Form #7 Form #7 Focus Group with Patients Protocol

A

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

HRQ PFE Guide Focus Groups

Post-Implementation Protocol–Patients, Component 1

July 1, 2010

Research design

• AIR will conduct a total of 9 focus groups with patients and family members during the post-implementation period (3 groups at each of 3 hospitals). At each hospital we will conduct:

  • 1 group of 6-8 patients – Focus on Component 1 (this protocol)

  • 1 group of 6-8 family members – Focus on Component 1

  • 1 group of 6-8 patients and family members – Focus on Component 2

Recruitment criteria

• Patients who were admitted to the hospital unit where the intervention was implemented from [MONTH, YEAR] to [MONTH, YEAR] and who had at least a 24-hour stay

• As possible, mix of age, sex, race/ethnicity

Testing materials

• Copies of intervention materials

• Informed consent forms (1 copy for participant to sign, 1 copy for participant to keep)

• Incentive receipt forms

• Incentives

• Moderator time clock

• Name placards

Obtain informed consent

As participants arrive, have them read and sign the informed consent form. Give each person an unsigned copy of the form to keep.

Public reporting burden for this collection of information is estimated to average 90 minutes per response, the estimated time required to complete the group. 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.

PFE Focus Group with Patients– Component 1

Topic

Introduction (welcome; background, ground rules)

Warm-up --brief introductions

Background

Communication Packet

Bedside Change of Shift Report

Discharge Plan

General Experience

Closing

Introduction

INSTRUCTIONS:

AS PARTICIPANTS ARRIVE, GREET PARTICIPANTS AND GIVE THEM INFORMED CONSENT FORMS (1 TO SIGN, 1 TO KEEP).

1. Welcome

Thank people for coming.

2. Background—explain purpose of the group

• Hello. My name is {NAME} and I’m the moderator for today’s discussion.

I’m here with {NOTE-TAKER}, who will be taking notes. We both work for a company called the American Institutes for Research, which is an independent non-profit research organization.

• Our group discussion today is part of a project being funded by a governmental organization known as the Agency for Healthcare Research and Quality to develop a guide to patient and family engagement around the issues of hospital safety and quality.

• The purpose of our discussion today is to talk about some of your experiences during your recent hospital stay at [HOSPITAL NAME]. In particular, we would like to discuss your reactions to materials that you may have received and interactions you may have had with your health care providers at the hospital.

• Nothing that you say or share today will affect your treatment or care at the hospital. We will not share your name or anything that you say individually.

• We are taping the discussion so that we can share what you say with other people who are working on this project.

• Questions?

3. Go over ground rules.

• During our discussion today, you may hear personal information about fellow participants. Please keep this information to yourself and within this room in order to be respectful of others’ privacy.

• We want to hear from everyone and want your honest opinions and reactions. There are no wrong answers—feel free to disagree.

• Don’t need to wait for me to call on you—though I may need to interrupt from time to time to keep the discussion moving. We have a lot to cover, so we can’t spend too long on just one topic.

• Since we’re recording, it’s very important for us to have only one person speaking at a time. So please take turns—let’s give everyone a chance to share their opinions.

• Also, because we’re recording, please try to speak in a voice at least as loud as the one I’m using now so that we can hear everyone on the tape.

• Location of bathroom.

• Turn off cell phones or set to vibrate.

• Questions?

Warm-up

Brief introductions

Let’s start with brief introductions. We’ll go around the table.

Starting with {name, seat #1},

• Please give your first name only and then briefly tell us about your most recent hospital stay at [HOSPITAL NAME]:

  1. Why were you in the hospital?

  2. How long was your most recent stay for?

Background

I’d like to start our discussion today by asking some general questions about your most recent hospital stay at [HOSPITAL NAME]. For purposes of our discussion today, I’m going to ask you to focus on the experiences you had while you were on the medical/surgical unit [INSERT UNIT NAME].

1. Tell me about your most recent experience(s) at the hospital. Overall, how satisfied were you with your hospital stay? Would you say that it was a good experience or bad experience? For what reasons?

2. Did a friend or family member stay with you while you were at the hospital? (NOTE: Be sure to distinguish between “visiting” and “staying.”)

