Abstract
Background: Capturing the provider’s experience, delivering care and provider well-being has become a major focus of health system leaders and recognized as the fourth component of the Quadruple Aim. However, tools to measure the experience of provider care are limited, with few examples in integrated care. Existing measurement is both specific to provider types/professional groups or is narrowly focused on teamwork measures. Instruments are needed to assess interprofessional health care providers experience and well-being in the context of integrated care. We sought to develop and test a provider experience scale applicable across provider types and organizations engaged in integrated care models.
Approach: A provider experience survey was developed through a three-phase approach. The first phase included a rapid literature review of provider experience surveys and research team consensus meetings to identify thematic areas and candidate items from existing survey tools. The second phase involved 4 focus groups with 16 providers including physicians, therapists, social workers, nurses and community health workers. The third phase was a field test of the survey in 3 health system interventions aimed to advance integrated care. The field test took place with providers in Ontario, Canada in the implementation of population-based integrated care models called Ontario Health Teams. Exploratory factor analysis was used to group items into domains and domain-specific factor scores and reliability was assessed.
Results: A 39-item survey was fielded to 2145 respondents with an average 22% response rate and 472 returned surveys. Factor analysis resulted in 5 subscales: 1) care coordination; 2) workplace culture; 3) autonomy; 4) burnout/satisfaction; and 5) digital/virtual care. The internal consistency estimates of reliability of each subscale ranged from 0.72 to 0.94, and overall reliability was 0.82.
Conclusions: This provider experience survey addresses gaps important for integrated care in that it was developed and validated with multiple professions and applied in the context of integrated care. Statistical results from an initial survey of 472 respondents in Ontario, Canada suggests strong internal consistency and reliability while engagement with providers in the development of the survey tool provides support for content validity. This tool is publicly available in French and English for integrated care programs to use to assess provider experience as essential outcome of integrated care initiatives. Further testing and refinement of the measure will strengthen the measurement of provider experience in quadruple aim evaluation of integrated care programs.