Attachment B – Cognitive Interview Guide for Medical Office VE Survey
Interview Guide for Draft Medical Office
Value and Efficiency Survey
File Contents:
Introduction for telephone cognitive interviews (with oral consent recorded)
Draft survey questions by potential dimensions and scripted interview probes
1-4-13
M
Form
Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX
Round 1 Telephone Cognitive Interviews: Introduction and Oral Consent
Respondent ID#: ___________________________
Respondent Job Title: __________________________
Number of providers: __________________
Date of Interview: _________________________
Time of Interview: _________________________
Interviewer: __________________________
Tape Recorded? _________________________
Introduction and Consent
Hello, my name is _____________________________. I have [a/two] colleague(s) with me here – [NAME(S)]. We work for Westat, a private research company in Rockville, Maryland. Thank you for taking the time to complete and talk about the draft survey on value and efficiency in medical offices.
Westat is working with the Health Research and Educational Trust (affiliated with the American Hospital Association) on this project, which is funded by the Agency for Healthcare Research and Quality, Department of Health and Human Services. One purpose of the project is to develop a survey about improving efficiency in the delivery of quality care that can be administered to everyone working in the medical office. You recently completed a set of these draft survey items.
I am talking with you today to find out how the survey items worked for you – for example, were the questions easy to understand and answer? I am interested in what you think about the questions, and I will be asking you what the questions mean to you. There are no right or wrong comments. Please speak up freely and tell me what you think.
This is a research project and your participation is voluntary. You may skip any question you do not want to answer and you may stop the interview at any point. I expect the interview to take about 1¼ hours. We take many steps to keep your comments and survey responses private. I will discuss your responses only with other project team members. We will not include your name or your medical office’s name in any written findings reports.
Public
reporting burden for this collection of information is estimated to
average 1
½ hours 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.
I will be happy to answer any questions you may have about this task. If you have any questions about your rights as a research participant, you may contact Westat’s IRB administrator, Sharon Zack. Would you like her phone number? (IF YES: Please call her toll-free at 1-800-937-8281 and ask for Sharon Zack]).
Because I want to pay close attention to what you say, I would like to tape record our interview so that I can listen to it later to see if I missed anything. Is that okay?
TURN ON THE RECORDER: I need to ask your permission again so that it is recorded: Today is mo/day/year at [time]. Do you agree to participate in this interview and to have it audio recorded?]
I will review the definitions on the first page, then ask a few general questions about the survey items, and then address specific survey items. Your comments will help in identifying possible problems. Please share your thoughts and don’t hesitate to bring up problems, suggest changes, or say which items you prefer – the whole purpose of this pretest is to improve the items and use the best ones in the survey.
Do you have a copy of your survey with you? Good. Before we start, do you have any questions? Okay, let’s begin.
Medical Office Value and Efficiency Survey |
Instructions |
Think about the way things are done in your medical office and provide your opinions on the efficiency with which care is delivered.
If a question does not apply to you or your medical office or you don’t know the answer, please check “Does Not Apply or Don’t Know.”
For the purposes of this survey, the following definitions apply to several items in this survey:
The
term provider refers to physicians, physician assistants,
and nurse practitioners who diagnose, treat patients, and prescribe
medications. The term staff refers to all others who work in
the office.
Wastesuch
as wasted time, wasted materials, extra steps in a process,
repeating work, etc.is
anything that does not add value for patients or staff.
Efficiency
in health care means removing waste from the system and
establishing care and business processes that are as streamlined
and simplified as possible.
Value
includes quality, cost, and outcomes and is ideally driven by
patient preferences of care.
Definitions Probes
Did you notice and read the definitions on the first page?
(IF DID NOT READ: Can you say more about that?)
IF YES: How easy or difficult were they to understand? (Why?)
(Would you change the definitions in any way?) (How?)
How helpful were the definitions in answering the questions?
How often do you hear the terms waste, efficiency, and value in your medical office?
