Attachment D - Exit Interviews Protocol
Form
Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX
Site information to be pre-filled prior to the interview by project team member
Date (Month Year):
Site Name:
Interviewee:
Respondent Type:
Site Leader
Site champion
Clinician
Clinical/Department leader
Quality improvement leader
Clinician, Other
Date of Site Attrition: (Month Year)
Thank you for agreeing to participate in today’s interview. Your participation is very important to us. I’m [name] from the RAND Corporation and I’m joined by our notetaker, [name]. We appreciate the opportunity to understand your experience with [tool name].
This survey is authorized under 42 U.S.C. 299a. Your answers are voluntary, and the interview is expected to take about 10 minutes to complete. It has been approved for use under OMB Number 0935-XXXX. We could not conduct this survey without that authorization. We will protect your privacy to the extent allowed by law. [IF RESPONDENT ASKS ABOUT PRA, READ PRA STATEMENT].
Before we begin, I want to give some information about the interview.
The interview will take 10 minutes or less.
Your participation in this interview is completely voluntary.
You can stop the interview at any time.
If there is a question you don’t want to answer, just tell me and we’ll move on to the next one.
We will not link anything you say here to your name or other identifiable information.
I am going to audio record our conversation to help me remember what you say and with our notetaking. I’ll destroy the recording once we finalize our notes.
Do you have any questions about this project or interview?
Do you agree to take part in this interview?
Do you agree to record the interview? IF YES: Ok great. Let me go ahead and start our recording.
This survey is
authorized under 42 U.S.C. 299a. This
information collection is voluntary and 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
10 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. The data you provide will help
AHRQ’s mission to produce evidence to make health care safer,
higher quality, more accessible, equitable, and affordable. 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, or by email to the AHRQ MEPS Project Director
at [email protected].
Before we get started, can we please confirm your name, site, and your role in implementing [tool name] at your site?
We
would like to know more about why you are unable to continue
participating in the evaluation. Can you please tell me more about
why your site is unable to continue on in the evaluation?
Optional
probes: Challenges related to:
Lack of leadership support or engagement
Lack of engagement or support from QI team members or other staff
Change in leadership/personnel (e.g., facility merger or leadership change)
Difficulties accessing available data
Difficulties processing or interpreting data
Legal/liability concerns
Competing priorities
Lack of resources
Lack of protected time
Of the things that we just discussed, what was the main thing that drove this decision?
As
a follow-up, can please you tell me about what would need to change
for your site to continue on in this evaluation?
Optional
probes:
Changes with respect to:
The tool itself
Training/evaluation team support
[tool name] training activities
Evaluation data collection and reporting
Leadership commitment at your site
Other issues at your site
We understand and are sorry you cannot continue to participate in the evaluation. Thank you for your time.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Claire O'Hanlon |
File Modified | 0000-00-00 |
File Created | 2024-08-05 |