title: The Trauma Center Organizational Culture Survey: development and conduction.
abstract: BACKGROUND
  The Trauma Center Organizational Culture Survey (TRACCS) instrument was developed to assess organizational culture of trauma centers enrolled in the American College of Surgeons Trauma Quality Program (ACS TQIP). The objective is to provide evidence on the psychometric properties of the factors of TRACCS and describe the current organizational culture of TQIP-enrolled trauma centers.
  
  
  METHODS
  A cross-sectional study was conducted by surveying a sampling of employees at 174 TQIP-enrolled trauma centers. Data collection was preceded by multistep survey development. Psychometric properties were assessed by an exploratory factor analysis (construct validity) and the item-total correlations and Cronbach alpha were calculated (internal reliability). Statistical outcomes of the survey responses were measured by descriptive statistics and mixed effect models.
  
  
  RESULTS
  The response rate for trauma center participation in the study was 78.7% (n = 137). The factor analysis resulted in 16 items clustered into three factors as described: opportunity, pride, and diversity, trauma center leadership, and employee respect and recognition. TRACCS was found to be highly reliable with a Cronbach alpha of 0.90 in addition to the three factors (0.91, 0.90, and 0.85). Considerable variability of TRACCS overall and factor score among hospitals was measured, with the largest interhospital deviations among trauma center leadership. More than 80% of the variability in the responses occurred within rather than between hospitals.
  
  
  CONCLUSIONS
  TRACCS was developed as a reliable tool for measuring trauma center organizational culture. Relationships between TQIP outcomes and measured organizational culture are under investigation. Trauma centers could apply TRACCS to better understand current organizational culture and how change tools can impact culture and subsequent patient and process outcomes.
authors.affiliation: Department of Surgery, Baylor Scott & White Health, Temple, TX. Electronic address: mdavis@sw.org.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Davis
authors.affiliation: Academic Research Integration, Baylor Scott & White Health, Temple, TX.
authors.forename: Hania
authors.initials: H
authors.lastname: Wehbe-Janek
authors.affiliation: The Trauma Quality Improvement Program, American College of Surgeons, Chicago, IL.
authors.forename: Haris
authors.initials: H
authors.lastname: Subacius
authors.affiliation: Department of Surgery, The University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON.
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Pinto
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, The University of Toronto, Toronto, ON.
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care / Q000592:standards*; D011594:Psychometrics / Q000379:methods* / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D014193:Trauma Centers / Q000458:organization & administration*; D055815:Young Adult
keywords: Organizational culture; Survey development; TQIP; Trauma center