T
Form
Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX
For retrospective case studies
When selecting participants, individuals will be categorized as a member of either frontline/departmental staff or key system staff. Core topics will be discussed with both groups. Modular topics will be tailored to each group.
This guide is appropriate for retrospective case studies, i.e. when the Lean/TPS implementation has occurred in the past 6 months to one year.
We have assumed one hour for each interview.
The purpose of this interview is to obtain information on Lean/TPS projects that have occurred in the past. Specifically, we will obtain the following information:
The role of the person being interviewed
A description of the Lean/TPS implementation
The impacts of the Lean/TPS implementation to date
The sustainability of the Lean/TPS implementation to date
The dissemination of information about Lean/TPS implementation or impacts
Lessons learned from Lean/TPS implementation
Public
reporting burden for this collection of information is estimated to
average 60
minutes per response, the estimated time required to complete
the interview. 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.
The purpose of these questions is to gain an understanding of the role and perspective of the person who is being interviewed and of how this individual and the department(s) and/or wider organization perceive quality improvement, in general. We also hope to gain a better understanding of the amount of experience in QI and with Lean/TPS. In the modular section, we want to gain a better understanding of how the department(s) and/or wider organizational structure and senior leadership support QI and what external factors affect the use of QI.
{Interviewer introduces himself/herself and gives some background on the project.}
1.1. Core Topics (to be asked of all individuals)
1.1.1. Individual Level
a) Please tell me about your current position.
POSSIBLE PROBES:
What is your title?
How long have you been in this position? At this organization?
What are your main / primary roles and responsibilities?
What types of experiences have you had with quality improvement initiatives? At this organization? At other organizations? With Lean/TPS?
1.1.2. Organizational Level
b) Please describe your department’s and/or organization’s quality improvement efforts. Please give me an example of a quality improvement effort that your department and/or organization has implemented recently. What about this effort was typical for your department and/or organization? What was atypical? Please tell me about that.
POSSIBLE PROBES:
Does your organization have a system-wide or organization-wide quality improvement initiative?
What prompted your initiative?
What are the broad goals of the initiative?
Please describe your organization’s experience with quality improvement activities or initiatives.
When did you organization begin in engaging in such initiatives
1.2. Modular Topics (to be asked of specific staff)
1.2.1. For Departmental Staff (to be asked of physicians, nurses, and other departmental/non-management staff)
a) Please describe your interactions with management and/or senior staff. Do you interact at least once or twice per month with senior and/or management staff in your organization? Specifically, with whom are these interactions? How much of these interactions involve or are about quality improvement activities and/or approach?
b) How often do you interact with other staff in your department? From your department, who do you interact with regularly? How much of these interactions involve or are about quality improvement activities and/or approach?
c) To whom do you report? Who has primary responsibility for the department? To whom do they report?
POSSIBLE PROBES
Who is in charge of your department? Of the physicians? Of the nursing staff?
Would you say you have formal and/or informal leaders? Which does each type of leader do? To what extent do they collaborate or compete/complement one another? Are there any leadership relationships that result in tensions or conflict?
When implemented in your department, who leads QI projects?
d) In your opinion, how much support do you receive from senior staff/organizational leadership to pursue or implement quality improvement activities at your level?
1.2.2. For Key System Staff (to be asked of senior leadership staff – e.g. CEO, Board member, etc.)
a) How is your organization (hospital and/or system) structured?
POSSIBLE PROBES:
Who are the key stakeholders in your organization? Who participates in your board of directors? How supportive is the board of quality improvement and/or Lean/TPS initiatives? How do they demonstrate their support?
How, if at all, have your major stakeholders (including payers) been involved in QI efforts?
Does your board of directors request information on the quality of care delivered? Do they request information on QA and QI efforts?
Do your payers request information on the quality of care delivered? Do they request information on QA and QI efforts?
b) Please describe the major payers in your area.
c) Do payers offer any financial incentives or rewards for improving quality, reducing waste, or making your care delivery more efficient?
POSSIBLE PROBES:
Does executive compensation reflect quality? If so, how?
What types of incentives? For how long?
d) Who are your major competitors?
What activities are your major competitors undertaking in QI?
e) Are there market, regulatory or other external pressures that encourage greater efficiency and increased quality of care?
The purpose of this section is to gain a better understanding of why and how Lean/TPS was selected at an organizational level and to understand the motivations and goals for Lean/TPS implementation.
2.1. Core Topics (to be asked of all individuals)
a) How did you or your organization decide to implement Lean at the system or organizational level?
POSSIBLE PROBES:
Who was involved in the decision to implement Lean/TPS? In the initial implementation of Lean/TPS?
