor i n the the department but also one of i t s more vocal and outspoken members. He mentioned that he thought the project was a good one and he supported i t . Shortly after this, the meeting was adjourned and Dr. Israels gave his consent to proceed with the study. Within a week of this meeting the questionnaires and covering letters (see Appendix III) for Round 1 of the Delphi sequence were mailed to each full-time member. The covering letter requested that an interview be set up between the researcher and each respondent, and that i f this was not possible, the respondent was requested to return the completed form i n the enclosed self-addressed envelope. The purpose of the interviews were twofold: 1) to c l a r i f y any misinterpretations which the respondent may have had 2) to increase the response rate (only 2 respondents mailed back the questionnaire i n Round 1). An arbitrary cutoff date of two weeks was set for each round i n order to minimize turnaround time between rounds to maintain respondent's interest. Furthermore i t was f e l t that two weeks would allow sufficient time to interview at least 13 of the respondents. Delphi research indicates that this i s the minimum 31 number necessary to achieve a wide array of answers. Larger groups may be better but not much better as the Law of Diminishing Returns becomes a factor i n groups larger than this (28). Sample Size. Delphi Round I t The sample was not random but selective, including only full-time members of the U.B.C. Department of Paediatrics. The department i s comprised of 30 full-time faculty members. Two members were on sabbatical at the time of Round 1 and one member i s on my thesis committee. He f e l t that since he had been involved i n the project as an advisor his responses might bias the findings. Therefore a total of 27 respondents were obtained, however one of these was discarded since "no opinion" was written across the survey form, resulting i n a 78$ response rate. Findings Delphi Round I t 1) One person completed the form and returned i t without an interview. 2) Two persons completed the form after discussing i t over the phone (each c a l l lasted approximately 20 minutes). 3) Eighteen persons completed the form during an interview with the researcher. During the interviews the questionnaire was used as a guide to help the respondent answer the question. In most cases the interviewer copied down the responses. In an attempt to ensure that the interviewer's interpretation of the respondent's answers were accurate, those responses were read back to the respondents to ensure that no misinterpretation had 32 occured. The interview times had a range of from 20 minutes to 60 minutes, the median time was 45 minutes. The 21 respondents i n Round 1 generated a l i s t of 110 objectives, that were perceived as being relevant to the entire Department of Paediatrics. Through editing of objec-tives which were exact duplicates or very smiliar to each other the l i s t was collapsed to 85 objectives. Any further collapsing would have caused the l i s t to lose some of i t s "richness" provided by individual responses. Many of the objectives l i s t e d included two separate entities i n one. For instance the teaching of medical students and nurses. In cases such as this the objectives were edited to: 1) the teaching of undergraduate medical students 2) the teaching of graduate medical students 3) the teaching of nurses. In the future i t i s suggested that respondents be given exam-ples of how to l i s t objectives. This w i l l make i t easier and w i l l save time i n the editing process. Upon further analysis of the 85 objectives i t became apparent that they could be categorized into six groups. The objectives were then a r b i t r a r i l y categorized by the researcher into the following groupings, which related to 1) Quality of Care 2) Teaching 3) Research 4) Levels of Care 33 5) The Community 6) The Department of Paediatric"s internal functions. There was a two week turn around period between the cut off date of Round 1 and the commencement of Round 2. This period was used to edit and collate the responses to Round 1 and prepare the questionnaire for Round 2 (see Appendix IV). Sample Size Delphi Round 2: The sample size was identical to that of Round 1, selective and non random. The response rate was 23 members or 85#. Findings Delphi Round 2i 1) Four respondents returned the questionnaire form without an interview 2) One form was discarded because of incomplete data 3) Nineteen respondents completed the form during an inter-view with the researcher. The range of time of these inter-views was from 35 to 75 minutes. The mean time was 45 minutes. 4) The majority of respondents found the questionnaire re-latively easy to complete, and where problems of interpretation did occur, these were c l a r i f i e d by the researcher. 5) A total of 20 written comments were made by the respon-dents, about specific objectives. Collation and Editing of Delphi Round 2 Responses; 1) Respondents' ratings for each objective were translated into group scores by summing the scale values and dividing the 34 total by the number of ratings. It should be noted that this method treats nominal scales as interval data. This total was then put on the round 3 questionnaire, along with the absolute range, and the respondents' previous rating. The median or interquantile range was not used, since there was consensus on 41 of the 84 total objectives. 2) Respondents replies to the primary acti v i t y necessary for achieving the objective were translated into the "mode" activity and transferred to the round 3 questionnaire, along with the respondents previous rating. 3) A third category was added to round 3 which requested respondents to allocate percentage distribution of time to each objective. The methodology for doing this was by f i r s t having the respondent allocate time to the global objectives such as research, and then allocating proportions of this time to the specific objectives within research. 4) The questionnaire (see Appendix V) was then pretested on two members of the department. They found the survey form to be relatively easy to complete, however they mentioned that the allocation of time to specific objectives was a laborious process. 5) Round 3 was then sent out on May 18, 19??, and inter-views were arranged with the respondents over the following two week period. Sample Size Delphi Round 3» The sample size was identical to that of rounds 1 and 2. Twenty responses were obtained, one of these was dis-carded because of incomplete data. Therefore 19 respondents 35 completed round 3 or 70%. Findings Round 3t 1) Four respondents returned the questionnaire form by mail 2) One form was discarded because of incomplete data 3) Sixteen questionnaire forms were completed during an interview with the respondent. The range of time of these interviews was 30 to 60 minutes. 4) A l l the respondents were able to allocate percent of time to the global objective, but only 13 were able to give a complete breakdown of time allotments to each of the specific objectives. However according to Milholland et a l . (28) this is a large enough group of respondents to provide a wide degree and spread a diverse answers. 36 CHAPTER IV RESULTS The actual process of conducting a Delphi study i s very time consuming on the part of the researcher. Figure 1 presents a chart of the various ac t i v i t i e s which are necessary to ensure a successful study. It i s crucial for the success of a Delphi study that top management within the organization being studied give their support for i t . In this way the other members of the organization being studied may respond more favourably i f the perceived that senior management i s supportive of the study. It i s also appropriate to have top management be active participants in the study as well. A cautionary note should be mentioned here; as more respondents participate i n the study, i t also becomes more d i f f i c u l t to administer. The logistics, administrative problems and work asso-ciated with a Delphi study have a direct relationship with the size of the respondent group. This includes the editing of responses, the preparation and mailing of subsequent round questionnaires, the scheduling of appointments and travelling time to interview respondents, and the maintenance of data f i l e s on each respondent. It i s suggested that for any one researcher conducting a Delphi study, that a group of 30 or less respondents i s most practical. Chart of Activities for Delphi Study: 37 10 week time period Complete faculty activity report r Initiate Delphi study by obtaining support from top management of the organization being studied I Pre test Round 1 Delphi questionnaire 3= Present proposal to the organization with top manage-ment i n attendance to help gain acceptance Modify Round 1 questionnaire i f necessary Send out Round 1 questionnaires and schedule interviews with respondents Collect, edit and collate a l l Round 1 responses Collect, edit and collate a l l Round 2 responses r Prepare and pre-test Delphi Round 3 questionnaire Send out Round 3 questionnaire and schedule interviews with respondents Collect, collate and analyze a l l Round 3 responses Prepare f i n a l report Prepare and pre-test Delphi Round 2 questionnaire Modify Round 2 questionnaire i f necessary Send out Round 2 questionnaires and schedule interviews with respondents Modify Round 3 questionnaire i f necessary FIGURE 1 38 The use of interviews with the respondents as they completed the questionnaire form was done to ensure that there would be no misinterpretation of the survey instrument, as well as to f a c i l i t a t e a higher response rate. It should be mentioned that i f the interviews had not been conducted in this particular study, the response rate on each of the 3 rounds would have been less than 15 percent. Table 1 presents the different categories of res-pondents, which includes professors, associate professors and assistant professors, i n the U.B.C. Department of Paediatrics. There are only four female physicians i n the department. Two have the rank of associate professor and two have the rank of assistant professor. Unfortunately only one of them p a r t i c i -pated i n the study. The other three had prior committments, or outrightly refused to be involved i n the study. Two other members of the department also refused to participate i n the study, on the basis that they thought the study was irrelevant, and they could not see the value of i t . Figure 2 presents a graph of consensus. In Round 1 there was no consensus on any of the objectives. Round 2 provided the respondents with their f i r s t opportunity to evaluate the objectives, and resulted i n a consensus on 41 of the objectives. The Round 3 results indicated that there was a consensus on 44 of the objectives, an increase of 3 from the previous round. Round 3 also brought to light a point that has not been reported previously i n the Delphi literature. TABLE 1 Participation and Returns by Categories of Respondents; Subpanel Invited to participate Agreed to participate Withdrew a* start of Round 1 Delphi panel Completed Round 1 Completed Round 2 Completed Round 3 F u l l Professors 7 7 0 7 7 6 5 Associate Professors 11 11 2(3) 9 7 7 7 Assistant Professors n ( 2 ) 9 0 9 7 9 7 Research Associate !<!> 0 0 0 0 0 0 TOTAL 30 27 2 25 21 22 19 (1) On Sabattical (2) One person was on my thesis committee (3) These people indicated i n i t i a l l y that they would par t i -cipate, but once the study got under way they declined on the basis that they thought the study was irrelevant to them. One suggested that he would participate i f he was renumerated for doing so. Their division head was much more receptive to the study and participated in a l l three rounds. 40 This concerned the fact that two objectives that had consensus i n Round 2 were reincluded i n Round 3 as not having consensus. This would seem to imply that Delphi has the effect of six achieving non-consensus as well as consensus. Figure 3 presents a comparison of consensus of "primary a c t i v i t i e s " between Delphi Rounds 2 and 3. It i s quite clear that the participants knew which were the primary ac t i v i t i e s for achieving the objectives. This i s indicated by the fact that there was a consensus on the primary activity for 62 objectives i n Round 2 and for 77 objectives i n Round 3. Two different methods of showing group scores were used i n Round 3. For "objectives" the group mean, absolute group range, and the respondents Round 2 evaluation were used. For "primary a c t i v i t i e s " the group mode and the respondents previous a c t i v i t y selection were used (see Appendix V). In this study the group mode was more effective for obtaining consensus than the group mean and absolute range. However i t was apparent from the interviews sessions that the respondents f e l t more strongly i n their evaluation of the importance of objectives, than as to the act i v i t i e s for achieving them. This was evidenced by the d i f f i c u l t y they had i n assigning evaluation numbers to each objective. There were only five respondents who evaluated a l l their Round objectives as being very important i n Rounds 2 and 3. The other respondents evaluated at least one of their Round 1 objectives, lower than "very important". In one instance a respondent evaluated two 41 Comparison of consensus of objectives  between Delphi Rounds 1, 2, and 3: Number of objectives 80 having consensus 60 50 40 30 20 10 0 NIL Round Round 1 n * 21 Round 2 n = 22 Round 3 n * 19 FIGURE 2 42 Comparison of consensus of primary  ac t i v i t i e s between Delphi Rounds 2 and 3: Number of primary act i v i t i e s having consensus for achieving objectives 80 70 60 50 40 30 20 10 0 Round Round 2 n * 22 Round 3 n m 19 FIGURE 3 43 of his Round 1 objectives as being "not at a l l important" i n Round 2 and 3. In Figures 4 and 5 the concept of consensus was taken one step further than i n other Delphi studies. This was based on the premise that the degree of consensus could be thought of as being either high, medium, or low, instead of being anything greater than 51 percent. Figures 4 and 5 indicate that the Delphi Round 3 questionnaire increased the degree of high consensus from Round 2 i n both "objectives" and primary a c t i v i t i e s . This would seem to indicate that the Delphi process has the a b i l i t y i n some instances not only to achieve consensus from round to round but also to increase the degree of consensus from round to round. This aspect of Delphi"could prove to be most bene-f i c i a l , i n that objectives with a high consensus should be easier to implement than those with a low consensus. Low consensus indicates that there i s probably a rather significant minority opposed to the majority viewpoint, and that the imple-mentation of an objective with a low consensus would be more d i f f i c u l t than one with a high consensus. Table 2 presents a comparison between the actual amount of time spent by the entire Department of Paediatrics on various a c t i v i t i e s , and the respondents of the Delphi study as to how much time they thought the entire department should be spending on the various a c t i v i t i e s . 4 4 Comparison of degree of consensus of  objectives between Delphi Rounds 2 and 3 t Number of objectives with consen-sus 8 0 70 60 50 4 0 30 20 10 0 Round 2 • Round 3 Low Moderate High Degree . of consensus Degree of consensus High - 8 3 . 8 - 100$ Moderate - 6 7 . 4 - 8 3 . 7 $ Low - 51.0 - 6 7 . 