Culture, Organization, and Management in Intensive Care questionnaire

Background:

This questionnaire was constructed to assess workers’ opinion on the organization of intensive care units. It consists of three parts. The first concerns the general functioning of the unit, the second deals specifically with organizational aspects, and the third concerns working relationships. The questionnaire is available in both English and French.

Psychometrics:

Test reliability are reported in Minvielle et al. (2005).

Author of Tool:

Minvielle, E., Dervaux, B., Retbi, A., Aegerter, P., Boumendil, A., Jars-Guincestre, M. C., .& Guidet, B.

Key references:

Minvielle, E., Dervaux, B., Retbi, A., Aegerter, P., Boumendil, A., Jars-Guincestre, M. C., .& Guidet, B. (2005). Culture, organisation, and management in intensive care: Construction and validation of a multidimensional questionnaire. Journal of Critical Care, 20, 126- 138.

Primary use / Purpose:

This questionnaire was designed to assess the culture, organization, and management of intensive care units.

Questionnaire on the Internal Organization of an Intensive Care Unit

 

Individual/Physician Questionnaire

Information for respondents

This questionnaire is designed to assess your opinion on the organization of the unit in which you work. It consists of three parts. The first concerns the general functioning of the unit, the second deals specifically with organizational aspects, and the third concerns working relationships. All your answers will remain strictly confidential. Information on how to respond to the different items is given in forewords 1 and 2, and on page 3.

Foreword 1

The following 13 questions concern the general functioning of your unit. All medical wards function in a specific way, and staff are expected to fulfill certain criteria. For example, some ward managers encourage competition among staff; as a result, each employee feels obliged to perform better than his or her colleagues.

When answering the following 13 questions, first read the initial statement and then indicate to what extent you feel the type of behavior it describes helps staff to integrate the unit and to meet the demands placed upon them.

When judging each statement it may be helpful to think of the behaviors that are encouraged and rewarded by your superiors. Don't forget that all the statements refer to relationships between the unit's staff members, not to relationships with persons who are not an integral part of the unit.

1. Organizational culture

To what extent are people expected or implicitly required to…?

… to a very great extend
… to a  great extend½
… to a moderate extend½½
… to a slight extend½½½
 not at all¯¯¯¯
ƒ
1.1

 

Contribute to other staff members' personal and professional well-being!!!!!
1.2Pay attention to the quality of human relations within the unit!!!!!
1.3Endeavor to be well considered!!!!!
1.4Apply norms and procedures without question!!!!!
1.5

 

Not to question instructions!!!!!
1.6Turn a blind eye to problems!!!!!
1.7a

 

Remain cool and collected in all circumstances
… to a very great extend gly
… to a  great extend½
… to a moderate extend½½
… to a slight extend½½½
 not at all¯¯¯¯
ƒ
1.7b

 

Indirectly question orders!!!!!
1.8

 

Exert their authority to the full!!!!!
1.9

 

Do whatever it takes to appear "the best"!!!!!
1.10

 

Be perfectionists!!!!!
1.11

 

Ensure they have the means required to fulfill their tasks!!!!!
1.12

 

Remain personally well-balanced while at work!!!!!

Organization of the unit

Foreword 2

The following questions concern communication, coordination (between and within units, and reactions to unexpected situations), problem management,  relationships with users, and, the capacity to learn, and to change. Finally, the last 22 items concern the psychological conditions in which you work.

We would like you to give your opinion of how people most often behave in your unit, independently of how you personally judge their behavior.

The word "physician" is used here to refer to all medical doctors who work in the unit, whether permanently, temporarily or occasionally. The term "nursing personnel" includes all other care-givers, from staff nurses to assistant nurses.

In the section on your psychological working conditions, please express your personal feelings.

2-Relations and communications within the unit

For each of the following statements, please select the response that best reflects your judgment.

… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
The following statements refer to relationships among the unit's physicians.

 

2.1I find it easy to discuss openly with the unit's physicians!!!!!
2.2I have sometimes been poorly informed by the unit's physicians!!!!!
2.3Communication among the unit's physicians is very open!!!!!
2.4I often have to check the accuracy of the information I receive from the unit's physicians!!!!!
2.5I find it very enjoyable to talk with the unit's physicians!!!!!
2.6When physicians talk with each other in this unit they understand each other well!!!!!
2.7The information exchanged by the unit's physicians is sometimes inaccurate!!!!!
2.8It's easy to ask for advice from the unit's physicians!!!!!
2.9I feel that some of the unit's physicians don't fully understand the information they receive!!!!!
… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
The following statements refer to relationships between the unit's physicians and nursing staff.

