Table 3

Construct validity of High-Value Care Culture Survey and institutional differences

Scores on factors
0–100, 100=best
FactorsSample questions (Agree to Disagree Scale)Centre A
mean (SD)
Centre B mean (SD)p ValueVBP Score correlation (r)*
Leadership and health system messaging‘The majority of clinicians in my group consistently role model providing quality care at lower cost…’
‘The leadership in our group value efforts to deliver quality care at lower cost…’
57.5 (14.0)76.0 (12.2)<0.00010.57
Data transparency and access‘Clinicians in my group have access to information about the costs of tests and procedures they order or provide…’
‘When clinicians in my group have questions about costs, they know where to go to find answers…’
31.0 (20.1)37.9 (26.2)<0.00010.15
Comfort with cost conversations‘Clinicians in my group are uncomfortable discussing costs of tests or treatments with patients…’
‘Clinicians in my group feel that it is not the role of physicians to discuss costs of tests or treatments with patients…’
54.9 (19.4)53.5 (18.5)0.6050.04
Blame-free environment‘Individual clinicians get blamed for medical or surgical complications…’
‘In my group, clinicians' fear of legal repercussions affects how often they order unneeded tests or procedures…’
46.0 (23.3)63.4 (19.4)<0.00010.37
Overall HVCCS Score (average of four domains)47.3 (12.8)57.7 (11.5)<0.00010.39
  • *The correlation between the factor and VBP Scores were estimated at the respondent level.

  • HVCCS, High-Value Care Culture Survey; VBP, Value-based Purchasing.

  • Bold text indicates statistical significance at p Value < 0.05.