Exploring Innovation and Quality Improvement in Health Care Micro-Systems A Cross-Case Analysis (2000) / Chapter Skim
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Methods
Methods
Pages 8-20
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From page 8... ...
were assisted by Julie Mohr, a Darth College graduate student whose now completed doctoral dissertation topic was on micro-systems. We also collaborated with the leaders of the Institute for Health Care improvement's Idealized Design of Office Practice (ID-COP)
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Stage 2: Study Design and Data Collection During the second stage of the study we developed and finalized the protocol, selected the micro-system sites, drafted, pilot tested, and revised the interview instruments, conducted tests of interrater reliability, conducted the interviews, and transcribed notes. Instrument and Protocol Development During late spring and summer 1999 we developed the methodology and structured interview content.
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At the time of the interview, the interviewer introduced him or herself and briefly explained the purpose of the interview, stated that no information would be attributed to them without their explicit permission, and that the interviewer would be taking notes and might wish to follow up to clarify information at a later time. Interviews were timed to be completed within 90 minutes unless the respondent wanted to continue.
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We interviewed individuals at a range of sites that included hospital units (such as emergency departments, cardiac care, and newborn intensive care) , primary care and other ambulatory settings, chronic disease management programs, hospice care, and a hospital specializing in a single procedure.
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12 N = Primary Care 15 V LL Care 19 Hospital Unit 9 Pediatric I o . o Adolescent Adult Geriatric Rural Urban Suburban 19 27 38 39 14 27 15 INNO VA TI ON AND Q UALI TY IMPR O CEMENT IN MI CR D-SYSTEMS TABLE 2 Range of Micro-Systems Studied Geographic Setting ~ _ 1 o 5 P: A Ad.
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For example, the interview contained a section on information technology, but some sites indicated that computer based clinical infonnation was not relevant for their site. During the interview, the response was confirmed, and questions that related to computerbased clinical information were skipped.
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We have four office staff to answer phones and make appointments, a "fringe" nurse to handle emergencies, nurses and medical assistants to get patients to rooms, give injections, and Maw blood, a medical secretary, several file clerks, an office manager, a billing person and two managed care coordinators.
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We are a community health center with two primary care medical clinics, two school-based teen health centers, and four dental clinics. We have eight FPs, one PA, five NPs, three CNMs.
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one clinical psychologist, one PA, six-10 RD, CDEs, 2200 primary care and specialty care physicians 13. We work with cardiac services on improving clinical and financial outcomes, decreasing morbidity and mortality.
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The system integrates the activities of five full time hospital employed academic critical care medicine (CCM) physicians along with six private practice pulmonary/ CCM physician with about 90 private staff physicians who admit and care for this population including the active Level ~ trauma and the neurosurgical services.
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18 INNOVATION AND QUALITYIMPROVEMENTINMICRO-SYSTEMS TABLE 3 Question Completion Rate Interview Question Sites °/0 Completion Asked (sites asked / 43) Level of Performance ....................................................................................................................................................................................................................................
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Looking at the data by interview question is useful, but still represents raw data. For this reason, coding was then used to assign descriptive codes to each phrase, sentence, or groups of words that represent common concepts.
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From page 20... ...
For example, "barriers" was a common idea found throughout the interviews, but barriers are not a characteristic of micro-systems. How the micro-systems deal with barriers, perhaps through an investment in improvement or use of information and information technology, did appear to be characteristic of the micro-systems interviewed, however and were coded in this way.
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