Development and Psychometric Evaluation of the Perioperative Synergy Index

Introduction: Synergy is achieved when perioperative services is high functioning and all component areas of the system support and enhance one another, resulting in efficiency and high-quality outcomes.
Problem: Achieving a high functioning, synergistic operating room (OR) is a challenge. Synergy emerges from the tactical allocation of resources and effort to areas most in need. Discernment of the reasons for inefficiencies and less than optimal outcomes and how they may be addressed relies heavily upon the experiences and expertise of perioperative managers. As a result, the efficiency and effectiveness of perioperative services are highly variable across hospitals and over time as perioperative leaders change duty stations. To have uniformly high-functioning, synergistic ORs across hospitals, managers need a tool that aids in the identification of specific deficiencies and how those deficiencies may be corrected.

Purpose: To develop a perioperative synergy index that has good validity and reliability.
Research questions: (a) What are the items necessary to ensure validity of the perioperative synergy index? (b) How should the items be worded to ensure readability and usability of the perioperative synergy index? (c) What are the factors that constitute the perioperative synergy index? and (d) What is the reliability and validity of the perioperative synergy index?

Methodology: This instrument development study will be completed using a nonexperimental design in three phases. In phase 1, a panel of perioperative experts will review survey items that have been developed from a directed content analysis of the literature on high functioning ORs to establish face and content validity of items for the index. In phase 2, an expert panel will evaluate the clarity and readability of items. In phase 3, the items will be field tested using a sample of up to 1,000 perioperative experts who are members of the Association of Perioperative Registered Nurses or the American Association of Nurse Anesthetists.
Concurrent criterion validity will be assessed using OR utilization, turnover time, and cancellation rates. A measure of intrapersonal competency, the 8-item short GRIT scale will be used as a measure of discriminant validity. A content validity index score will be calculated on phase 1 data by examining the degree of agreement among experts who endorse the item or instrument as content valid. Phase 2 data will be analyzed using percent of agreement and Cohen’s Kappa. Items will be modified based on feedback at the end of each phase. An exploratory factor analysis will be completed on 70% of collected responses from phase 3 to delineate the factor structure of the index; the remaining 30% will be held for confirmatory factor analysis. An overall synergy index score that ranges from an upper value of 1 to a lower limit of 0 will be calculated and correlated with the GRIT scale and the criteria of OR utilization, turnover time, and cancellation rates to establish discriminant and concurrent criterion validity of the index.

Relevance to military nursing science: Patient safety, quality of care, access to care, and overall success of both military and civilian medical facilities are impacted by how well perioperative services functions. The success of the area is tied to the abilities of the managers and leaders who attain knowledge and skills through years of experience. With leaders frequently changing duty stations, there is variability in how perioperative services is managed. This project is timely given current efforts to integrate medical resources across all three military services. The index could be used to provide information regarding areas in need of improvement in perioperative services, helping to standardize management across TriService medical facilities. Future plans include evaluating the instrument’s use at military, veteran, and civilian medical facilities.