Abstract
Background
Improving the healthcare sector in Palestinian territories is challenging. Organizations frequently use the balanced scorecard (BSC) for performance evaluation (PE) worldwide. BSC includes an evaluation of five perspectives: financial, customer, internal process, knowledge and innovation, and environmental. Most HealthCare Organizations (HCO) evaluated patient satisfaction in BSC, but none considered engaging patients in the evaluation process. This paper aims to develop an instrument to engage patients in assessing BSC perspectives (BSC-PATIENT) and customize it for Palestinian hospitals.
Methods
This is a cross-sectional study. Two panels of experts participated in the item generation of BSC-PATIENT. Forward and backward translation processes from English to Arabic and vice versa were performed. Pretesting was performed for 30 patients at one hospital. Then, 1000 patients were recruited at 14 hospitals between January and October 2021. Construct validity was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Additionally, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were assessed to find redundant and low correlated items.
Results
The scales had high adequate model fit in EFA and CFA. All items included had loadings higher than 0.50. Although the convergent validity was less than 0.50 for some constructs, their discriminant validity, CR, IIC, and CITC showed satisfactory results except the services experience (SERV EXR) construct, which had a CR of 0.50. The final best fit model in CFA comprised ten constructs with 34 items.
Conclusion
BSC-PATIENT is the first self-administered questionnaire specially developed to engage patients in evaluating their experiences and attitudes based on the BSC perspectives. The questionnaire scales were carried out following relevant guidelines and regulations. The results showed adequacy in the psychometric properties of this instrument. Three-point Likert scales are recommended to assess patient experiences and attitudes since they have higher response rates. Future research can be conducted using this instrument to evaluate the impact of patient experience on attitudes toward BSC perspectives and compare the differences based on patient and hospital characteristics.