Clinical Process Improvement Survey - word

Clinical Process Improvement Survey

Instructions

This survey asks questions about how you see yourself as a team member and how you see your health clinic. It begins on the next page with a short demographic section that is for descriptive purposes only. The Anonymous Linkage Code is requested so that information you give now can be “linked” to your responses to similar questions you may be asked later.

To complete the form, please mark your answers by marking the appropriate circles. If you do not feel comfortable giving an answer to a particular statement, you may skip it and move on to the next statement.

Clinical Process Improvement Survey

The anonymous linkage code below will be used to match data from different evaluation forms without using your name or information that can identify you.

Please complete the following items for your anonymous code:

First letter in mother’s first name: |___| First letter in father’s first name: |___|

First digit in your social security number: |___| Last digit in your social security number: |___|

Today’s Date: |___|___||___|___||___|___| Are you:  Male  Female

mo day yr

Your Birth Year: 19 |___|___|

Are you Hispanic or Latino?

 No  Yes

Are you: [MARK AS MANY AS APPLY]

 American Indian or Alaska Native  Black or African American

 Asian  White

 Native Hawaiian or other Pacific Islander

Highest Degree Status: [mark one]

 No high school diploma or equivalent  Bachelor’s degree

 High school diploma or equivalent  Master’s degree

 Some college, but no degree  Doctoral degree or equivalent

 Associate’s degree  Other (medical assistant, RN, post-doctorate)

Discipline/Profession: [mark all that apply]

 Physician  Other Human Services  Clerk

 Physician’s Assistant  Resident  RT, PT, EKG

 Nurse Practitioner  Intern  Pharmacy

 Nursing (LVN, RN)  Student  Interpreter

 PCT, NA  Administration  Other (specify)

 Social Work/LCDC  Manager

If Appropriate, List Area of Specialization:

(Ex. Internal Medicine, OB-GYN, etc.) ____________________

How long have you been in your present job?

 less than 1 year  1 to 3 years  over 3 years

CLINICAL PROCESS IMPROVEMENT ASSESSMENT

INSTRUCTIONS: Please answer the following questions based on your present situation. Each question allows you to choose from several alternatives. Please select the best response and fill in the corresponding circle.
The Institute for Healthcare Improvement Breakthrough Series offers a systematic approach for healthcare organizations to continually improve clinically related work processes and customer products and services (e.g., reducing patient waits and delays). Below is the definition for Clinical Process Improvement that will be used in this survey.
Successful clinical process improvement requires that healthcare providers: 1. Gather data regularly 2. Use technology more effectively 3. Participate in cross-functional teams 4. Involve customers in decision-making 5. Change work processes in response to new knowledge
In your opinion, has your hospital done what it can to facilitate clinician involvement in process improvement?
O	No, and it does not intend to within the next six months.
O	No, but it intends to within the next six months.
O	No, but it intends to within the next 30 days.
O	Yes, it has, but for less than six months.
O	Yes, it has for more than six months.
Given your role at your hospital, have you done what you can to get involved in clinical process improvement?
O	No, and I do not intend to within the next six months.
O	No, but I intend to within the next six months.
O	No, but I intend to within the next 30 days.
O	Yes, I have, but for less than six months.
O	Yes, I have for more than six months.
Have you been asked to get involved in clinical process improvement?
O	No
O	Yes

DECISIONAL BALANCE
The following statements represent different opinions about clinical process improvement. Based on your observations, please rate HOW IMPORTANT each of the following would be in your hospital’s decision to get involved in process improvement.
How important are the following in your hospital’s						Extremely important 5
decision to get involved in clinical process improvement?					Very important 4
				Moderately important 3
			Somewhat important 2
		Not at all important 1
1.	Help my hospital adapt to rapid changes in health care.						O	O	O	O	O
2.	Take time away from patient care.						O	O	O	O	O
3.	Improve work processes.						O	O	O	O	O
4.	Increase paperwork.						O	O	O	O	O
5.	Help my hospital be more competitive.						O	O	O	O	O
6.	Improve our ability to respond to change.						O	O	O	O	O
7.	Get us going in too many directions.						O	O	O	O	O
8.	Be a waste of time, like other management fads.						O	O	O	O	O
9.	Help ensure continued funding.						O	O	O	O	O
10.	Increase stress at work.						O	O	O	O	O
11.	Improve the quality of services.						O	O	O	O	O
12.	Create further demands for documented performance.						O	O	O	O	O
13.	Help my hospital adopt state of the art techniques.						O	O	O	O	O
14.	Strain working relationships.						O	O	O	O	O
15.	Help my hospital focus more on critical services.						O	O	O	O	O
16.	Create conflict across departments.						O	O	O	O	O

Organizational Processes of Change

Organizations engage in a variety of activities that can help clinicians get involved in clinical process improvement. Please indicate whether or not you observed your hospital engage in each of the following activities in the LAST THREE MONTHS. For each activity you did observe, rate how effective you think it was in getting clinicians involved in process improvement.

