Annual Session Proceedings.
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Congresses as Topic↗
Biomedical subjects
David W Chambers
Publications and source records attributed to David W Chambers.
Development of a mission-focused faculty evaluation system.
The development of a new system for annual evaluation of faculty members is described. A narrative of the procedure, including accounts of the problems encountered, is used to show that such a process is too complex and too close to the fundamental identity of a dental school and the self-image of faculty members to be created in a one-time, rational effort or imposed by administrative edict. The process required five years to complete and involved an intermediate model. The goals of the new performance appraisal system were to minimize the extreme rating inflation and significant discrepancies from one chair rater to another that had existed previously. It was also a goal that the new system would create rich and effective feedback for faculty and would orient faculty members toward the mission of the school as a common focus. In achieving these goals, it is the authors' perception that faculty members at this dental school value procedural justice (fairness in the process), that evaluation is a political process, and that a performance appraisal system grounded in organizational mission rather than individual tasks of faculty members fits the emerging career model of knowledge professionals.
California↗
Righteousness and reason.
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Attitude of Health Personnel↗
The mumpsimus.
It is an unfortunate side of human nature, on occasion, to stubbornly refuse to change our minds or listen to evidence that challenges our beliefs. In the extreme form, such individuals are called mumpsimuses. This column describes what research has been able to tell us about why individuals continue to escalate their commitments to failing causes and why beliefs are so resistant to change, even in the light of reason. In fact, it is usually best to leave a sleeping mumpsimus lie.
Attitude↗
Errors.
Errors are outcomes or patterns of outcomes you don't want to see. They are basically of two types: those that occur naturally as rare outcomes of effective processes and those that signal that the process is not working. The error rate in American medicine is known to be alarmingly large; it has not been looked at in dentistry. A topology of error is presented and it is shown how understanding the conditions that cause error, and thus the prevention of error, can only be developed by recognizing and analyzing error itself.
Humans↗
The ethics of experimenting in dental practice.
Experiments, in the sense of novel actions taken with only a probable chance of success, are common in dental practice. Use of new materials or techniques learned in continuing education courses are examples. The grounds for ethically defensible experiments include (a) undertaken for the patient's sake, (b) within the standard of care, (c) having a reason for expected success, and (d) performed reflectively. A taxonomy of experiments is presented. The ethical context for this paper is discursive ethics, an approach that emphasizes the right of all affected to participate in mutual acceptance of the action.
Dental Research↗
Picking your patients.
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Dental Health Services↗
Why.
There are two kinds of cause and effect. The scientific notion that is taught as part of the formal model is rigorous, but often limited in its generalizability across situations. The study of cause and effect in natural settings is also a rigorous field, with several useful and easily applied techniques. Root cause analysis is a set of approaches to identifying the factors in natural settings that initiate a chain of events with outcomes of interest. It is easier to improve processes when their true root causes have been identified. Risk management is a special case of root cause analysis.
Causality↗
Agents.
Although health care is inherently an economic activity, it is inadequately described as a market process. An alternative, grounded in organizational economic theory, is to view professionals and many others as agents, contracted to advance the best interests of their principals (patients). This view untangles some of the ethical conflicts in dentistry. It also helps identify major controllable costs in dentistry and suggests that dentists can act as a group to increase or decrease agency costs, primarily by controlling the bad actors who damage the value of all dentists.
Clinical Competence↗
Introduction: Gies Report redux.
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Biochemistry↗
Measured success.
Some practices "wing it," some pick outcomes after the fact in order to look good. But neither of these approaches creates much confidence that next year will be okay, let alone better. Using measurement to improve practice requires understanding the interplay among mission, vision, core values, key success factors, and performance indicators. Combined intelligently, these five elements drive strategic planning and budgeting. They also lead to monitoring progress toward success. This is best done with a balanced scorecard that includes leading and lagging indicators of mission and vision. Indicators should be sampled to represent the practice and monitored against targets to propel the practice toward success.
Benchmarking↗
Debt and practice profiles of beginning dental practitioners.
Escalating student debt for dental education has led some to speculate that beginning practitioners may undertake procedures that are beyond their competence in an effort to augment practice income. This hypothesis was tested directLy using a data set containing self-reports of practice profiles across a wide range of procedures and debt for education, practice, and personal purposes. Respondents were 113 individuals who had graduated from a private dental school from 1986 to 1997. Conservative dental practice was measured by comparing frequency of commonly and uncommonly performed procedures in the group as a whole against the profile for each respondent. There was no association between educationaL debt and propensity to engage in unconventional procedures. Older dentists and those who felt more competent at the time of graduation were less conservative. Amount of practice debt was a better predictor of unconventional practice than was educational debt.
California↗
Work.
The very nature of work is changing because of rapid social change, a culture of abundance, and the ability to substitute information for equipment, inventory, and other material aspects of value creation. In America, we are experiencing an erosion of the concept of a "job," a dramatic shift to service and information as the basis for value added, market commercialism, and the importance of the self-managed career. In some of these areas, dentistry has been consistent with the patterns of innovation--even being a model in some cases. There are also areas where dentistry is moving in contrary directions.
Attitude of Health Personnel↗