Measuring the continuous quality improvement orientation of medical education programs

Int J Health Care Qual Assur. 2020 Feb 7;ahead-of-print(ahead-of-print). doi: 10.1108/IJHCQA-06-2019-0102.


Purpose: There is a growing interest in applying continuous quality improvement (CQI) methodologies and tools to medical education contexts. One such tool, the "Are We Making Progress" questionnaire from the Malcolm Baldrige National Quality Award framework, adequately captures the dimensions critical for performance excellence and allows organizations to assess their performance and identify areas for improvement. Its results have been widely validated in business, education, and health care and might be applicable in medical education contexts. The measurement properties of the questionnaire data were analyzed using Rasch modeling to determine if validity evidence, based on Messick's framework, supports the interpretation of results in medical education contexts. Rasch modeling was performed since the questionnaire uses Likert-type scales whose estimates might not be amenable to parametric statistical analyses.

Design/methodology/approach: Leaders and teachers at 16 of the 17 Canadian medical schools were invited in 2015-2016 to complete the 40-item questionnaire. Data were analyzed using the ConQuest Rasch calibration program, rating scale model.

Findings: 491 faculty members from 11 (69 percent) schools participated. A seven-dimensional, four-point response scale model better fit the data. Overall data fit to model requirements supported the use of person measures with parametric statistics. The structural, content, generalizability, and substantive validity evidence supported the interpretation of results in medical education contexts.

Originality/value: For the first time, the Baldrige questionnaire results were validated in medical education contexts. Medical education leaders are encouraged to serially use this questionnaire to measure progress on their school's CQI focus.

Keywords: Continuous quality improvement; Medicine; Organizational performance; Performance measurement; Psychometrics; Quality frameworks.

MeSH terms

  • Adult
  • Canada
  • Education, Medical, Undergraduate / standards*
  • Faculty, Medical / psychology
  • Humans
  • Models, Theoretical
  • Psychometrics / instrumentation*
  • Quality Improvement*
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Total Quality Management*