3 $ FIGURE 4 5^ Comparison of degree of consensus of primary a c t i v i t i e s between Delphi Rounds 2 and 3» Number of primary a c t i -v i t i e s having consensus for achieving objectives 8 0 70 60 50 4 0 30 20 10 Round 2 • Round 3 Degree of consensus Degree of consensus High - 83.8 - 100$ Moderate - 67.4 - 83.7$ Low - 51.0 - 67.3$ FIGURE 5 46 TABLE 2 Comparison of Delphi Round 3 and activity  analysis Summer 1976: Percentage Distribution Department of Paediatrics ac t i v i t i e s Delphi Round 3 % distribution Activity analysis % distribution Teaching 33 25 Medical Care of Patients 20 26 Research 26 19 Administration 15 19 Other 6 11 TOTAL 100$ 100$ Delphi n 88 13 Activity Analysis n s 25 47 The method of arriving at these percentages was done by adding each individual's time together for each activity, and then adding them together to give a total department time for a l l a c t i v i t i e s which was combined into the following formula: total of a l l individuals time i n each activity x 100 * % of time total of a l l individuals time i n a l l a c t i v i t y for each departmental activity The Delphi findings indicate that i f the objectives are to be met departmental a c t i v i t i e s w i l l need to be restructured. More time must be directed towards teaching and research, and less time on the medical care of patient's without students present, administrative and 'other' a c t i v i t i e s . One of the largest components of the 'other' a c t i v i t i e s includes community participation. Although i t i s important to be active i n the community, i t was the general feeling of the respondents that much of this activity was f r u i t l e s s . For instance one respondent made the comment that "We must make an effort to show interest i n the community, however they never l i s t e n to us, and therefore not too much time should be spent i n these a c t i v i t i e s " . Tables 3, 4 and 5 indicate how the objectives were evaluated. The ratings of each of the respondents were trans-lated into group scores by summing the scale values and dividing the sum by the number of ratings. It should be noted that this procedure treats nominal scales as interval data (20). Thirty-two objectives which had consensus had group scores of less 48 TABLE 3 Degree of importance of objectives with consensus: Group Score (1) Importance No. of objectives with consensus Less than 1.80 Equal to or greater than 1.80 but less than 2.60 Equal to or, greater than 2.60 but less than 3.40 Greater than 3.40 but less than or equal to 4.20 Greater than 4.20 Very important Important Somewhat important Unimportant Not at a l l important 32 12 (1) Respondents ratings were translated into group score by summing the scale values and dividing by the number of ratings. It should be noted that this pro-cedure treats nominal scales as interval data (20). TABLE 4 Objectives evaluated as being "Very Important" i n decreasing  order of importance: Objectives Group Importance Evaluation To instruct medical students i n the provision of safe paediatric care and know their limitations 1.04 Improve the quality of care by setting an example of doing i t ourselves 1.09 To instruct medical students i n the basic fundamentals of paediatrics 1.13 Research i n child disease prevention 1.13 To provide strong leadership within the Faculty of Medicine, the University and the Community i n a l l areas relating to the development of the fetus, new-born and infants 1.18 The education of graduate medical students i n c l i n i c a l paediatrics 1.22 The education of undergraduate medical students i n c l i n i c a l paediatrics 1.2? Research which relates directly to improving patient care 1.31 The education of graduate medical students i n academic paediatrics 1.31 The delivery of tertiary care 1.33 To attract talented attending staff (support financially i f possible) 1.36 Act as a group of experts to meet the needs of diagnosis and treatment of conditions beyond the expertise of most physicians 1.38 13) Play a large role i n the organization of the new Children's Hospital 1.38 50 TABLE 4 Objectives evaluated as being "Very Important" i n decreasing  order of importance: Objectives Group Importance Evaluation 14) Provide f a c i l i t i e s and a stimulating environment for high quality basic and applied research related to paediatrics 1.40 1 5 ) The selection and training of specia-l i s t s and sub-specialists i n secondary and tertiary care I . 4 5 16) Improve the quality of care by review-ing the literature to find out what people are doing i n this area I . 4 5 1?) Caring for the patient as a whole 1.47 18) Research which relates directly to c l i n i c a l medicine 1.47 19) Research into the long term effects of treatment processes to children i n their later years I . 5 0 20) Maintain an objective surveillance of departmental teaching programs for strengths and weaknesses 1 . 5 ° 21) Stress preventive aspects of medicine, through the general education of the public, and i n areas of nutrition 1 . 5 ° 22) To encourage medical students to think about preventive measures such as nutrition and exercise and de-emphasize the bizarre or crises incidents I . 5 2 2 3 ) Advise governments and other bodies res-ponsible for legislative programs which affect child health and development I . 5 2 24) The delivery of secondary care 1 .52 TABLE 4 Objectives evaluated as being "Very Important" i n decreasing  order of importance: Objectives Group Importance Evaluation 25) To ensure a steady supply of the best teaching fellows 1.54 26) The total rehabilitation of children with mental, physical or emotional handicaps through comprehensive educa-tion and physical assessments of the child's needs i n order to assist the child become a self supporting well adjusted adult 1»55 2?) Provide advice to the community regar-ding areas of concern i n both sick and well children 1*57 28) Demonstrate new needs of children to the community 1*57 29) The efficient administration and use of public and voluntary funds 1.59 30) Demonstrate new methods of cure to the community 1.66 31) Closer involvement between the Depart-ment of Paediatrics and other departments (i.e. Health Services Planning) i n the delivery of health services to children 1*71 32) Each sub-specialty contributes to c l i n i c a l research I.72 5 2 TABLE 5 Objectives evaluated as being "Important" i n decreasing order  of importance: Objectives Group Importance Evaluation The development of programs related to paediatrics i n non-teaching hospi-tals and community settings ( i . e . the North) 1 . 8 1 Research i n the organization of health care delivery (particularly children's) at the regional, provin-c i a l and national level 1 . 8 l Aim at being the "best" department i n the Faculty of Medicine I . 8 5 Constant review of what i s being done i n the Department of Paediatrics 1 . 8 5 Developing methods to monitor care 1 . 9 0 Doing long term followup studies of treated people 1 . 9 0 Encourage research i n neonatal and i n -fant pharmacology 1 . 9 5 Research areas are the responsibility of the individual, however support should be provided by the Department of Paediatrics 2.04 The education of nurses and para-medical personnel i n paediatric health problems 2.04 Provide information to members of the community on a l l matters related to childhood i n the community and the country 2 . 1 9 To serve on lay boards by offering exper-tise i n child care matters 2.19 The provision of primary care on a consu-l t a t i v e basis only 2 . 5 8 than 1.80. Twelve objectives with consensus had group scores of greater than 1.80 but less than 2.60. Table 6 describes those objectives which had either a broad distribution of responses oi* exhibited polergation as to the degree of importance of the objective to the entire Department of Paediatrics. The Summary on page 58 and 59, represents a clus-tering of objectives by importance. The objectives were grouped together by the group rating and sorted by the act i v i t y necessary for achieving that objective. 5^ TABLE 6 Objectives which exhibited polarization  or a broad distribution of responses; Scale Value; Objectives Percent of Responses 1 2 3 4 5 Improve the quality of care by having adequate environment and f a c i l i t i e s 4 5 4 5 10 Improve the quality of care by having more nurses on paediatric wards 21 42 37 Improve the quality of care by having chart reviews 5 3 5 4 5 1 5 Developing a level of care which cor-responds to that which can be feasibly developed i n other areas of Br i t i s h Columbia 11 2 5 42 5 5 Evaluating the practise of medicine through the use of educational techni-ques and behavioral modification 10 28 42 10 10 The education of undergraduate medical students i n academic paediatrics 5° *H 9 The education of a l l other health care deliverers (i.e. Hospital administra-tors) about paediatric health problems 22 41 32 5 To decide what "we" i n the Department of Paediatrics are teaching under-graduate medical students for 5° 2 3 2 7 To decide i f the Department of Paediatrics should be teaching family practitioners 2 7 36 2 7 10 To provide continuing medical educa-tion for practising physicians outside the University 45 41 14 To put the instructional emphasis on (general paediatrics) with third-year undergraduate medical students 18 4 5 2 2 10 5 55 TABLE 6 Objectives which exhibited polarization  or a broad distribution of responses: Scale Value; Objectives Percent of Responses 1 2 3 4 5 The introduction of sub-specialty instruction to medical students i n fourth year 1:0,' 27 36 22 5 The u t i l i z a t i o n of practising physi-cians to instruct undergraduate medical students 43 38 19 Emphasize many more small group dis-cussions (5 or 6) on specific topics instead of grand rounds 5 24 28 24 19 Research i n child development 46 36 18 Research on normal children as com-pared to abnormal children 27 41 18 5 9 Physiological research on normal children 41 32 22 5 Biochemical research on normal children 36 32 27 5 Research of an interdisciplinary nature, the involvement of non-medical disciplines i n joint research projects for the improvement of child health 41 32 27 Research which looks at strategies of disease management i n terms of cost effectiveness 18 36 32 14 Research into patterns of children's health 23 45 27 5 Research i n contemporary and provin-c i a l health problems relating to children 36 46 9 9 Each sub-specialty contributes to basic research 32 45 18 5 56 TABLE 6 Objectives which exhibited polarization  or a broad distribution of responsesT" Objectives Scale Value; Percent of Responses 1 2 3 4 5 Basic research areas determined by the department 48 24 28 Find and stimulate the application of methods by which people w i l l become more concerned about their personal health 19 36 36 9 Research into the role of environmen-t a l factors, on the development of disease states (both psycho social and organic) 5 0 4 5 5 Improve and strengthen ambulatory primary care through leadership i n this area 48 3 3 19 The delivery of primary care 24 48 19 9 The education of members of the commu-nity in matters of child health and development 4 3 4 ? 5 5 Provide advice to various agencies i n terms of f a c i l i t y planning for children 29 4 7 24 The Department of Paediatrics should act as a resource centre for i n d i v i -duals and groups involved with children 4 3 4 7 10 To gain more autonomy for the Depart-ment of Paediatrics i n i t s relation-ships with the Greater Vancouver Regional Hospital District and the Vancouver General Hospital 2 5 3 5 3 0 10 To embark on new programs only when individuals have expertise i n the new program's area 13 41 2 2 10 5 5? TABLE 6 Objectives which exhibited polarization  or a broad distribution of responses: Scale Value; Objectives Percent of Responses 1 2 3 4 5 The efficient administration and use of manpower 4 5 5 0 5 The development of an i n t e r d i s c i p l i -nary approach to a l l children whether sick or well 3 3 24 3 8 5 The propagation of prophylactic medicine 5 0 3 6 5 9 The development of comparative studies between the U.B.C. Department of Paediatrics and other paediatric departments i n Canada and i n other countries 14 28 48 10 Establish good relationships with other University departments which are involved with children 41 5 0 9 Strive for c l i n i c a l excellence except for some few individuals the overall research effort i s half hearted and i s not always well advised 3 5 18 18 18 11 58 SUMMARY OF OBJECTIVES To improve the q u a l i t y of p a e d i a t r i c medical care, by s e t t i n g an example of p r o v i d i n g an exemplary l e v e l of care t o the whole p a t i e n t ; the constant review of new developments i n t h i s area; the teaching of nurses and para-medical personnel about p a e d i a t r i c h e a l t h problems; the development of new methods to monitor p a t i e n t care, and by p l a y i n g a lar g e r o l e i n the o r g a n i z a t i o n of the new C h i l d r e n ' s H o s p i t a l . To i n s t r u c t undergraduate and graduate medical s t u -dents i n preventive medicine as w e l l as the b a s i c fundamentals of p a e d i a t r i c s , and provide them with p r a c t i c a l experience i n order t h a t they can know t h e i r own l i m i t a t i o n s , i n p r a c t i c i n g safe p a e d i a t r i c care; and to ensure t h i s through c o n t i n u i n g o b j e c t i v e s u r v e i l l a n c e of departmental teaching programs f o r strengths and weaknesses. To provide f a c i l i t i e s and a s t i m u l a t i n g environment i n which each s u b - s p e c i a l t y can c a r r y out high q u a l i t y b a s i c and c l i n i c a l r esearch, i n c h i l d disease p r e v e n t i o n , neonatal and i n f a n t pharmacology, the long term e f f e c t s of treatment processes of c h i l d r e n i n t h e i r l a t e r y e a r s , as w e l l as p r o v i -ding encouragement and support where p o s s i b l e f o r i n d i v i d u a l research p r o j e c t s . To provide i n f o r m a t i o n and e x p e r t i s e to a l l members of the community, the government and other agencies r e s p o n s i b l e f o r programs which a f f e c t c h i l d h e a l t h and development, by se r v i n g on l a y boards; p r o v i d i n g advice i n areas of concern of both sick and well children; the stressing of preventive medicine such as nutrition and exercise; and by demonstrating new needs of children, and new methods of care. To develop closer links between the Department of Paediatrics and other University departments such as Health Services Planning, i n research projects i n the areas of the organization of health care delivery (particularly children's) at the regional, provincial and national level, and the deve-lopment and evaluation of programs related to paediatrics i n non teaching hospitals and community settings (i.e. the North). To act as a group of experts at the tertiary, secondary and primary levels of care to meet the needs of diagnosis and treatment of conditions which are beyond the expertise of most physicians to f a c i l i t a t e the total rehabili-tation of children with mental, physical or emotional handicaps, through comprehensive education and physical assess-ments of the child's needs, i n order to assist the child, become a self supporting well adjusted adult. To aim at being the "premier" department within the Faculty of Medicine, through the attraction of talented attending staff, the selection of and training of specialists and sub-specialists in secondary and tertiary care, i n order to ensure a continued supply of high quality teaching fellows, and the efficient administration of public and voluntary funds through constant review of the a c t i v i t i e s within the department. To provide strong leadership within the Faculty of Medicine, the University, and the community i n a l l areas rela-ting to the fetus, the newborn and infant. 61 CHAPTER V CONCLUSIONS AND RECOMMENDATIONS Several major generalizations can be made about Delphi from the experience gained from i t s use. It i s most appropriate to have the Delphi admini-strator be an independent person from outside the organization. This gives the respondents reassurance that the administrator i s not favouring any particular point of view. Furthermore the Delphi administrator must assure the in d i -vidual respondents that their responses w i l l remain confiden-t i a l and not be released i n any identifiable form. There i s a considerable amount of administrative problems and work in conducting a Delphi study; the editing of responses, the preparation and mailing of subsequent round quesionnaires; the scheduling of appointments and travelling time to interview each respondent; and the maintenance of data f i l e s on each respondents evaluations. The amount of admini-stration work i s directly associated with the size of the group. It i s suggested that for any one person conducting a Delphi study, a group of no more than 30 respondents i s practical. There was very l i t t l e trouble with the breaking of the rules of the study, two minor problems related to deci-phering the handwriting, and i n two cases respondents provided two typewritten or handwritten pages i n Round 1. 