Civility Among Healthcare Employees: The Impact on Patients AcademyHealth Annual Research Meeting June 2005  Boston, MA Mark Meterko PhD 1, David Mohr PhD 1, Martin Charns DBA 1, Nicholas Warren ScD 2, Michael Hodgson MD MPH 3 1 VA HSR&D Center for Organization, Leadership & Management Research 2 University of Connecticut Health Center 3 VA Occupational Health Program

2 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

3 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

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)

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

SHEP Surveys Monthly national random samples –VHA Office of Quality and Performance (OQP) Mail administration –Modified Dillman method with follow-up of non- respondents 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)

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

8 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)

9 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

10 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

11 Mean Civility Scores for Selected Workgroups with Five or More Respondents (n=6261) Ten Lowest Means, Ten Highest Means, Five at Median

12 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)

13 Relationship of Workplace Civility to SHEP Outpatient (Black) & SHEP Inpatient (Blue) Overall Quality Ratings Quartile Utility Analysis Quartile 4 High Civility Quartile 3Quartile 2Quartile 1 Low Civility Quartile 4 High Civility Quartile 3Quartile 2Quartile 1 Low Civility Civility Quartile Group SHEP Score (min=0/max=100)

14 Summary: Differences between Top and Bottom Quartiles on SHEP Outpatient (Green) & SHEP Inpatient (Red) Overall Quality Ratings for Four AES Scales

15 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