OMB Memo

Request: The Census Bureau plans to conduct additional research under the generic clearance for questionnaire pretesting research (OMB number 0607-0725). We will be conducting cognitive interviews for the new Management and Organizational Practices Survey– Hospitals (MOPS-HP).

Purpose: The Management and Organizational Practices Survey– Hospitals (MOPS-HP) was developed by external researchers with past experience in surveying hospitals on management practices. Many of the questions are adapted from the Census Bureau’s existing MOPS conducted in the manufacturing sector. Questions were also adapted from the World Management Survey (WMS). Implementation of the MOPS-HP has been discussed with the economic directorate as a supplement to the 2019 Services Annual Survey with mail out to hospital establishments in June, 2020. The current proposal is to have one electronic only instrument with separate forms for the hospital’s (1) chief financial officer and (2) clinical managers from the cardiac and surgical areas.

In the 2017 Economic Census, hospitals are asked three questions on performance monitoring, one dimension of management practices. Past research shows management practices are related to health care service providers' clinical and financial outcomes. This suggests providing measures on management practices may potentially help the U.S. health care system that is challenged by rising health care costs, increased demand from an aging society, and quality objectives. These data would permit users to examine relationships between management practices and financial outcomes using Census data (e.g., revenues). By accessing external data on clinical performance from either public-use sources (e.g., Medicare Compare) or obtaining access to restricted-use claims data, users can also use these new data on management practices to study their relationship with clinical outcomes. Content that will be tested for general medical and surgical hospitals (NAICS 6221) would include performance monitoring, financial and clinical targets, incentives, use of standards and protocols, management of team interactions, staffing and allocation of human resources to problems, and documentation/coding. The proposed questions are attached.

Staff from the Data Collection Methodology & Research Branch within the Economic Statistical Methods Division (ESMD) of the Census Bureau will be conducting cognitive interviews regarding this testing, with support from staff from the Center for Economic Studies (CES), the Office of the Associate Director for Economic Programs (ADEP), and the Economy-wide Statistics Division (EWD). For this testing, we will interview up to 40 respondents in two separate rounds. The 40 respondents will be divided between chief financial officers, or others who can speak on their behalf, and clinical managers.

Method:

The method of research will be cognitive interviews, which are interviews aimed at understanding the way that a person interprets the items that are being presented to them, in order to understand and reduce potential measurement error before these questions are included in the survey. We will be discussing the response process associated with gathering this information for the two reference years being requested. Additionally, we will be investigating the appropriate respondent indenting to inform data collection strategies.

These interviews will take place in-person at participants’ places of business or another location of their choosing. The interviews will follow a semi-structured interview protocol. A separate protocol has been developed for the clinical managers (Attachment A) and CFO questions (Attachment B).

Subject area specialists from the Census Bureau will participate in most, if not all, of the cognitive interviews. Where feasible, the outside sponsor supporting this research will also be present for interviews. Their primary purpose will be for observation, but they may also assist in cases where additional clarification of the subject matter is required, and to provide information on the purpose and uses of the survey. Cognitive interviews will be audio recorded with the participants’ permission, to aid researchers in accurately summarizing key findings from the interviews.

Sample Population:

Staff from EWD will provide DCMRB staff with a list of hospitals and respondent contact information from the most recent Services Annual Survey and/or the 2012 Economic Census, from which we will recruit. We will supplement this list with research from the internet in order to identify the appropriate clinical managers, if possible.

Approximately 40 interviews will be conducted in total, with approximately 20 interviews in each of the two rounds. This number of interviews was selected because it is a manageable number of interviews for the time period allotted, and should be large enough to provide reactions to the questions and definitions that are representative of the survey population.

Forty interviews will allow us to cover four different cities in a cost-effective manner for testing. The first round of testing will include the Boston, MA and Washington, DC areas. The locations for the second round of testing will be determined based on results from the first round of testing.

Sample recruitment:

We will contact potential participants via phone, explain the nature of our research, and ask them to participate in our study. The sample of participants will be those who are able to be contacted and who agree to participate in the study. Efforts will be made to sample respondents who are chief financial officers and clinical managers that are either top or mid-level managers.

Participants will be informed that their response is voluntary and that the information they provide is confidential and will be seen only by Census Bureau employees or those with Special Sworn Status who are involved in the research project. We will not be providing monetary incentives to participants in this study. Once interviews are scheduled, researchers will send respondents a confirmation via email, and may conduct reminder calls a few days before the meetings.

Timeline:

Recruiting for these interviews will begin as early as June 2018, for interviews that will be conducted during July and August 2018.

We anticipate that each interview will include one or two participants, for an average of 1.5 participants. We estimate that, on average, the interviews will take one hour. Thus, the total estimated burden for completed interviews is 60 hours (40 interviews X 1.5 participants X 1 hour).

Our goal is to schedule up 40 interviews. We anticipate that to reach 40 potentially interested persons, we may need to conduct 120 total calls lasting approximately 5 minutes; therefore, we anticipate up to 80 refusals or non-responses. The anticipated maximum burden for a refusal or a non-response is two minutes. As such, we estimate the maximum associated recruiting burden to be approximately 7.33 hours (40 screening calls x 5 minutes = 200 minutes; 120 refusals/nonresponses x 2 minutes = 240 minutes; 200 + 240 minutes = 7.33 hours). Thus, the estimated total public reporting burden for this research is approximately 67.33 hours.

Language:

Testing will be conducted in English only.

Enclosed are the draft questions, and the protocol that we will be using for the cognitive interviews.

The contact person for questions regarding data collection and statistical aspects of the design of this research is listed below:

Amy Anderson Riemer

Data Collection Methodology & Research Branch

Economic Statistical Methods Division (ESMD)

U.S. Census Bureau

Washington, D.C. 20233

(301) 763-7544

Amy.E.Anderson.Riemer@census.gov

cc:
Nick Orsini (DIR)        “          ”
Carol Caldwell             (ESMD)    “          ”
Diane Willimack             (ESMD)     “          ”
Amy Anderson Riemer  (ESMD)     “          ”

Carma Hogue (ESMD) “ ”

Kenneth Herrell (ESMD) “ “

Alice Zawacki (CES) “ “

Scott Ohlmacher (CES) “ “

Danielle Norman (PCO) “ ”

Mary Lenaiyasa (PCO) “ “

Jennifer Hunter Childs (ADRM) “ “

Jasmine Luck (ADRM) ” “

Catherine Buffington (ADEP) “ “

Andrew Baer (EWD) “ “

Kimberly Moore (EWD) “ “