Development and Validation of an Instrument to Assess Nursing Team Contexts and Competencies regarding Continuous Quality Improvement Culture

Background Contextual factors and competencies profoundly influence the efficacy of quality improvement initiatives and the presence of an improvement culture, particularly at the team level. Quantitative research on the magnitude of influence and interplay between the most critical contextual factors and competencies remains scarce. This study aimed to develop and validate an instrument for assessing these factors and competencies influencing continuous quality improvement culture. Methods A multi-phase approach was used to develop and validate a psychometric instrument based on prior evidence. The validation process included an expert round, cognitive pretesting, and pilot testing in the target population. Psychometric analyses, performed on two consecutive samples, assessed item properties, reliability and exploratory and confirmatory factor analyses to examine and validate the alignment of latent variables with the theoretical framework. Results The process resulted in a 40-item instrument categorised in conceptual groupings under four constructs: ‘motivation & trigger’, ‘continuous improvement at ward level’, ‘context at ward level’, and ‘context in organisation’. Items, groupings, and constructs demonstrated good to excellent reliability and validity. Latent factors from exploratory factor analyses aligned mainly with the theoretical framework and were cross-validated through confirmatory factor analyses, with three items excluded based on factor loadings, model fit, and theoretical rationale. The four constructs showed moderate inter-scale correlations, ideal internal consistency, and clear distinction, confirming the instrument's robustness and specificity. Conclusion This psychometrically validated instrument is a reliable and valid instrument for assessing the contextual factors and competencies influencing a continuous quality improvement culture in nursing teams, providing a solid foundation for future research.