1. Organizational culture Factor analysis of a Competing Values Framework instrument Christian D. Helfrich, MPH, PhD Implementation Research Coordinator Ischemic Heart Disease Quality Improvement Research Initiative

2. Background Organizational culture Within organizations and groups, individuals share common beliefs, assumptions and values that create powerful behavioral norms (James et al. 1990). These norms are taught to new members and guide members’ actions and interactions (Barker 1993).

3. Background Competing values framework (CVF) A dominant organizational culture model Linked to patient satisfaction (Meterko et al 2004), physician and nurse turnover (Mohr et al 2005) and adoption of QI activities (Shortell et al 1995) All VHA employees surveyed in 2004

4. Competing Values Framework FlexibilityControl Internal Team Culture Cohesion Morale Human resource development Mutual support Hierarchical Culture Clear lines of authority over organizational processes Respect for formal hierarchy Adherence to rules Stability and predictability External Entrepreneurial Culture Flexibility and creativity Acquisition of resources Responding to changes in external environment Growth and entrepreneurship Rational Culture Clarity of tasks Planning and productivity Efficiency Measurable outcomes

5. Specific Aims To validate an instrument based on the Competing Values Framework among non-managers Conduct item analysis to determine subscale reliability and assess the convergent / divergent qualities of the subscales Conduct exploratory factor analysis to determine if emergent factor solutions (i.e., emergent subscales) match conventional subscales Conduct confirmatory factor analysis to compare model fit between emergent and conventional subscales

6. Methods Design Cross-sectional, observational study Analysis Item analysis Cronbach’s alpha Item-rest correlation Item-to-scale correlation Factor analysis Exploratory factor analysis Confirmatory factor analysis

7. Data 2004 All Employee Survey (AES) Employee-level survey 14 items based on CVF subscales ~52% response rate among 200k employees (n = 102,118) Sample: non-supervisory employees n = 71,776

8. Questions so far?

9. Results - Respondents

10. Results – Item analysis Item analysis: see Table 1

11. Culture scatter plots, facility-level

12. Results - EFA Exploratory factor analysis: see Table 2

13. Results - CFA Confirmatory factor analysis: see Table 3

14. Discussion - External validity The CVF as a model, or the CVF instrument, may not generalize To VHA To non-managers Or to the combination of both Need for measurement equivalence / invariance analysis (ME/I) Among supervisory levels Over time

15. Discussion – Internal Validity Measurement error in original instrument Modifications made to the survey used in VHA Wording of individual items was adapted; primarily four items VHA instrument had two fewer items than the original 16-item scale Used normative (Likert) scales versus ipsative scales Terms such as “bureaucratic” and “innovative” likely carry normative connotations for lay readers Most original CVF items consist of two declarative statements Items within subscale were organized across four organizational domains: institutional characteristics, institutional leader, institutional “glue” and institutional emphases

16. Discussion – Construct Validity Possible poor construct validity for the four CVF culture types Three of four subscales may reflect single underlying factor One subscale may reflect multiple underlying factors

17. Conclusions CVF instrument did not perform as predicted in a population of non- managers from VHA May suggest caution in drawing inferences based on aggregated CVF scales when applied to populations where they have not been validated, such as non-managers Importance of validating organizational culture instruments in each new context they are used

18. Questions