Academic Faculty Practice Research Articles

Implementation of nursing services in community corrections: A community-academic partnership.

Persons who are incarcerated (PWAI) suffer from a disproportionately higher number of physical and mental health conditions. While most jails and prisons provide onsite healthcare, community correctional centers often do not and accessing community healthcare is challenging due to insurance issues, inadequate health literacy, mistrust, and long waits for appointments. A registered nurse-led wellness clinic provides a viable solution to addressing the healthcare needs of PWAI in a community correctional setting. Through a community-academic partnership between a college of nursing and two community correctional transitional centers for men, a registered nurse (RN) faculty member and nursing students provide onsite healthcare. Services include, but are not limited to, acute and chronic disease management, case management, healthcare navigation, and health education. In the first 2 years of operation, there have been 587 new resident health assessments, 882 RN visits, and 152 group education sessions. RN visits have been primarily for: connection to resources (42.6%), medication management (15.6%), and acute conditions (12%). A RN-led wellness clinic is an innovative way to address health needs for PWAI. While this model of care focuses on an academic RN faculty practice at community correctional centers it could be replicated across community settings.

Academic Nursing and Faculty Practice.

Many challenges are inherent in academic nursing, and additional unique challenges exist for faculty and nursing programs that simultaneously engage in or offer faculty practice. To date, little has been published on faculty practice and academic nursing outside of the mission of education. To describe faculty practice within the context of academic nursing as it pertains to scholarship and research, annual evaluations, promotion, support of faculty practice, and additional benefits and challenges. A convenience sample of faculty and administrators was surveyed from 6 different universities in the United States. A total of 25 faculty members and 11 administrators participated. Results indicate faculty practice offers both benefits and challenges to the noneducational aspects of academic nursing. The benefits and challenges should be carefully considered within the context of the future of academic nursing and faculty practice.

Reoperation rates for stress urinary incontinence and pelvic organ prolapse in women after undergoing Mid-Urethral sling with or without concomitant colporrhaphy in academic centers within the United States

In this study, the rates of reoperation for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women who underwent a mid-urethral sling (MUS) with or without concurrent colporrhaphy were evaluated. An academic faculty practice consortium database was used to identify a cohort of patients treated surgically for SUI with or without concurrent POP repair (apical, anterior, posterior, or a combination of the three) with or without hysterectomy between 2009 and 2011. A total of 20,484 patients matched the criteria. Of patients who underwent a MUS, 7.2% underwent secondary surgery, with a higher rate of 8.6% associated with those who underwent concurrent prolapse repair (Apical repair HR 1.84, p < .01; Anterior compartment repair HR 1.47, p < .01). Concurrent hysterectomy was associated with a lower hazard of secondary prolapse surgery (HR 0.48; p < .01) if the initial surgery involved a complete POP repair. Prolapse mesh repair resulted in a higher hazard of additional surgery (HR 1.43, p < .01). Medicaid insurance was also associated with an increased hazard ratio compared to commercial insurance for secondary surgery (HR 1.32, p < .01). For women undergoing MUS with complete prolapse repair, concurrent hysterectomy is associated with lower secondary surgery rates. Concurrent prolapse repair with mesh is associated with higher secondary surgery rates. Synopsis: For women undergoing MUS (mid-urethral sling) with complete prolapse repair, concurrent hysterectomy is associated with lower secondary surgery rates. Concurrent prolapse repair with mesh is associated with higher secondary surgery rates. Impact Statement What is already known on this subject? Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can present at the same time and negatively impact patients’ quality of life. There is little data regarding reoperation rates for patients who undergo both MUS and colporrhaphy in one setting. What do the results of this study add? This study found that patients who undergo concurrent MUS (mid-urethral sling) and complete POP repair with the addition of hysterectomy had a lower risk of secondary surgery. What are the implications of these findings for clinical practice and/or further research? Our data can be used by surgeons to counsel patients on the risks of re-operation for SUI for those who would like to undergo concurrent POP repair with or without hysterectomy.