   1. How were they involved in your care? What kinds of things did they do to help you?

3. Under what circumstances were you admitted to the hospital?

   1. Was your admission to the hospital planned or unplanned?

   2. How did you feel when you were admitted to the hospital?

   3. What went well? What could have been improved?

4. How important is it to you to be involved in decision making with your doctor or other medical staff?

5. How important is it to you to be a partner in care with your doctor or other medical staff? What does it mean for you to be a partner in your care?

Let’s talk a little bit about the health care providers that you interacted with during your most recent hospital stay.

6. What doctor(s) did you see during your hospital stay?

1. How often did you see the doctor(s)?

2. What kinds of things did you talk about?

3. How did the doctor treat you? Did the doctor listen to your concerns? Did you understand when the doctor explained things to you?

4. Did the doctor encourage you to ask questions, or not?

5. What kinds of questions did you ask the doctor?

6. How easy or difficult was it to talk to your doctor? To raise questions or concerns about your care? To get all of your questions answered?

7. Tell me about the nurses who cared for you during your hospital stay.

7. How did the nurses treat you? Did the nurses listen to your concerns? Did you understand when the nurses explained things to you?

8. Did the nurses encourage you to ask questions, or not?

9. What kinds of questions did you ask the nurses?

10. How easy or difficult was it to talk to your nurses? To raise questions or concerns about your care? To get all of your questions answered?

8. Tell me about any other hospital staff that you remember interacting with during your hospital visit. This could include staff such as nutritionists, respiratory therapists, physical or occupational therapists, and pharmacists.

11. What were these interactions like?

Communication Packet

[If the hospital ADMINISTERED the communication packet as a strategy, proceed to this section]

Now, let’s talk about when you were first admitted to the hospital.

I am going to hand out some materials. [Describe the materials.] These are materials that the hospital should have given to you when you were admitted to the hospital.

9. How many people remember getting these materials? [COUNT SHOW OF HANDS]

10. How did you get these materials? (e.g., were they given to you when you checked in?)

    1. Did you read the materials?

    2. Who gave them to you to read?

11. Did your doctors or nurses mention these materials during your stay?

12. What were your reactions to these materials? [FOR THOSE WHO DON’T REMEMBER OR DIDN’T GET THEM: Take a minute to review these materials now. What do you think of them?]

    1. Did you find the information helpful, or not?

    2. Did you find the information easy to understand?

    3. What did you like best? Was there anything you would have changed?

13. Why do you think the hospital gave you these materials? What do you think they wanted you to do with them?

14. How, if at all, did you use the information in these materials during your hospital stay?

15. Did the information in the packet help you communicate with the doctor(s) and/or nurse(s)? Why or why not?

16. Did the information in the packet help you ask questions? Raise concerns? Feel more comfortable and confident talking to your health care providers?

17. Did the information you received in the packet improve your experience at the hospital and the care you received? Why or why not?

18. Would you like to see other hospitals using these materials?

Bedside Change of Shift Report

[if the hospital administered THE BEDSIDE CHANGE OF SHIFT REPORT as a strategy, proceed to this section]

Now I’d like to talk about some of the care you received during your hospital stay.

As you may know, nurse shift changes occur when nurses who are going off duty share information about you with nurses coming on duty. At this hospital, this shift change may have happened at your bedside.

19. Do you remember if this (i.e., bedside change of shift) happened during your stay?

If YES,

1. Tell me about what the shift change was like for you.

2. What did the nurses do?

3. How, if at all, did you participate in the process?

4. Did you find this helpful, or not?

   1. If YES, how so?

   2. If NO, why not?

5. How involved did you feel during the change of shift report? Were you involved as much as you wanted to be?

6. Were you satisfied with the way information about your care was passed on from the nurse who was going off duty to the nurse who was coming on duty?

7. Did you have a friend or family member with you during this time? Were your friends/family members as involved as they wanted to be?

8. Were you able to ask any questions during this time? What types of questions did you ask? Were your questions answered?

9. Did you feel that your information was shared in a respectful manner? Did you have any concerns about confidentiality?

10. How, if at all, did participating or being present for the bedside change of shift report improve your care at the hospital?

If NO,

1. Were you given the opportunity to participate in shift changes?

2. Did anyone ever mention it to you?

Now, I am going to hand out some additional materials. These are materials that the hospital also should have given to you during your hospital stay to explain the bedside shift change process.

