Background
Aim
Method
Scale development
Literature search
Sub-factors for Subscale A and B | Examples of related experiences in the literature | Quotes from the exploratory interviews |
---|---|---|
• Knowledge and understanding (A & B): The knowledge and understanding of how economic efficiency/quality requirements affect how his/her work is to be conducted. | Awareness and understanding [17] Information and analysis [22] Planning for quality [23] | A: “If I don’t meet enough patients we get less money. So that’s very obvious. I think everyone knows and has an awareness of being a part of it.” (Respondent 5) B: “Quality follow-up. That’s done a lot right now. There are different ways. At the work place meetings. Some have white boards where they take notes continuously. And print graphs to share. They are educational and easy for staff to follow.”
(Respondent 2)
|
• Opportunity to influence (A & B): The experience of participating and being able to influence the financial situation/ quality improvement work at the unit. | Control [17] Strategic planning for quality analysis [22] | A: “They (staff) are not involved. You are not involved in the decision-making. You never get to know what financial resources there are, and what the costs are.” (Respondent 2) B: “So it is quite common that you measure quality in different ways, on the other hand there might be a lack of feedback. / ... / And if you get feedback it might not be obvious, what did I do that made a difference? Or you get feedback at a higher level of abstraction, and it’s difficult to know if you make a difference or not. You need to experience that you can influence quality.” (Respondent 3) |
• Motivation (A & B): The experience of motivation and engagement in improving the unit’s financial situation/quality. | Goal importance [16] Job satisfaction [21] Work load [21] Financial reward [14] Staff motivation [13] Human resource utilization analysis [22] Managerial role (Berlowitz et al., 2003 | A: “My experience is also that, usually, healthcare workers do not really think about this (economic efficiency), or are engaged in this.” (Respondent 7) B: “Taking a quality perspective, I think it’s much easier to discuss, and it feels better than when you refer to money. Because people are not like that. Physicians, and all healthcare professionals, are guided by their ethics. It’s so central, you want to provide good care, and you’re in this to create good things for patients. To work for better health, that’s the intrinsic driving force. ”(Respondent 1) |
• Impact on professional autonomy (A): The experience of economic efficiency requirements affecting his/her professional autonomy in meeting patient needs. | Clinical relevance [16] Impact on professional autonomy [16] Impact on clinical behavior, clinical relevance [17] Impact on clinical roles, alignment professional values [14] Impact on clinical autonomy, changed clinical practice [12] | A: “I feel that it is part of care, to do good /…/ It’s a driving force that’s part of who we are. It is in ethical perspectives we end up many times, in the ethical dilemmas. When I can’t do what I know is best for the patient. Although I would like to, and could, if the conditions were right.” (Respondent 3) |
• Organizational alignment (A): The experience that the unit’s financial resources are in line with its mission. | Impact on quality of care [21] Unintended consequences for patients [17] Supporting improvement, unintended consequences for patients [14] Fairness, appropriateness [13] | A: “It is always so, that we (health care providers) should do more using fewer resources. And it seems to me that the more promises of that kind that you throw into the political game, the better. But then what? /…/ Then we have to provide the same services, with less money.” (Respondent 4) |
Qualitative interviews to explore sub-factors
Applying a theoretical model
Item generation
Pilot testing and validating the GOV-EQ-scale
Study setting
Data collection
Sample characteristics
Demographic characteristics | n= | % | |
---|---|---|---|
Gender | Women | 76 | 84 |
Men | 13 | 14 | |
Other | 1 | 1 | |
Missing | 1 | 1 | |
Professional role | Occupational therapist | 10 | 11 |
Social worker | 6 | 7 | |
Speech therapist | 3 | 3 | |
Physician | 4 | 4 | |
Psychologist | 8 | 9 | |
Nurse | 8 | 9 | |
Assistant nurse | 22 | 24 | |
Physiotherapists and other | 29 | 32 | |
Missing | 1 | 1 | |
Experience as health care manager | Yes | 12 | 13 |
No | 76 | 84 | |
Missing | 3 | 3 | |
Mean | SD | ||
Age | Years | 43.7 | 12.4 |
Experience from working in health care | Years | 16.7 | 12.0 |
Statistical analysis
Translation
Results
Exploring dimensionality and items
Sub-factors and items (of subscale A/B) | Cronbach’s Alpha | Mean (SD) | F1 | F2 | F3 | F4 | F5 | F6 | F7 | F8 |
---|---|---|---|---|---|---|---|---|---|---|
Knowledge and awareness (A) | 0.86 | 2.99 (.91) | ||||||||
1. I know how I should take the unit’s financial situation into consideration in my work. | 3.26 (1.19) | −.802 | ||||||||
