Form #3 Form #3 Monthly semi-structured interview protocol

A

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

ttachment E. Monthly semi-structured interview protocol

1. What has happened with regard to RED implementation since we last spoke, [date]?

2. Follow-up on issues raised in last telephone call (list) :

a)

b)

3. What accomplishments/progress have you made since our last call?

4. What challenges have you encountered since our last call?

5. Where are you specifically in terms of your implementation plans (implementation fidelity)?

6. Are you on track according to your timeline? If not, in what areas are you behind? Are there specific reasons for this delay? Is there anything we can do to help you move forward in this area?

7. Have you made any changes to the implementation plan? Timeline?  Why?

8. Are there any areas where we need to collectively rethink any aspects of implementation?

[insert specific milestones or probes into this section based on where hospital is expected to be]

9. How receptive is the staff in your organization to the proposed changes?

10. Specifically, implementation team members:

Middle managers in units planning to implement RED:

Frontline nurses and physicians:

Organization leaders:

11. What are your next steps?

12. What are your goals over the next month? What is your plan to accomplish these goals?

13. Action items between over the next month:

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, 540 Gaither Road, Room # 5036, Rockville, MD 20850.