Development of the Chinese version of the Hospital Autonomy Questionnaire: A cross-sectional study in Guangdong Province

Abstract

Objective: We aimed to develop a questionnaire for quantitative evaluation of the autonomy of public hospitals in China. Method: An extensive literature review was conducted to select possible items for inclusion in the questionnaire, which was then reviewed by 5 experts. After a two-round Delphi method, we distributed the questionnaire to 404 secondary and tertiary hospitals in Guangdong Province, China, and 379 completed questionnaires were collected. The final questionnaire was then developed on the basis of the results of exploratory and confirmatory factor analysis. Results: Analysis suggested that all internal consistency reliabilities exceeded the minimum reliability standard of 0.70 for the α coefficient. The overall scale coefficient was 0.87, and 6 subscale coefficients were 0.92 (strategic management), 0.81 (budget and expenditure), 0.85 (financing), 0.75 (financing, medical management), 0.86 (human resources) and 0.86 (accountability). Correlation coefficients between and among items and their hypothesised subscales were higher than those with other subscales. The value of average variance extracted (AVE) was higher than 0.5, the value of construct reliability (CR) was higher than 0.7, and the square roots of the AVE of each subscale were larger than the correlation of the specific subscale with the other subscales, supporting the convergent and discriminant validity of the Chinese version of the Hospital Autonomy Questionnaire (CVHAQ). The model fit indices were all acceptable: Ξ2/df=1.73, Goodness of Fit Index (GFI) = 0.93, Adjusted Goodness of Fit Index (AGFI) = 0.91, Non-Normed Fit Index (NNFI) = 0.96, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.04, Standardised Root Mean Square Residual (SRMR) = 0.07. Conclusions: This study demonstrated the reliability and validity of a CVHAQ and provides a quantitative method for the assessment of hospital autonomy.