Form 1 Pre-post interview protocol

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

I. Pre/Post Interview Protocol

To be administered at the beginning and end of implementation by phone or in person.

Interviewer: ____________________

Date of interview: _______________

1. BASIC BACKGROUND

• Interviewer to fill in prior to the interview.

1. Hospital Name [XXXX e.g., St. Elizabeth’s]

2. Hospital System Name: [XXXX e.g., Trinity]

3. Stakeholder Group: [XXXX e.g., nurses, physicians, office staff]

4. Implementation Phase: [XXXX e.g., baseline, early, mature]

5. Main AHRQ QIs targeted

   1. For hospitals that provide only pediatric care:

      1. Main AHRQ PDIs targeted: [XXXX e.g., neonatal mortality rate]

   2. For hospitals that provide pediatric and adult care:

      1. Main AHRQ PDIs targeted: [XXXX e.g., neonatal mortality rate]

      2. Main AHRQ PSIs or IQIs targeted: [XXXX e.g., CABG mortality rate]

6. Intervention Strategy: [XXXX e.g. need intervention types here]

7. Hospital Type: [XXXX e.g., freestanding children’s, children’s hospital nested within a larger healthcare system, general hospital with pediatric unit, academic versus community]

8. Other important hospital selection characteristics: [XXXX e.g. rural, safety-net, etc]

9. Interview number: [first or second]

2. INFORMED CONSENT & INTRODUCTION

• Interviewer to review this section with each study participant.

This research is being conducted to learn how hospitals can work with the AHRQ Quality Indicators for quality improvement activities and how they may use the draft toolkit being developed in this project. This interview will allow us to collect information on your plans, progress, and success in implementing improvements, so we can develop the longitudinal story of your implementation process, its successes and challenges.

This interview is voluntary and anonymous, and the information you provide is not linked to you. Your responses will be kept confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). RAND will keep confidential the identities of those who participate in the interview and will not attribute any comments to any specific individuals. In the notes from the interview, we will not record individuals’ names associated with comments made. If you want to know more about this study, please call Peter Hussey, Ph.D., Principal Investigator, at 617-338-2059, ext. 8617.

Public reporting burden for this collection of information is estimated to average XX minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

3. QUESTIONS FOR HIGH LEVEL MANAGERS ONLY

• Ask these questions only of high-level senior leadership.

1. Please tell me the story of how your organization decided to pursue [INTERVENTION] and what factors were considered in that decision process.

• Probes:

• In your own words, what is the actual intervention?

• How were key decisions made on which area(s) to target?

• Which factors were most important in the decision to target that area(s)?

• How were key decisions made on which intervention strategy(ies) to use?

• Did you consider the impact of the recent change from ICD9- to ICD10 codes?

2) What role, if any, did your Board of Directors or one of its committees play in decisions regarding which QIs to address and what interventions to pursue?

• Probes:

• Was there a Board mandate to pursue this issue?

• What data on the QIs or other related performance measures were presented to the Board?

• How are you reporting progress on the initiative to the Board?

4. IMPLEMENTATION LEAD QUESTIONS ONLY

• Ask these questions only of implementation leads.

First, I would like to gather some basic facts related to your role as a lead of [INTERVENTION]. Then we will move into questions that ask about your experiences and opinions leading the implementation of [INTERVENTION].

1. We’re interested to learn the history and intent of [INTERVENTION]. Please describe how you reached a decision regarding which QI(s) to address in your quality improvement activities.

• Probes:

• What analyses of the QIs did you perform to guide the decision?

• What other analyses of issues or barriers did you perform?

• For pediatric/adult hospitals: How did you decide whether to target neonatal versus pediatric versus adult populations?

• Who was involved in making the decision?

• How did you use the tools in the toolkit to help the decision process?

2. Please tell the “story” of how [INTERVENTION] has taken shape, once you decided on the QI(s) to be addressed.

• Probes:

• How did you decide upon this intervention?

• Who was involved?

• In your own words, what is the actual intervention?

• How much did the UHC planning process guide or support your plan for intervention?

• How would you characterize your implementation progress as of this time?

3. How have you decided to organize and staff your implementation of the [INTERVENTION]?

• Probes:

• Who are the key leaders?

• What are their main roles and contributions?

• Who makes up the implementation team?

• How was this decided?

4. What type of monitoring, if any, have you done thus far to assess the progress of your intervention?

• Probes:

• What metrics does your organization routinely use to track performance progress?

• AHRQ QIs

• Other metrics from the Toolkit

• Other quality indicators (e.g., Joint Commission Core Measures)

• Process measures

• Employee survey data

• Other

• How is this monitoring working?

• What have you found?

