DUQuA measures: content, evidence of reliability and validity, and collection methods
| Measures | Content | Reliability and validity | Collection methods |
|---|---|---|---|
| Organisation-level QMS | |||
| QMSI | Ten subscales: quality policy; hospital governance board activities; quality resources; quality management; evidence-based medicine protocols; preventive protocols; internal quality methods (for general activities, personnel, clinical practice, patients) | Satisfactory internal consistency (0.72–0.82) was demonstrated for eight scales. The scale with the low coefficient—analysing feedback and patient experiences (α=0.48)—was retained due to the theoretical importance of this topic15* | Self-report questionnaire completed by the hospital's Quality Manager or equivalent (n=1) |
| QMCI | Four subscales: quality planning; monitoring patient and professional opinions; quality control and monitoring; improving quality of care | Cronbach's reliability coefficients were satisfactory (0.74–0.78) for the four scales16* | Quality assessment by experienced hospital surveyor (site visit) |
| CQII | Seven subscales: preventing and controlling healthcare associated infections; medication safety; preventing patient falls; preventing pressure injuries; routine assessment and diagnostic testing of patients in elective surgery; safe surgery that includes an approved checklist; recognising and responding to clinical deterioration in acute healthcare | Cronbach's reliability coefficients were satisfactory (0.82–0.93) for the seven scales16* | Quality assessment by experienced hospital surveyor (site visit) |
| Department-level QMS | |||
| SER | Assignment of clinical responsibilities for a condition | Factor loadings and Cronbach's α values reported as: AMI (0.58–0.63, α=0.69), stroke (0.29–0.50, α=0.46), and hip fracture (0.65–0.69, α=0.76)17* | Quality assessment by experienced hospital surveyor (site visit) |
| EBOP | Organisation of department processes (admission, acute care, and discharge to facilitate evidence-based care recommendations) | It was not possible to build one generic scale for the EBOP, because it consists of different items across pathways17* | Quality assessment by experienced hospital surveyor (site visit) |
| PSS | Use of international consensus based patient safety recommendations | Despite the same items being used across pathways for PSS, factor analysis did not produce a generic scale for the four pathways17* | Quality assessment by experienced hospital surveyor (site visit) |
| CR | Integration of audit and systematic monitoring in departmental quality management mechanisms | Factor loadings and Cronbach's α values reported as: AMI (0.64–0.91, α=0.86), stroke (0.65–0.93, α=0.84), and hip fracture (0.36–0.91, α=0.76)17* | Quality assessment by experienced hospital surveyor (site visit) |
| Department-level culture and leadership | |||
| SAQ and Shipton and colleagues’ Leadership Effectiveness Scale | Three subscales: teamwork climate (the perceived quality of collaborating between personnel); safety climate (perceptions of a strong and proactive organisational commitment to patient safety); perceptions of management (administrative and managerial support, staffing levels, and managerial style in the workplace) Leadership effectiveness (staff perceptions of the effectiveness of healthcare leaders in their workplace) | Composite scale reliability for the SAQ was 0.90 (Raykov's ρ coefficient), indicating strong reliability41 Validated in a survey of approximately 18 000 employees of the National Health Service in the UK (Cronbach's α=0.92)42 | Combined into a self-report questionnaire completed by doctors, nurses, and allied health professionals working in stroke, AMI, and hip fracture wards, and the ED (n=80) |
| Patient-level clinical treatment processes | |||
| Clinical audit tools | Nationally recognised process composite indicators based on evidence of impact on patient outcomes | NA | Patient data retrieved from national registries and/or by medical record review (n=90) |
| Patient-level outcomes | |||
| Nationally collected audit data | Includes readmission and mortality rates, and length of stay | NA | Collected from publicly available national data |
| Patient perceptions of care | |||
| PMOS | Eight domains: communication and team work; organisation and care; access to resources; ward type and layout; information; staff roles and responsibilities; staff training; equipment | Reliability was established using Cronbach's α (0.66–0.89) and test-retest reliability (r=0.75). The positive index significantly correlated with staff reported ‘perceptions of patient safety’ (r=0.79) and ‘patient safety grade’ (r=−0.81) outcomes from the Agency for Healthcare Research and Quality Safety Culture Survey, demonstrating convergent validity43 | Self-report or assisted questionnaire completed by patients meeting the inclusion criteria (AMI, stroke, and hip fracture) (n=90) |
n, participants per hospital.
*Reliability and validity details for original DUQuE measures, not the adapted versions.
AMI, acute myocardial infarction; CR, Clinical Review; CQII, Clinical Quality Implementation Index; DUQuE, Deepening our Understanding of Quality Improvement in Europe; EBOP, Evidence-Based Organisation of Pathways; ED, emergency department; NA, not available; PMOS, Patient Measure of Safety; PSS, Patient Safety Strategies; QMS, quality management systems; QMCI, Quality Management Compliance Index; QMSI, Quality Management Systems Index; SAQ, Safety Attitudes Questionnaire; SER, Specialized Expertise and Responsibility.