SFF Final Survey SFF Final Survey Practice/Site Name Name of Individual Completing Survey Role of Individual Completing Survey Confidence Please rate your current confidence in your knowledge and skills in the following areas (Scale of: 1 -not at all confident; 2 - somewhat confident; 3 - confident; 4 - very confident; 0 - N/A) Forming a QI team 0 1 2 3 4 Crafting an aim statement 0 1 2 3 4 Developing PDSA cycles 0 1 2 3 4 Scaling up PDSA cycle learning 0 1 2 3 4 Process Mapping (Office workflow) 0 1 2 3 4 Interpreting run charts 0 1 2 3 4 Using data to drive improvement 0 1 2 3 4 Reporting on practice improvement efforts and outcomes 0 1 2 3 4 Frequency Please rate the degree to which your practice now does the following items (Scale of 1 - Never, 2 - Rarely, 3 - Sometimes, 4 - Most of the Time, 5 - Always, 0 - N/A): Screen for smoke exposure for infants 0-1 at all well visits 0 1 2 3 4 5 Assess smoker’s willingness to quit 0 1 2 3 4 5 Provide resources to support smoke free homes 0 1 2 3 4 5 Document providing screening and interventions for smoking family members 0 1 2 3 4 5 Make referrals to the Ohio Quit Line 0 1 2 3 4 5 Have conversations with families about smoking and reducing smoke exposure for children 0 1 2 3 4 5 Screen and discuss safe sleep habits 0 1 2 3 4 5 Do you feel the changes made as a result of the SFF project improved efficiency related to identifying smoke exposure and made discussions with families more efficient (reduced waste, avoided duplication, made things run smoother)? (Select one) Yes No Unsure Please elaborate on changes in efficiency in your practice Do you plan to sustain any changes in practice made as a result of the Smoke Free Families project following the end of the Learning Collaborative? (Select one) Yes No Unsure What changes will be sustained (select all that apply): Continue to identify families with in home smoke exposure Continue using the screening tool in its entirety Continue using some questions from the screening in our EMR Continue using some questions from the screening verbally or on paper Continue having discussions about smoke exposure when identified Continue using the 5 As to discuss smoking cessation Continue using handouts/materials with families when smoke exposure is identified Continued sending referrals to the Ohio Quit Line OtherOther How often do you expect to use the changes made in the practice (select all that apply): Daily Weekly Occasionally (about monthly) Infrequently (about quarterly) OtherOther What has your team done to ensure that the changes made from the SFF project have been sustained? Why does your practice plan to stop any changes made during the SFF project (select all that apply): Families complained about repeat surveys Screening tool took too long to complete It was too difficult to incorporate changes into EMR Information was not appropriate for our patient population Only participated for the MOC Part IV credit Project champion at practice left or changed focus area Other topics or QI projects took priority OtherOther Are there any resources that could help sustain changes made during the SFF project? How did COVID-19 impact this program’s implementation – did you test any new strategies, pause the program, or have other lessons learned? What was the most helpful part of this project for improving your practice? Screening tools Resources/handouts Increased knowledge/education Networking OtherOther How helpful were the monthly action period calls in implementing the SFF project? Not helpful Somewhat helpful Helpful Extremely helpful Which components of the monthly action period calls were most helpful? Clinical topics Quality improvement topics Data feedback Practice sharing OtherOther What most motivated your practice to join the SFF project? What, if any, feedback did families provide on their experiences with this project? Did this project change the way you address smoking/vaping with other patient populations? (If so, how?) Would you recommend the SFF Project to other practice sites or colleagues? Yes No Unsure Would your practice be interested in participating or receiving information on Wave 4? Yes No Unsure What have you learned most about improvement that you believe other teams should know when they start their improvement work? What suggestions would you make to improve the SFF project for future waves? What additional resources would you have liked at the start of the project? Do you have any other comments you would like to share? Submit If you are human, leave this field blank.