Clinical placement challenges associated with radiography education in a low-resource setting: A qualitative exploration of the Ethiopian landscape

IntroductionClinical placements (CP) are of paramount importance in the learning and the acquisition of key competencies in terms of knowledge, skill and professional attributes required for clinical radiography practice. This study explored the challenges faced by radiography students and educators in relation to clinical placement and training in Ethiopia. MethodsA qualitative approach using focus group discussion and interviews were used to explore the experiences of students and educators, respectively, pertaining to challenges encountered in relation to the clinical placement of students across four university affiliated hospitals. Data obtained was analysed using a structured three step framework and the coding approach employed in a thematic analysis. ResultsParticipants comprise of third- and fourth-year undergraduate radiography students (n = 14) and educators [academic faculty (n = 7) and clinical practice educators (n = 8)]. Four main themes were identified, which relate to deficiencies of an existing training curriculum and its implementation strategies, inadequate resource and infrastructure within the CP environments and absence of advanced training opportunities. ConclusionThis research showed that there are many and varied challenges encountered by both students and educators in relation to CP and training of radiography students in Ethiopia. These challenges could potentially affect the future performance of students/practitioners and/or the appropriate application of the core clinical radiography skills and competencies in the world of work. Implications for practiceClinical radiography training in resource-limited settings will require urgent attention and support with modern infrastructure including simulation to augment their clinical development to acceptable standards.

A Heart Healthy Intervention Improved Tobacco Screening Rates and Cessation Support in Primary Care Practices.

We examined whether an evidence-based cardiovascular disease risk reduction intervention (Heart Health Now) would improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. Heart Health Now was a stepped wedge, stratified, cluster randomized trial for primary care practices that were staffed by 10 or fewer clinicians and had an electronic health record. The Heart Health Now intervention consisted of education tools, onsite practice facilitation for one year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. Our primary outcomes were practice-level rates of tobacco screening and tobacco cessation support-extracted from practices' electronic health records-and measured at pre-intervention and 6 months post-intervention. The 28 practices included in our analyses represented 78,120 patients and 17,687 smokers. Significant change occurred in practices' tobacco screening rates and cessation support rates over time. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2% (p < 0.001). Similarly, cessation support rates significantly increased from 44.3 to 50.1% (p = 0.03). Several practice-level factors were associated with improvement including being in an academic health center or faculty practice, having more clinicians, and having a lower percentage of White patients. In conclusion, a multi-component intervention focused on multiple cardiovascular disease risk reduction in multiple small primary care practices successfully improved rates of tobacco screening and cessation support.

Formalized Mentorship in Radiation Oncology: Bridging Existing Gaps in Mentorship

<h3>Purpose/Objective(s)</h3> The American College of Radiation Oncology (ACRO) Resident Committee offers a mentorship program to medical students, residents, and new practitioners. This program provides a unique opportunity to develop formal mentorship on a national level to bridge existing mentorship gaps. This abstract examined the perceived benefits of a formal mentorship program. <h3>Materials/Methods</h3> All applicants provided demographic information and specific mentorship need requests. Pairings occurred periodically based on a personalized pairing process. This year, due to COVID-19, all sessions were held virtually. A questionnaire was designed in Google Forms based on the Society for Women in Radiation Oncology (SWRO) annual survey to evaluate the mentorship program. Data were collected and analysis was conducted using JMP version 15(SAS Institute Inc, Cary, NC). <h3>Results</h3> Since June 2020, 78 individuals enrolled: 28 to become a mentor, 38 to become a mentee; 12 were interested in both. The mentor group consisted of radiation oncology residents (47.5%), academic faculty (40%) and private practice physicians (12.5%). 57.5% of the mentors were males and 4% associated with the LGBTQI+ community. Geographic distribution of mentors: 40% Midwest, 27.5% South/Southeast, 15% Northeast, 12.5% West Coast and 5% international. Among resident mentors, 58% were Junior (PGY1-3) and 42% were senior (PGY4-5) residents. Among mentees, 50% were residents, followed by medical students (46%) and new practitioners (4%). There were equal number of males and females. The geographic distribution was: 32% Midwest, 22% South/Southeast, 36% Northeast, 2% West Coast, and 8% international. The distribution across residency training years was: 57% Junior (PGY1-3) and 43% Senior (PGY4-5). The survey was sent out in January 2021 and we currently have 29/78, 37% response rate. This survey showed the most common method of communication was email (59%), followed by video call (52%) and phone (48%). 62% had at least 2 interactions since being paired. Both parties set up the interactions in 59% of pairs, followed by mentees being responsible in 24%. Mentors reported experiencing mutual respect (94%), a personal connection (67%), clear expectations (44%), and shared values (44%). Mentees similarly reported mutual respect (94%), shared values (76%), a personal connection (59%) and clear expectations (47%). 96% had mentor/mentee relationship outside ACRO program; however, 62% felt that a formal program is more beneficial than informal opportunities. <h3>Conclusion</h3> The results of our mentorship program highlight the continued interest and need for formal radiation oncology mentorship programs. The major strength of the program has been the high rates of interaction which is based on mutual respect, shared values and personal connection. Areas of future focus includes recruiting more new practitioners and private practice radiation oncologists to help enrich and diversify the mentorship program.

