Form 1 Questionnaire

MOPS-HP (Management and Organizational Practices Survey-Hospitals)

Subset of hospitals: General medical and surgical hospitals in NAICS 6221

Content for cognitive testing - April 6, 2018

'Others' instrument: Top- and middle-level clinical managers

Instrument for Chief Financial Officers

35 total questions for testing. Respond for 2012 and 2017.

20 Total questions for testing. Respond for 2012 and 2017.

Section A - Management Practices

Section A - Management Practices

1. In 2012 and 2017, what best describes what happened at the hospital in this location when a problem in the care delivery arose?

1. In 2012 and 2017, what best describes what happened at this hospital when a problem in financial performance arose?

Examples: overcrowding in emergency room, cluster of hospital acquired infection.

Examples: failing to meet revenue targets, unexpectedly high costs.

(Mark one box for each year)

(Mark one box for each year)

We fixed it but did not take further action

We fixed it but did not take further action

We fixed it and took action to make sure that it did not happen again

We fixed it and took action to make sure that it did not happen again

We fixed it and took action to make sure that it did not happen again, and had a continuous improvement process to anticipate problems like these in advance

We fixed it and took action to make sure that it did not happen again, and had a continuous improvement process to anticipate problems like these in advance

No action was taken

No action was taken

We tried to fix it, but did not remediate problem

We tried to fix it, but did not remediate problem

Not applicable (there were no problems in care delivery)

Not applicable (there were no problems in financial performance)

2. In 2012 and 2017, how many key performance indicators were monitored at this hospital?

2. In 2012 and 2017, how many key performance indicators were monitored at this hospital?

Examples: metrics on cost, waste, clinical quality, financial performance, absenteeism, patient safety.

Examples: metrics on cost, waste, clinical quality, financial performance, absenteeism and patient safety.

(Mark one box for each year)

(Mark one box for each year)

1-2 key performance indicators

1-2 key performance indicators

3-9 key performance indicators

3-9 key performance indicators

10 or more key performance indicators

10 or more key performance indicators

No key performance indicators

No key performance indicators

(If no key performance indicators in both years, SKIP to 6 )

(If no key performance indicators in both years, SKIP to 5)

3. During 2012 and 2017, how frequently were the key performance indicators reviewed by managers at this hospital?

3. During 2012 and 2017, how frequently were the key performance indicators reviewed by managers at this hospital?

(Mark all that apply)

(Mark all that apply)

NOTE: a manager is someone who has employees directly reporting to them, with whom they meet on a regular basis, and whose pay and promotion they may be involved with. Examples: Unit Manager, Human Resource Manager, Quality Manager.

NOTE: a manager is someone who has employees directly reporting to them, with whom they meet on a regular basis, and whose pay and promotion they may be involved with, for example: Unit Manager, Human Resource Manager, Quality Manager.

Yearly

Yearly

Quarterly

Quarterly

Monthly

Monthly

Weekly

Weekly

Daily

Daily

Hourly or more frequently

Hourly or more frequently

Never

Never

4. During 2012 and 2017, how frequently were the key performance indicators reviewed by frontline clinical workers at this hospital?

4. During 2012 and 2017, how frequently were the key performance indicators reviewed by frontline clinical workers at this hospital?

(Mark all that apply)

(Mark all that apply)

NOTE: frontline clinical workers include all clinical staff with non-managerial responsibilities, including nurses and physicians.

NOTE: frontline clinical workers include all clinical staff with non-managerial responsibilities, including nurses and physicians.

Yearly

Yearly

Quarterly

Quarterly

Monthly

Monthly

Weekly

Weekly

Daily

Daily

Hourly or more frequently

Hourly or more frequently

Never

Never

5. During 2012 and 2017, where were the display boards showing clinical quality and other key performance indicators located at this hospital?

(Mark one box for each year)

All display boards were located in one place (for example, at the nurses station; doctors’ lounge, etc.)

Display boards were located in multiple places

We did not have any physical display boards, but personnel had access to virtual display boards (for example, via email or intranet)

We did not have any display boards, physical or virtual

6. In 2012 and 2017, what best describes the time frame of clinical or operational (i.e. non-financial) targets at this hospital?

(Mark one box for each year).

