In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.
The authors describe the current dilemma facing academic health centers (AHCs) as they recruit department chairs. In the past, leaders at AHCs predominantly were concerned with fulfilling the esteemed tripartite missions of patient care, research, and education. Today, their time and energy are occupied by a different set of tasks that have a distinct business orientation, including winning contracts, enhancing revenue, reducing costs, recruiting and managing a diverse workforce, and dealing with consumer satisfaction and marketing. New visions and strategies must be developed--requiring different dimensions of leadership. The authors offer concrete recommendations for recruiting, retaining, and sustaining department chairs, and argue that a deliberative, thoughtful process of engaging chair candidates should begin by focusing on the candidates' values as a first priority. Candidates who most clearly share organizational values should then be engaged in an iterative process of developing a shared vision, resulting in a letter of agreement that explicitly states the mutual expectations and commitments of both the organization and the candidate. Once department chairs are in place, ongoing development through leadership training, mentoring, and other investments help to retain and sustain them.
While some patients expressed concern about confidentiality with telemedicine, the benefits of improved access and continuity of care were recognized, and overall satisfaction with telemedicine was high. These findings support the use of telemedicine as an acceptable health care delivery option for rural, underserved populations with sickle cell disease.
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