 

2.10I find it easy to discuss openly with the unit's nursing staff!!!!!
2.11I have sometimes been poorly informed by the unit's nursing staff!!!!!
2.12Communication between the unit's physicians and nursing staff is very open!!!!!
2.13I frequently have to check the accuracy of the information I receive from the unit's nursing staff!!!!!
2.14I find it very enjoyable to talk with the unit's nursing staff!!!!!
2.15When physicians talk in this unit with the nursing staff, they understand each other well!!!!!
2.16The information exchanged between the unit's physicians and nursing staff is sometimes inaccurate!!!!!
2.17It's easy to ask for advice from the unit's nursing staff!!!!!
2.18I feel that some of the unit's nursing staff don't fully understand the information they receive!!!!!

2-Relations and communications within the unit (continued)

For each of the following statements, please select the response that best reflects your judgment.

… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
The following statements refer to relations and communication within the unit.

 

2.19I obtain the information I need on a given patient's condition in a timely manner!!!!!
2.20I rapidly obtain the relevant information when a patient's condition changes!!!!!
… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
 

 

 

 

2.21There are needless delays in relaying information regarding patient care!!!!!
2.22Nurses call physicians in a timely manner during patient care procedures!!!!!

3-Relations with users

For each of the following statements, please select the response that best reflects your judgment.

… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
3.1The unit's nursing staff possess the necessary skills!!!!!
3.2The unit's nursing staff do not fully inform the patient or family/friends of how the patient is progressing!!!!!
… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
3.3The unit's nursing staff take into account the expectations of the patients and family/friends!!!!!
3.4The unit's nursing staff are sometimes impolite to patients or family/friends

 

!!!!!

4-Coordination

 

Coordination with other hospital units

For each of the following statements, please select the response that best reflects your judgment.

… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
4.1My unit has a constructive working relation with the hospital's other units!!!!!
4.2My unit does not receive sufficient cooperation from the hospital's other units!!!!!
… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
4.3Some of the hospital's other units seem to have a very poor opinion of my unit!!!!!
4.4Poor working relationships with some of the hospital's other units hinder the work of my unit!!!!!

Coordination within the unit

Various strategies and procedures are used to coordinate care in intensive care units. In your unit, to what extent do you feel each of the following measures contributes to the coordination of patient care and management? Select the answer that you feel applies best to your unit. If the measure is not used in your unit, please tick the last column ("not used".

€ Not used
… Very effective½
„ Effective½½
ƒ Moderately effective½½½
‚ Poorly effective½½½½
 Ineffective¯¯¯¯¯
 

 

ƒ
4.5Written rules and procedures

 

!!!!!!
4.6Written schedules and timetables

 

!!!!!!
4.7Managerial attempts to coordinate the unit's activities

 

!!!!!!
4.8Face-to-face meetings between managerial staff

 

!!!!!!
4.9Special ad hoc task forces

 

!!!!!!
4.10Written protocols for diagnostic and therapeutic management of certain clinical situations

 

!!!!!!
4.11Daily visits

 

!!!!!!

 

Reactions to unexpected situations

For each of the following statements, please select the response that best reflects your judgment.

… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
4.12Usually, the unit's staff react rapidly to unexpected situations

 

!!!!!
… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
4.13The unit's staff generally show a lack of initiative when confronted with unusual tasks

 

!!!!!

5-organizational learning and change

For each of the following statements, please select the response that best reflects your judgment.

… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
5.1The unit's staff are somewhat reticent to adopt new organizational ideas!!!!!
5.2The unit's staff have a fairly good attitude to new organizational ideas!!!!!
5.3There is not enough time to weigh up proposed changes to the unit's organization!!!!!
… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
5.4Dysfunctions in the unit are not sufficiently discussed!!!!!
5.5The unit's staff learn rapidly when confronted with new problems!!!!!
5.6The unit's staff do not like handling new tasks!!!!!
5.7The unit's staff are open to change!!!!!

6-Management of disagreements and conflicts within the unit

Consider what happens when a disagreement or conflict arises between the unit's physicians. On the basis of your own experience in the unit, estimate the likelihood of the following statements.

… Almost certain
„ Very likely½
ƒ Quite likely½½
‚ Unlikely½½½
 Not at all likely¯¯¯¯
ƒ
 

The following statements refer to the way in which disagreements and conflict between physicians are handled.