Examples of clinical or operational targets: infection rates, readmission rates, wait times, nurse to patient ratios.

Main focus was on short-term (less than one year) clinical and operational targets

Main focus was on long-term (more than one year) clinical and operational targets

Combination of short-term and long-term clinical and operational targets

No clinical and operational targets

7. In 2012 and 2017, how easy or difficult was it for this hospital to achieve its clinical or operational targets?

(Mark one box for each year)

Possible to achieve without much effort

Possible to achieve with some effort

Possible to achieve with normal amount of effort

Possible to achieve with more than normal effort

Only possible to achieve with extraordinary effort

8. In 2012 and 2017, who was aware of the clinical or operational targets at this hospital?

(Mark one box for each year)

Only senior managers (e.g. CNO, CMO)

Most managers and some frontline clinical workers

Most managers and most frontline clinical workers

All managers and most frontline clinical workers

9. In 2012 and 2017, what best describes the time frame of financial targets at this hospital?

5. In 2012 and 2017, what best describes the time frame of financial targets at this hospital?

(Mark one box for each year)

(Mark one box for each year)

Main focus was on short-term (less than one year) financial targets

Main focus was on short-term (less than one year) financial targets

Main focus was on long-term (more than one year) financial targets

Main focus was on long-term (more than one year) financial targets

Combination of short-term and long-term financial targets

Combination of short-term and long-term financial targets

No financial targets

No financial targets

Don't know

10. In 2012 and 2017, how easy or difficult was it for this hospital to achieve its financial targets?

6. In 2012 and 2017, how easy or difficult was it for this hospital to achieve its financial targets?

(Mark one box for each year)

(Mark one box for each year)

Possible to achieve without much effort

Possible to achieve without much effort

Possible to achieve with some effort

Possible to achieve with some effort

Possible to achieve with normal amount of effort

Possible to achieve with normal amount of effort

Possible to achieve with more than normal effort

Possible to achieve with more than normal effort

Only possible to achieve with extraordinary effort

Only possible to achieve with extraordinary effort

Don't know

11. In 2012 and 2017, who was aware of the financial targets at this hospital?

7. In 2012 and 2017, who was aware of the financial targets at this hospital?

(Mark one box for each year)

(Mark one box for each year)

Only senior managers (for example, CNO, CMO)

Only senior managers (for example, CNO, CMO)

Most managers and some frontline clinical workers

Most managers and some frontline clinical workers

Most managers and most frontline clinical workers

Most managers and most frontline clinical workers

All managers and most frontline clinical workers

All managers and most frontline clinical workers

Don't know

12. In 2012 and 2017, what was the primary way frontline clinical workers were promoted at this hospital?

(Mark one box for each year)

Promotions were based solely on performance and ability

Promotions were based partly on performance and ability, and partly on other factors (for example, tenure)

Promotions were based mainly on factors other than performance and ability (for example, tenure)

Frontline clinical workers were normally not promoted

13. In 2012 and 2017, what was the primary way managers were promoted at this hospital?

8. In 2012 and 2017, what was the primary way managers were promoted at this hospital?

(Mark one box for each year)

(Mark one box for each year)

Promotions were based solely on performance and ability

Promotions were based solely on performance and ability

Promotions were based partly on performance and ability, and partly on other factors (for example, tenure)

Promotions were based partly on performance and ability, and partly on other factors (for example, tenure)

Promotions were based mainly on factors other than performance and ability (for example, tenure)

Promotions were based mainly on factors other than performance and ability (for example, tenure)

Managers were normally not promoted

Managers were normally not promoted

14. In 2012 and 2017, when was an under-performing frontline clinical worker reassigned or dismissed at this hospital?

(Mark one box for each year)

Within 6 months of identifying frontline clinical worker underperformance

After 6 months of identifying frontline clinical worker underperformance

Rarely or never

No underperforming frontline clinical workers at this hospital

15. In 2012 and 2017, when was an under-performing manager reassigned or dismissed at this hospital?

9. In 2012 and 2017, when was an under-performing manager reassigned or dismissed at this hospital?

(Mark one box for each year)

(Mark one box for each year)

Within 6 months of identifying manager under-performance

Within 6 months of identifying manager under-performance

After 6 months of identifying manager under-performance

After 6 months of identifying manager under-performance

Rarely or never

Rarely or never

No underperforming managers at this hospital

No underperforming managers at this hospital.

