The Improvement Readiness scale of the SCORE survey: a metric to assess capacity for quality improvement in healthcare

Kathryn C Adair,Allan Frankel,Jochen Profit,Paul J Mosca,Michael Leonard,Allison Hadley,Krystina Quow,J Bryan Sexton

doi:10.1186/s12913-018-3743-0

Abstract

BackgroundQuality improvement efforts are inextricably linked to the readiness of healthcare workers to take them on. The current study aims to clarify the nature and measurement of Improvement Readiness (IR) by 1) examining the psychometric properties of a novel IR scale, 2) assessing relationships between IR and other safety culture domains 3) exploring whether IR differs by healthcare worker demographic factors, and 4) examining linguistic differences in word type use between high and low scoring IR work settings from their free text responses.MethodsOf 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate 81%) completed the 5-item IR scale, demographics, safety culture scales, and two open-ended questions. Psychometric analyses, correlations and ANOVAs tested the properties of IR. Linguistic Inquiry Word Count software assessed comments from open-ended questions.ResultsThe IR scale exhibited strong psychometric properties and a one factor model fit the data well (Cronbach’s alpha = .93; RMSEA = .07; CFI = 99; TLI = .99). IR scores differed significantly by role, shift, shift length, and years in specialty. IR correlated significantly and in expected directions with safety culture scales. Linguistic analyses revealed that people in low versus high IR work settings used significantly more words in their responses, and specifically more past tense verbs (e.g., “ignored”), negative emotion words (e.g., “upset”), and first person singular (“I”). Workers from high IR work settings used significantly more positive emotions words (e.g., “grateful”) and social words (e.g., “team”).ConclusionThe IR scale exhibits strong psychometric properties, is associated with better safety and teamwork climate, lower burnout, and predicts linguistic differences in high versus low IR groups.

Highlights

Quality improvement efforts are inextricably linked to the readiness of healthcare workers to take them on
The safety and reliability of healthcare delivery depends on healthcare workers having sufficient capacity and support to engage in continuous self-reflection and quality improvement
Design and study population This is a cross sectional study of 2016 survey data sent to 13,040 healthcare workers across 440 work settings within one academic health system as part of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) survey [7]

Summary

Introduction

Quality improvement efforts are inextricably linked to the readiness of healthcare workers to take them on. The safety and reliability of healthcare delivery depends on healthcare workers having sufficient capacity and support to engage in continuous self-reflection and quality improvement. How do leaders know if groups in their organization are Continuous learning around quality improvement can take many forms, such as integrating lessons learned from other work settings, incorporating insights and ideas of workers into the delivery of care, and learning from defects. In order to facilitate IR, many healthcare systems build organization-wide infrastructures to enable and support integrated assessments and feedback. These include explicit support from leadership and co-workers and protected time for continuous learning either on-the-job or via lectures and conferences [1,2,3]. Key barriers to learning include time and financial constraints, lack of support from leadership and peers, and a negative workplace culture with insufficient processes to facilitate employees’ learning [1, 2, 5]

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Conclusion