Now, let’s move on to the survey items.
Interview Guide: Draft Items by Dimension and Probes
Manager support for value/efficiency/waste reduction
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Before we start reviewing each question in Item set 1, do you have any general comments to make about the survey items overall or specifically?
Probes: Q1. In question 1, whom were you thinking about when you read the word “Managers”?
What does “simplify work processes” mean to you? (Can you give me some examples?)
IF POSITIVE ANSWER: How do staff learn that this is an expectation?
Q2. How did you arrive at your answer to question 2? (How do managers encourage staff?)
What staff were you thinking about?
Q3. Tell me more about your answer to question 3.
Is there a formal or informal process for making suggestions? (Please describe the process.)
(IFA/SA: How do managers follow up? Any examples?)
|
Manager support for value/efficiency/waste reduction (continued)
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Q4. Please tell me more about your answer to question 4.
(You said ____. What are some examples?)
Q5. What do you think question 5 is saying?
Were you thinking about both successful and unsuccessful implementation efforts? IF POSITIVE ANSWER: What managers do this?
IF POSITIVE ANSWER: How do they recognize staff? IF NONPOSITIVE ANSWER: What does recognize staff mean to you?
Q6. Please tell me more about your answer to question 6. (Are staff recognized if an improvement effort is not successful?)
Wrap up: If questions 1 through 6 had asked about Senior leaders in your medical office instead of Managers, would you have answered any of the items differently? IF YES: Which ones and why? IF NO: Why not? |
Staff engagement & empowerment
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Let’s look at Item set 2.
Q1: IF POSITIVE RESPONSE: You said ____ for item 1; can you tell me more about your answer?
(How are staff asked?) (Who asks for staff opinions?) (When are they asked?)
IF NONPOSITIVE RESPONSE: You said _____ for item 1. What do you think this question is asking? Have there been any changes to your work processes?
Q2: In item 2, whom were you thinking about?
NOTE IF R ANSWERED Q1+Q2 CONSISTENTLY (SIMILAR ITEM BUT ONE IS NEGATIVELY WORDED) IF RESPONSE IS INCONSISTENT: Tell me about why you answered ______________.
Q3. IF SA/A, I noticed you answered ____ for item 3. Can you tell me more about your answer – how are they encouraged?
IF SD/D, I noticed you answered _____ for item 3. What does it mean to you to be “encouraged to come up with more efficient ways of doing things”? Who might encourage you?
IF NA/DKA, I noticed you answered _____ for item 3. Can you tell me more about your response?
|
Staff engagement & empowerment (continued)
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Q4: In your own words, what is item 4 saying? (look for understanding of terms “empowered,” “solutions,” “workflow problems”)
Q5: Whom were you thinking of when you read item 5?
How did you arrive at your answer?
(IF SA/A: In what ways do they take responsibility?)
Q6. For question 6, you answered ____________. Can you tell me more about your answer? (IF A/SA: What are some examples?)
|
Staff engagement & empowerment (continued)
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Q7: When you read question 7, what staff were you thinking about?
Tell me more about your answer to Q7.
Q8: For question 8, you answered ____________. Can you tell me more about your answer?
What managers were you thinking about?
What senior leaders?
Do you think staff are equally comfortable making suggestions to managers and senior leaders? (Why is that do you think?)
|
Waste reduction
How often do the following statements apply to your medical office? |
Never |
Rarely |
Sometimes
|
Most
of the time |
Always |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
[BE SURE TO PROBE ON NEUTRAL OR DK/DNA ANSWERS FOR ALL ITEMS] Probes:
Now let’s look at the third set of items.
Q1. In your own words, what is item 1 saying?
(What does work processes mean to you?)
(Whom were you answering about – how did you interpret we?)
You answered ______________for question 1. Can you tell me more about that? (IF Always/Most of the time: How did staff in your medical office examine their work processes?)
(What are examples of unnecessary steps?)
Why do staff do this?
