Journal of Healthcare Management - March/April 2014 - (Page 98)

J o u r n al of H ealt H care M anage Ment 59:2 M arcH /a pril 2014 TA B L E 1 Number of Practices Selected for Semistructured Interview (by ability to improve their clinical process and outcome scores and practice change scores) Practice Change Scores Clinical Process/Outcome Scores Improved Not Improved Total Practices Improved 4 3 7 Not Improved 3 2 5 7 5 12 Total Practices Data Collection Across the 12 sites, we conducted 24 in-person, on-site, key informant focus group interviews between April 2011 and May 2012. Key informants included representatives from practice leadership (e.g., physicians, nurse practitioners, physician assistants, practice managers) (n = 31) and practice staff (e.g., registered nurses, licensed practical nurses, medical assistants, front desk and billing clerks) (n = 68). To maximize the diversity of perspectives and minimize singlesource bias, interviews were conducted in two groups-one with practice leadership and one with staff. Each interview lasted approximately one hour and was conducted by a member of the study team, with another member taking notes. All interviews were recorded and transcribed verbatim, with one exception, where permission to audiotape was denied. A transcript for the nonrecorded interview was prepared immediately following the site visit by combining notes from members of the study team. To standardize the interview process, we used a semistructured interview guide with probes to explore informant responses. Certain questions were tailored for different types of informants, and the interview guide was reviewed by members of the project's advisory board. Questions covered eight domains: (1) understanding and perception of IPIP, (2) motivation and power balance, (3) clinical performance and challenges, (4) extent of implementation, (5) resources and support, (6) physician/provider/staff stress, (7) spillover effects, and (8) cost. This study used information from domains 5 through 8. After each interview, we reviewed our notes and enhanced our interview guide when informant responses suggested new question probes. The biomedical institutional review board at the University of North Carolina at Chapel Hill reviewed and approved this study. Analyses Interview data were analyzed using a combination of deductive and inductive methods (Miles & Huberman, 1994; Strauss & Corbin, 1998). A code book was initially developed from the interview domains. New codes were added as concepts emerged. Four members of the study team coded two common 98

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014