Playing Well With Others: The Challenge of Academic and Community Radiology Practice Integration.

OBJECTIVE. In this article, we review models for clinical integration across the full spectrum of radiologic services in merged health systems that include both academic and community practice components. We also discuss the issues involved in the integration of disparate practice models and reward systems for both the community radiology group and the academic faculty practice group. CONCLUSION. Although we see advantages to the current trends in mergers and acquisitions within academic radiology, it remains to be seen whether academic and community practice radiology groups can truly work and play well together.

Trends and Factors Associated With Physician Burnout at a Multispecialty Academic Faculty Practice Organization

Physician burnout is common, and prevalence may differ throughout a clinician's career. Burnout has negative consequences for physician wellness, patient care, and the health care system. Identifying factors associated with burnout is critical in designing and implementing initiatives to reduce burnout. To measure trends and identify factors associated with physician burnout. Survey study conducted from May 16 to June 15, 2014, and again from May 16 to June 15, 2017, measuring rates of physician burnout in a large academic medical practice. Factors associated with burnout out were evaluated. In 2014, 1774 of 1850 eligible physicians (95.9%) completed the survey. In 2017, 1882 of 2031 (92.7%) completed the survey. Medical specialty, demographic characteristics, years in practice, and reported rates of burnout. Burnout rates measured at 2 points and risk factors associated with burnout. Respondents included 1027 men (57.9%) and 747 women (42.1%) in 2014 and 962 men (51.1%) and 759 women (40.3%) in 2017. The mean (SD) number of years since training completion was 15.3 (11.3) in the 2014 survey data and 15.1 (11.3) in the 2017 data. Burnout increased from 40.6% to 45.6% between the 2 points. The increased rate was associated with an increase in exhaustion (from 52.9% in 2014 to 57.7% in 2017; difference, 4.8%; 95% CI, 1.6%-8.0%; P = .004) and cynicism (from 44.8% in 2014 to 51.1% in 2017; difference, 6.3%; 95% CI, 3.1%-9.6%; P < .001). Compared with midcareer physicians (11-20 years since training), early-career physicians (≤10 years since training) were more susceptible to burnout (odds ratio, 1.36; 95% CI, 1.05-1.77), while physicians in their late career (>30 years since training) were less vulnerable (odds ratio, 0.59; 95% CI, 0.40-0.88). Efforts to alleviate physician burnout and administrative burden require a combination of a shared commitment from physicians and organizations and central and locally implemented programs. Continued research is necessary to establish the most effective initiatives to decrease physician burnout at the individual and organizational level.

Accuracy of Routine Prenatal Genetic Screening in Patients Referred for Genetic Counseling.

