A rapid interview protocol supporting patient-centered quality improvement: hearing the parent's voice in a pediatric cancer unit.
BACKGROUND
The Institute of Medicine's 2001 report on quality delimits six dimensions of optimal care: safety, effectiveness, efficiency, timeliness, patient centeredness, and equity. In fall 2001 parents of pediatric cancer patients were interviewed to determine how well they thought these dimensions were addressed with respect to medication administration. Immediate goals were to identify system weaknesses and devise strategies to prevent future errors. A higher-order goal was to develop and demonstrate a model protocol for rapid-cycle interview assessments.


METHODS
Hematology/oncology directors worked with a research expert to develop a semistructured interview protocol. After training, which included directed reading, oral instruction, and role-playing, a convenience sample of 20 English- and Spanish-speaking parents of inpatients was recruited. Parents were asked to characterize current medication administration practices and to describe problems that they had experienced or witnessed. Rapid content analysis techniques were used to identify issues of importance to the parents.


RESULTS
Parents' medication concerns centered on their children's comfort. Parents called for communication improvements, standardization of all nursing procedures and techniques, and a guide or an outline providing a clear understanding of what to expect when and from whom. Viewing these concerns in relation to the Institute of Medicine's quality domains allowed the department to frame an improvement action plan aligned with organizational and national priorities.


CONCLUSIONS
With good supervision and limited focused training, inexperienced staff can successfully administer semistructured qualitative interviews and help analyze findings for rapid cycle improvement purposes. The protocol can be adapted for use in organizations interested in rapid qualitative assessments of patient and parent preferences.
Sobo
Elisa J
EJ
Center for Child Health Outcomes, Children's Hospital and Health Center, San Diego, USA. esobo@chsd.org
Billman
Glenn
G
Lim
Lillian
L
Murdock
J Wilken
JW
Romero
Elvia
E
Donoghue
Donna
D
Roberts
William
W
Kurtin
Paul S
PS
D002140:California; D002648:Child; D002673:Child, Hospitalized; D003258:Consumer Behavior; D006302:Health Services Research / Q000379:methods*; D006405:Hematology / Q000592:standards; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008510:Medication Systems, Hospital / Q000592:standards*; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D009369:Neoplasms / Q000188:drug therapy*; D016522:Oncology Service, Hospital / Q000592:standards*; D010290:Parents / Q000523:psychology*; D018802:Patient-Centered Care / Q000592:standards*; D010372:Pediatrics / Q000592:standards; D017749:Total Quality Management / Q000379:methods*; D014481:United States