Form # 1 Form # 1 Cognitive Interview Guide

Form Approved

OMB No. 0935-XXXX

Exp. Date XX/XX/20XX

Attachment A - Cognitive Interview Guide for Ambulatory Surgery Survey

File Contents:

1. Introduction for telephone cognitive interviews (with oral consent recorded)

2. Draft survey questions by potential dimensions and scripted interview probes

8-30-2013

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.

Ambulatory Surgery Survey on Patient Safety

Round 2 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 _____________________________. There are a few other colleagues on the line --- [NAMES]. We work for Westat, a research company in Rockville, Maryland. Thank you for taking the time to complete and talk about the draft ambulatory survey on patient safety.

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. We are developing and testing a questionnaire that will be taken by health professionals and administrative staff who work in ambulatory facilities nationwide. The survey topic is patient safety in ambulatory settings. Thank you for recently completing this survey and returning your answers to us.

Today I would like to talk to you about how the survey items worked for you. For example, were the questions difficult or easy to understand and answer? We are interested in what you thought about when you read and answered the questions. There are no right or wrong comments. Please speak up freely and tell me what you think – our goal is to improve the survey.

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 1 1/2 hours. Everything we cover today will be kept confidential to the extent permitted by law. Confidential means that you and your facility will never be named in anything written down or reported.

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 audio 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?]

Do you have a copy of your survey with you? Good. Before we start, do you have any questions? Okay, let’s begin.

Ambulatory Surgery

Survey on Patient Safety

This survey asks for your opinions about patient safety in outpatient surgery/procedure/treatment facilities and takes at least 15 minutes to complete. If you work in multiple facilities, please answer only for the facility that gave you the survey.

Please review the following definitions and instruction before beginning the survey:

The term doctors refers to medical doctors (MDs or DOs) and other doctors, such as podiatrists and dentists, who perform surgeries, procedures, or treatments, including delivery of anesthesia.

• The term staff refers to all others (clinical and nonclinical) who work in your facility, whether they are employed directly by your facility or are contract/per diem/agency staff.

• “Patient Safety” is the prevention of harm resulting from the processes of health care delivery.

• A mistake is any type of error, incident, or event that contributed to patient harm or that could have caused patient harm but did not.

• If a question does not apply to you or your facility or you don’t know the answer, please check “Does Not Apply or Don’t Know.”

Probes:

Let’s look at the first page before the questions start (page 2 of your survey).

Did you read this page?

Can you say in your own words what you are being asked to do?

How did the definitions work for you? (Any problems are questions about them?)

DID YOU USE DNA/DK RESPONSE AT ALL: Did you notice the instruction in the bottom of the shaded box?

Before we start reviewing question by question, do you have any general comments to make about the survey items overall or specifically?

GENERAL PROBES: You were asked to answer about your facility, and the word facility appears in many items. What did you think about when you saw the word facility?

How do you usually refer to the place you answered about in this survey?

IF NOT FACILITY: Were you confused when you read the word facility? (Did it cause any problems in answering the survey questions?)

Some people work across a number of ambulatory facilities and others spend all their time in one facility. How many different ambulatory facilities do you currently work in?

IF MORE THAN ONE FACILITY: Which ambulatory facility where you thinking of when you answered these questions?

IF NECESSARY: What made you focus on that facility and not ~~~~~~ facility?

The survey is called the “Ambulatory Surgery Survey on Patient Safety.” Can you say something about the title? Do you feel that this is a survey that applies to you and your place of work?

Who do you feel this survey is about?

SECTION SPECIFIC PROBES:

Topic 1 (Teamwork)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
There is a good working relationship between doctors and staff	1	2	3	4	5	9
When someone in this facility gets really busy, others help out	1	2	3	4	5	9

PROBES:

[ALWAYS CHECK WHAT THE RESPONSE OPTION MEANS – “STRONGLY DISAGREE – WHY “STRONGLY” AND NOT JUST “DISAGREE”, ETC.]

