Measuring Workplace Climate in Community Clinics and Health Centers

Published in: Medical Care, 2016

Posted on RAND.org on July 06, 2016

by Mark W. Friedberg, Hector Rodriguez, Grant R. Martsolf, Maria Orlando Edelen, Arturo Vargas Bustamante

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Research Question

  1. What are the different aspects of workplace climate that can be measured by surveying clinicians and staff in community clinics and health centers?

Background

The effectiveness of community clinics and health centers' efforts to improve the quality of care might be modified by clinics' workplace climates. Several surveys to measure workplace climate exist, but their relationships to each other and to distinguishable dimensions of workplace climate are unknown.

Objective

To assess the psychometric properties of a survey instrument combining items from several existing surveys of workplace climate and to generate a shorter instrument for future use.

Materials and Methods

We fielded a 106-item survey, which included items from 9 existing instruments, to all clinicians and staff members (n=781) working in 30 California community clinics and health centers, receiving 628 responses (80% response rate). We performed exploratory factor analysis of survey responses, followed by confirmatory factor analysis of 200 reserved survey responses. We generated a new, shorter survey instrument of items with strong factor loadings.

Results

Six factors, including 44 survey items, emerged from the exploratory analysis. Two factors (Clinic Workload and Teamwork) were independent from the others. The remaining 4 factors (staff relationships, quality improvement orientation, managerial readiness for change, and staff readiness for change) were highly correlated, indicating that these represented dimensions of a higher-order factor we called "Clinic Functionality." This 2-level, 6-factor model fit the data well in the exploratory and confirmatory samples. For all but 1 factor, fewer than 20 survey responses were needed to achieve clinic-level reliability >0.7.

Conclusions

Survey instruments designed to measure workplace climate have substantial overlap. The relatively parsimonious item set we identified might help target and tailor clinics' quality improvement efforts.

Key Findings

  • Current surveys intended to measure workplace climate overlap substantially.
  • As an alternative to fielding multiple surveys, we generated a single, shorter survey of 44 items.
  • This shorter survey measures 3 overall dimensions of workplace climate (clinic workload; teamwork; and clinic functionality) and 4 sub-dimensions of clinical functionality: staff relationships, QI orientation, manager readiness for change, and staff readiness for change.

Recommendation

The shorter survey instrument could be useful for stakeholders who want to measure multiple dimensions of workplace climate but have limited time and resources to do so.

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