IF NOT POSITIVE ANSWER: If you were told to do this, what would you think about doing?
Q2. Tell me how you arrived at your answer of __ for question 2.
(What does time is wasted mean to you?)
[Ask for examples if none given.]
(Whom were you answering about – how did you interpret we?)
Q3. In your own words, what is question 3 saying?
(What would be some examples of this?)
How did you arrive at your answer?
(Whom were you answering about – how did you interpret we?)
|
Waste reduction (continued)
How often do the following statements apply to your medical office? |
Never |
Rarely |
Sometimes
|
Most
of the time |
Always |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Q4. In your own words, what is question 4 saying?
(What does the phrase point of care mean to you?) Why would supplies be kept at the point of care?
IF POSITIVE ANSWER: What are some examples of supplies that are kept at the point of care?
IF NONPOSITIVE ANSWER: How good an idea do you think it is to keep supplies at the point of care? (Why?)
Q5. Tell me more about your answer to question 5. (IF NOT NEVER: Ask for examples)
Q6. Again, please tell me how you arrived at your answer? (IF NOT NEVER: Ask for examples)
|
Waste reduction (continued)
How often do the following statements apply to your medical office? |
Never |
Rarely |
Sometimes
|
Most
of the time |
Always |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Q7. In your own words, what is question 7 saying?
(What are some examples of this?)
Tell me more about your answer.
Q8. You answered ___ for question 8. How did you arrive at that answer?
[Ask for examples if none given.]
Q9. In your own words, what is question 9 saying?
(What does duplicate work mean to you?) (Do you think it would be easier to understand this item if it asked about repeated work?)
(What are examples of this?)
(Why would staff have to duplicate/repeat the work?)
How did you arrive at your answer to Q9?
|
Measurement & data monitoring
How often do the following statements apply to your medical office? |
Never |
Rarely |
Sometimes
|
Most
of the time |
Always |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Now let’s move on to the next set of items – Set 4. The response scale changed back to Never/Always. Did you notice that, and did it cause any problems for you? Q1. For question 1, please tell me more about your answer.
(What data do you use? What improvement efforts were you thinking about?)
(PAY ATTENTION TO WHETHER R IS ANSWERING ABOUT SPECIFIC IMPROVEMENT EFFORTS)
How easy or hard was it to answer this question? (Why?)
Q2. In question 2, what work processes were you thinking about?
IF POSITIVE ANSWER: What data were collected? Who reviewed the data?
IF NONPOSITIVE ANSWER: Tell me more about why you answered ______?
Q3. Tell me more about your answer to question 3.
|
Measurement & data monitoring (continued)
How often do the following statements apply to your medical office? |
Never |
Rarely |
Sometimes
|
Most
of the time |
Always |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Q4. In your own words, what is question 4 saying?
(How did you interpret the words how well we are performing?)
How did you arrive at your answer?
(IF ANSWER WAS SOMETIMES/MOT/ALWAYS): Can you describe the type(s) of visual displays and where staff could see them?
Q5. How easy or difficult was it to answer question 5? Why?
What costs were you thinking about?
How did you arrive at your answer?
|
Patient centeredness
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: The response scale changed back to Agree/Disagree. Did you notice that, and did it cause any problems for you? Now let’s look at Item Set 5.
Q1: In question 1, what does “workflow redesign efforts” mean to you?
How did you arrive at your answer?
(IF POSITIVE RESPONSE: Can you give me an example?)
Q2: In your own words, what is item 2 saying?
In your experience, what do patients value?
Can you tell me more why chose the answer ____________?
DID R SAY THEY HAVE NOT CHANGED THEIR WORKFLOW?
Q3. For question 3, what does “add value for patients” mean to you?
You answered ___. Tell me more about that.
|
5. Patient centeredness (continued)
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes:
Q4: Tell me more about your answer also for question 4. (Any examples?)
