The Perioperative Synergy Index

Abstract

The presence of synergy within perioperative services has a significant bearing on a hospital’s viability and positive patient outcomes. Synergy is a positive emergence that arises as a value-added return on investment when all contributing factors and personnel work toward common goals. The purposes of this research were to develop a perioperative synergy model and to create an index to evaluate perioperative synergy. Research questions were: (a) What are the antecedents of synergy in the context of perioperative services? (b) What research is currently being conducted on high functioning perioperative services across perioperative disciplines? (c) What are the items necessary to ensure face and content validity of a perioperative synergy index? (d) How should the items be worded to ensure clarity, readability, and usability of a perioperative synergy index? (e) What are the underlying constructs that constitute perioperative services synergy? and (f) What are the psychometric properties of the perioperative synergy index? A three-phase survey methodology was adopted. For Phase 1, a directed content analysis of 20 years of research literature on high performing ORs was conducted using nine domains of a theoretical perioperative model. The analysis yielded 221 items that were presented to a panel of perioperative experts who rated each item’s relevance to perioperative success on a 4-point scale. Expert agreement on content was evaluated using a content validity index. In Phase 2, experts judged the wording and clarity of each item and of the instructions. Inter-rater agreement on clarity of items and instructions was evaluated using Gwet’s AC1 coefficient. For Phase 3, perioperative managers across the nation were surveyed and asked to rate levels of agreement with the items on a 6-point Likert scale as each item pertained to their hospital. Confirmatory factor analyses were completed on the responses, resulting in a model consisting of nine constructs and 53 indicators. Construct, convergent, and discriminant validity were assessed. Reliability was evaluated using composite reliability, inter-item correlations, and average inter-item correlations. Factor scores were employed to calculate a perioperative synergy index coefficient that ranged from 0 to 1, with higher values indicative of higher functioning perioperative services at the hospitals involved in the study. Managers can use the index to identify areas in need of improvement and can use the model to guide process improvements. Following further refinement, the index may serve as a new way to evaluate performance and standardize protocols across healthcare systems.