The American College of Obstetricians and Gynecologists (ACOG) guidelines recommend routine prenatal screening for genetic diseases that could affect the pregnancy. We sought to determine the rate of missed genetic information in the general obstetrician's routine prenatal genetic screening process. This is a sequential case series of women referred for genetic counseling between March and August of 2015. Once identified, all women completed a personalized genetic history/exposure intake form (GHEF) created by our certified genetic counselors, followed by an in-person genetic counseling session with pedigree generation. The corresponding prenatal record was reviewed for genetic history obtained by the referring provider, most often utilizing the standardized ACOG prenatal intake form's genetic and family history sections. This information was then compared with that discovered in the GHEF and through the in-person genetic counseling session. Missed genetic information was defined as information discovered on the GHEF or during the in-person genetic counseling session which was not noted on the prenatal genetic screening document from the obstetric provider. Missing genetic information that lead to a change in clinical care, either through additional laboratory screening tests, fetal imaging or prenatal diagnostic testing through chorionic villus sampling, or amniocentesis was considered significant. We also assessed the study population as to maternal race, parity, and referral source. Statistical significance was assessed using Chi-squared testing with p < 0.05 identifying significance. A total of 299 patients underwent genetic counseling. Of them, 57.5% patients were referred from private providers, 28.1% from academic faculty practice, and 14.4% from a federally funded clinic. Missed genetic information was discovered in 171/299 (57.2%) of patients in the genetic counseling process. Of these 171 patients, 28.7% were identified via the GHEF and 52.6% during the in-person genetic counseling session. Of the 171 patients who had new genetic information discovered, 73 (42.7%) findings were significant. There was no statistical difference in patient race or referring office setting in the occurrence of new information found. In our population, genetic history obtained in the general obstetrician's office, regardless of practice type, missed genetic information in over half of cases with approximately 40% of that information leading to a subsequent change in clinical care. Developing a genetic intake form similar to our pregenetic counseling form, or modification/clarification of the "Family History and Genetic Screening" section within the standardized ACOG prenatal genetic history form, used at most practices in our region may decrease missed genetic information in the general obstetrician's office.

The Sternum-Nipple Distance is Double the Nipple-Inframammary Fold Distance in Macromastia.

Reduction mammaplasty is one of the most commonly performed plastic surgery operations. For a majority of techniques, the most common long-term complication is pseudoptosis. It has previously been proposed that upper breast suspensory ligaments (SL) are weaker than lower breast SL. We tested this hypothesis through anthropometry of the proxies for upper and lower SL strength: the sternal notch-nipple (SN-N) distance and the nipple-inframammary fold (N-IMF) distance, respectively. An institutional review board-approved retrospective review of patients undergoing reduction mammoplasty in an academic faculty practice between 2008 and 2015 was conducted. Patient demographics included age, race, and body mass index (BMI); patient comorbidities included smoking status, diabetes, and hypertension. Breast anthropometric measurements included SN-N and N-IMF. Sternal notch-nipple was used as the primary metric of the upper SL strength, whereas N-IMF was used as the primary metric of the lower SL strength. Intraoperative details included reduction technique and resection mass. Postoperative complications were recorded, including nipple areola complex necrosis and hematoma. Linear regression analysis was performed with the primary endpoint of the relationship between SN-N and N-IMF distance in macromastia. Data from 208 patients, totaling 400 individual breast measurements, were collected. The mean SN-N length was 35.1 cm, mean N-IMF length was 16.0 cm, and mean resection weight was 1094 g. Linear regression found that N-IMF distance could be predicted as 45% of the SN-N distance (N-IMF = 0.454 * SN-N). This was a strong relationship, demonstrated by univariate analysis of SN-N and N-IMF (R, 0.624; P < 0.001). A Wise pattern was used in 89.9% of cases; an inferior pedicle was used in 83.7% of cases. Nipple areola complex necrosis occurred in 15 breasts (3.75%). Sternal notch-nipple (R, 0.127; P = 0.011) and N-IMF (R, 0.119; P = 0.017) were both predictive of nipple areola complex necrosis (Table 4). In our series, the N-IMF distance increased 0.45 cm for every 1 cm increase in the SN-N distance. This relationship strengthens our primary hypothesis that the lower pole ligaments stretch at a significantly slower rate than the upper pole ligaments. Taking this into consideration, we suggest that surgeons seeking to minimize pseudoptosis rates should favor techniques that minimally disrupt the lower SL.

