Form 3 ATTACHMENT F - Monthly Check-In

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

ATTACHMENT F - Monthly Check-In

Hospital: ______________________________ Interviewer:______________

Unit: _________________________________ Respondent: _____________________

Date: _________________________________ Last check-in date: ________________

Check-in # (circle): 1 2 3 4 5 6 7 8 9

Permission to record: Y/N Interviewer initials: ____

OVERVIEW

1. Please give us a brief overview of the progress your hospital/unit has made in terms of training health care professionals/leaders and improving informed consent practices?

TRAINING STATUS

2. What is the status of the AHRQ training modules for your hospital/unit staff (i.e., % trained, % trained by unit, % trained by health care professionals/leaders)?

3. Has any formal or informal training beyond the online modules been provided to staff or leaders? If so, please describe.

4. How have staff reacted to the training(s)?

Public reporting burden for this collection of information is estimated to average 60 minutes 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.

STRATEGIES

5. [1^st check-in] Which of the following strategies from the AHRQ Informed Consent Leaders Training Module is your hospital going to use?
   
   [Other check-ins] Previously you said that your hospital was implementing the following strategies.

[Interviewer: check all that apply and enter into attached table]

• Write and disseminate a clear and comprehensive informed consent policy

• Build support systems to improve the informed consent process

• Support #1: Compile a library of clear and simple informed consent forms

• Support #2: Maintain a library of high-quality decision aids and other patient education materials

• Support #3: Remove communication barriers (systems to identify patient language, provide language assistance, stock assistive devices)

• Support #4: Improve workflows

• Support #5: Address staff training needs

• Develop and implement an action plan

• Step 1: Establish a sense of urgency

• Step 2. Create a powerful guiding coalition/ gain organizational consensus

• Step 3. Develop a change vision

• Step 4. Communicate the vision

• Step 5. Empower broad-based action

• Step 6. Generate short-term wins; communicate about success

• Step 7. Never let up

• Step 8. Incorporate changes into the culture

• Other (please describe)
  
  

6. [1^st check-in] Which of the following strategies from the AHRQ Informed Consent Health Care Professionals Training Module is your hospital or units in your hospital going to use?
   
   [Other check-ins] Previously you said that your hospital or units in your hospital were implementing the following strategies.

[Interviewer: check all that apply and enter into attached table. Note if some strategies are being used only by some units]

• Strategies for Clear Communication

• Strategy 1: Prepare for the Informed Consent Discussion

• Strategy 2: Use Health Literacy Universal Precautions

• Strategy 3: Remove Language Barriers

• Strategy 4: Use Teach-Back

• Strategies for Presenting Choices

• Strategy 5: Offer Choices

• Strategy 6: Engage the Patient and Their Family and Friends

• Strategy 7: Elicit Goals and Values

• Strategy 8: Encourage Questions

• Strategy 9: Show High Quality Decision Aids

• Strategy 10: Explain Benefits, Harms, and Risks of All Options

• Improve Documentation of Informed Consent

• Improve Confirmation of Informed Consent

• Clarify Team Roles

7. [skip for 1^st check-in] Since last we spoke, have you decided to drop or add any strategies? If so, why?

8. Have you identified strategies or tools from other sources that you’re planning to use? If so, please describe.
   
   

PLANNED STRATEGIES

[1^st check-in: ask for each planned strategy. Other check-ins: ask only for new strategies]

9. How did you decide to [strategy]?

PROBES:

• Did you establish there was a problem with data?

• What were the considerations in choosing that strategy as opposed to others?

• Who were the decision makers?

• Was there opposition? If so, who opposed and why? How was the opposition overcome?
  
  

10. What changes are you planning to make to [strategy]?
    
    

11. How did you determine what should be done (e.g., assessment, data)?
    
    

12. What are the aims of your improvements?
    
    

13. [If relevant] What is the status of the planned improvements?
    [Interviewer: Fill-in attached table]
    
    PROBES:

    1. Have you assembled a team to implement the improvements? If so, who is involved? If not, why not? Have there been any changes in the team?

2. Have you developed an action plan for these improvements? If so, could you share it? What progress have you made in your action plan? Any changes to your plan? If so, why?

3. Have you communicated or promoted the improvements to staff? If so, how?

4. Have you developed a plan for testing the effectiveness of your intervention? If so, what is it?

5. Have you measured the impact? If so, would you mind sharing your results?

6. Have you developed a plan for how to sustain the improvements? If so, what is it?

IMPLEMENTATION SUCCESSES AND CHALLENGES

[Interviewer: skip this section if hospital has not begun implementation of any strategies]

14. [1^st check-in: omit the phrase “Since our last check-in”] What has been your experience since our last check-in call with implementing these strategies? [Interviewer: Fill-in attached table]

15. How helpful have the resources in the training modules been in implementing any of these strategies? Please be specific.

16. What problems have you run into implementing the strategies (ask for each strategy) (e.g., any opposition, delays, resources)? [Interviewer: Fill-in attached table]

1. Have you been able to troubleshoot these problems? If not, why not?

2. Are they resolved now? If not, why not?
   
   

3. How did you resolve them?
   
   

4. Did information in the training modules help you resolve the problem?

17. What problems remain unresolved?
    
    

1. What ideas do you have for how to resolve them?
   
   

2. Do you believe that you have the necessary expertise and resources in your hospital/unit to tackle these problems? If not, what do you need?

18. [1^st check-in: omit the phrase “Since our last check-in] Since our last check-in, what have been your greatest successes in improving your hospital/unit’s informed consent practices? And what helped you to succeed?

Greatest Successes	What Helped to Succeed

19. Since our last check-in, what have been your greatest challenges or barriers in improving your hospital/unit’s informed consent practices? And what was your response?

Greatest Challenges/Barriers	Response to the Challenges/Barriers

IMPLEMENTATION CLIMATE AND CONTEXT

20. Have there been any changes since last we spoke in the following? If so, please explain:

1. Leadership’s perception of the importance of improving informed consent

2. Clinical staff perceptions of the importance of improving informed consent processes

3. How much of a priority improving improve informed consent practices is for your hospital, or units in your hospital

4. Motivations for you to champion/lead these improvements in your hospital

5. Motivations for doctors, nurses, other staff to make changes to improve informed consent processes
   
   
   

21. Since we last spoke, what communications to staff have there been regarding the improvements to the informed consent process (e.g., goals of changes, feedback, learning)?
    
    
    

22. What changes, if any, have occurred in your hospital or unit that may affect your planned improvements or informed consent processes (e.g., new EHR, staff changes)?

DATA COLLECTED

23. What data have you collected (e.g., Rapid Feedback Patient Survey data, surgical cancellation/delay rates)?

24. Have you taken any action based on the data you have collected? If so, what action?

CLOSING

25. What implementation issues do you anticipate will arise in the coming month, if any?
    
    

26. Is there anything we can do to support your continued progress?
    
    

27. Is there anything else that you think would be helpful to know?

Implementation of Strategies (responses to questions 5, 6, 13, 14, and 16)

Planned Strategies	Status (e.g., planning, promoted, collecting data, measured impact)	Experiences/Problems

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