Measuring organizational attributes of primary care practices: Development of a new instrument

Objective. To develop an instrument to measure organizational attributes relevant for family practices using the perspectives of clinicians, nurses, and staff. Data Sources/Study Setting. Clinicians, nurses, and office staff (n=640) from 51 community family medicine practices. Design. A survey, designed to measure a practices' internal resources for change, for use in family medicine practices was created by a multidisciplinary panel of experts in primary care research and health care organizational performance. This survey was administered in a cross-sectional study to a sample of diverse practices participating in an intervention trial. A factor analysis identified groups of questions relating to latent constructs of practices' internal resources for capacity to change. ANOVA methods were used to confirm that the factors differentiated practices. Data Collection. The survey was administered to all staff from 51 practices. Principal Findings. The factor analysis resulted in four stable and internally consistent factors. Three of these factors, "communication," "decision-making," and "stress/chaos, " describe resources for change in primary care practices. One factor, labeled "history of change," may be useful in assessing the success of interventions. Conclusions. A 21-item questionnaire can reliably measure four important organizational attributes relevant to family practices. These attributes can be used both as outcome measures as well as important features for targeting system interventions.