Health and Healthcare Organization Leadership Interview

Health & Health Care Organization Leadership Interview Protocol

FORM APPROVED

OMB No: 0990-XXXX

Expires: MM/DD/YYYY

Introduction

Interviewer

Good (morning/afternoon)___________! Thank you again for your availability and willingness to participate in this interview. The United States Department of Health and Human Services, Office of Minority Health is conducting an evaluation of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. This interview is an important piece of the evaluation activities being conducted. Specifically, the purpose of this interview is for the Office of Minority Health to understand key stakeholders’ perceptions related to adoption and implementation of the National CLAS Standards. You have been selected because your organization identifies itself as implementing CLAS, implementing the National CLAS Standards, or both, and expressed interest in being included in an evaluation project.

My name again is ________. I work with SRA International, and we are completing these interviews on behalf of the Office of Minority Health. The interview will last approximately one and a half hours. Some of the questions may seem repetitive, but we just want to make sure that we capture as much information as possible.

My partner _____ will be taking notes from our discussion. We would also like to audio record this interview to ensure that we obtain all the information as accurately as possible, and capture any important information that we might miss in our notes. May we have your permission to audio record this interview? The information we collect from you today will only be accessible to the OMH CLAS Implementation Team Evaluation Subcommittee led by the HHS Office of Minority Health. This, and other information related to the project, is also explained in the Consent Form that we sent to you prior to this interview. Do you have any questions?

Great! Let’s begin the interview!

Transition to next phase.

Section I. Roles & Responsibilities

Interviewer

Before we begin, we would like to ask you a little about yourself.

Per HHS data collection requirements, we have to ask you some of the following questions. I will read each answer choice to you; please let me know when I have read the answer (or answers) you would like to select.

1. What is your sex?

____ Male

____ Female

2. What is your age? _________________

3. What is your ethnicity?

_____ Not of Hispanic, Latino/a, or Spanish origin

_____ Mexican, Mexican American, Chicano/a

_____ Puerto Rican

_____ Cuban

_____ Another Hispanic, Latino/a, or Spanish origin

4. What is your race?

_____ White

_____ Black or African American

_____ American Indian or Alaska Native

_____ Asian Indian

_____ Asian (PLEASE CIRCLE WHICH ASIAN RACE: Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian)

_____ Native Hawaiian

_____ Guamanian or Chamorro

_____ Samoan

_____ Other Pacific Islander

_____ Other_____________________________________________________________________

Now, we would like to ask you about the work you are currently doing.

5. What is your current position title within your organization?

6. What are your major responsibilities in this position?

7. Which of the following best describes the type of health or health care organization in which you work?

1. Ambulatory care service

2. Clinic/health center

3. Home health care organization

4. Hospital (e.g., private hospital, University-affiliated hospital, etc.)

5. Nursing home

6. Public health department

7. Private practice (individual or group)

8. Rehabilitation center

9. Mental health services

10. Oral health services

11. Other (Please specify): __________________________________________________________

8. Where is this organization located (city and state)?

9. What is the approximate total size of your organization?

10. Are your major responsibilities related to the National CLAS Standards or CLAS in general?

11. How long have you been in this position? ____________(whole # of years, if <0 enter 0)

Transition to next phase.

Section II. CLAS and NCS Awareness and Knowledge

INTERVIEWER

Now, let’s talk more about your experiences with CLAS and the National CLAS Standards. First, let’s talk about the term “culturally and linguistically appropriate services.”

12. How familiar are you with the term, “culturally and linguistically appropriate services” or “CLAS”?

PROBES: What does “culturally and linguistically appropriate services” mean to you?

What is the purpose of “culturally and linguistically appropriate services?

13. When did you first hear the term “culturally and linguistically appropriate services” or “CLAS”?

14. How have you learned more about CLAS?

Now, let’s talk specifically about the National CLAS Standards in health and health care organizations.

15. With which version of the National CLAS Standards, the original (2001) or enhanced (2013), are you most knowledgeable?

To the interviewer – if respondent answers “neither the original nor the enhanced,” skip to Question #18, and ask only about CLAS.

16. How did you first become aware that the National CLAS Standards existed?

PROBES:

From your work at another organization prior to starting your job in my current organization?