62 Although many of the objectives could be grouped together by generic statements, i t was f e l t that this would lose the "richness" of the individual responses. However, the 110 objectives l i s t e d i n Round 1 , were edited to 3 4 , where exact duplicates or very similar ones were stated. Many of the respondents had d i f f i c u l t y allocating time to the various departmental objectives. In fact only 13 respondents were able to do this, which brings up an interes-ting point. Time seems to be a factor in the majority of respondent's concerns, yet many were either unable or unwilling to allocate time to various objectives. Using the allocation of time done by the 13 respondents brought about an interes-ting comparison with the activity analysis (Table 2 ) which indicates that certain a c t i v i t i e s should be decreased and others increased. The Delphi technique generated a good deal of inte-rest from many of the respondents, when they were able to compare their own ratings, with the rest of the group as well as their own objectives. Some of the comments were "I f e l t inadequate, when I saw my colleagues objectives, they appeared so articulate and well thought out compared to my own", and "You can certainly t e l l that the community medicine people have responded to this study". As of the writing of this paper, the Department of Paediatrics has no written statement of objectives. The Summary of Objectives on pages 58 and 5 9 i s an attempt to formulate a statement of objectives i n which there was consensus. The 63 grouping of these objectives was done by clustering them by "importance" and then sorting them by primary activity. Where objectives did not f i t together by these two procedures sub-jective reasoning on the part of the researcher was used. There are several limitations and drawbacks concern-ing the use of Delphi which should be made clear at this point in the study. The study took into account only those objectives which were provided by f u l l time faculty members. The views of part-time faculty members, support staff, and patients were not taken into account. Finally the views of other department members within the Faculty of Medicine and the members of various administrations i n which the Department of Paediatrics i s associated with were not taken into account due to time and f i s c a l and manpower constraints. No researcher can guarantee accuracy when dealing with subjective data. It i s f e l t however that when certain precautions are taken i n the collection of data, then the estimates obtained from activity analysis are more accurate than otherwise could be obtained. It i s d i f f i c u l t to replicate a Delphi study, to determine whether the respondents would answer the questions in the same way, Judd (21) had mentioned that this was done in one study. The results appear to be encouraging, on the 64 basis that the consensus was only one number point away in either direction from the previous consensus. One should also be reminded that Delphi does not provide scientific truths i n the sense of the hard sciences, nor was i t intended to. Delphi i s a heuristic method. The Delphi technique relies on human judgement and opinion rather than more r i g i d c r i t e r i a and depends heavily on the r e l i a b i l i t y imagination, committment and technical adequacy of the respondents. The use of Delphi in conjunction with activity i s a useful exercise despite the drawbacks and limitations of relying on human judgement and opinion however well informed. With these factors i n mind the following tentative recommendations are suggested for the Department of Paediatrics. 1) Adopt the summary of objectives on pages 58 and 59 as a basis for a written statement of objectives and distribute this statement to a l l members of the department i n order that they may become aware of the departmental objectives, and can contribute i n their own capacity to the achievement of them. 2) Increase the amount of full-time faculty teaching manhours. The result of the Activity Analysis indicate that Z5fo of full-time faculty manhours are spent on teaching a c t i v i t i e s . However the results of the Delphi study (Table 8) indicate that 33$ of full-time faculty manhours should be devoted to teaching a c t i v i t i e s . 3) Increase the amount of full-time faculty research manhours. The results of the Activity Analysis indicate that 65 19$ of full-time faculty manhours are devoted to research a c t i v i t i e s . Upon closer inspection this 19$ i s made up of a small number of individuals that spend most of their time i n research. The Delphi study results (Table 2) indicate that 2 6 $ full-time faculty manhours should be spent on research a c t i v i t i e s . 4 ) Decrease where feasible the total full-time faculty manhours spent on medical care of patients without students present. The Activity Analysis indicated that 26$ of f u l l -time faculty manhours are spent on Medical Care a c t i v i t i e s . The Delphi study results (Table 2) indicate that 2 0 $ of f u l l -time faculty manhours should be allocated to medical care a c t i v i t i e s . Furthermore this decrease i n manhours can be sup-ported on the basis that on a department wide basis academic funding sources support 7 . 2 $ of service a c t i v i t i e s ( 2 5 ) • 5) Decrease where possible the amount of total full-time faculty manhours spent on administrative a c t i v i t i e s . Of course certain a c t i v i t i e s are necessary functions however i t may be-come apparent upon closer analysis that many of these a c t i -v i t i e s are really not medical or academic administrative a c t i v i t i e s , and i f this i s the case, perhaps these could be handled by a lay administrator i n the manner that the U.B.C. Department of Surgery has an administrator for Surgical Services. 66 CONCLUSION If the U.B.C. Department of Paediatrics i s to con-tinue to play a significant, dynamic and forceful role i n the areas of paediatrics, health and medical care i t must be able to define i t s objectives clearly and give direction to them. Until now the Department of Paediatrics ha sir not attempted to define i t s objectives i n any written form. Instead, i t has chosen to pursue rather vague objectives of research, teaching, and medical care of children. As a con-sequence the Department of Paediatrics has gone i n many directions at once and has never really defined i t s p r i o r i t i e s , which i s indicated by the wide variety of objectives found i n this study. This study was aimed at solving this dilemma by defining and evaluating the ac t i v i t i e s and objectives of the Department of Paediatrics by obtaining consensus of them. This study has accomplished the above mentioned dilemma by: 1) clarifying the objectives i n which there i s consensus 2) the identification of the primary a c t i v i t i e s for achieving these objectives 3) the quantification of the percent of total full-time manhours that need to be allocated to the primary ac t i v i t i e s for achieving the objective's 4) the identification of areas of disagreement about objectives. The information derived from this study should be used as a basis for the formulation of written objectives, and a written department policy. Although this study has achieved what i t was designed to do, i t by no means implies that the findings w i l l be applicable for any extended length of time. The objectives of the Department of Paediatrics should be re-evaluated every two or three years to determine i f they are being met, i f they should be changed, or whether they are s t i l l important, in the light of the continual changes and developments i n paediatric health and medical care. Areas of Further Research To further validate the findings of this study i t would be useful to approach the people not included i n the study as to what they view the objectives of the Department of Paediatrics to be. These would include support staff, patients and hospital administration. With the increased emphasis on medical administra-tion i n the health sciences, Delphi would appear to offer unlimited opportunities for determining the objectives of various departments within academic medicine., Especially i n light of the fact that much of the money from agencies pro-viding the funds for academic medicine are disbursed on an objective orientated basis. 6 8 References and Bibliography 1 . Bender, Douglas A., Alvin E., Ebright, George W., and von HaunaIter, George. "Delphic Study Examines Developments i n Medicine". Future. Vol. 1 , No. 4 , 1 9 6 9 , pp. 2 8 9 - 3 0 3 . " 2 . Braunwald, Eugene. "Future Shock i n Academic Medicine". The New England Journal of Medicine. Vol. 2 8 6 , No. 1 9 , May 1 1 , 1 9 7 2 , pp. 1931-1035• " 3 . Campbell, Robert M., and Hitchin, David. "The Delphi Technique: Implementation i n the Corporate Environment." Management Services. Vol. 5 , (Nov-Dec 1968) pp. 37-42. 4 . Campbell, T. J. Program Cost Allocation in Seven Medical Centres: A Pilot Study. Association of American Medical Colleges, Washington, D.D., 1968. 5 . Carroll, A. J. A Study of Medical College Costs. Association of American Colleges, Evenston, I l l i n o i s , 1 9 5 8 . 6 . Cicourel, A. V. Method and Measurement i n Sociology. The Free Press of Glencoe, 1964, pp. 7 3 - I O 5 . 7 . Cyphert, Frederick R., and Gant, Walter L. "The Delphi Technique: A Tool for Collecting Opinions i n Teacher Education." The Journal of Teacher Education. Vol. 2 1 , No. 3 , ( F a l l 1 9 7 0 ) , pp. 4 1 7 - 4 2 5 . 8 . Dalkey, Norman C. "Delphi." An Introduction to Technological Forecasting, ed. Joseph P. Martino, Gorden and Breach Science Publishers, New York, 1 9 7 2 , pp. 2 5 - 3 0 . 9 . , and Helmer, Olaf. "An Experimental Application of the Delphi Method to the Use of Experts. ' Management  Science. Vol. 9 , No. 3 , (April 1963), pp. 4 5 8 - 4 6 7 . 1 0 . , Rouke, Daniel L., Lewis, Ralph, and Snyder, David. Studies i n the Quality of Life. Delphi and  Decision Making. Lexington Books, Massachusetts, 1 9 7 2 . 1 1 . Enzer, Selwyn. "Delphi and Cross Impact Techniques: An Effective Combination for Systematic Future Analysis." Proceedings of the International Future Research Conference. Kyoto, Japan, 197°» PP. 18 -37 . 1 2 . Etzioni, Amitai. Modern Organization. Prentice Hall, New Jersey, 1 9 6 4 , pp. 1 - 9 . 1 3 . Gewald, K. "The Delphi Method as an Instrument of Techno-logical Forecasting - Practical Experience." Technological Forecasting i n Practice, ed. Hans Blohm and Karl Steinbuck, Lexington Books, Massachusetts, 1 9 7 3 , pp. 13-18. 69 14. Gordon, T. J., and Ament, R. H. Forecast of Some Techno-logical and Scientific Developments and Their  Societal Consequences. The Institute for the Future, •Middletown, Conneticut, September, 1 9 6 9 . 15* , "New Approaches to Delphi." Technological Forecasting for Industry and Government. Methods  and Applications, ed. James R. Bright, Prentice Hall, Inc., 1960, pp. 134-143. 1 6 . Granger, C. H. "The Hierarchy of Objectives." Harvard Business Review. Vol. 42, (May-June 1964), pp. 63-74. 1 7 . Helmer, 0 . "Analysis of the Future: The Delphi Method." Technological Forecasting for Industry and Government, Methods and Applications, ed. James R. Bright, Prentice Hall, Inc., 1968, pp. 1 1 6 - 1 3 3 . 18. Hilles, W. C. "Program Cost Allocation and the Utilization of Faculty Activity Involvement." Journal of Medical  Education. Vol. 48, 1 9 7 3 , pp. 8 0 5 - o l J i 19. Ingelfinger, F. J. "Medical Delphination." The New England Journal of Medicine. Vol. 292, No. 3 , (January 16, 1 9 7 5 ) , PP. 1 5 8 - 1 5 9 . 2 0 . J i l l s o n , I. A. "The National Drug-Abuse Policy Delphi: Progress Report and Findings to Date." The Delphi  Method Techniques and Applications. Harold A. Lmstone and Murray Turoff eds., Addison-Wesley Publishing Company, Inc., 1975# PP» 124-159. 2 1 . Judd, R. C. "The Use of Delphi i n Higher Education." Technological Forecasting and Social Change. Vol. 4, 1 9 7 3 , pp. 1 7 3 : - . 2 2 . Kumarin, K. M., Morin, R., and Rowe, M. "Consensus Taking in a Delphi Study." Hospital Administration i n Canada. October, 1 9 7 6 , pp. 7 0 - 7 2 . 23. Lanford, H. W. Technological Forecasting Methodologies. A Synthesis. American Management Association, 1 9 7 2 , pp. 2 0 X K > . 24. Linstone, H. A., and Turoff, M., ed. The Delphi Method. Techniques and Applications. Addison-Wesley Publishing Company, Inc., Reading, Massachusetts, 1 9 7 5 » 2 5 . Loughlin, K. G. "Activity Analysis U.B.C. Department of Paediatrics." The University of British Columbia, 1 9 7 6 . 2 6 . Mandanis, G. P. "The Future of the Delphi Technique." Technological Forecasting, ed. R. V. Arnfield, Edinburgh, University Press, 1969, pp. 1 5 9 - 1 6 9 . 7 0 2 7 . Martino, J. P. Technological Forecasting for Decision Making. American Elsevier Publishing Company, Inc., New York, 1972, pp. 18-63. 2 8 . Milholland, A. V., Wheeler, S. G., and Heieck, J. J. "Medical Assessment by a Delphi Group Opinion Technic." The New England Journal of Medicine. Vol. 288, No. 24, (June 14, 1973), pp. 1 2 7 2 - 1 2 7 5 . 29. Milkovich, A. V., Annoni, A. J., and Mahoney, T. A. "The Use of the Delphi Procedures i n Manpower Forecasting. Management Science. Vol. 1 9 , No. 4 , Part 1 , (December 1972) pp. 381-388. 3 0 . Morgenstern, 0 . , Knorr, K., and Heis, K. P. Long Term Projections of Power; P o l i t i c a l . Economic and Military  Forecasting,. Ballmger Publishing Co., Cambridge, Massachusetts, 1 9 7 3 , pp. 15-26. 3 1 . National Academy of Sciences, Institute of Medicine Report of a Study. Costs of Education i n the Health Care  Professions i n Three Parts. Washington, D.C, 1974. 3 2 . Organization for Economic Cooperation and Development. Technological Forecasting i n Perspective. Paris, 1 9 6 ? , pp. 137-140. 3 3 . Perrow, C Organizational Analysis;* A Sociological View. Wadsworth Publishing Co., California, 1970• pp. 1 3 3 -1 ? 4 . 3 4 . P i l l , J. "The Delphi Method; Substance, Context, A Critique and Annotated Bibliography." Socio-Economic Planning  Sciences. Vol. 5 , 19?1, pp. 5 7 - 7 1 . 3 5 . Rutherford, G. S., Schofer, J. L., Wachs, M., and Skutch, M. "Goal Formulation for Socio-Technical Systems." Journal of the Urban Planning and Development  Division, Proceedings of the American Society of  C i v i l Engineers. Vol. 9 9 . No. U.P. 2 , (September 1 9 7 3 ) , pp. 1 5 7 - 1 6 9 . 36. Sackman, H. Delphi Critique. Expert Opinion. Forecasting and Group Process. Lexington Books, Lexington, Massachusetts, 1 9 7 5 -3 ? . Salancik, J. R., Wenger, W. "The Construction of Delphi Event Statements." Technological Forecasting and Social Change. Vol. 1 , 1 9 7 1 , pp. 6 5 - 7 3 . 3 8 . Schiebe, M., Skutsch, M., and Schofer, J. "Experiments i n Delphi Methodology." The Delphi Method. Techniques  and Applications. Harold A. Linstone and Murray Turoff, ed., Addison-Wesley Publishing Co., Inc., 1 9 7 5 , PP. 124-159. 71 39. Simon, H. A. "On the Concept of Organizational Goal." Administrative Science Quarterly. Vol. 9 , (June 1964), pp. 1 - 2 2 . 40. siegal, S. Non Parametric Statistics For.The Behavioral Sciences. McGraw-Hill Book Company Inc., Toronto, I553T: 41. Skutsch, M., Schofer, J. L. "Goals - Delphi for Urban Planning: Concepts i n their design." Socio-Economic  Planning Sciences. Vol. 7 , 1973, pp. 3 0 5 - 3 1 3 . 42. Stoddart, G. L. "Effort Reporting and Cost Analysis of Medical Education." Journal of Medical Education. Vol. 48, 1973 , pp. 814-823. 4 3 . "Patient Care and Education Costs i n a Multi-disciplinary Family Practice Teaching Unit." The University of British Columbia, 1 9 7 3 . 44. Teeling-Smith, G. "Medicines i n the 1990*s: Experience with a Delphi Forecast." Long Range Planning. Vol. 3 , No. 4, (June 1 9 7 D . pp. 69-7*. 4 5 . Van De Ven, A. H., Debecq, A. L. "The effectiveness of normal Delphi, and interacting decision making pro-cesses." Academy of Management Journal. Vol. 17 , No. 4, (December 19?4), pp. 605-621. 46. Wedley, W. C. "Making Delphi Decisions .... A New P a r t i c i -pative Approach." Association of Administrative Sciences. 1976, pp. 1-19. 4 7 . Wills, G., et a l . Technological Forecasting. Penguin Books, Baltimore, Maryland, 1972, pp. 188-223. 