Psychometric evaluation of instruments measuring the work environment of healthcare professionals in hospitals: a systematic literature review

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Purpose</jats:title> <jats:p>Research shows that the professional healthcare working environment influences the quality of care, safety climate, productivity, and motivation, happiness, and health of staff. The purpose of this systematic literature review was to assess instruments that provide valid, reliable and succinct measures of health care professionals’ work environment in hospitals.</jats:p> </jats:sec> <jats:sec> <jats:title>Data sources</jats:title> <jats:p>Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, CINAHL EBSCOhost and Google Scholar were systematically searched from inception through December 2018.</jats:p> </jats:sec> <jats:sec> <jats:title>Study selection</jats:title> <jats:p>Pre-defined eligibility criteria (written in English, original work-environment instrument for healthcare professionals and not a translation, describing psychometric properties as construct validity and reliability) were used to detect studies describing instruments developed to measure the working environment.</jats:p> </jats:sec> <jats:sec> <jats:title>Data extraction</jats:title> <jats:p>After screening 6397 titles and abstracts, we included 37 papers. Two reviewers independently assessed the 37 instruments on content and psychometric quality following the COSMIN guideline.</jats:p> </jats:sec> <jats:sec> <jats:title>Results of data synthesis</jats:title> <jats:p>Our paper analysis revealed a diversity of items measured. The items were mapped into 48 elements on aspects of the healthcare professional’s work environment. Quality assessment also revealed a wide range of methodological flaws in all studies.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>We found a large variety of instruments that measure the professional healthcare environment. Analysis uncovered content diversity and diverse methodological flaws in available instruments. Two succinct, interprofessional instruments scored best on psychometrical quality and are promising for the measurement of the working environment in hospitals. However, further psychometric validation and an evaluation of their content is recommended.</jats:p> </jats:sec>

Defining a positive work environment for hospital healthcare professionals: A Delphi study

“…It would be interesting to study how we can blend several instruments to cover all elements. However, not every measurement tool has proven to be psychometrically valid and reliable [ 18 ]. It is wise to opt for a short, sound instrument that functions as a thermometer and identifies the WE areas that have issues.…”

“…Items pertaining to healthcare professionals’ WE were generated from a literature review [ 18 ] and semi-structured expert interviews.…”

“…The four criteria for inclusion were: 1) written in English, 2) reporting an original WE measurement instrument for healthcare professionals in hospitals; 3) not a translation or adaptation of another instrument; and 4) description of psychometric properties and distributed items into factors for construct validity. Based on these criteria, 37 papers were eligible for inclusion (see Maassen, Weggelaar-Jansen [ 18 ] for more information). Next, we extracted the items (subscales) of the instruments.…”

“…All elements that did not reach this threshold were excluded. The included elements were compared with the list of elements that were initially extracted by WE measurement tools in the literature review [ 18 ].…”

“…Because a positive WE is important for patients and employees, many organizations have embarked on efforts to measure their WE. However, there are many instruments for measuring the WE and these might lack consensus on which elements are important for a positive WE [ 17 , 18 ]. A clear and unambiguous understanding of the most important aspects for a positive WE, as perceived by healthcare professionals, is crucial if hospitals want to gain systematic objective insights into the WE.…”