The Patient Care Ownership Scale: Development of an Instrument to Measure Patient Care Ownership Among Internal Medicine Trainees
Patient care ownership is essential to delivering high-quality medical care but appears to be eroding among trainees. The lack of an objective measure has limited the study of ownership in physicians.
To develop an instrument to measure psychological ownership of patient care.
Internal medicine trainees in a large, academic hospital completing an inpatient rotation.
Our scale prototype adapted an existing ownership scale (developed in the non-medical setting) based on themes identified in qualitative studies of patient care ownership. We conducted cognitive interviews to determine face validity of the scale items. Our finalized scale measures ownership’s key constructs: advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, and perceived ownership. We distributed an online, anonymous, 46-question survey to 219 residents; 192 residents completed the survey; and 166 responses were included in the analysis. We calculated Cronbach’s α to determine the scale’s internal consistency. Exploratory factor analysis was used to explore possible subscales. We examined construct validity using bivariate and correlational analysis.
The 15-item ownership scale demonstrated good internal consistency (Cronbach’s α = 0.89). We identified three possible subscales corresponding to assertiveness, being the “go-to” person, and diligence. Training level and prior intensive care unit experience significantly predicted ownership (p < 0.01). There was no significant relationship between ownership and age, gender, inpatient service type, call schedule, patient turnover, or supervisory experience of the attending physician. We found a significant negative correlation between ownership and perceived degree of burnout (r = − 0.33), depression (r = − 0.24), detachment (r = − 0.35), and frustration (r = − 0.31) and a significant positive association between ownership and fulfillment (r = 0.37) and happiness (r = 0.36).
We developed an instrument to quantify patient care ownership in residents. Our scale demonstrates good internal consistency and preliminary evidence of validity. With further validation, we expect this to be a valuable tool to evaluate interventions aimed at improving ownership.
KEY WORDSmedical education medical decision-making behavioral science
The authors gratefully acknowledge Kevin Chen, MD, of the National Clinician Scholars Program at Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System for facilitating development of the figures.
Research reported in this publication was financially supported by the Yale-New Haven Hospital Traditional Internal Medicine Residency’s Research in Residency Program, the National Clinician Scholars Program at Yale University School of Medicine, and the Veterans Affairs Connecticut Healthcare System. This study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health, under Award Number AR060231-06 (Fraenkel).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
The funding sources had no role in the design or conduct of the study: collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views or policies of Yale-New Have Health, Yale University, the National Clinician Scholars Program, the Veterans Affairs Healthcare System, the National Institutes of Health, nor the US Government.
- 12.Avey JB, Avolio BJ.. Psychological Ownership Questionnaire. Psychological Ownership Questionnaire (POQ). Menlo Park, CA: Mind Garden.2009.Google Scholar
- 14.Olckers C. Psychological ownership: Development of an instrument. SA J Ind Psychol. 2013;39(2 SPL). https://doi.org/10.4102/sajip.v39i2.1105
- 16.DeVellis RF. Scale development: Theory and Applications: Thousand Oaks: Sage publications; 2016.Google Scholar
- 18.Cowley DS, Markman JD, Best JA, et al. Understanding ownership of patient care: A dual-site qualitative study of faculty and residents from medicine and psychiatry. Perspect Med Educ. 2017:1–8.Google Scholar
- 22.Jager AJ, Tutty MA, Kao AC, editors. Association between physician burnout and identification with medicine as a calling. Mayo Clinic Proceedings; 2017: Elsevier.Google Scholar