Q1.1 In question 1, you answered _____. What made you (response)?

(IF NEEDED TO VERIFY OR CLARIFY ANSWER TO Q1.1: Can you give some examples of what you just said.)

What groups of staff and doctors were you thinking about?

Who do you consider a doctor?

Q1.2. You answered ____ to question 2 – can you say more about that?

Who do you consider “someone” to be? Does it include the doctors?

Can you give an example for why you answered _________.

Topic 1 (Teamwork)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Doctors and staff clearly understand each other’s roles and responsibilities	1	2	3	4	5	9
We work together as an effective team	1	2	3	4	5	9

Q1.3. You answered _____ to question 3 – can you say more about that?

What does it mean to “understand each other’s roles and responsibilities”?

Can you give some examples?

Q1.4. You answered ______ to question 4 – can you say why you chose that answer?

What does an “effective team” mean to you?

Topic 1 (Teamwork)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
We treat each other with respect	1	2	3	4	5	9
We resolve work-related disagreements in a respectful way……………………………………	1	2	3	4	5	9

Q1.5. You answered ______ to question 5 – can you say more about that?

Who is the “each other” you were thinking of?

What does it mean to “treat each other with respect?”

Q.1.6. You answered ______ to question 6 – can you say more about that?

Who is the “we” you were thinking of? (Does “we” include doctors?)

What does it mean to “resolve disagreements in a respectful way?”

ASK IN ALL INTERVIEWS:

In general, what did you think the items in Topic 1 were asking about?

To your mind, what makes “teamwork” happen?

Are there any groups in your facility that separate themselves from others? [CHECK FOR CLIQUES]

Can you say more about that?

Topic 2 (Communication Openness)

How often do the following statements apply to your facility?	Never 	Rarely 	Sometimes 	Most of the time 	Always 	Does Not Apply or Don’t Know 
In this facility, we speak up when we see something that may negatively affect patient care	1	2	3	4	5	9
In this facility, we feel comfortable asking questions when something doesn’t seem right	1	2	3	4	5	9

PROBES:

Q2.1 You answered ______ to question 1 – can you say more about that?

Who is the “we” you were thinking of when you answered?

Can you describe “something that may negatively affect patient care”?

Q2.2 You answered ______ to question 2 – can you say more about that?

Who is the “we” you were thinking of when you answered?

Did you include yourself or did you think of other people but not yourself?

What does it mean to “feel comfortable” about asking questions when something doesn’t seem right?

What do you think of when you read “something doesn’t seem right”?

Topic 2 (Communication Openness)

How often do the following statements apply to your facility?	Never 	Rarely 	Sometimes 	Most of the time 	Always 	Does Not Apply or Don’t Know 
Staff feel free to question the decisions or actions of those with more authority	1	2	3	4	5	9
Staff who see others doing something unsafe for patients tell them it is unsafe.	1	2	3	4	5	9

Q2.3 What do you think question 3 is asking?

You answered ______ to question 3 – can you say more about that?

Is this something staff do – “question the decision or action of those with more authority”?

Can you give some examples?

Q2.4 You answered ______ to question 4 – can you say more about that?

What “staff” were you thinking about when you answered the question?

Who are the “others” in this question?

What kinds of things could you see a doctor do that would be “unsafe”?

Can you say more about that?

Topic 3 (Communication About Patient Information)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
In this facility, we do a good job communicating information that affects patient care	1	2	3	4	5	9
Problems often occur in the exchange of information between doctors and staff	1	2	3	4	5	9

Q3.1 You answered ______ to question 1 – can you say more about that?

What type of information is the question asking about?

How is this information communicated?

What facility were you thinking about when you answered the question?

Can you give some examples of “information that affects patient care”?

Q3.2 You answered ______ to question 2 – can you say more about that?

Can you say in your own words what the question is asking?

What kind of “problems” is the question referring to?

What kind of information is exchanged between doctors and staff?

Can you give some examples?

