Culture, organization, and management in intensive care: construction and validation of a multidimensional questionnaire

Abstract

Objective The objective of this study is to develop and validate a questionnaire designed to assess the culture, organization, and management of intensive care units. Design This is a prospective multicenter study. Setting The study was conducted in 26 intensive care units located in Paris. Participants All personnel were asked to complete the questionnaire. Intervention The questionnaire was developed in 2 steps: (1) development of a theoretical framework based on organizational theory and (2) testing of the reliability and validity of a comprehensive set of measures. Method The internal consistency of the items composing each scale was tested by using the Cronbach α. Convergent, and discriminant validity was assessed by factor analysis with varimax rotation. Results The overall completion rate was 74% with 1000 respondents (750 nurses, 26 head nurses, 168 physicians, and 56 medical secretaries). Starting with a 220-item questionnaire, we constructed a short version—conserving metrological characteristics with good reliability and validity. The short questionnaire, entitled Culture, Organization, and Management in Intensive Care, consists of 106 items distributed in 9 dimensions and 22 scales: culture (n = 3), coordination and adaptation to uncertainty (n = 3), communication (n = 3), problem solving and conflict management (n = 2), organizational learning and organizational change (n = 2), skills developed in a patient-caregiver relationship (n = 1), subjective unit performance (n = 3), burnout (n = 3), and job satisfaction and intention to quit (n = 2). All the scales showed good-to-high reliability, with Cronbach α scores higher than .7 (with the exception of coordination [.6]). Team satisfaction–oriented culture is positively correlated with good managerial practices and individual well-being. Conclusions The Culture, Organization, and Management in Intensive Care questionnaire enables staff and managers to assess the organizational performance of their intensive care unit.