Perceptions of fecal microbiota transplantation for Clostridium difficile infection: factors that predict acceptance

BackgroundDespite the effectiveness of fecal microbiota transplantation (FMT) for treating recurrent Clostridium difficile (C. difficile) infection, some patients are reluctant to accept this therapy. Our study examined attitudes towards FMT and factors that contribute to patients’ acceptance of this treatment.MethodsWe distributed patient surveys at a Veterans Affairs hospital, a public hospital, and an academic faculty practice. Multivariable logistic regression was performed, adjusting for factors associated with FMT acceptance on univariate analysis and prior experience with C. difficile infection.ResultsOf 267 patients, only 12% knew of FMT prior to the survey, but 77% would undergo the procedure if medically indicated. On multivariable analysis, those with children and with college degrees or higher were more likely to agree to FMT (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.02-4.35; OR 2.27, 95% CI 1.11-4.60 respectively). Sixty-five respondents (71%) chose colonoscopy as the preferred vehicle for FMT, while nasogastric tube was least preferred. Disease transmission was the most common concern (30%, n=242), and FMT success rate was the least selected concern (9.1%).ConclusionsMost patients in a diverse sample of gastroenterology clinics had no prior knowledge of FMT, but were receptive to the procedure. Having children and higher education levels were predictors for FMT acceptance. Our findings suggest that barriers to FMT utilization may be overcome with counseling about safety concerns. More data on the risk of transmitting diseases or clinical characteristics, such as obesity, through FMT are needed and will be important for the acceptance of this procedure.

Finding the perfect doctor: identifying lesbian, gay, bisexual, and transgender-competent physicians.

We assessed the existence of procedures and policies for identifying lesbian, gay, bisexual, and transgender (LGBT)-competent physicians at US academic faculty practices, and sought to identify physician training programs that enhance LGBT competency. We invited all 138 Liaison Committee on Medical Education-accredited US academic faculty practices to participate in a survey in 2012. We systematically assessed their procedures and policies to identify LGBT-competent physicians and their LGBT-competency training. We also assessed geographic region, funding source, and an LGBT health center in the same state. We performed univariate, bivariate, and multivariate logistic regression analyses. The response rate was 50%. Few participants had existing procedures (9%) or policies (4%) to identify LGBT-competent physicians. Procedures included online directories with self-identified LGBT-competent physicians available to the public. Sixteen percent of participants reported having comprehensive LGBT-competency training, and 52% reported having no training. Of note, 80% of participants indicated interest to do more to address these issues. There exist both need and interest for US academic faculty practices to develop procedures, policies, and programs that improve access to LGBT-competent physicians and to train physicians to become LGBT-competent.

Essential Competencies in Nursing Education for Prevention and Care Related to Unintended Pregnancy

To identify the essential competencies for prevention and care related to unintended pregnancy to develop program outcomes for nursing curricula. Modified Delphi study. National. Eighty-five nurse experts, including academic faculty and advanced practice nurses providing sexual and reproductive health care in primary or specialty care settings. Expert panelists completed a three-round Delphi study using an electronic survey. Eighty-five panelists completed the first round survey, and 72 panelists completed all three rounds. Twenty-seven items achieved consensus of at least 75% of the experts by the third round to comprise the educational competencies. Through an iterative process, experts in prevention and care related to unintended pregnancy reached consensus on 27 core educational competencies for nursing education. The competencies provide a framework for curricular development in an important area of nursing education.

Clinical nurse leaders in the community: Building an academic faculty practice partnership

The Affordable Care Act (ACA) emphasis on preventive care and primary health has given community organizations and outpatient care environments renewed attention. Nursing has been offered the opportunity to lead healthcare into a new era. One of the two new nursing programs to be given life in this movement is the Clinical Nurse Leader (CNL). The CNL is a graduate level educated nurse who specializes in healthcare systems leadership, a facilitator of care in the complex healthcare environments of today. They are equipped to see the wider and broader perspective of things, assess needs, research the best interventions for problems identified, implement these interventions, and evaluate the processes and outcomes of the interventions. This paper describes the experience of a school of nursing and health professions and a community non-profit organization in developing a community faculty practice partnership allowing for CNL, nurse practitioner, and Doctorate of Psychology students to be placed at a community clinic serving high-risk patients. The Synergy Model of community partnership formation by Lasker and Weiss is used as the complimentary model to show how the CNL approach to a microsystem can be effectively adopted into the community setting with beneficial outcomes to both parties of the partnership.

