Assessing Health Care Workers’ Satisfaction and Loyalty in a Balanced Scorecard: Development and Validation of BSC-HCWSL - a Cross-sectional Study

Abstract

BackgroundImproving health care in Palestinian territories is a challenging task. Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). In the BSC implementations, some health care organizations (HCOs) assessed the satisfaction of health care workers (HCWs), but none considered their loyalty. Furthermore, none of them explored the causal links between BSC dimensions and HCWs’ satisfaction based on HCWs’ observations. This research aims to provide a tool to assess the performance of BSC dimensions and their impact on HCWs’ satisfaction and loyalty (BSC-HCWSL). Additionally, it seeks to translate the BSC-HCWSL to Arabic and validate it at Palestinian hospitals.MethodsThis is a cross-sectional study. Two expert committees performed the BSC-HCWSL item development. We performed forward and reverse translations from English to Arabic and vice versa. Pretesting was performed on 13 HCWs at one hospital. Then, between January and October 2021, 540 questionnaires were retrieved in the other 14 hospitals. To detect redundant and poorly correlated items, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the construct validity.ResultsIn both EFA and CFA, the scales demonstrated a good level of model fit. All the items had loadings greater than 0.50. All constructs passed the discriminant validity. Although certain constructs’ convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine constructs and 28 items in CFA.ConclusionThe BSC-HCWSL is the first self-administered HCW questionnaire designed to assess BSC perspectives and dimensions and their impact on HCWs’ satisfaction and loyalty. The questionnaire scale was completed following all applicable rules and regulations. The findings revealed that this instrument’s psychometric characteristics were adequate. Therefore, BSC-HCWSL can be utilized in future BSC implementations. It can also be used to assess the influence of BSC factors on HCWs’ satisfaction and loyalty and examine differences depending on HCWs and hospital characteristics.