DDHA 8303 Week 9 Ethics Protocol Example

An Invitation From Inside the Organization: An Ethics Protocol for Interviewing and Surveying Remote and Onsite Coders Whose Accuracy Their Employer Already Audits

Student Name

Walden University

DDHA 8303: Research Methods for Healthcare Administrators

Instructor Name

Month Day, Year

An Invitation From Inside the Organization: An Ethics Protocol for Interviewing and Surveying Remote and Onsite Coders Whose Accuracy Their Employer Already Audits

Study Summary

This study asks whether inpatient coders at Halvorsen Health became more or less accurate after many of them began working from home in 2024, and how coders describe the way they handle difficult coding decisions. It has three parts. The first uses coding audit records the health system already keeps. The second is a nine-item survey about how coders feel about their work, which takes about two minutes. The third is a 45-minute interview with up to sixteen coders about how they decide what to code when a record is unclear. Taking part in the survey or the interview is voluntary. Choosing not to take part will not affect anyone's job, pay, schedule or work arrangement.

Participants and Setting

Participants are inpatient coders employed by Halvorsen Health, a five-hospital system, between January 2023 and December 2025. The audit records cover all 78 people who held the inpatient coder job code in that period, including fourteen who have left. The survey will be offered to about 64 current coders, and interviews to up to sixteen of them, selected as described in the sampling plan.

Risks

Physical risk is negligible. The real risks are professional and social, and the protocol names them plainly.

The first is that information gathered for research could be used to judge individual coders. Audit records already exist and are used by managers, but linking them to a coder's survey answers or interview comments would create new information about that coder, such as an admission that they guess on difficult records, that a manager could misuse. The second is that a coder could be identified from a report even without a name. Halvorsen's smallest hospital employed only three inpatient coders at the start of the period, so a result reported for that hospital would point to specific people. The third is discomfort: some coders may find it stressful to discuss errors, particularly if their audit scores have been low. Bell and Bryman (2007), in a review of the ethics codes used by management researchers, found that avoiding harm to participants, including harm to their careers, was among the principles the codes stressed most, and this protocol treats career harm as the main risk.

Consent as a Process

Consent is treated as a process with several stages, not a single signature.

The invitation reaches coders from the system's research office, not from the director of health information management or any coding supervisor. The research office sends the invitation text shown in Appendix A to each coder's work email, and coders reply only to the research office. Managers are not told who was invited, who replied or who declined.

Coders who reply receive the information sheet in Appendix B at least three days before any interview, so they have time to read it and ask questions without pressure. At the start of each interview, a member of the research team, who has no role in coding management, reviews the information sheet with the coder and asks whether they agree to continue. Survey consent is given on the first screen of the online survey, which repeats that answers are voluntary and cannot be seen by managers.

For the audit records, the study will ask the review board to waive individual consent. The records already exist, the research use poses minimal risk once they are de-identified, contacting every former coder would be impracticable and the waiver would not affect participants' rights or welfare. Current coders will be told in the invitation that their de-identified audit records are being used.

Withdrawal

Coders may stop an interview at any time and may withdraw their interview within thirty days afterward, in which case the recording and transcript will be destroyed. After thirty days, interview data will have been coded and combined with other interviews, and the information sheet says plainly that withdrawal after that point removes the coder's quotations from any report but cannot remove what their interview contributed to the analysis. Survey responses are anonymous once submitted and cannot be withdrawn, which the survey's first screen states. These limits are explained before participation rather than discovered afterward.

Confidentiality

All data will be stored on the research office's secure server, separate from the human resources and coding systems. Audit records will arrive with each name swapped for a study number, and only one research office analyst, with no role in coding or human resources, will hold the list matching numbers to employees.

Wiles et al. (2008) describe how researchers working within small communities must think about identification by insiders, not only by outsiders, because colleagues can often recognize one another from details a stranger would miss. For this study, the insiders are coding managers and other coders. Results will therefore be reported by move wave and by arrangement, never by hospital. No group smaller than five people will be reported. Interview quotations will be checked for details, such as a distinctive phrase or a reference to a particular physician, that a colleague could recognize, and these will be removed or altered. Recordings will be destroyed after transcription and checking.

The Employer Relationship

This section addresses the central ethical problem directly. The employer funds the study, owns the audit data and decides whether coders keep working from home. Coders may reasonably fear that the study is a step toward bringing them back, and that what they say could be used against them.

The protocol makes four commitments. First, no individual-level data from this study, including whether a coder took part, will be shared with Halvorsen managers. Second, the research office has a written agreement with the health information management department that study data will not be used for performance management. Third, the report will present findings about groups, and will say so in its first paragraph, so that no reader can interpret it as an assessment of individuals. Fourth, the information sheet tells coders that the study's results may inform decisions about remote work, because pretending otherwise would be misleading. The Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979) grounds respect for persons partly in giving people the information they need to decide freely, and coders cannot decide freely without knowing what the study could lead to.

Benefits

Coders receive no direct benefit. The study may help Halvorsen make its decision about remote coding from evidence rather than impression, which could benefit coders in both groups.

Appendices

Appendix A contains the invitation text sent by the research office. Appendix B contains the information sheet for the interviews and survey, including the withdrawal limits and the four commitments above. Both are referenced here rather than summarized, and the review board is asked to read them as part of the protocol.

References

Bell, E., & Bryman, A. (2007). The ethics of management research: An exploratory content analysis. British Journal of Management, 18(1), 63-77. https://doi.org/10.1111/j.1467-8551.2006.00487.x

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health, Education, and Welfare. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html

Wiles, R., Crow, G., Heath, S., & Charles, V. (2008). The management of confidentiality and anonymity in social research. International Journal of Social Research Methodology, 11(5), 417-428. https://doi.org/10.1080/13645570701622231