Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale

Erin P. Finley; Jacqueline A. Pugh; Holly Jordan Lanham; Luci K. Leykum; John Cornell; Poornachand Veerapaneni; Michael L. Parchman

doi:10.1370/afm.1554

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Re: Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale
David C Mohr

Published on: 07 February 2014
Re: Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale
Michelle Howard

Published on: 23 January 2014

Published on: (7 February 2014)
Page navigation anchor for Re: Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale
Re: Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale
David C Mohr, (1), Research Investigator.
Other Contributors:
Finley and colleagues' paper presents the development and multi-modal validation of a 15-item scale to assess work relationships among clinicians and staff in the delivery of primary care. Much interest exists among academics and practitioners in identifying, operationalizing, and measuring essential variables for work relationships among members of healthcare teams (1, 2, 3). Many of these efforts have led to the develo...
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Finley and colleagues' paper presents the development and multi-modal validation of a 15-item scale to assess work relationships among clinicians and staff in the delivery of primary care. Much interest exists among academics and practitioners in identifying, operationalizing, and measuring essential variables for work relationships among members of healthcare teams (1, 2, 3). Many of these efforts have led to the development of survey-based instruments that often share certain common domains (e.g., communication) but also differ in their inclusion of other domains. Even among instruments that share domains, differences often exist regarding conceptualization and measurement.
Finley et al., developed their scale by drawing from a conceptual model comprising seven characteristics of work relationships. (4) In addition to various psychometric analyses, they also assessed the validity of their scale through qualitative methods that entailed interviews at different clinics that scored on either the high or low end of their scale. We believe the combination of quantitative and qualitative approaches toward scale validation is a great strength of the study. We also suggest further research using mixed methods to distinguish, conceptually and empirically, important differences among scales that measure characteristics of effective work relationships among members of healthcare delivery teams. For example, what distinguishes a scale of relational coordination from one of relational climate, which have both been presented as a scales for measuring work relationships in healthcare.
Further, work relationship measures have been developed for use in specific health care settings, such as operating rooms and inpatient medicine. Greater integration and comparison of findings across settings would be useful; specifically, an exploration of whether certain work relationship factors are more important than others in different settings. A comparative study of instruments would be a great step in helping better understand the unique and complex nature of work relationships.
In addition, health care workers are increasingly working with a greater diversity of team members, such as inclusion of pharmacists on primary care teams. (5) Job roles and responsibilities are also changing in response to the formation of Patient-Centered Medical Homes and Accountable Care Organizations. How well do existing models and measures for effective working relationships generalize for changes in team composition and delivery models? As such, important new opportunities and challenges exist for the development of scales for measuring work relationships in healthcare settings.
1. Battles J, King HB. TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPC) Manual. Washington, DC: American Institute for Research, 2010
2. Stock R, Mahoney E., Carney PA. Measuring team development in clinical care settings. Fam Med. 2013; 45(10): 691-700.
3. Mohr DC, Benzer JK, Young GJ. Provider workload and quality of care in primary care settings: Moderating role of relational climate. Med Care 2013; 51: 108-114.
4. Lanahm HJ, McDaniel RR Jr, Crabtree BF, Miller WL, Stange KC, Tallia AF, Nutting, P. How improving practice relationships among clinicians and nonclinicians can improve the quality in primary care. Jt Comm J Qual Patient Saf. 2009; 35(9): 457-466.
5. Farrell B, Warnd N, Dore N, Russell G, Geneau R, Evans S. Working in interprofessional primary health care teams: What do pharmacists do? Res Social Adm Pharm. 2013; 9(3) 288-301.
David C. Mohr (1), Gary J. Young (1,2)
(1) VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, (2) Northeastern University Center for Health Policy and Healthcare Research, D'Amore-McKim School of Business and Bouve College of Health Sciences, Northeastern University
Competing interests: None declared
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Competing Interests: None declared.
Published on: (23 January 2014)
Page navigation anchor for Re: Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale
Re: Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale
Michelle Howard, Assistant Professor
Other Contributors:
This paper provides a succinct and validated scale measuring an important aspect of teamwork in primary care. It is interesting that one dimension was established in the instrument although the survey items appear to tap into issues of both relationships amongst people and openness to change in the work environment. Perhaps good relationships are forged through change, or people with good relationships are more willin...
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This paper provides a succinct and validated scale measuring an important aspect of teamwork in primary care. It is interesting that one dimension was established in the instrument although the survey items appear to tap into issues of both relationships amongst people and openness to change in the work environment. Perhaps good relationships are forged through change, or people with good relationships are more willing to take on the stresses of change and improvement efforts. The association between relationships in the clinic and patient perceptions of quality of care is rarely seen in the literature, as the authors note. With the coming of patient-centred medical homes in the U.S. and similar primary care models in other countries aiming to improve outcomes for patients through interprofessional teams(1), it will be important to have rigorous measures of these unfolding processes.
1. Rosser WW, Colwill JM, Kasperski J, Wilson L. Patient-centered medical homes in Ontario. N Engl J Med. 2010 Jan 21;362(3):e7
Competing interests: ?? None declared
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Competing Interests: None declared.