Assignment #2: Coding and Memoing on Project Data

Jonathan Lee Qualitative Methods Assignment #2 Subcritical test result follow-up focus groups Code: Subcritical definition This was the first code I created and I used it for any discussion of the definition of subcritical results. I used this quite often initially. However, after reviewing data from several transcripts I realized that it was too broad and did not capture finer points of the discussion. This led to the creation of multiple codes that were more specific to the data. Code: Differs by department This is used for excerpts discussing how the subcritical definition varies by whether the test department is laboratory or radiology. Code: People performed involved in defining This is used for excerpts discussing how those actually performing the tests (i.e., radiologists and laboratory personnel) should be involved in defining what constitutes subcritical results. Code: Time of follow-up This is used for excerpts discussing how the time frame of follow-up fits into the subcritical definition. Code: Clinical interpretation This is used for excerpts discussing how interpretation of the test result within the clinical scenario is necessary for results to be considered subcritical. Code: No uniform subcritical management system This is used for excerpts discussing either the lack of or variability in the systems currently in place for management of subcritical results. These more specific codes were used multiple times across the 5 focus group transcripts. Memo: There is no consensus subcritical definition or uniform management system and it may be difficult to define because of the need for clinical interpretation What struck me across multiple transcripts was how difficult it was for the participants to give a concise and clear definition of subcritical results. There was also disagreement about whether subcritical could even be defined because of the need for interpretation of the result within a clinical context. Within the larger context, this need for clinical interpretation would make the development of test management protocols for use by non-clinicians more difficult. Code: Dedicated non-MD tracker This is used for excerpts discussing the assignment of a non-physician provider (nurse practitioner or physician assistant) to be the individual primarily responsible for tracking and following up test results. Memo: Following up test results not clinical care? The concept of a non-physician provider being in charge of following-up results was brought up by participants in several focus groups and was in fact already in place in varying form at some sites. The idea of “outsourcing” follow-up to a non-physician running protocols seemed very attractive to the physicians in the focus groups. It raises the more general question of how physicians regard test follow-up in the hierarchy of their clinical duties. Do physicians not consider follow-up as important clinical work? Code: Rotating providers This is used for excerpts discussing the rotating schedule of providers as a barrier to communication of test results to the responsible provider. This was also brought up in several focus groups. Code: Team vs individual follow-up responsibility Code: Easier to contact clinic/team than individual These codes which likely can be combined refer to discussion of responsibility for test results using a team approach rather than individual responsibility. Code: Trusting others to follow-up This is used for excerpts discussing trust when handing off responsibility that the person given the responsibility will actually follow-up on the test results Memo: Clinical culture of responsibility We are all trained to be independent but also to work within systems (hence a core competency in residency being systems-based practice). However, relying solely on individual people is prone to error. Team-based approaches make sense in sharing responsibility. However, providers must be willing to share the responsibility and trust others. I think this is an important piece because in the larger sense this is also where healthcare as a whole is heading. Code: Assigning responsibility for results Code: Handoff responsibility Code: Difficulties identifying responsible person Code: Finding someone to take responsibility Code: Closed loop Code: Discussing follow-up responsibility Code: Responsibility based on time of follow-up Code: Responsibility contract based on test All of these codes refer to responsibility in some way, either assigning, trying to assign, handing off, discussing, or closing the loop of responsibility. I need to combine some of these together or all of them to simplify coding. Memo: The hot potato of responsibility/ownership There’s tension about who owns the results and who should follow-up. The person who initially owns the results is often not the person who eventually follows-up and there are steps in between to handing off this ownership/responsibility from the initial owner to the next person. It is often difficult to identify who this next person is, to actually speak to them or communicate in some way, and then to verify that they have accepted responsibility. Overall I think that I probably created too many codes especially given that there are only 5 focus groups. However, the number of codes is also likely related to the fact that while each focus group is homogeneous within the group (e.g., from the same department), they are heterogeneous compared to the other focus groups. So certain issues that come up in each focus group are specific to that focus group.