Bobiak Sarah N, Zyzanski Stephen J, Ruhe Mary C, Carter Caroline A, Ragan Brian, Flocke Susan A, Litaker David, Stange Kurt C
Departments of Family Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Qual Manag Health Care. 2009 Oct-Dec;18(4):278-84. doi: 10.1097/QMH.0b013e3181bee2f5.
Capacity for change, or the ability and willingness to undertake change, is an organizational characteristic with potential to foster quality management in health care. We report on the development and psychometric properties of a quantitative measure of capacity for change for use in primary care settings.
Following review of previous conceptual and empirical studies, we generated 117 items that assessed organizational structure, climate, and culture. Using information from direct observation and key informant interviews, a research team member rated these items for 15 primary care practices engaged in a quality improvement intervention. Distributional statistics, pairwise correlation analysis, Rasch modeling, and item content review guided item reduction and instrument finalization. Reliability and convergent validity were assessed.
Ninety-two items were removed because of limited response distributions and redundancy or because of poor Rasch model fit. The final instrument comprising 25 items had excellent reliability (alpha = .94). A Rasch model-derived capacity for change score correlated well with an independently determined, qualitatively derived summary assessment of each practice's capacity for change (rhoS = 0.82), suggesting good convergent validity.
We describe a new instrument for quantifying organizational capacity for change in primary care settings. The ability to quantify capacity for change may enable better recognition of practices likely to be successful in their change efforts and those first requiring capacity building prior to change interventions.
变革能力，即进行变革的能力与意愿，是一种具有促进医疗质量管理潜力的组织特征。我们报告一项用于基层医疗环境的变革能力定量测量工具的开发及心理测量特性。
在回顾以往概念性和实证性研究后，我们生成了117个评估组织结构、氛围和文化的项目。利用直接观察和关键信息人访谈获得的信息，一名研究团队成员对参与质量改进干预的15个基层医疗实践的这些项目进行评分。分布统计、成对相关分析、拉施模型和项目内容审查指导了项目删减和工具定稿。评估了信度和收敛效度。
由于反应分布有限和冗余或拉施模型拟合不佳，92个项目被删除。最终包含25个项目的工具具有出色的信度（α = 0.94）。拉施模型得出的变革能力得分与对每个实践变革能力的独立确定的、定性得出的总结评估相关性良好（rhoS = 0.82），表明收敛效度良好。
我们描述了一种用于量化基层医疗环境中组织变革能力的新工具。量化变革能力的能力可能有助于更好地识别在变革努力中可能成功的实践以及那些在变革干预之前首先需要进行能力建设的实践。
