Abstract Objective. The aim of this study was to develop and test a measurement instrument for spread of quality improvement in healthcare. The instrument distinguishes: (i) spread of work practices and their results and (ii) spread practices and effectiveness. Relations between spread and sustainability of changed work practices were also explored to assess convergent validity. Design. We developed and tested a measurement instrument for spread in a follow-up study. The instrument consisted of 18-items with four subscales. Setting and participants. The sample consisted of former improvement teams in a quality improvement program for longterm care (nteams = 73, nrespondents = 127). Data were collected in a questionnaire about 1 year post-pilot site improvement implementation. Interventions. Quality improvements in long-term care practices. Main outcome measures. Four variables were construed: (i) actions for spread of work practices, (ii) actions for spread of results, (iii) effectiveness of spread of work practices and (iv) effectiveness of spread of results. Results. Psychometric analysis yielded positive results on the item level. The intended four-factor model yielded satisfactory fit. The internal consistency of each scale was fine (Cronbach’s α 0.70–0.93). Bivariate correlations revealed that the spread variables were strongly related but distinct, and positively related to the sustainability variables. Conclusions. The psychometric properties are in line with methodological standards. Convergent validity was confirmed with sustainability. The measurement instrument offers a good starting point for the analysis of spread. Keywords: spread, measurement instrument, quality improvement, sustainability, spread practices

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doi.org/10.1093/intqhc/mzt016, hdl.handle.net/1765/39607
International Journal for Quality in Health Care
Erasmus School of Health Policy & Management (ESHPM)