Development and psychometric testing of the clinical networks engagement tool

Abstract

BackgroundClinical networks are being used widely to facilitate large system transformation in healthcare, by engagement of stakeholders throughout the health system. However, there are no available instruments that measure engagement in these networks.MethodsThe study purpose was to develop and assess the measurement properties of a multiprofessional tool to measure engagement in clinical network initiatives. Based on components of the International Association of Public Participation Spectrum and expert panel review, we developed 40 items for testing. The draft instrument was distributed to 1,668 network stakeholders across different governance levels (leaders, members, support, frontline stakeholders) in 9 strategic clinical networks in Alberta (January to July 2014). With data from 424 completed surveys (25.4% response rate), descriptive statistics, exploratory and confirmatory factor analysis, Pearson correlations, linear regression, multivariate analysis, and Cronbach alpha were conducted to assess reliability and validity of the scores.ResultsSixteen items were retained in the instrument. Exploratory factor analysis indicated a four-factor solution and accounted for 85.7% of the total variance in engagement with clinical network initiatives: global engagement, inform (provided with information), involve (worked together to address concerns), and empower (given final decision-making authority). All subscales demonstrated acceptable reliability (Cronbach alpha 0.87 to 0.99). Both the confirmatory factor analysis and regression analysis confirmed that inform, involve, and empower were all significant predictors of global engagement, with involve as the strongest predictor. Leaders had higher mean scores than frontline stakeholders, while members and support staff did not differ in mean scores.ConclusionsThis study provided foundational evidence for the use of this tool for assessing engagement in clinical networks. Further work is necessary to evaluate engagement in broader network functions and activities; to assess barriers and facilitators of engagement; and, to elucidate how the maturity of networks and other factors influence engagement.

Thematic Analysis

“…This variable-oriented strategy (Miles, Huberman, & Saldana, 2014) also facilitated cross-case analysis of the data during later stages of analysis. Phase 1 has been completed (Norris, Hecker, Rabatach, Noseworthy, & White, 2017; Norris, White, Nowell, Mrklas, & Stelfox, 2017). Phase 2 data are currently undergoing analysis, while data collection for Phase 3 has begun.…”

How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study

“…Within our program of research, SCN members at different organizational levels significantly differed in their views of the levels at which they were engaged: leaders were more engaged, while frontline clinicians were less engaged [ 46 ]. In this study, however, stakeholders across these same organizational groups defined engagement similarly—an unexpected finding.…”

“…Specifically, levels of engagement span from one-way information sharing to shared decision-making and stakeholder empowerment [ 40 – 42 ], a spectrum that involves increasingly participatory, transformative, and democratic processes [ 31 ]. While used to inform engagement with patient groups [ 43 ] and healthcare clinicians [ 44 , 45 ], there is minimal empirical evidence to support the use of these models in implementation [ 46 ].…”

Co-production as a co-creation or co-destruction process? An internal evaluation of a co- production exercise with family caregivers living in a rural and remote area  

“…In recent decades, practitioners and researchers have identi ed co-production as a possible solution for several managerial issues. Indeed, recent studies have suggested co-production as a means to increase users' satisfaction and trust in service providers [1], enhance innovation [2], and improve the effectiveness and e ciency of products and services [3,4]. However, its fame has increased to such an extent that the co-production concept has 'enchanted' its audience [5]; it seems to have become a magic solution for both public and private challenges [6].…”