Extremely effective 5

Very effective 4

Moderately effective 3

Observed?

Somewhat effective 2

Yes No My hospital…

Not at all effective 1

1.

O

O

Provides clinicians with adequate hands-on training.

O

O

O

O

O

2.

O

O

Provides time for meetings related to clinical process improvement.

O

O

O

O

O

3.

O

O

Instills fear of what will happen if my hospital does not change.

O

O

O

O

O

4.

O

O

Helps clinicians feel excited about how changes in processes can improve my hospital.

O

O

O

O

O

5.

O

O

Monitors how new rules related to clinical process improvement are followed.

O

O

O

O

O

6.

O

O

Rewards clinicians when important milestones related to process improvement are reached.

O

O

O

O

O

7.

O

O

Has leadership that publicly states a commitment to process improvement.

O

O

O

O

O

8.

O

O

Provides skills training related to clinical process improvement.

O

O

O

O

O

9.

O

O

Gives clinicians the time off from other duties to get involved in process improvement.

O

O

O

O

O

10.

O

O

Generates anxiety about what can happen if clinicians do not get involved in process improvement.

O

O

O

O

O

11.

O

O

Encourages clinicians to understand how their behavior contributes to the overall success of the process improvement initiative.

O

O

O

O

O

12.

O

O

Discards old policies that might interfere with process improvement.

O

O

O

O

O

13.

O

O

Acknowledges clinicians’ process improvement activities with public recognition.

O

O

O

O

O

14.

O

O

Has leadership that “walks the talk.”

O

O

O

O

O

15.

O

O

Provides training to encourage a shift from the old way of doing things.

O

O

O

O

O

Organizational Processes of Change (Continued)

Organizations engage in a variety of activities that can help clinicians get involved in clinical process improvement. Please indicate whether or not you observed your hospital engage in each of the following activities in the LAST THREE MONTHS. For each activity you did observe, rate how effective you think it was in getting clinicians involved in process improvement.

Extremely effective 5

Very effective 4

Moderately effective 3

Observed?

Somewhat effective 2

Yes No My hospital…

Not at all effective 1

16.

O

O

Frees up time for clinicians to participate in process improvement.

O

O

O

O

O

17.

O

O

Creates a sense of urgency about the change initiative.

O

O

O

O

O

18.

O

O

Helps clinicians think about how process improvement is consistent with their own goals and values.

O

O

O

O

O

19.

O

O

Establishes policies that are consistent with clinical process improvement.

O

O

O

O

O

20.

O

O

Rewards individuals who contribute to the success of the process improvement initiative.

O

O

O

O

O

21.

O

O

Has leadership that is clearly committed to seeing the process improvement initiative succeed.

O

O

O

O

O

22.

O

O

Provides ongoing training for clinicians who are developing new skills.

O

O

O

O

O

23.

O

O

Relieves clinicians of their usual responsibilities so they can contribute to process improvement.

O

O

O

O

O

24.

O

O

Stresses that clinical process improvement is necessary for our survival.

O

O

O

O

O

25.

O

O

Encourages clinicians to think about how participating in process improvement will benefit them personally.

O

O

O

O

O

26.

O

O

Links my hospital policies to the goals of process improvement.

O

O

O

O

O

27.

O

O

Praises people who make an effort to get involved in clinical process improvement.

O

O

O

O

O

28.

O

O

Has leadership that is actively involved in making the process improvement initiative succeed.

O

O

O

O

O

29.

O

O

Provides time to participate in cross-functional teams related to process improvement.

O

O

O

O

O

30.

O

O

Creates alarm about our hospital’s ability to compete if clinicians fail to participate in process improvement.

O

O

O

O

O

Thank you for your time and thoughtful responses. We value your input.

© Copyright 2002 TCU Institute of Behavioral Research, Fort Worth, Texas. All rights reserved.