Topic 3 (Communication About Patient Information)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
We share key information about patients as it becomes available	1	2	3	4	5	9
Key patient care information is clearly communicated across areas in this facility	1	2	3	4	5	9

Q3.3 You answered _______ to question 3 – can you say more about that?

What kinds of information were you thinking about when answering this question?

What does “as it becomes available” mean to you?

Can you give some examples?

Q3.4 You answered _______ to question 4 – can you say more about that?

What “areas” were you thinking of?

Can you give some examples?

Topic 4 (Organizational Learning - Continuous Improvement)

How often do the following statements apply to your facility?	Never 	Rarely 	Sometimes 	Most of the time 	Always 	Does Not Apply or Don’t Know 
This facility makes improvements when someone points out patient safety problems	1	2	3	4	5	9
We are good at changing processes to make sure the same patient safety problems don’t happen again	1	2	3	4	5	9

[ALWAYS CHECK WHAT THE RESPONSE OPTION MEANS – “STRONGLY DISAGREE – WHY “STRONGLY” AND NOT JUST “DISAGREE”, ETC.]

Q4.1 You answered _____ to question 1 – how did you arrive at this answer?

Can you describe some examples that help us to understand your answer?

What kind of improvements were you thinking about?

Q4.2 You answered _____ to question 2 – can you say more about what that means?

What kind of “patient safety problems” were you thinking of when you answered the question?

What kind of “processes” were you thinking of?

Topic 4 (Organizational Learning - Continuous Improvement)

How often do the following statements apply to your facility?	Never 	Rarely 	Sometimes 	Most of the time 	Always 	Does Not Apply or Don’t Know 
When our efforts to improve patient safety are unsuccessful, we keep trying to find a better way to do things	1	2	3	4	5	9
We try to prevent patient harm by learning from mistakes	1	2	3	4	5	9

Q4.3 You answered _____ to question 3 – can you say more about that?

The question asks about “when our efforts to improve patient safety are unsuccessful” – is this something you have any experience with?

What does it mean to “keep trying to find a better way to do things”?

Who is the “we”? [CHECK IF MANAGEMEN/DOCTORS ARE INCLUDED]

Q4.4 You answered _____ to question 4 – can you say more about that?

Who is the “we” in this question?

How can you prevent patient harm by learning from mistakes?

Can you think of a specific mistake made at your facility that you learned from?

Is there a difference between mistakes and errors? What about incidents? Events?

Topic 4 (Organizational Learning - Continuous Improvement)

How often do the following statements apply to your facility?	Never 	Rarely 	Sometimes 	Most of the time 	Always 	Does Not Apply or Don’t Know 
This facility is open to making changes to improve patient safety	1	2	3	4	5	9
Mistakes have led to improvements in patient safety in this facility	1	2	3	4	5	9

Q4.5 You answered _____ to question 5 – can you say more about that?

What does it mean to be “open to making changes that improve patient safety”?

Who were you thinking about when you read “this facility”?

Q4.6 You answered _____ to question 6 – can you say more about that?

What are some examples of mistakes leading to improvements in patient safety?

Topic 5 (Response to Mistakes)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
We are informed about errors that happen in this facility	1	2	3	4	5	9
We discuss if any of our processes contributed to mistakes that affect patient care	1	2	3	4	5	9

[ALWAYS CHECK WHAT THE RESPONSE OPTION MEANS – “STRONGLY DISAGREE – WHY “STRONGLY” AND NOT JUST “DISAGREE”, ETC.]

Q5.1 Can you say in your own words what question 1 is asking?

How are you “informed about errors”?

Who is “we” in this question?

Q5.2 You answered ____ to question 2 – can you say more about that?

Who is the “we” you thought of when answering?

Who do you discuss mistakes that affect patient care with?

How can “processes” contribute to mistakes?

Topic 5 (Response to Mistakes)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Management emphasizes learning rather than blame when staff make patient safety mistakes	1	2	3	4	5	9
We try to understand the factors that lead to patient safety errors	1	2	3	4	5	9

Q5.3 Can you say in your own words what question 3 is asking?