48. Young, R. C. "Goals and Goal Setting." Journal of the American Institute Planners. March 1966, pp. 7 6 - 8 5 . APPENDIX I FACULTY ACTIVITY REPORT (AND EXPLANATORY LETTER 73 THE UNIVERSITY OF BRITISH COLUMBIA To: Full-time Members of Faculty Department of Paediatrics From: P.M. Nerland Date: July 5th 1976 ; oOo Late i n 1975, Professor S. Isra e l s asked me to conduct a study of the organizational, administrative and f i n a n c i a l relationships between the University Department of Paediatrics and the various health care i n s t i t u t i o n s with which i t i s a f f i l i a t e d . Professor Israels agreed that the study could be delayed u n t i l the summer months, so that I could have a graduate student a s s i s t me.. Mr. Keith Loughlin, who has completed the f i r s t year of the M.Sc. (Health Services Planning) programme, i s the student now working with me. As a part of the study, we are t r y i n g to get an estimate of the proportion of time each faculty member devotes to various a c t i v i t i e s . A questionnaire intended to provide t h i s information i s attached. I t has been adapted from one used by the National Academy of Sciences, I n s t i t u t e of Medicine. Would you please peruse t h i s questionnaire, but leave completion of i t u n t i l Mr. Loughlin meets with you. I would be grateful i f you would a s s i s t him i n t h i s part of the study. I f you have any questions, please c a l l me at PMN:s c. Professor S. Israels Keith Loughlin FACULTY ACTIVITY REPORT NAME: ACADEMIC RANK: POSITION IN THE DEPARTMENT OF PAEDIATRICS: OTHER DEPARTMENT IF JOINT APPOINTMENT: 7 5 FACULTY ACTIVITY ANALYSIS INSTRUCTIONS You are being asked i n t h i s questionnaire to estimate how you spend your time during working hours i n the f i s c a l year from A p r i l 1, 1975 to March 31, 1976 as a faculty member of the University of B r i t i s h Columbia, Department of Paediatrics. ' . The following guidelines are intended to help you make your estimate as accurate as possible. 1) Estimate your time as i t has been spent over t h i s l a s t year. ( A p r i l 1, 1975 to March 31, 1976). Try to give a representative picture for the entire year including a l l changes i n a c t i v i t y . 2) Estimate only the time you spend on Paed i a t r i c Department business. For example i f you have a j o i n t appointment and you spend 80% of your time i n the Paediatrics Department and 20% of your time i n the Department of Surgery . . . . , the 80% at the Paediatric Department constitutes 100% of your time for t h i s report. S i m i l a r l y i f you work at the Department of Paediatrics two days per week, that constitutes 100% of your time. 3) Include any time spent on patient home v i s i t s and telephone contacts. 4) Patient education i s considered part of the medical care of patients. 5) The term 'students' refers to any health science students. I f your Paediatrics Department a c t i v i t i e s involves students from other f a c u l t i e s , please indicate who they are i n Section H of t h i s questionnaire. 6) In determining your estimate of time, disregard sources of income. 7) You are encouraged i n the space available at the end of t h i s questionnaire to make any comments or explanations about t h i s questionnaire or the topic i t deals with. 8) To help you i n your estimates of time, the various a c t i v i t i e s to consider are l i s t e d at the beginning of each section (B through F). 9) The hours to consider for your a l l o c a t i o n of time are as follows: 8:00 a.m. to 6:00 p.m., Monday through Friday. 76 10) The procedure for estimating your time i s as follows. In Section A indicate the percentage of your time spent on the f i v e items l i s t e d on the l e f t . Then for each of the f i v e items indicate what percentage of the appropriate figure i n Section A was directed toward the various categories indicated i n Sections B, C, D, E, and F. The following example should help to c l a r i f y t h i s procedure. EXAMPLE SECTION A Gross a l l o c a t i o n o f P a e d i a t r i c Department t i m e o v e r the p a s t y e a r . % o f P a e d i a t r i c Department time. 1) T e a c h i n g ( i n s t r u c t i o n , p r e p a r a t i o n , c u r r i c u l u m development; p a t i e n t s may be p r e s e n t but f o r d e m o n s t r a t i o n p u r p o s e s o n l y ) . 30% 2) M e d i c a l c a r e of p a t i e n t s ( w i t h o r w i t h o u t s t u d e n t s p r e s e n t ) . 35% 3) A d m i n i s t r a t i o n ( g e n e r a l o r h o s p i t a l ) 15% 4) R e s e a r c h ( w i t h o r w i t h o u t s t u d e n t s p r e s e n t ) 15% 5) Other. ( S e l f e d u c a t i o n , c o n f e r e n c e s , c o n v e n t i o n s , s a b b a t i c a l s , servi',e to your own p r o f e s s i o n . ) 5% TOTAL 100% Now we would l i k e you to give a more detailed a l l o c a t i o n of your time i n each of the above categories. Please f i l l i n a l l blanks and boxes. Those which are not applicable please indicate with an "X". EXAMPLE SECTION E In S e c t i o n A, Item 1 you i n d i c a t e d t h a t 30% of your p a e d i a t r i c time was spent on t e a c h i n g . 6) To t h e b e s t o f your knowledge what p e r -centage of t h i s time was spent on p r e p a r a t i o n for t e a c h i n g and c u r r i c u l u m development. /i0Z 7) How much of t h i s time was spent on i n s t r u c t i o n . | 60% TOTAL 1100% 77 ACTIVITY QUESTIONNAIRE FOR THE FACULTY OF THE PAEDIATRIC DEPARTMENT SECTION A Please estimate your gross a l l o c a t i o n of time i n the following a c t i v i t i e s as a Faculty member of the Department of Paediatrics over the past year. ( A p r i l 1, 1975 to March 31, 1976.) % of Paediatric Time 1. Teaching (curriculum development, preparation for and i n s t r u c t i o n of students; patients may be present but for demonstration purposes only. 2. Medical care of patients (with or without students present, and private o f f i c e p r a c t i c e ) . 3. Administration. (Hospital - service on ho s p i t a l or c l i n i c a l committees, general administration and in t e r n a l service to the i n s t i t u t i o n . ) 4. Research (with or without students present) 5. Other. (Self-education, sabbaticals, service to your own profession.) TOTAL 100 78 SECTION B Now we would l i k e you to give a more d e t a i l e d a l l o c a t i o n of your time i n each of the previous f i v e categories. Please f i l l i n a l l blanks and boxes. Those which are not a p p l i c a b l e i n d i c a t e with an "X". The a c t i v i t i e s , t h e i r d e f i n i t i o n s and examples are l i s t e d below. ACT! VT'EY T e a c h i n g P r e p a r a t i o n C u r r i c u l u m DEFINITION F o r m a l i n s t r u c t i o n i n - the c l a s s r o o m , l a b o r a t o r y , c l i n i c a l , o r o t h e r s e t -t i n g . P a t i e n t s may be p r e s e n t b ut t o r d e m o n s t r a t i o n p u r p o s e s o n l y . T o p i c o r i e n t e d s t u d e n t s a l w a y s p r e s e n t . P r e p a r a t i o n f o r t e a c h i n g a c t i v i t i e s i n c l u d i n g p r e p a r a t i o n f o r c l i n i c a l a c t i v i t i e s . G e n e r a l c u r r i c u l u m development and e v a l u a t i o n t e a c h i n g s u p p o r t a c t i v i t i e s p r e p a r a t i o n f o r c o u r s e s t o be t a u g h t i n f u t u r e t e r m s . EXAMPLES C o n d u c t i n g l a b s , l e c t u r e s , s e m i n a r s , c o n f e r e n c e s ( d i d a c t i c o r c l i n i c a l ) , t u t o r i a l s . A d m i n i s t r a t i o n o f ex a m i n a t i o n ; ; . T e a c h i n g c o n t i n u i n g e d u c a t i o n c o u r s e s I n f o r m a l a f t e r - c l a s s d i s c u s s i o n s w i t h s t u d e n t s about c l a s s m a t e r i a l s . T h e s i s g u i d a n c e and s u p e r v i s i o n . P r e p a r a t i o n f o r r o u n d s , c o n f e r e n c e s , l e c t u r e s o r s e m i n a r s , p r e p a r i n g r e a d i n g e x a m i n a t i o n p a p e r s , l i s t s , l a b o r a t o r y m a t e r i a l s , p r e p a r a t i o n of c o u r s e m a t e r i a l s . A t t e n d i n g c o u r s e s f o r v.'liich one i s p a r t l y r e s p o n s i b l e . T r a v e l r e l a t e d t o t e a c h i n g . S u p e r v i s i o n o f t e a c h i n g a s s i s t a n t s . D i s c u s s i o n s w i t h c o l l e a g u e s about c o u r s e s . S t u d e n t e v a l u a t i o n . A r r a n g i n g f o r g u e s t s p e a k e r s . A t t e n d i n g m e e t i n g s o f c u r r i c u l u m o r a d m i s s i o n s c o m m i t t e e . I n t e r v i e w i n g p o t e n t i a l s t u d e n t s . W r i t i n g l e t t e r s o f recommendation. D e v e l o p i n g and s c h e d u l i n g c o u r s e s . L i b r a r y c o m m i t t e e , s t u d e n t c o u n s e l l i n g . In Section A item 1 you i n d i c a t e d that % of your time was a l l o c a t e d to teaching 1. To the best of your knowledge what percentage of your teaching time was spent on preparation f o r i n s t r u c t i o n ? 2. What percentage of your teaching time was spent on curriculum development? 3. What percentage of your teaching time was spent on ac t u a l i n s t r u c t i o n ? TOTAL % 1% 100 79 SECTION C I f you are a p h y s i c i a n please complete Section C and continue with Section D. I f you are not a ph y s i c i a n (M.D.) disregard t h i s s e c t i o n and proceed to Section D. ACTIVITY. M e d i c a l C a r e o f P a t i e n t s M e d i c a l C a r e o f P a t i e n t s M e d i c a l C a r e o f P a t i e n t s DEFINITION S t u d e n t s p r e s e n t . C l i n i c a l , s x i r g i c a l o r l a b o r a t o r y p r o c e d u r e s , e i t h e r b e i n g c o n d u c t e d by f a c u l t y o r by s t u d e n t s w i t h f a c u l t y members s u p e r -v i s i n g . No s t u d e n t s p r e s e n t . P r i v a t e o f f i c e p r a c t i c e . EXAMPLES Rounds where m e d i c a l c a r e o f p a t i e n t s i s p e r f o r m e d . Work c o n f e r e n c e s c o n c e r n i n g s p e c i f i c p a t i e n t d i a g n o s i s . P a t i e n t o r t r e a t m e n t c o n s u l t a t i o n s ( w i t h s t u d e n t s p r e s e n t ) . I n f o r m a l d i s c u s s i o n o f p a t i e n t s ( w i t h s t u d e n t s p r e s e n t ) . S u r g i c a l o r o b s t e t r i c a l p r o c e d u r e s w i t h s t u d e n t s p r e s e n t . C o n s u l t a t i o n s w i t h p a t i e n t s o r w i t h c o l l e a g u e s c o n c e r n i n g p a t i e n t s . R e a d i n g X - r a y s . Time on c a l l a t t h e h o s p i t a l S e e i n g p a t i e n t s on a f e e - f o r - s e r v i c e b a s i s i n w h i c h you a r e p e r s o n a l l y r e i m b u r s e d . _% of your time i s spent on the In Section A item 2 you i n d i c a t e d that medical care of p a t i e n t s . • 1. To the best of your knowledge what percentage of t h i s time was spent on the medical care of p a t i e n t s with students present? 2. What percentage of t h i s time was spent on medical care of pati e n t s without students present? 3. What percentage of t h i s time was spent on the medical care of p a t i e n t s i n p r i v a t e o f f i c e p r a c t i c e ? % TOTAL 100 % SECTION D ACTIVITY DEFINITION EXAMPLES A d m i n i s t r a t i o n G e n e r a l a d m i n i s t r a t i o n and o t h e r i n t e r n a l s e r v i c e t o t h e i n s t i t u t i o n . A t t e n d i n g p r o m o t i o n and t e n u r e m e e t i n g s . A t t e n d i n g e x e c u t i v e f a c u l t y o r p l a n n i n g m e e t i n g s . Y J r i t i n g l e t t e r s o f recommendation f o r p e r s o n n e l , ( o t h e r t h a n s t u d e n t s ) . P r e p a r i n g bud ge t s. S u p e r v i s i o n . o f n o n - f a c u l t y o r t e c h n i c a l p e r s o n n e l . O t h e r g e n e r a l o f f i c e r o u t i n e . H o s p i t a l A d m i n i s t r a t i o n H o s p i t a l o r c l i n i c a d m i n i s t r a t i o n . S e r v i c e , on h o s p i t a l o r c l i n i c c o mmittees.* P l a n n i n g and r e v i e w of h o s p i t a l o r c l i n i c a c t i v i t i e s . S c h e d u l i n g and' r e v i e w o f house s t a f f a c t i v i t i e s . In Section A item 3 you have indicated that % of your time was spent on administration a c t i v i t i e s . 1. To the best of your knowledge how much of t h i s administration time was spent on general administration? j 2. How much of t h i s administration time was spent on h o s p i t a l i administration? | . TOTAL I 81 SECTION E ACTIVITY DEFINITION EXAMPLES R e s e a r c h I Independent r e s e a r c h i n c l u d i n g r e s e a r c h a d m i n i s t r a t i o n - n£ s t u d e n t s p r e s e n t . lienchwork. W r i t i n g up and p r e s e n t i n g r e s u l t s . W r i t i n g p r o p o s a l s . A d m i n i s t r a t i o n o f r e s e a r c h p r o j e c t s . S u p e r v i s i o n o f t e c h n i c i a n s . R e a d i n g f o r r e s e a r c h . P r e p a r a t i o n and a t t e n d a n c e a t r e s e a r c h committee m e e t i n g s . R e s e a r c h I I R e s e a r c h and i n s t r u c t i o n - s t u d e n t s p r e s e n t . Same as i n d e p e n d e n t r e s e a r c h w i t h s t u d e n t s p r e s e n t . In Section A item 4 you have indicated that % of your time i s allocated to research a c t i v i t i e s . 1. To the best of your knowledge what percentage of t h i s i research time had students present? | 2. What percentage- of your research time was spent without i students present? | TOTAL SECTION F ACTIV'J TY DEFINITION EXAMPLES Other Includes items such as s e l f education, s e r v i c e to your profession, absence from p r o f e s s i o n a l d u t i e s . S e l f Education A c t i v i t i e s to keep oneself abreast of developments i n one's f i e l d . General j o u r n a l reading. Attending continuing education courses. Attending other courses or seminars to keep current i n one's profession. Attending p r o f e s s i o n a l s o c i e t y meetings or conventions. T r a v e l r e l a t e d to these a c t i v i t i e s . Service Service to your own profession and i n a p r o f e s s i o n a l capacity to outside organizations. Lectures to p r o f e s s i o n a l s o c i e t i e s . Lectures or other services to community organizations. Service on advisory boards or councils for government organiza-t i o n s . Planning and administration r e l a t e d to health maintenance. Organizations or other community health s e r v i c e . Absence Absence from p r o f e s s i o n a l d u t i e s . I l l n e s s , vacation, s a b b a t i c a l , other leave. Section A item 5 you have i n d i c a t e d that % of your time i s taken up by other a c t i v i t i e s such as s e l f - e d u c a t i o n , s e r v i c e and s a b b a t i c a l s . 1. To the best of your knowledge what percentage of t h i s other time was used f o r s e l f - e d u c a t i o n . 2. What percentage of t h i s other time was used i n serving your own p r o f e s s i o n or i n a p r o f e s s i o n a l capacity to outside organizations? 