Journal of Healthcare Management - May/June 2013 - (Page 208)

Journal of H ealt H care M anage Ment 58:3 M ay /J une 2013 Organizational Change and Change Processes at Mount Sinai Medical Center, Cancer Treatment Measurement and Reporting, and Moving Forward with This Research. These domains were selected to organize questions about breast cancer measurement and reporting in the context of quality improvement and organizational change. For instance, questions around organizational change sought to explore potential facilitators and barriers to change associated with past change efforts that might be relevant to the hospital’s efforts to improve breast cancer treatment measurement and reporting (e.g., “Can you tell me any stories about how you’ve been involved in formal organizational change programs within Mount Sinai Medical Center? What went well? What challenges did you experience?”). In our analyses for this article we focus on barriers and facilitators to breast cancer treatment measurement and reporting that emerged from responses to questions about other organizational changes, organizational communication processes, and competing priorities. We also incorporated analyses of interviewees’ specific responses to the question, “What three (to five) things need to be done to improve measurement and reporting at Mount Sinai Medical Center?” analysis Our analytic approach used a combination of inductive and deductive methods. As the study progressed, we read and discussed interview transcripts and preliminary findings using a grounded theory approach (Glaser & Strauss, 1967; Strauss & Corbin, 1998) to guide our exploration of the data. This iterative process allowed us to explore emergent themes in the data and enabled us to verify these themes as we interviewed additional key informants. For instance, after early interviewees mentioned the implementation of an electronic health record system (EHR) in the hospital as an example of change, we introduced question probes in subsequent interviews about availability of and access to information technologies in the context of improving breast cancer treatment measurement and reporting processes. When we had completed all interviews, we created a coding team, which included the lead qualitative investigator (ASM) and a research assistant. This team reviewed interview guides and transcripts to identify broad themes and issues that emerged. The coders conferred to produce an agreed-on list of codes and a coding frame. This preliminary coding process allowed us to organize our data into categories of findings (Constas, 1992). We then applied our coding frame to three common transcripts, enabling us to compare individual coding decisions and to clarify codes and emergent themes within the data. Coders continued to hold scheduled calls to permit regular discussions about the analytic process and to ensure consistency of coding. These frequent conversations also helped us reach agreement about final themes emerging from our data. We categorized the themes we report in this article on the basis of responses to (1) direct questions about barriers (e.g., “What do you believe are the major barriers to timely and accurate treatment measurement 208

Table of Contents for the Digital Edition of Journal of Healthcare Management - May/June 2013

Journal of Healthcare Management - May/June 2013
Contents
Interview with Thomas C. Dolan, PhD, FACHE, CAE, President and CEO, American College of Healthcare Executives
Equity in Care: Picking Up the Pace
How Might a Reforming U.S. Healthcare Marketplace Threaten Balance Sheet Liquidity for Community Health Systems?
Assessing the Productivity of Advanced Practice Providers Using a Time and Motion Study
A Positive Deviance Perspective on Hospital Knowledge Management: Analysis of Baldrige Award Recipients 2002–2008
How to Improve Breast Cancer Care Measurement and Reporting: Suggestions from a Complex Urban Hospital
The Fear Factor in Healthcare: Employee Information Sharing

Journal of Healthcare Management - May/June 2013