Culture, organization, and management in intensive care: Construction and validation of a multidimensional questionnaire

Objective: The objective of this study is to develop and validate a questionnaire designed to assess the culture, organization, and management of intensive care units. Design: This is a prospective multicenter study. Setting: The study was conducted in 26 intensive care units located in Paris. Participants: All personnel were asked to complete the questionnaire. Intervention: The questionnaire was developed in 2 steps: (1) development of a theoretical framework based on organizational theory and (2) testing of the reliability and validity of a comprehensive set of measures. Method: The internal consistency of the items composing each scale was tested by using the Cronbach α. Convergent, and discriminant validity was assessed by factor analysis with varimax rotation. Results: The overall completion rate was 74% with 1000 respondents (750 nurses, 26 head nurses, 168 physicians, and 56 medical secretaries). Starting with a 220-item questionnaire, we constructed a short version-conserving metrological characteristics with good reliability and validity. The short questionnaire, entitled Culture, Organization, and Management in Intensive Care, consists of 106 items distributed in 9 dimensions and 22 scales: culture (n = 3), coordination and adaptation to uncertainty (n = 3), communication (n = 3), problem solving and conflict management (n = 2), organizational learning and organizational change (n = 2), skills developed in a patient-caregiver relationship (n = 1), subjective unit performance (n = 3), burnout (n = 3), and job satisfaction and intention to quit (n = 2). All the scales showed good-to-high reliability, with Cronbach α scores higher than .7 (with the exception of coordination [.6]). Team satisfaction-oriented culture is positively correlated with good managerial practices and individual well-being. Conclusions: The Culture, Organization, and Management in Intensive Care questionnaire enables staff and managers to assess the organizational performance of their intensive care unit.