It is possible to implement the EFQM model at the hospital was level and it has a positive influence on staff communication and involvement. It is important, when working at this level, to adequately focus the scope of the project on improving quality in those areas where there is decision-making capacity.

Background The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. Objective In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). Methods Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. Results A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). Conclusions The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic.

Backgroud: This study designed and validated a scale to measure acute stress experienced during the care of patients with COVID-19 (EASE scale). Methods: The COSMIN recommendations were followed in the design and validation of the EASE scale. Internal consistency was calculated using Cronbach's Alpha and McDonald's Omega. Qualitative research was conducted to assess content validity. Exploratory and Confirmatory Factorial Analysis were used to assess construct validity. Mann-Whitney-Wilcoxon test and Lineal Regression were applied to assess criterion validity. Responsiveness and interpretability were also assessed.Results: A total of 228 health professionals from the Spanish public health system responded to the ten items, of the EASE scale. Internal consistency was 0.87 (McDonald’s Omega). Two factors explaining 55% of the variance were isolated. Goodness-of-fit indices confirmed this factor structure. The highest level of stress was found among professionals working in health services who accumulated a higher number of deaths from COVID-19 (P<.05). By means of translation-counter-translation, it was adapted to Latin American Spanish, Brazilian Portuguese, and English.Conclusions: EASE gathers adequate metric properties. Its systematic use would allow the identification of professionals with a higher risk of developing affective/anxiety disorders and Moral injury that could limited that patients received safety and integrated care.

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