An online survey created as a resource for critical care nurses to assess the health of the work environment is a valid and reliable tool for use by interprofessional patient care teams throughout hospitals and other healthcare organizations.
The American Association of Critical-Care Nurses (AACN) developed the online assessment tool in 2009 as a companion to “AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence.” The AACN Healthy Work Environment (HWE) Assessment Tool (HWEAT) became a trusted resource to measure baseline status and subsequent progress of a hospital unit’s journey to implement the HWE standards. The 18-question survey is designed to help organizations or departments identify areas for improvement, while not diagnosing specific challenges.
A study in the American Journal of Critical Care (AJCC) reports the results of a two-phase administration of the tool to 2,621 patient-care employees at Boston Children’s Hospital. The findings provide new insights about the tool’s reliability and validity across professional staff categories and patient care areas to support its use as an organizational measure.
The researchers share their findings in “Interprofessional Use and Validation of the AACN Healthy Work Environment Assessment Tool,” published in AJCC‘s September 2018 issue.
“Although AACN’s assessment tool has been used primarily among acute and critical care nurses, our findings support consideration of wider use in multiple healthcare settings,” said principal investigator Jean Anne Connor, PhD, RN, CPNP, director of nursing research, cardiovascular and critical care patient services at Boston Children’s Hospital. “Clinical leaders understand that to safeguard the quality of patient care, attention must be focused on the performance of healthcare teams.”
The hospital has used the Agency for Healthcare Research and Quality’s (AHRQ) Hospital Survey on Patient Safety Culture (H-SOPS) since 2010 to assess how employees perceive their work environment in regard to patient safety. It’s also administered the AACN HWEAT to interprofessional staff in critical care and cardiovascular programs annually since 2010 and recently expanded it to an enterprise-wide assessment.
For this study, researchers administered the survey using a test-retest, two-stage approach. First, the AACN HWEAT was administered to all healthcare team members, including physicians, nurses, social workers, therapists, clinical assistants and administrators. Email invitations and reminders, as well as a chance to win one of six $50 gift cards in a raffle, helped recruit potential respondents.
Three weeks later, the researchers sent the survey to a random sample of 200 potential respondents stratified by role (physician, nurse and others). Each respondent in the second survey received a $10 gift card for participation.
Unique identifiers allowed individual surveys from the first round to be linked to those in the second round. Identifiers of the patient care units were also retained to allow the researchers to compare unit-level results of the AACN HWEAT with unit-level results of the most recent AHRQ H-SOPS.
The first survey wave received 1,030 responses from 2,621 potential employee participants, for a response rate of 39.3 percent. Approximately 75 percent of the respondents identified themselves as nurses.
The response rate for the second wave was 83.5 percent, with 167 participants of 200 team members invited to respond.
The test-retest assessment indicates that the HWEAT is a reliable measure. Moreover, the results of the internal consistency analyses of the subscales and of the confirmatory factor analysis provide strong evidence of the internal reliability and validity of the tool.
In addition, the correlations between the HWEAT and AHRQ H-SOPS on similar key domains such as staffing, communication, collaboration/teamwork and meaningful recognition/respect showed moderate to strong convergent validity.
Despite the limitations of the study, the results have been used in the development of measurement benchmarks and led to use of the HWEAT in a nurse-led consortium of 30 cardiovascular programs in freestanding children’s hospitals.
The HWEAT is part of a growing collection of AACN resources to help organizations align quality and safety improvement efforts with the HWE standards. Healthcare professionals can use the free online tool to survey staff, compare their results with industry standards and develop step-by-step strategies to improve performance, patient safety, staff recruitment and retention, and their workplace environment.