In this video, we will review a case study, where we conducted quality improvement projects to improve family engagement in Family- Centered Rounds. Our focus will be the use of a qualitative data and quantitative data at different stages of this redesign process. For other details of the projects, please read our case study published in The Journal of Economics. Family- Centered rounds are multidisciplinary rounds conducted at the bedside. The objective of family-centered rounds is to improve patient safety by engaging patients and families in daily discussion of the care, and clinical decision making. According to a study, family-centered rounds has been adopted as a standard practice by 44% of pediatric hospital in the US. And our project was conducted on two inpatient services at a Children's Hospital in the mid western U.S. Family-centered rounds has been implemented in this hospital for several years. But what is unclear, is to what extent families are actually engaged in the rounding process. So that's why we conduct these projects to improve family engagement in family-centered rounds. And our quality improvement team consists of representatives of different groups of stakeholders that are directly engaged, or indirectly engaged in the rounding session, including patient families, the different groups of physicians, bedside nurse and nurse managers. We start the quality improvement project with an initial analysis of the current rounding process. We took video recordings of the rounding process, and use it to establish coding scheme to quantitatively code the video data, to assess family engagement. And based on the coding scheme, family engagement was divided into four elements, relationship building, information giving, information gathering and decision making. In addition to the video recordings, we also conduct field observations of the rounding process, and took qualitative notes to describe the rounding process. And based on the observation data, we create this process map of the rounding process. Informed by the quantitative video data and the qualitative observation data, we move to the next phase, collaborative design. We start with what we call stimulated recall interviews with different groups of stakeholders, to identify strategies for engaging families in the rounding process. During this stimulated recall interviews, we ask the participants to review the videos of the rounding process that we took, and talk about what went well, and what could be improved, And based on the interview data, we identified a total of 21 categories of strategies. Seven categories are related to work system, and 14 categories are related to the rounding process. Based on the interviews data we collect, we develop two surveys to assess the impact and feasibility of identify strategies. And the quality improvement team review the survey data and finally decide to develop a family center round checklist, family preference system to engage families in the rounding process. During the intervention implementation phase, we pilot test intervention on both services, and we collect additional observation and interview data to revise the intervention and its implementation, and this is the final version of the family center round checklist. The last phase is evaluation, during which we assess the impact of the intervention on three things. First, the use of the family-centered round checklist, second, family engagement in family centered round and parent perceptions of the children's hospitals safety culture. To assess the use of family-centered round checklist, we conduct additional observations of more than 250 rounding processes. The differences between this observation, and the observations we conducted during the analysis phases, this time we use a semi-structured observation form to guide observation, and we collect quantitative data to assess clinicians compliance with tasks on the checklist. In addition to the observations, we also collect interview data with a small group of clinicians who use the checklist to collect feedback. To assess the impact of the intervention on family engagement in family centered round, again we took video recordings of post implementation rounding process, and used the same coding scheme to assess family engagement, and we compare the pre and post implementation data. To assess the impact of the intervention on family perceptions of the hospital's safety climate, we use the quantitative data collected by the hospital safety climate surveys. This is a summary of how we use qualitative data and quantitative data in different phases of the project. During the analysis phase, we use a convergent parallel design, and collect both quantitative and qualitative data to understand the current rounding process. And during the design phase, we use a sequential explanatory design, and first collect qualitative interview data to identify strategies for engaging families, and then collect quantitative survey data to prioritize those strategies. And during the implementation stage, we collect additional quantitative and qualitative data to revise the intervention and its implementation. And during the evaluation phase, again we use a convergent parallel design to collect both quantitative data and qualitative data on the impact of the intervention.
