Abstract
BackgroundIn 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.MethodsFactors 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.ResultsThe 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).ConclusionsThe 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.
Highlights
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
The analyses show that the staff experience of governance of economic efficiency and quality (GOV-EQ) scale distinguishes between eight interrelated experiences and holds good psychometric qualities
The GOV-EQ scale can contribute to the understanding of how governance of health care is perceived among staff and can help determine the likeliness of staff behavior change in accordance with the demands at the provider level
Summary
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. This implies change in staff behaviors, evaluation studies commonly focus on organizational outputs. In publicly funded systems, governing bodies struggle to design governance models that push public service providers to attain economic efficiency and quality, to optimize the value of tax payers’ money This has resulted in increased provider competition and the introduction of financial incentive models, in primary care [2]. The economic efficiency and quality requirements are highly interrelated in health care provision, and economic governance models can’t be evaluated, or understood, without perspectives on quality (and vice versa)
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