Friedberg Mark W, Rodriguez Hector P, Martsolf Grant R, Edelen Maria O, Vargas Bustamante Arturo
*RAND Corporation †Department of Medicine, Brigham and Women's Hospital ‡Department of Medicine, Harvard Medical School, Boston, MA §School of Public Health, University of California, Berkeley, CA ∥RAND Corporation, Pittsburgh, PA ¶Department of Health Policy and Management at the UCLA Fielding School of Public Health, University of California, Los Angeles, CA.
Med Care. 2016 Oct;54(10):944-9. doi: 10.1097/MLR.0000000000000585.
The effectiveness of community clinics and health centers' efforts to improve the quality of care might be modified by clinics' workplace climates. Several surveys to measure workplace climate exist, but their relationships to each other and to distinguishable dimensions of workplace climate are unknown.
To assess the psychometric properties of a survey instrument combining items from several existing surveys of workplace climate and to generate a shorter instrument for future use.
We fielded a 106-item survey, which included items from 9 existing instruments, to all clinicians and staff members (n=781) working in 30 California community clinics and health centers, receiving 628 responses (80% response rate). We performed exploratory factor analysis of survey responses, followed by confirmatory factor analysis of 200 reserved survey responses. We generated a new, shorter survey instrument of items with strong factor loadings.
Six factors, including 44 survey items, emerged from the exploratory analysis. Two factors (Clinic Workload and Teamwork) were independent from the others. The remaining 4 factors (staff relationships, quality improvement orientation, managerial readiness for change, and staff readiness for change) were highly correlated, indicating that these represented dimensions of a higher-order factor we called "Clinic Functionality." This 2-level, 6-factor model fit the data well in the exploratory and confirmatory samples. For all but 1 factor, fewer than 20 survey responses were needed to achieve clinic-level reliability >0.7.
Survey instruments designed to measure workplace climate have substantial overlap. The relatively parsimonious item set we identified might help target and tailor clinics' quality improvement efforts.
社区诊所和健康中心为提高医疗质量所做努力的成效可能会受到诊所工作氛围的影响。目前有多项用于衡量工作氛围的调查，但它们之间的相互关系以及与工作氛围可区分维度的关系尚不清楚。
评估一种结合了多项现有工作氛围调查项目的调查工具的心理测量特性，并生成一个更简短的工具以供未来使用。
我们向加利福尼亚州30家社区诊所和健康中心的所有临床医生和工作人员（n = 781）发放了一份包含106个项目的调查问卷，这些项目来自9种现有工具，共收到628份回复（回复率为80%）。我们对调查回复进行了探索性因子分析，随后对200份预留调查回复进行了验证性因子分析。我们生成了一个新的、更简短的由具有强因子载荷的项目组成的调查工具。
探索性分析得出了六个因子，包括44个调查项目。其中两个因子（诊所工作量和团队合作）与其他因子相互独立。其余四个因子（员工关系、质量改进导向、管理层变革准备度和员工变革准备度）高度相关，表明它们代表了一个我们称为“诊所功能”的高阶因子的维度。这个两级六因子模型在探索性和验证性样本中都能很好地拟合数据。对于除一个因子外的所有因子，实现诊所层面可靠性>0.7所需的调查回复少于20份。
旨在衡量工作氛围的调查工具存在大量重叠。我们确定的相对简洁的项目集可能有助于针对并调整诊所的质量改进工作。
