Using Interviews and Videotaping to Fuel Quality Improvement
An Interview with Stephen Raab, MD
There are many ways of assessing the need for quality improvement (QI) in the lab. This interview with Stephen Raab, MD, focuses on videotaping work and interviews with staff as sources of information that can fuel QI. Dr. Raab, who described latent errors in the lab in the April 2009 issue of Patient Safety Focus, is a nationally recognized expert in patient safety, including the application of Lean to pathology services. He is professor of pathology, vice chair of quality, and director of anatomic pathology at the University of Colorado, Denver.
Michael Astion, MD, PhD, conducted this interview.
Videotaping staff members performing their regular work
can help uncover lab processes that are good targets for quality improvement.
Q: How do you use videos to inform QI?
A: We take video of staff members performing their regular work, such as accessioning, transporting, or prepping a specimen for gross anatomic pathology. We then review the videotapes to find places where processes can be improved.
Q: Why is this better than having supervisors observing staff performing work?
A: Videotaping is a supplement to direct observation. It allows for more people to review the work. This can include the workers themselves as well as “outside” eyes, usually other lab staff with insight into QI who don’t normally observe these workers.
Q: Do lab staff object to being videotaped?
A: It varies from person to person. At first there tends to be resistance; however, most of the objections are overcome by letting staff know that the videotapes will be used to fuel QI and that they will not be used punitively. In addition, we let staff know the information will be used internally and will not be published.
Q: Do some staff members like to be videotaped?
A: Yes, some lab workers like to be on camera, especially if they feel overworked. They perceive that videotaping is a way to demonstrate problems in the workplace.
Q: What are some of the positives that have come out of videotaping work processes?
A: Overall, the thoughtful review of videotapes has helped us answer the question: “How could we perform this procedure better?” It has also helped us determine what parts of a procedure are error-prone and find places in a procedure where we can put in safety checks to detect errors. The lab staff can then correct many of the errors with no adverse impact on patients.
Q: Do you take videos after a procedure is improved?
A: Yes. It is important to take both pre- and post-improvement videos. Post-improvement videos are good because they demonstrate that a procedure has become much safer. This is good for both patients and staff morale.
Q: What methods work best for interviewing?
A: We have found that it is best to use a professional interviewer who asks open-ended questions. We only interview staff who consent to be interviewed. We also let staff know that they will remain anonymous and that the information will not be used punitively. This encourages openness and honesty.
Q: Why are interviews useful as a needs assessment method for guiding QI?
A: Interviews can get at issues that strongly impact the ability to perform QI, but not revealed by direct observation, videotaping work processes, or traditional QI activities like incident reporting. For example, when we analyze interviews we assess attitudes and feelings about patient safety, including feelings about teamwork, feelings about overwork, and fears related to making errors. This helps guide the continuing education of staff and also helps guide our approach to implementing patient safety interventions. Interventions are easier to implement if you understand the work culture in which the interventions are being implemented.
Disconnection from patients and care providers: A latent error in pathology and laboratory medicine. Clin Lab News 2009;35(4):14. Also available online.