J3 Interview guide for qualitative interviews with AIM Team

Safety Program for Perinatal Care II – Demonstration Project

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

This survey is authorized under 42 U.S.C. 299a. The confidentiality of your responses to this survey is protected by Sections 944(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)].  Information that could identify you will not be disclosed unless you have consented to that disclosure. Your participation is voluntary and all of your answers will be kept confidential to the extent permitted by law. Public reporting burden for this collection of information is estimated to average 60 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, 5600 Fishers Lane, # 07W41A, Rockville, MD 20857.

Baseline / Wave 1 Interview Guide

Introduction

Thank you for agreeing to participate in this interview regarding the Safety Program for Perinatal Care (SPPC-II) Teamwork Toolkit. We are interested in your opinions on the Toolkit and its utility, therefore, there are no right or wrong answers. With your approval, this interview will be recorded for note taking purposes and to ensure that we capture all your feedback.

Your responses will be kept confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). That law requires that information collected for research conducted or supported by AHRQ that identifies individuals or establishments be used only for the purpose for which it was supplied unless you consent to the use of the information for another purpose.

Do you have any questions?

[QUESTIONS FOR THE AIM TEAM LEADS and FRONTLINE PROVIDERS]

1. To get started, can you please share your current position and in what capacity are you involved with the implementation of the AIM patient safety bundles at your hospital.

• How did you come into this role? [probe for being appointed, volunteered, voluntold]

• Can you also please state your age, sex, and number of years of experience in obstetrics?

• [IF AIM TEAM LEAD]: Did you attend the Tier 2 SPPC-II Workshop in February 2020?

• What AIM bundle(s) is your hospital currently implementing or maintaining?

2. [IF AIM TEAM LEAD]: Can you please describe why your hospital decided to implement the SPPC-II Toolkit?

• Who was involved in making this decision?

  • Was there anyone who should have been involved in making the decision but wasn’t?

• What outcomes do you hope to achieve by implementing the Toolkit?

• Did any particular guidelines, policies, or financial incentives influence the decision to implement the Toolkit?

3. The SPPC-II Teamwork Toolkit consists of the following components [PROVIDE HANDOUT 1 (list of Toolkit components)]. Which components of the Toolkit do you have first-hand experience with?

4. In thinking about the implementation of the Toolkit, what has gone well? [probe for specific components of the Toolkit mentioned in previous question]

   • Have you faced any obstacles or challenges? What was the hardest thing you faced?

     • [IF LACK OF PROVIDER BUY-IN]: What kind of supporting evidence about the effectiveness of the intervention do you think is needed to get staff on board?

   • Who is leading the implementation of the Toolkit?

     • Has it been the same lead coordinator throughout the SPPC-II implementation to date?

     • [IF FRONTLINE STAFF]: Can you describe people’s perceptions of the AIM Team lead?

     • Aside from the AIM Team Lead, are there other people in your Labor and Delivery Unit who are likely to champion (go above and beyond what might be expected) the Toolkit?

       • Were they formally appointed in this position, or was it an informal role?

       • Can you describe people’s perceptions of this champion / individual?

   • When did implementation of SPPC-II start in your unit, and how [i.e. what event or activity or communication]?

     • [IF AIM TEAM LEAD]: Has frontline staff’s progress completing the online training modules and/or convening the facilitated learning sessions been impacted by the COVID-19 pandemic? If so, how?

5. [IF AIM TEAM LEAD] Can you describe the plan for implementing the Toolkit?

• How detailed is the plan? Who knows about it? Is the plan overly complex? Understandable? Realistic and feasible?

  • Are there individuals/groups that should know about and ideally participate in the plan who are hard to reach? For example, patients or physicians who are not employees of the hospital.

• Do you have a communication or education strategy for getting the word out about the Toolkit?

  • What materials/modes/venues do you plan to use? For example e-bulletin boards, emails, brochures, group text messages?

  • What process do you plan to use to communicate? For example, going to staff meetings, talking to people informally?

  • Were frontline staff told how to access the SPPC-II training e-modules, and provided a schedule for completing the modules?

• What kind of information do you plan to collect as you implement the Toolkit?

• Which measures will you track? For example, participation in online modules / facilitated sessions, perceptions of the Toolkit components (e.g., ease of access, length), levels of engagement, etc.

• How will you track them?

• Are any of these measures part of existing data collection efforts for other interventions?

• How will this information be used?

• To what extent has your unit set goals for implementing and applying the Toolkit?

  • What are the goals? How and to whom will they be communicated?

• Who are the key influential individuals to get on board with this implementation?

  • What are influential individuals saying about the Toolkit?

6. Do you feel like the training [workshop for AIM Team Leads; online modules for frontline staff] prepared you to carry out the roles and responsibilities expected of you? [PROVIDE HANDOUT 2 (list of online modules)].

   • What about the training was positive?

   • What about the training could be improved?

