BACKGROUND Measures that quantify clinician fulfillment and engagement with work (clinician experience measures) have the potential to improve the quality, effectiveness, and enjoyment of patient care. Many existing measures of clinician fulfillment and engagement with work are relatively long and potentially burdensome, negatively framed, or address personal well-being. A measure with a small number of items that address positive attributes to which a team aspires may be a more useful measure to guide organizational improvement efforts. QUESTIONS/PURPOSES In a series of cross-sectional studies we asked: (1) Can we develop a brief, positively framed, and team-oriented care team experience measure (CTEM)? (2) How does the CTEM perform relative to the Team Climate Inventory (TCI)? METHODS In a first step, the clinical leadership group of a nascent multispecialty group practice curated 21 items, some from existing engagement and burnout measures and others based on suggestions from clinical leaders. After pilot testing and interviews with specific clinicians, these items were then administered to all clinicians in the practice, and 44% (120 of 274) participated. Factor analysis identified three groups of items (factors). In a second step, 43% (493 of 1135) of patient-facing employees (75% [368] of whom were women and 45% [222] of whom were ages 42 to 61 years) of a statewide musculoskeletal specialty practice rated 12 items (two from each of the factors identified in the first stage and six new items recommended by administrative leaders) and completed the TCI. Participants were then randomly allocated to a learning cohort (70% [343 participants]), in which we performed factor analysis and item response theory to develop a new CTEM and validation cohort (30% [150 participants]) to test the consistency of the findings. The best-performing items in terms of factor loadings (the degree to which an individual item represents an identified factor or "theme"; we chose a minimum of 0.4 as items above this threshold are generally regarded as stable), item discrimination (ability to measure different experiences among participants), item difficulty (the ability of an item to contribute to variation in scores), and model fit (the degree to which the estimates of the statistical model align with the observed data) were selected to form a new three-item CTEM. The CTEM was subsequently evaluated for internal consistency (Cronbach alpha, which measures the extent to which different subsets of the included items would provide the same measurement), floor and ceiling effects (the percentage of the lowest and highest possible scores, with high percentages indicating that information is lost because of the inability of a tool to measure the extremes of variation), and correlation with the TCI. RESULTS Factor analysis identified two groups of items representing "effectiveness" (nine items, including "I am proud of the work we do") and "collaboration" (three items, including "Our team encourages everyone's input before making changes"). The best-performing items of "effectiveness" (two items) and "collaboration" (one item) were selected to form the three-item CTEM, which had good internal consistency (Cronbach α = 0.77; > 0.7 generally considered acceptable); a notable ceiling (37%; higher than desired, common with experience measures, and-in our opinion-acceptable for routine use given the trade-off of limited participant burden) and limited floor effect (1.3%); strong correlation with the TCI (Spearman ρ 0.77 [95% confidence interval 0.70 to 0.85]), which supports convergent validity (part of construct validity, meaning correlation with measures of related concepts); and similar correlations with participant characteristics compared with the TCI, supporting construct and criterion validity (association with real-world outcomes). CONCLUSION A small number of positively framed, team-oriented questions (the CTEM) can quantify clinician and care team experience and provide a practical and feasible method for health organizations to monitor and improve the experience of their clinicians. CLINICAL RELEVANCE Routine measurement of organizational climate at regular intervals using a brief, user-friendly, team-oriented measure might help organizations improve their culture and help their clinicians feel appreciated and engaged.

中文翻译：

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制定一个简短的、积极框架的护理团队体验测量。


背景 量化临床医生成就感和工作参与度的措施（临床医生经验测量）有可能提高患者护理的质量、有效性和享受。许多现有的临床医生成就感和工作参与度的衡量标准相对较长且可能很繁琐，具有消极的框架，或涉及个人幸福感。一个包含少量项目的度量值解决了团队渴望的积极属性，这可能是指导组织改进工作的更有用的度量值。问题/目的 在一系列横断面研究中，我们问道： （1） 我们能否制定一个简短的、积极的、以团队为导向的护理团队体验测量 （CTEM）？（2） CTEM 相对于团队气候量表 （TCI） 的表现如何？方法 第一步，一个新生的多专业小组实践的临床领导小组策划了 21 个项目，其中一些来自现有的参与度和倦怠措施，另一些则基于临床领导者的建议。在试点测试和与特定临床医生的访谈之后，这些项目被给予实践中的所有临床医生，44% （274 人中的 120 人） 参与。因子分析确定了三组项目 （factors）。第二步，全州肌肉骨骼专业实践中 43%（1135 人中的 493 人）面向患者的员工（其中 75% [368] 是女性，45% [222] 年龄在 42 至 61 岁之间）对 12 个项目（第一阶段确定的每个因素中各 2 个，行政领导推荐的 6 个新项目）进行了评分，并完成了 TCI。 然后将参与者随机分配到一个学习队列 （70% [343 名参与者]），其中我们进行因子分析和项目反应理论，以开发一个新的 CTEM 和验证队列 （30% [150 名参与者]）来测试结果的一致性。在因子载荷（单个项目代表已识别因素或“主题”的程度;我们选择的最低值为 0.4，因为高于此阈值的项目通常被认为是稳定的）、项目区分度（测量参与者之间不同体验的能力）、项目难度（项目导致分数变化的能力）方面表现最好的项目， 和模型拟合（统计模型的估计值与观察到的数据的一致程度）被选择以形成一个新的三项 CTEM。随后评估了 CTEM 的内部一致性（Cronbach alpha，它衡量所包含项目的不同子集在多大程度上提供相同的测量）、下限和上限效应（最低和最高可能分数的百分比，高百分比表示由于工具无法测量极端变化而丢失了信息）， 以及与 TCI 的相关性。结果 因子分析确定了两组项目，分别代表“有效性”（九个项目，包括“我为我们所做的工作感到自豪”）和“协作”（三个项目，包括“我们的团队在做出改变之前鼓励每个人的意见”）。选择表现最好的 “有效性” （2 项） 和 “协作” （1 项） 组成三项 CTEM，具有良好的内部一致性 （Cronbach α = 0.77;> 0.7 通常被认为是可以接受的）;显著的上限（37%;高于预期，与体验措施相同，并且我们认为考虑到有限的参与者负担的权衡，常规使用是可以接受的）和有限的下限效应（1.3%）;与 TCI （Spearman ρ 0.77 [95% 置信区间 0.70 至 0.85]）具有很强的相关性，它支持收敛效度（结构效度的一部分，意味着与相关概念的度量的相关性）;以及与 TCI 相比与参与者特征的类似相关性，支持结构和标准有效性（与真实世界结果的关联）。结论 少量积极构建、面向团队的问题 （CTEM） 可以量化临床医生和护理团队的体验，并为卫生组织提供一种实用可行的方法来监测和改善其临床医生的体验。临床相关性 使用简短、用户友好、面向团队的措施定期对组织氛围进行常规测量，可能有助于组织改善其文化，并帮助其临床医生感到被欣赏和参与。