RT Journal Article
SR Electronic
T1 Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 493
OP 502
DO 10.1136/bmjqs-2020-012407
VO 31
IS 7
A1 Joann Sorra
A1 Katarzyna Zebrak
A1 Naomi Yount
A1 Theresa Famolaro
A1 Laura Gray
A1 Martha Franklin
A1 Scott Allan Smith
A1 Suzanne Streagle
YR 2022
UL http://qualitysafety.bmj.com/content/31/7/493.abstract
AB Background Given rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of our study was to develop survey items to assess clinician and staff perspectives about the extent to which the organisational culture in hospitals and medical offices supports value and efficiency.Methods Development began with a literature review and interviews with experts and clinicians and staff from hospitals and medical offices. We identified key areas of value and efficiency culture, drafted survey items and conducted cognitive testing. Using purposive sampling to select sites, the 36-item surveys were pilot tested in 47 hospitals and 96 medical offices. Psychometric analysis was conducted on data from 3951 hospital respondents (42% response) and 1458 medical office respondents (63% response).Results Factor loadings, multilevel confirmatory factor analysis model fit and reliability estimates were acceptable for the 13 items grouped into 4 composite measures: Empowerment to Improve Efficiency (3 items), Efficiency and Waste Reduction (3 items), Patient Centeredness and Efficiency (3 items) and Management Support for Improving Efficiency and Reducing Waste (4 items). All composite measures were significantly intercorrelated and related to the four Overall Ratings of Healthcare Quality, indicating adequate conceptual convergence among the measures. Eight items assessing Experiences With Activities to Improve Efficiency were also included.Conclusion We developed psychometrically sound survey items measuring value and efficiency culture. When added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets extend those surveys by assessing additional dimensions of organisational culture that affect care delivery. Healthcare organisations can use these item sets to assess how well their organisational culture supports value and efficiency and identify areas for improvement.All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study and available are included in the article or uploaded as supplementary information.