Evaluating clinician experience in value-based health care: the development and validation of the Clinician Experience Measure (CEM)

Abstract

Background Clinicians’ experiences of providing care constitute an important outcome for evaluating care from a value-based healthcare perspective. Yet no currently available instruments have been designed and validated for assessing clinicians’ experiences. This research sought to address this important gap by developing and validating a novel instrument in a public health system in Australia. Methods A multi-method project was conducted using co-design with 12 clinician leaders from a range of NSW Health Local Health Districts to develop the Clinician Experience Measure (CEM). Validity and reliability analyses were conducted in two stages, first assessing face and content validity with a pool of 25 clinicians and then using psychometric analysis with data from 433 clinicians, including nurses, doctors and allied health and representing all districts within one jurisdiction in Australia. Results Data gathered from 25 clinicians via the face and content validity process indicated that the initial 31-items were relevant to the range of staff employed in the NSW state health system, with minor edits made to the survey layout and wording within two items. Psychometric analysis led to a rationalised 18-item final instrument, comprising four domains: psychological safety (4-items); quality of care (5-items); clinician engagement (4-items) and interprofessional collaboration (5-items). The 18-item four-factor model produced a good fit to the data and high levels of reliability, with factor loadings ranging from .62 to .94, with Cronbach’s alpha (range: .83 to .96) and composite reliability (range: .85 to .97). Conclusions The CEM is an instrument to capture clinicians’ experiences of providing care across a health system. The CEM provides a useful tool for healthcare leaders and policy makers to benchmark and assess the impact of value-based care initiatives and direct change efforts.

Measuring clinician experience in value-based healthcare initiatives: a 10-item core clinician experience measure

“…The CEM-10 captures the key indicators of clinician's experiences of providing care as determined by international research literature, 3 but also by clinicians in the NSW public health system. 6 In doing so, the CEM-10 is a contextually relevant instrument for VBHC initiatives in NSW that requires examination for relevance to further Australian and international health systems.…”

“…4,5 Clinician experience was defined as 'clinicians' perceptions of the quality and safety of care provision, interprofessional collaboration, work environment, their engagement in decision-making, and psychological experiences in the workplace when providing care'. 6 The definition was used as a basis for the co-design and construction of an 18-item clinician experience measure (CEM) comprising four domains. The 18-item CEM was applied to enable the New South Wales (NSW) health system to benchmark and assess clinicians' experiences of providing care system-wide during the acute coronavirus disease 2019 (COVID-19) pandemic period.…”

Community-based participatory-research through co-design: supporting collaboration from all sides of disability

“…However, as identified by Rahman et al [16], the 'why' is well known, but there is limited knowledge of 'how' to co-design. Multiple articles provide high-level descriptions of workshops or briefly mention the co-design process [13,[17][18][19]. Pearce et al [5] include an in-depth table of activities across an entire co-creation process, however within each part i.e., co-design, limited descriptions were included.…”