How does management “emphasize learning rather than blame”?

When you answered about “management” in this question, who were you thinking about? Anyone else?

Q5.4 You answered ____ to question 4 – can you say more about that?

Who is the “we” you thought of when answering?

What does it mean to “understand the factors that lead to patient safety errors”?

What kind of errors were you thinking about?

Topic 5 (Response to Mistakes)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Staff feel comfortable reporting patient safety errors	1	2	3	4	5	9
Staff are treated fairly when they make patient safety mistakes	1	2	3	4	5	9

Q5.5 You answered _____ to question 5 – can you say more about that?

What does it mean to “feel comfortable reporting patient safety errors”?

What staff where you thinking about when you answered?

What kind of patient safety errors were you thinking of when you answered?

Q5.6 Can you say what question 6 is asking in your own words?

How did you arrive at your answer of ______?

Can you describe how staff are either treated fairly or unfairly?

Topic 5 (Response to Mistakes)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
When staff take shortcuts that put patient safety at risk, managers work with them to change their behavior	1	2	3	4	5	9

Q5.7 How did you choose your answer of _____?

What does “shortcuts” mean to you?

Can you say more about staff “taking shortcuts”?

Who are the “managers” in this question?

What does it mean to work with someone to change their behavior?

Can you think of any examples?

Topic 6 (Documenting Mistakes)

	Never 	Rarely 	Some- times 	Most of the time 	Always 	Does Not Apply or Don’t Know 
When a mistake is made that could harm the patient, but does not, how often is it documented?	1	2	3	4	5	9

Q6.1 You answered ______ to question 1 – can you say why you chose that answer?

Could you describe in your own words the kind of mistake the question is asking about?

The question asks “how often is it documented” – what type of documentation is the question referring to?

Can you give some examples of the types of mistakes the question is referring to?

Topic 7 (Staff Training)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Staff feel pressured to do tasks they haven’t been trained to do	1	2	3	4	5	9
Staff receive adequate training in this facility on how to manage complications with patient care.	1	2	3	4	5	9

[ALWAYS CHECK WHAT THE RESPONSE OPTION MEANS – “STRONGLY DISAGREE – WHY “STRONGLY” AND NOT JUST “DISAGREE”, ETC.]

Q7.1 You answered ____ to question 1 – can you say more about that?

What does it mean to “feel pressured to do tasks they have not been trained to do”?

What kind of tasks were you thinking about?

Q7.2 You answered ____ to question 2 – can you say more about what that means?

Can you say in your own words what the question is asking?

Who do you think of when you see “staff “?

What does “adequate training in this facility on how to manage complications with patient care” mean to you?

What kind of complications were you thinking about?

Topic 7 (Staff Training)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Staff who are new to this facility receive adequate orientation	1	2	3	4	5	9
This facility provides effective training on patient safety policies and procedures.	1	2	3	4	5	9

[ALWAYS CHECK WHAT THE RESPONSE OPTION MEANS – “STRONGLY DISAGREE – WHY “STRONGLY” AND NOT JUST “DISAGREE”, ETC.]

Q7.3 You answered ______ to question 3 – can you say more about that?

When the question asks about “adequate orientation” what do you think of?

Q7.4 You answered ______ to question 4 – can you say more about that?

What does “effective training” mean to you?

What “patient safety policies and procedures” were you thinking of when you answered?

What is an example of this type of training in your facility?

Topic 7 (Staff Training)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Staff get the on-the-job training they need in this facility	1	2	3	4	5	9

[ALWAYS CHECK WHAT THE RESPONSE OPTION MEANS – “STRONGLY DISAGREE – WHY “STRONGLY” AND NOT JUST “DISAGREE”, ETC.]

Q7.5 You answered ______ to question 5 – can you say more about that?

What “staff” were you thinking about when you answered the question?

What does “on-the-job training” mean to you?