5. How have your implementation approach or activities changed over time, if at all?

6. What are your plans for future improvement efforts?

• Probes:

• Working with the same QIs you addressed this time?

• Working with other QIs?

7. How has the recent switch from ICD-9 to ICD-10 codes affected the implementation of your intervention?

• Probes:

• How did you prepare for this change?

5. EXPERIENTIAL QUESTIONS

• Ask these questions of all study participants.

Now we’d like to ask you to talk about your expectations and experiences related to the [INTERVENTION]. We would like to cover the topics covered in this table, which include aspects of the [INTERVENTION] as well as factors that might have influenced its progress.

Use the grid for this portion of the interview.

6. WRAP-UP QUESTIONS

• Ask these questions of all study participants including the leads and high-level managers.

1. Sometimes synergies can occur within an organization across different improvement efforts.

1.a. To what extent has this improvement effort had effects on other outcomes in addition to the targeted QIs?

1.b. What synergies with other processes or changes within your organization have you found?

2. What advice would you give to another organization like yours about implementing an intervention like the one you have?

• Probes:

• What lessons about doing quality improvement for the QIs have you learned so far that could be useful for others?

• What advice do you have for others on how best to use the tools in the QI toolkit?

7. CONCLUSION

• Ask these questions of all study participants.

We’re at the end of the interview. Do you have any questions or any other comments?

Thank you very much for your time. We appreciate it.

Interview Grid for Collection of Experiential Data

Intervention Strategy: [e.g.,] ______________ **

Stakeholder Group: [e.g., patients, physicians, nurses, , office staff, upper management] _______________

Implementation Phase [e.g., baseline, early, mature]: _________________

** Insert this strategy name for [intervention] where it appears in the questions in the grid cells.

	Perceptions and Views of Stakeholder Group
		Actual Progress of Strategy		Effects on Stakeholders
Structure and Process Components Relevant to Strategy	What You Expected to Happen	Successes	Challenges	Your Actions	Other Stakeholders
Selecting the Quality Indicators and priorities for action	What did you expect would be your QI priorities? Why?	What successes did you have in the measure selection process? Why?	What decision challenges arose for the QI priority selection? Any surprises?	How has the choice of QI priority affected you actions?	What groups were involved in selecting QI priorities? How were they affected?
Process for Strategy Implementation Interventions undertaken Leaders and team Implementation synergies Changes accomplished	What did you expect for each aspect of [intervention] (listed in left column)? Why did you expect this? What value to you?	What QI successes have you seen? Why did they occur? Any surprises?	What implementation challenges arose? How well have they been managed? Any surprises?	How has the [intervention] affected your work or actions: - daily workload? - interaction with other staff? - interaction with patients	Who do you think are key stakeholders in this [intervention]? How has the QI process affected them?
Roles, Responsibilities of Key Stakeholders Patients and families Senior management Implementation team Staff involved in implementation Other departments and functions	How did you expect the various stakeholders would be involved in the [intervention]? What value to you?	What successes have you seen in stakeholder roles and involvement? Effects on QI progress?	What challenges have you seen in stakeholder roles and involvement? Effects on QI progress?	Are you in one of the key stake-holder groups identified for this [intervention]? How have your actions been affected by the stakeholders roles defined?	How have other stakeholders been affected by roles defined for them (or not) in the [intervention]?

	Perceptions and Views of Stakeholder Group
		Actual Progress of Strategy		Effects on Stakeholders
Structure and Process Components Relevant to Strategy	What You Expected to Happen	Successes	Challenges	Your Actions	Other Stakeholders
Influence of Organizational Philosophy Policy Culture of excellence Roles and positions	How did you expect the current philosophy of the organization to affect the [intervention]?	How has the organizational philosophy contributed to the successes you identified? Any surprises?	How has the organizational philosophy contributed to the challenges you identified? Any surprises?	How has the organizational philosophy contributed to effects of the [intervention] on your actions?	How has the organizational philosophy contributed to effects of the [intervention] on other stakeholders?
Influence of Organizational Capacity System-level(s) Management-level Individual-level	How did you expect the organization’s current management, systems, and staff capacities to affect the [intervention]?	How has the organizational capacity contributed to the successes you identified? Any surprises?	How has the organizational capacity contributed to the challenges you identified? Any surprises?	How has the organizational capacity contributed to effects of the [intervention] on your actions?	How has the organizational capacity contributed to effects of the [intervention] on other stakeholders?
Influence of External Environment Market Policy Information (reporting, data)	How did you expect factors in the external environment to affect the QI process?	How has the external environment contributed to the successes you identified? Any surprises?	How has the external environment contributed to the challenges you identified? Any surprises?	How has the external environment contributed to effects of the QI process on your actions?	How has the external environment contributed to effects of the QI process on other stakeholders?

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