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BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Sara Korlén, Anne Richter, Isis Amer-Wåhlin, Peter Lindgren, Ulrica von Thiele Schwarz

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

In 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.

Methods

Factors 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.

Results

The 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).

Conclusions

The 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.
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Literature
1.
OECD. Fiscal sustainability of health systems: OECD; 2015.
2.
Greer S, Wismar M. Figueras J. Better Policies, Stronger Performance. The European Observatory on Health Systems and Policies: Strengthening Health System Governance; 2016.
3.
Saltman RB, Durán A, Dubois HF. Governing public hospitals. Reform strategies and the movement towards institutional autonomy. The European Observatory on Health Systems and Policies; 2011.
4.
Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27(3):759–69.
5.
Smith PC, Anell A, Busse R, Crivelli L, Healy J, Lindahl AK, et al. Leadership and governance in seven developed health systems. Health Policy. 2012;106(1):37–49.PubMedCrossRef
6.
Conrad D, Perry L. Quality-based financial incentives in health care: can we improve quality by paying for it? Annu Rev Public Health. 2009;30:357–71.PubMedCrossRef
7.
Roland M, Olesen F. Can pay for performance improve the quality of primary care? BMJ. 2016;354.
8.
Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database of Systematic Reviews; 2011. Contract No.: Issue 7 Art. No: CD009255.
9.
Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, et al. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database of Systematic Reviews; 2011. Contract No.: Issue 9. Art. No: CD008451.
10.
Mandavia R, Mehta N, Schilder A, Mossialos E. Effectiveness of UK provider financial incentives on quality of care: a systematic review. Br J Gen Pract. 2017;67(664):e800–e15.PubMedPubMedCentralCrossRef
11.
Michie S, Van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):42.PubMedPubMedCentralCrossRef
12.
McDonald R, Harrison S, Checkland K, Campbell SM, Roland M. Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study. BMJ. 2007;334(7608):1357.PubMedPubMedCentralCrossRef
13.
Hackett J, Glidewell L, West R, Carder P, Doran T, Foy R. ‘Just another incentive scheme’: a qualitative interview study of a local pay-for-performance scheme for primary care. BMC Fam Pract. 2014;15(1):168.
14.
Campbell SM, McDonald R, Lester H. The experience of pay for performance in English family practice: a qualitative study. Ann Fam Med. 2008;6(3):228–34.PubMedPubMedCentralCrossRef
15.
Furr M. Scale construction and psychometrics for social and personality psychology. London, UK: SAGE Publications Ltd; 2013.
16.
Young GJ, Beckman H, Baker E. Financial incentives, professional values and performance: a study of pay-for-performance in a professional organization. J Organ Behav. 2012;33(7):964–83.CrossRef
17.
Meterko M, Young GJ, White B, Bokhour BG, Burgess JF, Berlowitz D, et al. Provider attitudes toward pay-for-performance programs: development and validation of a measurement instrument. Health Serv Res. 2006;41(5):1959–78.PubMedPubMedCentralCrossRef
18.
Saltman RB, Duran A. Governance, government, and the search for new provider models. Int J Health Policy Manag. 2016;5(1):33–42.CrossRef
19.
Lynn LE, Heinrich CJ, Hill CJ. Studying governance and public management: challenges and prospects. J Public Adm Res Theory. 2000;10(2):233–62.CrossRef
20.
Hinkin TR. A brief tutorial on the development of measures for use in survey questionnaires. Organ Res Methods. 1998;1(1):104–21.CrossRef
21.
Roland M, Campbell S, Bailey N, Whalley D, Sibbald B. Financial incentives to improve the quality of primary care in the UK: predicting the consequences of change. Prim Health Care Res Dev. 2006;7(01):18–26.CrossRef
22.
Shortell SM, O'Brien JL, Carman JM, Foster RW, Hughes E, Boerstler H, et al. Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. Health Serv Res. 1995;30(2):377.PubMedPubMedCentral
23.
Berlowitz DR, Young GJ, Hickey EC, Saliba D, Mittman BS, Czarnowski E, et al. Quality improvement implementation in the nursing home. Health Serv Res. 2003;38(1p1):65–83.
24.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
25.
Rattray J, Jones MC. Essential elements of questionnaire design and development. J Clin Nurs. 2007;16(2):234–43.PubMedCrossRef
26.
Spector PE. Summated rating scale construction: an introduction. Newbury Park, CA: Sage; 1992.CrossRef
27.
28.
Drennan J. Cognitive interviewing: verbal data in the design and pretesting of questionnaires. J Adv Nurs. 2003;42(1):57–63.CrossRefPubMed
29.
Willis GB. Cognitive interviewing: a tool for improving questionnaire design. Thousand Oaks, CA: Sage Publications; 2004.
30.
Spark MJ, Willis J. Application of cognitive interviewing to improve self-administered questionnaires used in small scale social pharmacy research. Res Social Adm Pharm. 2014;10(2):469–74.PubMedCrossRef
31.
Flynn BB, Sakakibara S, Schroeder RG, Bates KA, Flynn EJ. Empirical research methods in operations management. JOM. 1990;9(2):250–84.CrossRef
32.
Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res. 2009;9(1):160.PubMedPubMedCentralCrossRef
33.
Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods. 1999;4(3):272.CrossRef
34.
Costello AB, Osborne JW. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. PARE. 2005;10(7):1–9.
35.
Williams B, Onsman A, Brown T. Exploratory factor analysis: A five-step guide for novices. AJP. 2010;8(3).
36.
Tabachnick BG, Fidell LS. Using multivariate statistics, 6th. Pearson Education Limited: London, UK; 2013.
37.
Field A. Discovering statistics using IBM SPSS statistics. London, UK: Sage Publications LTD; 2013.
38.
Acquadro C, Conway K, Hareendran A, Aaronson N. Literature review of methods to translate health-related quality of life questionnaires for use in multinational clinical trials. Value Health. 2008;11(3):509–21.PubMedCrossRef
39.
Swaine-Verdier A, Doward LC, Hagell P, Thorsen H, McKenna SP. Adapting quality of life instruments. Value Health. 2004;7(s1):S27–30.PubMedCrossRef
40.
Macinati MS. NPM reforms and the perception of budget by hospital clinicians; lessons from two case-studies. FAM. 2010;26(4):422–42.
41.
Macinati MS, Bozzi S, Rizzo MG. Budgetary participation and performance: the mediating effects of medical managers’ job engagement and self-efficacy. Health Policy. 2016;120(9):1017–28.PubMedCrossRef
42.
Freidson E. Professionalism. The third logic. Oxford: Polity press; 2001.
43.
Madara JL, Burkhart J. Professionalism, self-regulation, and motivation: how did health care get this so wrong? JAMA. 2015;313(18):1793–4.PubMedCrossRef
44.
MacCallum RC, Widaman KF, Zhang S, Hong S. Sample size in factor analysis. Psychol Methods. 1999;4(1):84.CrossRef
45.
Korlén S, Essén A, Essén A, Lindgren P, Amer-Wahlin I, von Thiele Schwarz U. Managerial strategies to make incentives meaningful and motivating. J Health Organ Manag. 2017;31(2):126–41.PubMedPubMedCentralCrossRef
46.
Creswell JW, Clark VLP. Designing and conducting mixed methods research. California: Sage Publisher; 2007.
Metadata
Title
The development and validation of a scale to explore staff experience of governance of economic efficiency and quality (GOV-EQ) of health care
Authors
Sara Korlén
Anne Richter
Isis Amer-Wåhlin
Peter Lindgren
Ulrica von Thiele Schwarz
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3765-7

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