Assessing Patient Experience and Attitude: BSC-PATIENT Development, Translation, and Psychometric Evaluation-A Cross-Sectional Study

Abstract

Health care organizations (HCO) did not consider engaging patients in balanced scorecard (BSC) implementations to evaluate their performance. This paper aims to develop an instrument to engage patients in assessing BSC perspectives (BSC-PATIENT) and customize it for Palestinian hospitals. Two panels of experts participated in the item generation of BSC-PATIENT. Translation was performed based on guidelines. Pretesting was performed for 30 patients at one hospital. Then, 1000 patients were recruited at 14 hospitals between January and October 2021. Construct validity was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Additionally, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were assessed to find redundant and low correlated items. As a result, the scales had a highly adequate model fit in the EFA and CFA. The final best fit model in CFA comprised ten constructs with 36 items. In conclusion, BSC-PATIENT is the first self-administered questionnaire specifically developed to engage patients in BSC and will allow future researchers to evaluate the impact of patient experience on attitudes toward BSC perspectives, as well as to compare the differences based on patient and hospital characteristics.

Keywords: balanced scorecard; hospital; patient engagement; performance evaluation; quality; satisfaction.

Figure 2

Duke University Health System Strategic Map [15].

Figure 1

Balanced Scorecard perspectives [11].

Figure 3

A summary of BSC perspectives in health care and their contents [12]. Figure legend: Summary of BSC perspectives and the underlying major and minor subdimensions for the PE of HCOs. Note: BSC, balanced scorecard; HCWs, health care workers; HCO, health care organization; IC, infection control; HW, health waste; WT, waiting time; LOS, length of stay; KAP knowledge, attitude, and practices; TI, technology and information; CSR, corporate social responsibility; ERRORS, errors, accidents, and complications; No. of AVD, number of admissions, visits, and diseases; EUP, efficiency, utilization, and productivity; AQSS, availability and quality of supplies and services; OPT, operation processing time; RESCOMM, response to patients’ needs; Patient-CENT, patient-centeredness; ENGMOT, HCWs’ engagement and motivation; HCW-CENT, HCW-centeredness; MANAGPE, managerial tasks and performance evaluation; SCIDEV, scientific development.

Figure 4

BSC-PATIENT conceptual model.

Figure 5

Flow chart for BSC-PATIENT development and psychometric validation.

Figure 6

Confirmatory factor analysis (CFA). Independent items on the right side and dependent items on the left side. Note: COMP IMAGE, complications perceived image; TECH IMAGE, technology perceived image; BSCP ATT, patient attitude toward balanced scorecard perspectives; INFO EXR, information experience; PR EXR, price experience; PT EXR, patient experience; ACC EXR, access experience; SERV EXR, services experience; BUILENV EXR, building environment experience; BUILCAP EXR, building capacity experience.