Development and evaluation of a hospital management practice rating scale

Abstract

Background: Lacking methods to quantify the inter-hospital variance in hospital management practice (HMP) is a bottle neck for research on HMP and quality of care. This study aims to quantify the inter-hospital variance in HMP by developing a novel rating scale of HMP and evaluating its feasibility, reliability and validity.Methods: Based on the theory of hospital management, we developed a HMP rating scale with 4 dimensions: Target, operations, performance and talent management. We used questionnaires to collect relevant information from the hospital director, the medical affairs director, the head of the department of cardiology, and a cardiologist. And we also requested a list of administration documents. For validation of the scale, we applied it to 101 hospitals that had participated in the Third Phase of the Clinical Pathways in Acute Coronary Syndromes Study (CPACS-3) in 2013 and repeated it in 2014.Results: The HMP rating scale includes 17 indicators and 47 sub-indicators in the four dimensions; 85% and 97% of hospitals responded to the first and second survey respectively. A high degree of the test-retest reliability for the overall score (ICC = 0.8) was found between the two time points. Both split-half and Cronbach’α coefficient of the overall score exceeded 0.85. Cumulative percentage of variance in all dimensions was above 60%, and factors extracted in each dimension were highly consistent with the designed indicators and sub-indicators. The overall HMP score was different between hospital groups with different revenues, patients’ hospital stays, and number of clinical pathways (All p values < .01).Conclusions: The HMP rating scale was demonstrated reliable, valid, and responsive, but future studies with larger sample size in different settings are needed to confirm the study findings.