Attachment C_Telephone Int Topic Guide_060809

Topic guide for Telephone Interviews

For prospective case studies

Approach

Telephone interviews will include only department level staff. These individuals will probably already be familiar with the project and will have been interviewed during the first site visit. Thus, questions about the interviewee’s job/position will be skipped, unless the staff person is new to the organization and has not been interviewed in the past.

We have assumed 30 minutes for each interview.

1.0. Lean/TPS Implementation to date (15 minutes)

1.1 In the past three months, what, if any, Lean/TPS projects have been completed in your department? Please describe the completed projects and the activities involved.

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?

1.2 In the next three months, what Lean/TPS projects are currently being planned in your department? Please describe these expected projects.

POSSIBLE PROBES:

• How, if at all, do these projects fit into an overall initiative?

• What types of issues will these projects address?

• Are these projects planned based on a crisis or delinquency in a department or are they part of a systematic change?

• What Lean/TPS tools will you use for each project?

• How, if at all, did staff react when they heard about this new Lean project? Was there a specific staff person to champion this effort? How were they told of this decision? What types of questions did they ask?

1.3 What, if any, Lean/TPS projects are currently ongoing in your department? Please tell me about these projects.

POSSIBLE PROBES:

• What staff are 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 these projects assigned? Please describe this process.

• Please describe the tools or Lean techniques which are being used. Why were these specific tools and techniques selected? Do all projects use these same tools and techniques? Why or why not?

• What are the project objectives; what measurements will you use or are you using /what did you measure to gauge the success or failure of Lean? To whom will you report results? Please tell me how you collected the data to measure the success or failure.

1.4 In the past three months, what training and/or resources have been provided to YOU for Lean/TPS implementation? What training and/or resources have been provided to other staff in your department? Resources might include external coaches, consultation with other successful teams, time assigned just to Lean, extra staff, IT support, etc.

1.5 Thinking back on the Lean/TPS work you have done in your unit (including all Lean projects in your department), 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).

1.6 Thinking back on the lean work you have done in your unit (including all Lean projects in your department), what were the 2 or 3 greatest facilitators?

POSSIBLE PROBES (for each facilitator):

• What 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).

1. 7 Please describe any surprises or unintended consequences (positive or negative) of the intervention and its implementation (e.g., staff morale improved or got worse, new ways to utilize advanced practice nurses) surfaced during the implementation process? If so, please describe.

2.0. Impacts of Lean (9 minutes)

2.1 In your opinion, how have the Lean/TPS projects progressing in the past three months? In general, have these Lean/TPS projects been 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.

2. 2 Please describe the impacts or outcomes of each Lean project. What has changed in your department since Lean/TPS implementation? Have these changes been positive or negative? Please describe these impacts.

Interviewer should probe on the following impacts, 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

2.3 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?

2.4 Have any of these results undergone independent review? Have any of these results been published? If so, where?

2.5 Please tell me how, if at all, these results have been validated?

3.0. Sustainability/Dissemination of Lean (5 minutes)

3.1 In the past three months, have improvements from the projects been sustained? Have the successes or improvements decreased over time, remained the same, or continued to improve? Why do you say this?

3.2 What do you think are the challenges to the sustainability of Lean in both the department and the organization? What about things that facilitate sustainability?

3.3 In the past three months, how, if at all, have you been involved in the sharing of information about Lean work and spread of Lean techniques? Please consider dissemination to other staff, other departments within your organization, other organizations, and/or the general public.

POSSIBLE PROBES:

• How did you share what you learned about Lean/TPS? You might participated in a conference or round table, spoken to leaders of other departments, been interviewed by the press, etc.

• How, if at all, did individuals or other organizations react to what you told them about Lean? Please tell me about this.

• Have other departments or organizations adopted the information you have disseminated? Have the practices been spread and implemented?

3.4 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?

4.0. Closing (1 minutes)

4.1 Do you have any additional comments about the Lean/TPS implementation in your department in the past three months?

Thank you for your time.

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