Journal of Healthcare Management - May/June 2013 - (Page 209)

H ow to I MProve B rea St c ancer c are M eaSure Ment /r e Port I ng and reporting?”) and facilitators and (2) other interview questions that involved a discussion of emergent issues that we classified as barriers and facilitators (e.g., complex process, limited understanding, mistrust). We used the qualitative data analysis software program Atlas.ti (version 6.0) to assist us with the coding and analysis process (Scientific Software Development, 2009). r E S U lt S Population Studied We interviewed 31 administrative and clinical informants at the study hospital and in associated community practice sites. Our key informants included medical, surgical, and radiation oncologists and administrative representatives from multiple practice settings. Across sites we interviewed hospital executives and hospital medical directors (n = 6), hospital administrative directors (n = 4), hospital-based oncologists (n = 5), hospital-based cancer administrators (n = 4), community-based oncologists (n = 4), the office staff of communitybased oncologists (n = 5), hospitalbased IT managers (n = 2), and the hospital tumor registrar (n = 1). Barriers to Breast Cancer Measurement and reporting Seven management-related themes emerged from respondents’ answers to questions about barriers to breast cancer measurement and reporting. Here we describe each barrier in greater detail, and we present additional evidence supporting these themes by respondent type (i.e., community-based physician versus hospital-based physician versus administrator or office staff) in Table 1. Barrier 1: Complicated Measurement and Reporting Process One issue that was salient across informant groups was that the complicated nature of the measurement and reporting process itself created a barrier. As one physician summarized, “We don’t have a standardized way of following up with patients, especially breast cancer cases. Breast cancer patients have a lot of doctors, so they sometimes pull out with one doctor and follow up with one or two others.” Administrative interviewees also described this complexity: “We are not only dealing with the office, we deal with numerous facilities when it comes to the patient.” Barrier 2: Limited Understanding of the Reporting Process The second barrier involved a limited understanding of the TR and the TR reporting process; it was noted by interviewees across groups. As one community-based oncologist explained, “If there is any reporting, I don’t mind doing it, but there is no mechanism for me to do it. Do I call you up and say, ‘Oh, by the way, I have a new breast cancer patient’? I don’t even know what to say.” A number of hospital-based physicians were similarly confused. One summarized, “I get nothing from the registry. I have no idea what they do, who they are, or how it benefits us.” Barrier 3: Competing Priorities A third barrier was related to the need for all types of respondents to manage competing priorities. For both community- and hospital-based physicians, interviewees noted how the additional tasks required to properly track adjuvant 209

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