3. What percentage of t h i s other time was used as a r e s u l t of absence from p r o f e s s i o n a l d u t i e s . A. I f t h i s other time was used f o r d i f f e r e n t a c t i v i t i e s than those already mentioned please s p e c i f y what these were i n the space provided below. TOTAL :TION G' 83 nennrtrent of P a e d i a t r i c s c a r r i e s out i t s a c t i v i t i e s at various f a c i l i t i e s throughout the r n a o As a f a c u l t y number of the Department of P a e d i a t r i c s you may spend loZZ a l l of those f a c i l i t i e s . Could you please estimate the percentage o t me , l t rn f n r i l i t i o - c a r r v i n - out your a c t i v i t i e s . Por example, i f you spend halt o l / I N " P T 0 it W o d l n d 7 ^ the other h a l f at the R.E.A.C.H. c l i n i c you would i n d i c a t e L i t e SUCTION, 50% Woodlands and 50% R.E.A.C.H. along the h o r i z o n t a l axxs to give a t o t a l 100*/. F a c i l i t i e s Where A c t i v i t i e s Are Carried Out • ACTIVITIES Woodlands Instructional Resources Ctr., UBC Family Practice Centre, UBC I .. — R.E.A.C.H. Clinic Health Centre for Children Children's Hospital Sunnyhill Hospital Cancer Control Institute Neonatology Variety Treatment Centre, Surrey C.A.R.S. j Children's Hosp. Diagnostic Ctr., W.lOth UBC Faculty of Medicine at VGH G.F. Strong Rehabilitation Centre Other (Please specify) TOTAL -on-students always present 100% nn development 100% _on for teaching 100% :are of patients (students present) 100% .are of patients ients present) 100% are of patients e o f f i c e practice) 100% •ation (General) 100% •ation (Hospital) 100% (students present) 100% (no students present) 100% ation (conferences, conventions) 100% our own profession or i organizations 100% :rom professional duties i specify i n the space below) 100% .ease specify) 100% 84 SECTION H ' Comments or Explanations: APPENDIX II PROPOSAL FOR A DELPHI STUDY 86 Keith Loughlin Health Services Planning Department of Health Care and Epidemiology U.B.C. February 9 i 1977 Dr. S. Israels and Full-time Members of Faculty Department of Paediatrics U.B.C. 715 West 1 2 t h Avenue ^ Vancouver, B.C. Dear Dr. Israels and Full-time Members of Faculty: In the summer of 1976 Mr. Paul Nerland, at the request of Dr. Israels began a study of the organizational, adminis-trative and financial, relationships between the University Department of Paediatrics and the various health care institutions with which i t i s associated. As you may r e c a l l I assisted Mr. Nerland i n the study, by doing an activity analysis of full-time faculty members within the department. The results of the activity analysis were then presented to Dr. Israels and four senior professors i n the Department of Paediatrics, during November 1 9 7 6 . As a continuation of this study we are now attempting to determine the objectives of the Department of Paediatrics. We plan to do this by using a technique referred to i n the literature as "Delphi" (New England Journal of Medicine: Vol. 2 8 8 , pp. 1 2 7 2 - 1 2 7 5 , 1973 and Vol. 2 9 2 , pp. 1 5 8 - 5 9 , 1 9 7 5 ) . The Delphi technique i s a method of s o l i c i t i n g opinions from a group of experts on an individual basis about a p a r t i -cular subject. These opinions are then tabulated and returned to the experts for their evaluation and comments over several iteration rounds. From these individual opinions, evaluations and comments i t w i l l become clear, i n this study where there i s a consensus of opinion and where there i s not, regarding the objectives of the Department of Paediatrics. Since your responses, comments, and evaluations are anonymous to everyone except the researcher (myself) i t avoids a l l the inherent psychological factors found i n face to face group meetings, such as dominant personalities, group leaders, bandwagon effects, and perceived status differentials. This study w i l l provide you with an unusual opportunity to express many of your views which you might not ordinarily mention under normal circumstances. Furthermore your replies w i l l remain anonymous and w i l l not be released i n any identifiable form to your colleagues, supervisors or depart-ment chairman. Therefore you are urged to participate i n this study. Not only w i l l you bo able to express your own viev/s, but you w i l l also be able to see your colleagues viewpoints as woll. Finally by participating i n this survey you vri.ll be able to contribute useful and necessary information v/hich can be used as a basis for the planning of, and the alloca tion of resources, to current and future a c t i v i t i e s of the Department of Paediatrics. I w i l l be most grateful i f you w i l l assist me i n this study. I f you have any questions please contact me at Yours Respectfullyji Keith Loughlin -APPENDIX III DELPHI ROUND 1 QUESTIONNAIRE AND EXPLANATORY LETTER 89 Keith Loughlin Health Services Planning Department of Health Care and Epidemiology U.B.C. March lif, 1977 Dr. S. Israels and Full-time Members of Faculty Department of Paediatrics U.B.C. 715 West 1 2 t h Avenue Vancouver, B.C. Dear Dr. Israels and Full-time Members of Faculty: In the summer of 1976 Mr. Paul Nerland, at the request of Dr. Israels began a study of the organizational, adminis-trative and financial relationships between the University Department of Paediatrics and the various health care institutions with which i t i s associated. As you may r e c a l l I assisted Mr. Nerland i n the study, by doing an act i v i t y analysis of full-time faculty members within the department. The results of the act i v i t y analysis were then presented to Dr. Israels and five senior professors i n the Department of Paediatrics, during November 1 9 7 6 . As a continuation of this study we are now attempting to determine the objectives of the Department of Paediatrics. We plan to do this by using a technique referred to i n the literature as "Delphi" (New England Journal of Medicine: Vol. 2 8 8 , pp. 1 2 7 2 - 1 2 7 5 , 1973 and Vol. 2 9 2 , pp. 1 5 8 - 5 9 , 1 9 7 5 ) . A "Delphi" questionnaire which attempts to obtain this information i s enclosed. Please peruse this form but leave completion of i t u n t i l I can meet with you. Since one of the facets of "Delphi" i s to provide a quick turn around time between iterations, to maintain the respondent's interest, I would appreciate i t , i f I could arrange a meeting with you during the next 14 days to discuss and complete the questionnaire. If a meeting cannot be arranged within the next 14 days please complete the survey form and return i t to me i n the self addressed envelope by March 3 0 , 1 9 7 7 . I w i l l be most grateful i f you w i l l assist me i n this study. If^you have any questions please contact me anytime at Yours respectfully, Keith Loughlin 90 " D e l p h i " Q u e s t i o n n a i r e U.B.C. Department o f P a e d i a t r i c s Code Round 1 Name You a r e b e i n g a s k e d t o p a r t i c i p a t e i n a s e r i e s o f q u e s t i o n p e r i o d s w h i c h w i l l d e t e r m i n e t h e o b j e c t i v e s o f th e U.B.C. Department o f P a e d i a t r i c s . As you may r e c a l l a t t h e F a c u l t y m e e t i n g on March 12,1977, t h i s p r o j e c t was d i s c u s s e d and s u p p o r t e d by Dr. I s r a e l s . The s t u d y i s t h e f i n a l phase o f what began as an a c t i v i t y a n a l y s i s o f t h e department i n t h e summer o f 1976. T h i s t y p e o f s t u d y i s r e f e r r e d t o i n t h e l i t e r a t u r e as " D e l p h i " . S i m p l y s p e a k i n g , i t i s a method o f s o l i c i t -i n g o p i n i o n s from a group o f e x p e r t s on an i n d i v i d u a l b a s i s about a p a r t i c u l a r s u b j e c t . These o p i n i o n s a r e t h e n t a b -u l a t e d and r e t u r n e d t o t h e e x p e r t s f o r t h e i r e v a l u a t i o n o v e r s e v e r a l i t e r a t i o n r o u n d s . From t h e i n d i v i d u a l o p i n -i o n s , comments and e v a l u a t i o n s i t w i l l become c l e a r , i n t h i s s t u d y , where t h e r e i s a consensus o f o p i n i o n and where th.ere i s n o t , r e g a r d i n g t h e o b j e c t i v e s o f t h e De-partment o f P a e d i a t r i c s . The c o n c e p t o f o b j e c t i v e s i m p l i e s "aims" f o r e g o n e as w e l l as t h o s e w h i c h a r e s o u g h t ; o t h e r w i s e a l l t h a t r e m a i n s i s a s e t o f Boy Scout maxims. F o r i n s t a n c e , t h e more g l o b a l o b j e c t i v e s o f t h e Department o f P a e d i a t r i c s may be t h o u g h t of as r e s e a r c h , t e a c h i n g , p r o v i s i o n o f m e d i c a l c a r e and some a d m i n i s t r a t i v e f u n c t i o n s . These o b j e c t i v e s a r e v e r y d e s i r a b l e and p r o b a b l y w o u l d evoke l i t t l e argument, y e t t h e y a r e a l s o r a t h e r vague. They say n o t h i n g about d e p a r t m e n t a l o b j e c t i v e s i n r e g a r d s t o what k i n d s o f r e -s e a r c h s h o u l d be done, what k i n d s o f t e a c h i n g a c t i v i t i e s s h o u l d be c a r r i e d o u t , who s h o u l d be t a u g h t , and w h i c h l e v e l s ( p r i m a r y , t e r t i a r y ) o r t y p e s ( p r e v e n t a t i v e , c r i s e s management) o f m e d i c a l c a r e s h o u l d be p r o v i d e d t o p a t i e n t s . There may a l s o be o t h e r o b j e c t i v e s w h i c h a r e i m p o r t a n t t o t h e Department o f P a e d i a t r i c s . Some o f t h e s e may i n c l u d e m a i n t a i n i n g a s t r o n g degree of i n f l u e n c e and autonomy w i t h i n t h e F a c u l t y o f M e d i c i n e . The i n f l u e n c i n g o f v a r i o u s l e v e l s o f government and o t h e r f u n d i n g a g e n c i e s t o p r o v i d e new p a e d i a t r i c f a c i l i t i e s . A n o t h e r o b j e c t i v e may be an i n t e r n a l one, r e l a t i n g t o s t a b i l i t y and growt h o f t h e department. T h e r e f o r e t h e aim o f t h i s s u r v e y , i s t o s o l i c i t y o u r o p i n i o n s i n r e g a r d s t s p e c i f i c o b j e c t i v e s ( i . e . k i n d s o f r e s e a r c h ) as i s s u e s w i t h i n t h e more g l o b a l o b j e c t i v e s ( i . e . r e s e a r c h ) o f t h e Department o f P a e d i a t r i c s . The above m e n t i o n e d c o n c e p t s a r e o f f e r e d as a g u i d e to a s s i s t you i n c o m p l e t i n g t h i s s u r v e y form. F u r t h e r m o r e I w i l l a l s o be a v a i l a b l e i f you w i s h t o c l a r i f y o r q u e s t i o n any a s p e c t s o f t h i s s u r v e y . 92 S i n c e your r e s p o n s e s , comments and e v a l u a t i o n s a r e anonymous t o everyone e x c e p t t h e r e s e a r c h e r ( m y s e l f ) i t a v o i d s a l l the i n h e r e n t p s y c h o l o g i c a l f a c t o r s f o u n d i n th e f a c e t o f a c e group m e e t i n g s such as dominant p e r s o n a -l i t i e s , group l e a d e r s , bandwagon e f f e c t s , and p e r c e i v e d s t a t u s d i f f e r e n t i a l s . T h i s s t u d y w i l l p r o v i d e you w i t h an u n u s u a l o p p o r t u n i t y t o e x p r e s s many o f your v i e w s w h i c h you might not o r d i n a r i l y m ention under normal c i r c u m s t a n c e s . F u r t h e r m o r e your r e p l i e s w i l l r e m a i n anonymous and w i l l not be r e l e a s e d i n any i d e n t i f i a b l e form t o y o u r c o l l e a g u e s , s u p e r v i s o r s , o r department c h a i r m a n . T h e r e f o r e you a r e u r g e d t o p a r t i c i p a t e i n t h i s s t u d y . Not o n l y w i l l you be a b l e t o e x p r e s s your own v i e w s , but you w i l l a l s o be a b l e t o see y o u r c o l l e a g u e ' s v i e w p o i n t s . F i n a l l y , by p a r t i c i p a t i n g i n t h i s s u r v e y , you w i l l be a b l e t o c o n t r i b u t e u s e f u l and n e c e s s a r y i n f o r m a t i o n w h i c h can be used as .a b a s i s f o r t h e p l a n n i n g o f c u r r e n t and f u t u r e a c t i v i t i e s o f t h e Department o f P a e d i a t r i c s . A t t h i s s t a g e I am l o o k i n g f o r y o u r i n d i v i d u a l p e r c e p t i o n s as t o what t h e o b j e c t i v e s o f t h e U.B.C. D e p a r t -ment o f P a e d i a t r i c s a r e . I f i t i s p o s s i b l e I would l i k e t o a r r a n g e an appo i n t m e n t w i t h you, w i t h i n t h e n e x t 14 days, t o go o v e r t h i s s u r v e y . However, i f t h i s i s not c o n v e n i e n t , p l e a s e complete t h e s u r v e y and r e t u r n i t i n t h e s e l f - a d d r e s s e d e n v e l o p e . I f you have any q u e s t i o n s r e g a r d i n g t h e form, p l e a s e f e e l f r e e t o c a l l me a n y t i m e a t Now, would you p l e a s e t u r n t o t h e nex t page and com p l e t e P a r t I . o v e r . 93 P a r t I In t h e f o l l o w i n g s p a c e s p l e a s e l i s t t h e o b j e c t i v e s (up t o a maximum o f 5) w h i c h you f e e l a r e r e l e v a n t t o t h e e n t i r e U.B.C. Department o f P a e d i a t r i c s . P l e a s e be s p e c i f i c i n y o u r l i s t i n g o f o b j e c t i v e s ( i . e . more r e s e a r c h needs t o be done i n t h e a r e a o f e n v i r o n m e n t a l c a u s e s o f c h i l d r e n ' s d i s e a s e s ; r a t h e r t h a n s i m p l y s a y i n g do more r e s e a r c h ) . (1) (2) (4) (5) A f t e r c o m p l e t i o n o f P a r t I , p l e a s e p r o c e e d and c o m p l e t e P a r t I I . o v e r . 9 ^ Part II In Part "I you l i s t e d the ob jec t ives which you f e l t were re levant to the Department of P a e d i a t r i c s as a whole. In Part II you are now asked to l i s t the ob jec t ive s (up to a maximum of 5 ) , which you f e e l are re levant to your own area of r e s p o n s i b i l i t y w i t h i n the Department of P a e d i a t r i c s . (1) (2) (3) (4) (5) Thank you for tak ing time to complete t h i s form. If i t i s not po s s ib l e to arrange an appointment between us w i t h i n the next 14 days, please re turn the completed form i n the s e l f -addressed envelope by March 30, 1977. APPENDIX IV DELPHI ROUND 2 QUESTIONNAIRE AND EXPLANATORY LETTER 96 Keith Loughlin Health Services Planning Department of Health Care and Epidemiology U.B.C A p r i l 1 8 , 1977 Dr. S. I s r a e l s and Full-time Members of Faculty Department of Paediatrics U.B.C. 715 West 1 2 t h Avenue Vancouver, B C C Dear Dr. I s r a e l s and Full-time Members of Faculty: Thank you for your p a r t i c i p a t i o n i n Round 1 of t h i s Delphi study, which i s intended to determine the objectives that are relevant to the entire U.B0C. Department of P a e d i a t r i c s . The response rate to the Delphi Questionnaire, Round 1, was a very g r a t i f y i n g 7 8 % . This return rate i s one of the highest, according to the l i t e r a t u r e currently a v a i l a b l e for Delphi Round 1 responses, inv o l v i n g groups comprised of more than,15 members. For those of you who partook i n Round 1, as well as •those O-f vnn who wore n n a h l o t o . T Rr.rnrigly ".rgfi yO1,1 t o p a r t i c i p a t e i n Round 2„ Your p a r t i c i p a t i o n w i l l benefit the e n t i r e U CB 0C. Department of Paediatrics as well as each one of you i n d i v i d u a l l y by: 1) c l a r i f y i n g areas of agreement and disagreement upon department "objectives" 2) evaluating "objectives" i n terms of t h e i r r e l a t i v e p r i o r i t i e s to each other 3) i d e n t i f i c a t i o n of those "primary a c t i v i t i e s " which are necessary f o r achieving department objectives It) and f i n a l l y the c l a r i f i c a t i o n of objectives and the i d e n t i f i c a t i o n of p r i o r i t i e s and primary a c t i v i t i e s w i l l provide an excellent source of "data" on which the planning and a l l o c a t i o n of resources to current and future departmental a c t i v i t i e s can be made. Once again, I want to emphasize that your r e p l i e s s h a l l remain c o n f i d e n t i a l and w i l l not be released i n any i d e n t i -f i a b l e form to your colleagues, supervisors, or department chairman. over/ 97 I would l i k e t o a r r a n g e an appointment w i t h you t o d i s c u s s and complete tho e n c l o s e d D e l p h i Round 2 Q u e s t i o n -n a i r e , w i t h i n the n e x t \\\ days. I f t h i s i s not c o n v e n i e n t f o r y ou, p l e a s e complete the s u r v e y form and r e t u r n i t t o me, i n tho e n c l o s e d , s e l f a d d r e s s e d e n v e l o p e by A p r i l 28, 1977. I w i l l be most g r a t e f u l i f you w i l l a s s i s t me i n Round 2 o f t h i s s t u d y . I f you have any f u r t h e r q u e s t i o n s , p l e a s e f e e l f r e e t o c o n t a c t me anytime a t Yours r e s p e c t f u l l y , Keith Loughlin "DELPHI" QUESTIONNAIRE ROUND 2 Th i n quest: ionna i. t •«.; contains a l l of thr.: objectivuw of the Department of I'aedi atrj.es which wore: submitted by tin.; respondents in thr,- f i r s t round. L i s t e d below and on the next page are an "importance s c a l e " and a chart d e f i n i n g a c l i v i t i c i s as they are c a r r i e d out by f u l l - t i m e f a c u l t y members. Importcinco Scale Scale reference D e f i n i t i o n s 1. Very important A most relevant point . F i r s t order p r i o r i t y 2. Important Is a relevant point. Second order p r i o r i t y 3. Somewhat Important May be a r e l e v a n t point T h i r d order p r i o r i t y 4. Unimportant I n s i g n i f i c a n t l y relevant Low p r i o r i t y 5. Not at a l l Important No relevance No p r i o r i t y Please use the "Importance Scale" shown above to choose a number which represents your evaluation of each o b j e c t i v e f o r i t s importance to the e n t i r e Department of P a e d i a t r i c s . D e f i n i t i o n and Examples of A c t i v i t i e s Code D e f i n i t i o n s Examples T Teaching (curriculum development, prepar-a t i o n f o r , and i n s t r u c t i o n of students, p a t i e n t s may be present but for demon- s t r a t i o n purposes only) Conducting labs, l e c t u r e s , seminars. Preparation f o r labs, l e c t u r e s , seminars. Developing and scheduling courses. Medical care of patients (with or without students present and p r i v a t e p r a c t i c e ) Rounds where medical care i s given, Consultations, s u r g i c a l or o b s t e t r i c a l procedures. R Research (with or without students present) A H o s p i t a l or U n i v e r s i t y administration 0 S e l f education, s e r v i c e to your own p r o f e s s i o n , s a b b a t i c a l s , s e r v i c e to outside agencies through p r o v i s i o n of e x p e r t i s e Benchwork, w r i t i n g proposals, w r i t i n g up r e s u l t s , attending research committee meetings Service on h o s p i t a l or c l i n i c a l committees, attending promotion and tenure meetings. Keeping up with the l i t e r a t u r e . Serving on advisory boards and c o u n c i l s , attending p r o f e s s i o n a l s o c i e t y meetings. Please use the " D e f i n i t i o n of A c t i v i t i e s " chart shown above to s e l e c t the a c t i v i t y which you f e e l i s of primary importance to achieving a s p e c i f i c o b j e c t i v e . The example on the following page should help to c l a r i f y t h i s procedure. . 