What approaches did you consider when you were planning for your redesign / quality improvement activities?
When did you first begin to consider Lean as an approach?
How did Lean compare to these other approaches?
After selecting Lean, how, if at all, did you begin to implement it on the system level?
b) What were the overall department and/or organizational goals and time frame for the Lean implementation?
POSSIBLE PROBES:
Are your Lean projects one-time pilot projects or part of a multi-year project?
How did you determine these goals?
Who set these goals?
Did these goals differ from the organizational level to the department level? If so, how?
c) How did you or your organization decide in which unit or department to first implement Lean?
POSSIBLE PROBES:
Why did you decide to start implementation of Lean/TPS in these departments? How did you determine which Lean/TPS projects would be prioritized?
2.2. Modular Topics (to be asked of specific staff)
We do not anticipate specific modular topics for this section.
The purpose of this section is to gather information on the various Lean/TPS projects being implemented and on the details of each of these projects.
3.1. Core Topics (to be asked of all individuals)
I would like to now focus on the Lean/TPS activities in the [XX] department. [Clinical staff and most low to mid-level managers will be asked about projects within their own departments. High-level managers and technical staff with a grasp of organization-wide policies and practices will be asked about the organization as a whole. Interviewers will receive instructions in advance about whether to refer to a single department or the organization as a whole.]
a) What projects have been completed in this department? Please describe the completed projects.
POSSIBLE PROBES:
Was the focus of these projects on clinical or administrative processes?
Were these projects implemented one by one or all at the same time? Were they implemented in phases or not?
When was Lean/TPS implementation in your department?
How was Lean/TPS implemented initially?
What staff were involved? How were staff involved? [If applicable], how were staff selected to be involved? How much, if any, experience did these staff have in using Lean or in quality improvement activities?
How, if at all, was the leadership for Lean implementation assigned? Please describe this process.
What training and/or resources were provided to staff? Resources might include external coaches, consultation with other successful teams, time assigned just to Lean, extra staff, IT support, etc.
Please describe the tools or Lean techniques which were used. Why did you select these specific tools and techniques? Will all projects use these same tools and techniques? Why or why not?
What were the project objectives; what measurements did you use /what did you measure to gauge the success or failure of Lean? To whom did you report results? How did you decide that this is what you wanted to measure? Please tell me how you collected the data to measure the success or failure?
Has the implementation at the department level changed from it started? Please describe the reasons for these changes.
b) Thinking back on the lean work you have done in your unit (including all Lean/TPS projects), what were the 2 or 3 greatest challenges?
POSSIBLE PROBES (for each challenge):
Did you or your staff anticipate these problems? If so, please describe.
Who tackled these challenges? Was a particular staff member assigned to address the challenge?
How did you seek overcome these challenges? What did you do specifically? How successful were these efforts? Please describe the issue.
Interviewer should probe on the following challenges:
at the system level (e.g., lack of visibility and resources),
at the project team level (e.g., competing demands),
at the department level (e.g., lack of leadership, challenges of implementing in a residency practice, disruption of patient flow),
at the individual physician or staff level (e.g., some resistant to intervention),
at the patient level (e.g., types of patient seen, negative response to intervention overall or aspects of it).
c) Thinking back on the lean work you have done in your unit (including all Lean/TPS projects), what were the 2 or 3 greatest facilitators?
What helped you and/or your department implement and/or make progress with your Lean/TPS project?
POSSIBLE PROBES (for each facilitator):
What resources made Lean/TPS easier to implement on the organizational/departmental/or project level?
How was it that you had access to this / these resources?
Interviewer should probe on the following facilitators:
at the system level (e.g., visibility and resources),
at the project team level (e.g., expertise; coaching;),
at the department level (e.g., leadership, type or size of practice),
at the individual physician or staff level (e.g., enthusiasm about intervention),
at the patient level (e.g., types of patients seen, positive response to intervention overall or aspects of it).
d) Please describe any surprises or unintended consequences (positive or negative) of the intervention and its implementation (e.g., staff morale improved or got worse, found new ways to utilize advanced practice nurses) surfaced during the implementation process? If so, please describe.
3.2. Modular Topics (to be asked of specific staff)
3.2.1. For Departmental Staff
a) How, if at all, did staff react when they heard Lean/TPS would be implemented in their departments? Was there a specific staff person to champion this effort? How were they told of this decision? What types of questions did they ask?
b) How did you first react when hearing of the organization’s decision to implement Lean/TPS in your department? Why did you feel this way? Did you play a role in this decision? Please tell me about that.
c) What type of support did you receive from the senior management/leadership when implementing Lean/TPS in your department? Support might include staff, training, additional staff, time assigned to Lean/TPS, IT support, or other resources. Please tell me about this/these.