Who is responsible for providing the “on-the-job training”?

Can you give some examples?

Topic 8 (Staffing, Work Pressure, and Pace)

How often do the following statements apply to your facility?	Never 	Rarely 	Sometimes 	Most of the time 	Always 	Does Not Apply or Don’t Know 
Pressure to move quickly from case to case gets in the way of patient safety	1	2	3	4	5	9
We feel rushed when taking care of patients	1	2	3	4	5	9

[PROBE ON THE SWITCH TO FREQUENCY RESPONSE SCALE]

The way you answer the questions changed. How did that work for you? – Never, rarely, most of the time, always, etc.

Q8.1 You answered ______ to question 1 – can you say more about that?

What is the question asking about?

What “pressures” is the question asking about?

What does it mean to “move quickly from case to case”?

How would that “get in the way of patient safety”?

Q8.2 You answered ______ to question 2 – can you say more about that?

The question says “we” – who is the “we” you answered for?

What does it mean to “feel rushed”?

Would you know whether other staff felt rushed?

What does “when taking care of patients” mean to you?

Topic 8 (Staffing, Work Pressure, and Pace)

How often do the following statements apply to your facility?	Never 	Rarely 	Sometimes 	Most of the time 	Always 	Does Not Apply or Don’t Know 
We have enough staff to handle the workload	1	2	3	4	5	9
There is enough time between procedures to properly prepare for the next one.	1	2	3	4	5	9

Q8.3 You answered ______ to question 3 – can you say more about that?

Again, who is the “we” you answered for?

Would some parts of your center feel that there were enough staff and others feel that there were not enough staff?

What does it mean to “handle the workload”?

Q8.4 You answered ______ to question 4 – can you say more about that?

Can you say in your own words what the question is getting at?

( What does it mean to “properly prepare for the next procedure”?)

When the question says “procedures” what do you think of? [ARE SURGERIES INTERCHANGEABLE WITH PROCEDURES?]

Topic 8 (Staffing, Work Pressure, and Pace)

How often do the following statements apply to your facility?	Never 	Rarely 	Sometimes 	Most of the time 	Always 	Does Not Apply or Don’t Know 
The scheduling of patients allows enough time to safely care for them.	1	2	3	4	5	9
We have enough time to safely care for patients	1	2	3	4	5	9

Q8.5 You answered ______ to question 5 – can you say more about what that means?

Can you say in your own words what the question is getting at?

How did you arrive at your answer?

Can you think of any examples when scheduling has affected patient safety?

Q8.6 You answered ______ to question 6 – can you say more about what that means?

Who is the “we” you answered for?

What does “have enough time to safely care for patients” mean to you?

Topic 9 (Management Support for Patient Safety)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Management encourages everyone to suggest ways to improve patient safety	1	2	3	4	5	9
Management makes sure staff follow patient safety rules and procedures	1	2	3	4	5	9

Q9.1 You answered _____ to question 1 – can you say more about that?

Who is “everyone”? Does it include doctors? Patients?

What does “encourage” mean here?

Does something have to change for there to be “encouragement”?

What does it mean to “suggest ways to improve patient safety”?

Q9.2 You answered ______ to question 2 – can you say more about that?

Who is “management” in this question? [CHECK FOR DOCTORS]

When the question asks about “staff” who do you think of?

What does it mean to “follow patient safety rules and procedures”?

What does it mean for management to make sure?

Can you think of any specific procedures?

Topic 9 (Management Support for Patient Safety)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Management examines near misses that could have harmed patients but did not	1	2	3	4	5	9
Management provides adequate resources to improve patient care processes	1	2	3	4	5	9

Q9.3 You answered ______ to question 3 – can you say more about what that means?

Who is “management” in this question? [CHECK FOR DOCTORS]

When you saw “near misses” in the question, what did you think of?

Q9.4 You answered ______ to question 4 – can you say more about what that means?

Who is “management” in this question? [CHECK FOR DOCTORS]

When you saw “resources to improve patient care processes”, what did you think of?