Q5: In your own words, what is item 5 saying?
|
Senior leadership support for value/efficiency/waste reduction
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Okay. Let’s start with question 1 in item set 6. Probes: Q1. In question 1, thinking about your medical office, what do the words “Senior leaders” mean to you?
In the same question, what were you thinking about when you read the words “work processes”?
Whom were you thinking about when you read everyone’s job? (All persons working in the medical office, including non-staff physicians and senior leadership as well as nurses, medical assistants, technicians, front desk, billing, insurance, and other staff?)
Can you tell me more about your answer?
Q2. In question 2, when you read “identify ways to make their work processes more efficient” what were you thinking about?
Please tell me more about your answer. (If positive answer: Ask for examples).
|
Senior leadership support for value/efficiency/waste reduction (continued)
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Q3. In question 3, what things came to your mind when you read “reduce waste in our systems and procedures”?
IF POSITIVE ANSWER: What are some examples of how senior leaders visibly support efforts to reduce waste in your systems and procedures?
Tell me why you answered _____.
Instead of “waste in systems and procedures”, would the phrase “waste in our work” be better?
Q4. For question 4, tell me how you arrived at your answer.
[DID R SAY SOME SENIOR LEADERS ARE COMMITTED BUT OTHERS ARE NOT? IF SO, DID R FACTOR THAT INTO CHOICE OF ANSWER?]
(How did R interpret reducing waste and the way we do things?)
Wrap up: If items 1 through 4 had asked about Managers in your medical office instead of Senior leaders, would you have answered any of the items differently? IF YES: Which ones and why? IF NO: Why not?
|
Priority on value and efficiency
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Now let’s look at Item Set 7.
Q1: In your own words, what do you think this item is saying?
Please tell me more about your answer.
Q2: In your own words, what is item 2 saying? How do you know what the goal(s) of your medical office are?
(How are the goals communicated to you?)
Tell me more about your answer.
Q3: For item 3, you answered ____________. Can you tell me more about that?
IF POSITIVE RESPONSE: What are some examples?
|
Priority on value and efficiency (continued)
How much do you agree or disagree with the following statements? Think about your medical office when answering: |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
|
1 |
2 |
3 |
4 |
5 |
9 |
|
1 |
2 |
3 |
4 |
5 |
9 |
Probes: Q4: For item 4, what does “continually look” mean to you? (How often?)
Tell me about your answer.
Q5: In your own words, what is item 5 saying?
IF POSITIVE RESPONSE: Tell me more about your answer.
|
Experience/Involvement with quality or process improvement activities
In the past 12 months, have you done the following activities to improve efficiency, add value, or reduce waste in your medical office? |
Yes |
No |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
[BE SURE TO PROBE MORE ON ALL ITEMS] Probes: Now let’s look at Item Set 8. Q1. Item 1 - What does map a workflow process mean to you?
(IF YES: Please describe what you did.)
IF NO: Do you know of anyone in your medical office who has participated any of these things in the past 12 months? (IF YES TO KNOWING SOMEONE: Were they trained to do them?)
Q2. In your own words, what is question 2 asking?
IF YES: Can you tell me more about that experience?
IF NO: Do you know of anyone who has ever done this in your hospital?
Q3. In your own words, what is question 3 asking?
IF YES: Can you tell me more about a suggestion you made to management?
IF NO: Do you know of anyone who has ever done this in your medical office?
|
Experience/Involvement with quality or process improvement activities (continued)
In the past 12 months, have you done the following activities to improve efficiency, add value, or reduce waste in your medical office? |
Yes |
No |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
Probes: Q4. IF YES: For question 4, tell me more about when and how you identified inefficient work processes.
IF NO: What might be an inefficient work process?
Q5. IF YES: For question 5, please tell me more about this; can you give an example?
IF YES: Were you trained to do this?
IF NO: What do you think question 5 is saying?