     • What additional resources or support did you need or do you still need? [If not mentioned in response, PROMPT: Would you benefit from reviewing one or more of the SPPC–II training modules online at any time in the future? If so, what module(s) would you like to re-take, and approximately when?]

   • Overall, did you find the information presented as part of the training useful for your clinical practice? In what ways?

   • Has your Labor and Delivery Unit undergone TeamSTEPPS training?

     • [IF YES]: How does this training compare with the TeamSTEPPS training(s) you were exposed to in the past?

   • [IF AIM TEAM LEAD]: Was it difficult to attend the SPPC-II workshop training in February 2020? [PROMPT: Given the time commitment you had to make, work responsibilities, travel costs.]

     • Do you think you would have gained the same knowledge online in a virtual workshop rather than an in person workshop?

     • Did you find the SPPC-II training materials easy to understand and presented in a logical sequence? Was there any information that was presented in a confusing way?

   • [IF AIM TEAM LEAD]: How did providers at your hospital react to the SPPC-II online modules? Why do you think they reacted this way?

7. Have you had facilitation sessions to discuss the tools you have learned of the SPPC-II Toolkit?

   • Who typically attends?

   • How often do you meet?

   • What is the typical agenda?

   • How helpful are these facilitation meetings?

   • Have you discussed these tools at other meetings besides the SPPC-II facilitation sessions arranged by your AIM Team Lead? Or informally?

   • [IF AIM TEAM LEAD]: How did providers at your hospital react to the facilitated sessions? Why do you think they reacted this way?

8. [IF YES to Q7]: Do you feel like the facilitated session(s) prepared you to carry out the roles and responsibilities expected of you?

   • What about the facilitated session(s) was positive?

   • What about the facilitated session(s) could be improved?

9. What additional resources from the SPPC-II program (e.g., PDFs of the scenarios, facilitation guide) are available to help you implement and use the Toolkit?

   • What is your perception of the quality of these resources?

   • In what ways can the SPPC-II program be more helpful?

10. What is the general level of receptivity in your Labor and Delivery unit to implementing the Toolkit?

    • Is there a strong need for this intervention?

    • What do influential stakeholders at your hospital think of the intervention? (e.g., well-respected clinicians, administrative leaders)?

    • How well do the teamwork and communication tools supported by the Toolkit fit with existing work processes and practices in your setting?

      • Are there any tools that are being consistently used by a majority of frontline staff?

      • For tools that are not being consistently used, what kinds of changes or alterations do you think need to be made so that these tools can be applied effectively in your setting?

      • Has use of these tools been impacted by the COVID-19 pandemic? If so, how?

      • How well do you think the application of the recommended tools will meet the needs of your patient population to provide safer care?

    • How does the priority of implementing the SPPC-II Toolkit compare to other priorities in your Labor and Delivery unit? For your own work? (probe for “normal time” scenario versus COVID-19 scenario)

11. What level of endorsement or support have you seen or heard from leaders?

• Who are these leaders and how has this affected things so far? Going forward?

  • Are there leaders who have not endorsed or supported the Toolkit? How might this affect the work? How do you suggest gaining the support of these leaders?

• [IF AIM TEAM LEAD]: Do you expect to have sufficient resources (e.g., dedicated personnel time, space, equipment) to implement and administer the intervention?

  • [IF NO] What resources will not be available?

12. Can you describe any efforts your unit has made to support shared-decision making between providers and patients (i.e., to ensure that the treatment plan reflects patients’ values and goals)?

• Have you faced any obstacles or challenges trying to support shared-decision making? From the providers’ perspective? From the patients’ perspective?

• Do you have decision aids related to [insert AIM bundle] to share with patients and families? For example, pamphlets or web-based tools that describe the options available as well as possible benefits and harms?

• Do you think [insert AIM bundle] helps foster shared-decision making (e.g., by helping professionals in being well informed, not only about the best option, but other available options in specific decision contexts)?

13. Have you involved patients in the planning and/or implementation of the [insert AIM bundle]?

    • [IF YES]: What were you hoping to achieve by involving patients?

    • [IF YES]: What, if any, obstacles have you encountered?

    • [IF YES]: How did you go about involving patients? What did you invite them to do?

    • [IF YES]: How would you characterize the impact of involving patients in the implementation process?

      • Are there opportunities you may have missed if patients had not been involved?

      • Are there things your practice is doing differently because patients were involved?

    • [IF NO]: What do you think has prevented your unit from involving patients in this process?

14. [IF THERE IS TIME]: How would you describe the culture of your organization?

    • How do you think your Labor and Delivery unit and organization’s culture (general belief, values, assumptions that people embrace) will affect the implementation of the Toolkit?

    • In general, to what extent do you feel like you can try applying the tools in providing care to your patients on a day to day basis?

      • Do you feel like you have the time and energy to think about ways to improve things?

      • Do you feel valued/respected by your supervisor for the role you play?

Thank you for your time.

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