Healthcare Team Vitality Instrument (HTVI)

National Center for Interprofessional Practice and Education's picture
Submitted by National Center... on Oct 3, 2016 - 10:07am CDT

Upenieks, V.V.
Lee, E.A.
Flanagan, M.E.
Doebbeling, B.N.

The HTVI was designed to provide healthcare staff with a way to measure team "vitality" in hospital settings.  Specifically, the self-report tool measures the individual’s perceptions of environmental support structures, engagement and empowerment, patient care transitions, and team communication. It was designed to be administered to a wide variety of licensed and unlicensed staff.  The reference listed below describes a study which sought to refine and shorten the original 20-item HTVI survey to better allow organizations to track the impact of work environments improvements on team vitality.  In Phase I of this study, the authors used cognitive interviews to evaluate the response process validity to the original 20-item survey; they also conducted a cross-sectional survey of 439 health care staff to assess the HTVI's convergent validity with two other instruments.  In Phase two, they used exploratory and confirmatory factor analysis to analyze responses of the revised HTVI from a sample of 464 healthcare workers.  The results demonstrated good factor structure for 10 items measuring the four factors identified above. 

Link to Resources
Descriptive Elements
Who is Being Assessed or Evaluated?: 
Instrument Type: 
Self-report (e.g., survey, questionnaire, self-rating)
Source of Data: 
Health care providers, staff
Notes for Data Sources: 

The survey is designed for a broad range of hospital staff.  Nurses (registered, licensed vocational) and nursing assistants, however, comprised 80% of the sample for Phase I and Phase II of the study described here.

Instrument Content: 
Reported perceptions, experiences of working relationships, teamwork
Organizational environment, culture
Organizational processes of care (e.g., care models, staffing)
Notes for Content: 

The conceptual framework used to develop the HTVI focused on the characteristics of the work environment as related to the job satisfaction of nursing staff, e.g., maintaining a focus on patient safety, patient-centered care, reducing waste, overall team vitality, and a sense of joy in work.

The revised HTVI contains items measuring four factors:

  • Support structures
  • Engagement and empowerment
  • Patient care transitions
  • Team communication 
Instrument Length: 

10 likert-type items and one demographic item for respondents to indicate their profession. No time length specified.

Item Format: 
5-point Likert-type scale ranging from strongly disagree (1) to strongly agree (5). The demographic (forced choice checklist) options are: Registered Nurse, Physician, LPN, Nursing Assistant, Unit Clerk, Dietary personnel, Respiratory Therapist, Physical Therapist, and "Other."
Paper and pencil. No specific administration instructions specified.
Scores are averaged for each of the four factors.
None described.
Open access (available on this website)
Notes on Access: 

This instrument is also accessible through the Institute for Healthcare Improvement website.  Registration on the site is required, but free.

Psychometric Elements: Evidence of Validity
Items for the original HTVI were adapted from existing instruments on engagement, teamwork, work setting, and safety.
Response Process: 
As part of Phase I of the study, the authors conducted cognitive interviews with a convenience sample of 18 providers (mostly registered nurses and ancillary staff). After taking the survey, providers were asked, "When you answered this question, what did you think you were being asked?" After reviewing the providers' answers and the fit between their answers with the item's intended construct, authors eliminated one and revised two items.
Internal Structure: 
As part of Phase II of the study, the authors conducted exploratory factor analysis on the revised 19-item HTVI using a split sample of 464 health care providers. The results indicated a good fit for a four-factor model with 58% of scale variance explained by 10 items. Confirmatory factor analysis of the second half of the sample indicated good fit for a four-factor model, NNFI = 0.96, CFI = 0.98, RMSEA = 0.06.
Relation to Other Variables: 
As part of Phase I of the study, the authors conducted a cross-sectional survey of 439 health care workers to examine the relationship between the 19 revised HTVI items and those from established instruments: (1) the Nursing Work Index-Revised (NWI-R), which focuses on job satisfaction, and (2) the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey of Patient Safety. Ten of the 19 items were correlated <.50 with either the NWI-R or the AHRQ instrument.
None described.