Assessing Patient Experience and Attitude: BSC-PATIENT Development, Translation, and Psychometric Evaluation—A Cross-Sectional Study

Abstract

Health care organizations (HCO) did not consider engaging patients in balanced scorecard (BSC) implementations to evaluate their performance. This paper aims to develop an instrument to engage patients in assessing BSC perspectives (BSC-PATIENT) and customize it for Palestinian hospitals. Two panels of experts participated in the item generation of BSC-PATIENT. Translation was performed based on guidelines. Pretesting was performed for 30 patients at one hospital. Then, 1000 patients were recruited at 14 hospitals between January and October 2021. Construct validity was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Additionally, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were assessed to find redundant and low correlated items. As a result, the scales had a highly adequate model fit in the EFA and CFA. The final best fit model in CFA comprised ten constructs with 34 items. In conclusion, BSC-PATIENT is the first self-administered questionnaire specifically developed to engage patients in BSC and will allow future researchers to evaluate the impact of patient experience on attitudes toward BSC perspectives, as well as to compare the differences based on patient and hospital characteristics.

How to Engage Health Care Workers in the Evaluation of Hospitals: Development and Validation of BSC-HCW1—A Cross-Sectional Study

“…BSC-HCW1 was developed using the previously reported technique for BSC-PATIENT development [ 23 ] with HCW adaptation. The same two panel experts conducted item and scale generation.…”

“…In addition, hospital executives were invited to indicate any additional important subdimension or KPI that was not included on the list. The characteristics and sociodemographics of this panel were described in a previous study [ 23 ]. For the following stage, we identified the important subdimensions.…”

“…We specified an average score of seven as a threshold. These efforts were made in tandem with the creation of BSC-PATIENT [ 23 ]. As a consequence, 58 items remained.…”

“…Because of the large number of KPIs, we narrowed our focus to those that are directly related to the demands of HCWs at each BSC perspective. In tandem with reviewing 34 studies in the literature [ 2 , 6 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], we separately examined 77 causal linkages between each BSC dimension or KPIs and HCW satisfaction and loyalty, as explained in the perspectives below. We made this choice since HCW satisfaction was deemed one of the latest affected perspectives in the strategic maps [ 53 ].…”

“…In BSC, this perspective is usually combined with the information perspective. However, previous studies revealed the need to evaluate them separately [ 2 , 23 ]. The effect of technical and medical equipment on HCW satisfaction was assessed in this context [ 21 ].…”