Concerns about the quality of care in healthcare settings have increasingly highlighted the necessity of fostering workplace cultures that prioritize high-quality, safe, and compassionate care. Creating a supportive environment where healthcare staff can operate effectively is paramount. A crucial first step for healthcare organizations in cultivating such cultures is to accurately assess their existing culture of care. This article explores the development and validation of a valuable instrument: the Culture of Care Barometer. This tool is specifically designed to evaluate healthcare workers’ perceptions of a caring culture, serving as a foundational step towards meaningful culture change within healthcare organizations.
The Culture of Care Barometer was developed and rigorously tested through an exploratory mixed-methods study. This research was structured to create and validate a tool capable of measuring ‘culture of care’ through a combination of qualitative and quantitative data collection methods, specifically focus groups and questionnaires. The questionnaire’s development was informed by several key stages: a comprehensive review of existing literature on healthcare culture, expert input from professionals in the field to generate relevant items, and in-depth focus group discussions with a diverse range of healthcare staff. These participants represented various specialties, roles, and levels of seniority across three distinct types of public healthcare organizations within the UK. The tool was intentionally designed to be applicable across different healthcare professions. Initial pilot testing was conducted with a sample of 467 nurses and healthcare support workers within acute care settings. Subsequently, the tool underwent validation with a larger sample of 1698 staff members working across a broader spectrum of healthcare services in England, including acute care, mental health services, and community health services. To understand the underlying dimensions captured by the Barometer, exploratory factor analysis was employed.
The psychometric evaluation of the Culture of Care Barometer led to the refinement of a 30-item questionnaire. These items are structured around four key domains, each representing a critical facet of care culture. Statistical analysis confirmed that the retained items effectively loaded onto these four factors:
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Organizational Values: This domain assesses the extent to which healthcare staff perceive the organization as embodying caring values in its operations and priorities (α=0.93, valid n=1568, M=3.7). It reflects the alignment between espoused organizational values and the lived experiences of staff.
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Team Support: This factor measures the level of support healthcare workers feel they receive from their immediate teams (α=0.93, valid n=1557, M=3.2). It captures the essence of teamwork, mutual assistance, and collaborative spirit within the workplace.
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Relationships with Colleagues: This domain evaluates the quality of interpersonal relationships among colleagues, focusing on aspects such as respect, trust, and mutual understanding (α=0.84, valid n=1617, M=4.0). Positive colleague relationships are crucial for a healthy and supportive work environment.
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Job Constraints: This factor assesses the degree to which job-related pressures and limitations impact staff’s ability to provide care (α=0.70, valid n=1616, M=3.3). It acknowledges the influence of workload, resources, and systemic barriers on the experience of care culture.
In conclusion, this research successfully developed and validated the Culture of Care Barometer, a robust and reliable instrument for measuring various dimensions of care culture as perceived by healthcare staff. Its potential for organizational benchmarking is significant, allowing healthcare organizations to compare their culture of care against others and track changes over time. By providing a data-driven approach to understanding care culture, the Culture of Care Barometer serves as a valuable tool for initiating and monitoring culture change initiatives, ultimately contributing to improvements in care quality, patient safety, and the well-being of healthcare professionals.