Q6. IF YES: For question 6, please tell me more about this; can you give an example? IF NO: What do you think question 6 is referring to? (What does standardizing a work process mean to you?)
|
Experience/Involvement with quality or process improvement activities (continued)
In the past 12 months, have you done the following activities to improve efficiency, add value, or reduce waste in your medical office? |
Yes |
No |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
Probes: Q7. IF YES: For question 7, please describe the improvement activity you participated in.
IF NO: Was there an improvement project in your work area in the past 12 months? IF YES: What staff participated – did they volunteer or were they asked or assigned to participate?
Q8. IF YES: For question 8, please describe the activity you implemented.
(Did you do this on your own or as a team leader or a team member?)
IF NO: In your own words, what is question 8 asking?
Q9. IF YES: Tell me more about your answer for question 9.
IF NO: Did anyone else in your medical office serve on such a team or committee in the past 12 months? (Can you say more about the work process they improved?)
|
Experience/Involvement with quality or process improvement activities (continued)
In the past 12 months, have you done the following activities to improve efficiency, add value, or reduce waste in your medical office? |
Yes |
No |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
Probes: Q10. Tell me more about your answer to question 10. (What data were collected? How did you collect the data? How were the data used?)
Q11. In your own words, what is question 11 asking?
(What kinds of savings might be achieved?)
IFYES: What costs did you track?)
Q12. IF YES: Tell me more about your answer.
IF NO: Are you aware of someone else in your medical office who has done this? IF YES TO AWARE OF SOMEONE ELSE: Can you say more about that?
Q13. IF YES: For question 13, please describe the change in the activity.
IF NO: Are you aware of someone else in your medical office who has done this? IF YES TO AWARE OF SOMEONE ELSE: Can you say more about that?
NOTE IF R SAYS THERE HAVEN’T BEEN ANY UNSUCCESSFUL IMPROVEMENT ACTIVITIES.
Wrap-up: How easy or hard was it to answer this series of questions in Item Set 8? (Why?)
|
In my experience, improvement efforts in this medical office tend to result in:
Mark ONE answer
1 |
Long-term or lasting change |
2 |
Initial or temporary changes, but the changes don’t last |
3 |
No change—no noticeable improvement |
Probes: Q9. How did you arrive at your answer to question 9?
How easy or hard was it to choose an answer? (Why?)
(What improvement efforts were you thinking about?)
|
Overall rating
Thinking back on your survey answers, what overall rating would you provide for your medical office on value, efficiency, and waste reduction?
Poor ▼ |
Fair ▼ |
Good ▼ |
Very good ▼ |
Excellent ▼ |
1 |
2 |
3 |
4 |
5 |
Probes: Please tell me how you arrived at your rating of _____________.
(What would need to be different to get a higher rating?) |
Closing Probes
(For Rs who did not select DK/DNA): Now I have a general question about the response scales. I noticed you didn’t select Does Not Apply or Don’t Know - the response option in the last column. Did you notice it?
[Note to interviewer: If you know R has worked in other medical offices: Would you have answered any differently for any other medical offices you have worked in?]
That’s all of my specific questions. Our goal is to shorten this series of questions. In your opinion, which of the questions were the hardest for you to understand or answer? (Why?)
Thanks. Do you have any additional comments?
Thank you very much for participating in this pretest. Your comments have been helpful.
TURN OFF RECORDER
To show our appreciation for your time and help, we will send you a check for [$100/$175]. Please [confirm/tell me] your mailing address [DOCUMENT ON NEXT PAGE]:
Mailing address:
(Say we will send by FedEx but they do not have to be there to sign for it.) Note: We have to submit info to accounting by COB Monday or Thursday for Tuesday and Friday processing - let person know approximately when to expect check.
Immediately after the interview, notify Vicki that the interview has been completed and provide her with the following:
Participant ID#
First and last name of the participant
Participant’s gender
Indicate if the participant is a physician
Mailing address
Phone number (for FedEx form)
Incentive amount
Name of lead interviewer
NOTE: After Vicki has the new address, remove this page from the Interview Guide and shred it.
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File Created | 2021-01-29 |