100 V e r y Somewhat Un- Not a t a l l I m p o r t a n t i I m p o r t a n t i I m p o r t a n t • i m p o r t a n t i I m p o r t a n t • 1 2 3 4 5 I n t h e box t o t h e r i g h t o f each o b j e c t i v e , p l e a s e i n d i c a t e y o u r c h o i c e o f t h e number f r o m t h e " i m p o r t a n c e s c a l e " shown above, w h i c h r e p r e s e n t s y o u r e v a l u a t i o n o f t h e i m p o r t a n c e o f t h a t o b j e c t i v e t o t h e e n t i r e Department o f P a e d i a t r i c s . A l s o i n d i c a t e by c i r c l i n g t h e a p p r o -p r i a t e l e t t e r , t h e a c t i v i t y you f e e l i s , p r i m a r y f o r a c h i e v i n g t h e s p e c i f i c o b j e c t i v e . The f o l l o w i n g example s h o u l d h e l p c l a r i f y t h i s p r o c e d u r e . I f you f e e l more t h a n one a c t i v i t y i s i m p o r t a n t , r a n k them as shown be l o w . Department of P a e d i a t r i c s O b j e c t i v e s  E v a l u a t i o n o f I m p o r t a n c e o f O b j e c t i v e s C i r c l e t h e l e t t e r below w h i c h i n d i c a t e s t h e p r i m a r y a c t i v i t y f o r a c h i e v i n g t h a t o b j e c t i v e  QUALITY OF CARE OBJECTIVES . Improve t h e q u a l i t y o f c a r e by: 1) S e t t i n g an example o f d o i n g i t o u r s e l v e s © © R Z I Y o u r r e p l i e s w i l l r e m a i n anonymous, and w i l l n o t be r e l e a s e d i n any i n d e n t . i f i a b l e form t o y o u r c o l l e a g u e s , s u p e r v i s o r s , o r d e p a r t m e n t c h a i r m a n . I would l i k e t o a r r a n g e an a p p o i n t m e n t w i t h you t o d i s c u s s and c o m p l e t e t h i s f o r m w i t h i n t h e n e x t 14 d a y s . However, i f t h i s i s n o t p o s s i b l e p l e a s e r e t u r n t h e c o m p l e t e d form i n t h e e n c l o s e d , s e l f - a d d r e s s e d e n v e l o p e by A p r i l 28, 1977. I f you have any q u e s t i o n s r e g a r d i n g t h i s f o r m , p l e a s e f e e l f r e e t o c o n t a c t me a n y t i m e a t 936-5622. Now p l e a s e p r o c e e d , and c o m p l e t e t h e s u r v e y f o r m . Name very Iinpor tant Important Somewhat Important Un-important i Hot at a l l Important i. 1 2 3 4 5 Department of P a e d i a t r i c s . Objectives E v a l u a t i o n of Importance of Objectives C i r c l e the l e t t e r below which i n d i c a t e s the primary a c t i v i t y f o r a chieving that o b j e c t i v e  OtJALlTY OF CARE OBJECTIVES Improve the standard of p a e d i a t r i c care 1. ' Setting an example of doing i t ourselves 2. Providing adequate environ-ment and f a c i l i t i e s 3. . Caring for the p a t i e n t as a whole (not only s p e c i f i c parts) by: Having more nurses on p a e d i a t r i c ward 5. Having chart reviews 6. . Developing methods to monitor care 7. Reviewing the l i t e r a t u r e and f i n d i n g out what other people are doing i n t h i s area Doing long term follow up studies of treated people 9. Constant review of what-.is being done i n the Department of P a e d i a t r i c s 10. Developing a l e v e l of care which corresponds to that which can be f e a s i b l y developed i n other areas of B r i t i s h Columbia : 1 1 . Evaluating the p r a c t i c e of medicine through the use of educational techniques and behavioral m o d i f i -c a t i o n • • • • • • • • o • • T M R A 0 T M R A 0 T M R A O T M R A 0 T M R A O T M R A 0 T M R A 0 T H R A O T M R A O T M R A O T M R A O Comments or other o b j e c t i v e s r e l a t i n g to q u a l i t y of care Very Important Important Somewhat Important Un-important Hot at a l l . Important 1 ? Department of P a e d i a t r i c s . O b j e c t i v e s . Ev a l u a t i o n of Importance of Objectives • TEACHIUG ODJECTIVES To i n s t r u c t : 1. ' tiedical students i n the basic fundamentals of p a e d i a t r i c s 2. Medical students i n the.provision of safe p a e d i a t r i c care and to know t h e i r l i m i t a t i o n s The education of: 3. Undergraduate medical students i n academic p a e d i a t r i c s 4. Graduate medical students i n academic p a e d i a t r i c s Undergraduate medical students i n c l i n i c a l p a e d i a t r i c s 6. Graduate medical students i n c l i n i c a l p a e d i a t r i c s 7. Nurses and para medical personnel i n p a e d i a t r i c health problems 8. A l l other health care d e l i v e r e r s ( i . e . , H o s p i t a l Administrators) about p a e d i a t r i c health problems 9. To decide what "we" i n the Department of P a e d i a t r i c s are teaching undergraduate medical students f o r 10. To decide i f the Department of P a e d i a t r i c s should be teaching family p r a c t i t i o n e r s 11. To provide continuing medical education for p r a c t i c i n g physicians outside the u n i v e r s i t y 12. To put the i n s t r u c t i o n a l emphasis on "general p a e d i a t r i c s " witli t h i r d-year undergraduate medical students 13. The i n t r o d u c t i o n of sub-specialty i n s t r u c t i o n to medical students i n fourth year 14. The u t i l i z a t i o n of p r a c t i c i n g physicians to i n s t r u c t under-graduate medical students 15. Emphasize many more small group di s c u s s i o n s (5 or 6) on s p e c i f i c t o p i c s instead of grand rounds 16. To encourage students to think about preventative measures such as n u t r i t i o n and exerci s e , and de-emphasize the bizarre or c r i s i s i n c i d e n t s • • • • • • • • • • • • • • • • " C i r c l e the l e t t e r below which i n d i c a t e s the primary a c t i v i t y f o r ac h i e v i n g that o b j e c t i v e  T H R A O T M R A O T M R A 0 T M R A 0 T M R A O T M R A O T M R A O T H R A O T M R A O T M R A O T M R A O T M . R A O T M R A O T M R A O T M R A O T M R A 0 Comments or other o b j e c t i v e s r e l a t i n g to teaching: Very Important Important Somewhat Important Un-important Hot at a]I Important Department of P a e d i a t r i c s . Objectives  E v a l u a t i o n of Importance of O b j e c t i v e s C i r c l e the l e t t e r below which i n d i c a t e s . t h e primary a c t i v i t y f o r a c h i e v i n g that o b j e c t i v e RESEARCH OBJECTIVES Research: 1. ' Which r e l a t e s d i r e c t l y to c l i n i c a l medicine In c h i l d development 3. In c h i l d disease prevention Which r e l a t e s d i r e c t l y to improving p a t i e n t care On normal c h i l d r e n as compared to abnormal c h i l d r e n . P h y s i o l o g i c a l , research on normal c h i l d r e n Biochemical research on normal c h i l d r e n Of an i n t e r d i s c i p l i n a r y nature, the involvement of non-medical d i s c i p l i n e s in j o i n t research p r o j e c t s fr>r r h ^ imnrnvpnipnr, r»f r h l l r l h e a l t h • • • • • • • • T M R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A 0 9. Which looks at s t r a t e g i e s of disease management i n terms of cost e f f e c t i v e n e s s 10. Into patterns of c h i l d r e n ' s h e a l t h 11. In the o r g a n i z a t i o n of h e a l t h care d e l i v e r y ( p a r t i c u l a r l y c hildren's) at the r e g i o n a l , p r o v i n c i a l and n a t i o n a l l e v e l 12. In contemporary and p r o v i n c i a l health problems r e l a t i n g to c h i l d r e n 13. Into long term a f f e c t s of t r e a t -ment processes to c h i l d r e n i n t h e i r l a t e r years 14. Each sub - s p e c i a l t y contributes to basic research 15. Each sub-specialty contributes to c l i n c i a l research 16. The area of research i s the r e s p o n s i b i l i t y of the i n d i v i d u a l , however, support for i t should be provided by the Dept. of P a e d i a t r i c s 17. Basic research areas determined by the Department 18. Find and stimulate the a p p l i c a t i o n of methods by which people w i l l be-come more concerned about t h e i r personal health 19. Provide f a c i l i t i e s and a s t i m u l a t i n g •environment for high q u a l i t y basic and appl i ixl research r e l a t e d to • • • • • • • • • • n T M R. A 0 M T R A O T M R A 0 T M R A O T M R A O T M R A O T M R A 0 T M T M T M A 0 A 0 A 0 A 0 Very Important .1 Important Somewhat Important Un-important riot at a 13 Important Department of P a e d i a t r i c s . O b j e c t i v e s  E v a l u a t i o n of Importance of Objectives C i r c l e the l e t t e r below which i n d i c a t e s the primary a c t i v i t y f o r ac h i e v i n g that o b j e c t i v e  20. Research i n t o the r o l e of environmental f a c t o r s on the development of disease s t a t e s , (both psychosocial and organic) 21. Encourage increased research i n neonatal and i n f a n t pharmacology • • Comments or other o b j e c t i v e s r e l a t i n g to Research: / Very Important Important Somewhat Important • Un-important • i Not at a l l Important t 1 2 3 . 4 5 Department of P a e d i a t r i c s O b j e c t i v e s  LEVELS OF CARE OBJECTIVES P r o v i s i o n f o r : E v a l u a t i o n of Importance of Objectives C i r c l e the l e t t e r below which i n d i c a t e s the primary a c t i v i t y f o r achieving that o b j e c t i v e , Primary care on a c o n s u l t a t i v e b a s i s only The t o t a l r e h a b i l i t a t i o n of c h i l d r e n with mental, p h y s i c a l or emotional handicaps through comprehensive edu-c a t i o n and p h y s i c a l Assessments of the c h i l d ' s needs i n order to a s s i s t ' the c h i l d , become a s e l f - s u p p o r t i n g w e l l adjusted a d u l t Improve and strengthen amulatory primary care, through strong leadership i n t h i s area Closer involvement between the Dept. of P a e d i a t r i c s and other departments ( i . e . , Health Services Planning) i n the d e l i v e r y of health s e r v i c e s to c h i l d r e n The delivery of primary care The delivery of secondary care • • • • "•n • • T II R A 0 T M R A 0 T M R A O T M R A 0 T M R A O T M R A O I 1 Very Important .! 1 Important Somewhat Important Un-important j 4 l!ot at a l l Important JLVO Department of P a e d i a t r i c s . O b j e c t i v e s  8. Action ns a group of experts to meet the needs of diagnosis and treatment of conditions be-yond the ex p e r t i s e of most physicians E v a l u a t i o n of Importance of Objectives • Comments or other o b j e c t i v e s r e l a t i n g to l e v e l s of care: C i r c l e the l e t t e r below which i n d i c a t e s the primary a c t i v i t y f o r achieving that o b j e c t i v e  COMMUNITY OBJECTIVES 1. The education of members of the • community i n matters of c h i l d health and development 2. Provide information to members of the community on a l l matters re l a t e d to childhood i n the community and the country 3. Play a large r o l e i n the organization of the new Ch i l d r e n ' s H o s p i t a l 4. To serve on lay boards, by o f f e r i n g e x p e rtise i n c h i l d care matters • • • • T M R A 0 T M R A 0 T M R A 0 T M R A 0 5. Provide advice to the community regarding areas of concern i n both sick and w e l l c h i l d r e n 6. Provide advice to various agencies i n terms of f a c i l i t y planning f o r c h i l d r e n 7. The Department of P a e d i a t r i c s should act as a resource centre f o r i n d i v i d u a l s and groups involved with c h i l d r e n 8. Stress preventative aspects of medicine, through the general education of the p u b l i c , and i n areas of n u t r i t i o n 9. Demonstrate new methods of care to the'community 10. Demonstrate new needs of c h i l d r e n to the community 11. Advise government and other bodies r e s p o n s i b l e for l e g i s l a t i v e programs which a f f e c t c h i l d health and development • • • • • • • T M R A O T M R A O T M R A O T M R A O T M R A O T M R A O T M R A O Comments or other o b j e c t i v e s r e l a t i n g to the community: Very Important Important Soinewhnt I in porta nt Un-important Hot at a l l Important 106 Department of P a e d i a t r i c s O b j e c t i v e s E v a l u a t i o n of Importance of Object Ives. " c i r c l e The T o t t e r below which i n d i c a t e s the primary a c t i v i t y f o r achieving that o b j e c t i v e  INTERNAL DEPARTMENT OBJECTIVES 1. To gain more autonomy f o r the Department of P a e d i a t r i c s i n i t s r e l a t i o n s h i p s with the Greater Vancouver Regional H o s p i t a l D i s t r i c t and Vancouver General H o s p i t a l 2. The s e l e c t i o n and t r a i n i n g of s p e c i a l i s t s and s u b - s p e c i a l i s t s i n t e r t i a r y and secondary care 3. To provide strong l e a d e r s h i p with the F a c u l t y of Medicine, the U n i v e r s i t y and the community i n a l l areas r e l a t i n g to the development of the f e t u s , newborn, 4. To a t t r a c t t a l e n t e d attending s t a f f , (support f i n a n c i a l l y i f possible) and i n f a n t s 5. To ensure a steady supply of the best teachers (teaching fellows) To embark on new programs only when i n d i v i d u a l s have e x p e r t i s e i n the new program's area 7. The e f f i c i e n t a d m i n i s t r a t i o n and use of manpower 8. The e f f i c i e n t a d m i n i s t r a t i o n and use of p u b l i c and v o l u n t a r y funds 9. M a i n t a i n a strong p r o f i l e w i t h i n the F a c u l t y of Medicine i n l i g h t of the f a c t o r s t h a t p a e d i a t r i c s i s a l i t t l e u n c e r t a i n of i t s future d i r e c t i o n s , and furthermore general p r a c t i t i o n e r s are r e a l l y not that w e l l equipped i n d e a l i n g w i t h the h e a l t h problems of c h i l d r e n 10. Aim at being the "best" department i n the F a c u l t y of Medicine 11. M a i n t a i n an o b j e c t i v e s u r v e i l l a n c e of departmental teaching programs f o r strengths and weaknesses 12. The development of an i n t e r d i s c i p l i n a r y approach to a l l c h i l d r e n whether s i c k or w e l l 13. The development of t r a i n i n g programs r e l a t e d to p a e d i a t r i c s i n non-teaching h o s p i t a l s and community s e t t i n g s ( i . e . , the North) 14. The propogation of p r o p h y l a t i c medicine 15. The development of comparative s t u d i e s between the U .B . C. Department of P a e d i a t r i c s and other p a e d i a t r i c departments i n Canada and other c o u n t r i e s 16. E s t a b l i s h good r e l a t i o n s h i p s with other U n i v e r s i t y departments which are i n v o l v e d with c h i l d r e n • • • id inf • • • • • 17. S t r i v e f o r c l i n i c a l e x c e l l e n c e , except f o r some few i n d i v i d u a l s , o v e r a l l research e f f o r t i s h a l f -hearted and i s not always w e l l advised the • • • • • • • • • T M R A 0 T M R A 0 T M R A O T M R . A 0 T M R A 0 T M R A 0 T M R A 0 T • M R A 0 T M . R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A 0 T M R A' 0 Commento or «t-hor nb-}octi.v(.-:i related to internal dnpartment .pbjc^Uvci:: Thank you f o r t a k i n g t h e t i m e t o c o m p l e t e t h i s f o r m . I f i t i s n o t p o s s i b l e t o a r r a n g e and i n t e r v i e w w i t h i n t h e n e x t 14 d a y s , p l e a s e r e t u r n y o u r c o m p l e t e d f o r m i n t h e e n c l o s e d s e l f -addressed e n v e l o p e by A p r i l 28, 1977. APPENDIX V DELPHI ROUND 3 QUESTIONNAIRE AND EXPLANATORY LETTER Keith Loughlin Health Services Planning Department of Health Care and Epidemiology U.B.C. May 1 9 , 1977 Dr. S. I s r a e l s and Full-time Members of Faculty Department of Paediatrics U.B.C. 715 West 1 2 t h Avenue Vancouver, B.C, Dear Dr. I s r a e l s and Full-time Members of Faculty: Thank you f o r your p a r t i c i p a t i o n i n Round 2 of t h i s Delphi study, which i s intended to determine the objectives that are relevant to the entire U.B.C. Department of Paed i a t r i c s . The response rate to the Delphi Questionnaire Round 2 was a very encouraging 85%, an increase of ?