16. What year did you start working at this hospital?

10. What year did you start working at this hospital?

17. What year did you start working as a manager at this hospital?

11. What year did you start working as a manager at this hospital?

Management Training

Management Training

18. Have you ever participated in a managerial training course?

12. Have you ever participate in a managerial training course?

Yes

Yes

No [please skip the next question]

No [please skip the next question]

19. What type of managerial training course have you participated in?

13. What type of managerial training course have you participated in?

MBA (at least 1 year or more full time)

MBA (at least 1 year or more full time)

Executive MBA course (at least 1 year or more full time)

Executive MBA course (at least 1 year or more full time)

Selected executive courses shorter than one year but longer than a week

Selected executive courses shorter than one year but longer than a week

Selected executive courses of duration of a week or less

Selected executive courses of duration of a week or less

Use of standards and protocols

20. In 2012 and 2017, how were standardized clinical and operational protocols (for example, checklists or patient bar-coding) used at this hospital?

A few standardized protocols existed, and were used by some clinical staff at the hospital, but not all

A few standardized protocols existed, and were used by all clinical staff at the hospital

Many standardized protocols existed, and were used by some clinical staff at the hospital, but not all

Many standardized protocols existed, and were used by all clinical staff at the hospital

No standardized protocols existed. Different clinical staff had different approaches to the same treatment. [Please skip to question 24]

21. In 2012 and 2017, who created new standardized protocols at this hospital?

Senior managers only (e.g. CNO, CMO).

Department chiefs/nurse managers and/or clinical frontline staff only

Both senior managers and department chiefs/nurse managers.

No new standardized protocols were created at this hospital (e.g. we only use state or federal mandated protocols)

22. In 2012 and 2017, who monitored the appropriate use and implementation of standardized protocols at this hospital?

Senior managers only (e.g. CNO, CMO).

Department chiefs/nurse managers only

Both senior managers and department chiefs/nurse managers

The appropriate use and implementation of standardized protocols at this hospital was not monitored at this hospital.

23. In 2012 and 2017, who modified/updated standardized protocols at this hospital?

Senior managers only (e.g. CNO, CMO).

Department chiefs/nurse managers and/or clinical frontline staff only

Both senior managers and department chiefs/nurse managers.

Standardized protocols were not usually modified/updated at this hospital

Management of team interactions.

24. In 2012 and 2017, how often did department chiefs/nurse managers and clinical frontline staff participate in meetings dedicated to the discussion of clinical outcomes with frontline clinical staff?

Never

Yearly

Quarterly

Monthly

Weekly

Daily or multiple times within a day

25. In 2012 and 2017, what best describes the type of participants involved in meetings dedicated to the discussion of clinical outcomes?

The meetings typically involved only department chiefs/nurse managers and physicians

The meetings typically involved only department chiefs/nurse managers   and nurses

The meetings typically involved department chiefs/nurse managers, physicians and nurses

The meetings typically involved department chiefs/nurse managers,  physicians, nurses as well as other support staff

26. In 2012 and 2017, what best describes the type of data used in meetings dedicated to the discussion of clinical outcomes?

The meetings did not usually involve discussion of data

The meetings sometimes involved discussion of data. The data was visible only to department chiefs/nurse managers

The meetings sometimes involved discussion of data. The data was visible only to clinical frontline staff

The meetings sometimes involved discussion of data. The data was visible to both department chiefs and clinical frontline staff

27. In 2012 and 2017, what best describes the nature of the meetings dedicated to the discussion of clinical outcomes?

The meetings were used exclusively to report past performance

The meetings were used exclusively to discuss ways to improve future performance

The meetings were used exclusively to report past performance, as well as ways to improve future performance

28. In 2012 and 2017, what best describes what happened after meetings dedicated to the discussion of clinical outcomes?

Follow up plans were drafted, but they were only visible to department chiefs/nurse managers. The adherence to follow up plans was not actively monitored.

Follow up plans were drafted, and they were visible to both department chiefs/nurse managers  and clinical frontline workers. The adherence to follow up plans was not actively monitored.