2. I know what I can do to make the unit’s financial situation as good as possible. | 3.09 (1.17) | −.809 | ||||||||
3. I know how to deal responsibly with the unit’s financial resources. | 3.26 (1.18) | −.711 | ||||||||
4. I know how to plan my work to ensure that we stay within the unit’s budget. | 2.58 (1.21) | −.786 | ||||||||
5. I find it difficult to see how I can influence the unit’s financial situation (R). | 2.54 (1.30) | −.500 | ||||||||
6. I am aware of the unit’s financial situation when I make decisions in my work with patients. | 3.22 (1.06) | −.326 | ||||||||
Opportunity to influence (A) | 0.89 | 1.97 (.95) | ||||||||
7. I get involved in discussions concerning the unit’s financial situation. | 2.07 (1.12) | −.795 | ||||||||
8. I can influence how the financial resources are used in the unit. | 1.77 (1.07) | −.925 | ||||||||
9. I am able to express my opinions on how we can use the unit’s resources more efficiently. | 2.37 (1.09) | −.728 | ||||||||
10. My opinions matter when budgetary decisions are made. | 1.72 (1.07) | −.838 | ||||||||
Motivation (A) | 0.83 | 3.08 (1.01) | ||||||||
11. It’s motivating to work with issues that concern the unit’s financial situation. | 2.54 (1.19) | .822 | ||||||||
12. It’s fulfilling to try to improve the unit’s financial situation. | 3.51 (1.18) | .803 | ||||||||
13. I am interested in the unit’s financial situation. | 3.22 (1.16) | .693 | ||||||||
Impact on professional autonomy (A) | 0.62 | 3.31 (.92) | ||||||||
14. The unit’s financial status affects my ability to do what is best for patients. | 3.53 (1.19) | .499 | ||||||||
15. The unit’s financial limitations affect my ability to adhere to my own ethical values. | 2.97 (1.26) | .638 | ||||||||
16. I feel free to do what is best for the patient, regardless of the unit’s financial situation (R). | 3.44 (1.21) | .315 | ||||||||
Organizational alignment (A) | 0.87 | 2.29 (.84) | ||||||||
17. I think the unit’s financial resources are reasonable. | 2.27 (.99) | .830 | ||||||||
18. We have the financial resources needed to meet patient needs. | 2.26 (1.07) | .831 | ||||||||
19. I think the unit’s financial situation is sustainable. | 2.19 (.91) | .906 | ||||||||
20. The unit’s financial status is sufficient to allow us to fulfill our mission. | 2.30 (1.01) | .739 | ||||||||
21. The financial requirements placed on the unit negatively impact our patients. (R) | 2.36 (1.16) | .568 | ||||||||
Single item: Impact on clinical behavior (A) | ||||||||||
22. I take the unit’s financial situation into consideration in my clinical work. | 3.32 (1.00) | .342 | .389 | |||||||
Knowledge and awareness (B) | 0.82 | 4.06 (.72) | ||||||||
23. I know what leads to good quality care for our patients. | 4.09 (.88) | 0.637 | ||||||||
24. I know what I should do, in my role, to ensure that we maintain high levels of quality. | 4.35 (.72) | 0.821 | ||||||||
25. I know how I can get involved in quality improvement. | 3.59 (1.14) | 0.454 | ||||||||
26. I know how to plan my work to ensure that what I do is of good quality. | 4.21 (.80) | 0.877 | ||||||||
Opportunity to influence (B) | 0.89 | 3.31 (.91) | ||||||||
27. I can influence how the unit works with quality improvement. | 3.10 (1.17) | −.817 | ||||||||
28. I participate in the unit’s work with quality improvement. | 3.40 (1.18) | −.687 | −.340 | |||||||
29. I can influence where we focus our improvement work. | 3.01 (1.16) | −.933 | ||||||||
30. My opinions matter when we work with quality improvement. | 3.13 (1.09) | −.834 | ||||||||
31. By the time we begin our work on quality improvement, it has already been decided how it should be carried out. (R) | 3.28 (1.08) | −.622 | ||||||||
32. I find it difficult to see how I can influence quality at the unit. (R) | 3.85 (1.07) | −.377 | ||||||||
Motivation (B) | 0.78 | 4.15 (.69) | ||||||||
33. Quality improvement work is motivating. | 4.11 (.94) | −.762 | ||||||||
34. I think it is part of my role to get involved with quality improvement. | 4.27 (.73) | −.763 | ||||||||
35. It’s fulfilling to try to improve quality at the unit. | 4.32 (.92) | −.310 | ||||||||
36. I am interested in how we compare to other units with regard to quality. | 3.89 (.96) | −.338 | ||||||||
Single item: Impact on clinical behavior (B) | ||||||||||
37. I take quality into consideration in my clinical work. | 4.24 (.85) | .561 |
Inter-factor relationships
Sub-scale | Index | M (SD) | 1. | 2. | 3. | 4. | 5. | 6. | 7. | 8. |
---|---|---|---|---|---|---|---|---|---|---|
A | 1. Knowledge and awareness | 2.99 (.91) | 1 | |||||||
A | 2. Opportunity to influence | 1.97 (.95) | .398** | 1 | ||||||
A | 3. Motivation | 3.08 (1.01) | .220* | .215* | 1 | |||||
A | 4. Impact on professional autonomy | 3.31 (.92) | −.065 | −.167 | −.096 | 1 | ||||
A | 5. Organizational alignment | 2.29 (.84) | .055 | .187 | .019 | −.475** | 1 | |||
B | 6. Knowledge and awareness | 4.06 (.72) | .452** | .152 | .081 | −.091 | −.152 | 1 | ||
B | 7. Opportunity to influence | 3.31 (.91) | .094 | .214* | .278** | −.256* | .114 | .278** | 1 | |
B | 8. Motivation | 4.15 (.69) | .129 | .051 | .415** | .070 | −.174 | .450** | .474** | 1 |