Form #1 Form #1 Interview guide

S

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

ystem Redesign for Value in Safety Net (SN) Hospitals and Delivery Systems

Attachment A: Research Master Guide of Interview Topics

1. System design activities targeted in site selection

Section I asks questions about the system redesign activities identified by the project team in advance of the site visit as part of the site selection.

1. Strategic goals and progress of the target system redesign efforts

• What did your organization hope to accomplish when beginning this system redesign? Probe for:

  • Impetus

  • Goals

  • People who initiated it

• What were the key components of the redesign? Probe for extent of:

  • Multi-dimensional changes in the management and delivery of care

  • Alignment and synergy among quality improvement efforts

  • Linkages with management structures through, e.g., use of performance measures and incentives; reporting to C suite and board

• Were these redesign activities linked to the business/financial strategy of the organization? Probe for intentions to address major challenges the organization was/is facing, e.g.,

  • Financial viability;

  • Competitive position/ market share;

  • Quality of care;

  • Patient experience of care

• Were redesign activities linked to policy changes at the local, state or federal level?

• What progress have you made? Probe for:

  • Whether redesign has gone as planned

  • Changes in goals and objectives; reasons for changes

  • Whether met objectives

• What challenges arose in carrying out this system redesign? Probe for:

  • How challenges were addressed

  • Whether successful in overcoming challenges

2. External support used or sought

• What external supports were/are being used to advance these redesign efforts? Which organizations and/or individuals are providing the support? Probe for:

  • Training

  • Participation in collaboratives/learning sessions

  • Participation in grants/demonstration projects

  • Work with consultants/suppliers

  • Work with affiliated academic institutions

  • Implementation of new IT systems

  • Benchmarking

  • Hiring expert staff

  • Other

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• How were the external supports located and selected?

• How were the external supports used?

  • Which local staff were involved and in what capacities?

  • What objectives intended to meet? Did they meet them?

  • What was the impact of those supports? Have they had lasting effects?

• What factors affected their success and usefulness – or lack thereof? Were there challenges and how were they addressed? Probe for:

  • Appropriateness of resources provided

  • Staff readiness for change, skill in improvement methods

  • IT system used to support redesign

  • Adequacy and flexibility of clinical locations and physical plant(s);

  • Internal resources to support redesign

  • External policy and reimbursement environment

  • Organizational Culture/Readiness for change

• Were you satisfied with the external resources available?

  • If not, why not?

• Are there gaps – areas where you could have used support but weren’t able to find or access what you needed?

2. Context and antecedents for system redesign in this healthcare system

Section II asks questions more broadly about the organizational context and antecedent conditions for system redesign and use of external resources in this site.

3. Organizational challenges

• What are the major strategic challenges the organization is facing? [If not covered earlier,] probe, for example, for:

  • Financial viability

  • Competitive position/ market share

  • Quality of care

  • Patient experience of care

4. System redesign (SR) initiatives

• Beyond the targeted system redesign activities discussed earlier, what other current system redesign activities are underway?

  • Approximate # of projects

  • Approximate % of staff involved in SR activities

• How are SR opportunities identified, prioritized, communicated?

  • Aligned with strategic priorities?

  • Provided with dedicated staff time?

  • Communicated as a priority from leadership?

    • Recognized and supported by middle management?

  • Is there a sense of urgency to SR work?

• How is SR work done?

  • Preferred methods and tools

  • Usual processes

• How are teams organized/staffed?

• Could you describe the key initiatives? Probe for initiatives in the following areas:

  • Strategy & vision

  • Restructuring care, administrative services, or operations – for improved quality, efficiency, cost

  • Improving financial management and controls

  • Improving knowledge & skills management

  • Promotion of teamwork

  • Implementing or expanding health IT and other technologies

  • Improving performance/outcomes measures

  • Broad-based application of process redesign methodologies such as Lean, Six Sigma, etc.

• What is progress in implementing these redesigns to date?

• Accomplishments in meeting objectives?

• Did you use external resources on these system redesign efforts? Probe for:

• Types of resources brought in;

• Issues/skills/goals they were intended to address

• Whether objectives met

• Challenges faced and how addressed

• Satisfaction with these external resources. If not, why not?

• Other external resources that would have been helpful but were not available

• Factors facilitating progress/success

• Barriers and challenges?

• What makes the difference between successful SR initiatives and less than successful ones?

• Barriers to staff involvement in system redesign?

5. Internal improvement infrastructure

• How does the organization create capacity for staff involvement in system redesign?

  • Human capital capacity?

  • System/infrastructure/IT capacity?

  • Data/measurement capacity?

• How are teams supported internally?

  • Experience improvement advisors actively supporting teams?

  • Just in time training

  • Protected time to do the work

  • Involvement in SR activities part of staff performance expectations

  • What is the structure of SR expertise within the organization?

• Are staff at middle and front-lines of the organization receptive to change and experience in quality improvement and system redesign?

• How are SR expectations/goals communicated throughout the organization?

  • How do senior/middle managers convey & support expectations?

  • How are expectations translated into departmental/unit activities?

  • Extent to which staff (top to bottom) understand and share in expectations

6. Management structures & processes for alignment and integration of system redesign with organizational priorities and business strategies

• Management structures are used to oversee SR efforts?

• Given competing demands, how does hospital assure that sufficient resources are allocated to system redesign?

• How do teams resolve obstacles – e.g., resources, problem resolution?

• How does the hospital assures coordination & integration across departments or functions working on system redesign?

• What happens when an SR initiative identifies the need for changes in hospital-wide practices or systems?

• Reporting structure for staff responsible for SR activities?

  • Number of staff

• Integration of system redesign with other types of quality management/improvement activities?

• How is accountability maintained?

• What happens when performance falls short of expectations or targets?

7. Leadership support

• To what extent is SR a priority of leadership?

  • How is that communicated to middle managers?

    • Frontline staff?

  • Examples of ways senior leaders demonstrate personal support of SR goals?

• Is SR supported by the governing board? Probe for evidence, examples?

• Examples of ways other leaders/managers (e.g., middle managers) demonstrate support of SR goals?

• Challenges in engaging leaders? How leaders/managers motivate staff involvement in SR efforts?

• How do leaders/managers sustain a focus on improvement?

• How do leaders/managers use lessons learned in one area to guide activities in other areas?

• How do leaders/managers spread improvements from one initiative across all units?

8. Summative Discussion

• What will it take to assure that redesign gains are sustained?

• What have been your biggest challenges in building strong system redesign capability?

• What specific recommendations do you have for how to strengthen the types of external supports available to SN systems that want to engage in strategic redesign?

  • Lessons learned from your experience

  • Issues with access/affordability

  • Issues with finding the right resources

  • How to learn from peers’ experiences

  • Gaps relative to needs

  • Areas for industry investment

  • Etc.

• How are SN systems’ needs/experiences unique compared to other types of hospital systems?

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