Development and testing of the ‘Culture of Care Barometer’ (CoCB) in healthcare organisations: a mixed methods study

Abstract

ObjectiveConcerns about care quality have prompted calls to create workplace cultures conducive to high-quality, safe and compassionate care and to provide a supportive environment in which staff can operate effectively. How healthcare organisations assess their culture of care is an important first step in creating such cultures. This article reports on the development and validation of a tool, the Culture of Care Barometer, designed to assess perceptions of a caring culture among healthcare workers preliminary to culture change.Design/setting/participantsAn exploratory mixed methods study designed to develop and test the validity of a tool to measure ‘culture of care’ through focus groups and questionnaires. Questionnaire development was facilitated through: a literature review, experts generating items of interest and focus group discussions with healthcare staff across specialities, roles and seniority within three types of public healthcare organisations in the UK. The tool was designed to be multiprofessional and pilot tested with a sample of 467 nurses and healthcare support workers in acute care and then validated with a sample of 1698 staff working across acute, mental health and community services in England. Exploratory factor analysis was used to identify dimensions underlying the Barometer.ResultsPsychometric testing resulted in the development of a 30-item questionnaire linked to four domains with retained items loading to four factors: organisational values (α=0.93, valid n=1568, M=3.7), team support (α=0.93, valid n=1557, M=3.2), relationships with colleagues (α=0.84, valid n=1617, M=4.0) and job constraints (α=0.70, valid n=1616, M=3.3).ConclusionsThe study developed a valid and reliable instrument with which to gauge the different attributes of care culture perceived by healthcare staff with potential for organisational benchmarking.

Developing the Australian Midwifery Workplace Culture instrument

“…Basing the questions on the established CoCB instrument (Rafferty et al, ) provided a robust foundation for the development of the AMWoC instrument, as the CoCB items were content valid and reliable measures of workplace culture. However, as nurses predominated in the CoCB development and testing process, and the instrument aimed at a more generic health workforce (Rafferty et al, ), it was necessary to re‐word some original items to ensure they were applicable to midwifery contexts.…”

“…These domains differed from those we originally hypothesized, based on the seven themes identified in the CoCB development process (Rafferty et al, ). Neither did they match the domains in the CoCB final version (addressing macro, meso and micro levels of workplace culture) (Rafferty et al, ). The AMWoC instrument also varies in scope from the Perceptions of Empowerment in Midwifery Scale, having a greater emphasis on teamwork and relationships with peers.…”

“…The AMWoC instrument was substantially based on the Culture of Care Barometer (CoCB), a validated tool developed to assess workplace culture in British healthcare organizations (Rafferty et al, ). The CoCB had 30 items grouped into four subscales (or domains) associated with dimensions of the workplace environment: macro (organizational values), meso (team support relationships and management and development of employees) and two micro level domains (relationships with colleagues and resource issues).…”

“…Many quantitative instruments have been developed to measure multiple dimensions of organization culture within healthcare environments, with differing characteristics, purposes and properties (Mannion et al, ). More recently, the Culture of Care Barometer (CoCB) (Rafferty, Philippou, Fitzpatrick, Pike, & Ball, ) was based on a national strategy to enhance compassionate healthcare in England, and had at its core, the 6Cs for health professional values: care, compassion, competence, communication, courage and commitment. The authors of this tool argued that there were inseparable links between workplace culture and the quality of care given, and that in order for compassion to thrive in healthcare, positive workplace environments were essential.…”

“…We developed the Australian Midwifery Workplace Culture (AMWoC) instrument, based on the British CoCB (Rafferty et al, ). The purpose of the AMWoC instrument is to assess multiple dimensions of midwifery workplace culture encompassing not only personal dimensions of engagement, role and empowerment identified in measures such as PEMS, but also broader issues of resources, leadership, values and teamwork.…”