Patient Safety Work Product – Privileged and Confidential
Patient Safety and Quality Improvement Act of 2005 (42 U.S.C. 299b-21 to 26), the Patient Safety and Quality Improvement final rule (42 C.F.R. §3.102(c)(2)(i))
Breast Cancer Center Leader - Interview Guide
After obtaining the staff member’s verbal consent, the interviewer will thank them for his or her time and provide a brief
introduction to the project.
Thank you for taking the time to talk with me today. I am interested in learning more about your experiences so that we
can improve breast cancer screening and care. There are no right or wrong answers. I would just like to hear about your
experiences and suggestions for improvements.
If any questions make you feel uncomfortable and you do not wish to answer, you may skip them and go on to the next
question. You may also choose to stop participating at any time during the interview. Your answers will be held in the
strictest of confidence and will only be seen by myself and authorized research staff. Most importantly, your
participation in this study will not in any way affect your employment.
This interview guide is intended to steer the conversation, however the discussion will direct how these questions are
asked and the order of questions may change based on the interviewee’s answers.
Leadership
1. How are the breast cancer screening and care areas structured and what services are provided
1.1. Screening? Diagnostic Imaging? Diagnostic biopsy? Pathology? Surgery? Reconstructive Surgery? Radiation
Therapy? Systematic Therapy/Medical Oncology? Supportive Services? - use inventory to recap at end of
discussion
1.2. Which of these areas are employees of the institution? Which are private practices?
1.3. How are external practices monitored by the institution?
1.4. How are employees of the institution incentivized beyond salary? Are metrics used? If so, what are they? How
are they different by area of the institution (with a focus on areas serving or supporting breast cancer
patients)?
2. Do you have a tumor board, breast conference, cancer committee or other such review group
2.1. Purpose and focus?
2.2. Who is required to participate (in person, phone, WebEx)? Who else participates?
2.3. Frequency of meeting? Typical agenda? Typical duration of meeting?
2.4. How are discussion, decisions and actions documented?
2.5. Are there metrics tracked and reviewed by the group on a regular basis? If yes, what are the key metrics
2.6. How are patients who are receiving care at your institution and at others handled by the group? What % of
patients with breast cancer diagnosed at your institution chose to receive all of the care available at your
institution? What care do patients go elsewhere for? Where do they typically go?
This project has been made possible by generous support from the Susan G. Komen for the Cure Foundation
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Patient Safety Work Product – Privileged and Confidential
Patient Safety and Quality Improvement Act of 2005 (42 U.S.C. 299b-21 to 26), the Patient Safety and Quality Improvement final rule (42 C.F.R. §3.102(c)(2)(i))
Leadership
3. Does your institution have a tumor registry?
3.1. If yes, who is responsible for registering breast cancer tumors? If not, where are patients typically registered?
3.2. How does your institution define date of diagnosis of breast cancer?
4. What accreditations, certificates, associations, other does your institution have in Cancer, Breast Cancer
screening and breast cancer care? What are you currently pursuing? What are you considering?
4.1. What standards are typically used as the basis for care protocols / pathways? (American College of Radiology,
College of American Pathologists, American College of Surgeons (CP3R NAPBC), ASTRO, NCCN, ASCO, other
5. Training, CME, Education of Staff
5.1. What type of training / or CME is provided to or made accessible for staff?
5.2. What are staff and practicing physicians expected to do on their own to keep up their skills?
5.3. How is training / CME tracked?
5.4. Are opportunities provided to nurses for advanced training (advanced practice, nurse practitioner, etc)?
6. What external resources are used by the institution, Such as Adjuvant! Online for systematic therapy
decisions…?
7. What relationships does your institution have that refer patients in? What relationships do you have to
refer patients elsewhere for care?
7.1. Relationships with PCPs, Family Practitioners? Clinics?
7.2. Relationships with supportive care service organizations? Patient support groups? Peer counseling? Other?
7.3. Referrals to other ______ for services not provided onsite?
7.4. Second opinions?
8. Insurance status?
8.1. How are uninsured patients cared for during screening? What changes when there is a malignant diagnosis?
8.2. Is there a person or a department responsible to help uninsured patients diagnosed with breast cancer
through the Medicaid process? If not, where are patients directed?
8.3. What is the institution able to do for patients that are under-insured?
9. Supportive Care?
9.1. What resources / services do you have for breast cancer patients (if not already discussed)?
9.2. What resources, services, and groups do you have for breast cancer patients who have completed their
treatments (survivors)?
9.3. Are there any resources at your institution for families/friends of breast cancer patients? If so what are they
This project has been made possible by generous support from the Susan G. Komen for the Cure Foundation
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Patient Safety Work Product – Privileged and Confidential
Patient Safety and Quality Improvement Act of 2005 (42 U.S.C. 299b-21 to 26), the Patient Safety and Quality Improvement final rule (42 C.F.R. §3.102(c)(2)(i))
Leadership
10. Information Systems / Software at Institution
10.1.
10.2.
10.3.
10.4.
10.5.
10.6.
10.7.
10.8.
How does the IT department interact with the breast cancer center?
Scheduling, managing screening appointments and follow up (used for other areas as well?)
Medical Records: Imaging results? Lab results? Surgical procedures? Therapies?
Workflow capabilities? Inter-department communications/interactions at patient level?
Lab orders
Pharmaceutical orders
Billing
Other
11. What are patient frustrations ?
11.1. What does the patient think about the care process, what feedback do you get from patients?
How do you get this feedback?
11.2. What hoops do you need to jump through to reduce patient frustrations?
11.3. What are the longest wait times for patients?
12. When a patient is moving from one part of care to another (E.g.; surgery to med Onc), how is
that “handoff” handled?
12.1. Who communicates with whom?
12.2. What is the typical timing?
12.3. How do you know – is it monitored ? is it measured?
13. Who is involved or informed during the patients course of breast cancer care and why? Who
should be involved?
14. What information is required by PATIENT and by PROVIDER/STAFF during the Breast Cancer Care
process and why? What is the source of the info (system, paper, etc)?
This project has been made possible by generous support from the Susan G. Komen for the Cure Foundation
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Patient Safety Work Product – Privileged and Confidential
Patient Safety and Quality Improvement Act of 2005 (42 U.S.C. 299b-21 to 26), the Patient Safety and Quality Improvement final rule (42 C.F.R. §3.102(c)(2)(i))
15. Breast Cancer Screening
through Breast Cancer
Care to Survivorship
What is working well?
Why do you think it works?
How do you know it works (metrics,
tracking methods, patient feedback,
questionnaires)?
What could be done
better?
What are the challenges?
Why? (delays, breakdowns)
Effective – Measured by compliance with
guidelines in using appropriate therapies,
procedures, diagnostics and pharmacogenomics for
patient subgroups.
Timely - specifically timing, sequencing, duration
Safety – adverse events, errors, etc
Efficient – Measured by use of resources and
duration of care cycle. Includes: cost of care, RVUs,
and time duration of care
Patient Centered – patient interactions,
adherence to care plans and satisfaction with care
Utility / Usability
- adoption and
acceptance of care process by institution and
patients
Equitable – consistency of care protocols
regardless of insurance, sex, race, culture, religion,
economic status, education level
This project has been made possible by generous support from the Susan G. Komen for the Cure Foundation
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