Development and validation of an organizational readiness to change instrument focused on cultural competency

Abstract

To validate a brief survey developed to be used in hospitals nationwide to assess organizational readiness to change to increase cultural competency. Analysis of primary data collected as part of a 125-item Organizational Assessment Survey conducted in the ten US hospitals participating in the Robert Wood Johnson Foundation Expecting Success program in 2005-2006. The study utilized a cross-sectional survey. Surveys were distributed to participants in the ten hospitals based on job title and role within the organization (including clinicians, clinical administrators, other clinical professionals, and those in relevant nonclinical roles; respondents=513; response rate=31%). Missing data were deleted listwise. We computed internal consistency reliability via Cronbach's alpha and interrater agreement using the rwg(j) index, and conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine validity of the survey. We subsequently conducted ANOVAs to examine whether the instrument adequately distinguished between hospitals. Across 408 complete responses, a scree plot generated by the EFA and a follow-up CFA indicated a 2-factor solution (RMSEA = 0.06; CFI = 0.96; GFI = 0.96; RMSR = 0.08). We identified these primary factors as two scales, a 12-item Readiness to Address Quality scale (α=0.85; rwg(j) =0.93) and an 11-item Readiness to Address Disparities scale (α=0.65; rwg(j) =0.89). ANOVAs suggested that these scales distinguished between hospitals (RTAQ: F[9, 428] = 3.70, P < .001; RTAD: F[9, 435] = 3.02, P = .002). This survey can help identify an organization's readiness to change to increase cultural competency.