Practical Applications of Rapid Qualitative Analysis for Operations, Quality Improvement, and Research in Dynamically Changing Hospital Environments

Keniston, Angela; McBeth, Lauren; Astik, Gopi J.; Auerbach, Andrew D.; Busch, Johanna; Kangelaris, Kirsten N.; Kulkarni, Shradha A; Linker, Anne S.; Sakumoto, Matthew; Leykum, Luci K.; Burden, Marisha

doi:10.1016/j.jcjq.2022.11.003

Cited by 19 publications

(27 citation statements)

References 14 publications

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“…A matrix analysis was then conducted. The matrix contained the content of the summaries with the domains in columns and the individual interviews in rows 18,22–24 . The matrix was analyzed by members of the Workforce Planning group, and insights were discussed until consensus was reached and themes and subthemes surfaced.…”

Section: Methodsmentioning

confidence: 99%

“…Following the focus groups, we utilized a rapid qualitative analysis process to analyze the content of the focus groups, applying methods similar to prior work. [17][18][19][20] Rapid qualitative methods have been previously described, consisting of a structured analysis that can be useful in situations of dynamic, rapidly changing real-world situations (such as a pandemic). 18,21 Templated summaries were created for each of the interviews and focus groups.…”

Section: Ranking and Analysismentioning

confidence: 99%

“…[17][18][19][20] Rapid qualitative methods have been previously described, consisting of a structured analysis that can be useful in situations of dynamic, rapidly changing real-world situations (such as a pandemic). 18,21 Templated summaries were created for each of the interviews and focus groups. Each team member summarized the same transcript (A. L., M. B., M. S., S. K.) and then compared across team members to standardize the summary template methodology.…”

Section: Ranking and Analysismentioning

confidence: 99%

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Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field

Kulkarni

Keniston

Linker

et al. 2023

Journal of Hospital Medicine

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Background: The hospitalist workforce has been at the forefront of the pandemic and has been stretched in both clinical and nonclinical domains. We aimed to understand current and future workforce concerns, as well as strategies to cultivate a thriving hospital medicine workforce.Design, Setting, and Participants: We conducted qualitative, semistructured focus groups with practicing hospitalists via video conferencing (Zoom). Utilizing components from the Brainwriting Premortem Approach, attendees were split into small focus groups and listed their thoughts about workforce issues that hospitalists may encounter in the next 3 years, identifying the highest priority workforce issues for the hospital medicine community. Each small group discussed the most pressing workforce issues. These ideas were then shared across the entire group and ranked.We used rapid qualitative analysis to guide a structured exploration of themes and subthemes.Results: Five focus groups were held with 18 participants from 13 academic institutions. We identified five key areas: (1) support for workforce wellness; (2) staffing and pipeline development to maintain an adequate workforce to match clinical growth; (3) scope of work, including how hospitalist work is defined and whether the clinical skillset should be expanded; (4) commitment to the academic mission in the setting of rapid and unpredictable clinical growth; and (5) alignment between the duties of hospitalists and resources of hospitals. Hospitalists voiced numerous concerns about the future of our workforce. Several domains were identified as high-priority areas of focus to address current and future challenges.

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Section: Methodsmentioning

confidence: 99%

Section: Ranking and Analysismentioning

confidence: 99%

Section: Ranking and Analysismentioning

confidence: 99%

See 1 more Smart Citation

Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field

Kulkarni

Keniston

Linker

et al. 2023

Journal of Hospital Medicine

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“…We will use rapid qualitative methods to conduct a mixed inductive–deductive thematic analysis at the semantic level. Templated summaries and matrix analysis will be used to analyze the data 30,31 …”

Section: Methods and Analysismentioning

confidence: 99%

“…Templated summaries and matrix analysis will be used to analyze the data. 30,31 During each small group discussion, the moderators will take field notes and observations to supplement the audio recordings. The audio recordings and field notes will be used to support Aim 2 collaborative efforts as well as for Aim 4 program evaluations.…”

Section: Hypothesis 4b Statistical Approachmentioning

confidence: 99%

Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: A multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients

Schnipper,

Raffel,

Keniston

et al. 2023

Journal of Hospital Medicine

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BackgroundFew hospitals have built surveillance for diagnostic errors into usual care or used comparative quantitative and qualitative data to understand their diagnostic processes and implement interventions designed to reduce these errors.ObjectivesTo build surveillance for diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates.Methods and AnalysisAchieving diagnostic excellence through prevention and teamwork (ADEPT) is a multicenter, real‐world quality and safety program utilizing interrupted time‐series techniques to evaluate outcomes. Study subjects will be a randomly sampled population of medical patients hospitalized at 16 US hospitals who died, were transferred to intensive care, or had a rapid response during the hospitalization. Surveillance for diagnostic errors will occur on 10 events per month per site using a previously established two‐person adjudication process. Concurrent reviews of patients who had a qualifying event in the previous week will allow for surveys of clinicians to better understand contributors to diagnostic error, or conversely, examples of diagnostic excellence, which cannot be gleaned from medical record review alone. With guidance from national experts in quality and safety, sites will report and benchmark diagnostic error rates, share lessons regarding underlying causes, and design, implement, and pilot test interventions using both Safety I and Safety II approaches aimed at patients, providers, and health systems. Safety II approaches will focus on cases where diagnostic error did not occur, applying theories of how people and systems are able to succeed under varying conditions. The primary outcome will be the number of diagnostic errors per patient, using segmented multivariable regression to evaluate change in y‐intercept and change in slope after initiation of the program.Ethics and DisseminationThe study has been approved by the University of California, San Francisco Institutional Review Board (IRB), which is serving as the single IRB. Intervention toolkits and study findings will be disseminated through partners including Vizient, The Joint Commission, and Press‐Ganey, and through national meetings, scientific journals, and publications aimed at the general public.

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Identifying and Measuring Administrative Harms Experienced by Hospitalists and Administrative Leaders

Burden,

Astik,

Auerbach

et al. 2024

JAMA Intern Med

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ImportanceAdministrative harm (AH), defined as the adverse consequences of administrative decisions within health care that impact work structure, processes, and programs, is pervasive in medicine, yet poorly understood and described.ObjectiveTo explore common AHs experienced by hospitalist clinicians and administrative leaders, understand the challenges that exist in identifying and measuring AH, and identify potential approaches to mitigate AH.Design, Setting, and ParticipantsA qualitative study using a mixed-methods approach with a 12-question survey and semistructured virtual focus groups was held on June 13 and August 11, 2023. Rapid qualitative methods including templated summaries and matrix analysis were applied. The participants included 2 consortiums comprising hospitalist clinicians, researchers, administrative leaders, and members of a patient and family advisory council.Main Outcomes and MeasuresQuantitative data from the survey on specific aspects of experiences related to AH were collected. Focus groups were conducted using a semistructured focus group guide. Themes and subthemes were identified.ResultsForty-one individuals from 32 different organizations participated in the focus groups, with 32 participants (78%) responding to a brief survey. Survey participants included physicians (91%), administrative professionals (6%), an advanced practice clinician (3%), and those in leadership roles (44%), with participants able to select more than one role. Only 6% of participants were familiar with the term administrative harm to a great extent, 100% felt that collaboration between administrators and clinicians is crucial for reducing AH, and 81% had personally participated in a decision that led to AH to some degree. Three main themes were identified: (1) AH is pervasive and comes from all levels of leadership, and the phenomenon was felt to be widespread and arose from multiple sources within health care systems; (2) organizations lack mechanisms for identification, measurement, and feedback, and these challenges stem from a lack of psychological safety, workplace cultures, and ambiguity in who owns a decision; and (3) organizational pressures were recognized as contributors to AHs. Many ideas were proposed as solutions.Conclusions and RelevanceThe findings of this study suggest that AH is widespread with wide-reaching impact, yet organizations do not have mechanisms to identify or address it.

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Practical Applications of Rapid Qualitative Analysis for Operations, Quality Improvement, and Research in Dynamically Changing Hospital Environments

Cited by 19 publications

References 14 publications

Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field

Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field

Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: A multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients

Identifying and Measuring Administrative Harms Experienced by Hospitalists and Administrative Leaders

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