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

• Main Authors: Kathryn C. Adair, Krystina Quow, Allan Frankel, Paul J. Mosca, Jochen Profit, Allison Hadley, Michael Leonard, J. Bryan Sexton
• Format: Article
• Language: English
• Published: BMC 2018-12-01
• Series: BMC Health Services Research
• Subjects: Improvement readiness; SCORE, quality improvement; Qualitative responses; Learning environment; Safety culture survey
• Online Access: http://link.springer.com/article/10.1186/s12913-018-3743-0

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.