Development of a high-value care culture survey: A modified Delphi process and psychometric evaluation

Reshma Gupta, Christopher Moriates, James D. Harrison, Victoria Valencia, Michael Ong, Robin Clarke, Neil Steers, Ron D. Hays, Clarence H. Braddock, Robert Wachter

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background Organisational culture affects physician behaviours. Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists. We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by healthcare leaders and training programmes to target future improvements in value-based care. Methods We conducted a two-phase national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds. We then administered a cross-sectional survey at two large academic medical centres in 2015 among 162 internal medicine residents and 91 hospitalists for psychometric evaluation. Results Twenty-six (93%) experts completed the first phase and 22 (85%) experts completed the second phase of the modified Delphi process. Thirty-eight items achieved ≥70% consensus and were included in the survey. One hundred and forty-one residents (83%) and 73 (73%) hospitalists completed the survey. From exploratory factor analyses, four factors emerged with strong reliability: (1) leadership and health system messaging (α=0.94); (2) data transparency and access (α=0.80); (3) comfort with cost conversations (α=0.70); and (4) blame-free environment (α=0.70). In confirmatory factor analysis, this four-factor model fit the data well (Bentler-Bonett Normed Fit Index 0.976 and root mean square residual 0.056). The leadership and health system messaging (r=0.56, p<0.001), data transparency and access (r=0.15, p<0.001) and blame-free environment (r=0.37, p<0.001) domains differed significantly between institutions and positively correlated with Value-Based Purchasing Scores. Conclusions Our results provide support for the reliability and validity of the HVCCS to assess high-value care culture among front-line clinicians. HVCCS may be used by healthcare groups to identify target areas for improvements and to monitor the effects of high-value care initiatives.

Original languageEnglish (US)
Pages (from-to)475-483
Number of pages9
JournalBMJ Quality and Safety
Volume26
Issue number6
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

Keywords

  • Healthcare quality improvement
  • Quality measurement
  • Safety culture

ASJC Scopus subject areas

  • Health Policy

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