Follow up plans were drafted, but they were only visible to department chiefs/nurse managers.  The adherence to follow up plans was actively monitored.

Follow up plans were drafted, and they were visible to both department chiefs/nurse managers and clinical frontline workers. The adherence to follow up plans was actively monitored.

No follow up plans were drafted

Staffing and allocation of human resources to problems

29. Who decided how work was allocated to clinical staff?

Only senior managers (e.g. CNO, CMO).

Mostly senior managers

Both senior managers and department chiefs/nurse managers.

Mostly department chiefs/nurse managers.

Only department chiefs/nurse managers.

30. What was the typical nurse to patient ratio?

31. Who determined the typical nurse to patient ratio?

State or federal regulations

Only senior managers (e.g. CNO, CMO)

Mostly senior managers

Both senior managers and department chiefs/nurse managers.

Mostly department chiefs/nurse managers.

Only department chiefs/nurse managers.

32. What was the typical medical assistant to patient ratio?

33. Who determined the typical medical assistant to patient ratio?

State or federal regulations

Only senior managers (e.g. CNO, CMO)

Mostly senior managers

Both senior managers and department chiefs/nurse managers.

Mostly department chiefs/nurse managers.

Only department chiefs/nurse managers.

Coding

14. Thinking about the computer systems and tools that your hospital had to encourage documentation and coding in 2012 and 2017, who at the hospital interacted with these systems and tools:

Managers

Physicians

Nurses

Coding staff

15. In 2012 and 2017, how long did the typical query for coders to clinicians take before the clinician responded?

Less than a day

One to three days

Three days to one week

More than one week

16. During 2012 and 2017, how often did frontline clinical workers receive training in documentation and coding (Mark all that apply)

Yearly

Quarterly

Monthly or more frequently

Training did not occur with regularity, but did occur on an ad-hoc basis

Never

17. Thinking about the processes that were in place to train frontline clinical workers about documentation in 2012 and 2017, which of the following statements would you say are true:

Clinicians were aware of important keywords and their effect on reimbursement

Clinicians who poorly document patients were required to meet with hospital administrators

Clinicians who poorly document patients were required to receive training

There was no consequence for clinicians who poorly document patients

18. Thinking about the actions you would have taken in response to a physician’s documentation and coding, which of the following statements would you say were true? Mark all that apply

We took actions that were non-financial in nature in response to good documentation and coding. Please consider any potential (non- monetary) response that a physician could get for supporting proper documentation and coding. Examples could include recognition by managers or better access to hospital amenities.

We took actions that were non-financial in nature in response to poor documentation and coding. Please consider any potential (non- monetary) response that a physician could get for failing to support proper documentation and coding. For example, the physician was required to meet with a hospital staffer and their documentation performance was discussed or sat in on a training or education session.

We used financial or monetary incentives to encourage documentation and coding. This could include paying physicians to use tools that improved documentation, providing extra payments when documentation was good, or reducing payments to physicians when documentation was poor.

VALIDATION: AHA-LIKE QUESTION

VALIDATION: AHA-LIKE QUESTION

34. In 2017, how many staffed beds did this hospital have in general medical-surgical care?

19. In 2017, how many staffed beds did this hospital have in general medical-surgical care?

VALIDATION: AR-LIKE QUESTION

VALIDATION: AR-LIKE QUESTION

35. For the pay period including March 12, 2017, what was the number of all full- and part-time employees working at this establishment?

20. For the pay period including March 12, 2017, what was the number of all full- and part-time employees working at this establishment?

Include: Employees working at this establishment whose payroll was reported on Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return. Exclude: * Temporary staffing obtained from a staffing service, * Contractors, subcontractors, or independent contractors, * Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN, * Purchased or managed services, such as janitorial, guard, or landscape services, * Professional or technical services purchased from another firm, such as software consulting, computer programmin, engineering, or accounting services.

Include: Employees working at this establishment whose payroll was reported on Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return. Exclude: * Temporary staffing obtained from a staffing service, * Contractors, subcontractors, or independent contractors, * Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN, * Purchased or managed services, such as janitorial, guard, or landscape services, * Professional or technical services purchased from another firm, such as software consulting, computer programmin, engineering, or accounting services.

END OF QUESTIONS

END OF QUESTIONS

CERTIFICATION

CERTIFICATION