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BMC Health Serv Res. 2018 Dec 17;18(1):975. doi: 10.1186/s12913-018-3743-0.

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

Author information

1
Duke Patient Safety Center, Duke University Health System, Durham, NC, USA. kathryn.c.adair@duke.edu.
2
Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA. kathryn.c.adair@duke.edu.
3
Duke University School of Medicine, Duke University Health System, Durham, NC, USA.
4
Safe and Reliable Healthcare, Evergreen, Colorado, USA.
5
Duke Network Services, Duke University Health System, Durham, NC, USA.
6
Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
7
Division of Neonatal Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA.
8
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital and Health Center, Durham, NC, USA.
9
Duke Patient Safety Center, Duke University Health System, Durham, NC, USA.
10
Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA.

Abstract

BACKGROUND:

Quality 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.

METHODS:

Of 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.

RESULTS:

The 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").

CONCLUSION:

The 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.

KEYWORDS:

Improvement readiness; Learning environment; Qualitative responses; SCORE, quality improvement; Safety culture survey

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