One Pager Justification

Request for Approval under the “Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery” (OMB Control Number: 0704-0553)

TITLE OF INFORMATION COLLECTION: Patient Experience Informal Interviews

PURPOSE: The Defense Health Agency (DHA) Patient Experience Branch is seeking to better understand patience experience throughout their journey of care at military medical treatment facilities (MTFs). The goal of conduced information patient interviews is to “walk the gemba” as impartial and unexpecting patients visit the MTF, soliciting feedback in real time at specific physical locations and phases of care, expanding reach of experience capture into factors supporting or auxiliary to the care experience – facility attributes, convenience, accessibility, design, atmosphere, etc.

The interview question guide has a list of possible categories and questions to ask patients depending on where the interaction will occur (for example, a patient waiting at the laboratory may be asked ancillary service questions specific for their experience with the lab). The guide provides leading questions for the interviewer to use, but the interviewer will ultimately allow the customer/patient to direct the feedback and perceptions they want to share regarding their journey with the health care system. The purpose is to receive real patient insights and perspectives at different points of the journey.

Interviewers will be personnel from the DHA Health Care Operations Patient Experience Branch who are Patient Experience SMEs and Champions.

Phases of the patient experience include:

1. Overall Experience

2. Entry to MTF

3. Primary Care (PC) Clinic Experience

4. Ancillary Services Experience

5. Specialty Clinic Experience

It is intended that each patient interview will be no more than 10 minutes with no more than 5 questions asked per interview/patient.

DESCRIPTION OF RESPONDENTS: Beneficiaries/patients at five different MTFs designated as DHA venture sites. Each site has varying demographics that will allow us to capture diverse perspectives and points in the patient journey.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [X] Other: Interviews

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: GABRIELLE A. CRANE, CDR, NC, USN

Chief, Patient Experience Branch

Health Care Administration/Health Care Operations/Healthcare Optimization Division

Defense Health Agency

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Beneficiaries	75	10 minutes	12.5 hours
TOTAL	75	10 minutes	12.5 hours

PUBLIC COST: The estimated annual cost to the public is $394.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [X] No

The informal interviews will occur in-person. Patients will be selected randomly at the MTF and asked if they would like to participate in a short interview about their experience.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

4