% over Round 1. This i s only the second time, according to the avail a b l e l i t e r a t u r e , that a Delphi^ Round 2 response has been higher than that of Round 1. For those of you who have partaken i n Rounds 1 and 2 of t h i s study as well as those of you who have been unable to, I strongly urge you to p a r t i c i p a t e i n Round 3. This i s the f i n a l round i n t h i s unique experience and your p a r t i c i p a t i o n w i l l benefit the entire U„B.C. Department of Paediatrics, as well as each one of you i n d i v i d u a l l y by: 1) i d e n t i f y i n g the t o t a l number of f u l l - t i m e f a c u l t y manhours that need to be allocated towards each of the department "objectives" 2) c l a r i f y i n g areas of agreement and disagreement upon department "objectives" 3) i d e n t i f i c a t i o n of those "primary a c t i v i t i e s " which are necessary for achieving department objectives 4) evaluating "objectives" i n terms of t h e i r r e l a t i v e p r i o r i t i e s to each other 5) the c l a r i f i c a t i o n of objectives, the i d e n t i f i c a t i o n of p r i o r i t i e s and primary a c t i v i t i e s , as well as the a l l o c a t i o n of manhours to- these objectives, w i l l provide an excellent "data" base on which the planning and a l l o c a t i o n of resources to current and future departmental a c t i v i t i e s can be made over/ 110 6) F i n a l l y , next year i s "The Year of the Child" and apparently the W.II.O. w i l l be requesting within the next few months the p o l i c i o s of organizations that are involved with the care of children. The r e s u l t s of t h i s study should bo most h e l p f u l i n formulating t h i s p o l i c y . Therefore, for the reasons mentioned above, 1 urge a l l of you to p a r t i c i p a t e i n t h i s f i n a l round. Once again, I want to emphasize that your r e p l i e s s h a l l remain c o n f i d e n t i a l and w i l l not be released i n any i d e n t i -f i a b l e form to your colleagues, supervisors, or department chairman. I would l i k e to arrange an appointment v/ith you to discuss and complete the enclosed Delphi Round 3 Questionnaire, within the next Ik days. I f t h i s i s not convenient for you, please complete the survey form and return i t to me, i n the enclosed, s e l f addressed envelope by May 3 1 , 1 9 7 7 . I w i l l be most g r a t e f u l i f you -.Till a s s i s t me i n Round 3 of t h i s study. I f you have any further questions, please f e e l free to contact me anytime at Yours r e s p e c t f u l l y , Keith Loughlin "DELPHI" QUESTIONNAIRE' U.B.C. DEPARTMENT OF PAEDIATRICS ROUND 3 hours to each o b j e c t i v e . Examples 1 and 2 s'. Importance Scale S c a l e r e f e r e n c e D e f i n i t i o n s Very important A most relevant p o i n t F i r s t order p r i o r i t y Important Is a r e l e v a n t p o i n t Second order p r i o r i t y Somewhat Important May be a r e l e v a n t p o i n t t h i r d order p r i o r i t y .. Unimportant I n s i g n i f i c a n t l y r e l e v a n t Low p r i o r i t y Not a t a l l Important No relevance No p r i o r i t y Please use the "Importance Scale" shown above to choose a number which repre-sents your e v a l u a t i o n of each o b j e c t i v e f o r i t s importance to the e n t i r e Department of P a e d i a t r i c s . Id help c l a r i f y t h i s procedure.. D e f i n i t i o n and Examples of A c t i v i t i e s Code d e f i n i t i o n s Examples T Teaching (curriculum development, prepar-a t i o n f o r , and i n s t r u c t i o n of students, p a t i e n t s may bo present but f o r demon-Conducting l a b s , l e c t u r e s , seminars. P r e p a r a t i o n f o r l a b s , l e c t u r e s , seminars. Developing and s c h e d u l i n g s t r a t i o n purposes only) courses. M Medical care o:: p a t i e n t s (with or without students present and p r i v a t e p r a c t i c e ) Rounds where medical care i s g i v e n . C o n s u l t a t i o n s , s u r g i c a l or o b s t e t r i c a l procedures. R Research (with or without students present) Benchwork, w r i t i n g p r o p o s a l s , w r i t i n g up r e s u l t s , a t t e n d i n g research committei meetings A H o s p i t a l or U n i v e r s i t y a d m i n i s t r a t i o n S e r v i c e on h o s p i t a l or c l i n i c a l committees, attending promotion and tenure meetings. 0 S e l f education, s e r v i c e to your own p r o f e s s i o n , s a b b a t i c a l s , s e r v i c e to outside agencies through p r o v i s i o n of e x p e r t i s e Keeping up with the l i t e r a t u r e . S e r v i n i on a d v i s o r y boards and c o u n c i l s , a t t e n d i n g p r o f e s s i o n a l s o c i e t y meetings Please una the " D e f i n i t i o n of A c t i v i t i e s c h a r t shown above to s e l e c t the a c t i v i t y which "ou f e e l i s of primary importance to a c h i e v i n g a s p e c i f i c o b j e c t i v e . Example 2 on the f o l l o w i n g page should help to c l a r i f y t h i s procedure. T h e ' c i r c l e to the r i g h t represents the total'manhours that a l l f u l l time f a c u l t y members of the Department of P a e d i a t r i c s can devote to the a c t i v i t i e s necessary to achieve the o b j e c t i v e s that ire r e l e v a n t to the e n t i r e department. From rounds 1 and 2 i t •has become c l e a r that the Department of P a e d i a t r i c s has 6 g l o b a l o b j e c t i v e s . These inclu d e Q u a l i t y of Care, Teaching, Research, Levels of Care, Community, and i n t e r n a l department o b j e c t i v e s . IJo'v would you please d i v i d e the c i r c l e i n t o percentage proportions of t o t a l f u l l time f a c u l t y manhours which represent the amounts of time which you f e e l are necessary to achieve each of the 6 g l o b a l o b j e c t i v e s l i s t e d below. Indicate on the l i n e s below Global Objectives of the Department of P a e d i a t r i c s Q u a l i t y of Care Teaching Research Levels of Core Community I n t e r n a l Department In the fourth box to the r i g h t of each o b j e c t i v e please i n d i c a t e your choice of the number from the "importance s c a l e " above which, represents "your evaluation of the importance of that o b j e c t i v e to the e n t i r e U.B.C. Department of P a e d i a t r i c s . The other boxes i n d i c a t e the group r a t i n g and.your own r a t i n g from round 2. Please c i r c l e the appropriate l e t t e r which represents the a c t i v i t y which you f e e l i s primary f o r achieving the s p e c i f i c o b j e c t i v e . F i n a l l y i n the box to the f a r r i g h t of each o b j e c t i v e i n d i c a t e the percentage of t o t a l f u l l time f a c u l t y manhours which you f e e l should be devoted to that o b j e c t i v e . A l l o c a t e t h i s time as a percentage pr o p o r t i o n of 100 percent. Department of P a e d i a t r i c s O b j e c t i v e s "Mean" Group Evalu-a t i o n Round 2 Group range Round 2 Your evalu-ation Round 2 Your Please c i r c l e the l e t t e r new below, which i n d i c a t e s the ev.ilu- primary a c t i v i t y f o r at:'.on ac h i e v i n g that o b j e c t i v e "Mode" Group Sel e c -t i o n Round 2 Your Selec-t i o n Round 2 Indicate % of t o t a l dept. man-hours devoted t o each o b j e c t i v e QUALITY OF CARE OBJECTIVES Improve the q u a l i t y of care by: 20*\ 1. S e t t i n g an example of doing i t ourselves 2. P r o v i d i n g adequate environ-ment and f a c i l i t i e s 3. Having more nurses on p a e d i a t r i c wards 4. Having chart reviews Comments or other o b j e c t i v e s r e l a t i n g  Please give a reason i f your new r a t i n g i s more than one whole number away from the group mean i n e i t h e r d i r e c t i o n : re: #3 More nurses do not n e c e s s a r i l y improve the q u a l i t y of cars:, however more experienced nurses i n p a e d i a t r i c sub s p e c i a l t i e s would improve the q u a l i t y OJ : care. * 20 Taken from Example 1, where 20% of t o t a l f u l l time f a c u l t y manhours are a l l o c a t e d t o Q u a l i t y of Care o b j e c t i v e . LD Q T © R A 0 [ M • 60 % R B LU j^ rj T M R © 0 3 • 15 Q. •o t i l j~2~j T ' M R © 0 • 15 % • R A 0 M 10 % q u a l i t y of care TOTAL 100 % Your r e p l i e s w i l l remain anonymous, and w i l l not be r e l e a s e d . i n any i d e n t i f i a b l e form to your colleagues, s u p e r v i s o r s , or department chairman. I would l i k e to arrange an appointment with you, to discuss and complete t h i s form w i t h i n the next 14 days. However, i f t h i s i s not p o s s i b l e , please return the completed form i n the enclosed s e l f - a d d r e s s e d envelope by May 31, 1977. If you have any questions regarding t h i s form, please f e e l -free to°contact me anytime at 936-5622. Now please proceed and complete t h i s survey form. Name H J—• Part A. The c i r c l e to the r i g h t represents the t o t a l manhours that a l L f u l l time f a c u l t y members of the Department of P a e d i a t r i c s can devote to the a c t i v i t i e s necessary to achieve the ob j e c t i v e s that are relevant t o the e n t i r e department. From rounds 1 and 2 i t has become c l e a r that the Department'of P a e d i a t r i c s has 6 g l o b a l o b j e c t i v e s . These inclu d e Quality- of Care, Teacnmg, Research, Levels of Care, Community and I n t e r n a l department o b j e c t i v e s . Mow would you please d i v i d e the c i r c l e i n t o percentage proportions of t o t a l f u l l time f a c u l t y manhours which represent th-; amounts of time which you f e e l are necessary t o acnieve eac of the 6 g l o b a l o b j e c t i v e s l i s t e d below. M ON Department of P a e d i a t r i c s O b j e c t i v e s QUALITY OF CARE OBJECTIVES Improve the q u a l i t y of care by: 1. S e t t i n g an example of doing i t o u r s e l v e s 2. P r o v i d i n g adequate environ-ment and f a c i l i t i e s 3. C a r i n g f o r .the p a t i e n t as. a whole (not only s p e c i f i c parts) Having more nurses on p a e d i a t r i c wards Group Your Evalu- Group evalu-ation range a t i o n Round Round Round 2 2 2 1.1 1.7 1.5 2.1 • 0 • 0 • 0'0 5. Having chart reviews 6. Developing methods to monitor care 7. Reviewing the l i t e r a t u r e and f i n d i n g out what other people are doing i n t h i s area . Doing long term f o l l o w up s t u d i e s of t r e a t e d people 2.6 1.8 1.5 2.0 ".'-'.ode" Group " Your Your Please c i r c l e the l e t t e r S e l e c - Selec-<> (•.•.•; be lew which i n d i c a t e s the t i o n ; t i o n c v a l u - , primary a c t i v i t y f o r Round Round a t i o n a c h i e v i n g ' t h a t o b j e c t i v e 2 2 • • • • • • • • I n d i c a t e % o f t o t a l dept. man-hours devoted to each o b j e c t i v e T M R A 0 T M R A 0 T M R; A 0 T M R A 0 T M R A 0 M . R A O T M R A 0 T M R A 0 0 0 • O 0 • 0 0 :0 0 0 0 0 0 0 0 0 0 0 0 0 o researcher! use only -o Department of P a e d i a t r i c s O b j e c t i v e s "Mean" Group Evalu-a t i o n Round -> Group range Round Your evalu-a t i o n Round 9 Your Please c i r c l e the l e t t e r .•,jw below v/hich i n d i c a t e s the svalu- primary a c t i v i t y f o r at.1 on achieving" t h a t o b j e c t i v e QUALITY OF CARE OBJECTIVES (Cont'd) improve "the'quality of care by: 9. Constant review of what i s being done i n the Department of P a e d i a t r i c s 10.. Developing a l e v e l of care which corresponds to that which can be f e a s i b l y developed i n other areas of B r i t i s h Columbia 11. E v a l u a t i n g the p r a c t i c e of medicine through the use of educational techniques and b e h a v i o r a l m o d i f i c a t i o n 1.9 1-3 2.7 1-5 • • 2.8 1-5 • • • "Mode Group Selec-t i o n Round 2 Your Selec-t i o n Round 9 I n d i c a t e % c f t o t a l dept. man-hours devoted t o each o b j e c t i v e M,T 0 • • • • Comments from Round 2: al s o , i f your e v a l u a t i o n i n Round 3 i s mere than one whole number away from the group mean, please state your reason i n the space below. T o t a l 100 % #3 More nurses do not n e c e s s a r i l y improve.the q u a l i t y of care, however more experienced nurses i n p a e d i a t r i c sub s p e c i a l t i e s would improve the q u a l i t y of care. _ . #10 We should develop a l e v e l of care, that i s higher, than i n other areas of B r i t i s h Columbia. #2 & 4 These o b j e c t i v e s are p a r t l y beyond my c o n t r o l . Department of P a e d i a t r i c s O b j e c t i v e s Group Your Evalu- Croup evalu-a t i o n range a t i o n Round Round Round 2 2 2 TEACHING OBJECTIVES To i n s t r u c t : .1.' I l e d i c a l students i n the b a s i c fundarr.<2nr.als of p a e d i a t r i c s 2. Medical students i n the p r o v i s i o n of safe p a e d i a t r i c care and to kr.cv; t h e i r , l i m i t a t i o n s The education of: 3. Undergraduate medical students i n academic p a e d i a t r i c s 4. Graduate medical students i n academic p a e d i a t r i c s 5. Undergraduate medical students , i n c l i n i c a l p a e d i a t r i c s 6. Graduate medical students i n . c l i n i c a l p a e d i a t r i c s 7. Nurses and para medical personnel in. p a e d i a t r i c h e a l t h problems 8. A l l other h e a l t h care d e l i v e r e r s ( i . e . . H o s p i t a l Administrators) about p a e d i a t r i c h e a l t h problems 1.1 L 0 4 1.6 1.4 1.3 1.3 2.1 2.1 0 0 0 0 0 0 0 O 0 0 0 0 0 O 0 0 Your new ev a l u -a t i o n .Please c i r c l e the l e t t e r , below which i n d i c a t e s the primary a c t i v i t y f o r a c h i e v i n g t h a t o b j e c t i v e "Mode" Group . Se l e c -t i o n Round 2 Your Sel e c -t i o n Round 2 I n d i c a t e % of . t o t a l dept. man-hours devoted t o each o b j e c t i v e 0 T 11 R A 0 0 ; 0 researcher's use only 0 T M R A 0 0 • 0 0 M R A 0 0 : 0 0 \ 0 . T M R A 0 0 : 0 0 M R A 0 0 •'• 0 0 T ' M R A 0 0 i o -0* 0 T M R A 0 0 ; •0 0 T M R A ' • 0 0 0 0 ' t—1 M VO Department of P a e d i a t r i c s O b j e c t i v e s •'Mean" Group Evalu-a t i o n Round 2 Your Group evalu-rar.ge a t i o n Round Round 2 2 TEACHING OBJECTIVES (Cont'd) 10. 11. 12. 13. 14. 15. J o i / l i a t c" i n t he Dopart . - . G n t of P a e d i a t r i c s are teaching undergraduate medical students f o r •To decide i f the Department of P a e d i a t r i c s should be teaching f a m i l y p r a c t i t i o n e r s Tc provide c o n t i n u i n g medical education f o r p r a c t i c i n g p h y s i c i a n s o u t s i d e the u n i v e r s i t y To put the i n s t r u c t i o n a l emphasis or. "general p a e d i a t r i c s " with ;-(third-year undergraduate medical 'students The i n t r o d u c t i o n of s u b - s p e c i a l t y i n s t r u c t i o n to medical students i n f o u r t h . y e a r The u t i l i s a t i o n c f p r a c t i c i n g p h y s i c i a n s to i n s t r u c t under-graduate medical students Emphasize many more small group d i s c u s s i o n s (5 or 6) on s p e c i f i c t o p i c s i n s t e a d of grand rounds 1.9 2.2 1.9 3.4 0 • 0 • 3 • 2.3 3.0 1.8 0 • "Mode" Group Your cur Please c i r c l e the l e t t e r S e l e c - S e l e c - I n d i c a t e % o f ew below which i n d i c a t e s the t i o n t i o n t o t a l dept. ir.an-v a l u - primary a c t i v i t y f o r Round Round hours devoted t o t i o n a c h i e v i n g ' t h a t o b j e c t i v e 2 2 each o b j e c t i v e • • • • • • T M R A O T M R A O T M ' R A 0 T M R A 0 T M R A O T M R A 0 T M R A 0 • • • • • • • • • • • • • O Department of P a e d i a t r i c s O b j e c t i v e s Group Your Evalu- Group evalu- .Your, a t i o n range a t i o n new .Round Round Round' c v a l u -2 2 - 2 n t i o n TEACHING 03JECTIVES (Cont'd) 16. To encourage students to think about preventive measures such as n u t r i t i o n and e x e r c i s e , and de-err.phasize the b i z a r r e or • c r i s i s i n c i d e n t s 1.7 B Q • Please c i r c l e the l e t t e r below which i n d i c a t e s the primary a c t i v i t y f o r a c h i e v i n g that o b j e c t i v e Group Selec-t i o n Round 2 Your Selec-t i o n Round 2 I n d i c a t e % of t o t a l dept. man-hours devoted t o each o b j e c t i v e • • • T o t a l Comments from Round 2: a l s o i f your eva l u a t i o n i n Round 3 i s mors than one whole number away from the group mean, please s t a t e your reason Ln the space below. 