20. How many people remember getting these materials? [COUNT SHOW OF HANDS]

21. How did you get these materials? (e.g., when were they given to you? when you checked in?) Who gave them to you?

22. Did your doctors or nurses mention these materials during your stay?

23. What were your reactions to these materials? [FOR THOSE WHO DON’T REMEMBER OR DIDN’T GET THEM: Take a minute to review these materials now. What do you think of them?]

1. Did you find the information helpful, or not?

2. Did you find the information easy to understand?

3. What did you like best? Was there anything you would have changed?

24. Why do you think the hospital gave you these materials? What do you think they wanted you to do with them?

25. How, if at all, did you use the information in these materials during your hospital stay?

26. Did the information in these materials prepare you to participate in the shift change process the way that you wanted to? Why or why not?

27. Did the information in these materials help you communicate with the doctor(s) and/or nurse(s)? Why or why not?

28. Did the information in these materials help you ask questions? Raise concerns? Feel more comfortable talking confidently to your health care providers?

29. Would you like to see other hospitals using these materials?

Discharge Plan

[If the this hospital Administered THE DISCHARGE PLAn as a strategy, proceed to this section]

Now I’d like to talk to you about what happened when you were getting ready to leave the hospital.

30. When did someone at the hospital start talking to you about getting ready to leave the hospital or what would happen after you left the hospital? (Probe for: at what point during the hospital stay was discharge discussed.)

31. What kinds of things did the hospital do to help you get ready to leave the hospital? What worked well? What could have been improved?

1. Did you feel that you were ready to leave the hospital? Why or why not?

2. Did you have any problems with your health when you got home? Was there anything that could have been done before you left to make this transition easier, or not?

I am going to hand out some materials you may have gotten prior to your discharge.

32. How many people got something like this when they left the hospital? [COUNT SHOW OF HANDS]

33. How did you get these materials? (e.g., when were they given to you?)

1. Did you read the materials?

2. Who gave them to you to read?

34. Did your doctors or nurses mention these materials at any point during your stay?

35. Why do you think the hospital gave you these materials? What do you think they wanted you to do with them?

36. What were your reactions to these materials? [FOR THOSE WHO DON’T REMEMBER OR DIDN’T GET THEM: Take a minute to review these materials now. What do you think of them?]

1. Did you find the information helpful, or not?

2. Did you find the information easy to use?

3. What did you like best? Was there anything you would have changed?

4. How, if at all, did you use the information in these materials (either during or after your hospital stay)?

5. Would you like to see other hospitals use these materials?

37. Did you feel that the hospital included you in the decisions that needed to be made while you were preparing to leave the hospital? How so?

38. Where did you go after you left the hospital? Home? Another care facility?

39. Did someone in the hospital offer to make your follow-up appointments for you? How did that work out?

General Experience

40. Overall, on a scale of 1 to 10, where 1 represents the worst care possible and 10 represents the best care possible, how would you rate the quality of care you received during your recent hospital stay? Please tell me more about that. How did you come up with that number? What contributed to the quality of care you received?

41. Overall, how would you rate the safety of care you received during your recent hospital stay? Please tell me more about that. How did you come up with that number? What contributed to the safety of care you received?

1. Probe if necessary: What happened that made you feel safe? How did the hospital, doctor(s), nurse(s), and/or other staff help to make you feel safe?

2. Probe if necessary: What happened that made you not feel safe?

42. Were you and your friends/family members able to participate in your care as much as you wanted? Tell me about that. How did you want to participate?

1. Probe for specifics about what it means to them to participate in care.

43. How confident did you feel about your ability to participate in your care?

44. Did you feel like your health care providers wanted you to participate in your care?

45. How you would you compare the experience you had during this hospital stay to previous stays at this hospital? At other hospitals? If there are differences, why or how was the experience different this time?

Closing

Before we end, I’d like to give everyone a chance to share any additional thoughts or comments about the things we talked about today. Is there anything that you didn’t have a chance to say during our discussion today, or something that we didn’t talk about that you wish we had, or any other thoughts you’d like to share with us?

Thank you very much for participating in this discussion today. We appreciate your time.

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