The Perceived Impact of the Postgraduate Diploma in Higher Education and Training as an Academic Development intervention in an Institution of Higher Learning

Following mixed views in literature on the relevance and return on investment of formal higher education professional development initiatives, the current study sought the views of the impact of the Postgraduate Diploma in Higher Education and Training (PGDHET) on the professional practice of higher education staff in one institution. Framed in the interpretive paradigm, the study adopted a case study design in which multiple sources of data were utilised. Data were collected through an open-ended questionnaire from eleven (11) purposefully selected lecturers possessing a PGDHET qualification. The data was corroborated with a data analysis of PGDHET reports. Qualitative data thus collected was analysed through the extraction and aggregation of meaning units into themes. Quantitative data was used to discern and describe impact trends of the PGDHET. It emerged from the study that the PGDHET challenged lecturers’ conceptions of teaching and learning, and expanded their repertoire of innovative teaching strategies. Furthermore, participants reported contributions to advancement of departmental best teaching practices and the status of teaching institutionally. The conclusion drawn is that the PGDHET impacts beyond the lecture room as it influences also the academic development practices, faculty and departmental practices, as well as the overall culture of the institution. This research recommends ways of further consolidating and further advancing the impact of the PGDHET. DOI: 10.5901/mjss.2014.v5n11p157

Patterns of graduate students' information seeking behavior: a meta‐synthesis of the literature

PurposeThe purpose of this review is to draw out patterns of information seeking behavior of graduate students as described in the empirical research published from 1997 to the present.Design/methodology/approachA systematic search of databases for studies on information behavior and graduate students was employed in order to retrieve studies for a systematic review. Common themes that emerged from the literature were synthesized into a discussion of behavior patterns. Additionally a study quality analysis was conducted for all retrieved studies using a critical appraisal checklist for library and information research.FindingsThis review revealed that graduate students begin their research on the internet much like any other information seeker, consult their faculty advisors before other people, and use libraries in diverse ways depending on the discipline studied. Additionally differences were noted between international and home students, and doctoral and master's students.Practical implicationsThe findings of this review indicate that information behavior research conducted on graduate students should delineate between masters' and doctoral students. Further, the findings may inform both academic librarian and faculty practice as to how to assist students with their research by helping them to understand how students typically approach research and how other institutions address common issues with special populations, such as non‐native speakers and distance learners.Originality/valueNo comprehensive review of information behavior studies, encompassing only the behaviors of graduate students has been conducted to date.

Should an Academic Radiation Oncologist Be Allowed to “Opt Out” of Medicare?

Federal law permits physicians to "opt out" of Medicare. When a radiation oncologist chooses this option, he or she may neither bill nor collect from Medicare, but may legally attempt to charge and collect what he or she considers the value of services provided to Medicare-eligible patients. Many academic faculty practice plans permit members to opt out. Even if it is permissible for a radiation oncologist to opt out of Medicare, is it appropriate? The question raises significant ethical and economic issues as one attempts to balance the good of the individual faculty member against the good of the clinical faculty as a whole. In this commentary, the authors offer the principal arguments in favor of and against permitting a faculty radiation oncologist to opt out. They conclude by recommending broad faculty oversight over such decisions.

Outpatient Quality Improvement in Academic Faculty Practice Plans: Does it Exist?

