Hello once again. As you can see from our title slide, we

are continuing to prioritize needs. And this is part B of the lecture.

And we'll be focusing now on how to go about actually doing these in context

interviews with your stake holders. So, once again, we're beginning to call

them key informants now, these stakeholders.

We're going to identify the knowledge gaps in their perspective.

That's one of the key reasons why you interview these folks.

As we've said before, each of these folks are going to be bringing to you a, a

perspective that's governed by their roles and responsibilities and their

experiences. Be sure that you're the one that takes

all of their perspectives and recognizes where one perspective is limited.

Where the other one complements that perspective and fills in gaps.

Where there are gaps that remain. These are the kinds of things you're

going to be looking for as well as developing sort of themes and patterns

that you see in the interview subjects as they talk about this focus issue.

Now, in order to eventually analyze what your developing with these interviews be

sure to use the same terminology and definitions each time you discuss the

issue with each of the stakeholder groups.

That way, you have a structure that can govern the input that you receive.

Now, how're you going to go about finding these people to help you?

Recruitment can be undertaken through something called snowball sampling.

See, many of us have a network of associates, of colleagues, of friends,

who have some kind of entree into the health care environment.

We begin with these folks and of course during your observation, you had

hopefully people who were willing to allow you to shadow them through the

healthcare environment. Begin with those folks and those folks in

the snowball sampling affect will then refer you to others that you can contact

and interview. The only caveat, the only warning to that

is please be careful about bias intruding.

Being introduced into your data. Why would bias be introduced?

Well, it's sort of like an echo chamber effect, you know that if you ask one

person for a referral. That person is likely going to refer a

colleague that shares with them a particular point of view.

That means you maybe have an overabundance of one point of view and

neglect entirely several others. So be very wary about that, but still

snowball sampling can be an effective means to gather together and recruit

particular key informants. Now, the other thing to do in order to

get a richer data, data set is to combine in a mixed methods way, to combine these

interviews which are essentially qualitative research.

With a more quantitative research which is finding methods, whether online or in

person, to provide your informants with a way of voting on particular issues.

You set up the, the structure the survey questions on which they can vote.

And you can use a questionnaire, or you could use a structured questioning method

that's known as the Delphi method. In which you take a panel of experts, the

Delphi method insists it's very important to have that group dynamic.

So you take a panel of people who have in, in the Delphi method, they recommend

people with decision making power, strategists who are there to determine

the future of the organization. You take these panel ex-, of experts and

you put them through a structured communication process.

At first, you allow them to do some initial vetting of ideas, exchange of

ideas. And you, you give them time to do some

individual thinking about it. And once these ideas are gathered there's

a second phase in which the, you, these panels respond to the original

suggestions. So that's one technique for eliciting

prioritization of observed needs. And finally, we want to talk about the

differences among key stakeholders, key informants, and their relative power to

affect your project. This is what what happens when you need

to prioritize your stakeholders, in a sense.

Which input, which group, is more important to the success of your solution

then the other groups. This weighing of input is something I'll

address in a, in a succeeding slide. Just hold on a minute, and we'll get

there. We'll get there shortly.

Some special remarks about engaging clinician stakeholders.

Those of you who are not clin-, clinicians yourselves.

Will understand that the impetus for discovery within the clinical world is

now considered evidence based practice. In other words, the conscientious,

explicit and judicious use of all of what we call the scientific literature, the

medical literature, the studies. the reliable, verifiable valid studies of

what works and what doesn't work, of what approaches are are beneficial and where

the gaps are in our evidence. That kind of evidence based practice in

making decisions about the care of individual patients is something that is

inplicated in the medical culture and the nursing culture.

It's very important to speak to clinicians within the terms.

Of this very critical part of their lives and practice.

Evidence is essential for proving your case, for substantiating your case.

And that means that if you're not a clinician yourself, you should take this

time to spend a great deal of effort in understanding journal articles.

And understanding what it means to create an integrated view of the medical

literature. Or of the quality improvement literature.

So what you're looking for in the literature are relevant evidence gaps.

In other words this is a real need because we don't have evidence yet to

confirm or deny the efficacy of one or the other approach.

These gaps in the literature can be fulcrums on which to turn.

And persuade clinicians to get on board with your project.

So, engage them in a conversation in which you make them aware that you've

done your homework. And that you have identified relati-,

relevant evidence gaps in the current research literature.

