Developing and testing an instrument to measure the presence of conditions for successful implementation of quality improvement collaboratives.
BACKGROUND
In quality improvement collaboratives (QICs) teams of practitioners from different health care organizations are brought together to systematically improve an aspect of patient care. Teams take part in a series of meetings to learn about relevant best practices, quality methods and change ideas, and share experiences in making changes in their own local setting. The purpose of this study was to develop an instrument for measuring team organization, external change agent support and support from the team's home institution in a Dutch national improvement and dissemination programme for hospitals based on several QICs.


METHODS
The exploratory methodological design included two phases: a) content development and assessment, resulting in an instrument with 15 items, and b) field testing (N = 165). Internal consistency reliability was tested via Cronbach's alpha coefficient. Principal component analyses were used to identify underlying constructs. Tests of scaling assumptions according to the multi trait/multi-item matrix, were used to confirm the component structure.


RESULTS
Three components were revealed, explaining 65% of the variability. The components were labelled 'organizational support', 'team organization' and 'external change agent support'. One item not meeting item-scale criteria was removed. This resulted in a 14 item instrument. Scale reliability ranged from 0.77 to 0.91. Internal item consistency and divergent validity were satisfactory.


CONCLUSIONS
On the whole, the instrument appears to be a promising tool for assessing team organization and internal and external support during QIC implementation. The psychometric properties were good and warrant application of the instrument for the evaluation of the national programme and similar improvement programmes.
Dückers
Michel L A
ML
NIVEL - Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.duckers@nivel.nl
Wagner
Cordula
C
Groenewegen
Peter P
PP
D003299:Cooperative Behavior; D006302:Health Services Research; D006801:Humans; D008330:Management Audit; D009426:Netherlands; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration*; D011594:Psychometrics / Q000295:instrumentation*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires