Advertisement

Journal of General Internal Medicine

, Volume 34, Issue 8, pp 1530–1537 | Cite as

The Patient Care Ownership Scale: Development of an Instrument to Measure Patient Care Ownership Among Internal Medicine Trainees

  • Mia DjulbegovicEmail author
  • Jason W. Beckstead
  • Liana Fraenkel
Original Research

Abstract

Background

Patient care ownership is essential to delivering high-quality medical care but appears to be eroding among trainees. The lack of an objective measure has limited the study of ownership in physicians.

Objective

To develop an instrument to measure psychological ownership of patient care.

Design

Cross-sectional study.

Participants

Internal medicine trainees in a large, academic hospital completing an inpatient rotation.

Main Measures

Our scale prototype adapted an existing ownership scale (developed in the non-medical setting) based on themes identified in qualitative studies of patient care ownership. We conducted cognitive interviews to determine face validity of the scale items. Our finalized scale measures ownership’s key constructs: advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, and perceived ownership. We distributed an online, anonymous, 46-question survey to 219 residents; 192 residents completed the survey; and 166 responses were included in the analysis. We calculated Cronbach’s α to determine the scale’s internal consistency. Exploratory factor analysis was used to explore possible subscales. We examined construct validity using bivariate and correlational analysis.

Key Results

The 15-item ownership scale demonstrated good internal consistency (Cronbach’s α = 0.89). We identified three possible subscales corresponding to assertiveness, being the “go-to” person, and diligence. Training level and prior intensive care unit experience significantly predicted ownership (p < 0.01). There was no significant relationship between ownership and age, gender, inpatient service type, call schedule, patient turnover, or supervisory experience of the attending physician. We found a significant negative correlation between ownership and perceived degree of burnout (r = − 0.33), depression (r = − 0.24), detachment (r = − 0.35), and frustration (r = − 0.31) and a significant positive association between ownership and fulfillment (r = 0.37) and happiness (r = 0.36).

Conclusion

We developed an instrument to quantify patient care ownership in residents. Our scale demonstrates good internal consistency and preliminary evidence of validity. With further validation, we expect this to be a valuable tool to evaluate interventions aimed at improving ownership.

KEY WORDS

medical education medical decision-making behavioral science 

Notes

Acknowledgments

The authors gratefully acknowledge Kevin Chen, MD, of the National Clinician Scholars Program at Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System for facilitating development of the figures.

Funders

Research reported in this publication was financially supported by the Yale-New Haven Hospital Traditional Internal Medicine Residency’s Research in Residency Program, the National Clinician Scholars Program at Yale University School of Medicine, and the Veterans Affairs Connecticut Healthcare System. This study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health, under Award Number AR060231-06 (Fraenkel).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The funding sources had no role in the design or conduct of the study: collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views or policies of Yale-New Have Health, Yale University, the National Clinician Scholars Program, the Veterans Affairs Healthcare System, the National Institutes of Health, nor the US Government.

Supplementary material

11606_2019_5066_MOESM1_ESM.docx (35 kb)
ESM 1 (DOCX 34 kb)
11606_2019_5066_MOESM2_ESM.docx (19 kb)
ESM 2 (DOCX 19 kb)

