The Detailed Staffing Exercise (DSE) Approach
Initial Efforts

The first meeting of the other physician specialties panel was convened in April of 1990. The primary purpose was to determine whether the expert judgment panel process, as the study committee first conceived it, represented a viable means for determining physician staffing for these four physician specialties at individual VAMCs. This process required the development of staffing instruments that provide the panel with information about workload, about various nonphysician personnel that might be available to deliver care, and then, given that conditional information, to make judgments about what physician FTEE are appropriate to meet that workload, consistent with good-quality care. In preparation for the first panel meetings, staffing instruments were constructed for three actual VAMCs.

Focusing on the analysis of these instruments, study staff tested the feasibility of this process at the first meeting and found that it was generally acceptable, that panel members could render physician staffing judgments, but that they wished to have more detailed information about workload and other factors. The panel concluded that study staff should proceed with the expert judgment process, but that the staffing instruments should be modified in several specific ways:

  • subdivide workload into more homogeneous and exhaustive categories, distinguishing in greater detail the types of tests;

  • define workload in standardized terms whenever possible;

  • provide more descriptive detail about workload levels (e.g., number of patient admissions, number of patients, case mix, number of outpatient visits, as well as nursing and domiciliary patients);

  • specify relative incidence of new versus old patients;

  • for laboratory medicine, unweighted tests should be better defined (by noting the number in hematology, chemistry, microbiology, etc.) and the workload levels should reflect total tests performed in the facility, including not only the main but all satellite laboratories.

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