A measurement instrument for spread of quality improvement in healthcare

Int J Qual Health Care. 2013 Apr;25(2):125-31. doi: 10.1093/intqhc/mzt016. Epub 2013 Feb 18.


Objective: The aim of this study was to develop and test a measurement instrument for spread of quality improvement in healthcare. The instrument distinguishes: (i) spread of work practices and their results and (ii) spread practices and effectiveness. Relations between spread and sustainability of changed work practices were also explored to assess convergent validity.

Design: We developed and tested a measurement instrument for spread in a follow-up study. The instrument consisted of 18-items with four subscales.

Setting and participants: The sample consisted of former improvement teams in a quality improvement program for long-term care (nteams = 73, nrespondents = 127). Data were collected in a questionnaire about 1 year post-pilot site improvement implementation.

Interventions: Quality improvements in long-term care practices.

Main outcome measures: Four variables were construed: (i) actions for spread of work practices, (ii) actions for spread of results, (iii) effectiveness of spread of work practices and (iv) effectiveness of spread of results.

Results: Psychometric analysis yielded positive results on the item level. The intended four-factor model yielded satisfactory fit. The internal consistency of each scale was fine (Cronbach's α 0.70-0.93). Bivariate correlations revealed that the spread variables were strongly related but distinct, and positively related to the sustainability variables.

Conclusions: The psychometric properties are in line with methodological standards. Convergent validity was confirmed with sustainability. The measurement instrument offers a good starting point for the analysis of spread.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diffusion of Innovation*
  • Female
  • Follow-Up Studies
  • Humans
  • Long-Term Care / standards*
  • Male
  • Netherlands
  • Psychometrics
  • Quality Improvement*
  • Surveys and Questionnaires*