References

  1. 1.
    Dubov A, Fraenkel L, Seng E. The importance of fostering ownership during medical training. Am J Bioeth. 2016;16(9):3–12.CrossRefGoogle Scholar
  2. 2.
    Pierce JL, Kostova T, Dirks KT. The State of Psychological Ownership: Integrating and Extending a Century of Research. Rev Gen Psychol. 2003;7(1):84–107.  https://doi.org/10.1037//1089-2680.7.1.84 CrossRefGoogle Scholar
  3. 3.
    Pierce JL, Kostova T, Dirks KT. Toward a theory of psychological ownership in organizations. Acad Manag Rev. 2001;26(2):298–310.CrossRefGoogle Scholar
  4. 4.
    Pierce JL, O’Driscoll MP, Coghlan A-M. Work environment structure and psychological ownership: The mediating effects of control. J Soc Psychol. 2004;144(5):507–34.  https://doi.org/10.3200/SOCP.144.5.507-534 CrossRefPubMedGoogle Scholar
  5. 5.
    Pierce JL, Jussila I. Collective psychological ownership within the work and organizational context: Construct introduction and elaboration. J Organ Behav. 2010;31(6):810–34.  https://doi.org/10.1002/job.628 CrossRefGoogle Scholar
  6. 6.
    Avey JB, Avolio BJ, Crossley CD, Luthans F. Psychological ownership: Theoretical extensions, measurement and relation to work outcomes. J Organ Behav. 2009;30(2):173–91.  https://doi.org/10.1002/job.583 CrossRefGoogle Scholar
  7. 7.
    Lee DY, Myers EA, Rehmani SS, et al. Surgical residents’ perception of the 16-hour work day restriction: concern for negative impact on resident education and patient care. J Am Coll Surg. 2012;215(6):868–77.CrossRefGoogle Scholar
  8. 8.
    Griner D, Menon RP, Kotwall CA, Clancy TV, Hope WW. The eighty-hour workweek: surgical attendings’ perspectives. Journal of Surgical Education 2010;67(1):25–31.CrossRefGoogle Scholar
  9. 9.
    Drolet BC, Whittle SB, Khokhar MT, Fischer SA, Pallant A. Approval and perceived impact of duty hour regulations: survey of pediatric program directors. Pediatrics. 2013;132(5):819–24.CrossRefGoogle Scholar
  10. 10.
    Pincavage AT, Dahlstrom M, Prochaska M, et al. Results of an enhanced clinic handoff and resident education on resident patient ownership and patient safety. Acad Med. 2013;88(6):795–801.CrossRefGoogle Scholar
  11. 11.
    Desai SV, Asch DA, Bellini LM, et al. Education outcomes in a duty-hour flexibility trial in internal medicine. N Engl J Med. 2018;378(16):1494–508.CrossRefGoogle Scholar
  12. 12.
    Avey JB, Avolio BJ.. Psychological Ownership Questionnaire. Psychological Ownership Questionnaire (POQ). Menlo Park, CA: Mind Garden.2009.Google Scholar
  13. 13.
    Vandewalle D. Psychological Ownership: An Empirical Examination of its Consequences. Group Org Manag. 1995;20(2):210–26.  https://doi.org/10.1177/1059601195202008 CrossRefGoogle Scholar
  14. 14.
    Olckers C. Psychological ownership: Development of an instrument. SA J Ind Psychol. 2013;39(2 SPL).  https://doi.org/10.4102/sajip.v39i2.1105
  15. 15.
    Kline P. Handbook of Psychological Testing: Abingdon: Routledge; 2013.CrossRefGoogle Scholar
  16. 16.
    DeVellis RF. Scale development: Theory and Applications: Thousand Oaks: Sage publications; 2016.Google Scholar
  17. 17.
    McLaren K, Lord J, Murray SB, et al. Ownership of patient care: a behavioural definition and stepwise approach to diagnosing problems in trainees. Perspect Med Educ. 2013.  https://doi.org/10.1007/s40037-013-0058-z CrossRefGoogle Scholar
  18. 18.
    Cowley DS, Markman JD, Best JA, et al. Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry. Perspect Med Educ. 2017:1–8.Google Scholar
  19. 19.
    Kim H, Sefcik JS, Bradway C. Characteristics of qualitative descriptive studies: a systematic review. Res Nurs Health. 2017;40(1):23–42.CrossRefGoogle Scholar
  20. 20.
    Beckstead JW. On measurements and their quality. Paper 4: Verbal anchors and the number of response options in rating scales. Int J Nurs Stud. 2014;51(5):807–14.CrossRefGoogle Scholar
  21. 21.
    Brown G, Lawrence TB, Robinson SL. Territoriality in organizations. Acad Manag Rev. 2005;30(3):577–94.CrossRefGoogle Scholar
  22. 22.
    Jager AJ, Tutty MA, Kao AC, editors. Association between physician burnout and identification with medicine as a calling. Mayo Clinic Proceedings; 2017: Elsevier.Google Scholar
  23. 23.
    Shanafelt TD, Dyrbye LN, West CP. Addressing physician burnout: The way forward. JAMA. 2017;317(9):901–2.  https://doi.org/10.1001/jama.2017.0076 CrossRefPubMedGoogle Scholar
  24. 24.
    Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. Mayo Clin Proc. 2016;91(7):836–48.  https://doi.org/10.1016/j.mayocp.2016.05.007 CrossRefPubMedGoogle Scholar
  25. 25.
    Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000.CrossRefGoogle Scholar
  26. 26.
    Grol R, Mokkink H, Smits A, et al. Work satisfaction of general practitioners and the quality of patient care. Fam Pract. 1985;2(3):128–35.CrossRefGoogle Scholar
  27. 27.
    Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medicine: the consequences of physician dissatisfaction. Med Care. 2006;44(3):234–42.CrossRefGoogle Scholar
  28. 28.
    Montiel-Company JM, Subirats-Roig C, Flores-Martí P, Bellot-Arcís C, Almerich-Silla JM. Validation of the Maslach Burnout Inventory-Human Services Survey for Estimating Burnout in Dental Students. J Dent Educ. 2016;80(11):1368.PubMedGoogle Scholar
  29. 29.
    Beck AT, Rial WY, Rickels K. Short Form of Depression Inventory: Cross-validation. Psychol Rep. 1974;34(3, Pt 2):1184–6.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  • Mia Djulbegovic
    • 1
    • 2
    Email author
  • Jason W. Beckstead
    • 3
  • Liana Fraenkel
    • 2
    • 4
  1. 1.National Clinician Scholars ProgramYale University School of MedicineNew HavenUSA
  2. 2.Veterans Affairs Connecticut Healthcare SystemWest HavenUSA
  3. 3.College of Public HealthUniversity of South FloridaTampaUSA
  4. 4.Section of RheumatologyYale University School of MedicineNew HavenUSA

Personalised recommendations