12 Appendix L: Training Observation Tool

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Appendix L

Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation

OMB: 0935-0179

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Appendix L – Training Observation Tool


AHRQ – Building Diagnostic Safety Capacity


TeamSTEPPS® Course Pilot Test Evaluation


Training Observation Tool


The training observation tool will be used to periodically assess the practices during their implementation of the TeamSTEPPS® modules. This assessment will be completed by a project team member and have minimal respondent burden. We aim to observe up to 2 module trainings during each practice’s adoption of the TeamSTEPPS® Course.


MedStar Health Research Institute (MHRI) will conduct direct observations of the TeamSTEPPS® training for up to 2 trainings per practice (n=40 trainings. Total time for the encounter burden was estimated at 1 hour per encounter.


Recruitment Criteria


Healthcare setting administrators who have been exposed to the TeamSTEPPS® Course within their setting will be eligible to participate in the interview. MHRI team members will work with the practice champions to identify administrators to participate in the interviews. We will aim to recruit administrators in the following manner:


  • Administrators involved in the decision making around implementation of the TeamSTEPPS® Course or how have had experience using the TeamSTEPPS® Course


Interview Goals


The goals of the interviews will be to:


  • Obtain feedback on the intervention Course materials

  • Obtain feedback on the barriers and facilitators encountered during implementation

  • Obtain feedback on satisfaction with instructions and materials

  • Obtain feedback on receptivity and enhancements to the Course to improve adoption and implementation


Interview Materials


  • Copies of the Course materials

  • Informed consent documents

  • Digital recorder


Location


Interviews will be conducted at a location within the practice or within the practice’s community. Interviews may also be conducted virtually via the telephone.


Participant Stipends


None.


Each observation will take no more than 60 minutes.


Informed Consent Procedures


Participants will complete the informed consent process at the time of arrival to the interview.




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Form Approved
OMB No. xxxx-xxxx
Exp. Date xx/xx/
20


AHRQ – Building Diagnostic Safety Capacity


TeamSTEPPS® Course Pilot Test Evaluation


Training Observation Tool


TeamSTEPPS® Course Component

Observed

Description

Module being Observed

  • Module 1

  • Module 2

  • Module 3

  • Module 4

  • Module 5

  • Module 6

  • Module 7

Observer Name

Materials used during the training

[Free Text]

Strategies Trained on During the Training


[Free Text]

Questions posed by staff during the training

[Free Text]

Questions posed by providers during the training


[Free text]

Observer’s Recommendations for Improvement of Materials


[Free Text]



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This survey is authorized under 42 U.S.C. 299a. The confidentiality of your responses to this survey is protected by Sections 944(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)].  Information that could identify you will not be disclosed unless you have consented to that disclosure. Public reporting burden for this collection of information is estimated to average 20 minutes per response, the estimated time required to complete the survey. 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, 5600 Fishers Lane, Room #07W42, Rockville, MD 20857.











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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHill, Mary A
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File Created2021-01-13

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