The Patient Care Ownership Scale: Development of an Instrument to Measure Patient Care Ownership Among Internal Medicine Trainees

J Gen Intern Med. 2019 Aug;34(8):1530-1537. doi: 10.1007/s11606-019-05066-8. Epub 2019 Jun 3.


Background: Patient care ownership is essential to delivering high-quality medical care but appears to be eroding among trainees. The lack of an objective measure has limited the study of ownership in physicians.

Objective: To develop an instrument to measure psychological ownership of patient care.

Design: Cross-sectional study.

Participants: Internal medicine trainees in a large, academic hospital completing an inpatient rotation.

Main measures: Our scale prototype adapted an existing ownership scale (developed in the non-medical setting) based on themes identified in qualitative studies of patient care ownership. We conducted cognitive interviews to determine face validity of the scale items. Our finalized scale measures ownership's key constructs: advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, and perceived ownership. We distributed an online, anonymous, 46-question survey to 219 residents; 192 residents completed the survey; and 166 responses were included in the analysis. We calculated Cronbach's α to determine the scale's internal consistency. Exploratory factor analysis was used to explore possible subscales. We examined construct validity using bivariate and correlational analysis.

Key results: The 15-item ownership scale demonstrated good internal consistency (Cronbach's α = 0.89). We identified three possible subscales corresponding to assertiveness, being the "go-to" person, and diligence. Training level and prior intensive care unit experience significantly predicted ownership (p < 0.01). There was no significant relationship between ownership and age, gender, inpatient service type, call schedule, patient turnover, or supervisory experience of the attending physician. We found a significant negative correlation between ownership and perceived degree of burnout (r = - 0.33), depression (r = - 0.24), detachment (r = - 0.35), and frustration (r = - 0.31) and a significant positive association between ownership and fulfillment (r = 0.37) and happiness (r = 0.36).

Conclusion: We developed an instrument to quantify patient care ownership in residents. Our scale demonstrates good internal consistency and preliminary evidence of validity. With further validation, we expect this to be a valuable tool to evaluate interventions aimed at improving ownership.

Keywords: behavioral science; medical decision-making; medical education.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Female
  • Humans
  • Internal Medicine / education*
  • Internship and Residency
  • Male
  • Ownership
  • Patient Care / psychology*
  • Qualitative Research
  • Reproducibility of Results
  • Surveys and Questionnaires / standards*
  • Young Adult