The development and validation of a scale to explore staff experience of governance of economic efficiency and quality (GOV-EQ) of health care

Abstract

BackgroundIn publicly funded health care systems, governance models are developed to push public service providers to use tax payers’ money more efficiently and maintain a high quality of service. Although this implies change in staff behaviors, evaluation studies commonly focus on organizational outputs. Unintended consequences for staff have been observed in case studies, but theoretical and methodological development is necessary to enable studies of staff experience in larger populations across various settings. The aim of the study is to develop a self-assessment scale of staff experience of the governance of economic efficiency and quality of health care and to assess its psychometric properties.MethodsFactors relevant to staff members’ experience of economic efficiency and quality requirements of health care were identified in the literature and through interviews with practitioners, and then compared to a theoretical model of behavior change. Relevant experiences were developed into sub-factors and items. The scale was tested in collaboration with the Department of Rehabilitation Medicine at a university hospital. 93 staff members participated. The scale’s psychometric properties were assessed using exploratory factor analysis, analysis of internal consistency and criterion-related validity.ResultsThe analysis revealed an eight factor structure (including sub-factors knowledge and awareness, opportunity to influence, motivation, impact on professional autonomy and organizational alignment), and items showed strong factor loadings and high internal consistency within sub-factors. Sub-factors were interrelated and contributed to the prediction of impact on clinical behavior (criterion).ConclusionsThe scale clearly distinguishes between various experiences regarding economic efficiency and quality requirements among health care staff, and shows satisfactory psychometric quality. The scale has broad applications for research and practice, as it serves as a tool for capturing staff members’ perspectives when evaluating and improving health care governance. The scale could also be useful for understanding the underlying processes of changes in provider performance and for adapting management strategies to engage staff in driving change that contributes to increased economic efficiency and quality, for the benefit of health care systems, patients and staff.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3765-7) contains supplementary material, which is available to authorized users.

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“…Second, with the retained items there was an a priori theoretical structure reflecting a two-factor model (S-R generation, and C-M change). Indeed, it is important to apply qualitative judgement to evaluate factor appropriateness in relation to the intended factor structure (e.g., Korlén et al, 2018) and to be guided by theory to Psychotherapy Research 5 provide the results that make the most sense (Osborne, 2014). We wanted to pragmatically arrive at a final set of items that clearly assess theoretically derived emotion beliefs.…”

A Systematic Review: The Dimensions utilized in the Performance Evaluation of Healthcare- An Implication during the COVID-19 Pandemic

“…As a result, the hospital converted 11 million American dollar losses into four million profits after four years of implementation [25]. Since then, BSC has gained increasing attention, and many HCO in high-income countries and low-and middle-income countries have strategically utilized BSC to develop their organizations [28][29][30][31][32].…”

“…Another review [28] revealed that there had been a lack of engaging stakeholders in BSC implementations, such as engaging patients and HCWs. However, researchers have pointed to the importance of patient and HCW engagement in the process of PE and delivery improvement [29][30][31]. The rest of the BSC reviews [28,[32][33][34][35][36][37][38][39][40][41][42] focused only on the general narration of the BSC perspectives and subdimensions used.…”

Exploring staff experience of economic efficiency requirements in health care: A mixed method study

“…A single item measuring impact of economic considerations on clinical behavior is also included. Items are rated on a 5‐point Likert scale showing satisfactory psychometric properties . Definitions of subfactors and sample items are described further in the result section.…”

“…Items are rated on a 5-point Likert scale showing satisfactory psychometric properties. 27 Definitions of subfactors and sample items are described further in the result section.…”