The QII Approach

Intercept Interviews in Extreme Situations

Date: September 20, Katy Carew

KNow Research refines our qualitative intercept interview (QII) approach current intercept interview research methodology to meet the ever-changing needs of our clients. Our goal was not to mimic mall intercepts but to provide another option, a qualitative conversation, had in situ. These interviews last anywhere from 5-20 minutes (depending on the client’s goals and the amount of the gift card incentive!). They take place anywhere we can get permission to be: clients’ stores, pop-up storefronts, malls, farmer’s markets, festivals, etc. They cover a range of topics and usually include some close-ended and some open-ended questions, all discussed with participants by a qualitative moderator. Participants enjoy the chance to participate in a research study immediately, not having to book an appointment or go to another location or be taken through endless screening questions. They are often surprised it is so easy and proud that they have given their feedback to a brand, product or idea that plays a role in their lives.

Authentic Participant Target

When conducting intercept interviews, we recruit participants directly from the point of service we are trying to understand their experience with. This means we can have complete confidence that we are speaking directly to qualified and authentic customers. Intercept Interviews are extremely useful when trying to understand a participant experience with a good or service. It is a valuable methodological tool in trying to understand how someone feels after shopping in your store, browsing merchandise, using facilities, and/or interacting with staff. Since participants are unaware they will be asked about their experience in an interview, their experience is experienced in an unbiased way. This means when you speak to them, they are less likely to be influenced by the interviewing process.

Incentives

Since the whole world is not in a rush, one of the most difficult parts of conducting these interviews is getting participants to give you their time. This is when an appropriately sized incentive can be very useful. An appropriate incentive amount is different for every population and with every ask. It is important to consider; the income level of the population, the price of items at the point of service, they type of service being offered, the pace of the type of service being offered, the time of day, the subgroups of the population, the type and depth of the information you need to collect and the amount of time you will need from them. When your incentive is to low, it is very hard to get people to speak to you when your incentive is too high, you will have people lining up to speak to you.

Criteria and Quotas

Intercepting participants randomly gives us a higher probability of a representatively accurate frame of the population. However, at times we do have specific criteria in mind (e.g. non-purchasers) when trying to understand a subset of the population and their needs/unmet needs. We know that criteria need to be more of a guide than a quota and that the number of completes needs to be a range rather than an absolute in all intercept interview environment. However, our latest foray into intercept interviewing landed us in the emergency room to interview patients receiving care there and taught us about an entirely new level of difficult interviewing situations!

In our attempts to collect the most insightful data for its clients no matter what, we have occasionally landed in extreme interviewing situations and locations!

Case Study

Our annual pro bono project this year focused on optimal use of the emergency room on behalf of John Muir Health. We conducted a series of key stakeholder interviews, followed by patient interviews and intercepts to paint the full picture of why lower acuity patients choose to visit the ER over other care choices, what patient groups are the most frequent users of the ER in these circumstances and what some options might be to help them find more appropriate care options. It was an illuminating experience; especially putting our Qualitative Intercept Interviews (QIIs) to the test by intercepting patients in the ER!

The Methodology: 2-Phrase Approach

  • 1. Phase 1: Interviews with Key Informants who work on the front lines in the ED
  • 2. Phase 2: Interviews with 2 patient sub-groups: 
    • Group 1: Patients who are considered high utilizers. High utilizers are patients who have come into the ED more than 6 times in 6 months for the care of a chronic condition that is not being cared for outside of the ED 
    • Group 2: Are patients who have come into the ED with low acuity conditions / non-emergent conditions (such as UTI’s, skin conditions, and sprained ankles)

Participant Sources

Our clients graciously gave us access to a list of participants for both the key informant Interviews (KII’s) and Group 1 the high utilizers. However, we were unable to identify patients to speak to regarding low acuity issues coming into the ED. We developed a new and innovative way to identify and interview low acuity patients, we decided this was a perfect opportunity to use intercept interviews.

Intercepts in the ED

Our intercepts interviews were completed in the Rapid Medical Evaluation (RME) area of the ED. The RME was created specifically to treat low acuity patients who come into the ED with non-emergent / non-urgent conditions. It was a rich source of patient feedback; however, we encountered a few key hurdles to navigate in order to receive the proper permission to conduct interviews.

Our Process

  • We contacted the Compliance Officer at the hospital to make sure we are following HIPPA guidelines and protecting patient privacy.
  • The Compliance Officer approved out research plan and gave us a script to work off of.
  • The script included making sure the patient understood ‘they had a choice to participate in the research,’ the goal of the research (understanding patient experience and access to care), and lastly the amount given for the incentive.
  • As researchers, we were not allowed to interact with the patient until the patient had agreed to participate. This meant we worked in collaboration with a staff nurse who asked the patient if they wanted to participate based off of the script.
  • We then had to get permission from the Direct of the ED to be in the emergency room. The Director of Emergency Services was concerned we would impede patient care and also interfere with ER stats that are measured every day to quantify performance. To avoid this, we waited behind the nurses’ station and only spoke to patients once they had agreed to participate and been discharged.

Once the patient had opted in with the nurse, they signed the participant agreement and asked them not to share any personally identifiable information.

Key Considerations: Time Management, Participate Rates & Empathetic Listening

  • Time Management: Since different populations use the ED at different times, it was important to stager our research times over the course of the week. The majority of the interviews were intercepted between 6 pm and 11 pm, (the ED’s busiest times). 
  • Participation Rate: We had a 50% participation rate, meaning for every 2 patients asked, 1 agreed to participate. Completing intercepts in the ED is a longer process than in other environments due to the slower cadence of traffic entering and leaving the ED. We were able to complete 1 30-minute interview roughly every 1.5 – 2 hours. 

Empathy: We tapped into our empathic compassion resources and really listened to all points of view in and around the hospital and worked with the client team to discuss what solutions are currently working and what might be considered in the future.

Learnings

We learned much from the complex and challenging nature of completing intercepts in the ED. We were able to successfully hit our intercept quota; the patients found the interviewing process a painless and welcomed opportunity to share their feedback.

The feedback we received from the interviews has been extremely valuable to our hospital client as well. While the hospital had a sense of what was happening in its ED and the motives and experience its patients are having. Intercept interviews were a valuable tool that elicited actionable learnings that would not have been understood had we not spoken to the patients in situ. This research allowed the hospital to gain insights that will shape how their approaches to patient care in the future.

Tips for conducting interviews in extreme situations

Get help from the staff; ask them to send potential candidates your way. This is invaluable and saves you time and hassle (participants are more likely to trust an employee than a researcher they don’t know.) These participants are in a difficult situation and completing an interview is the last thing on their mind. Honor that personal situation with a generous incentive. You will hear a lot of “no’s” in this situation. People have their own reasons for not wanting to participate, everything from protecting their privacy, to lack of trust, to lack of time or interest. It is important in extreme situations to expect even more of this refusal and to acknowledge that they have even more reasons than usual to not be able or interested in completing an interview. Be prepared to camp out where ever you are, especially in these unpredictable environments! Come prepared with food, water, charging sources and comfortable shoes to stay there all day. This type of research requires you to be fully present and ready to jump into an interview for hours at a time. However, pack light! You don’t want to be standing in a location for hours caring heavy things, and you don’t want to set down your bag full of incentives in a location where it could be lost or stolen. In general, I only care a handful of incentives at a time and leave the rest in a secure location. Be aware of your surroundings, some neighborhoods are better than others. Your safety is more important than the research, again, when walking around with a client’s incentives, it is important to be aware.

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