What does “adequate” mean to you?

Topic 9 (Management Support for Patient Safety)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
The actions of management show that patient safety is a top priority.	1	2	3	4	5	9
Management sends a clear message that patient safety is everyone’s responsibility	1	2	3	4	5	9

Q9.5 Can you say in your own words what the question is getting at?

Who is “management” in this question? [CHECK FOR DOCTORS]

What kinds of “actions” were you thinking of?

Q9.6 You answered _____ to question 6 – can you say more about that?

Can you say in your own words what the question is asking?

How is the “clear message” sent?

Who is “everyone” in this question?

How can everyone be responsible for patient safety?

Topic 10 (Overall Perceptions of Patient Safety)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
We are well prepared to manage medical complications that occur in this facility	1	2	3	4	5	9
We have patient safety problems in this facility	1	2	3	4	5	9

Q10.1 What does it mean to be “well prepared to manage medical complications”?

Who is the “we” you answered for?

What types of medical complications were you thinking about when you answered?

What is it about your facility that led to your answer of ______?

Q10.2 You answered ______ to question 2 – can you say more about what that means?

Can you say in your own words what the question is asking?

Who is the “we” here?

What were you thinking when you read “patient safety problems at this facility”?

Can you say more about that?

Topic 10 (Overall Perceptions of Patient Safety)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
This facility places more emphasis on quick turnover time than on patient safety	1	2	3	4	5	9
The way we do things in this facility reflects a strong focus on patient safety	1	2	3	4	5	9

Q10.3 Can you say in your own words what question 3 is asking.

Who were you thinking about when you answered?

What does “quick turnover time” mean to you?

Can you say something about how “quick turnover time” can affect patient safety?

Q10.4 You answered _____ to question 4 – can you say more about that?

When you answered this question, who is the “we”?

What does “the way we do things” mean”?

What would “a strong focus on patient safety” be?

Can you give some examples?

Topic 10 (Overall Perceptions of Patient Safety)

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
Our work processes and procedures are good at preventing mistakes that could affect patients	1	2	3	4	5	9
This facility is good at preventing patient safety mistakes	1	2	3	4	5	9

Q10.5 You answered ______ to question 5 – can you say more about that?

What kind of “work processes and procedures” were you thinking of when you answered?

How can “processes and procedures” prevent mistakes from happening?

When you read “mistakes that could affect patients”, what do you think of?

Q10.6 You answered ______ to question 6 – can you say more about that?

Can you provide an example of how this facility prevents patient safety mistakes?

Topic 11 (Information Exchange)

	Daily 	Weekly 	Monthly 	Several times in the past 12 months 	Once or twice in the past 12 months 	Not in the past 12 months 	Does Not Apply or Don’t Know 
Over the past 6 months, how often were a patient’s medical records or lab/diagnostic results not available when needed?	1	2	3	4	5	6	9

Q11.1 You answered _____ to question 1 – can you say more about that?

How did you arrive at your answer?

What are some common patient records, lab or diagnostic results needed?

When are they needed?

Topic 12 (Overall Patient Safety Ratings)

How much do you agree or disagree with the following statement about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
I would feel safe being treated here as a patient	1	2	3	4	5	9
	Poor ▼	Fair ▼	Good ▼	Very good ▼	Excellent ▼
Overall, how would you rate the systems and clinical processes your facility has in place to prevent, catch, and correct problems that have the potential to affect patients……………………	1	2	3	4	5

Q12.1 You answered _____ to question 1 – can you say more about that?

How did you arrive at your answer?

What does “feel safe” mean in this question?

Q12.2 You answered ____. Can you explain what your answer represents?

What makes you say that?

(IF DID NOT SAY EXCELLENT): What would your center have to do to get a higher rating?

Topic 13 (Use of a Procedure/Surgical Safety Checklist)

a. Are you typically in the room during the performance of surgeries, procedures, or treatments?

1	Yes
2	No Go to Section 14

Q13.a Can you say in your own words what question a is asking?