During your initial employment orientation in your current organization?

Through notices via employee bulletin boards or newsletters in your current organization?

Through staff meetings in your current organization?

Through other in-service, continuing education, or professional development activity in your current organization?

From your involvement in another organization (which one?)?

17. When did you first become aware that the National CLAS Standards existed?

18. How do you think leadership and staff in your organization became aware that (CLAS)/the National CLAS Standards exist?

19. What is the perception of (CLAS)/the National CLAS Standards within your organization?

PROBES: What is the perception of (CLAS)/the National CLAS Standards among governance and leadership?

What is the perception of (CLAS)/the National CLAS Standards among staff?

20. How would you describe (CLAS)/the National CLAS Standards to colleagues or others in your organization?

PROBES: What are (CLAS)/the National CLAS Standards?

21. (What is the purpose or purposes of CLAS?)/What are the National CLAS Standards’ purpose or purposes?

22. What has been helpful in increasing awareness of (CLAS)/the National CLAS Standards among your organization’s governance, leadership, management, and staff?

PROBES: Helpful in increasing your own awareness?

23. What have been the main challenges in increasing awareness of (CLAS)/the National CLAS Standards among your organization’s governance, leadership, management, and staff?

PROBES: Challenges in increasing your own awareness?

24. What resources do you suggest to others in your organization who want to learn more about (CLAS)/the National CLAS Standards?

Great! Now, I’d like to talk briefly about how your organization made the decision to adopt or use (CLAS)/the National CLAS Standards.

To the interviewer – if respondent answered “neither the original nor the enhanced,” to Question #15, skip to Question #27, and ask only about CLAS.

Transition to next phase.

Section III. Adoption of the NCS/CLAS

INTERVIEWER

25. Which version of the National CLAS Standards is your organization currently adopting, the original (2001) or enhanced (2013)?

To the interviewer – if respondent answers “both versions,” precedence is given to the enhanced Standards.

26. First, how was the decision made to adopt (CLAS)/the National CLAS Standards in your organization?

PROBES: What happened to initiate the conversation/deliberation?

Who was involved in these conversations?

What information was shared to help inform the decision?

What were advantages were discussed?

What disadvantages were discussed?

How long did the deliberations take before a final decision was made?

How was the final decision made?

Who was involved in making the final decision?

27. To your knowledge, what were the major factors that contributed to the final decision to adopt (CLAS)/the National CLAS Standards?

PROBES: For example, what were the internal factors that prompted this decision?

What were the external factors that prompted this decision?

28. To your knowledge, what, if anything, could have made the decision to adopt (CLAS)/the National CLAS Standards easier?

PROBES: For example, what additional information would have helped decision-makers make a final decision more quickly?

What additional outside resources would have helped decision-makers make a final decision more quickly?

What additional internal resources would have helped decision-makers make a final decision more quickly?

29. What were the difficulties or challenges in your organization deciding to adopt (CLAS)/the National CLAS Standards?

30. Once the decision to adopt (CLAS)/the National CLAS Standards in your organization was made, how was that decision communicated throughout the organization?

PROBES: How was the decision communicated to governance, leadership, and management?

How was the decision communicated to staff?

Through your organization’s publications (e.g., newsletter, Annual Report, etc.)?

Through an organization-wide email?

Through workshop or training in your organization?

Through a regular staff meeting?

Through a one-on-one meeting between staff and a supervisor?

Through your organization’s website?

Thank you for this information. Now, let’s talk about implementation.

Section IV. Implementation of the NCS

INTERVIEWER

31. To what extent was your organization already implementing culturally and linguistically appropriate services before deciding to adopt and implement (CLAS) /the National CLAS Standards?

PROBE: Did the National CLAS Standards lead to your organization implementing culturally and linguistically appropriate services?

32. Once the decision to adopt (CLAS)/the National CLAS Standards in your organization was made, how was the decision made to implement or start using them?

PROBES: Was the decision made to adopt all of the Standards or just certain Standards? If certain Standards, which ones and why?

Was implementation going to be gradual or immediate? How so?

Were the Standards going to be used throughout the organization or in specific departments? If specific departments, which ones and how was the decision made?

