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The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare

BACKGROUND: Few validated assessment tools are available to increase understanding and measure factors associated with sustainment of clinical practices, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool (CSAT), designed to a...

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Autores principales: Malone, Sara, Prewitt, Kim, Hackett, Rachel, Lin, John C., McKay, Virginia, Walsh-Bailey, Callie, Luke, Douglas A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285819/
https://www.ncbi.nlm.nih.gov/pubmed/34274004
http://dx.doi.org/10.1186/s43058-021-00181-2
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author Malone, Sara
Prewitt, Kim
Hackett, Rachel
Lin, John C.
McKay, Virginia
Walsh-Bailey, Callie
Luke, Douglas A.
author_facet Malone, Sara
Prewitt, Kim
Hackett, Rachel
Lin, John C.
McKay, Virginia
Walsh-Bailey, Callie
Luke, Douglas A.
author_sort Malone, Sara
collection PubMed
description BACKGROUND: Few validated assessment tools are available to increase understanding and measure factors associated with sustainment of clinical practices, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool (CSAT), designed to assess factors that contribute to sustainable practices in clinical settings. METHODS: Sixty-four participants from clinical and research fields participated in concept mapping and were recruited to brainstorm factors that lead to sustained clinical practices. Once repeated factors were removed, participants sorted items based on similarity and rated them by importance and feasibility. Using concept mapping analyses, items were grouped into meaningful domains to develop an initial tool. We then recruited pilot sites and early adopters, for a total of 286 practicing clinicians, to pilot and evaluate the tool. Individuals were recruited from clinical settings across pediatric and adult medical and surgical subspecialties. The data were analyzed using confirmatory factor analysis (CFA) to test hypothesized subscale structure in the instrument. We used root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) to assess fit and thus the ability of CSAT to measure the identified domains. RESULTS: The concept mapping produced sorted statements that were edited into items that could be responded to, resulting in the creation of a tool with seven determinant domains and 47 items. The pilot and CFA testing resulted in a final CSAT instrument made up 35 items, five per domain. CFA results demonstrated very good fit of the seven domain structure of the CSAT (RMSEA = 0.049; SRMR = 0.049). Usability testing indicated the CSAT is brief, easy to use, easy to learn, and does not require extensive training. Additionally, the measure scored highly (18/20) on the Psychometric and Pragmatic Evidence Rating Scale (PAPERS). The seven final CSAT domains were engaged staff and leadership, engaged stakeholders, organizational readiness, workflow integration, implementation and training, monitoring and evaluation, and outcomes and effectiveness. CONCLUSIONS: The CSAT is a new reliable assessment tool which allows for greater practical and scientific understanding of contextual factors that enable sustainable clinical practices over time. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-021-00181-2.
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spelling pubmed-82858192021-07-19 The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare Malone, Sara Prewitt, Kim Hackett, Rachel Lin, John C. McKay, Virginia Walsh-Bailey, Callie Luke, Douglas A. Implement Sci Commun Methodology BACKGROUND: Few validated assessment tools are available to increase understanding and measure factors associated with sustainment of clinical practices, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool (CSAT), designed to assess factors that contribute to sustainable practices in clinical settings. METHODS: Sixty-four participants from clinical and research fields participated in concept mapping and were recruited to brainstorm factors that lead to sustained clinical practices. Once repeated factors were removed, participants sorted items based on similarity and rated them by importance and feasibility. Using concept mapping analyses, items were grouped into meaningful domains to develop an initial tool. We then recruited pilot sites and early adopters, for a total of 286 practicing clinicians, to pilot and evaluate the tool. Individuals were recruited from clinical settings across pediatric and adult medical and surgical subspecialties. The data were analyzed using confirmatory factor analysis (CFA) to test hypothesized subscale structure in the instrument. We used root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) to assess fit and thus the ability of CSAT to measure the identified domains. RESULTS: The concept mapping produced sorted statements that were edited into items that could be responded to, resulting in the creation of a tool with seven determinant domains and 47 items. The pilot and CFA testing resulted in a final CSAT instrument made up 35 items, five per domain. CFA results demonstrated very good fit of the seven domain structure of the CSAT (RMSEA = 0.049; SRMR = 0.049). Usability testing indicated the CSAT is brief, easy to use, easy to learn, and does not require extensive training. Additionally, the measure scored highly (18/20) on the Psychometric and Pragmatic Evidence Rating Scale (PAPERS). The seven final CSAT domains were engaged staff and leadership, engaged stakeholders, organizational readiness, workflow integration, implementation and training, monitoring and evaluation, and outcomes and effectiveness. CONCLUSIONS: The CSAT is a new reliable assessment tool which allows for greater practical and scientific understanding of contextual factors that enable sustainable clinical practices over time. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-021-00181-2. BioMed Central 2021-07-17 /pmc/articles/PMC8285819/ /pubmed/34274004 http://dx.doi.org/10.1186/s43058-021-00181-2 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Methodology
Malone, Sara
Prewitt, Kim
Hackett, Rachel
Lin, John C.
McKay, Virginia
Walsh-Bailey, Callie
Luke, Douglas A.
The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare
title The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare
title_full The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare
title_fullStr The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare
title_full_unstemmed The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare
title_short The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare
title_sort clinical sustainability assessment tool: measuring organizational capacity to promote sustainability in healthcare
topic Methodology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285819/
https://www.ncbi.nlm.nih.gov/pubmed/34274004
http://dx.doi.org/10.1186/s43058-021-00181-2
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