The four communities are Detroit, Memphis, Minneapolis-St. Paul, and Seattle.
In each community, two of the larger hospitals were judgmentally selected to conduct interviews, for a total of eight hospitals.
To provide a range of perspectives, we interviewed the leadership in each hospital, including the chief executive officer, the chief nursing officer, and the director of quality improvement.
We also interviewed respondents representing key national- and state-level accreditation and quality improvement programs to obtain additional insights and perspectives on the issues.
The findings are based on semi-structured phone interviews conducted by two-person interview teams between February and August 2007 with approximately 30 respondents.
We used Atlas.ti, a qualitative software package, to analyze the interview data.