100 % #3 and 4, Education does not imply l e a r n i n g . Education i s l s c t u r e s ; e t c . items 3-6 should concentrate on t h i s #3 - 6, C l i n i c a l and academic p a e d i a t r i c s cannot be separated, they go on at the same time Various l e v e l s of p a e d i a t r i c teaching should be i n t e g r a t e d . Learning i s g e t t i n g i n v o l v e d , doing, p a r t i c i p a t i n g Department of P a e d i a t r i c s O b j e c t i v e s Group Year Evalu- Group evalu-a t i o n range a t i o n Round Round Round 2 2 2 •RESEARCH OBJECTIVES Research: 1. * V.'hich r e l a t e s d i r e c t l y to c l i n i c a l medicine 2. In c h i l d development In c h i l d d i s e a s e prevention 4. Which r e l a t e s d i r e c t l y to improving p a t i e n t care 5. On normal c h i l d r e n as compared to abnormal c h i l d r e n 6. P h y s i o l o g i c a l r e s e a r c h on normal c h i l d r e n 7. Biochemical r e s e a r c h on 'normal c h i l d r e n 1.5 1.9 1.2 1.4 2.3 2.0 2.0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 ">-:bde" Group Your 'our Please c i r c l e the l e t t e r . S e l e c - S e l e c - I n d i c a t e % of ..ew . below which i n d i c a t e s the t i o n t i o n t o t a l dept. man- -•.valu- primary a c t i v i t y f o r Round Round hours devoted to .tion a c h i e v i n g t h a t o b j e c t i v e 2 2 each o b j e c t i v e • researcher's use only 0 > M R A O A T • M R A O M R A O M R A 0 T M R A 0 0 0 0 0 •• 0 0 0 : o - 0 R ; 0 . • 0 R 0 0 0 ; o 0 0 0 r—1 Department of P a e d i a t r i c s O b j e c t i v e s RESEARCH OBJECTIVES (Cont'd) Research: 8. Of an i n t e r d i s c i p l i n a r y nature, the involvement of non-medical ' d i s c i p l i n e s i n j o i n t research p r o j e c t s f o r the improvement of c h i l d health 9. Which looks at s t r a t e g i e s of d i s e a s e management i n terms of c o s t e f f e c t i v e n e s s 10. Into patterns of c h i l d r e n ' s h e a l t h 11. In the o r g a n i z a t i o n of h e a l t h care d e l i v e r y ( p a r t i c u l a r l y c h i l d r e n ' s ) a t the r e g i o n a l , p r o v i n c i a l and n a t i o n a l l e v e l 12. In contemporary and p r o v i n c i a l h e a l t h problems r e l a t i n g to c h i l d r e n 13. Into Icr.g term e f f e c t s of t r e a t -ment processes to c h i l d r e n i n t h e i r l a t e r vears 14. Each s u b - s p e c i a l t y contributes to b a s i c r e s e a r c h Mean Group Your Evalu- Group evalu-a t i o n range a t i o n Round Round Round 2 2 2 1.8 2.4 2.1 2.0 2.0 1.5 2.1 0 • 0 0 0 0 0 0 0 0 0 0 0 0 J Moce Group Your four Please c i r c l e the l e t t e r S e l e c - Selec-aew below which i n d i c a t e s the t i o n t i o n e v a lu- primary a c t i v i t y f o r Round Round ation a c h i e v i n g t h a t o b j e c t i v e 2 2 I n d i c a t e % of t o t a l dept. man-hours devoted to | j T ' M R A 0 • : 0 o 0 | | T. M R , A 0 0 0 0 | | M T R A O 0 0 | | T M R A O . 0 • / o | | T M R A 0 0 0 '• 0 | | T M ' R A 0 R ' 0 0 0 M R A 0 0 Department of P a e d i a t r i c s Obj e c t i v e s ""Mean" Group Evalu-a t i o n Round 2 Group range Round 2 • Your evalu-a t i o n Round 2 RESEARCH OBJECTIVES (Cont'd) Research: 15. Each s u b - s p e c i a l t y c o n t r i b u t e s to c l i n c i a i research 16. The area c f research i s the r e s p o n s i b i l i t y of the i n d i v i d u a l , however, support f o r i t should be provided by the Dapt. of P a e d i a t r i c s 17. B a s i c research areas determined by the Department .18. F i n d and s t i m u l a t e the a p p l i c a t i o n of methods by which people w i l l be-come more concerned about t h e i r p e rsonal h e a l t h 19. Provide f a c i l i t i e s and a s t i m u l a t i n g environment f o r high q u a l i t y b a s i c and a p p l i e d research r e l a t e d to p a e d i a t r i c s 1.7 2.1 3.8 2.2 1.4 0 • 0 • 0 • • & • . Vour Please c i r c l e the l e t t e r :iew below which i n d i c a t e s the evalu-, primary a c t i v i t y f o r .'ation a c h i e v i n g t h a t o b j e c t i v e "Mode" Group Selec-t i o n Round 2 Your Selec-t i o n Round 2 I n d i c a t e % of t o t a l dept. man-hours devoted to each o b j e c t i v e | | T M R A 0. • • . • [ | ' •,T M R A 0 R • • R A O R • • | | T M R A ; 0 | R | • | | T M R A | 0 R • • ro Department of P a e d i a t r i c s O b j e c t i v e s RESEARCH OBJECTIVES (Cont'd) Research: Group Evalu-a t i o n Round 9 Group range Round 2 Your evalu-a t i o n Round 2 Your Please c i r c l e the l e t t e r new. below which i n d i c a t e s the 2 v a l u - primary a c t i v i t y f o r ation a c h i e v i n g t h a t o b j e c t i v e Group S e l e c -t i o n Round 2 Your Se l e c -t i o n Round 2 Ind i c a t e % of t o t a l dept. man-hours devoted t o each o b j e c t i v e 20. Research i n t o the r o l e of environmental f a c t o r s on the development of disea s e s t a t e s , (both p s y c h o s o c i a l and organic). 21. Encourage increased research i n neonatal and i n f a n t pharmacology 1.6 2.0 0 0 - 0 0 0 ' • M 0 0 . 0 0 0 0 Comments from Round 2: a l s o i f your eva l u a t i o n i s more than one whole number away from the group mean please s t a t e your reason i n the space below. TOTAL 10 0. re: #16 and 17, These can only be marked true or f a l s e #20 and 21, Research teams can be u s e f u l l y developed i n conjunction with other departments (i.e., pharmacology, biochemistry, biomedical engineering) # 1 and #4, These are the same th i n g . # 5,6,and 7, These are the same things, i t would be nice to do research on normal c h i l d r e n , however there are e t h i c a l c o n s t r a i n t s , furthermore the department does not have the resources, t o do t h i s type.of research ro Department of P a e d i a t r i c s O b j e c t i v e s Group Evalu-a t i o n Round o LEVELS OF CARE OBJECTIVES P r o v i s i o n f o r : 1. Primary care on a c o n s u l t a t i v e b a s i s only 2. The t o t a l r e h a b i l i t a t i o n of c h i l d r e n with mental, p h y s i c a l or emotional handicaps through comprehensive education and p h y s i c a l assessments of the c h i l d ' s needs i n order to a s s i s t the c h i l d , become a s e l f -supporting w e l l adjusted adult 3. Improve and strengthen ambulatory primary care, through strong . l e a d e r s h i p i n t h i s area 4. C l o s e r involvement between the Department of P a e d i a t r i c s and other departments ( i . e . , Health S e r v i c e s Planning) i n the. d e l i v e r y of h e a l t h s e r v i c e s to c h i l d r e n 5. The d e l i v e r y of primary care 6-. The d e l i v e r y of secondary care 7. The d e l i v e r y of t e r t i a r y care 2.7 1.5 1.9 Your Group eva i range a t i o Round Roun 2 2 0 ' • 0 • 0 o 1.8 1-3 2.1 1-3 1.5 1-3 1.3 1-3 ew valua-t i o n Mode Group Your Please c i r c l e the l e t t e r S e l e c - Selec-belcw which i n d i c a t e s the t i o n t i o n primary a c t i v i t y f o r Round Round ac h i e v i n g t h a t o b j e c t i v e 2 2 I n d i c a t e % of t o t a l dept. man-hours devoted to each o b j e c t i v e _researcher' s use only 0 0 0 0 0 T M R A 0 T M R A 0 0 0 o 0 o 0 0 .'T M R . • A , Q LA_ M R A 0 K M R A . d M M R A 0 0 ro ON Department of P a e d i a t r i c s O b j e c t i v e s LEVELS OF CARE OBJECTIVES (Cont'd) P r o v i s i o n f o r : 8. A c t i o n as a group of experts to meet the needs of diagnosis and treatment of con d i t i o n s beyond the e x p e r t i s e of most ph y s i c i a n s Mean Group Evalu-a t i o n Round 9 Group range Round 2 • Your evalu-a t i o n Round 9 1.5 B • Your Please c i r c l e the l e t t e r :ow below which i n d i c a t e s the •svalu- primary a c t i v i t y f o r ation a c h i e v i n g t h a t o b j e c t i v e "Mode" Group Selec-t i o n Round 2 Your Selec-t i o n Round 2 Ind i c a t e % of t o t a l dept. man-hours devoted t o each o b j e c t i v e M H • • Comments from Round al s o i f your evaluation i n Round 3 i s mora than one whole number away from the group mean please state your reason i a the.space below. TOTAL re: #1, can only be marked true or f a l s e #1, we should provide primary care, i . e . , i f a p a t i e n t develops a.sore t h r o a t while under our care m h o s p i t a l #2, t h i s i s impossible to achieve #5, we should be involved i n primary care, but only i n a. teaching c a p a c i t y ' #3, strong l e a d e r s h i p does not make a d i f f e r e n c e i n primary ambulatory care, i t i s a p o l i t i c a l t h i n g . #1, i r r e l e v a n t ro 1 z Department of P a e d i a t r i c s O b j e c t i v e s i-.can Group atior. Round 2 Your Group evalu-range a t i o n Round Round 2 • 2 CO."_MU:;iTY OBJECTIVES 4 . 5. 6. 7. The education of members of the community i n matters of c h i l d h e a l t h and development 1.7 Provide i n f o r m a t i o n to members of the community on a l l matters r e l a t e d to chi l d h o o d i n the community and the j-, 2 | country Play a la r g e r o l e i n the o r g a n i z a t i o n ! I of the new C h i l d r e n ' s H o s p i t a l P" 4 1 To serve on l a y boards, by o f f e r i n g e x p e r t i s e i n c h i l d care matters Provide advice to the community regarding areas of concern i n both s i c k and w e l l c h i l d r e n Provide a d v i c e . t o various agencies • i ' i terms of f a c i l i t y planning f o r - c h i l d r e n The Department of P a e d i a t r i c s should act as a resource centre f o r i n d i v i d u a l s and groups i n v o l v e d w i t h c h i l d r e n 2.2 1.6 1.9 • • B B B B B B B B B B cur Please c i r c l e the l e t t e r ew below which i n d i c a t e s the v a l u - primary a c t i v i t y for. t i o n a c h i e v i n g t h a t o b j e c t i v e "Mode" Group Your S e l e c - Selec-t i o n t i o n I n d i c a t e % of t o t a l dept. man-Round Round hours devoted t o 2 2 each o b j e c t i v e • • • • • researcher's T • M R A O T ' M ' R A 0 T M R A 0 T M R A 0 T M R A T M R A O T M R n use only • • • • • R • • 0 • • • • • I\3 CD Department of P a e d i a t r i c s O b j e c t i v e s COMMUNITY OBJECTIVES (Cont'd) 8 . S t r e s s preventive aspects of medicine, through the general education of the p u b l i c , and i n areas of n u t r i t i o n 9. Demonstrate'new methods of care to the community 10. Demonstrate now needs of c h i l d r e n to the community Group Evalu-a t i o n Round 7 1.5 1.5 1.6 Your Group evalu- '.'.our range a t i o n new• Round Round cvalu-2 2 iiti'on Please c i r c l e the l e t t e r below which i n d i c a t e s the primary a c t i v i t y f o r a c h i e v i n g t h a t o b j e c t i v e Group Selec-t i o n Round 2 Your S e l e c -t i o n Round . 2 I n d i c a t e % of t o t a l dept. man-hours devoted to each o b j e c t i v e 1-3 1-3 . 1-3 • • • • M M-1.6' M R 11. Advise government and other bodies r e s p o n s i b l e f o r l e g i s l a t i v e programs which a f f e c t c h i l d h e a l t h and development Comments from. ROund 2: a l s o i f your e v a l u a t i o n i n Round 3 i s more than one whole number away from the group mean, please s t a t e your reason i n the space below, re: Community O b j e c t i v e s , involves other p r o f e s s i o n a l s i n t e r e s t e d i n c h i l d r e n B B : • B B B B B B B B . B • B TOTAL 10 0 • % ro Department of P a e d i a t r i c s O b j e c t i v e s INTERNAL DEPARTMENT OBJECTIVES 1. To gain more autonomy for the Department of P a e d i a t r i c s i n i t s r e l a t i o n s h i p s with the Greater Vancouver Regional H o s p i t a l D i s t r i c t and the Vancouver General H o s p i t a l 2. The s e l e c t i o n and t r a i n i n g of s p e c i a l i s t s and s u b - s p e c i a l i s t s i n t e r t i a r y and secondary care 3. To provide strong leadership with the F a c u l t y of Medicine, the U n i v e r s i t y and the community i n a l l areas r e l a t i n g to the development of the f e t u s , newborn, and i n f a n t s 4. To a t t r a c t t a l e n t e d attending, s t a f f (support f i n a n c i a l l y i f p o s s i b l e ) 5. To ensure a steady supply of the best teachers (teaching fellows 6. To embark on new programs only when i n d i v i d u a l s have expert-i s e i n the new program's area "Mean" Group Your Evalu- Group evalu-a t i o n range a t i o n Round Round Round 2 2 2 2.1 1.5 1.2 1. 4 1.5 2.5 0 • 0 0 0 0 1-2 1-2 0 0 0 o Group Your Please c i r c l e the l e t t e r S e l e c - S e l e c - I n d i c a t e % of below which i n d i c a t e s the t i o n t i o n t o t a l dept. man-primary a c t i v i t y f o r Round Round hours devoted to a c h i e v i n g t h a t o b j e c t i v e 2 2 each o b j e c t i v e researcher's . use only T M R A 0 T M R A O T M R A O T M R A .0 T M • R A 0 T M R A O 0 0 0 0 0 o 0 0 ' ' 0 0 0 0 0 o 0 0 0 0 o Department c f P a e d i a t r i c s O b j e c t i v e s "Mean" Group Evalu-a t i o n ' Round 2 INTERNAL DEPARTMENT OBJECTIVES (Cont'd) 7. The e f f i c i e n t a d m i n i s t r a t i o n and use of manpower 8.- The e f f i c i e n t a d m i n i s t r a t i o n and use of p u b l i c and voluntary funds 0 0 9. >;?..:. L : \ i: .: •„ : ..: ._• - c o i i l o witl'iin the F a c u l t y c f Medicine i n l i g h t of the f a c t o r s that p a a d i a t r i c s i s a l i t t l e u n c e r t a i n of i t s f u t u r e d i r e c t i o n s , and furthermore general p r a c t i t i o n e r s are r e a l l y not tha t w e l l equipped i n d e a l i n g with the h e a l t h problems of c h i l d r e n 10. Aim a t being the :'best" department i n the F a c u l t y of Medicine 11. Main t a i n an o b j e c t i v e s u r v e i l l a n c e of departmental teaching programs f o r strengths and weaknesses 0 0 1.5 12. 13. The development of an i n t e r d i s c i p l i n a r y auoroaoh to a l l c h i l d r e n whether s i c k or" w e l l 12.0 The development of t r a i n i n g programs re l a t e d ' t o . p a e d i a t r i c s in non-teaching h o s p i t a l s and community s e t t i n g s ( i . e . , the North) |1.9 Your Group evalu- Your range a t i c n new Round Round evalu-2 • 2 c t i c n 1-3 1-3 1-3 1-5 1-3 t-3 0 • o o 0 0 0 0 0 0 0 0 0 Group Your Please c i r c l e the l e t t e r S e l e c - S e l e c - I n d i c a t e % of be lev/ which i n d i c a t e s the t i o n t i o n primary a c t i v i t y f o r ac h i e v i n g t h a t o b j e c t i v e t o t a l dept. man-Round Round hours devoted t o each o b j e c t i v e T M , R . A O M R A 0 T M R A O T M R A O T M R A 0 0 0 0 0 0 0 0 o 0 0 0 • 0 R 0 0 M 0 0 M 0 0 Department c f P a e d i a t r i c s O b j e c t i v e s Group Your Evalu- Group e v a l u — Y Dur a t i c n range a t i o n n-:w . Round Round Round e /aiu-2 • 2 2 a ;ion INTERNAL DEPARTMENT OBJECTIVES (Cont'd) 14. The propagation of p r o p h y l a c t i c medicine 15. The development of comparative s t u d i e s between the U.B.C. Department of P a e d i a t r i c s and other p a e d i a t r i c departments i n Canada and other c o u n t r i e s 16. E s t a b l i s h good r e l a t i o n s h i p s with other U n i v e r s i t y departments which are i n v o l v e d with c h i l d r e n 17. S t r i v e f o r c l i n i c a l e x c e l l e n c e , except f o r some few i n d i v i d u a l s , the • o v e r a l l research e f f o r t i s h a l f -. hearted and i s not always w e l l advised i i i 7 1-4 • P.7 1.: 2.6 0 • 0 • 0 • Please c i r c l e the l e t t e r below which i n d i c a t e s the primary a c t i v i t y f o r a c h i e v i n g t h a t o b j e c t i v e Group Your S e l e c - S e l e c - I n d i c a t e % of t i o n t i o n t o t a l dept. man-Round Round hours devoted to 2 2_ each o b j e c t i v e T M R T. M R A 0 T. M R A O M R A 0 Comments from Round 2: #17, a l s o i f your ev a l u a t i o n i n Round 3 i s more than one whole number away from the group mean please state your reason i n the space below. • • • • • • • • • M,A| We should s t r i v e f o r excellence at a l l l e v e l s , what we t r y to achieve'depends on the a b i l i t i e s of each i n d i v i d u a l f a c u l t y member . ' • '-#8, This i s a Community o b j e c t i v e not an I n t e r n a l one.. #17, I s t r o n g l y disagree with" disbanding the research e f f o r t i n favour of c l i n i c a l e x c e l l e n c e , i n s t e a d we should strengthen the research e f f o r t s i g n i f i c a n t l y . #9,10 I r r e l e v a n t TOTAL 100 % Thank you f o r t a k i n g the time t o complete t h i s form. I f i t ~s not p o s s i b l e to arrange an interview w i t h i n the next 14 days, please r e t u r n your completed form i n the enclosed, self-addressed envelope by May 31st, 1977. 

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