 

 

6.1If physicians disagree, they ignore the problem and "hope it goes away"

 

!!!!!
6.2The physicians will withdraw from the conflict

 

!!!!!
6.3All the different viewpoints are carefully examined to arrive at the best possible solution

 

!!!!!
6.4All the physicians do everything they can to arrive at the best solution

 

!!!!!
6.5The physicians involved continue to discuss the problem until they are all satisfied with the decision taken

 

!!!!!
6.6Each person contributes to finding an acceptable solution by drawing on his/her own experience

 

!!!!!
6.7Disagreements between physicians will be ignored or avoided!!!!!
… Almost certain
„ Very likely½
ƒ Quite likely½½
‚ Unlikely½½½
 Not at all likely¯¯¯¯
ƒ
 

The following statements refer to how disagreements and conflicts between physicians and nursing staff are handled.

 

 

6.8If physicians and members of the nursing staff disagree, they ignore the problem and "hope it goes away"

 

!!!!!
6.9The two parties will withdraw from the conflict

 

!!!!!
6.10All the different viewpoints are carefully examined in order to arrive at the best possible solution

 

!!!!!
6.11The physicians and nursing staff do everything they can to arrive at the best solution

 

!!!!!
6.12The two parties continue to discuss the problem until they are all satisfied with the decision taken

 

!!!!!
6.13Each person contributes to finding a good solution by drawing on his/her experience

 

!!!!!
6.14Disagreements between physicians and nursing staff will be ignored or avoided!!!!!

7-Perceived effectiveness

For each of the following statements, please select the response that best reflects your judgment.

… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
7.1Our unit almost always meets its treatment aims

 

!!!!!
7.2We get good results, considering the severity of the patients we treat

 

!!!!!
7.3The unit correctly handles the needs of the patients' families

 

!!!!!
7.4The unit correctly uses the latest available technology to meet patients' needs

 

!!!!!
7.5We are able to recruit the best intensive-care nursing staff!!!!!
… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
7.6We manage to keep our best intensive-care nursing personnel

 

!!!!!
7.7We are able to recruit the best intensive-care physicians

 

!!!!!
7.8We manage to keep the best intensive-care physicians

 

!!!!!
7.9In general the unit functions very well, as a  team!!!!!

8-psychological working conditions

Please read carefully the following 22 statements, then give your opinion on your current working situation.

‡ Every day
† A few times a week½
… Once a week½½
„ A few times a month½½½
ƒ Once a month or less½½½½
‚ A few times a year or less½½½½½
 Never¯¯¯¯¯¯
 

 

ƒ
8.1I feel mentally exhausted by my work!!!!!!!
8.2I feel tired when I get up in the morning, knowing I have to go to work!!!!!!!
8.3I understand very well how my patients feel!!!!!!!
8.4I feel I treat some patients as if they were "objects"!!!!!!!
8.5I find it hard to work all day as part of this team!!!!!!!
8.6I deal with my patients' problems very effectively!!!!!!!
8.7I feel burn out by my work!!!!!!!
8.8I have become more insensitive to others since I arrived in this unit!!!!!!!
8.9I worry that this job is  hardening  me emotionally!!!!!!!
8.10I don't really care about what happens to some patients!!!!!!!
8.11I find it easy to create a relaxed atmosphere with my patients!!!!!!!
8.12I feel I've achieved a lot in this job!!!!!!!
8.13I feel like I am at the end of my rope!!!!!!!

9-General job satisfaction and intention to quit

Please tick the appropriate response

… I entirely agree
„ I agree½
ƒ I neither agree nor disagree½½
‚ I disagree½½½
 I strongly disagree¯¯¯¯
ƒ
9.1In general, I'm satisfied with my job!!!!!
9.2As things stand, it wouldn't take much to make me leave the unit!!!!!

 

 

PERSONAL INFORMATION

Sex                                         Male                                   Female           

Age:                                                                                         years

Position                                  Full-time Physician              

                        Part-time Physician                                     

                        Resident                                                        

                                                Other (please specify): ………………….……….

Time spent:               in the unit                               years  months

                                    in the hospital                        years  months

                                    in my current position           years  months

                                    in intensive care                    years  months

Thank you for your help. Your answers will remain fully confidential. No individual answers will be communicated. The questionnaire will be analyzed to assess the situation in your unit, which will then be compared with that in the other units that participated in this survey. The results will be sent to each unit's director for distribution.