Civility Among Healthcare
Employees: The Impact on Patients
AcademyHealth Annual Research Meeting
June 2005 v Boston, MA
Mark Meterko PhD1, David Mohr PhD1,
Martin Charns DBA1, Nicholas Warren ScD2,
Michael Hodgson MD MPH3
1VA
HSR&D Center for Organization, Leadership & Management Research
2University of Connecticut Health Center
3VA Occupational Health Program
Study Goals
• Examine empirical support for a civility
scale within VA national employee
survey
• Explore the relationship between
employee civility and organization
performance
– Patient satisfaction
2
Study Design
• Secondary analysis of 3 independent
surveys administered in VHA in 2004:
– All Employee Survey (AES)
– Survey of Healthcare Experiences of
Patients (SHEP): Ambulatory Care
– SHEP: Inpatient Care
3
2004 All Employee Survey (AES)
• Anonymous survey administered to a census of
VHA employees in April/May 2004
• Available to employees by web, phone or paper
– 76% responded by web, 14% phone, 10% paper
• Response rate: 52% (n=110,490)
• 54 items divided among three perspectives
– Individual job satisfaction (13 items)
– Workgroup functioning (27 items)
– Organization culture (14 items)
4
2004 AES:
Workgroup Functioning Scales
•
•
•
•
•
•
•
Leadership
Resources
Rewards & Recognition
Planning & Evaluation
Diversity Acceptance
Employee Development
Cooperation
•
•
•
•
•
•
•
Supervisory Support
Innovation
Customer Orientation
Work-Family Balance
Pay Satisfaction
Conflict Resolution
Change Management
5
2004 SHEP Surveys
• Monthly national random samples
– VHA Office of Quality and Performance (OQP)
• Mail administration
– Modified Dillman method with follow-up of nonrespondents
• Approximately 100 items in four sections
–
–
–
–
Evaluations of care (Picker)
Functional status (SF-12)
Demographics
Health behaviors
• Response rates
– Outpatient: 70% (n=74,667)
– Inpatient: 56% (n=39,657)
6
2004 SHEP:
Evaluations of Ambulatory & Inpatient Care
Ambulatory & Inpatient
• Access
• Courtesy
• Emotional Support
• Patient Education
• Coordination
• Patient Preferences
• Overall Quality
Ambulatory Only
• Continuity of Care
• Overall Coordination
• Specialist Care
•
Pharmacy: Mail
•
Pharmacy: Window
Inpatient Only
• Family Involvement
• Physical Comfort
• Transition
7
Analysis Plan
• Randomly split employee survey respondents
into derivation & validation samples
• Identify: Exploratory factor analysis
– Derivation sample
• Confirm: Multi-trait analysis (MTA)
– Validation sample
• Explore: Examine relationship between
workgroup functioning & performance (patient
satisfaction)
8
Exploratory Factor Analysis Results
• Management for Achievement (k=10; alpha=.93)
– Employees rewarded for high quality service
– Managers set challenging but attainable goals
• Civility & Coworker Support (k=10; alpha=.93)
– People treat each other with respect
– Managers work well with employees of different
backgrounds
• Resources (k=5; alpha=.81)
– Employees are protected from health hazards
– Employees have supplies, materials & equipment they
need to do job
• Pace (k=1)
– My job requires that I work very fast
9
Multi-Trait Analysis (MTA) Results
• Based on multi-trait/multi-method technique
– Evaluates the assumptions of Likert measures of
multiple constructs in a single instrument
• Percent item internal consistency: 100%
– Correlation with own scale >=.40
• Percent item discriminant validity: 96%
– Correlation of item with own scale significantly
greater than with any other scale
10
Mean Civility Scores for Selected Workgroups with Five or More
Respondents (n=6261)
Ten Lowest Means, Ten Highest Means, Five at Median
5.00
4.73 4.74 4.74 4.76 4.80 4.81 4.81
4.83 4.86 4.95
4.50
Civility Scale Score
4.00
3.47 3.47 3.47 3.47 3.47
3.50
3.00
2.50
2.00 1.79 1.80
1.95 1.98
1.85 1.91 1.91
2.00 2.03 2.07
1.50
1.00
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Workgroup
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24
25
Workgroup Functioning & Patient Satisfaction
• Correlations among four workgroup scales
– Ranged from .10 to .81
– Median r = .57
• Correlations with patient satisfaction
– Outpatient (12 dimensions): Strong (>=.30) correlations
•
•
•
•
Civility (6)
MFA (1)
Resources & Safety (0)
Pace (0)
– Inpatient (10 dimensions): Strong (>=.30) correlations
•
•
•
•
Civility (8)
MFA (0)
Resources & Safety (1)
Pace (9)
12
Relationship of Workplace Civility to
SHEP Outpatient (Black) & SHEP Inpatient (Blue) Overall Quality Ratings
Quartile Utility Analysis
85
SHEP Score (min=0/max=100)
83
81
79.5
79
77.37
77
77.32
75.72
75
75.18
73.81
73
71.85
71.1
71
69
67
65
Quartile 4
High Civility
Quartile 3
Quartile 2
Quartile 1
Low Civility
Civility Quartile Group
Quartile 4
High Civility
Quartile 3
Quartile 2
Quartile 1
Low Civility
Civility Quartile Group
13
10
Summary:
Differences between Top and Bottom Quartiles on
SHEP Outpatient (Green) & SHEP Inpatient (Red) Overall Quality Ratings
for Four AES Scales
SHEP Points (0-100 scale)
9
8.4
8
7
6
6.45
6.46
Resources
Pace
5.52
5
4
3.25
4
3.6
3
2
1
0.38
0
Civility
Mgmt For
Ach
Resources
Outpatient
Pace
Civility
Mgmt for
Ach
Inpatient
14
Conclusions & Next Steps
• Civility is one of four constructs measured
by AES
• Civility among employees positively related
to patient satisfaction
• Next Steps
– Examine relationship between organization
culture, civility & performance
• Culture  Civility  Performance
15