Form 8 ED Director Interview Guide

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment I:

ED Directors Interview Guide

1. Interviewee Involvement

• What role did you play in rolling out this tool?

What level/type of participation did you have during the period that the EDT was being tested?

2. Impression of the Value, Strengths and Weaknesses of Tool and Guide

• What is your overall sense of how effective the Tool and Guide are likely to be in reducing ED use by frequent users?

• Do you feel the EDT (or either of its components) provided any added value to the care you provide?

  • If so, which parts of the tool appeared to have particular value and what is the nature of the value they add?

• Consider the Screening Tool:

  • Prior to implementing the EDT, did you try to identify patients at risk of revisits? If so, what method did you use?

  • To what degree did the Screening Tool improve your ability to efficiently identify those at greater risk of revisits?

• With regard to the UG:

  • How helpful was the UG in preparing your ED to address the needs of the patients identified through the screening process?

  • Did the UG cause you to make any changes in your processes prior to implementation of the EDT?

• Recommended interventions:

  • Prior to implementing the EDT, did you target specific interventions to patients who appeared to be at high risk of frequent revisits?

  • Overall, how well have the interventions outlined in the User’s Guide appeared to meet the needs of patients seen in your ED?

• Were there any unintended consequences, positive or negative, resulting from use of the EDT?

  • Did use of the EDT adversely affect patient flow/ ED length of stay?

3. Your Initial Impressions  

• What were your first reactions/initial expectations when you were introduced to the EDT?

• Was it immediately evident how it was to be used?

• What potential benefits did you anticipate?

• What challenges did you anticipate?

• Based on your initial impression, had you not already agreed to participate in the pilot study, would you have been interested in testing the tool in your ED?

4. Roll out/ Preparation for Initial Launch

• How was your staff first informed about the plan to use the tool in your ED?

• What steps did you take (if any) to ready your department for implementing the screening tool? Can you please provide some examples? (education/training? assignment of staff ?)

  • In hindsight, were there any additional steps you might have taken to better prepare?

  • Are there any characteristics of your ED that you feel made it more or less prepared to undertake the pilot test?

  • Who (# staff and position titles) from your staff had an explicitly assigned role in implementing or routinely using the screening tool)?

    • Did any staff need/ receive protected time to support their participation? (or was this function expected to be entirely handled by the RA?)

    • What were their reactions to being asked/expected to use the tool? (Did you encounter any initial staff resistance to the specific tasks expected of them)?

• What steps did you take (if any) to ready your department for utilizing the interventions that you selected for your screened patients?

  • How helpful were the decision trees in selecting the interventions that your unit would develop/ use for identified patients

  • Did you make any modifications to the recommended interventions from the User Guide prior to testing to accommodate specific characteristics/needs of your ED (e.g. Did you customize, enhance or modify the interventions outlined in the User’s Guide? What did that involve?)

  • Who (# staff and position titles) from your staff had a role in using the User Guide to prepare for implementation of the EDT?

    • What were their reactions to being asked/expected to use the Guide? (Did you encounter any initial staff resistance to the project or to the specific tasks expected of them)?

  • Who (# staff and position titles) from your staff had an explicitly assigned role in implementing the recommended interventions from the User Guide)?

5. Experience with Implementation:

With regard to the Screening Tool:

• How did implementation of the Screening Tool go?

  • (e.g., relative ease; understanding of roles; ability of staff to perform assigned roles)

  • Were there any unexpected costs or challenges? (e.g., unanticipated burdens on staff? issues of coordination? disruptions to existing work flow?)

• How did use of the screening tool affect existing work flow?

  • Was the use of the screening tool integrated into the existing work, or was it a separate function conducted only by the RA?

  • Did you have to make any formal or informal changes to work processes to accommodate any aspects of implementation?

• How did having an RA on site to administer the tool impact implementation?

  • Did having an RA fully eliminate any potential burden on hospital staff associated with use of the screening tool?

  • Did having an RA require unanticipated changes to work processes?

• Did you make any changes to the Screening Tool during implementation to accommodate specific characteristics or needs of your ED?

With regard to the User’s Guide:

• How and to what degree did the availability of the User’s Guide change work processes or decision-making for your staff?

• Did you make any changes to the recommended interventions from the User’s Guide during implementation to accommodate specific characteristics or needs of your ED

Overall

• Is there anything else about the experience of your hospital that would be helpful for me to know?

6. Suggestions for Improvement

• What modifications to the content or structure of the Screening Tool might you suggest to improve the value or usability of the EDT

  • Would you modify the risk factors that are captured?

    • Were there particular risk factors for which the tool was more/less helpful?

  • Are there parts of the tool that your staff found to be difficult/ confusing/ cumbersome to use?

• What changes to the content or structure of User’s Guide would you suggest?

  • Are there any enhancements you would recommend (e.g., interventions your unit uses that you would recommend including? Any other interventions or resources you suggest including in the Guide?)

1. Longer Term Value and Use

• How likely would you be to want to continue to use this tool (in whole or in part) in the future?

• Have there been/might there be any long term changes in what you do that result from this project?

• What are the factors that would motivate you to continue use of this tool in the future?

  • (If not raised in answering this question, probe for role of limited resources and competing priorities in influencing the decision)

• What level of success would the tool have to demonstrate to motivate your future use? (how would success be measured?)

• During the pilot test, an RA performed a task that would otherwise be performed by one or more persons on your staff

  • Would the absence of an RA to perform this task affect your decision-making about future use of the tool?

  • Were you able to judge from the pilot test what the additional burden on your staff would be and what workflow changes might be required if an RA were not available to perform this task

Conclusion: Do you have any concluding comments about the EDT?

Thank you for your time.

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