The purpose of this study was to (a) investigate the extent to which academic faculty practice plans (FPPs) are currently involved in ambulatory care quality improvement (QI), (b) describe the structure of QI initiatives at outpatient FPPs, and (c) delineate facilitators and barriers to development of FPP outpatient QI initiatives. Members of the Steering Committee of the Group Practice Council of the University HealthSystem Consortium (UHC), representing the leadership of 88 FPPs, were asked to respond to a 38-item Web-based questionnaire during February and March 2003. The survey elicited information on the organizational characteristics of FPPs, their current degree of engagement in outpatient QI activities, and factors driving interest and barriers impeding efforts to conduct outpatient QI initiatives. Descriptive statistics for all variables of interest were performed. Responses were received from 33 participants believed to represent at least 28 of the total 88 FPP members of the UHC. Nearly all respondents indicated that some types of outpatient QI initiatives were currently taking place in their FPP. However, only 12% of respondents met 4 or more of the 6 criteria deemed to be essential to having a robust outpatient QI program. Among key QI indicators, one third of respondents reported that their FPP had a separate and distinct outpatient quality committee, and some one fifth had a budget for outpatient QI or financial incentives for outpatient clinics to engage in QI (or both). The majority of respondents stated that at least some departments in their FPP were collecting quality data. Most respondents reported that patient safety and external demand for outpatient QI were the "more important" factors driving QI efforts, whereas lack of human resources and other resources were the "more significant" barriers hindering QI initiatives. The results of the study suggest that, although FPPs showed a strong interest in outpatient QI initiatives, FPPs' efforts are still in an infancy phase and lag far behind inpatient performance measurement activities. Without appropriate resources, it appears unlikely that FPPs will be able to move the agenda forward to develop a quality culture and robust program of self-assessment and improvement in the outpatient setting.

Quality and customer service aspects of faculty practice

Quality and customer service are accepted as crucial components of the business world. Providing high quality in addition to customer-oriented service is equally critical in academic faculty practice. Key steps involve identifying customers (both external and internal) and researching and codifying needs. A customer-oriented faculty practice model is presented that serves all customers and meets provider needs. This model is built on recognizing the importance of personal ongoing customer relationships and accepting the constancy of change within the boundaries of service. Quality and customer service should reflect standards appropriate to nursing leaders, thus attending to and advancing the public view of nursing. Customer service is more than a sound health care business principle. Customer service also lives out the moral and ethical commitment made in the implicit contract in the care-giving encounter. It is the philosophy and framework inherent in nursing's social policy statement; therefore, these principles can be applied across all health care settings. Quality and customer service are accepted as crucial components of the business world. Providing high quality in addition to customer-oriented service is equally critical in academic faculty practice. Key steps involve identifying customers (both external and internal) and researching and codifying needs. A customer-oriented faculty practice model is presented that serves all customers and meets provider needs. This model is built on recognizing the importance of personal ongoing customer relationships and accepting the constancy of change within the boundaries of service. Quality and customer service should reflect standards appropriate to nursing leaders, thus attending to and advancing the public view of nursing. Customer service is more than a sound health care business principle. Customer service also lives out the moral and ethical commitment made in the implicit contract in the care-giving encounter. It is the philosophy and framework inherent in nursing's social policy statement; therefore, these principles can be applied across all health care settings. Nancy O. McNiel is an Associate Dean for Management and Associate Professor of Clinical Nursing at the University of Texas Health Science Center at Houston School of Nursing, Houston, TX. Thomas A. Mackey is Director, University of Texas Health Services and Professor of Clinical Nursing at the University of Texas Health Science Center at Houston School of Nursing, Houston, TX. Gwen D. Sherwood is an Executive Associate Dean and Professor at the University of Texas Health Science Center at Houston School of Nursing, Houston, TX.

Quality and customer service aspects of faculty practice

Quality and customer service are accepted as crucial components of the business world. Providing high quality in addition to customer-oriented service is equally critical in academic faculty practice. Key steps involve identifying customers (both external and internal) and researching and codifying needs. A customer-oriented faculty practice model is presented that serves all customers and meets provider needs. This model is built on recognizing the importance of personal ongoing customer relationships and accepting the constancy of change within the boundaries of service. Quality and customer service should reflect standards appropriate to nursing leaders, thus attending to and advancing the public view of nursing. Customer service is more than a sound health care business principle. Customer service also lives out the moral and ethical commitment made in the implicit contract in the care-giving encounter. It is the philosophy and framework inherent in nursing's social policy statement; therefore, these principles can be applied across all health care settings.