3.2.2. For Key System Staff
a) How were departmental or “frontline” staff told about the organization’s decision to implement Lean/TPS? To the best of your knowledge, how did they first react when they heard of this decision? What types of questions did they ask?
b) In your opinion, how does the departmental/frontline/non-management staff view Lean/TPS? To what extent do they support or not support Lean? Are they excited about Lean/TPS or not? Do they feel positively or negatively? Please let me why you think this.
c) What infrastructure was needed to support the Lean/TPS implementation on the department or organizational level? Please explain.
d) What, if any, resources (training, monies, staff) did you give to departmental staff in order to implement Lean/TPS?
The purpose of this section is to gain information on the impact of Lean/TPS. Specifically, we would like to know about both anecdotal information and systematic data collected on the impacts of Lean/TPS. Similarly, we hope to gain a better understanding of the organization’s view on the business case for Lean/TPS.
4.1. Core Topics (to be asked of all individuals)
a) In your opinion, how did Lean/TPS progress for each project, in each department, and within the organization? In general, has Lean/TPS been successful?
Please provide a description of the most successful Lean/TPS project or initiative.
Please provide a description of the least successful Lean/TPS project or initiative.
How many other Lean/TPS projects conducted would you consider to have been successful? How many, in your opinion, were not successful?
POSSIBLE PROBES:
How do you know this?
How do you define “success” for Lean/TPS?
Returning to your original goals, have these been met?
Would others in organization describe Lean/TPS as a success or not? Please tell me about this.
b) Please describe the impacts or outcomes of Lean implementation. What has changed since Lean/TPS implementation? Have these changes been positive or negative? Please describe these impacts.
c) In your opinion, is there a business case for Lean implementation? Why or why not? By business case, we mean whether Lean/TPS works and results in enough benefits to the organization in a sufficient time frame for this organization and others to continue to pursue it.
How could you know if there is a business case for Lean/TPS implementation?
What kind of data do you collect?
If NONE, will you collect this data in the future?
Interviewer should probe on the following impacts/aspects of the business case, as necessary:
efficiency
patient safety
quality of care
cost
patient satisfaction
job satisfaction
external parties/stakeholders/payers/competition
other departments or aspects of the organization, such as IT, etc.
contribution to learning, ability to solve problems and do QI in the future
d) For all of these outcomes, what methods did you use to measure the impact? Are you still collecting data on these outcomes? How long do you anticipate collecting these data?
e) Have any of these results undergone independent review? Have any of these results been published? If so, where?
f) Please tell me how, if at all, these results have been validated.
4.2. Modular Topics (to be asked of specific staff)
We do not anticipate specific modular topics for this section.
The purpose of this section is to gain a better understanding or if Lean/TPS has been sustainable for each project and across the department and organization. We also hope to gain information on how Lean/TPS is being disseminated to other interested parties.
5.1. Core Topics (to be asked of all individuals)
a) To date, is Lean/TPS still being implemented in your organization? Specifically, in what departments or units is Lean being implemented? How does your organization determine which departments should next implement Lean/TPS?
b) Over what time period have improvements from projects been sustained? Have the successes or improvements decreased over time, remained the same, or continued to improve? Why do you say this?
c) What do you think are the challenges to the sustainability of Lean/TPS in both the department and the organization? What about things that facilitate sustainability?
d) How, if at all, have you been involved in the sharing of information about Lean/TPS work and spread of Lean/TPS techniques? Please consider dissemination to other staff, other departments within your organization, other organizations, and/or the general public.
POSSIBLE PROBES:
How, if at all, did individuals or other organizations react to what you told them about Lean/TPS? Please tell me about this.
Have other departments or organizations adopted the information you have disseminated? Have the practices been spread and implemented?
e) Based on what the project team has learned to date, what are the insights and/or lessons learned for your own system and practices as well as others? If you were advising others about Lean and its implementation, what would you most want them to know? What should they be aware of, what should they do, what should they NOT do?
5.2. Modular Topics (to be asked of specific staff)
We do not anticipate specific modular topics for this section.
Do you have any additional thoughts you’d like to share with us about Lean/TPS in your department and/or organization? Decision to pursue, implementation, sustaining it?
Thank you for your time.
| File Type | application/msword |
| File Title | Topic guide for In-Person Interviews |
| Author | Preferred Customer |
| Last Modified By | Kristin Carman |
| File Modified | 2009-08-11 |
| File Created | 2009-08-11 |