33. How was the decision to implement (CLAS)/the National CLAS Standards communicated throughout the organization?

PROBES: How was the decision communicated to governance, leadership, and management?

How was the decision communicated to staff?

34. What steps or actions have your organization taken to actually implement (CLAS)/the National CLAS Standards?

PROBE: What steps or actions did your organization take to prepare to implement the National CLAS Standards?

35. Who in your organization is involved in the implementation of (CLAS)/the National CLAS Standards?

PROBES: What did that person (or each person) do?

Who was the primarily responsible for implementation?

Was anyone outside of your organization involved in the implementation? If so, who and in what capacity?

36. Please tell me about the resources available in and to your organization that support implementation of (CLAS)/the National CLAS Standards?

PROBES: For example, were or are there conferences held?

Were or are workshops or training sessions held?

Dedicated time during supervision?

In-person or online training modules made available?

Access to written resources (e.g., pamphlets, articles, books)

Access to online resources – which ones?

37. What are the costs to your organization in implementing (CLAS)/the National CLAS Standards?

PROBES: What were the financial costs?

What were the human resources costs?

What were other relevant costs?

38. What factors made implementation of (CLAS)/the National CLAS Standards in your organization easier?

PROBES: What factors came from inside the organization? (e.g., budget, training, leadership support, staff support, feedback from those served, etc.)

What factors came from outside of the organization? (e.g., additional funding, community support, outside training resources [which one(s)?], etc.)

39. What barriers or challenges has your organization faced in implementing (CLAS)/the National CLAS Standards?

PROBES: What challenges came from inside the organization? (e.g., lack of interest or resistance among leadership/staff, lack of budget, lack of staff, lack of time, competing demands, etc.)

What challenges came from outside of the organization? (e.g., inability to locate appropriate resources to support implementation, resistance from community, lack of awareness that the National CLAS Standards exist, lack of knowledge about the National CLAS Standards)

40. How have the barriers or challenges to implementation been handled in your organization?

41. How is implementation of (CLAS)/the National CLAS Standards monitored in your organization?

PROBES: Who in your organization is involved in making sure implementation is progressing?

How is implementation progress defined and determined?

When and how are changes in implementation made?

42. How is implementation of (CLAS)/the National CLAS Standards evaluated in your organization?

PROBES: What data is gathered to demonstrate implementation?

How is data used to improve implementation of the Standards?

43. What have been the lessons learned as your organization has implemented (CLAS)/the National CLAS Standards?

44. Looking ahead, what changes in implementing (CLAS)/the National CLAS Standards do you think your organization will make?

PROBE: What is (would be) the cause of these changes?

Thank you for this information. Now, I’d like to ask you about the anticipated and actual outcomes of your organization implementing (CLAS)/the National CLAS Standards.

Section V. Anticipated and Actual Outcomes of Implementing CLAS/NCS

INTERVIEWER

45. What changes were expected in your organization as a result of implementing (CLAS)/the National CLAS Standards?

46. What changes in your organization have actually been achieved as a result of implementing (CLAS)/the National CLAS Standards?

PROBES: What have been the changes in organizational policies?

What have been the changes in organizational programs?

What have been the changes in the communities served?

47. Given the costs that you mentioned earlier, what do you think is your organization’s return on investment of implementing (CLAS)/the National CLAS Standards?

PROBE: For example, in thinking about the financial, social, political, and/or organizational costs of implementing the Standards, what do you think was gained from implementing them?

48. What outcomes do you think could be achieved in your organization after several years (e.g., 5+ years) of implementing (CLAS)/the National CLAS Standards?

Thank you for this information. Let’s now continue with the last section of this interview.

Section VI. Overall Comments and Closing

INTERVIEWER

Thank you so much for your time and participation. We have learned a great deal from you today.

49. Before we end, is there anything else that we have not asked you about that you would like to share?

To the interviewer – discuss any issue or questions that arose during the interview that were not discussed (e.g., preference/knowledge of original Standards vs. enhanced, more detail about implementation, etc.)

We appreciate you sharing your knowledge and ideas. They will help us and other health and health care organizations tremendously in understanding this process. Thank you again for your participation and please do not hesitate to contact us with any further comments or questions you may have.