You answered _____ to question a – can you say more about that?

Over the past 6 months, for how many procedures did the following things happen?	No procedures 	Few procedures 	About half the procedures 	Most procedures 	All procedures 	Does Not Apply or Don’t Know 
In preparation for procedures, we confirmed patient identity and procedure details with patients or their caregivers.	1	2	3	4	5	9

Q13.1 You answered _____ to question 1 – can you say more about that?

Who is the “we” you thought of when answering?

Can you say what a “procedure” is? [CHECK FOR WHAT IS INCLUDED AS A SURGICAL PROCEDURE – STAFF WHO JUST DO PROCEDURES MAY HAVE TROUBLE WITH THIS QUESTION]

What do you think “details” mean?

Can you give some examples?

When does this step take place – in the Pre-op, OR, or both?

Over the past 6 months, for how many procedures did the following things happen?	No procedures 	Few procedures 	About half the procedures 	Most procedures 	All procedures 	Does Not Apply or Don’t Know 
Before the start of procedures, all team members stopped to discuss the overall plan of what was to be done.	1	2	3	4	5	9
The doctor encouraged every team member to speak up if they had any concerns during a case……………………………………………	1	2	3	4	5	9

Topic 13 (Use of a Procedure/Surgical Safety Checklist)

Q13.2 You answered _____ to question 2 – can you say more about that?

Who are the “team members” you were thinking of?

The question asks about “before the start of procedures” -- can you say more about this? [IS THIS A POINT THAT IS EASILY IDENTIFIED OR IS THIS A VAGUE NOTION?]

What is the starting point for a procedure? Can you describe what happens right before a procedure starts?

What does “discuss the overall plan of what is to be done” mean?

Can you give some examples?

Q13.3 You answered _____ to question 3 – can you say more about that?

What does “encourage” mean here?

Who are the “team members” you were thinking of?

What “concerns” were you thinking of?

Topic 13 (Use of a Procedure/Surgical Safety Checklist)

Over the past 6 months, for how many procedures did the following things happen?	No procedures 	Few procedures 	About half the procedures 	Most procedures 	All procedures 	Does Not Apply or Don’t Know 
After procedures, team members discussed any problems that may have occurred or ways to improve patient safety.	1	2	3	4	5	9
After procedures, team members discussed any concerns for patient recovery…………….	1	2	3	4	5	9

Q13.4 You answered ______ to question 4 – can you say more about that?

The question asks about “after procedures” – what does “after procedures” mean here?

Who are the “team members” you were thinking about when you answered the question?

Is this done for all procedures or only problematic ones?

Is this done in the OR?

What kinds of things are included in “any problems that may have occurred”? In “ways to improve patient safety”?

Q13.5 You answered _____ to question 5– can you say more about that?

The question asks about “after procedures” – what does “after procedures” mean here?

Who are the “team members” you were thinking about when you answered the question?

When you answered this question, what did you think would be a “concern”?

What kinds of things are included in “patient recovery”?

Topic 13 (Use of a Procedure/Surgical Safety Checklist)

Over the past 6 months, for how many procedures did the following things happen?	No procedures 	Few procedures 	About half the procedures 	Most procedures 	All procedures 	Does Not Apply or Don’t Know 
We stopped and used a procedure/surgical checklist: Before the patient entered the procedure room	1	2	3	4	5	9
In the procedure room before the procedure began	1	2	3	4	5	9
After the procedure ended	1	2	3	4	5	9

Q13.6 What does “stop and use a procedure/surgical checklist” mean to you?

Q13.6a You answered ______ to question 6a – can you say more about what that means?

When you read “before the patient enters the procedure room”, what were you thinking of?

What “room” were you thinking of when you answered?

Q13.6b You answered ______ to question 6b – can you say more about that?

The question asks about “before the procedure begins” – what does that mean?

What “room” were you thinking of when you answered?

Q13.6c You answered ______ to question 6c – can you say more about what that means?

What does “after the procedure ends” mean here?

[IF THEY PERFORM THIS STEP] How long after the procedure does this occur?

Where does this usually occur?

Topic 13 (Use of a Procedure/Surgical Safety Checklist)

Over the past 6 months, for how many procedures did the following things happen?	No procedures 	Few procedures 	About half the procedures 	Most procedures 	All procedures 	Does Not Apply or Don’t Know 
We read our procedure/surgical safety checklist out loud and did not say it from memory	1	2	3	4	5	9

Q13.7 You answered ______ to question 7 – can you say more about what that means?

Who is the “we” you thought of when answering?

What does it mean to “read the checklist out loud and do not say it from memory”?

How much do you agree or disagree with the following statements about your facility?	Strongly Disagree 	Disagree 	Neither Agree nor Disagree 	Agree 	Strongly Agree 	Does Not Apply or Don’t Know 
The procedure/surgical safety checklist has improved teamwork……………………………	1	2	3	4	5	9
The procedure/surgical safety checklist has improved communication…………………	1	2	3	4	5	9

Q13.8 You answered ______ to question 8 – can you say more about that?

What does “teamwork” mean to you in this question?

[IF ANSWER IS A or SA] Can you think of some examples of how the checklist has improved teamwork?

Q13.9 You answered ______ to question 9 – can you say more about that?

When you read “communication”, what were you thinking of?

[IF ANSWER IS A or SA] How has the checklist improved communication in your facility?

Topic 14 (Background Questions)

1. What is your position in this facility? Check ONE category that best applies to your job.

a. Doctor (non-anesthesia)/Physician/Surgeon

b. Anesthesiologist

c. Certified Registered Nurse Anesthetist (CRNA)

d. Physician Assistant or Nurse Practitioner

e. Management

Medical Director	Nurse Manager
Center Director Clinical Director/Administrator	Materials Manager Office Manager
Business Manager	Other Manager

f. Nurse

Registered Nurse (RN)

Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN)

g. Technician

Surgical/Scrub Technician	X-Ray Technician
Sterile Processing Technician	Other Technician

h. Other clinical staff or clinical support staff

Anesthesiologist Assistant

Medical Assistant

Nurse Assistant

Other clinical staff or clinical support staff

i. Administrative, Clerical Staff, or Business staff

Billing Staff	Medical Records
Front Desk	Scheduler (appointments, surgery, etc.)
Receptionist	Other administrative or clerical staff position
Insurance Processor

j. Other position; please specify:

Q14.1 You answered ______ to question 1--was this easy or difficult to answer?

Can you say more about your job?

Are these the types of job categories you use at your facility or do you use other types of job categories?

2. Indicate all the areas in this facility where you typically work:

Mark all that apply

a. Admission/Check-in

b. Office/Business/Administrative area

c. Holding/Pre-op

d. Surgery or Procedure Rooms

e. PACU/Post-op/Recovery

f. Sterile Processing

g. Other area, please specify ___________________

3. Typically, how many hours per week do you work in this facility?

a. 1 to 16 hours per week

b. 17 to 31 hours per week

c. 32 to 40 hours per week

d. More than 40 hours per week

Q14.2 You answered ______ to question 2 – can you say more about that?

Are these the types of areas you have at your facility or do you use other types of areas?

Q14.3 You answered ______ to question 3 – how did you arrive at that answer?

How difficult was it arrive at this answer?

(IF MORE THAN 40 HOURS PER WEEK ASK HOW MANY HOURS TYPICALY PER WEEK)

Your Comments

Please feel free to write any comments about how things are done or could be done in your facility that might affect patient safety.

Thank you for completing this survey.

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 ambulatory/outpatient facilities: Would you have answered any differently for any other facilities 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 [$200 for doctors/$100 for other staff]. 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 doctor

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.

AMBUALTORY SURGERY SURVEY ON PATIENT SAFETY, DRAFT 8-30-13 DO NOT DISTRIBUTE 52