I also would recommend that you engage early and often the role that I name here

the middle manager and in fact the title middle manager sort of says it all.

These are people, critical people, who live and work in that role and

responsibility that lies between the executive suite on the one hand.

And the front line staff that really cares for the patient on the other.

So you've got someone who, who communicates between the two realms.

And is absolutely vital to the sucess of any project.

In fact, the middle manager can essentially make or break implementation

of any innovation within a complex organization.

These critical people can really key you into problems before they manifest

themselves in ways that could really break your project.

They are the ones to tell you when the organization, the unit that they work

within and, and the staff that they supervise don't have the incentives to

play ball with you. To, to be persuaded that your innovation,

that the, that the need that you have focused on is a need that should and can

be addressed. So make sure that the incentives for the

staff, as identified by the middle manager, are there.

And if not how to remedy that situation. These middle managers can also be your

key informants as to the professional barriers that may lie in your path.

That may not be something that you're aware of but they are certainly aware of

because they live with these professional barriers.

also competing priorities. any time an organization focuses on

addressing one need, they are ignoring several others.

It, it's just inevitable. We call this lost opportunity, they don't

have the budget to allocate resources to one or the other direction, which may be

dear to the heart of very important people within the organization.

If they devote resources instead to your project.

So these competing priorities are something that you really have to keep in

mind and be able to negotiate and be able to appreciate and empathize with.

The difficult situation of the middle manager having to balance these competing

needs. Also, the middle manager will be the

person to alert you immediately to inertia within the organization.

Whether they realize it themselves, or whether it comes out in their interview,

they will be conveying the relative readiness of an organization to make

change happen. So, these are key things to take into

account. And will be factors that you want to

include in your analysis. As you begin to hone into that need that

is not only top priority for your stakeholders, but actually addressable

within the, the, the actual context of healthcare in the environment that you

are focused on. Now, weighing the input of this vast

array of stakeholders is something that we also want to, to help you, guide you

to do effectively. As you can see in this table, there's a

four sector table. And you note that on one axis, there's

high or low power individuals. And then, the other axis, there's low or

high impact on individuals. What we mean by this is, you have to

analyze your key informants in terms of their power and influence to reach

decisions for the organization. And also the extent to which they will

themselves be impacted by a change in the problem care area.

You may find, and this is certainly the case for patients, that, that you have a

a stakeholder who doesn't have much power.

To reach decisions for the organization, but will be extremely impacted by any

change that transpires. So what you should do at, at the point

after you've interviewed them, and in deciding whom to interview.

Is use this kind of four sector table to get a real sense of where the stakeholder

groups lie within this weighting mechanism.

And that way, at the end, you'll be able to prioritize the stakeholders.

And finally, if you take, give back. Give back your findings to the

organization. Understand that these stakeholders have

taken time out of their day to work with you.

So express your thanks by sharing your findings.

And those findings can be structured in this manner.

Why did you conduct these interviews? Make sure the body of your reports

suggests why, first of all. Who did you interview?

By category, not necessarily by name. The names that you would like to thank

can be appended to the document at the end.

But by category, what kinds of people did you interview?

And over what period of time? Then what was the general focus of your

questions? Remember, the actual protocol, the

interview protocol, the questions you ask.

Can be appended to the document at the end, and should be.

But in the body of the text, you're going to talk in general terms about the types

of questions you asked. And the most important part is your

synthesis, your analysis. Finally, what themes emerged from your

conversation? And in describing those themes, be sure

to use un-, unattributed quotes. Attribution is always something that,

that, that will appear in the appendices to your, to your report.

But in the body of the text focus on your synthesis and your conclusions.

What are the action items that you draw from this entire proceeding?

At this point, I think you should have the elements that you will need to, to,

reach a prioritized list of needs. And at this point, you've got a short

list, a short list of three or four important needs that you want to

particularly focus on. As you, go forward in this week's video

lectures. Bob will be explaining other factors,

other criteria. Other tools and techniques for honing in,

zeroing in. On the need that you want to define most

clearly and address most energetically. Once again, and as always, I thank you

for listening and I can't wait to see what transpires in the discussion forums

as you begin to prioritize your long list of needs.

Thank you. Once again, bye for now.

Prioritizing Needs: Seeing the Full Cycle of Care Part B

Healthcare Innovation and Entrepreneurship

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